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CULTURALCARE Guide

Cultural Conflicts

The following scenarios are composite situations that may be encountered in a variety of clinical settings. In order to prevent stereotyping, the heritage of the patient involved in the situation is not given here. Rather, the situations are presented in a generic fashion. The tools for assessment and process are then presented with a subsequent section on selected HEALTH traditions. At the end of the guide, each scenario is revisited and the possible “CULTURALCARE Conclusions” are presented. They serve to demonstrate how a given situation may, in fact, occur among people from many different ethnocultural backgrounds.

  1. A person who is bleeding refuses surgery when they are forced to remove what appears to be a piece of jewelry.
  2. A person is admitted to the emergency room with welts and large red circles on their back.
  3. A person who is being interviewed refuses to answer questions directly or to look the provider in the eye.
  4. An adult immunization clinic is held in a public building and the turnout for the program is minimal.
  5. A new mother does not want to hold or see her baby following the delivery.
  6. A person on a liquid diet refuses to eat the gelatin.
  7. A young patient refuses a blood transfusion and is supported by the family.
  8. A patient is given a supply of antibiotics in the emergency room to treat a respiratory infection and leaves the medication behind.
  9. A person is acutely ill and does not respond to the questions being asked.
  10. A person who is terminally ill is found to have a card hidden under the pillow.
  11. The family of a person who died refuses to leave the room.
  12. A patient who is 24-hours post–chest surgery does not request pain medication.

CULTURALCARE Considerations

This section of the guide contains practical guides: Heritage Assessment, CULTURALCARE Phenomena Affecting HEALTH, CULTURALCARE Etiquette, HEALTH Traditions Assessment Model, and HEALTH Traditions Assessment Guidelines for the community.

Heritage Assessment Tool

This set of questions can be used to investigate a given patient’s or your own ethnic, cultural, and religious heritage. It can help you to perform a heritage assessment to determine how deeply a given person identifies with a particular tradition. It is most useful in setting the stage for understanding a person’s HEALTH traditions. The greater the number of positive responses, the greater the person’s identification with a traditional heritage. The one exception to positive answers is the question about family name change. This question may be answered negatively.
  1. Where was your mother born?___________________________________________________
  2. Where was your father born?____________________________________________________
  3. Where were your grandparents born?
    1. Your mother’s mother?_____________________________________________________
    2. Your mother’s father?______________________________________________________
    3. Your father’s mother?______________________________________________________
    4. Your father’s father?_______________________________________________________
  4. How many brothers __________________ and sisters __________________ do you have?
  5. What setting did you grow up in? Urban __________________ Rural __________________ Suburban __________________
  6. What country did your parents grow up in?
    Father______________________________________________________________________
    Mother_____________________________________________________________________
  7. How old were you when you came to the United States?____________________________________            
  8. How old were your parents when they came to the United States?
    Mother_____________________________________________________________________
    Father______________________________________________________________________
  9. When you were growing up, who lived with you?
    ___________________________________________________________________________
  10. Have you maintained contact with
    1. Aunts, uncles, cousins?       (1) Yes _________    (2) No _________
    2. Brothers and sisters?            (1) Yes _________    (2) No _________
  11. Parents?                               (1) Yes _________    (2) No _________
    d.   Your own children?             (1) Yes _________    (2) No _________
  12. Did most of your aunts, uncles, cousins live near your home?
    (1) Yes _________    (2) No _________
  13. Approximately how often did you visit your family members who lived outside your home?
    (1) Daily _________    (2) Weekly _________    (3) Monthly _________
    (4) Once a year or less _________    (5) Never _________
  14. Was your original family name changed?
    (1) Yes _________    (2) No _________
    14. What is your religious preference?
    (1) Catholic _________    (2) Jewish _________
    (3) Protestant _________Denomination _______________________________
    (4) Other _________    (5) None _________
  15. s your spouse the same religion as you?
    (1) Yes _________    (2) No _________
  16. Is your spouse the same ethnic background as you?
    (1) Yes _________    (2) No _________
  17. What kind of school did you go to?
    (1) Public _________    (2) Private _________    (3) Parochial _________
  18. As an adult, do you live in a neighborhood where the neighbors are the same religion and ethnic background as yourself?
    (1) Yes _________    (2) No _________
  19. Do you belong to a religious institution?
    (1) Yes _________    (2) No _________
  20. Would you describe yourself as an active member?
    (1) Yes _________    (2) No _________
  21. How often do you attend your religious institution?
    (1) More than once a week _________    (2) Weekly _________
    (3) Monthly _________    (4) Special holidays only _________
    (5) Never _________
  22. Do you practice your religion in your home?
    (1) Yes _________    (2) No _________
    (If yes, please specify)
    (3) Praying _________    (4) Bible reading _________
    (5) Diet _________    (6) Celebrating religious holidays _________
  23. Do you prepare foods of your ethnic background?
    (1) Yes _________    (2) No _________
  24. Do you participate in ethnic activities?
    (1) Yes _________    (2) No _________
    (If yes, please specify)
    (3) Singing _________    (4) Holiday celebrations _________
    (5) Dancing _________    (6) Festivals _________
    (7) Costumes _________    (8) Other _________
  25. Are your friends from the same religious background as you?
    (1) Yes _________    (2) No _________
  26. Are your friends from the same ethnic background as you?
    (1) Yes _________    (2) No _________
  27. What is your native language?___________________________________________________
  28. Do you speak this language?
    (1) Prefer _________    (2) Occasionally _________    (3) Rarely _________
  29. Do you read your native language?
    (1) Yes _________    (2) No _________


