For us as a student nurse we have to know and learn all the different kinds of tradition in terms  of taking care of the patients.And we have to respect their own beliefs.We have to communicate properly and sensitively to the patient so that we can understand and give all the patients needs.We have to prioritize our patient and give them a proper care and medication that they deserve.

            

               As a student nurse we have to respect and learn more about their religions belief,about their countries and most specially all the different kinds of cultural and traditional beliefs to be able to communicate better to the patients.

                As a student nurse we need to have more patience and be understanding to the patients.

                                                                             Thank you and may God Bless you all!

                                                                                By:Irene Balmores and Irene mendoza

Culture and Health 


"But if everyone is genetically humming the same notes, why do people from different cultures and nations sing different melodies?"
"Why do people from various cultures view health and illness differently?"
"What role does culture play in people's expectations of professional nurses and nursing?"

Margaret M. Andrews, Ph.D., R.N. C.T.N. in Transcultural Nursing: concepts, theories, research & practice (xvi, 2002.)

Transcultural nursing and Madeleine Leininger (Leininger & McFarland, 2002)

History of transcultural nursing:

Madeleine Leininger envisioned transcultural nursing in the 1950s as a formal and essential study and practice. There was a critical need to prepare nurses in education and research needed to care for for the culturally different, neglected and vulnerable cultures and subcultures.

She prepared herself with a master's degree in nursing and a Ph.D. in cultural and social anthropology. Dr. Leininger did ethnographic research with the Gadsup of the Eastern Highlands of New Guinea in the 1960s. During this time, Dr. Leininger developed her theory of Culture Care Diversity and Universalityand the ethnonursing research method.

A major shift in the history of nursing, she wrote the first qualitative nursing research book in 1985. Dr. Leininger has studied 15 other Western and non-Western cultures using the Culture Care theory and the ethnonursing research method.

"Today and in the future, cultures have the human rights to have their cultural values, beliefs, and needs respected, understood, and appropriately used within any caring or curing process..." M. Leininger (p.6, 2002)

Transcultural nursing is a formal area of study and practice
focused on comparative human-care (caring) differences and similarities
of the beliefs, values and patterned lifeways of cultures
to provide culturally conguent, meaningful, and beneficial health care to people.
(Leininger& McFarland, 2002)

Global factors influencing the need for transcultural nursing:

• increased migration worldwide
• worldwide increases and demands in health technologies, internet and electronic communications, bringing people closer together virtually or physically
• increase in the number of health care professionals from other cultures and to other cultures
• rise in cultural identities with health care consumers expecting that their beliefs, values and lifeways be respected
• marked increase in moral and ethical cultural concerns between cultures
• increased use of complementary or alternative medicines or therapies
• major shift in Western cultures from hospital to community-based health care related to concern with increasing health-care costs
• a growing gap between culture of the poor and the cultures of the rich showing a need for social justice and equal rights in health care
• increase in cultural and ethnic clashes and violence worldwide, influencing the health, survival, and death of people of diverse cultures.
• increased awareness that health anc culture cannot be divorced from the broader socio-economic-political context in which the individual is situated

Some myths about transcultural nursing:
"Common sense and a smile are all that is needed to care for other cultures."
Why this is a myth: Common sense and smile is generally helpful in this American/Western culture, but common sense and a smile may mean different things in other cultures.
"Anybody can teach culturally competent care."
Why this is a myth: Transcultural nursing is complex and requires diligent and extensive study in the theory and methods. Unprepared staff teaching transcultural nursing without graduate preparation in the theory and methods is educationally unsound and clinically unsafe (p. 33).
"Good medical and nursing psychosocial assessment will tell you everything you need to know about a client."
Why this is a myth: The human is a being who is embedded in a cultural context that influences his/her wellness and illness patterns and beliefs about caring modalities. Holistic culture care assessments are imperative to provide culturally congruent care.
"Having knowledge and experience and interaction with different cultures is sufficient in knowing how to take care of them."
Why this is a myth: Reflective experience needs to be grounded in ethnographically derived holding knowledge, not just on hunches and personal generalizations.


Aug. 17, 2004 :
Most People of Color are Lactose Intolerant (from diversityinc.com)
As many as 75 percent of all African Americans and Native Americans, 90 percent of Asian Americans, and 51 percent of the Latino population are lactose intolerant, according to the National Digestive Diseases Information Clearinghouse.
Want to Find Out More? Read 'Got Milk?' Ads: Culturally Competent or Culturally Insensitive? . 

Notes from Exploring Medical Anthropology (Joralemon, 1999):
This book is an introduction to medical anthropology and discusses the following points:

• Every aspect of the person's experience of illness is shaped by the cultural frameworks of both the sufferer and the helper
• The society's economic and political structures play a critical role in the health risks and treatments that are available
• Ethnography provides the foundation for a holistic understandiing of sickness and healing
• Medical anthropology can play an active role in alleviating human suffering.

Source: http://www.geocities.ws/cultureadvantage/cultureandhealth.htm

Transcultural nursing

From Wikipedia, the free encyclopedia

Transcultural nursing is how professional nursing interacts with the concept of culture. Based in anthropology and nursing, it is supported by nursing theory, research, and practice. It is a specific cognitive specialty in nursing that focuses on global cultures and comparative cultural caring, health, and nursing phenomena. It was established in 1955 as a formal area of inquiry and practice. It is a body of knowledge that assists in providing culturally appropriate nursing care.

