2.1.3: Cultures

In this next section, we will explore some common cultures. Please note that this discussion of cultures is not comprehensive, meaning that there are many more cultures than those listed here. Remember also that the information here is to be used as a guide. Each person is unique. The information here is to provide some basic knowledge about the culture. It is also not intended to mean that just because a person is from one of the cultures listed here that they necessarily share the customs and beliefs described. It is important for the Home Health Aide/Personal Care Aide to get to know their patient, their beliefs, traditions, and values. It will make all the difference in their work with them and will lead to a positive working relationship! To learn more about various cultures and healthcare practices, please visit Dimensions of Culture: Cross-cultural communications for Healthcare Professionals at: http://www.dimensionsofculture.com/

African American

Africa is a continent that has dozens of different tribes, ethnic, and cultural groups, with hundreds of different languages and dialects spoken. A person may define themselves as “African” if they live in or come from one of the African countries.The term “black” is usually defined as people who descended from an African country (Carteret, 2011b).The term “African American” can be defined as ‘blacks” who are born in the United States but who descended from the African continent (Carteret). Depending on family and cultural values and beliefs, people may prefer one term over the other as a way to identify themselves. Learn the terms a patient chooses to use to define their identity. It is important to remember that people cannot be defined by their skin color, as there are a variety of skin tones, from light to dark of people who define themselves as African American (Carteret). Remember, a shared complexion does not necessarily mean there is a shared culture. It is important to find out the terms a patient uses to define their identity.

The African American family may include extended family and people outside of the biologic family, or “fictive kin” (Carteret, 2011b). Elders are highly respected, with the woman often taking on a matriarchal role, although decision making may be done by either the mother or father. Families tend to avoid placing loved ones in long-term care facilities and instead care for their elders or disabled family members in the home (Carteret).

African Americans often have ties to a religious community, with many having a Christian faith or following Islam (Carteret, 2011). Additionally, according to Carteret, during times of illness and impending death, many African Americans often turn to their faith. It is important to find out a patient‘s’ religious or spiritual beliefs and to honor these. Carteret also writes that it is often important for extended family and friends to be present to gather around their loved one during times of imminent death (death that is likely to happen soon) and that effort to inform and allow extended family to be present should be made.

Due to the historical mistreatment of African Americans in healthcare, they may be mistrustful of healthcare providers and reluctant to participate in treatment or share personal issues (Carteret, 2011b). It is very important to work on building trust while providing health care.

Self Check Activity \(\PageIndex{1}\)

True or False?

1. Many African Americans have a strong sense of family and spiritual faith. Those considered family may be outside of their family of origin and include close friends, or “fictive kin”.

2. You can use the term “black”, “African”, or “African American” to describe any person of color.

Solution

1. True

2. False

Feedback:

1. Many African Americans do have a strong sense of family and spiritual faith.

2. There are many terms that people may use to identify themselves. Remember, a shared complexion does not necessarily mean there is a shared culture. It is important to find out the terms a patient uses to define their identity.

Asians

The term Asian is a general term for many different cultures that originate in an Asian country. According to Carteret (2010a, 2010b), Asian cultures include people from various Asian countries and may be delineated by the specific Asian country from which they live or originate. People who consider themselves to be Asian may be Pacific Islanders (from Hawaii, Samoa, or Guam), Southeast Asians (from India, Vietnam, Thailand, Cambodia, Laos, Burmese, and Philippines), and East Asians (from China, Japan, and Korea). Each of these cultures has many different beliefs, norms, and traditions. It is important to not generalize from one Asian culture to the next. Get to know the patient and their beliefs and customs.

Generally speaking, Asians tend to be group and family oriented (Carteret, 2010a). This is known as a collectivist culture. Different from the typical individual oriented culture in the United States, decisions and actions are made as part of a group and with consideration to the effects on the group. Loyalty is very important to the family and family members’ behaviors are a reflection of the honor and respect shown to the family. Therefore, decisions are often made with the effects on the family in mind and it is important to take care not to disgrace oneself or one’s family (Carteret).

