Nursing 401

Cultural Exploration Table

Description of cultural
group (9)
Culture
Origin
Current
population in US
Current
population in your
community

The official language of Jamaica is English, but very few speak standard English exclusively. Most are bilingual also
speaking Patois and some speak patois only. Jamaican cuisine reflects the impact of the different ethnic groups that
have had a place in Jamaica's history - Taino, Spanish, English, Indian, Chinese. Music is probably the farthest reaching
element of Jamaican culture. Although reggae has been greatly popularized, it is not the only Jamaican music form in
use. Hand in hand with music goes Jamaican dance which is ever evolving: from European forms of the past, through
African forms, to steps from the 21st century. Jamaicans are deeply religious and they are known for having the largest
number of churches per square mile in the world. The country is mostly Christian, but other religions such as Rastafari,
Hinduism, Islam, Judaism, and some African Cults can be found on the island. Existing alongside Christianity is the
frowned-upon practice of Obeah or witchcraft. Many Jamaican traditions can be directly linked to African roots. Some
can be linked to both European and African background. http://www.real-jamaica-vacations.com/jamaican-culture.html
According to the 2001 census, Jamaica's population is overwhelmingly of African descent (taken to Jamaica for slavery
during the 17th century). The second-largest racial group is multiracial Jamaicans. Still, most mixed-race people in the
country self-report as just "Jamaican." Jamaicans of African descent represent 76.3% of the population, followed by
15.1% Afro-European, 3.4% East Indian and Afro-East Indian, 3.2% Caucasian, 1.2% Chinese and 0.8% other.
http://worldpopulationreview.com/countries/jamaica-population/
736,513 people marked their ethnic origin as Jamaican on the United States Census survey in 2000.
http://names.mongabay.com/ancestry/Jamaican.html

Cultural beliefs related

to communication (10)
(eye contact, space &
distance issues, time &
punctuality, gender
communications)

Jamaicans tend to be quite formal. They always greet each other with "good morning", "good afternoon", and "good
evening" depending on the time of day and also using formal titles to address each other (Mr. and Ms. or even Sir and
Madame). They also maintain an arms-length distance as getting closer lends itself to being "familiar" and could offend.
However, Jamaicans do tend to touch more when speaking. Greeting is by a firm handshake whether, male or female,
and eye contact is made without staring. Avoiding eye contact is seen suspiciously and does not lend itself to a
successful meeting. Some Jamaicans take time to warm up to foreigners and it is important to build rapport and trust.
Family, work and hobbies are generally excellent topics of discussion when meeting someone for the first time while
discussion regarding politics, religion and homosexuality may offend.
The Caribbean sense of time is quite different from that of North America. In Jamaica, there is much less emphasis on
punctuality and meeting deadlines. Things generally move slower and get done when they get done. Jamaica is a very
"macho" society, where men often expect women to be subservient. Status is extremely important to Jamaicans.
Unfortunately, status and class divisions in Jamaica are still largely related to skin color. There is an unwritten color code

that states that the lighter ones shade of skin, the more prosperous one is assumed to be. Some Jamaicans may seem
very aggressive when speaking so you will need to be assertive and direct in order to get your voice heard.
http://www.intercultures.ca/cil-cai/ci-ic-eng.asp?iso=jm#cn-16
How is health
maintained? (7)
Dietary
restrictions,
health rituals, etc

Jamaicans use a mix of traditional and biomedical healing practices. The degree of use of traditional means, including
spiritual healing, is inversely related to class status. When traditional means fail, modern medicine is tried.
http://www.everyculture.com/Ja-Ma/Jamaica.html#ixzz3L2PfLyjt Jamaicans use fruits and vegetables for their healing
properties. Papaya helps relieve indigestion, while guava leaves treat diarrhea, and tamarind soothes itchy skin and
chicken pox. Herbal medicines are popular, and herbal medicine practitioners and balmists, who practice bush
medicine, provide treatment for a wide range of ailments. Herbs are administered as an infusion (tea), a poultice or bath.
A popular treatment is bush tea, which can contain many ingredients such as lemon, fever grass, sour sop, breadfruit
leaves and pepper elder. The herbs "search-mi-heart" and "shame o' lady" are popular treatments for colds and stomach
ailments, while marijuana can be boiled into a tea for asthma and eye complaints. The cerassee vine is used as an
overall health booster and sold in teabags. Emotional or psychological disorders can be treated by applying a cloth
dampened with nutmeg oil or lavender water to the patient's head. http://www2.massgeneral.org/interpreters/b_jam.asp
Rastafarians follow the dietary law established in the Bibles book of Leviticus. This allows just fruits, vegetables, ground
products and clean meat - they dont eat pork, shellfish or anything in the ocean without scales. This is what they call
ital. (http://www.jamaican-traditions.com/rastafarian-diet.html)
Rastafarians believe in and use herbs just like they use foodanother biblical principle. The belief is that for every
sickness you can find, there is a herb that can heal it. The rasta doctor is sought out for his expertise in finding the
appropriate herbs and adding a little prayer and/or sorcery to conjure up the medicine for the healing of the rastaman.