Description

According to Madeleine Leininger, the pioneer of transcultural nursing, transcultural nursing is a substantive area of study and practice that focuses on the comparative cultural values of caring, the beliefs and practices of individuals or groups of similar or different cultures.^[1] According to MEDLINE, transcultural nursing is an area of expertise in nursing that responds to the need for developing global perspective within nursing practice in a world of interdependent nations and people. As a discipline, it centers on combining international and transcultural content into the training of nurses. It includes learning cultural differences, nursing in other countries, international health issues, and international health organizations.^[1]

Goals

The goals of transcultural nursing is to give culturally congruent nursing care, and to provide culture specific and universal nursing care practices for the health and well-being of people or to aid them in facing adverse human conditions, illness or death in culturally meaningful ways.^[1]

Founder

As the initiator of and the leader in the field of transcultural nursing, Madeleine Leininger was the first professional nurse who finished a doctorate degree in anthropology. Leininger first taught a transcultural nursing course at the University of Colorado in 1966. In 1998, Leininger was honored as a Living Legend of the American Academy of Nursing. Leininger was the editor of the Journal of Transcultural Nursing, the official publication of the Transcultural Nursing Society, from 1989 to 1995. She authored books about the field of transcultural nursing.

History

Through Leininger, transcultural nursing started as a theory of diversity and universality of cultural care. Transcultural nursing was established from 1955 to 1975. In 1975, Leininger refined the specialty through the use of the "sunrise model" concept. It was further expanded from 1975 to 1983. It's international establishment as a field in nursing continued from 1983 to the present. After being formalized as a nursing course in 1966 at the University of Colorado, transcultural nursing programs and track programs were offered as masters and doctoral preparations during the early parts of the 1970s.

Transcultural nurses

Nurses who practice the discipline of transcultural nursing are called transcultural nurses. Transcultural nurses, in general, are nurses who act as specialists, generalists, and consultants in order to study the interrelationships of culturally constituted care from a nursing point of view. They are nurses who provide knowledgeable, competent, and safe care to people of diverse cultures to themselves and others.

Certification

Certification as a transcultural nurse is offered under a graduate study or track programs by the Transcultural Nursing Society since 1988.

Transcultural Nursing Society

The Transcultural Nursing Society is the official organization of transcultural nurses. Chartered in 1974, the society is the publisher of the Journal of Transcultral Nursing, a publication that had been in existence since 1989.

Publications

Apart from the Journal of Transcultural Nursing, other publications related to transcultural nursing include the Journal of Cultural Diversity (since 1994), and the Journal of Multicultural Nursing (since 1994, currently published as the Journal of Multicultural Nursing and Health: Official Journal of the Center for the Study of Multiculturalism and Health Care).

Madeleine M. Leininger

Madeleine M. Leininger

PhD, LHD, DS, CTN, RN, FAAN, FRCNA

Madeline Leininger was a pioneer nurse anthropologist. Appointed dean of the University of Washington, School of Nursing in 1969, she remained in that position until 1974. Her appointment followed a trip to New Guinea in the 1960’s that opened her eyes to the need for nurses to understand their patients’ culture and background in order to provide care. She is considered by some to be the "Margaret Mead of nursing" and is recognized worldwide as the founder of transcultural nursing, a program that she created at the School in 1974. She has written or edited 27 books and founded the Journal of Transcultural Nursing to support the research of the Transcultural Nursing Society, which she started in 1974.

Dr. Leininger's web pages now reside on a discussion board. Dr. Leininger has provided downloads and answers to many common questions. Board users are encouraged to post questions to her discussion board about transcultural nursing, her theory, and her research. Dr. Leininger enjoys helping students and she responds to questions as her time permits. Board users are also encouraged to respond to each other. Dr. Leininger has provided the following materials that can be downloaded on the discussion board: Sunrise Enabler (Sunrise Model), Information Pack about Dr. Leininger, Information on Dr. Leininger's 2005 Breakthrough Awards and Scholarships, Open Letter to Nurses with Contact Information.

ASIAN INDIANS CULTURE

Immigration of Asian Indians to America has taken place in several waves, in the 1700s, the early 1900s, and the 1950s (mainlystudents and professionals). The elimination of immigration quotas in 1965 prompted successively larger waves of Indian immigrants in the 1970s and 1980s, and with the technology boom of the 1990s, the largest influx of Asian Indians arrived between 1995 and 2000. This population is among the fastest growing ethnic groups in the U.S. and is the third largest Asian American ethnic group, following Chinese and Filipino Americans. California, New York, New Jersey, Texas, and Illinois have the largest Asian Indian populations in the country.

Social Structure

Although the U.S. Census has used the term Asian Indian for immigrants who came to America from India, the terms East Indian and South Asian are also commonly used terms for this population. Asian Indians also have emigrated from Indian communities in the United Kingdom, Canada, and other Southeast Asian nations.

Indians in the U. S.  represent diverse cultures, traditions, customs, and languages. Although legally abolished for many years, the caste system still influences social relations in India. The caste system is a hierarchy of four social classes: Brahmins (priest class), Kshatriyas (warrior class), Vaishyas (merchant class), and Sudras (laborer class). Individuals inherit their class from parents and believe that birth in a particular caste is predetermined by karma from previous lives. Asian Indians assimilate well into American culture, while at the same time, keeping the culture of their ancestors. They may assimilate more easily than other immigrant groups because they have fewer language barriers: English is widely spoken in India among professional classes; Indians in the U.S. are disproportionately well-educated; and they come from a democratic society. Indian culture, like many other Asian cultures, emphasizes achievement as a reflection upon the family and community. Younger persons often use titles to show respect, especially when greeting parents, older relatives, teachers, religious leaders, and persons of higher status. Indians and other Asians, have the highest educational qualifications of all ethnic groups in the U.S. Nearly 67 percent of the population has a bachelor’s or higher degree (compared to 28 percent nationally). Nearly 40 percent have a master’s, doctorate, or other professional degree—five times the U.S. average. A Duke University/ University of California Berkeley study revealed that Indian immigrants have founded more engineering and technology companies in the past 15 years than immigrants from China, Japan, Taiwan, and the United Kingdom, combined. One-third of the engineers in Silicon Valley are of Indian descent, with seven percent of hi-tech firms led by Indian CEOs.