CULTURALCARE Phenomena Affecting HEALTH

Giger and Davidhizar* have identified six cultural phenomena that vary among cultural groups. These are

  1. Environmental control—The ability of members of a particular cultural group to plan activities that control nature or direct environmental factors. Included are the complex systems of traditional health and illness beliefs, the practice of folk medicine, and the use of traditional healers. These play an extremely important role in the way clients respond to health-related experiences, including the ways in which they define health and illness and seek and use health-care resources and social supports.
  2. Biological variations—People from one cultural group differ biologically (physically and genetically) from members of other cultural groups:
    1. Body build and structure
    2. Skin color
    3. Enzymatic and genetic variations
    4. Susceptibility to disease
    5. Nutritional variations
  3. Social organization—The family unit, (nuclear, single-parent, or extended family) and the social group organizations (religious or ethnic) with which clients and families may identify.
  4. Communication—Communication differences are presented in many ways, including language differences, verbal and nonverbal behaviors, and silence.
  5. Space—Personal space and territoriality involves people’s behaviors and attitudes toward the space around themselves and are influenced by culture. The following terms indicate different types of space and relate to acceptable behaviors within these zones:
    1. Intimate zone: extends up to 1 1/2 feet.
    2. Personal distance: extends from 1 1/2 to 4 feet.
    3. Social distance: extends from 4 to 12 feet.
    4. Public distance: extends 12 feet or more.
  6. Time orientation—The viewing of the time in the present, past, or future varies among different cultural groups.
    1. Future-oriented: People are concerned with long-range goals and with health-care measures taken in the present to prevent the occurrence of illness in the future.
    2. Present-oriented: People are oriented more to the present than the future and may be late for appointments because they are less concerned about planning ahead to be on time.

Cultural Phenomena Affecting Health Care

 

African (Black) Americans

Asian/Pacific Islander Americans

American Indians Aleuts, and Eskimos

Hispanic Americans

European (White) Origin Americans

Nations of Origin

West coast (as slaves) of Africa
Many African countries
West Indian islands
Dominican Republic
Haiti
Jamaica

China, Japan, Hawaii, the Philippines, Vietnam, Asian India, Korea, Samoa, Guam, and the remaining Asian/Pacific islands

200 American Indian nations indigenous to North America
Aleuts, and Eskimos in Alaska

Hispanic countries
Spain, Cuba, Mexico, Central and South America
Puerto Rico

Germany, England, Italy, Ireland, Former Soviet Union, and all other European countries

Environmental Control

Traditional health and illness beliefs may continue to be observed by “traditional” people

Traditional health and illness beliefs may continue to be observed by “traditional” people

Traditional health and illness beliefs may continue to be observed by “traditional” people
Natural and magicoreligious folk medicine tradition
Traditional healer: medicine man or woman

Traditional health and illness beliefs may continue to be observed by “traditional” people
Folk medicine tradition
Traditional healers: curandero, espiritista, partera, señora

Primary reliance on “modern, Western” health-care delivery system
Remaining traditional health and illness beliefs and practices may be observed
Some remaining traditional folk medicine
Homeopathic medicine resurgent

Biological Variations

Sickle cell anemia
Hypertension
Cancer of the esophagus
Stomach cancer
Coccidioido-mycosis
Lactose intolerance

Hypertension
Liver cancer
Stomach cancer
Coccidioido-mycosis
Lactose intolerance
Thalassemia

Accidents
Heart disease
Cirrhosis of the liver
Diabetes mellitus

Diabetes mellitus
Parasites
Coccidioido-mycosis
Lactose intolerance

Breast cancer
Heart disease
Diabetes mellitus
Thalassemia

Social Organization

Family: many single-parent female-headed households
Large, extended family networks
Strong church affiliations within community
Community social organizations

