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8/10/2019 TUGAS KELOMPOK 1A.

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beliefs, and practices that differ from those of Anglo-Americans (U.S. Caucasians who trace

their ancestry to the United Kingdom and Western Europe).

TUGAS KELOMPOK IV :

MINORITYThe term minority is used when referring to groups of people who differ from the majority

in terms of cultural characteristics such as language, physical characteristics like skin color,

or both. Minority does not necessarily imply that there are fewer group members in

comparison with others in the society. Rather, it refers to the groups status in regard to

power and control. For example, men of European ancestry are the current majority in the

United States. Slightly more women than men are in the United States, yet women are

considered a minority. By the year 2020, the number of Latinos and Asian Americans living

in the United States is expected to triple, and the number of African Americans will double

(Andrews, 1999). Until these groups acquire more political and economic power in society,they will continue to be classified as minorities.

TUGAS KELOMPOK V :

ETHNICITYEthnicity (bond or kinship a person feels with his or her country of birth or place of ancestral

origin) may exist regardless of whether or not a person has ever lived outside the United

States. Pride in ones ethnicity is demonstrated by valuing certain physical characteristics,giving children ethnic names, wearing unique items of clothing, appreciating folk music and

dance, and eating native dishes (Fig. 6-1). Because cultural characteristics and ethnic pride

represent the norm in a homogeneous group, they tend to go unnoticed. When two or more

cultural groups mix, however, as often happens at the borders of various countries or

through the process of immigration, unique differences become more obvious. One or both

groups may experience cultural shock (bewilderment over behavior that is culturally

atypical). Consequently many ethnic groups have been victimized as a result of bigotry

based on stereotypical assumptions and ethnocentrism.

TUGAS KELOMPOK VI :

StereotypingStereotypes (fixed attitudes about all people who share a common characteristic) develop

with regard to age, gender, race, sexual preference, or ethnicity. Because stereotypes are

preconceived ideas usually unsupported by facts, they tend to be neither real nor accurate.

In fact, they can be dangerous because they interfere with accepting others as unique

individuals.

Generalizing

Generalization (supposition that a person shares cultural characteristics with others of asimilar background) is different than stereotyping. Stereotyping prevents seeing and


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treating another person as unique, whereas generalizing suggests possible commonalities

that may or may not be individually valid. Assuming that all people who affiliate themselves

with a particular group behave alike or hold the same beliefs is always incorrect. Diversity

exists even within cultural groups. A generalization provides a springboard from which to

explore a persons individuality. For example, when a nurse is assigned to care for a

terminally ill client whose last name is Vasquez, the nurse may assume that the client is

Roman Catholic because Catholicism is the religion of most Latinos. Before contacting a

priest to assist with the clients spiritual needs, however, the nurse understands that the

generalization concerning religion may not be accurate. A culturally sensitive nurse strives

to obtain information that confirms or contradicts the original generalization.

TUGAS KELOMPOK VII :

Ethnocentrism

Ethnocentrism (belief that ones own ethnicity is superior to all others) also interferes withintercultural relationships. Ethnocentrism is manifested by treating anyone different as

deviant and undesirable. This form of cultural intolerance was the basis for the Holocaust

during which the Nazis attempted to carry out genocide, the planned extinction of an entire

ethnic group (in this case European Jews). Ethnocentrism continues to play a role in the

ethnic rivalries between Bosnians and Serbs in Eastern Europe, Arabs and Jews in the Middle

East, Tutsis and Huntas in West Africa, and other regions where culturally diverse groups

live in close proximity. Similar conflicts also occur among U.S. ethnic groups.