Diet

The cuisine of India is characterized by the use of spices, herbs, vegetables, fruits, and a wide assortment of dishes that varies from region to region, reflecting the varied demographics of a large, ethnically diverse country. India’s religious beliefs and culture, as well as exposure to the foods of Greece, the Middle East, and Asia have influenced its cuisine. Hinduism encourages a vegetarian diet.

Staples include rice, whole wheat flour, red lentils, peas, and seeds. Most Indian curries are cooked in peanut, mustard, soybean, or coconut oil. The most frequently used Indian spices are turmeric, chili pepper, black mustard seed, cumin, ginger, coriander, cinnamon, clove, and garlic. Popular spice mixes are garam masala and goda masala. In southern India, a banana leaf is used as a plate for festive occasions. When hot food is served on banana leaves it adds a particular aroma and flavor to the food. Food is most often eaten using two fingers of the right hand, with bread, such as naan, puri, or roti, to scoop the curry without letting it touch the hands. Pan, or beetle leaves, are often chewed after a meal to aid digestion.

Religion

In India, nearly 83 percent of Indians are Hindus. Indians are also Muslim, Sikh, Jain, Buddhist, Parsis, Christian, Jewish, and Zoroastrian. While Hindus believe in one God, they worship many forms of gods and goddesses in temples or at home and read from holy scriptures (Vedas, Upanishads, and Gita).

Medical Care

Indians tend to accept and respect most Western medical practices, including regular exams, screening procedures, transfusions, and surgeries, although they may prefer to receive blood from persons in their own family or religion. Along with Western medical practice, Indian immigrants may also use faith and spiritual healing, including ritual acts and reciting charms, and the belief that yoga eliminates certain physical and mental illnesses. Hindus and Sikhs believe that disease is due to karma, the result of one’s actions in past lives. They may also attribute illness to body imbalances, which create toxins that can accumulate in weaker areas of the body, resulting in conditions such as arthritis. Many older Indian immigrants use home remedies based on the Indian medicine system called Ayurveda (knowledge of life/health), which uses spices and herbs for cold, congestion, and heart problems. Remedies may include turmeric paste as an antiseptic, ginger and lime juice for stomach ache, and buttermilk stored in an iron utensil for anemia. Asian ndians in the U.S. have a high prevalence and risk of coronary artery disease—three times as high as the general U.S. population. Type 2 diabetes is common in this population due to hypertension and a genetic resistance to insulin.

End of Life

Hindus and Sikhs believe in reincarnation— the body dies, but the soul is immortal. When death is imminent, the father, husband, or other responsible person decides whether to tell the patient and informs all relatives and friends. Indians strongly prefer death to take place at home, where they may perform religious rituals.

Among Hindus and Sikhs, the body is washed by close family members, dressed, and prepared for cremation. Hindus save ashes of the cremated body until they can be scattered into the sacred river Ganges in India. Organ donation and autopsy are unacceptable to many Hindu, Sikh, and Christian Indians.

Culture in context

Culture is essential in assessing a person’s health and well-being. Understanding a patient’s practice of cultural norms can allow providers to quickly build rapport and ensure effective patient-provider communication. Efforts to reduce health disparities must be holistic, addressing the physical, emotional, and spiritual health of individuals and families. Also important is making connections with community members and recognizing conditions in the community. Get to know your patients on an individual level. Not all patients from diverse populations conform to commonly known culture-specific behaviors, beliefs, and actions. Generalizations in this material may not apply to your patients

Source: www.stratishealth.org

AFRICAN AMERICAN CULTURE

The following cultural patterns may represent many African Americans, but do not represent all people in a community. Each person is an individual, as well as a community member. The term African American generally refers to people descended from Africans who did not come to the US voluntarily—descendants of the four million slaves brought to the US between 1600 and 1800.

Social structure

According to the University of California School of Nursing, in Culture and Clinical Care, many aspects of African American culture today reflect the culture of the general US population. The structure in African American families is often nuclear and extended with non-related “family” members. The family may be matriarchal, although father or mother may take on the decision-making role. For African Americans, women more than men tend to remain unmarried, and more women have been educated at the college level.

In general, the older generation is more conservative, may have a more traditional view of gender roles, and may shun interracial dating and marriage. Elders are respected and often provide care for their grandchildren. Institutionalization of elders has historically been avoided, with sons and daughters taking on the family caretaker role.

Diet

Many African Americans like hearty meals that may include meat, fish, greens, rice, grits, white and sweet potatoes, corn, turnips, eggplant, peanuts, and homemade desserts. Leafy greens may include spinach, collards, mustard, kale, and cabbage. Traditionally, many elders eat a large noon meal on Sunday after church.

Traditional African-American food—sometimes referred to as “soul food”—is diverse and flavorful with origins in Africa, the West Indies, and American southern states. The idea of what soul food is differs greatly among African Americans. Soul food may refer to meals made with fried chicken, pork chops, chitterlings, grits, cornbread, macaroni and cheese, and hushpuppies. Dishes such as hoppin’ John (rice, black-eyed peas, and salt pork), gumbos, jambalyas, fried porgies, and potlikker may all be considered soul food. Okra is the principal ingredient in gumbo, a Creole stew, and is believed to have spiritual and healthful properties. Many of these foods found their way from the south to the north via the Mississippi River. Cajun and Creole cooking, which originated from the French and Spanish in Louisiana, was changed in character and composition by the influence of African cooks.

