Cultural Diversity and Community Oriented Nursing Practice.
Ethical Quandaries in Community Health Nursing
Objectives of the practical:
● Define and explain the concept of culture.
● Discuss the meaning of cultural diversity and its significance for community health nursing.
● Describe the meaning and effects of ethnocentrism on community health nursing practice.
● Identify five characteristics shared by all cultures.
● Contrast the health-related values, beliefs, and practices of selected culturally diverse populations with those of the dominant
● Conduct a cultural assessment.
● Apply transcultural nursing principles in community health nursing practice.
● Describe the nature of values and value systems and their influence on community health nursing.
● Identify personal and professional values that you bring to decision-making with and for community health clients.
● Articulate the impact of key values on professional decision-making.
THE MEANING OF CULTURE
Culture refers to the beliefs, values, and behavior that are shared by members of a society and provide a design or 
“map” for living. It is culture that tells people what is acceptable or unacceptable in a given situation. It is culture that dictates what to do, say, or believe. Culture is learned. As children grow up, they learn from their parents and others around them how to interpret the world. In turn, these assimilated beliefs and values prescribe desired behavior. Anthropologists describe culture as the acquired knowledge that people use to generate behavior and interpret experience (Spradley & McCurdy, 2000). This knowledge is more than simply custom or ritual; it is a way of organizing and thinking about life. It gives people a sense of security about their behavior; without having to consciously think about it, they know how to act. Culture also provides the underlying values and beliefs on which people’s behavior is based. For example, culture determines the value placed on achievement, independence, work, and leisure. It forms the basis for the definitions of male and female roles. It influences a person’s response to authority figures, dictates religious beliefs and practices, and shapes child-rearing. According to Giger and Davidhizar (2002, p. 80), “Culture is a patterned behavioural response that develops over time as a result of imprinting the mind through social and religious structures and intellectual and artistic manifestations.” Every community and social or ethnic group has its own culture. Furthermore, all of the individual members believe and act based on what they have learned within that specific culture. As anthropologist Edward Hall (1959) said a halfcentury ago, culture controls our lives. Even the smallest elements of everyday living are influenced by culture. For instance, culture determines the proper distance to stand from another person while talking. A comfortable talking distance for Americans is at least
Cultural Diversity
Race refers to biologically designated groups of people whose distinguishing features, such as skin color, are inherited; examples include Asian, Black, and White. An ethnic group is a collection of people who have common origins and a shared culture and identity; they may share a common geographic origin, race, language, religion, traditions, values, and food preferences (Spector, 2000). A person’s ethnicity is that group of qualities that mark his or her association with a particular ethnic group. When a variety of racial or ethnic groups join a common, larger group, cultural diversity occurs. Cultural diversity (also called cultural plurality) means that a variety of cultural patterns coexist within a designated geographic area. Cultural diversity occurs not only between countries or continents, but also within many countries, including the
Immigration patterns over the years have contributed to significant cultural diversity in the
As shown in Table 4–2, immigrants come from all regions of the world, in greater numbers from some areas than others. Of the 849,807 people immigrating in 2000, almost
half came from the Western Hemisphere: 20% from Mexico, 16% (138,100 immigrants) from Central and South America, and 10% (85,875 immigrants) from the Caribbean, including Cuba, Dominican Republic, Haiti, Jamaica, Trinidad, and Tobago (U. S. Department of Commerce, 2001). Undocumented immigrants, mostly from
The 2000 U. S. Census indicated that 33 million people were added to the total
People representing more than 100 different ethnic groups, more than half of them significant in size, live in the
Immigration patterns are strongly influenced by immigration laws established since the 1800s. The Immigration Reform and Control Act of 1986 (Public Law 99–603) and the Immigration Act of 1990 (Public Law 101–649) set new limits on the number of immigrants admitted. These laws set annual numerical ceilings on certain immigrant groups while authorizing increases for highly skilled workers or family members of aliens who have recently achieved legal status. After the terrorist attacks on September 11, 2001, President Bush suspended all immigration for 2 months. Suspicion about people from Middle Eastern countries permeated the nation. This did not help the social climate for immigrants. Immigrants and refugees in recent years have found themselves in a more confusing social climate than did those who came before them. This climate is characterized by ambivalence about whether immigrants should be accepted and ambiguity about their status. The newcomers find an environment that is both welcoming and hostile. On one hand, they may find tolerance of diversity in the
Although broad cultural values are shared by most large national societies, within those societies smaller cultural groups called subcultures exist. Subcultures are relatively large aggregates of people within a society who share separate distinguishing characteristics, such as ethnicity (e.g., African-American, Hispanic-American), occupation (e.g., farmers, physicians), religion (e.g., Catholics, Muslims), geographic area (e.g., New Englanders, Southerners), age (e.g., the elderly, school-age children), gender (e.g., women), or sexual preference (e.g., the gay community).