Family: hierarchical structure, loyalty
Large, extended family networks
Devotion to tradition
Many religions, including Taoism, Buddhism, Islam, and Christianity
Community social organizations

Extremely family-oriented to both biological and extended families
Children are taught to respect traditions
Community social organizations

Nuclear families
Large, extended family networks
Compadrazzo (godparents)
Strong church affiliations within community
Community social organizations

Nuclear families
Extended families
Judeo-Christian religions
Community and social organizations

Communication

National languages
Dialect: Pidgin French, Spanish, Creole

National language preference
Dialects, written characters
Use of silence
Nonverbal and contextual cueing

Tribal languages
Use of silence and body language

Spanish or Portuguese are the primary languages

National languages
Many learned English rapidly as imigrants
Verbal, rather than nonverbal

Space

Close personal space

Noncontact people

Space very important and has no boundaries

Tactile relationships: touch, handshakes, embrace
Value physical presence

Noncontact people: aloof, distant
Southern countries: closer contact and touch

Time Orientation

Present over future

Present

Present

Present

Future over present

Adapted from: Spector, R. “Cultures, Ethnicity, and Nursing,” in Fundamentals of Nursing, 3rd ed, eds. Potter, P. and Perry, A. (St. Louis: Mosby, 1992), p. 101.


CULTURALCARE Etiquette

There are countless ways in which the etiquette essential to a satisfactory provider–patient encounter is breached. This table presents an overview of selected situations wherein etiquette can be modified to the needs of a patient.
Cultural Phenomena Affecting Etiquette


Time

Visiting

Inform patient when you are coming

 

Being on time

Avoid surprises
Explain your expectations about time
Ask patients from other regions and cultures what they expect

 

Taboo times

Be familiar with the times and meanings of patient’s ethnic and religious holidays

Space

Body language and distances

Know, from many perspectives, cultural and/or religious customs regarding contact and touch with others

Communication

Greetings

Know the proper forms of address for people from a given culture and the ways by which people welcome one another
Know when touch, such as an embrace or handshake, is expected and when physical contact is prohibited

 

Gestures

Gestures do not have universal meaning—what is acceptable to one cultural group is taboo with another

 

Smiling

Smiles may be indicative of friendliness to some, taboo to others

 

Eye contact

Avoiding eye contact may be a sign of respect

Social Organization

Holidays

Know what dates are important and why, whether or not to give gifts, what to wear to special events, what the customs and beliefs are

 

Special events

Know how the event is celebrated, meaning of colors used for gifts, expected rituals at home or religious services

 

•   Births

 

•   Weddings

 

•   Funerals

Biological Variations

Food customs

Know what can be eaten for certain events, what foods may be eaten together or are forbidden, what and how utensils are used

Environmental Control

Health practices and remedies

Know what the general health traditions are for a given patient and question observations for validity

HEALTH Traditions Assessment Model

People who identify with a traditional ethnocultural heritage may tend to define HEALTH and illness in a holistic way, and have health beliefs and practices that differ from those of the Western, or modern, health-care delivery system.
Imagine holistic HEALTH as a three-dimensional phenomenon that encompasses the following: body (the physical self), mind (feelings, attitudes, and behavior), and spirit (the I who I am).
HEALTH, in the traditional sense, is the state of balance within the body, mind, and spirit, and with the family, community, and the forces of the natural world.
Illness is the opposite.
Many traditional HEALTH beliefs and practices exist today among people who know and live by the traditions of their given ethnocultural heritage.
HEALTH, in this traditional context, has three dimensions each of which has three aspects, making a total of nine interrelated facets.

  1. Maintaining HEALTH
    1. Physical—Are there special clothes one must wear; foods one must eat, not eat, or combinations to avoid; exercises one must do?
    2. Mental—Are there special sources of entertainment; games or other ways of concentrating; traditional “rules of behavior”?
    3. Spiritual—Are there special religious customs; prayers; meditations?
  2. 2.   Protecting HEALTH
    1. Physical—Are there special foods that must be eaten after certain life events, such as childbirth; dietary taboos that must be adhered to; symbolic clothes that must be worn?
    2. Mental—Are there special people who must be avoided; rituals for self-protection; familial roles?
    3. Spiritual—Are there special religious customs; superstitions; amulets; oils or waters?
  3. Restoring HEALTH
    1. Physical—Are there special folk remedies; liniments; procedures, such as cupping, acupuncture, and moxibustion?
    2. Mental—Are there special healers, such as curanderos, available; rituals; folk medicines?
    3. Spiritual—Are there special rituals and prayers; meditations; healers?
Traditional methods of maintaining, protecting, and restoring HEALTH require the knowledge and understanding of HEALTH-related resources from within a given person’s ethnoreligious cultural heritage and community. These methods may be used instead of or along with modern methods of health care. They are not alternative methods of health care in the sense that they are methods that are an integral part of a person’s given heritage.