In 1965, African Americans were more than twice as likely as whites to eat a recommended diet of fruit, vegetables, fat, fiber, and calcium. By 1996, 28 percent of this population was reported to have a poor-quality diet, compared to 16 percent of whites. A poor quality diet often can be attributed to greater access to packaged, processed, and fast foods; the common practice of using fats in cooking; and the high cost of fresh produce and lean meat. And fast foot companies have specifically targeted African American communities as a growing market for their products.

Although many African Americans eat foods such as greens, beans, and rice, which are rich in nutrients, economic issues and deep-rooted dietary habits create challenges for changing behaviors and lowering disease risk in this population. However, through health education and increased awareness of healthy eating practices, African Americans are replacing traditional pork products with turkey, fried foods with baked foods, and starchy vegetables with tomatoes and green vegetables. National programs to improve diet quality and the overall health of African Americans and other minority groups have been initiated. Body and Soul: A Celebration of Health Eating and Living for African Americans offers information targeted to African Americans on eating a health diet rich in fruits and vegetables.

Religion

African Americans often have strong religious affiliations. Many are affiliated with Christian denominations—notably Baptist and Church of God in Christ. Many follow Islam. Maintaining good health is associated with good religious practice. Many churches maintain a health ministry, through which congregations and parish nurses support good health with flu shots, blood pressure checks, and health education. Before the advent of health ministries, African American churches had mission volunteers who attended services and administered to parishioners.

Medical care

African Americans are becoming increasingly health conscious, seeking health screenings and treatments, although health literacy in this population tends to vary by generation. Older African Americans may be suspicious of clinicians, believing their health is personal and up to God’s will. Because they may be reluctant to share personal or family issues, building a trusting relationship is key.

African Americans are affected disproportionately by the leading causes of death in the US, with more morbidity and mortality from premature births, cancer, HIV/AIDS, obesity, and diseases related to obesity, including heart disease, hypertension, stroke, and type 2 diabetes.

* African American men have higher rates of getting and dying from prostate cancer than other men. * Forty-five percent of African American adults in the US are obese. * African Americans are more likely to die from asthma than other populations. * Nearly half of those infected with HIV/AIDS are African American.

Sickle cell anemia is the most common genetically inherited condition in African Americans. They also exhibit a higher incidence of lactose intolerance, periodontal disease, and have common skin problems such as melasma (discoloration of the face) and other pigment disorders. Death and dying

Many older African Americans believe that death is at God’s will, but tend to believe that life support should be continued as long as necessary. A family-centered approach is recommended for conveying serious medical information, seeking consents, and explaining issues such as autopsy and organ donation. Cremation is generally avoided in this community and organ donation may be viewed by some as a desecration of the body. Because of the importance of family in the African American culture, the family should be informed of an impending death so that extended family members who live out of state can be notified.

In the African American community, death is an important aspect of culture, with unique traditions, mourning practices, burial rites, and even the structure of cemeteries. Rather than a time of sadness, death is a time to celebrate that the deceased no longer has to endure the trials of the earthly world. Some present day customs associated with death can be traced back to African roots. Customs have been passed down in the form of expressions, superstitions, religious practices, and music. At the time of death, old beliefs and superstitions are remembered and may be acted upon, such as not burying the deceased on a rainy day or burying the deceased with feet facing east to allow rising on Judgment Day. Coins may be placed on the eyes or in the hands of the deceased, or placed around the grave site as the deceased’s contribution to the community of ancestors.

Culture in context

Culture is essential in assessing a person’s health and well-being. Understanding a patient’s practice of cultural norms can allow providers to quickly build rapport and ensure effective patient-provider communication. Efforts to reduce health disparities must be holistic, addressing the physical, emotional, and spiritual health of individuals and families. Also important is making connections with community members and recognizing conditions in the community.

Get to know your patients on an individual level. Not all patients from diverse populations conform to commonly known culture-specific behaviors, beliefs, and actions. Generalizations in this material may not apply to your patients.

Source: www.stratishealth.org

AMERICAN INDIAN CULTURAL

The following cultural patterns may represent many American Indians, but do not represent all people in a community. According to the University of California School of Nursing, in Culture and Clinical Care, many aspects of Indian culture today reflect the culture of the general US population.

Social structure

The American Indian concept of family includes immediate and extended family members, as well as community and tribal members. Women are the traditional care givers. Grandparents help counsel and care for their grandchildren, and children are expected to respect and care for their elders and take pride in their culture. At powwows, elders are served meals first and are given special seating areas. Indian communities encourage education with an emphasis on the unique cultural legacies of the community. Younger people often leave home to become educated, then return to help their families and tribes.

Diet

The traditional diet of American Indians was generally nutritious and low in fat, but today a typical diet is similar to that of the general US population, although it is often poorer in quality, consists of high-fat, salty, and sugary foods, and lacks sufficient fruit, vegetables, grains, and dairy products. Indians are more likely to report not having enough to eat than other US households. Traditionally, the Anishinabe and Dakota ate fresh or dried wild game and foul and gathered wild rice, berries, acorns, ginger, and leaves and twigs for teas. They planted potatoes, corn, pumpkins, squash, and turnips, and made maple syrup. Fish, the principal food of the Anishinabe, was boiled, cooked over a fire on a stick, or eaten in soup, and was dried, salted, or frozen in the snow to preserve.