Within these subcultures are even smaller groups that anthropologists call microcultures. “Microcultures are systems of cultural knowledge characteristic of subgroups within larger societies. Members of a microculture usually share much of what they know with everyone in the greater society but possess a special cultural knowledge that is unique to the subgroup” (Spradley & McCurdy, 2000, p. 15). Examples of microcultures can range from a group of Hmong immigrants adopting selected aspects of the
The members of each subculture and microculture retain some of the characteristics of the society from which they came or in which their ancestors lived (Mead, 1960). Some of their beliefs and practices—such as the food they eat, the language they speak at home, the way they celebrate holidays, or their ideas about sickness and healing—remain an important part of their everyday life. Native American groups have retained some aspects of their traditional cultures. Mexican-Americans, Irish-Americans, Swedish- Americans, Italian-Americans, African-Americans, Puerto Rican–Americans, Chinese-Americans, Japanese-Americans, Vietnamese-Americans, and many other ethnic groups have their own microcultures.
Furthermore, certain customs, values, and ideas are unique to the poor, the rich, the middle class, women, men, youth, or the elderly. Many deviant groups, such as narcotics abusers, transient alcoholics, gangs, criminals, and terrorist groups, have developed their own microcultures. Regional microcultures, such as that of the White Appalachian people living in the hills of
Ethnocentrism
There is a difference between a healthy cultural or ethnic identification and ethnocentrism. Anthropologists explain that “ethnocentrism is the belief and feeling that one’s own culture is best. It reflects our tendency to judge other people’s beliefs and behavior using values of our owative culture” (Spradley & McCurdy, 2000, p. 16). It causes people to believe that their way of doing things is right and to judge others’ methods as inferior, ignorant, or irrational. Ethnocentrism blocks effective communication by creating biases and misconceptions about human behavior. In turn, this can cause serious damage to interpersonal relationships and interfere with nurse effectiveness (Leininger, 2001).
People can experience a developmental progression along a continuum from ethnocentrism, feeling one’s own culture is best to ethnorelativism, seeing all behavior in a cultural context. Some people may stop progressing and remain stagnated at one step, and others may move backward on the continuum. The left side of the continuum represents the most extreme reaction to intercultural differences: refusal or denial. On the right side is the characterization of people who show the most sensitivity to intercultural differences: incorporation (Figure 4–1).
CHARACTERISTICS OF CULTURE
In their study of culture, anthropologists and sociologists have made significant contributions to the field of community health. Their findings shed light on why and how culture influences behavior. Five characteristics shared by all cultures are especially pertinent to nursing’s efforts to improve community health: (1) culture is learned, (2) it is integrated, (3) it is shared, (4) it is tacit, and (5) it is dynamic.
Culture Is Learned
Patterns of cultural behavior are acquired, not inherited. Rather than being genetically determined, the way people dress, what they eat, and how they talk are all learned. Each person learns his or her culture through socialization with the family or significant group, a process called enculturation. As a child grows up in a given society, she or he acquires certain attitudes, beliefs, and values and learns how to behave in ways appropriate to that group’s definition of the female or male role; by doing so, children are learning their culture.