TUGAS KELOMPOK VIII :

ANGLO-AMERICAN CULTURE AND U.S. SUBCULTURESThe U.S. culture can be described as Anglicized, or English-based, because it evolved

primarily from its early English settlers. Box 6-1 provides an overview of some common

characteristics of U.S. culture. To suggest that everyone who lives in the United States

embraces the totality of its culture, however, would be foolhardy. Although it is a gross

oversimplification, four major subcultures (unique cultural groups that coexist within the

dominant culture) exist in the United States. In addition to Anglo-Americans, there are

African Americans, Latinos, Asian Americans, and Native Americans (Table 6-2). The term

African Americans (those whose ancestral origin is Africa) is used here instead of Black

Americans to avoid any association based only on skin color. Latinos (those who trace their

ethnic origin to Latin or South America) are sometimes referred to as Hispanics, a term

coined by the U.S. Census Bureau, or Chicanos when speaking of people from Mexico.

Asian Americans (those who come from China, Japan, Korea, the Philippines, Thailand,

Cambodia, Laos, and Vietnam) make up the third subculture. Native Americans (Indian

nations found in North America including the Eskimos and Aleuts) include approximately 2.3

million American Indians and Alaskan Natives belonging to 545 federally recognized tribes in

the United States (U.S. National Library of Medicine, 1999). Although Anglo-American

culture predominates in the United States, those of African, Asian, Hispanic, and Arabic

descent outnumber those who trace their ancestry to the United Kingdom and Western

Europe. As the population becomes more diverse, the need for transcultural nursing is

becoming increasingly urgent.


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TUGAS KELOMPOK IX :

BOX 6-1Examples of U.S. Cultural Characteristics

a. English is the language of communication.b. The pronunciation or meaning of some words varies according to regions within the United States.c. The customary greeting is a handshake.d. A distance of 4 to 12 feet is customary when interacting with strangers or doing business (Giger and Davidhizar,

1995).e. In casual situations, it is acceptable for women as well as men to wear pants; blue jeans are a common mode of

dress.f. Most Americans are Christians.g. Sunday is recognized as the Sabbath.h. Government is expected to remain separate from religion.i. Guilt or innocence for alleged crimes is decided by a jury of ones peers.j. Selection of a marriage partner is an individuals choice.k. Legally, men and women are equals.

l. Marriage is monogamous (only one spouse); fidelity is expected.m. Divorce and subsequent remarriages are common.n. Parents are responsible for their minor children.o. Aging adults live separately from their children.p. Status is related to occupation, wealth, and education.q. Common beliefs are that everyone has the potential for success and that hard work leads to prosperity.r. Daily bathing and use of a deodorant are standard hygiene practices.s. Anglo-American women shave the hair from their legs and underarms; most men shave their faces daily.t. Licensed practitioners provide health care.u. Drugs and surgery are the traditional forms of medical treatment.v. Americans tend to value technology and equate it with quality.w. As a whole, Americans are time oriented and, therefore, rigidly schedule their activities according to clock hours.

x. Forks, knives, and spoons are used, except when eating fast foods, for which the fingers are appropriate.

TUGAS KELOMPOK X :

TRANSCULTURAL NURSINGMadeline Leininger coined the term transcultural nursing (providing nursing care within the

context of anothers culture) in the 1970s. Aspects of transcultural nursing include the

following:

Assessments of a cultural nature

Acceptance of each client as an individual

Knowledge of health problems that affect particular cultural groups

Planning of care within the clients health belief system to achieve the best health

outcomes

To provide culturally sensitive care, nurses must become skilled at managing language

differences, understanding biologic and physiologic variations, promoting health teaching

that will reduce prevalent diseases, and respecting alternative health beliefs or health

practices.

Cultural Assessment

To provide culturally sensitive care, the nurse strives to gather data about the unique

characteristics of clients.Pertinent data include the following:


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Language and communication style

Hygiene practices including feelings about modesty and accepting help from others

Special clothing or ornamentation

Religion and religious practices

Rituals surrounding birth, passage from adolescence to adulthood, illness, and death

Family and gender roles including child-rearing practices and kinship with older adults

Proper forms of greeting and showing respect

Food habits and dietary restrictions

Methods for making decisions

Health beliefs and medical practices

Assessment of these areas is likely to reveal many differences. Examples of variations

include language and communication, eye contact, space and distance, touch, emotional

expressions, dietary customs and restrictions, time, and beliefs about the cause of illness.