Religion

Spirituality is central to the identity of the American Indian, and is viewed holistically. People and nature are interconnected. Every animate and inanimate form of life has a spirit and is considered sacred. For example, water is viewed as a sacred, life-sustaining source and a way of connecting with the earth. The head and hair are considered particularly sacred. Respecting and nurturing life and developing a positive relationship with the spirits is core to Indian spirituality. Indians nurture that relationship through prayer and a purification ritual in a sweat lodge. They burn sage and sweet grass, and smoke a special ceremonial tobacco for cleansing, blessings, and healing. Drumming, dancing, and singing also are traditional spiritual expressions associated with healing. American Indians have endured decades of assimilation policies designed to strip them of their identity and integrate them into the dominant society. Many Indian people who grew up in the mid-twentieth century describe a feeling of shame in their heritage during that time. This was partly due to the fact that it was illegal for Indians to practice their religious ceremonies until the American Indian Religious Freedom Act was passed in 1978. As a result, many Indians today have Christian ties or practice no religion at all.

Medical care

According to the Centers for Disease Control and Prevention, the top causes of death in the American Indian population are heart disease, cancer, unintentional injuries, diabetes, and stroke. Also prevalent are chronic liver disease and cirrhosis, chronic respiratory disease, suicide, influenza/pneumonia, and kidney disease. Obesity, smoking, and alcohol abuse in this population are related to many of these diseases. Among racial and ethnic groups, the prevalence of smoking is highest among American Indians/Alaska Natives (32 percent). Because their lands are sovereign nations, Indians are not subject to taxes or to state laws prohibiting the sale and promotion of tobacco products to minors. Chronic cigarette smoking and spit tobacco used by this population have increased its risk of developing tobacco-related health problems, such as heart disease, cancer, and stroke.

Because health is related to spirituality in Indian culture, sickness may be viewed as a result of disharmony between the sources of life. A patient may seek western medicine for treatment as well as medicine from a traditional healer—a medicine man—to address the disharmony that caused the illness. The medicine man has been given the power to heal through his relationship with spiritual beings. Spirits work through him, helping him diagnose and treat physical and spiritual illness. Traditionally, the medicine man is chosen by the spirits and comes from a specific family lineage. His life is hard because he cannot deny a request for treatment and never charges for his services. Indian patients may be reluctant to discuss use of these traditional practices with a clinician. Indians have been taught to resist any expression of pain. Although they may not express pain directly, they may report feeling uncomfortable or may use storytelling or circular conversation to build trust and describe symptoms. A personal story about a sick neighbor may be used as a metaphor for the patient’s symptoms. Direct eye contact is often avoided out of respect or out of concern for soul loss. Time and silence are often used to prepare to listen, to maintain harmony, and to be non-confrontational. Patients may occasionally be late or miss appointments because of a different perception of the concept of time—time orientation for Indians has been traditionally cyclical and present-oriented compared to the linear, future-oriented concept of time in Western culture.

Death and dying

Because of the importance of family in American Indian culture, immediate and extended family members should be informed of an impending death. A family-centered approach is recommended for conveying serious medical information and explaining issues such as autopsy and organ donation. Organ donation may be viewed as a desecration of the body. The entire family may be included when making decisions and signing documents. Due to the misuse of signed documents throughout the history of the American Indian, some Indian patients may be unwilling to sign informed consents, advance directives, and durable power of attorney forms. Patients may perceive verbal agreement as sufficient.

Honoring ancestors is especially important in Indian culture. Several Indian nations across the US are currently in the process of attempting to retrieve the remains of ancestors that have been unearthed by archeologists so they can be properly buried.

Culture in context

Culture is essential in assessing a person’s health and well-being. Understanding a patient’s practice of cultural norms can allow providers to quickly build rapport and ensure effective patient-provider communication. Efforts to reduce health disparities must be holistic, addressing the physical, emotional, and spiritual health of individuals and families. Also important is making connections with community members and recognizing conditions in the community. Get to know your patients on an individual level. Not all patients from diverse populations conform to commonly known culture-specific behaviors, beliefs, and actions. Generalizations in this material may not apply to your patients.

Source: www.stratishealth.org

TRADITIONAL ASIAN MEDICINE

Traditional Chinese Medicine

TCM is inextricably linked to Chinese Cosmology, as system of beliefs that can be summed up as follows: all of creation is born from the marriage of two polar principles, Yin and Yang. Examples are earth and heaven, winter and summer, night and day, cold and hot, wet and dry, inner and outer, body and mind. These pairs of opposites are connected via a circular harmony. The yin and yang symbol is helpful in representing this concept. Harmony means health, good weather, and good fortune, while disharmony leads to disease, disaster, and bad luck. The strategy of Chinese medicine is to restore harmony. Each human is seen as a world in miniature, and every person has a unique terrain to be mapped, a resilient yet sensitive ecology to be maintained. Like a gardener uses irrigation and compost to grow robust plants, the doctor uses acupuncture, herbs and food to recover and sustain health.

Chinese Herbal Medicine

Herbal medicine is an important part of Traditional Chinese Medicine (TCM). Herbs are prescribed holistically according to the patient’s individual condition (not only on the basis of current symptoms). Herbal medicines are used to regulate the natural balance of the body and restore health. They come in the form of pills, powders, tinctures and raw herbs taken internally or as balms for external use. Chinese herbal medicine has been used for centuries to treat most health conditions and as a preventative dietary supplement. They can also be used safely in conjunction with many western therapies. Diagnosis is made by talking to the patient, looking at physical characteristics and employing the ancient arts of tongue and pulse diagnosis.

Japanese Herbal Medicine

Kampo is Japanese herbal medicine, which has a long history of clinical application. Kampo uses precisely measured herbs to treat illness, based on the skillful use of well-known formulas, valued for their impact on clear as well as vague conditions. (Kampo does not use rare or endangered plant or animal products). The distinguishing feature of Kampo is it’s method of diagnosis through abdominal palpation. Kampo medicine is based on the theory that diseases arise because of a disharmony in the flow of Qi (Chi). By stressing prevention, Kampo helps the patient to maintain good health according to natural principles.