HEALTH Traditions Assessment Guidelines

A given patient’s interrelated HEALTH traditions can be assessed in countless ways. The following grids contain suggested questions and are parallel to the nine interrelated facets of HEALTH (the physical, mental, and spiritual aspects of the personal and communal dimensions of maintaining, protecting and restoring HEALTH that are a theme throughout Cultural Diversity in Health and Illness and this assessment guide.

Assessment Guide for Personal Methods to Maintain, Protect, and Restore Health

 

Physical

Mental

Spiritual

Maintain HEALTH

Are there special clothes you must wear at certain times of the day, week, year?
Are there special foods you must eat at certain times?
Do you have any dietary restrictions?
Are there any foods that you cannot eat?

What do you do for activities, such as reading, sports, games?
Do you have hobbies?
Do you visit family often?
Do you visit friends often?

Do you practice your religions and attend church or other communal activities?
Do you pray or meditate?
Do you observe religious customs?
Do you belong to fraternal organizations?

Protect HEALTH

Are there foods that you cannot eat together?
Are there special foods that you must eat?
Are there any types of clothing that you are not allowed to wear?

Are there people or situations that you have been taught to avoid?
Do you take extraordinary precautions under certain circumstances?
Do you take time for yourself??

Do you observe religious customs?
Do you wear any amulets or hang them in your home?
Do you have any practices, such as always opening the window when you sleep?
Do you have any other practices to protect yourself from “harm”?

Restore HEALTH

What kinds of medicines do you take before you see a doctor or nurse?
Are there herbs that you take?
Are there special treatments that you use?

Do you know of any specific practices your mother or grandmother may use to relax?
Do you know how big problems can be cared for in your community?
Do you drink special teas to help you unwind or relax?
Do you know of any healers?

Do you know of any religious rituals that help to restore health?
Do you meditate?
Did you ever go to a healing service?
Do you know about exorcism?

Community HEALTH Traditions Assessment Guidelines

HEALTH traditions come alive the moment one leaves institutional confines and goes into the community. An in-depth community assessment of an ethnoreligious community alerts you to the vast resources that exist within traditional communities and that may be tapped. The following outline serves as a community assessment guide:

Demographic Data

•     Total population size of entire city or town
•     Breakdown by areas—residential concentrations
•     Breakdown by ages
•     Other breakdowns

•     Nations of origin of residents of the location and the target neighborhood

Traditional HEALTH Beliefs

•     Definition of HEALTH
•     Definition of illness
•     Overall HEALTH status

Causes of Illness

•     Poor eating habits
•     Wrong food combinations
•     Viruses, bacteria, other organisms
•     Punishment from God
•     The evil eye
•     Hexes, spells, or envy
•     Witchcraft
•     Environmental changes
•     Exposure to drafts
•     Over- or underwork
•     Grief and loss
Methods of Maintaining HEALTH
Methods of Protecting HEALTH
Methods of Restoring HEALTH—Home Remedies
Visits and Use of M.D. or Other Health-Care Resources
Health-Care Resources, Such As Neighborhood Health Centers
Anyone Else Within Community Who Looks After People, Such As Traditional Healers
Child-Bearing Beliefs and Practices
Child-Rearing Beliefs and Practices
Rituals and Beliefs Surrounding Death and Dying

Walk through the community and observe the traditional grocery stores, pharmacies, markets, jewelry stores, beauty parlors, morticians, and churches. If possible, visit several places, purchase remedies, eat in a restaurant, and

Assessment Guide for Communal Methods and Resources for Maintaining, Protecting, and Restoring Health

 

Physical

Mental

Spiritual

Maintain HEALTH

Where are people able to purchase special clothing?
Where are specific foods purchased?
What types of health education are a part of the person’s culture and who teaches this information?
Where is the information obtained?

What are examples of culture-specific books, games, and other activities for this given client?
Where are books, games, and other forms of culture-specific materials obtained?
What are culture-specific rules for this patient, such as conversation, eye contact?

Are there resources to meet the patient’s identified spiritual needs?
How are the people and places accessed?

Protect HEALTH

Where are special clothes obtained?
What are some examples of symbolic clothing a person may obtain?

Who within the patient’s family and community teaches the cultural rules?
Are there rules about avoiding people or places?
Are there special activities that must be observed?

Who teaches the spiritual practices?
Where can the patient purchase special amulets and other symbolic objects?
Are they costly?
Are they readily available?

Restore HEALTH

Where are various remedies purchased?
Are people able to grow herbs and other remedies in their own homes?
Where are other traditional services obtained?
Who are the traditional healers within the patient community and where do they practice?

