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Transcultural Nursing Marlon Rey Anacleto, RN,MAN Retrospective Analysis What is your sociocultural heritage?

What major sociocultural events occurred in your lifetime? What is the demographic profile of the community you grew up? How would you acquire economic help if necessary? How do you define health? How do you define Illness? What do you do to maintain your health? What do you do to protect your health? Do you diagnose your own health problem? From whom do you seek health care? What do you do to restore your health? Definition of terms Heritage- passed to your descendants. Culture- sum total of inherited characteristics passed to the next generation. Ethnicity- condition belonging to an ethnic group. Religion-set of beliefs based on a teachings of a spiritual being. Acculturation- cultural or behavioral assimilation. Socialization- raised within a culture acquiring the characteristics of a group. Case scenario Tsikita, 3 year old girl was brought to the emergency room of a rural health hospital due to epileptic seizures. Both parents are unable to communicate in English. The hospital staff do not include competent interpreters in Hmong language.From the parents view, Tsikita was experiencing the fleeing of her soul from her body and the soul become lost. They know these symptoms to be quag dab peg. The spirit catches you and you fall down. National Standards for Culturally and Linguistically Appropriate Services in Health Care ( 14 standards ) Standard 1 Health care organizations should ensure that patients/consumers receive from all staff member's effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language. Standard 2 Health care organizations should implement strategies to recruit, retain, and promote at all levels of the

organization a diverse staff and leadership that are representative of the demographic characteristics of the service area. Standard 3 Health care organizations should ensure that staff at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery. Standard 4 Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation. Standard 5 Health care organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services. Health care organizations must assure the competence of language assistance provided to li Standard 6 Health care organizations must assure the competence of languageassistance provided to limitedEnglish proficient patients/consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (except on request by the patient/consumer). Standard 7 Health care organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area. Standard 8 Health care organizations should develop, implement, and promote a written strategic plan that outlines clear goals, policies, operational plans, and management accountability/oversight mechanisms to provide culturally and linguistically appropriate services. Standard 9 Health care organizations should conduct initial and ongoing organizational self-assessments of CLAS-related activities and are encouraged to integrate cultural and linguistic competence-related measures into their internal audits, performance improvement programs,

patient satisfaction assessments, and outcomes-based evaluations. Standard 10 Health care organizations should ensure that data on the individual patient's/consumer's race, ethnicity, and spoken and written language are collected in health records, integrated into the organization's management information systems, and periodically updated. Standard 11 Health care organizations should maintain a current demographic, cultural, and epidemiological profile of the community as well as a needs assessment to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area. Standard 12 Health care organizations should develop participatory, collaborative partnerships with communities and utilize a variety of formal and informal mechanisms to facilitate community and patient/consumer involvement in designing and implementing CLASrelated activities. Standard 13 Health care organizations should ensure that conflict and grievance resolution processes are culturally and linguistically sensitive and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by patients/consumers. Standard 14 Health care organizations are encouraged to regularly make available to the public information about their progress and successful innovations in implementing the CLAS standards and to provide public notice in their communities about the availability of this information. Cultural Care Culturally Competent *Understands, attends Culturally Appropriate *Applies underlying knowledge Culturally Sensitive *Knowledgeable and constructive attitude Heritage Consistency Model of heritage consistency

Heritage consistency According to Estes and Zitzow: Degree to which ones lifestyle reflects to his /her tribal culture. Consistent heritage- tradition Inconsistent heritage- acculturated includes also, determination of ones culture , religion, ethnic background. Socialization- Process being raised within a culture and acquiring the characteristics of that group. Acculturation- involuntary in nature, must belong to a minority, is always forced to assimilate culture. Assimilation- process of cultural development of a cultural identity. Being like the dominant culture. Culture Is the medium of personhood and social relationships. Only a part is conscious Extension of biological capabilities. Interlinked web of symbols. Device for creating and limiting human choices. Can be in two places at once. Ethnicity Pertains to a social group within a cultural and social system which has a special status on the basis of complex, often variable traits including religious, linguistic, ancestral or physical characteristics. Geographical origin Migratory status Race Language and dialect Religious faith Kinship, community boundaries Shared traditions, values and symbols Literature, folklore and music Food preferences Settlement/ employment patterns Special interest with regards to politics

Religion Roman Catholic Protestant Jewish Mormons Others

Factors indicating Heritage Consistency Childhood development occurred in the persons country. Extended members are encourages to participate in religious or traditional activities. Individual visits to country of origin. Family homes are within ethnic community. Individual participates in ethnic cultural events. Raised in an extended family setting. Maintain regular contact with extended family.