TUGAS KELOMPOK XI :

Language and Commun ication

Because language is the primary way to share and gather information, the inability to

communicate is one of the biggest deterrents to providing culturally sensitive care. Foreign

travelers and many residents in the United States do not speak English or they have learned

it as their second language and do not speak it well. Estimates are that 13.8% of those who

live in the United States speak a language other than English at home (Perkins et al., 1998).

Those who can communicate in English may still prefer to use their primary language

especially under stress.

EQUAL ACCESS.

Federal law, specifically Title IV of the Civil Rights Act of 1994, states that people with

limited English proficiency are entitled to the same health care and social services as those

who speak English fluently. In other words, all clients have a right to unencumbered

communication with a health provider. Using children as interpreters or requiring clients to

provide their own interpreters is a civil rights violation. The Joint Commission on

Accreditation of Healthcare Organizations requires that hospitals have a way to provide

effective communication for each client. The use of untrained interpreters, volunteers, or

family is considered inappropriate because it undermines confidentiality and privacy. It also

violates family roles and boundaries. It increases the potential for modifying, condensing,

omitting, or adding information or projecting the interpreters own values during

communication between client and health care provider. To comply with the laws and

accreditation requirements, health care agencies are strongly encouraged to train

professional interpreters. A competent trained interpreter demonstrates the skills listed in

Box 6-2.

TUGAS KELOMPOK XII :


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BOX 6-2 Characteristics of a Skilled Interpretera. Learns the goals of the interaction

b. Demonstrates courtesy and respect for the client

c. Explains his/her role to the client

d. Positions himself/herself to avoid disrupting direct communication between the health care worker and client

e. Has a good memory for what is saidf. Converts the information in one language accurately into the other without commenting on the content

g. Possesses knowledge of medical terminology and vocabulary

h. Attempts to preserve the emphasis and emotions that both people express

i. Asks for clarification if verbalizations from either party are unclear

j. Indicates instances where a cultural difference has the potential to impair communication

k. Maintains confidentiality

NURSECLIENT COMMUNICATION.

If the nurse is not bilingual (able to speak a second language), he or she must use an

alternative method for communicating. See Nursing Guidelines 6-1 for more information.

Understanding some unique cultural characteristics involving aspects of communication mayease the transition toward culturally sensitive care. It is helpful to be aware of general

communication patterns among the major U.S. subcultures. Native Americans tend to be

private and may hesitate to share personal information with strangers. They may interpret

questioning as prying or meddling. The nurse should be patient when awaiting an answer and

listen carefully because people of this culture may consider impatience disrespectful (Lipson,

Dibble & Minarik, 1996). Navajos, currently the largest tribe of Native Americans, believe

that no person has the right to speak for another and may refuse to comment on a family

members health problems.Because Native Americans traditionally preserved their heritage

through oral rather than written history, they may be skeptical of Anglo-American nurses

who write down what they say. If possible, the nurse should write notes after, rather than

during, the interview.

TUGAS KELOMPOK XIII :

Afr ican Ameri canshave good reason to mistrust the medical establishment, because they

have been uninformed subjects in past research projects and have sometimes been treated

as second-class citizens when seeking health care. The nurse must demonstrate

professionalism by addressing clients by their last names and introducing himself or herself.He or she should follow up thoroughly with requests, respect the clients privacy, and ask

openended rather than direct questions until trust has been established. Because of their

experiences as victims of discrimination, African Americans may hesitate to give any more

information than what is asked. Latinos are characteristically comfortable sitting close to

interviewers and letting interactions unfold slowly. Many Latinos speak English but still have

difficulty with medical terminology. They may be embarrassed to ask the interviewer to

speak slowly, so the nurse must provide information and ask questions carefully. Latino men

generally are protective and authoritarian regarding women and children. They expect to be

consulted in decisions concerning family members. Asian Americans tend to respond with

brief or more factual answers and little elaboration, perhaps because traditionally theyvalue simplicity, meditation, and introspection. Asian Americans may not openly disagree


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with authority figures, such as physicians and nurses, because of their respect for harmony.

