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The

HEALTH traditions model is predicated on the concept of holistic health and describes what people do from a traditional perspective to maintain, protect, and restore health.
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THREE FOLD PHENOMENON - balance of all aspects of the person. 1. Body 2. Mind 3. Spirit

BODY include genetic inheritance, body chemistry, gender, age, nutrition, and physical condition. MIND include thoughts, memories, and knowledge of such emotional processes.

SPIRITUAL includes both positive and negative learned spiritual practices and teachings, dreams, symbols, stories, protecting forces, and metaphysical or native forces.

PHYSICAL MAINTAIN HEALTH Proper clothing Proper diet Exercise/rest

MENTAL Concentration Social and family support systems Hobbies Avoid certain people who can cause illness Family activities

SPIRITUAL Religious worship Prayer Meditation Religious customs Superstitions Wearing amulets and symbolic objects to prevent the Evil Eye or defray other sources of harm
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PROTECT HEALTH

Special foods and food combination Symbolic clothing

PHYSICAL
RESTORE HEALTH Homeopathic remedies Liniments Herbal teas Special foods Massage Acupuncture/ Moxibustion

MENTAL
Relaxation Exorcism Curanderos and other traditional healers Nerve teas

SPIRITUAL
Religious rituals, special prayers Meditation Traditional healings Exorcism

Magico-religious health belief Scientific or Biomedical health belief Holistic Health belief

may believe that illness is the result of being bad or opposing Gods will. Some cultures believe that MAGIC, SORCERER or WITCH, and EVIL SPIRIT can cause illness. not supported by empirical evidence EXAMPLE: A man who experiences gastric distress, headaches, and hypertension after being told that a spell has been placed on him may recover only if the spell is removed by the cultures healer.

Believe that life and life processes are controlled by physical and biochemical processes that can be manipulated by humans. The client with this view will believe that illness will caused GERMS, VIRUSES, BACTERIA or a breakdown of the human machine, the body.
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Holds that forces of nature must be maintained in BALANCE and HARMONY. Human life must be in harmony with the rest of nature. When harmony is disturbed, illness results.

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Used by NATIVE AMERICANS. Teaches the four aspects of the individuals nature: physical, mental, emotional, and the spiritual. 4 dimensions must be in balance to be healthy.

Holistic Health Belief

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Used in the Chinese culture Yin illness or a cold illness and Yang illness or a hot illness.

Holistic health belief

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Examples:

The mother who has just delivered a baby should be offered warm or hot foods and kept warm with blankets because childbirth is seen as a cold condition. Cooling the body to reduce the fever.

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FOLK MEDICINE is defined as those beliefs and practices relating to illness prevention and healing that derive from cultural traditions rather than from modern medicines scientific base.
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Many persons have special teas or cures such as (chicken soup) to treat colds, fevers, indigestion, and other common health problems. It is thought to be more humanistic than biomedical health care. More culturally based, so it is often more comfortable and less frightening for the client.

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is the basic unit of society. Cultural values can determine communication within the family group, the norm for family size, and the roles of specific members. The nurse need to identify who has the authority to make decisions in a clients family.

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CULTURAL GENDER ROLE BEHAVIOR

In some countries, men dominate and women have little status. Men from these countries may not accept instruction from a female nurse.

CULTURAL FAMILY VALUES

In some cultures, only the nuclear and extended family will want to visit for long periods and participate in care. Some are very reluctant to disclose family information to outsiders, including health care professionals.
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CULTURAL NAMING SYSTEMS

In some cultures (Japanese and Vietnamese), the family name comes first and the given name second. Other nomenclature may be used to delineate gender, child or adult status. In Japanese, they adress other adults by surname followed by san meaning Mr., Mrs., or Miss and kun for boys and chan for girls.

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EXAMPLE: Maurakami san In Central America, a woman who marries retains her fathers name and takes her husbands. EXAMPLE: Louisa Vicarrio de Gonzales
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Communication and culture are closely interconnected. Through communication, the culture is transmitted from one generation to the next. Verbal communication Non-verbal communication
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1.
2.

The most obvious cultural difference is in verbal communication: vocabulary, grammatical structure, voice qualities, intonation, rhythm, speed, pronunciation, and silence. becomes even more difficult when an interaction involves people who speak different languages.

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For the client whose language is not the same as that of the health care provider, an INTERPRETER may be necessary.

INTERPRETER

is an individual who mediates spoken or signed communication between people speaking different languages without adding, omitting, or distorting meaning or editorializing.
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Avoid slang words, medical terminology, and abbreviations. Augment spoken conversation with gestures or pictures Speak slowly, in a respectful manner and at a normal volume. Frequently validate the clients understanding of what is being communicated.