Tibetan Medicine

It is known as gSo-ba Rigpa in Tibetan, meaning ‘the science of healing’. The basic principle is to balance the three principal energies of the body. The practitioner employs the ancient tools of pulse diagnosis and urine analysis, to find the root causes of disease. Treatment is carried out through diet, lifestyle adjustments and herbal medicines grown naturally in Tibet and the Himalayas. Tibetan Medicine is based on Buddhist principles and the close relationship between mind and body.

Traditional Vietnamese Medicine

The distinguishing feature of TVM is the emphasis on nourishing the blood and vital energy, rather than concentrating on specific symptoms. TVM views building up the blood and energy as the key to good health. The main treatments employed by TVM are herbal medicine, acupuncture, and moxibustion.The cornerstone of its theories is based on the observed effects of Qi (energy) in the body. Qi can be inherited from one’s parents or it can be extracted from food. It is also blood and “fuel” gathered and stored by the body.

Acupuncture

Acupuncturists insert tiny needles into specific points on the energy channels of the body, to promote healing and stimulate the free flow of energy in the body and mind. It is used to treat many conditions including muscular pain, headaches, asthma, gynecological problems, digestive complaints, as well as anxiety and depression. Acupuncture is also useful for preventative health care.

Moxibustion, Coin Rubbing & Cupping

Moxibustion is a therapy utilizing moxa, or mugwort herb. It plays an important role in the traditional medical systems of China, Japan, Korea, Vietnam, Tibet, and Mongolia. Suppliers usually age the mugwort and grind it up to a fluff; practitioners burn the fluff or process it further into a stick that resembles a (non-smokable) cigar. They can use it indirectly, with acupuncture needles, or sometimes burn it on a patient’s skin.

Coin Rubbing in Chinese is called Gua Sha, or literally “to scrape away fever.” It is an ancient technique used to scrape away disease by allowing the disease to escape as sandy-looking objects through the skin.” The Vietnamese term for this practice is cạo gió (pronounced “cow zaw”), meaning roughly to “scrape wind.” It is also used in Indonesia.

Cupping Fire, or simply cupping, is a form of traditional medicine found in several cultures. It involves placing glass, plastic, or bamboo cups on the skin. This technique, in varying forms, has been found in the folk medicine of China, Vietnam, the Balkans, Iran, Mexico, Russia and Poland. In traditional Chinese medicine (TCM), cupping is a method of applying acupressure by creating a vacuum next to the patient’s skin. The therapy is used to relieve what is called “stagnation” in TCM terms, and is used in the treatment of respiratory diseases such as the common cold, pneumonia, and bronchitis. Cupping is also used to treat back, neck, shoulder, and other musculoskeletal pain.

This brief introduction to traditional medicines of Asian cultures no doubt leaves many questions unanswered and so it seems appropriate to invoke Ben Franklin’s caution, “a little learning is a dangerous thing.”  This article is meant to assist clinicians by providing a general framework, a baseline for learning.  No hard and fast rules about interacting with Asian patients and families are being offered. Becoming fully familiar with the normative cultural values affecting interactions with patients from different cultures is a process that takes time and experience. Using the links provided for further study, consulting colleagues from other ethnic groups, and speaking to interpreters and community members are all ways to learn more about the practices and health beliefs one encounters that are different from one’s own. It is also important to learn to ask patients questions in a culturally sensitive way, understanding that fear of making mistakes in communicating with them blocks the exchange of vital information.  There have been instances where practices such as coining and cupping have been misinterpreted by conscientious healthcare workers and reports of child abuse made in error. Thorough efforts at communication might have prevented these erroneous reports which traumatized families.

A cross-cultural mindset requires understanding one’s own health beliefs and behaviors first and then applying that baseline of understanding as a means of making effective comparisons across cultures. Clinicians should keep in mind that individuals subscribe to group norms to varying degrees. Factors such as socio-economics, education, degree of acculturation and English proficiency have an enormous impact on an individual’s health beliefs and practices. Searching out and really trying to understanding the individual patient is crucial.

HMONG CULTURE

Hmong (the H is silent) in the US represent a small Southeast Asian minority group of people who immigrated to the US at the end of the Vietnam War. According to US Census 2005 American Community Survey data, the majority of Hmong live in California (65,345), Minnesota (46,352), and Wisconsin (38,814). Hmong people originally lived in the mountains of South China, Laos, Vietnam, Burma, and Thailand.

Social structure

Hmong are organized into 18 clans determined by ancestral lineage. They have large, extended families and practice traditional ceremonies to remember their ancestors. Clan leaders are the key decision makers. Each person has a last name that represents the clan they belong to. When a woman marries, she keeps her maiden name. The Hmong language, Hmoob (Hmong in English), has many dialects, although most Hmong speak either White Hmong or Green Hmong. Hmong was not a written language until the late 1960s and has few medical terms.

Diet

Traditional staples of the Hmong diet are rice, noodles, fish, meat, and green vegetables with hot chili sauces. Hmong tend to eat the same types of food at each meal, with very little fruit or dairy products. Hmong people often prefer hot dishes and drink hot or warm water. Traditionally, a sick person must eat hot food with certain vegetables. Within 30 days of childbirth, Hmong mothers usually eat only warm foods.

Religion

The Hmong shaman is a religious leader who makes all decisions related to spiritual healing and conducts religious ceremonies. The shaman acts as a medium between the visible world and an invisible spirit world, and practices rituals for healing, divination, and control over natural events. Since coming to the US, a number of Hmong have become Christian.