Such reticence can conceal disagreement or potential noncompliance with a particular

therapeutic regimen that is unacceptable from their perspective.

TUGAS KELOMPOK XIV :

Eye Contact

Anglo-Americans generally make and maintain eye contact throughout communication.

Although it may be nat-ural for Anglo-Americans to look directly at a person while speaking,

that is not always true of people from other cultures. It may offend Asian Americans or

Native Americans who are likely to believe that lingering eye contact is an invasion of

privacy or a sign of disrespect. Arabs may misinterpret direct eye contact as sexually

suggestive.

Space and DistanceProviding personal care and performing nursing procedures often reduce personal space,

which causes discomfort for some cultural groups. For example, Asian Americans may feel

more comfortable with the nurse at more than an arms length away. The physical closeness

of a nurse in an effort to provide comfort and support may threaten clients from other

cultures. It is best, therefore, to provide explanations when close contact during procedures

and personal care is necessary.

TUGAS KELOMPOK XV :

Touch

Some Native Americans may interpret the Anglo-American custom of a strong handshake as

offensive. They may be more comfortable with just a light passing of the hands. People from

Southeast Asia consider the head to be a sacred body part that only close relatives can

touch. Nurses and other health care workers should ask permission before touching this

area. Southeast Asians also believe that the area between a females waist and knees is

particularly private and should not be touched by any other male than the womans

husband. Before doing so, a male nurse can relieve the clients anxiety by offering an

explanation, requesting permission, and allowing the clients husband to stay in the room.

Emot ional Express ion

Anglo-Americans, in general, freely express their positive and negative feelings. Asian

Americans, however, tend to control their emotions and expressions of physical discomfort

(Zborowski, 1952, 1969) especially among unfamiliar people. Similarly, Latino men may not

demonstrate their feelings or readily discuss their symptoms because they may interpret

doing so as less than manly (Andrews & Boyle, 2003). The Latino cultural response can be

attributed to machismo, a belief that virile men are physically strong and must deal with

emotions privately. Because this behavior is atypical from an Anglo-American perspective,

nurses may overlook the emotional and physical needs of people from these cultural

groups.


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TUGAS KELOMPOK XVI TUGAS KELOMPOK XVII

a. Greet or say words and phrases in the clients

language, even if carrying on a conversation is

impossible. Using familiar words indicates a

desire to communicate with th1e client even if the

nurse lacks the expertise to do so extensively.

b. Use Web sites with the client that translate

English to several foreign languages and vice

versa. Examples are found at

http://ets.freetranslation.com and

http://babel.altavista.com/tr. A computer with

Internet access provides sites with easy-to-use,

rapid, free translations of up to 150 words at a

time.c. Refer to an English/foreign language dictionary or

use appendices in references such as Tabers

Cyclopedic Medical Dictionary. Some dictionaries

provide medical words and phrases that may

provide pertinent information.

d. Compile a loose-leaf folder or file cards of

medical words in one or more languages spoken

by clients in the community. Place it with other

reference books on the nursing unit. A

homemade reference provides a readily available

language resource for communicating with othersin the local area.

e. Request a trained interpreter. If that option is

impossible, call ethnic organizations or church

pastors to obtain a list of people who speak the

clients language and may be willing to act as

emergency translators. Someone proficient at

speaking the language is more effective in

obtaining necessary information and explaining

proposed treatments than is someone relying on

a rough translation.

f.