Individual name has not been americanized. Educated within the ethnical philosophy. Engages in social activities of the same ethnic group. Has knowledge of culture and language of origin. Possessed elements of personal pride about heritage

Ethno-cultural Life Trajectories 1900-1909 1903- Wright Brothers at Kitty Hawk 1906- San Francisco earthquake 1908- Model T Ford 1910-1919 1914- Panama Canal opened 1914-18 WW 1 1917 Russian Revolution 1918- Germany surrendered 1920-1929 1920 Women Suffrage 1921- First Miss America 1925- Scopes Trial 1927- Lindbergh flight from NY to Paris 1929- Stock Market Crash 1930-39 1930- Great Southern Drought 1931- rise of Nazi Party in Germany 1932- FDR elected President 1933- Prohibition ends 1935- New Deal and Social Security Act passed 1936- Life Magazine was born 1938- Kristallnacht in Germany 1939- Germany invades Poland 1940- London Burned 1941- Attack at Pearl Harbor, WW2, US at War with Japan and Germany. 1944- Normandy Invasion 1945- War ends in Europe Aug. 6, 1945- Nagasaki and Hiroshima 1946- 1st electronic computer assembled 1947- Transistor invented by William Shockley, John Bardeen, Walter Brattain. 1951-Rosenberg Trial 1953- Stalin dies, I love Lucy 1954- TV dinners invented 1955- Disneyland opening, the case of Rosa Parks, Elvis Presley, Marilyn Monroe, Bus Boycott. 1956- Brown vs. BOE, desegregation of schools 1957- Sputnik ( Yuri Gagarin ) 1959- Cuban Revolution





JFK elected, bay of Pigs, US sends 2 helicopters to Vietnam. 1962- Berlin Wall, Stand off bet. JFK/ Kruschev, Beatles led the youthful rebellion, Civil rights movement. 1963- JFK assassinated, Vietnam war, march on Washington with Martin Luther King Jr. 1965- Assassination of Malcolm X , Chicago Riots, Civil rights Act passed. 1965-68 race Riots 1968- MLK Jr. assassinated, Robert Kennedy Assassinated 1969- Neil Armstrong walked on Moon, Woodstock 1970- Kent State protest, My Lai Massacre 1972-Watergate Break in, Nixon to China 1973-74 Oil embargo, Nixon resigns 1975- Vietnam Truce 1981-Air Traffic controllers strike 1981- Reaganomics, tax cuts 1982- Vietnam memorial wall dedication 1983- Recognition of AIDS/ HIV epidemic 1986- Challenger Explosion 1987- Black Monday- Stock Market Crash 1989- Tiananmen Square massacre; Berlin Wall down





1991- Desert Storm, Beating of Rodney King 1992- Los Angeles Riots 1993- Waco incident- Davidians 1995- Oklahoma Bombing, Million Man March 1998- Clinton Impeachment, Desert Fox Sept. 11, 2001- US attack by terrorist, WTC collapse. 2002- Fall of the Stock Market 2003- War in Iraq 2004 2005 Hurricane Katrina strikes 2006 First employment contract law protest in France, Trial of Saddam Hussein 2007 iphone mania. Mortgage crises in US, Stem cell Breakthrough 2010 Release of the first ipad. 2011 Death of Steve Jobs, Osama. 2012 Death of Rodney King,


Potential sources of Cultural Conflict Decade of Birth Generation in US Class Language Education Cultural Conflict Events that occur when there is a polarization between 2 groups an they are intensified by the way they are perceived. control of the symbols of culture Fields of conflict 1. family 2. education 3. media and the arts 4. law 5. electoral politics 6. Healthcare

Cultural Phenomena Environmental control Biological Variations Social Organization Communication Space Time Orientation

Space Intimate Zone- within 1 feet Personal Distance- 1 - 4 feet Social distance- 4- 12 feet Public Distance- 12 feet or more Time Orientation Present, past or future