Medical care

Chronic diseases common among the Hmong population include chronic obstructive pulmonary disease, diabetes, congestive heart failure, and hypertension. The adoption of a Western diet and sedentary life style has lead to a dramatic increase in the prevalence of diabetes. A lack of roughage in the diet has resulted in chronic constipation and diarrhea among many Hmong. Refugees 30 years of age or older may have long-term effects from malnutrition and exposure to yellow rain and other war zone chemicals. Many refugees have intestinal parasites, tuberculosis, anemia, depression, and post traumatic stress syndrome. Although Hmong have been exposed to Western medicine since the 1950s, they traditionally view illness from a holistic perspective, with perfect health being a balance between the spirit and the body. Good health comes from the souls living within each person. When a person is ill, they seek the help of a shaman to determine if the cause of the illness is within the realm of the spirit. Spiritual causes require religious remedies. Traditional spiritual causes of illness may include evil spirits or because one’s own spirit has left the body. A person may be ill because an ancestor or evil spirit is unhappy with them or their family or because someone cursed the family or offended the family’s ancestors or spirits. The sick person may accept either the appropriate Hmong medicine or treatment, or the Western approach. Some Hmong people will not communicate dissatisfaction with the quality of health care they receive. If they are dissatisfied with their care, they may refuse care and turn to traditional treatments. Older Hmong may listen attentively to health professionals, but avoid direct eye contact, which is considered to be rude.

Many Hmong practice spiritual healing, which involves retrieving the lost soul from another plane of existence. They may consider an illness or an invasive surgical procedure to be the cause of soul loss. Hmong may conduct healing ceremonies in the hospital or in the home. Herbal medicine and traditional healing practices are often widely used before a person seeks Western medical remedies. A person also may use traditional herbal treatments as complements to Western treatments and practices. Surgery is usually not acceptable to older Hmong people unless laboratory or other tests identify a disease. Blood transfusions and organ donation also are considered unacceptable.

Recent immigrants are unaccustomed to doing things at specific times. In their native lands, farmers organized their activities around sun up and sun down. Appointment times need to be written down and fully explained. Take advantage of the following tips to help you provide the most appropriate, culturally competent care for your Hmong patients:

•             Demonstrate respect to Hmong patients by asking how they would like to be addressed. Hmong do not call each other by their first name. They address one another by their title, such as aunt, uncle, brother, etc. (The medical record is filed under first and last name.)

•             Maintain physical distance during an initial encounter. As trust develops, Hmong patients become comfortable shaking hands. Not using direct eye contact with the opposite sex demonstrates respect. Saying “no” to a Hmong patient demonstrates disrespect.

•             Involve the patient and family in the care plan and in obtaining consent signatures. Ask the patient, “In what language do you prefer to discuss your health with us?” Use trained medical interpreters rather than family members. Never use children as interpreters.

•             Ask patients what they believe is causing their illness. Be aware that Hmong health beliefs are intermingled with spirituality. Schedule longer appointments for Hmong patients, and take the time to explain care options. Explain the long term consequences of not taking care of chronic illnesses, and the need to take medications even when they are feeling well.

•             Ask elderly patients, “Who in your family can help you do this?” Solicit support from adult children in caring for their elderly parents.

•             Educate patients about the safety of non FDA-approved foreign medications. Ask if they use herbs or medications from Thailand, China, Laos, or France.

•             Provide the patient and family with current knowledge about an incurable disease. Explain that a cure has not yet been discovered for this disease. Hmong people sometimes feel they do not receive the same treatments others receive that could cure them.

•             Review instructions orally and ask patients to repeat them back to you. Hmong may say “yes,” but still do not understand. Explain by comparing a condition or disease to a familiar household process such as using heat to control room temperature.

•             Explain your telephone triage system. You may need to make appointments for some patients and to call them before their next scheduled appointment.

•             Provide educational materials in Hmong and English. The patient, family member, or someone else at home may be able to read at least one of the languages.

Death and dying

Traditional Hmong view life as a continuous journey, rather than the Western perspective of life as a journey with a beginning and an end. They believe that death is merely a phase people go through when passing from this plane of existence to the next. They believe people are destined to live to a certain age. When that age is reached, it is time for the person to depart. Hmong believe the spirit will reincarnate. Religious ceremonies conducted on behalf of a dying person are intended to make the person happier. The deceased is dressed in fine Hmong clothes to demonstrate to the community and family that the person has lived a good life, will be missed, and will make a proper entrance into the next world.

Culture in context

Culture is essential in assessing a person’s health and well-being. Understanding a patient’s practice of cultural norms can allow providers to quickly build rapport and ensure effective patient-provider communication. Efforts to reduce health disparities must be holistic, addressing the physical, emotional, and spiritual health of individuals and families. Also important is making connections with community members and recognizing conditions in the community. Get to know your patients on an individual level. Not all patients from diverse populations conform to commonly known culture-specific behaviors, beliefs, and actions. Generalizations in this material may not apply to your patients.


Source: www.stratishealth.org

RUSSIAN CULTURE

The following cultural patterns may represent many immigrants from Russia and Eastern Europe, but do not represent all people in a community.

Social structure

The family is a source of stability for Russian Americans. Elders are expected to help raise their grandchildren if both parents are working and children are expected to care for their elders in old age. Children are expected to be respectful of their elders, addressing them as Mr., Mrs., Uncle, or Aunt. The strongest personality in a Russian family (mother, father, eldest son, or eldest daughter) is usually the spokesperson and decision-maker for the family. Family members have strong kinship bonds, provide support for each other during a crisis, and are often consulted during health care planning, especially when consents for release of information are required.