Contact an international telephone operator in acrisis, if there is no other option for

communicating with a client. International

telephone operators are generally available 24

hours a day; however, their main responsibility is

the job for which they were hired.

g. When several interpreters are available, select

one who is the same gender and approximately

the same age as the client. Some clients are

embarrassed relating personal information to

people with whom they have little in common.

h.Look at the client, not the interpreter, whenasking questions and listening for responses. Eye

i. If the client speaks some English, speak slowly,

loudly, using simple words and short sentences. Len

or complex sentences are barriers when communica

with someone not skilled in a second language.

j. Avoid using technical terms, slang, or phrases wi

double or colloquia vernacular, especially if he or

learned English from a textbook rather t

conversationally. cAsk questions that can be answere

a yes or no. Direct questions avoid the need to pro

elaborate responses in English. If the client app

confused by a question, repeat it without changing

words. Rephrasing tends to compound confusion becit forces the client to translate yet another grou

unfamiliar words.

k. Give the client sufficient time to respond. The process

interpreting what has been said in English and

converting the response from the native language

to English requires extra time.

l. Use nonverbal communication or pantomime. B

language is universal and tends to be communicated

interpreted quite accurately.

m.Be patient. Anxiety is communicated interpersonally

tends to heighten frustration.

n. Show the client written English words. Some non-Eng

speaking people can read English better than they

understand it spoken.

O. Work with the health agencys records committe

obtain consent forms, authorization for health insura

benefits, and copies of clients rights written in languother than English. Legally, clients must understand

they are consenting to.

p. Develop or obtain foreign translations describing com

procedures, routine care, and health promotion.

resource is the Patient Education Resource Center in

Francisco, which provides publications in m

languages on numerous health topics. All clients

entitled to explanations and educational services.
http://babel.altavista.com/trhttp://babel.altavista.com/trhttp://babel.altavista.com/tr


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contact indicates that the client is the primary

focus of the interaction and helps the nurse to

interpret nonverbal clues.

TUGAS KELOMPOK XVIII

Dietary Custom s and Restr ict ions

Basically food is a means of survival: it relieves hunger, promotes health, and prevents

disease. Eating also has social meanings that relate to communal togetherness, celebration,

reward and punishment, and relief of stress. Culture dictates the types of food and how

frequently a person eats, the types of utensils used, and the status of individuals such as who

eats first and who gets the most. Religious practices within some cultures impose certain

rules and restrictions such as times for fasting and foods that can and cannot be consumed

(Table 6-3). Nurses can jeopardize the compliance of clients with a therapeutic diet for

medical disorders if dietary teaching disregards cultural and religious food preferences.

Time

Throughout the world, people view clock time and social time differently (Giger &

Davidhizar, 1999). Calendars and clocks define clock time, dividing it into years, months,

weeks, days, hours, minutes, and seconds. Social time reflects attitudes concerning

punctuality that vary among cultures. Punctuality is often less important to people from other

cultures than it is to Anglo-Americans. Tolerating and accommodating cultural differences

related to time facilitates culturally sensitive care.

TUGAS KELOMPOK XIX

Beliefs Con cerning I l lness

Generally people embrace one of three cultural views to explain illness or disease. The

biomedical or scientific perspective is shared by those from developed countries who base

their beliefs about health and disease on research findings. An example of a scientific

perspective is that microorganisms cause infectious diseases, and frequent handwashing

reduces the potential for infection. The naturalistic or holistic perspective espouses that

humans and nature must be in balance or harmony to remain healthy; illness is an outcome of

disharmony. Native Americans share this view. Another example is Asian Americans who

uphold the Yin/Yang theory, which refers to the belief that balanced forces promote health.

Latinos embrace a similar concept referred to as the hot/

cold theory. It implies that illness is an imbalance between components ascribed as havinghot or cold attributes.

Adding or subtracting heat or cold to restore balance also can restore health. Lastly there is

the magico-religious perspective in which there is a cultural belief that supernatural forces

contribute to disease or health. Some examples of the magico-religious perspective include

cultural groups that accept faith healing or who practice forms of witchcraft or voodoo.

Although nurses may disagree with a clients beliefs concerning the cause of health or

illness, respect for the person who believes them helps to achieve healthcare goals.

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