Who are the traditional people within the community that the person may seek care and advice from?
Are there culture-specific activities, such as story telling that may be available to the patient?
Where are the ingredients for special “teas” purchased?

Are there traditional healers in the community?
Who are they and how are they accessed?

Selected Health Traditions


Nation

Maintain HEALTH

Protect HEALTH

Restore HEALTH

Austria

Soups and sleeping
Dress warmly and wear shoes

Use Schweden-bitter (herb extract)
Promote sweating

Chest cold: Scoop inside of a black radish, fill the cavity with rock candy and bake it. Then drink the contents.
Ear aches: Take a white sock and put heated salt inside of it and place it on the ear.
Fever: Wrap wet towel around body.
Cough: Melt sugar and crystallize with onion juice.

Bangladesh

Eat fruits and rice

Eat a special plant from the rain forest

Use herbs

Bolivia

Sleep, eat, and drink in moderation

Walk

Use cupping to improve circulation

Brazil

Take Cachaca
Cook and clean all day

Drink herbal teas
Eat chicken soup

Drink herbal teas
Eat herbs

China

Always clean the floor
Use Chinese herbs

Drink ginger tea to prevent the flu

Cough: Scratch the back with a coin
Drink herbal teas
Diarrhea: Drink a burned rice tea

Colombia

Drink agua de panela con limon
Eat garlic for general health
Eat chicken and rice

Use botanica (herbal plants)

Cold: Prepare onions and oil by cooking until pulp is soft, strain, and eat with honey
Baby’s colic: Prepare star anise tea
Nerves: Drink tilo
Cramps: Cook onion and place on stomach
Visit traditional healers

Croatia

Eat organically grown food, goat’s milk, fish from the Adriatic Sea

Get plenty of fresh air and exercise

Broken bones: Place a dead animal on the skin
Upset stomach: Drink chamomile tea
Ear aches: Place hot oil on cotton ball in the ear

Cuba

Drink carrot juice and eat fruits, vegetables, garlic, tea soups, and stews

Dress warmly

Sore throat: Drink olive oil and salt, or a tea of boiled water with lemon rind for 10 minutes then put in cup with regular tea bag and juice of lemon, add honey to sweeten
Use pig skins as bandages to cure cuts
Visit traditional healers (santero)

Dominican Republic

Use oils or herb teas

Keep the sick inside the house
Get a lot of rest
Keep out of cold rain

Use plants, oils, and roots for homemade medicines
Cover a person with a fever with a heavy blanket for two to three hours until he or she sweats

Ecuador

Eat healthful food; drink teas

Drink teas
Wear amulets

Drink teas

England

Take cod liver oil daily

Get lots of fresh air
Wrap up warmly
Drink brown ale after cleaning a sick room to prevent catching the disease

Fever: Drink mint or chamomile tea
Cough and congestion: Put formaldehyde crystals in a plastic bag and place on the chest
Mumps: Apply hot mustard poultice
Nosebleed: Put a cold key down your back
General illness: Feed bread cubes in a warm sweet milk (pobs)

Ethiopia

Make sure food is on the table for everyone

Give people water blessed by the spirit (church) to drink

Pray

France

Eat a big lunch with different foods
Drink drinks with herbs
Drink soup
Eat chocolate
Take cod liver oil
Eat bread and butter
Put hot stones under the bed
Put iron nails in water

Take cod liver oil (oil of fish liver)

General illness: Drink Daliborng water
Cuts and bruises: Put castor oil on right away to prevent pain and swelling

Germany

Eat meatball soup, lots of vegetables, and good food
Every day before going to bed eat an apple
Take cod liver oil
Get fresh air, and work hard

Take castor oil daily
Dress warmly
Wrap salted herring and wear it around your neck
Drink boneset tea daily

Colds: Apply mustard plaster
Visit neighborhood pow-wow doctors
Worms: Eat hot garlic milk with honey
Any illness: Eat chicken soup
Cold: Place a cut onion next to your bed while sleeping to help breathing

Greece

Eat good food
Drink chamomile tea
Wear a wool undershirt
Never go out of house after bath

Eat 1 tablespoon of honey each day during the cold months to prevent colds
Keep warm
Wear amulets containing flowers from the Epitafio on Holy Friday
Pray to God

Stomach ailments: Drink mountain tea (mint tea with honey)
Pray
Colds and pneumonia: Use cupping (cotton inserted in a glass and lit with a match and left on the back)
Ear aches: Warm olive oil and place it in the ear

Haiti

Eat well
Eat fresh foods

Drink tea every day made with sorosi to increase appetite

Fever: Mix castor oil, alcohol, and shallot. Heat the mixture, rub together in hand, and rub all over the body