Although culture is learned, the process and results of that learning are different for each person. Each individual has a unique personality and experiences life in a singular way; these factors influence acquisition of culture. Families, social classes, and other groups within a society differ from one another, and this sociocultural variation has important implications. Because culture is learned, parts of it can be relearned. People might change certain cultural elements or adopt new behaviors or values. Some individuals and groups are more willing and able than others to try new ways and thereby influence change.
Culture Is Integrated
Rather than being merely an assortment of various customs and traits, a culture is a functional, integrated whole. As in any system, all parts of a culture are interrelated and interdependent. The various components of a culture, such as its social mores or religious beliefs, perform separate functions but come into relative harmony with each other to form an operating and cohesive whole. In other words, to understand culture, single traits should not be described independently. Each part must be viewed in terms of its relationship to other parts and to the whole.
A person’s culture is an integrated web of ideas and practices. For example, a nurse may promote the need for consuming three balanced meals a day, a practice tied to the beliefs that good nutrition leads to good health and that prevention is better than cure. These cultural beliefs, in turn, are related to the nurse’s values about health. Health, the nurse believes, is essential for maximum energy output and productivity at work. Productivity is important because it enables people to reach goals. These values are linked to social or religious beliefs about hard work and taboos against laziness. Through such connections, these ideas and beliefs about nutrition, health, economics, religion, and family are all interrelated and work to motivate behavior. For example, parents who are Jehovah’s Witnesses may refuse a blood transfusion for their child. Their actions might seem irrational or ignorant to those who do not understand the parents’ religious beliefs. However, the couple’s choice represents behavior consistent with their cultural values and standards. The single behavior of refusing blood transfusions, when viewed in context, is seen to be part of a larger religious belief system and a basic component of the parents’ culture.
In some cultural groups (eg, Muslims), modesty for women may make it uncomfortable and perhaps traumatic to be examined by a person of the opposite sex. Asking certain Native American groups to comply with rigid appointment scheduling requires them to reframe their concept of time. It also violates their values of patience and pride. Before nurses attempt to change a person’s or group’s behavior, they need to ask how that change will affect the people involved through its influence on other parts of their culture. Extra time and patience or different strategies may be needed if change still is indicated. Nurses often may find, however, that their own practice system can be modified to preserve clients’ cultural values.
Culture Is Shared
Culture is the product of aggregate behavior, not individual habit. Certainly, individuals practice a culture, but customs are phenomena shared by all members of the group. Thirty years ago, anthropologist G. Murdock explained (1972, p. 258):
Culture does not depend on individuals. An
ordinary habit dies with its possessor, but a
group habit lives on in the survivors and is
transmitted from generation to generation.
Moreover, the individual is not a free agent with
respect to culture. He is born and reared in a
certain cultural environment, which impinges on
him at every moment of his life. From earliest
childhood his behavior is conditioned by the
habits of those around him. He has no choice but
to conform to the folkways current in his group.
A culture’s values are among its most important elements. A value is a notion or idea designating relative worth or desirability. For example, some cultures place value on honesty, loyalty, and faithfulness more than other traits. Also, there may be strong values against lying, stealing, and cheating, behaviors to avoid. Each culture classifies phenomena into good and bad, desirable and undesirable, right and wrong. When people respond in favor of or against some practice, they are reflecting their culture’s values about that practice. One person may eagerly anticipate eating a steak for dinner. Another, who believes that eating meat is sacrilegious or unhealthful, experiences revulsion at the idea. Some American subcultures think that loud, vocal expressions are a necessary way to deal with pain; others value silence and stoicism. Some have high regard for speed and efficiency, whereas others prefer patience and thoughtfulness. Either way, values serve a purpose. Shared values give people in a specific culture stability and security and provide a standard for behavior. From these values, members know what to believe and how to act. The normative criteria by which people justify their decisions are based on values that are more deeply rooted than behaviors and consequently more difficult to change.