Compared with other major immigrant populations in the U. S., Russian Americans are generally older (83 percent are age 50 or older), have fewer children, and are more educated (95 percent have at least a high school diploma).

In addition to speaking Russian, most Russian immigrants also speak the language of the republics where they formerly lived (e.g., Belorussian, Ukrainian, and Uzbek). Native languages of Yiddish and Ladino are also spoken at home, although typically only the oldest generation of Russian Jews can still understand and speak these older languages. Many Russian Americans hold professional positions as physicians, engineers, and teachers, although many encounter difficulties pursuing careers in the U.S. due to certification or licensing requirements. The most recent arrivals tend to be less educated and are employed in manufacturing, trade, and service industries. Many small, Russian-owned businesses have been successfully launched in the United States.

Diet

Russian Americans often maintain a diet high in fat, carbohydrates, and sodium, contributing to health problems that include diabetes, hypertension, and coronary and gastrointestinal diseases.

During the early years of communism and food shortages in Russia, the main concern was eating enough calories to stay alive. Meals were heavy, fatty, and salty, though otherwise bland. The ideal meal for a working peasant included boiled buckwheat with lard and a fermented drink made from dense, sour, black bread—food that would “hold you to the earth” and last a full working day. Conventional wisdom dictated that the richer and more fatty the food, the harder one would work. Traditional meals eaten by some Russian Americans today include pickled and dried meats, fish, bread, potatoes, dumplings, porridge, cabbage and beet soup, and vegetables.

Religion

In the US, many Russian immigrants practice Judaism or Eastern Orthodox Christianity, Russia’s traditional and largest religion. The Eastern Orthodox church is widely respected by both believers and nonbelievers, who see it as a symbol of Russian heritage and culture. Many Russian immigrants in the US also belong to Christian Baptist and Pentecostal churches. Smaller numbers of Russians follow other Christian religions, such as Roman Catholicism, Armenian Gregorian, and various Protestant denominations. As a product of the anti-religion policy of the former Soviet Union established in the early 1900s, many Russian immigrants are atheists.

Medical care

Common diseases seen in immigrants from Eastern Europe include diabetes, hypertension, coronary disease, gastrointestinal problems, tuberculosis, mental illness, and alcohol and substance abuse.

Some Russians believe that disability or illness is caused by something the individual did not do right, such as not eating well or not dressing warmly enough. Good health is equated with absence of pain. Illnesses that do not cause pain often go undiagnosed and under-treated, such as diabetes, hypertension, and high cholesterol. Mental illness is regarded as disgraceful in many Eastern European countries. Immigrants often do not answer questions regarding a family history of mental illness or past treatment.

Expression of feelings in Russian culture is different from that in American culture. Many immigrants are unfamiliar with the cultural etiquette of American medicine and tend to expect more compassion and emotional closeness with their physician—seeking a professional yet close relationship with providers. In Russia, a patient can confess to a doctor as if speaking with a priest. Problems can arise in the health care setting directly from this cultural difference. Rather than appreciating the privacy and autonomy of American medical culture, patients may complain about the quality of medical treatment they receive and question the physician’s ability to understand their problems.

Practices associated with physical examinations in Eastern European culture are different from those in American medical culture. In Eastern Europe, hospital gowns are not provided during examinations. Most patients are examined in their undergarments; nudity is not considered shameful.

Some immigrants from Eastern Europe may be distrustful of physicians and reject health recommendations, such as refusing to take medications as prescribed or combining medications and therapies with home remedies and treatments. Home remedies are often used prior to seeking medical attention, such as oil rubs, mud or steam baths, and exposure to fresh air and sunlight. The “bonki” is a cold and flu remedy where glass cups are pressed on a sick person’s back and shoulders to ease symptoms. The bonki often leaves behind bruises and welts, which may be misinterpreted as a sign of physical abuse. When a Russian person is ill, family members and friends are expected to visit in order to provide support to the individual and immediate family. Bad health news is not given to a person who is ill or disabled. The family does not want the person to become anxious. It is commonly believed that the individual needs to be at peace so physical and emotional conditions do not worsen. The family prefers to receive the news first, then decides whether or not to tell the patient of the condition and prognosis. Eastern European immigrants tend to appreciate the high quality medical care, equipment, and variety of medications available in America. They especially value the right to choose their own physician and receive follow-up care from that same physician. They appreciate having excellent medical services available in cities and remote areas, with preventive check-ups covered by insurance, home health aides, transportation services, and programs like meals on wheels.

Death and dying

To ensure a more peaceful death, family may believe that the patient should not know of imminent death. The moment of death and the patient’s last words are highly significant. In some cases families may prefer to care for the patient at home rather than a nursing home. Some family members may ask a rabbi, priest, or others to pray for the patient. Depending on the person’s religion, family members may want to wash and dress the body. Jewish families never leave the body alone until after burial as a sign of respect. Some Jews believe that the body should remain intact. Because both Christians and Jews believe the body is sacred, organ donation is uncommon. Most Russians will refuse autopsy. Jewish law forbids euthanasia and assisted suicide.

Culture in context

Culture is essential in assessing a person’s health and well-being. Understanding a patient’s practice of cultural norms can allow providers to quickly build rapport and ensure effective patient-provider communication. Efforts to reduce health disparities must be holistic, addressing the physical, emotional, and spiritual health of individuals and families. Also important is making connections with community members and recognizing conditions in the community. Get to know your patients on an individual level. Not all patients from diverse populations conform to commonly known culture-specific behaviors, beliefs, and actions. Generalizations in this material may not apply to your patients.


Source: www.stratishealth.org