India

Eat vegetables
Eat healthful foods and exercise

Use black pepper and licorice

Indigestion: Drink cumin water
Upset stomach: Drink buttermilk and fenugreek
Sore throat: Drink tumeric in hot milk

Ireland

Eat lots of potatoes and cabbage
Wear warm clothing
Keep clean
Get fresh air, and work hard
Sleep with the window open a crack

In spring time take nettles (wild), boil them down, and then drink it
Eat porridge at night before going to bed
Pray
Do not go to bed with wet hair
Drink nettle soup to clear the blood
Put camphor on a cloth and wear around neck

Drink plenty of tea and Guiness (ale)
Cold: Eat a whole raw onion and have a shot of whiskey
“Wind,” (flatulance): Face rear end to the fire
Boils and cuts: Wrap hot bread, sugar, soap in linen cloth and place it on the wound to prevent infection
Cold or flu: Apply poultices and molasses
Fever: Tie onions to wrists or dirty sock around the neck

Italy

Love each other
Eat chicken soup
Wear and eat garlic
Drink a glass of wine a day
Wear a camphor bag around the neck
Eat fresh fruit and vegetables every day
Get lots of sleep

Children should wear a pouch with raw garlic around neck to keep unhealthy children away
“Spring cleaning”—Drink bitter greens boiled in water

Cold and cough: Put warm to hot red brick wrapped in wool cloth on chest
Inhale very hot water with turpentine, or drink boiled wine with apples
Get rid of the evil eye or to cast out any evil spirits: Drink cod liver oil
Colic: Drink fennel seed tea
Pray to God
Upset stomach: Drink water mixed with sugar and bay leaf

Jamaica

Eat a lot of tropical fruits, especially mangoes
Get a lot of exercise in the form of chores
Take weekly cathartics to wash out the system and drink cerasee tea (each Sunday)

Drink different kinds of herb and bush teas
Get plenty of rest
Drink whole milk and beef soup, and eat fresh fruit and vegetables

Take medicine in the form of herbal bushes
Pray to the Lord for help
Back pain: Use a poultice
Stomach problems: Drink dandelion and ginger teas

Japan

Children: Every morning (even in winter) massage his or her naked body to keep healthy

Gargle with salt water
Sleep well, eat good things, and exercise

Keep body warm with blanket and sleep
Cure asthma attacks: yaeto usually burned on upper back and shoulders
Upset stomach: Drink green tea

Lithuania

Eat fresh fruits and vegetables
Take herbal enemas

Eat good food, get plenty of rest

Apply mustard plasters
Colds and stomach aches: Drink brandy

Mexico

Eat eggs and bread
Sleep and drink tea

Use herbs and amulets

Use herbs, and visit traditional healers

Netherlands

Practice cleanliness
Eat pancakes
Eat cooked vegetables

Make sure to get up on the right foot
Eat a lot of fruit
Eat chicken soup

Headache: Mop the floor with ammonia
Eat soft-boiled eggs

Norway

Eat fruit and vegetables

Wear coats and pants

Eat soup and drink hot chocolate

Pakistan

Take lemon in summer to beat the heat
Eat chicken soup in the winter

Eat garlic to prevent colds in the winter

Headache: Drink green tea
Gas in stomach: Drink ginger

Philippines

Pray
Eat healthful food, such as vegetables, meat, chicken, and fruits and have excellent hygiene

Eat pigeon soup
After working in the fields, soak feet in salted water
Avoid too much sun or rain

Eat chicken soup
Painful joints: Pound ginger mix with coconut oil and massage
Stomach ache: Toast uncooked rice until brown, add water, mix, and drink the fluid
Wounds: Boil guava leaves and drink the fluid, or grind guava leaves and apply to the wound to cure fresh wound faster
Take herbal medicines

Poland

Eat chicken soup
Tie garlic around neck
Eat well (fat)
Drink tea with honey or cinnamon
Drink tea from Camile tree flowers
Practice cleanliness

Dress warmly
Eat broth
Use herbal tonics
Eat garlic

Practice blood letting using leeches
Colds: Eat chicken soup, drink hot tea, apply mustard plasters, hot cups, compresses; drink raspberry juice
Stomach problems: Drink mint tea

Prussia

Drink herbal teas
Eat plantain leaves
Drink tea with honey and ground ambgor every day
Use feverfew and mint

Wear Yiddish amulets and keep good luck coins

To draw out infection: Apply pitch from pine trees

Romania

Saturday night bath for all children in the same water
Eat a balanced diet
Eat chicken soup
Eat mush and drink fresh milk