Knowing that culture is shared helps nurses to understand human behavior. For example, a community health nurse tried unsuccessfully to persuade a mother to limit the amount of catnip tea she fed her infant. The infant was pacified with the tea and was not consuming a sufficient amount of infant formula, thus putting him at risk for nutritional deficiencies and developmental problems. The nurse discovered that the mother was acting in the tradition of her rural subculture, which held that catnip promoted good health (it acts as an antispasmodic, perhaps causing relaxation and resulting in a more contented infant with fewer symptoms of colic [Spector, 2000]). The fact that all of the other mothers in that group also used catnip with their babies proved a powerful deterrent to the change suggested by the nurse. Individual health behavior always is influenced by other people of the same culture. It is difficult for one person to eliminate a cultural practice when it is reinforced by other group members. Group acceptance and a sense of membership usually depend on conforming to shared cultural practices (Spradley & McCurdy, 2000).
Community health nurses may need to focus on an entire group’s health behavior to affect individual practices. In the example described, the pattern of consuming large amounts of catnip tea was modified after the nurse worked with the entire rural community. She began with a wellrecognized cultural strategy: working through formal or informal leaders. She contacted the oldest woman in the community and discussed the cultural practice. The elder shared the group’s beliefs that catnip tea is vital to the well-being of infants for the first 6 months. When the nurse explained her concerns about low formula intake and low weight gain, the community leader clarified that only one or two ounces of the tea a day was needed. The nurse shared this information among the women, and as a result, the mothers gradually reduced the amount of tea they gave their infants. Consequently, the clients’ infants drank more formula and gained weight appropriately. A cultural tradition was retained while the health of the infants was improved. The community health nurse could then use this new information and supportive information from the community leader to improve the health of other infants.
Culture Is Mostly Tacit
Culture provides a guide for human interaction that is tacit – that is, mostly unexpressed and at the unconscious level. Members of a cultural group, without the need for discussion, know how to act and what to expect from one another. Culture provides an implicit set of cues for behavior, not a written set of rules. Spradley and McCurdy explained that culture often is “so regular and routine that it lies below a conscious level” (2000, p. 16). It is like a memory bank in which knowledge is stored for recall when the situation requires it, but this recall process is mostly unconscious. Culture teaches the proper tone of voice to use for each occasion. It prescribes how close to stand when talking with someone and how to respond to elders. Individuals learn to make responses that are appropriate to their sex, role, and status. They know what is right and wrong. All of these attitudes and behaviors are so ingrained, so tacit, that people seldom, if ever, need to discuss them.
Because culture is mostly tacit, realizing which of one’s own behaviors may be offensive to people from other groups is difficult. It also is difficult to know the meaning and significance of other cultural practices. In some groups, such as Native American or Islamic women, silence is valued and expected but may make others uncomfortable. Offering food to a guest in many cultures is not merely a social gesture but an important symbol of hospitality and acceptance; to refuse it, for any reason, may be an insult and a rejection. Touching or calling someone by their first name may be viewed as a demonstration of caring by some groups but is seen as disrespectful and offensive by others. Consequently, community health nurses have a twofold task in developing cultural sensitivity: not only must they try to learn their clients’ cultures, but they also must try to make their own culture less tacit and more explicit. Nurses bring both their professional and personal cultural history to the workplace, often developing unique values not shared with others who are not in the profession (Cherry & Jacob, 2001). Cross-cultural tension can be resolved through conscious efforts to develop awareness, patience, and acceptance of cultural differences (Display 4–2).
Culture Is Dynamic
Every culture undergoes change; none is entirely static. Within every cultural group, some individuals generate innovations. More important, some members see advantages in doing things differently and are willing to adopt new practices. Each culture, including our own, is an amalgamation of ideas, values, and practices from a variety of sources. This process depends on the extent of exposure to other groups. Nonetheless, every culture is in a dynamic state of adding or deleting components. Functional aspects are retained; less functional ones are eliminated.