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Use of silence, touch, eye movement, facial expressions, and body posture. To communicate effectively with culturally diverse clients, the nurse needs to be aware of two aspects of non-verbal communication: 1. what non-verbal behavior mean to client 2. what specific non-verbal behaviors mean in the clients culture

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American culture- HANDSHAKE is a recognized form of greeting that conveys character and strength. European culture- a KISS in one or both cheeks. Some Asian cultures- only certain elders are permitted to touch the head of others, and children are never patted on the head.

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 African

American and Spanish- more likely to smile readily and use facial expression especially to strangers. Western cultures- direct eye contact is regarded as important, conveys self- confidence, honesty and openness. Lack of eye contact may be interpreted guilt, shyness and even a sign of mental illness.

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Communication is an essential part of establishing relationship with a client and his or her family.

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is a relative concept that includes the individual, the body, the surrounding environment, and objects within that environment. The relationship between the individuals own body and objects and persons within space is influenced by CULTURE. Example : In nomadic societies, space is not owned; it is occupied temporarily until the tribe moves on.

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Western culture- tend to be more territorial, as reflected in phrases such as This is my space or Get out of may space.

The

nurse need to explain to the client why there is a need to be close. Explain the procedure and await permission to continue.

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refers to an individuals focus on the past, the present, and the future. American focus on time tends to be directed to the future, emphasizing time and schedules.

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European

Americans often plan for next week, their vacation or their retirement. Navajo Indians do not have the word late and a Navajo mother may not become upset if her child does not achieve a specific developmental milestone.
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Nurses need to be aware of the meaning of time for clients. When caring for a present oriented client, it is important to avoid fixed schedules
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Staple foods : Asians is rice; Italians is pasta; Eastern Europeans is wheat. The way food is prepared and served is also related to culture practices

Example: In the United States, a traditional food served for the Thanksgiving holiday is stuffed turkey. In Southern States, stuffing may be made of cornbread. In New England, seasoned bread and chestnuts.

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Whether to breast-feed or bottle-feed infants and when to introduce solid foods. Food classified as hot foods may be used to treat illnesses that are classified as cold illnesses.

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Religious practice associated also with specific cultures also affects diet. Roman Catholics avoid meat as Ash Wednesday and Good Friday, and some Protestant faith prohibit meat, tea, coffee, or alcohol. Both Judaism and Islam prohibit pork or pork products. Buddhists, Hindus, and Sikhs are strict vegetarians.
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Assessing, Diagnosing, Planning, Implementing and Evaluating

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This model is based on a framework that integrates transcultural nursing, medical anthropology, and multicultural counseling. Nurses need are encouraged to integrate the following five constructs:
a. b. c. d. e.

Cultural awareness Cultural knowledge Cultural skills Cultural encounters Cultural desires
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HERITAGE ASSESSMENT TOOL - set of questions is to be used to describe a given clients-or your own- ethnic, cultural, and religious background. - the greater the number of positive responses, the greater the degree to which the person may identify with his or her traditional heritage.

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CONVEYING CULTURAL SENSITIVITY

- trust must be established before clients before clients can be expected to volunteer and share sensitive information. Some ways to do:
Always address clients, support people

and other health care personnel by their last names. When meeting a person for the first time, introduce yourself by your full name.
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Be authentic with people Use language that is culturally sensitive. Find out what the client thinks about his or her health problems, illness and treatments. Do not make any assumptions about the client, and always ask about anything you do not understand. Show respect for the clients values, beliefs, and practices. Show respect for the clients support people. Make a concerted effort to obtain the clients trust.

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It is essential to expand the understanding of the nursing practice to include cultural beliefs. This is accomplished through developing cultural sensitivity and a considering how a clients culture influences his or her responses to health conditions.
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A potential outcome is that the client can promote, maintain, and/or regain mutually desired and obtainable levels of health within the realities of their life circumstances.
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Implementation of cultural nursing care includes (a) Cultural preservation and maintenance (b) Cultural accommodation and negotiation. C. Preservation may involve the use of health care practices

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C. Accommodation requires expert communication skills, such as responding empathically, validating information, and effectively summarizing content. Negotiation is a collaborative process. It acknowledges that the nurse-client relationship is reciprocal.
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C.

Native American women value large body size and may be resistant to weight control. A Hispanic or Asian client may be unable to obtain hospice care Members of Jehovas witness faith do not accept blood transfusions Orthodox six do not cut their hair.

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Evaluating nursing care of clients that incorporates the concepts of heritage and ethnicity is performed in the same way as with any client.

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THANK YOU FOR LISTENING

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