Hockenberry: Wongs Nursing Care of Infants and Children, 10th Edition

Chapter 02: Social, Cultural, Religious, and Family Influences on Child Health Promotion
Key Points - Print

Culture is the sum total of mores, traditions, and beliefs about how people function. It
encompasses other products of human works and thoughts specific to members of an
intergenerational group, community, or population. It is an ingrained orientation to life that
serves as a frame of reference for ones own perception and judgment. Culture is the way of
life of a group of people that incorporates experiences of the past, influences thought and
action in the present, and conveys these traditions to future group members.
Nurses have a responsibility to continually develop cultural competence. This includes
understanding and respecting the influence of culture, race, and ethnicity on the
development of social and emotional relationships, childrearing practices, and attitudes
toward health.
A childs self-concept evolves from ideas about his or her social roles. Roles are cultural
creations; therefore, the culture prescribes patterns of behavior for persons in a variety of
social positions.
Cultural shock is characterized by the inability to respond to or function within a new or
strange situation. This can happen to a patient in a hospital or to a nurse caring for patients
with different cultural backgrounds. Immigrants to a new country and persons from a
subcultural group experience the same cultural shock when they must adjust to the ways of
an unfamiliar subgroup or setting.
Important subcultural influences on children include ethnicity, socioeconomic class,
poverty, homelessness, immigration, religion, school, community, and peers. Childrens
membership in a cultural subgroup is, for the most part, involuntary.
A trend that has significantly influenced the American family is increasing geographic and
economic mobility. There is less reliance on tradition. Families are fragmented, with
limited opportunity to transmit and acquire the traditional and accepted customs of a
culture.
Ethnicity is the classification of or affiliation with any of the basic groups or divisions of
humankind or any heterogeneous population differentiated by customs, characteristics,
language, or similar distinguishing factors.
Membership in a minority group presents special challenges for children, although changes
in societal attitudes are slowly taking place. The United States has more racial, ethnic, and
religious minority groups than any other country. Because American cultures and
subcultures can be so diverse, it is essential that nurses be knowledgeable about the
predominant groups in their work community and apply this knowledge in their practice.
Peer relationships become increasingly important and influential as children proceed
through school. In school, children have what can be regarded as a culture of their own.
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This is even more apparent in an unsupervised playgroup because in school, the culture is
partly produced by adults.
A childs physical characteristics and susceptibility to health problems can be related to
ethnic and cultural variations of hereditary and socioeconomic forces.
Groups of children with greater physical and mental health problems are those living in
poverty, those who are homeless, those in migrant farm families, and those who are
recent immigrants to the United States. A high correlation between poverty and illness has
long been observed. Impoverished families experience poor nutrition; without medical
insurance, they have little if any preventive health care, inadequate health maintenance, and
limited access to health services. One of the most significant health problems related to
poverty is a high infant mortality rate. Homeless children have physical and mental
disorders more often than do poor children who have a permanent residence. Homeless
children lack basic health care, including routine immunization and screening for routine
problems, and they have high rates of acute and chronic illnesses.
Because communication, both verbal and nonverbal, is an important cultural consideration,
nurses need to acknowledge and respect their patients practices for productive interaction
to occur. In working with families, it is essential for nurses to identify key members and
decision makers; failure to include these significant individuals in teaching can seriously
hinder adherence to the care plan.
Nurses must be aware of the need to consider cultural differences in patients when
providing health care. In planning and implementing patient care, nurses need to strive to
adapt ethnic practices to the familys health needs rather than attempt to change
longstanding beliefs.
Food customs and symbolism of various cultural, ethnic, and religious groups are an
integral part of families lives. It is important for nurses and other health care providers to
be mindful of the meaning of food and eating within a family or community. Feeding and
food preparation are ways in which families nurture and care for one another.
No cultural group is homogeneous; every racial and ethnic group contains great diversity.
Nurses can often recognize a familys health-related cultural perceptions and interpretations
through discussion and observation. Implications of these perceptions should be explored
and considered when planning culturally appropriate interventions.
Health beliefs related to the cause of illness and the maintenance of health are an integral
part of a familys cultural heritage. Often inseparable from religious beliefs, they influence
the way families cope with health problems and respond to health care providers.
Predominant among most cultures are beliefs related to natural forces, supernatural forces,
and an imbalance between forces.
All cultures have some types of home remedies that they apply before seeking help from
other persons. Avoid attacking traditional health cultural beliefs and practices as wrong or
harmful or implying that biomedical measures are uniformly correct and effective and the
only way to prevent illness or treat sickness. Such attacks usually result in rejection of
Copyright 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

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biomedical health care practitioners and health teaching based on biomedicine or scientific
facts.

Religion influences the lifestyles of most cultures. Among many groups, illness, injury, or
death is believed to be sent by God as a punishment for sin. Nurses promote holistic nursing
care through an integration of spiritual and psychosocial care. The care focuses on activities
that support a persons system of beliefs and worship, such as praying, reading religious
materials, and performing religious rituals. Meeting the spiritual needs of the child and
family can provide strength.
Because there is no universal agreement about the definition of family, a family is what an
individual considers it to be. The term family has been defined in many different ways
according to the individuals own frame of reference, value judgment, or discipline. Earlier
definitions of family emphasized that family members were related by legal ties or genetic
relationships and lived in the same household with specific roles. Later definitions have
been broadened to reflect both structural and functional changes.
The family structure, or family composition, consists of individuals, each with a socially
recognized status and position, who interact with one another on a regular, recurring basis in
socially sanctioned ways. Although the traditional family structure has been nuclear or
extended, in recent years other forms, such as the single-parent family, have emerged.
Family size and positioning within the family structure have a strong impact on a childs
development. Parenting practices differ between small and large families. Age differences
between siblings affect the childhood environment but to a lesser extent than does the sex of
the sibling.
In all family groups, the socially recognized status of father and mother exists with socially
sanctioned roles that prescribe appropriate sexual behavior and childrearing responsibilities.
Roles are learned through the socialization process. During all stages of development,
children learn and practice, through interaction with others and in their play, a set of social
roles and the characteristics of other roles. They behave in patterned and more or less
predictable ways.

Copyright 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.