ETHNOCULTURAL HEALTH CARE PRACTICES
Throughout history, people have relied oatural elements to treat various maladies that family, clan, tribe, or community members experience. Knowledge of culturally recognized practices or substances, such as berries, plants, barks, or rituals and incantations usually becomes the responsibility of one person in the community. This revered community leader is known as a medicine man/woman, healer, or shaman (Spector, 2000). As time passes this person teaches the skills of recognizing and treating ailments or performing rituals to an apprentice, thereby continuing the healing knowledge and traditions.
In the following sections, we discuss how various geographic or ethnocultural groups view health care, including the biomedical, magicoreligious, and holistic views. We then look at selected folk medicines and home remedies, such as herbs, over-the-counter (OTC) drugs, and patent medications.
In addition to these forms of treatments, there are complementary or alternative therapies and various self-care practices. This section concludes with the community health nurse’s role and responsibilities to provide culturally competent care in relation to caring for, respecting, teaching, and treating clients from different cultures.
The World Community
Beliefs about the causes and effects of illness, health practices, and health-seeking behaviors are all influenced by a person’s, group’s, or community’s perception of what causes illness and injury and what actions will treat or cure the health problem. The three major views in the world community are biomedical, magicoreligious, and holistic health beliefs (Spector, 2000).
Role of the Community Health Nurse
When working with different cultural groups in the area of health care practices, the community health nurse can be an effective advocate for the client. First, however, the nurse must be prepared to speak knowledgeably about health care practices and choices. The nurse also must be able to assess the client or family adequately so as to know what belief system motivates their choices. Finally, the nurse must be prepared to teach clients about the limits and benefits of cultural health care practices. The community health nurse should always individualize assessment and caregiving for the client within his or her culture and should not generalize about the client based on cultural group norms.
Preparation of the Community Health Nurse
To be effective when working with clients in the area of cultural health care and spirituality, the nurse needs to be prepared. There are many ways to increase your cultural awareness and promote sensitivity to the differences among people from ethnocultural groups different from your own. You can acquire information from peers who are from the same cultural group as your clients; attend workshops or conferences on chosen cultural topics; read books on ethnocultural health care practices, herbalism, or complementary therapies; talk with clients about their views and practices and learn from them; keep an open mind and be curious about various practices; or attend community cultural events such as Native American powwows, ethnic food events held in some cities, or Cinco de Mayo celebrations. There are textbooks, novels, and articles about cultures in the community in which one practices. For example, The Spirit Catches You and You Fall Down (Fadiman, 1997) describes a Hmong child, her American doctors, and the collision of two cultures. Universities offer courses in transcultural nursing, ethnic studies programs or courses, and cultural events that can be valuable.
Assessment
When beginning to work with a group or family, it is important for the nurse to be as familiar with them as possible. In addition to a family assessment or an individual health assessment, your care of the group would be enhanced by doing an ethnocultural or self-care assessment. Such an assessment reveals information about day-to-day living, cultural/spiritual influences, traditional/cultural health care choices and practices, and cultural taboos. Often this type of information is the most useful as you work with clients on a regular basis. Tools that might be useful are the two cultural assessment tools at the end of this chapter (see Tables 4–7 and 4–8) and the selfcare assessment tool in Chapter 23.
Teaching
Teaching is a most important community health nursing role. When working with families, it takes most of your time. It is something you have studied and prepared to do with all clients in acute care settings and at home. And it is what communities, groups, families, and clients need the most. Likewise, it is something that can be done in ways that are incomplete, culturally inappropriate, or inadequate. Becoming ethnoculturally focused and prepared to teach from the client’s view of the world will start you in the right direction. The suggestions in Display 4–3 offer ideas for providing culturally competent care. Chapter 12 on Health Education will help prepare you as well.