Eat garlic daily

Cold or flu: Eat chicken soup
To purify blood: Eat garlic
Constipation: Eat yogurt and herbs
Warts: Apply poultice of chicken skin and mustard

Russia

Eat chicken soup
Keep warm
Eat lots of vegetables
Take cod liver oil
Eat raw garlic and onions

Wear garlic bags around the neck
Children wear camphor enclosed in a cloth necklace
Wear dry socks
Keep the feet warm and the head covered

Colds and flu: Use cupping
Colds and sore throat: Drink milk with butter; or apply a mustard plaster using dry mustard in a gauze bag and dipping into water and placing on chest
Sore throat: Drink guggle muggle (a drink of hot milk, honey [or sugar] and butter) or boil together 1 jigger of wine or brandy, juice of 1 lemon, and 1 tbs. of honey. Drink
Stye: Rub eye with wedding ring and spit three times

Slovakia

Eat chicken soup
Wash hands
Eat cabbage soup
Eat prune desserts to keep in balance
Eat garlic and sauerkraut (also juice from it) especially in winter
Drink herbal teas (chamomile for general health)

Get lots of sleep and exercise
Eat garlic
Get fresh air
Eat a lot of vegetables
Keep dry and warm

Cold: Drink tea with honey and lemon
Pray (novenas—nine days of praying)
Infections: Epson salts in bath water
Sore throat: Drink hot milk with squeezed garlic in it plus 2 teaspoons of honey
Heavy cough, pain in chest: Heat fat in a small pot, apply to a cloth and put on chest until it is covered with a slight film of fat. Cover with plastic (to keep it warm) and blend into towel and try to sleep with it overnight
Indigestion: Eat garlic soup

Thailand

Take care of children

Eat healthful foods

Use herbs, plants

Turkey

Eat a cup of yogurt a day

Drink hot milk with egg yolk and sugar
Keep your feet warm and head cool
Don’t worry too much

Insect bites: Cover with mud mixed with urine
Sprains: Apply garlic and raisin poultice to the area
Toothache: Drink brandy
Minor illness: Boil mint with lemon and drink
Common cold: Drink linden flower tea
Blunt injuries (minor): Cover with dough and hammered meat
Stye: Apply garlic

Ukraine

Eat chicken soup
Drink vodka

Eat healthful food
Bundle up in cold weather
Drink vodka

Coughs: Use cupping
Fever: Apply mustard packs
Constipation: Use enemas
Cold (stuffy nose): Wrap boiled potatoes in a towel, hold on nose, also mix honey and water as nose drops
Drink vodka

Venezuela

 

Use homeopathic medicine

Upset stomach: Drink hot milk with butter

Vietnam

Eat well
Eat soup and drink tea

Use massage
Take steambaths
Apply tiger oil

Use Chinese medicine

CULTURALCARE Guide*

The following guidelines will help you understand your patients better and allow you to provide the needed help.