Self-control is also important; expression of intense emotion such as crying, yelling, pain, or grief may not be shown (Carteret, 2010a). Many people from Asian cultures may not be direct in conversation, and may see such directness as rude. Many Asians may smile when confused or embarrassed, which can be mistaken as a sign of pleasure or understanding (Carteret). Similarly, many Asians may also nod during conversation, which can also be mistaken as understanding during conversations about health care concerns and treatment. It is important to try to determine if a patient truly understands the situation. According to Carteret, Asian cultures typically take the context of the situation in mind. This means that they pay careful attention to nonverbal cues during conversation such as gestures, tone of voice, eye contact, and silence. It is important to remember to pay attention to the nonverbal cues you are using and to try to understand those that are being Conveyed (said) by a patient. Much of the meaning of what is being conveyed (said) can be found in the nonverbal cues rather than the verbal words in Asian patients.

Many Asians believe in fatalism, or the belief that nothing can be done about a situation or one’s healthcare; it is decided by fate or karma. This may make Asian patients and families appear to be “resigned to their situation” (Carteret, 2010a). It is important to take care when discussing a health care situation or disease in how it is presented. While in the United States we often look at healthcare in terms of fighting a disease, Asian patients may not look at seeking treatment in this way. There also may be many healthcare practices outside of what Western medicine considers treatment, which are unique to each Asian culture.

Many Asian cultures focus on the holistic treatment or treating both the body and mind, while Western medicine tends to only focus on treating the body. Herbal remedies and the use of acupuncture may be health care practices of many Asian patients (Carteret, 2010b). It is important if Home Health Aides/Personal Care Aides become of aware of the use of herbals and other medicines that they report these to their supervisor. While it is important to respect and honor cultural practices of patients, it is also important that the healthcare team knows which practices are being used. There are some herbs for example that interact with Western medications. Some Asian cultures also practice a technique called cupping, in which a glass or plastic cup is pressed against the skin, creating a vacuum in order to relieve the patient of pain and to treat respiratory diseases (Carteret. If Home Health Aides/Personal Care Aides become aware of areas on their patient’s body such as burns or circles, it is important to ask the patient, in a non-judgmental way to explain them and then they should discuss findings with their supervisor.

Self Check Activity \(\PageIndex{2}\)

True or False

1. When working with Asian patients, it is generally important to pay attention to nonverbal cues, such as nodding, smiling, tone of voice, and gestures during conversations. __________

2. Many Asian cultures are collectivist, meaning they consider how their individual decisions will impact their whole family, so health care decisions and treatments should be focused on the family as a whole. _______________

Solution

1. True

2. True

Feedback:

1. Many Asian people typically take the context of the situation in mind. This means that they pay careful attention to nonverbal cues during conversation such as gestures, tone of voice, eye contact, and silence. It is important to remember to pay attention to the nonverbal cues you are using as well as those being used by your patient in order to have the best understanding of the meaning behind what is being conveyed.

2. Generally, Asians tend to be group and family oriented which is known as belonging to a collectivist culture. Therefore, decisions and actions are made as part of a group and with consideration to the effects on the group. Honor and respect should be shown to the entire family.

Latinos

The term Latino means a person whose origins are from a Spanish-speaking country, such as: Caribbean, Mexico, South America, and Central America (Carteret, 2011a). Latinos often have a very deep sense of family connection, called familismo. These family members include extended members of the family and close friends whom they trust; they may be slow to trust outsiders (Carteret, 2010f; 2011a). Family members, including extended members of the family such as grandparents, aunts and uncles may be very involved in the healthcare of the patient, and want to be present to help make healthcare decisions (Carteret, 2010f). It is very important to include all members of the family during health care decision making and care provision. This will help the patient and family to trust the health care worker and be willing to work with them.

Latinos are traditionally very focused on relationships (Carteret, 2011a). As such, it is important for Home Health Aides/Personal Care Aides to take their time during the provision of care, demonstrate warmth, touch, concern, friendliness, and a sense of confidence. Latinos feel great respect for physicians and healthcare providers as they believe in the importance of respect, or respecto, so may not want to question health care providers (Carteret). This could result in not understanding healthcare treatment. Respect is very important for many Latinos. According to Carteret, Latinos may expect a “formal friendliness” from their healthcare providers. They may expect to be greeted and say goodbye with a handshake and “good morning/afternoon.”They may also prefer a more formal address, such as “Mr. or Mrs.” in conversation.The concept of hierarchy in a Latino family is another aspect that healthcare providers should be aware of to ensure they are demonstrating respect for the family.

In the presence of other family members or a husband or wife, all members should be greeted in such a way to demonstrate respect. This includes greeting family members as “Mr. or Mrs.” The oldest male of the family often has the greatest power of the family and decisions may be deferred to him (Carteret, 2011a). The concept of machismo means male Latinos are expected to be providers of the family and uphold the honor of their family. As such, female Latinos may defer decisions to their husbands or take on a more submissive role. Healthcare providers should be aware of this and ensure that healthcare decisions are also discussed with the head of the household.