What causes ill

health? (5)

Health beliefs/ practices

specific to pregnancy,
the birthing process,
and childrearing
Who attends the
birth? (3)

Among the African Jamaicans, illness is believed to be caused by spiritual forces or violation of cultural taboos.
Consequently, most illnesses are treated holistically. When traditional means fail, modern medicine is tried.
http://www.everyculture.com/Ja-Ma/Jamaica.html#ixzz3L2PfLyjt
Not so long ago, many Jamaican children were born at home and subject to a number of different actions. Birth rituals
were overseen by nanas or midwives, and varied from place to place, depending on race and class. All, however,
reflected a deep sense of connection to, and respect for, the spirit world. Today, the use of midwives is still popular; but,
most children are born in hospitals and prenatal and post-partum activities conform to western medical guidelines. For
this reason, many birth rituals have disappeared with retention being strongest in rural areas. To prepare for birth, the
room had to have an open bible on display. The nana would anoint the mother's belly with castor oil which would later be
given to both mother and child. Following the birth, Jamaican nanas dressed the child's navel with nutmeg. The nana
also blew smoke into the child's eyes, often from an old clay pipe which these women traditionally smoked. The nana

then washed her own face with rum and sometimes she herself took a stiff drink to give her 'eyesight,' since the
witnessing of each birth was said to affect her sight. New mothers are encouraged to stay indoors for a few days so as
not to catch a 'baby cold'. It used to be customary for both mother and newborn to be isolated for eight days after birth.
http://www.real-jamaica-vacations.com/jamaican-traditions.html

Is circumcision
done? If so, what
rituals are
associated with
it? (3)

Circumcision is viewed with skepticism in most parts of Britain and the majority of Jamaican doctors tend to side with the
British. Most Jamaican doctors do not support routine circumcision for babies or widespread circumcision for the
general public because of the pain affixed and because it is costly. For these reasons, less than 20% of the population
is circumcised. When done, there are no rituals associated with it.
(http://www.jamaicaobserver.com/magazines/allwoman/161148_Snip--snip-Should-you-circumcise-)

Is birth control
practiced and if it
is what are the
birth control
practices? (3)

There have been sustained family planning campaigns in Jamaica. The efforts initiated decades ago by pioneering
founders of the Jamaica Family Planning Association gave birth to the staterun National Family Planning Board (NFPB)
which promotes sustainable family planning services in Jamaica. According to the 2011 World Population Report, 73%
of married Jamaican women, up to age 49, were using contraception. However, there remains a negative attitude
towards contraception and the perception that a woman should have out her lot. Some people still argue that its a
means to reduce the black population. These views are primarily shared by people in some of the poorest rural and
inner-city communities. http://www.jamaicaobserver.com/news/Poor-shun-birth-control

Are there
customs
associated with
the postpartum
period for the
mother or the
infant? (3)

Many Jamaican postpartum customs have disappeared.

The afterbirth was buried in a special location with a tree planted on that spot. The tree became known as a birth tree
which became the child's property and that of his/her future progeny. This is said to have helped to reinforce the concept
of 'family land' that is passed down from generation to generation. Following delivery, the mother and child were often
isolated for eight days, during, which time the nana took control of the house. It was considered very important to protect
mother and child from spiritual harm and any physical dangers that came with childbirth. A special broom was used to
sweep out the room and the sweepings were kept, perhaps to prevent others from getting hold of them. The child was
marked with blue, and the scissors or knife used to cut the umbilical cord was watched carefully. Some sort of charm or
'guzu' (often a strong-smelling substance) was used to protect the child. The child was also washed in cold water that
contained rum and a silver coin given by the father. The water and coin were later buried in the yard along with the
afterbirth. The nana counted the knots on the umbilical cord to determine how many children the mother was destined to
have. On the tenth day, the mother and child were taken outside to receive greetings as well as presents from family
members and other visitors. The child was also named on that day. This practice is believed to have come from the West
African belief that until day eight, the child's fate is uncertain and its personality/soul is not fully formed. In addition, there
was the possibility that the child could be a visitor from the spiritual world, and if that was the case, then he/she must not
be welcomed. If the child died during this period, for example, it was believed that an evil spirit had arrived.

Is breast-feeding
supported in the
culture? (3)

What are the

practices
regarding
immunizations?
(3)
Health beliefs/ practices
specific to end of life &
death rituals (5)
What are the
practices for
caring for the
dying and the
dead?
If any, what are
the funeral
practices of the
culture?