TRANSCULTURAL COMMUNITY
HEALTH NURSING PRINCIPLES
Culture profoundly influences thinking and behavior and has an enormous impact on the effectiveness of health care. Just as physical and psychological factors determine clients’ needs and attitudes toward health and illness, so too does culture. Kark emphasized 30 years ago that “culture is perhaps the most relevant social determinant of community health” (1974, p. 149). Culture determines how people rear their children, react to pain, cope with stress, deal with death, respond to health practitioners, and value the past, present, and future. Culture also influences diet and eating practices. Partly because of culturally derived preferences, dietary practices are very difficult to change (Nakamura, 1999). Despite its importance, the client’s culture often is misunderstood or ignored in the delivery of health care (Leininger, 2001). The growth ion-White populations demands that “health care providers must be prepared for interactions with increasingly diverse health care team members and clients.” (Giger & Davidhizar, 2002, p. 80). Nurses must avoid ethnocentric attitudes and must attempt to understand and bridge cultural differences when working with others. Nurses must develop knowledge and skill in serving multicultural clients and must put clients’ responses to experiences within the context of their clients’ lives; otherwise, their understanding and interpretation of their clients’ experience will be limited.
Overcoming ethnocentrism requires a concerted effort on the nurse’s part to see the world through the eyes of clients. It means being willing to examine one’s own culture carefully and to become aware that alternative viewpoints are possible. It means attempting to understand the meaning of other people’s culture for them and appreciating their culture as important and useful to them. Ignoring consideration of clients’ different cultural origins often has negative results, as was illustrated in the Clinical Corner discussion about Maria Juarez.
Culture is a universal experience. Each person is part of some group, and that group helps to shape the values, beliefs, and behaviors that make up their culture. In addition, every cultural group is different from all others. Even within fairly homogeneous cultural groups, subcultures and microcultures have their own distinctive characteristics. Further differences, based on such factors as socioeconomic status, social class, age, or degree of acculturation, can be found within microcultures. These latter differences, called intraethnic variations, only underscore the range of culturally diverse clients served by community health nurses. Given such diversity, community health nurses face a considerable challenge in providing service to cross-cultural groups. This kind of practice, known as transcultural nursing, means providing culturally sensitive nursing service to people of an ethnic or racial background different from the nurse’s. Community health nurses in transcultural practice with client groups can be guided by several principles: (1) develop cultural self-awareness, (2) cultivate cultural sensitivity, (3) assess the client group’s culture, (4) show respect and patience while learning about other cultures, and (5) examine culturally derived health practices.
Develop Cultural Self-Awareness
The first transcultural nursing principle focuses on the nurse’s own culture. Self-awareness is crucial for the nurse working with people from other cultures (Leininger, 2001). Nurses must remember that their culture often is sharply different from the culture of their clients. Cultural self-awareness means recognizing the values, beliefs, and practices that make up one’s own culture. It also means becoming sensitive to the impact of one’s culturally based responses. The community health nurse who assisted Mrs. Juarez probably thought that she was being friendly, efficient, and helpful. In terms of her own culture, this nurse’s behavior was intended to reassure clients and meet their needs. Unaware of the negative consequences of her behavior, the nurse caused damage rather than meeting needs.
To gain skill in understanding their own culturally based behavior, nurses can complete a cultural self-assessment by analyzing their own
• Ethnic and racial background influences
• Typical verbal and nonverbal communication patterns
• Cultural values and norms, or expected cultural practices or behaviors
• Religious beliefs and practices
• Health beliefs and practices
Start with a detailed list of values, beliefs, and practices relative to each point. Next, enlist one or more close friends to call attention to selected behaviors, to bring them to a more conscious level. Videotaping practice interviews with colleagues and actual interviews with selected clients creates further awareness of the nurse’s unconscious culturally based responses. Finally, ask selected clients to critique nursing actions in the light of the clients’ own culture. Feedback from clients’ perspectives can reveal many of the nurse’s own cultural responses. Because culture is mostly tacit, as discussed earlier, it takes conscious effort and hard work to bring the nurse’s own cultural biases or influence to the surface. Doing so, however, rewards the nurse with a more effective understanding of self and an enhanced ability to provide culturally relevant service to clients.