Preparing

Enhancing Communication
Promoting Positive Change

CULTURALCARE Conclusions

Each of the cases presented in the beginning of this guide book can be understood if viewed through a lens of CULTURALCARE. Initially, the patient in each scene must be assessed with the Heritage Assessment tool. Once the given patient’s ethnocultural history is learned and the degree to which this person identifies with the given tradition detected, emphasis must be placed on discovering the role that the given heritage plays in the situation. Each situation has specific reasons for occurring within a cultural context. The text, Cultural Diversity in Health and Illness, 5th ed., provides a much deeper theoretical background relevant to each of the situations. A summary is presented here.
  1. A person who is bleeding refuses surgery when they are forced to remove what appears to be a piece of jewelry.
    This person may be from an ethnocultural tradition where amulets are worn and the removal of the amulet may precede certain death. The amulet is believed to protect the person from external evils and the person may be reluctant to remove it for this reason. The person may be from an African, Hispanic, Asian, or European heritage.
  2. A person is admitted to the emergency room with welts and large red circles on their back.
    The person may come from an ethnocultural tradition where coining or cupping are used to treat many maladies, especially respiratory infections. These traditional practices include people from Asian and Eastern European heritages.
  3. A person who is being interviewed refuses to answer questions directly or to look the provider in the eye.
    The person may come from an ethnocultural tradition that places a taboo on interviews where the recording of answers is taboo and/or eye contact with strangers is prohibited. The heritages may include, but are not limited to, American Indian, African American, and Moslem.
  4. An adult immunization clinic is held in a public building and the turnout for the program is minimal.
    The person may come from an ethnocultural tradition wherein it is believed that immunization is not necessary for adults, especially the elderly. Many believe that since they were not immunized as children, it is not necessary now. Others believe that diet, amulets, and other practices serve to protect their HEALTH. This phenomena may be observed among people from all heritages.
  5. A new mother does not want to hold or see her baby following the delivery.
    The mother may come from an ethnocultural tradition where she has been socialized to believe that the baby must not be bonded with until it is a certain age, as it is vulnerable to outside evil forces. Many rituals of a religious or ethnocultural nature must be observed until the baby is seen to be free from a state of taboo and then bonding is permissible. This may be observed among people from Middle Eastern countries. Also, it may be observed that the mother, or grandmother, may place a red ribbon on the baby.
  6. A person on a liquid diet refuses to eat the gelatin.
    The person may come from an ethnocultural tradition that prohibits the eating of pig and/or animal products and gelatin is made from pig bones, unless specified as “kosher.” Jews and Muslims who follow the kosher diet may reject this food.
  7. A young patient refuses a blood transfusion and is supported by the family.
    The person may come from an ethnocultural tradition that prohibits the use of blood. This is especially seen when caring for Jehovah’s Witnesses, but other religions also prohibit the use of blood.
  8. A patient is given a supply of antibiotics in the emergency room to treat a respiratory infection and leaves the medication behind.
    The person may come from an ethnocultural tradition that rejects the use of Western medications. The person may elect to use traditional medications and seek the services of a traditional herbalist. This is observed among Hispanics and Asian Americans.
  9. A person is acutely ill and does not respond to the questions being asked.
    The person may come from an ethnocultural tradition that views the answering of direct questions to be taboo. The given person may prefer to answer questions that are asked indirectly and where metaphors are used as statements. This practice is found among American Indians.
  10. A person who is terminally ill is found to have a card hidden under the pillow.
    The person may come from an ethnocultural tradition that holds beliefs in healing. A patient I once cared for had hidden a prayer card for St. Peregrine, the patron saint of cancer sufferers, under her pillow and stated that she felt that this was more comforting than any words someone could offer her.
  11. The family of a person who died refuses to leave the room.
    The family of the recently deceased person may come from an ethnocultural tradition that believes that the soul of the person must be protected and the body must be ritually cared for by members of the family and/or religious community.
  12. A patient who is 24-hours post–chest surgery does not request pain medication.
    The person may come from an ethnocultural tradition that believe in “saving face” and that to complain of pain is taboo. This belief is particularly common among Chinese people.
Needless to say, even with these brief scenarios and explanations there is the danger of stereotyping. However, the situations are real—they occurred within the scope of my own practice and experiences. When situations such as these occur, the most important aspect of care is to have the “cultural” antenna sharp and to question the patient, the family, and/or community people to determine the ethos of the patient’s cultural beliefs and practices. In this way, a proper way can be found to avoid harming the patient and holding respect for the patient’s cultural traditions.

Selected CULTURALCARE Terms

CULTURALCAREa concept that describes professional health care that is culturally sensitive, culturally appropriate, and culturally competent.

Culturally appropriate—implies that the health-care provider applies the underlying background knowledge that must be possessed to provide a given patient with the best possible health care.

Culturally competent—implies that within the delivered care the health-care provider understands and attends to the total context of the patient’s situation including awareness of immigration, stress factors, and cultural differences.

Culturally sensitive—implies that the health-care providers possess some basic knowledge of and constructive attitudes towards the diverse cultural groups found in the setting in which they are practicing.

Emerging Majority—People of color—Black; Asian or Pacific Islander; American Indian, Eskimo, or Aleut; and Hispanic origin, who are expected to comprise a majority of the American population by the year 2020.

HEALTHthe balance of the person, both within one’s being—physical, mental, and spiritual—and in the outside environment—natural, familial and communal, and metaphysical.

HEALTH maintenance—the traditional beliefs and practices, such as daily health-related activities, diet, exercise, rest, and clothing, used to maintain HEALTH.


HEALTH protection—the traditional beliefs and practices about what should be done on special occasions or on an ongoing basis for HEALTH protection, such as food taboos and wearing amulets.

HEALTH restoration—the traditional beliefs and practices concerning the activities, such as the use of folk remedies and healers, that must be used to restore HEALTH.




Sample Grid for Cultural Health Assessment

 

Physical

Mental

Spiritual

Maintain HEALTH

 

 

 

Protect HEALTH

 

 

 

Restore HEALTH

 

 

 

*Giger, J.N. and Davidhizar, R.E. Transcultural Nursing Assessment and Intervention, 2nd ed. St. Louis: Mosby, 1995, pp. 19, 43, 61, 89, 113, and 127.

*From: Schilling, B. and Brannon, E. Cross-Cultural Counseling–A Guide for Nutrition and Health Counselors. Alexandria, VA: (United States Department of Agriculture, United States Department of Health and Human Services, Nutrition and Technical Services Division, September, 1986), p. 19. Reprinted with permission






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