What are the

mourning
practices of the
culture? (5)

Physiological variations
within the culture which
affects treatment or
response to treatment
Are there

(http://jamaica-gleaner.com/gleaner/20070305/news/news2.html)
Most Jamaican mothers are not practicing exclusive breastfeeding as it goes against their belief that babies require
water or tea. However, breastfeeding is supported and there is commitment to increase the rates of exclusive
breastfeeding via a collaborative effort between the Ministry of Health and UNICEF.
http://www.jamaicaobserver.com/magazines/allwoman/push-for-exclusive-breastfeeding
Immunization rates have declined from rates above 90% in the mid-1990s to a range of 80-90% in 2004.
http://www.unicef.org/jamaica/children.html

Except in the case of the very old, cause of death is believed to be the violation of a cultural norm, evil spirits, or envy.
When someone dies, there are rituals which are sometimes performed in the person's home. The furniture in the
deceased's room is rearranged and the mattress turned over. This is to ensure that the person's spirit will not recognize
the room, and therefore won't want to stay there. If a person dies at home, someone may sweep behind the body as it is
being carried out of the house, so that the spirit will leave along with the body. Funerals are one of the most important
African-Jamaican rituals. Although the concept is African derived, the proceedings at a wake have a strong European
Christian influence. Special hymns (sankeys) are sung emphasizing the soul's journey to heaven. The singing is done in
a style known as 'tracking', where someone will call out one line of the sankey at a time, and then the rest of the
gathering will sing the line together. Before a grave is dug, it is necessary for the diggers to have white rum on hand to
pour a libation to the earth spirits before ground is broken. http://www.real-jamaica-vacations.com/jamaicantraditions.html

One of the strongest Jamaican traditions concerning death is that of a wake, also called Nine Night or Set Up. It was
believed by African slaves that a person's spirit took nine days to travel home to Africa, and this is probably where the
tradition started. Family and friends gather at the dead person's home to comfort the bereaved, lend support and assist
in funeral preparations which involve washing and tying the body. This is done to give the spirit a good send off from this
world and may be done on one or many nights, with the ninth night or the night immediately preceding the funeral being
of the most importance. It was an African belief that the person's spirit would live on and become a nuisance to the
survivors if not treated with respect before burial. http://www.real-jamaica-vacations.com/jamaican-traditions.html
Because 90% of Jamaicans have African heritage, it is important to consider race variations as well as the many
conditions which Africans tend to run a higher risk for such as hypertension, stroke and cardiovascular disease.

variations within
the culture based
upon geography?
(3)
Are there genetic
predispositions to
any diseases?
(5)

Are there
environmental
factors resulting
in physiological
variations? (3)

Role of nursing within

the culture
How are nurses
valued, viewed /
utilized? (5)

Are there
restrictions
related to the
practice of
nursing? (5)
Based on the information
provided in this table, how
would you provide
culturally sensitive

Jamaicans of African heritage have a strong genetic disposition to keloid formation. However, most of the prevalent
diseases in Jamaica are lifestyle related and not due to genetic predisposition. For example, diabetes is prevalent
among Jamaicans. Also, with a rate of approximately 500 in every 100,000, chronic kidney disease is a serious
problem. More than 50% of persons with renal failure stem from hypertension, and more than 27% is from diabetes.
These numbers reflect the high percentage of both lifestyle-related diseases being responsible for the problem. Jamaica
is at approximately number four compared to the rest of the world, in terms of the prevalence rate. (http://jamaicagleaner.com/gleaner/20140312/health/health1.html) And, according to the doctors, cardiovascular disease kills 20
Jamaicans every day. That works out to 7,300 people annually. The conditions that qualify as heart disease include
coronary heart disease, heart attack, congestive heart failure and congenital heart disease. Seventy-one per cent of all
diabetics die from cardiovascular disease. (http://www.jamaicaobserver.com/news/Number-1-killer_7918985)
The tropical environment/heat of the Caribbean island is one factor that has resulted in physiological variation.

Nursing is a respectable career in Jamaica and nurses occupy many specialties and roles. There are nursing
organizations and a climate is fostered for research and academic excellence. However, the government has
recognized that they are underpaid in comparison to other Caribbean countries as well as the United States.

In researching, no restrictions related to the practice of nursing in Jamaica were discovered.

Perhaps one of the first things to consider should be the potential for a language barrier since some Jamaicans speak
patois only. In communications, it should also be recalled that Jamaicans tend to be formal and so titles should always
be used. It should also be recalled that some Jamaicans take time to warm up to foreigners and so effort should be
made to develop rapport. However, certain topics such as politics and religion should be avoided. Also, homosexuality

nursing care to a patient

from this culture? Be
specific (10)

is a topic that can be offensive and this should be considered in assessment. For me, it would also be relevant to recall
that women are considered subservient and that status and class divisions in Jamaica are still largely related to skin
color. These views would likely affect the way I as a black female nurse am perceived. Because herbal medicines are
popular, it is important to ask about any such medicines currently being taken. It is also important to consider dietary
restrictions of the Rastafarians. Because illness is believed to be caused by spiritual forces or violation of cultural
taboos, a holistic approach to care is necessary. With regard to pregnancy and childbirth, although most prenatal and
post-partum activities now conform to western medical guidelines it is important to ask about any rituals as there is still
retention in some areas. It is also beneficial to understand practices for caring for the dying and dead as well as
mourning. It is also important to remember that circumcision is viewed with skepticism. There may also be some needs
for education: regarding contraception (for Jamaicans from the poorest rural and inner-city communities), the benefits of
exclusive breastfeeding and the importance of immunizations. Finally, it is important to provide education about diseases
persons of African heritage are more susceptible to and how about how certain lifestyle choices can increase incidence
of those diseases.

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