Multicultural Aspects of Learning

Cultural Differences

If predictions prove true, it will be the first time in U.S. history that minority subgroups will become the majority of the total population. If the present demographic trends continue, when this historical milestone is reached, the racial and ethnic composition of this country will be 23.4% Hispanics, 14.7% blacks, 12% Asians and others. As of the year 2000, according to the U.S. Census Bureau, the current composition of the U.S. population was 71.3% whites 12.2% blacks, 11.2% Hispanics, 3.8% Asian/Pacific Islanders, and 0.7% American Indians.

To keep pace with a society that is increasingly more culturally diverse, nurses will need to have sound knowledge of the cultural values and beliefs of specific ethnic groups as well as be aware of individual practices and preferences.

 In the past, healthcare providers have experienced difficulties in caring for clients whose cultural beliefs differ from their own, because beliefs about health and illness vary considerably among cultural groups.
Lack of cultural sensitivity by healthcare professionals has resulted in millions of dollars wasted annually through misuse of heathcare services, the alienation of large numbers of people, and the misdiagnosis of health problems with often tragic and dangerous consequences.

In addition, certain underrepresented groups are beginning to demand culturally relevant health care that respects their cultural rights and incorporates their specific beliefs and practices into the delivery of care.

 This expectation is in direct conflict with the unicultural, Western, biomedical paradigm taught in many nursing and other healthcare provider programs across the country. Andrews (1992) suggested that a serious conceptual problem exists within the nursing profession because nurses are presumed to understand and be able to meet the healthcare needs of a culturally diverse population, even though they do not have the formal educational preparation to do so.

Definition of Terms
Acculturation: A willingness to modify ones own culture as a result of contact with another culture
Assimilation: The willingness of a person emigrating to a new culture to gradually adopt and incorporate characteristics of the prevailing culture

Cultural assessment: A systematic appraisal of beliefs, values, and practices conducted in order to determine the context of client needs and to tailor nursing interventions

Cultural Competence: A conscious process of demonstrating knowledge and understanding of a clients culture
Cultural diversity: representing a variety of different cultures Cultural relativism: implies that the values every human group assigns to its conventions arise out of its own historical background and can be understood only in the light of that background Culture: A complex concept that is the integral part of each persons life

Ethnicity: refers to how members of a group perceive themselves and how, in turn, they are perceived by others Ethnocentrism: describes the universal tendency of human beings to think that their ways are the only right and proper Transcultural nursing: a formal study and practice focused on a comparative analysis of different cultures and subcultures

Promoting Cultural Knowledge

3 Approaches: 1. fact-centered approach provide info about the health beliefs and behaviors of specific ethnic groups 2. attitude-centered emphasizing the importance of valuing and respecting all cultures; acknowledgement of culture and fostering of positive attitude; (eg. focus on cultural sensitivity) 3. ethnographic approach learning how to ask; focus is on inquiry, reflection, and analysis as a means of getting to know an individual

Assessing Culturally Diverse Learner

Communication Space Social Organization Time Environmental Control Biological variations

General Assessment and Teaching Interventions

The following specific guidelines for assessment should be used regardless of the particular culture orientation of the client: 1. Observe the interactions between patient and family members and among family members. 2. Listen to the patient.

3. Consider communication abilities and patterns.

4. Explore customs or taboos.

5. Determine the notion of time. 6. Be aware of cues for interaction. Use of Translators In teaching clients who are only partially fluent in English, the following strategies, adapted from Tripp-Reimer and Afifi and Poss & Rangel, are recommended to help the nurse alter the style of interaction when no translator is used: 1. speak slowly and distinctly, allowing for twice as much time as a typical teaching session would take. 2. use simple sentence structures, relying on a direct subject-verb pattern and an active rather than passive voice

3. Avoid technical terms

4. Organize instructional material

5. Make no assumptions that the info given has been understood.

The 4 Major Cultural Groups

Hispanic American Culture
-fastest-growing minority group -11.9% of the total pop. -sometimes referred to as Latinos -Latin American or Spanish decent or who use the Spanish lang. -Mexicans, Puerto Ricans, Central and S. Americans, Cubans -affected by certain Ca, alcoholism, drug abuse, obesity, HPN, Diabetes, adolescent pregnancy, dental dse & HIV/AIDS -use of herbs, teas, home remedies, OTC drugs, belief on health healers known as curenderos or espiritistas for health advice & tx

Black American Culture

-make up the largest historically underrepresented group -speak French, Spanish, African dialects & various forms of English -occupation-related dses, obesity, food is a symbol of health & wealth -poverty, low educational attainment -high death rates from Ca, CVDs, cirrhosis, diabetes, accidents, homicides & infant mortality -high risk for addiction, teenage pregnancy & STDs -pessimistic about human rel., suspicious of healthcare professionals -concept of extended family, respect of elders & ancestors

3 themes regarding Black Americans belief system: 1. The world is a hostile & dangerous place to live 2. The individual is vulnerable to attack from external f forces 3. The individual is considered helpless w/ few internal resources to combat adversity

Asian/Pacific Islander

-people from Asian countries & the Pacific Islands constitute

this cultural group -language barrier wide variety of cultural, religious & language background -common values: male authority & dominance, saving face, strong family ties, respect for parents, elders, teachers, & other authority figures

Native American Culture

American Indian or Native Alaskan descent -major characteristics: 1. A spiritual attachment to the land & harmony with nature 2. An intimacy of religion & medicine 3. Emphasies on strong ties to an extended family network, including immediate family, other relatives, & the entire tribe 4. The view that children are an asset, not a liability 5. A belief that supernatural powers exist in animate as well as in inanimate objects 6. A desire to remain Native American & void acculturation, thereby retaining ones own culture & language 7. A lack of materialism, time consciousness, & a desire to share w/ others
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-practices witchcraft -family and tribe is of utmost importance -talking is unnecessary, but simply being there is highly impt -kinship system -children are given a great deal of freedom & independence to learn by their decisions & live by the consequences of their actions -not very future oriented -tend not to live by clocks & schedules -belief that death is just a part of the life cycle

Gender differences in brain structure

Men TEMPORAL LOBE Regions of the cerebral cortex help to control hearing In cognitively normal men, a small region of the temporal lobe has about 10% fewer neurons Women More neurons are located in the temporal region where language, melodies & speech tones are understood

Gender differences in brain structure

Men CORPUS CALLUSOM The main bridge b/w the L & R brain contains a bundle of neurons that carry messages b/w the 2 brain hemispheres This part of the brain in men takes up less volume than a women does, which suggests less communication b/w the 2 brain hemispheres Women The bak portion of the callusom in women is bigger than in men, w/c may explain why women use both sides of their brains for language

Gender differences in brain structure

ANTERIOR COMMISSURE This collection of nerve cells, smaller than the corpus callusom, also connects the brains 2 hem The commissure in men is smaller than in women, even though mens brains are, on average, larger in size than womens brains The commissure in women is larger than in men, w/c may be a reason why their cerebral hemispheres seem to work together on tasks from language to emotional response

Gender differences in brain structure

Men BRAIN The R hem of HEMISPHERE mens brains The L side of the tends to be dominant brain controls language, & the R side of the brain is the seat of emotion Women Women tend to use their brains more holistically, calling on both hem simultaneously

Gender differences in brain structure

BRAIN SIZE Total brain size is approximately 3 lbs. Men Women Mens brains, on Have smaller average, are larger brains, on average, than womens than men because the anatomical structure of their entire bodies is smaller. However, have more neurons than men (an overall 11%) crammed into the cerebral cortex