Latinos may also have different concepts or health and healthcare practices from traditional healthcare practices. Latinos often believe that life is full of uncertainty and that there is not much they can do to alter the course of their life (Carteret, 2011a). This belief is called fatalism, which means there is little they can do to alter the course of their fate. This may result in delaying treatment or healthcare seeking behaviors.

Latinos may have many folk beliefs which influence their healthcare decisions and practices. Many Latinos may believe that people who suffer from physical illness do so because of an illness of emotional or spiritual origins (Carteret, 2010b). For example, some Latinos believe illness of a child may be caused by an evil eye or Mal de Ojo (Carteret). The belief is that someone who strongly admires and wants the child has placed a spell on the child, resulting in illness. It is common for parents to place an amulet, or a azabache on the child in the form of jewelry to protect them against Mal de Ojo (Carteret). Additionally, Carteret describes a practice common to Latinos where a folk healer may treat the child by passing an egg over the child and placing it under the child’s pillow at night; if the egg cooks, then the child had Mal de Ojo.

Self Check Activity \(\PageIndex{3}\)

True or False

1. For many Latinos, there is a strong sense of family, or familismo, in which health care decisions and treatments involve the entire family, including extended family members. _________

2. It is important for many Latinos that healthcare providers show respect, or respect and greet all members of the family at the start and end of healthcare encounters. _____________

Solution

1. True

2. True

Feedback:

1.Latinos often have a very deep sense of family connection, called familismo. Family may include extended members of the family and close friends whom they trust.

2. Due to the strong sense of family, it is to include all members of the family during health care decision making and care provision. This will help the patient and family to trust and be willing to work with the health care worker.

Middle East

Countries associated with the Middle East traditionally include: Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Palestine, Saudi Arabia, Syria, Turkey, and Yemen to name a few. People from the Middle East traditionally have a strong sense of affiliation with their family. Families and friends may be very close-knit and involved in the healthcare of the patient, with the elder member of the family expecting to be involved in health care decisions (Carteret, 2010c). Because of the close connection among those considered to be part of the patient’s close-knit circle, members of the family may have “doubt about the intentions of those outside their intimate circle” (Carteret). Healthcare providers may need to provide reassurance about having their family members’ needs taken care of. They must also take care to be cognizant (aware) of gender differences.

People of the Middle East may often prefer to have same-sex caregivers and have the eldest member of the family or the husband answer questions and make decisions for female patients (Carteret, 2010c). Additionally, according to Carteret, direct eye contact with members of the opposite sex is frowned upon. Middle Easterners may touch more frequently and tend to have a closer personal space during conversation than those from Western cultures (Carteret). However, take care to remember gender differences, as too-direct contact, for example between a male healthcare provider and a Middle Eastern female may be seen as a sign of sexual interest. As such, male Middle Easterners may have difficulties interacting with females who are in a position of authority, such as female physicians.

Middle Easterners generally value Western medicine but may have some folk beliefs such as illness being caused by the Evil Eye, or a person who is jealous, which causes the illness the patient is experiencing (Carteret, 2010c). Further, according to Carteret, Middle Easterners may also follow special diets and may not eat certain foods together at the same meal. Foods may be considered “hot” or “cold”. People of the Middle East may resist going to the hospital as it is seen as a place where people die (Carteret). They may also be concerned that their loved one will not be cared for after death according to religious customs. Mourning for the death of a loved one is often loud and with great emotion expressed, as this is a sign of respect (Carteret).

Self Check Activity \(\PageIndex{4}\)

True or False

1. When working with Middle Eastern patients, it is a good idea to check to see if there are gender preferences for whether the patient would prefer to have a male or female to provide their care. ______

2. It is not important to consider the family as part of the healthcare team when working with Middle Eastern patients. __________

Solution

1. True

2. False

Feedback:

1. True

2. False

Feedback:

1. People of the Middle East may often prefer to have same-sex caregivers. Direct eye contact with members of the opposite sex is often frowned upon. Health care workers should check with the family to determine gender preferences for caregivers.

2. People from the Middle East traditionally have a strong sense of affiliation with their family. Families and friends may be very close-knit and involved in the healthcare of the patient, with the elder member of the family expecting to be involved in health care decisions