Cultivate Cultural Sensitivity
The second transcultural nursing principle seeks to expand the nurse’s awareness of the significance of culture on behavior. Nurses’ beliefs and ways of doing things frequently conflict with those of their clients. A first step toward bridging cultural barriers is to recognize those differences and develop cultural sensitivity. Cultural sensitivity requires recognizing that culturally based values, beliefs, and practices influence people’s health and lifestyles and need to be considered in plans for service. Mrs. Juarez’s values and health practices sharply contrasted with those of the clinic’s staff. Failure to recognize these differences led to a breakdown in communication and ineffective care. Once differences in culture are recognized, it is important to accept and appreciate them. A nurse’s ways are valid for the nurse; clients’ ways work for them. The nurse visiting the Kim family avoided the dangerous ethnocentric trap of assuming that her way was best, and she consequently developed a fruitful relationship with her clients.
As a part of developing cultural sensitivity, nurses need to try to understand clients’ points of view. They need to stand in their clients’ shoes and try to see the world through their eyes. By listening, observing, and gradually learning other cultures, the nurse must add a further step of choosing to avoid ethnocentrism. Otherwise, the nurse’s view of a different culture will remain distorted and perhaps prejudiced. The ability to show interest, concern, and compassion enabled Sandra Josten to win the trust and respect of the Native American women and told the Kims that their nurse cared about them. These nurses attempted to understand the feelings and ideas of their clients; in this way, they established a trusting relationship and opened the door to the possibility of their clients’ adopting healthier behaviors.
SUMMARY
Community health clients belong to a variety of cultural groups. A culture is a design for living; it provides a set of norms and values that offer stability and security for members of a society and plays a major role in motivating behaviors. The increase in and great variety of cultural groups reinforce the need for community health nurses to understand and appreciate cultural diversity. Ethnocentrism is the bias that a person’s own culture is best and others are wrong or inferior. It can create serious barriers to effective nursing care. Understanding cultural diversity and being sensitive to the values and behaviors of cultural groups often is the key to effective community health intervention. Culture has five characteristics: it is learned from others; it is an integrated system of customs and traits; it is shared; it is tacit; and it is dynamic. Every culture preserves its integrity by deleting nonfunctional practices and acquiring new components that better serve the group. To gain acceptance, nurses must strive to introduce improved health practices that are presented in a manner consistent with clients’ cultural values.
Five transcultural nursing principles, drawn from an understanding of the concept of culture, can guide community health nursing practice:
1. Develop cultural self-awareness.
2. Cultivate cultural sensitivity.
3. Assess the client group’s culture.
4. Show respect and patience while learning other cultures.
5. Examine culturally derived health practices.
REFERENCES
Al-Shahri, M. (2002). Culturally sensitive caring for Saudi patients. Journal of Transcultural Nursing, 13(2), 133–138.
Antai-Otong, D. (2002). Culturally sensitive treatment of African- Americans with substance-related disorders. Journal of Psychosocial Nursing, 40(7), 14–21.
Baqi-Aziz, M. (2001). Where does she think she is? American Journal of Nursing, 101(11), 11.
Bernal, H. (1993). A model for delivering culture-relevant care in the community. Public Health Nursing, 10(4), 226–232.
Callister, L.C. (2001). Culturally competent care of women and newborns: Knowledge, attitude, and skills. JOGNN, 30(2), 209–215.
Cherry, B., & Jacob, S.R. (2001). Contemporary nursing: Issues, trends, & management (2nd ed.).
CROSS-CULTURAL WEB SITES
AltaVista’s Translator—translates any Web page to one of 8 languages: http://abelfish.altavista.com
American Diabetes Association, Facts and Figures: http://www.diabetes.org
American Immigration Resources on the Internet—general references for immigrants: http://theodora.com
Cultural Competence Compendium: http://www.ama-assn.org
Culture and Diversity: http://www.amsa.org
