Learning about Culture

Characteristics of Culture
This includes gender, race, ethnicity, sexuality identity, age, physical ability, social circumstances, and religion. With cultural diversity come identifiable differences in language, communication, dress, behavior, and socialization among groups.

Bonder offer the following points about culture

1. Culture is learned and transmitted from one generation to another 2. Culture is localized and is created through specific interactions with specific individuals 3. Culture is patterned. These patterns emerge from the repetition of specific behaviors. 4. Culture is evaluative. Values are the central components of culture and reflected in individual behaviors. Values also reflect shared belief that facilitate social interaction with others. 5. Culture has continuity, with change. In general, cultural identity is stable but ones cultural knowledge changes over the course of life as one encounter new objects, situations, and ideas in the environment.

Promoting Cultural Knowledge

3 Main Approaches to promoting cultural knowledge and competency for healthcare providers and nurse educators 1. fact-centered approach
provides information about the health belief and behaviors of specific ethnic groups. The starting place for interactions with one individual. The focus is factual
knowledge

1. Attitude-centered
Emphasizing the importance of valuing and respecting all cultures. The acknowledgement of the culture and fostering of positive attitudes . The focus is cultural sensitivity

2. Ethnographic to cultural competence offers a practical strategy of learning how to ask. The focus is on inquiry, reflection, and analysis as a means of getting to know an individual.

Cultural Competence
cross cultural situation. The ability to work effectively in a

Campinha-Bacote (1998) as the process in which the healthcare provider continuously strives to achieve the ability to effectively work within the cultural context of a client, individual, family or community. This model allows nurses to see themselves as becoming culturally competent, rather than being culturally competent.

 Cultural Knowledge. Obtaining factual knowledge about different culture Cultural Skill. Collecting relevant cultural data about a clients health history and accurately performing culturally specific physical assessment. Cultural Encounter. Engaging in cross cultural encounters with people from other culture. Cultural Awareness. Becoming respectful and appreciative of anothers culture. Cultural Desire
Wanting to engage in learning cultural competence

Cultural Awareness

It is the process whereby the nurse becomes respectful, appreciative and sensitive to the values, beliefs, practices, and problem-solving strategies of the clients culture. It involves self-examination of ones own prejudices and bias about other cultures, in addition to an in-depth exploration of ones own cultural background. It ranges from ethnocentrism to ethnorelativism.

Behavior is a behavior in which a person is totally unaware of others cultural beliefs and values. The ethnocentric individuals assumes that his/her values, beliefs and practices are the only corrected perceptions. Leininger emphasized that if you are not aware of the influence of your own cultural values, there is a risk that you may engage in cultural imposition, which is the tendency to impose your own beliefs,values practices and patterns of behavior upon another. This lead to non compliance with health care regimens.

CampinhaBacote (1998) reports that noncompliance is not a client problem, but rather maybe the nurse failure to provide culturally responsive care that incorporates the clients cultural beliefs and values.

This reflects an attitude of nurses who value respect, and integrate cultural differences into their practices. They are aware of their cultural backgrounds, along with prejudices and biases about other culture. This awareness alone does not ensure culturally responsive interventions. Nurses must develop other needed components of cultural competence.

Cultural Knowledge
This involves the process of seeking and obtaining factual information about different culture. Campinha-Bacote (1998) 4 stages of obtaining cultural knowledge Unconscious incompetence
Individuals being unaware that he/she lacks cultural knowledge

Conscious incompetence
The awareness that he/she lacks knowledge about another culture and is willing to seek and obtain the knowledge

Conscious competence
Act of learning about a clients culture, verifying generalizations and providing culturally responsive nursing intervention

Unconscious competence
The ability to automatically apply knowledge and culturally congruent care to clients from diverse cultural backgrounds. The nurse who has unconscious competence interacts naturally and easily with clients from diverse culture.

Cultural Encounter
The process whereby a nurse engages directly in cross-cultural interactions with clients from culturally diverse backgrounds. The purpose is to refine or modify ones belief about those groups to prvent possible stereotyping.

Cultural Skill
The ability to collect relevant cultural data about a clients health history and health problems, as well as to accurately perform culturally specific physical assessment.
Leininger (1978) defined a cultural assessment as

Systematic appraisal or examination of individuals, groups and communities as to their cultural beliefs, values and practices to determine explicit needs and intervention practices within the context of the people to be evaluated.

The nurses motivation to engage in the process of cultural competence. Nurses need to want to work toward cultural competence as they provide individualized and safe care to clients.

1. Discomfort caused by lack of knowledge, skills or exposure to group member 2. Discomfort caused by disapproval or negative attitudes toward group member. 3. Discomfort as a result of feeling threatened by group members 4. Discomfort caused by feelings of guilt, sympathy or pity toward group members

The Culture of Teacher and Learner

Most nurse ducator are from the dominant culture and never examined their own culture. They tend to be more homogenous. Some authors reported that differences in interactions between teachers and students are attributable to race, ethnicity, or gender and the differences are reflected in students perfromance.

Variables found to promote successful student learning and acjievemnt include faculty commitment and advisement, prompt and individualized attention to students and satisfaying relaationship with faculty staff and peers.

 Become self-aware of your own cultural values, norms and beliefs and the influence they have on your view of life, family of life and relationship. Develop and maintain an attitude of respect for the broad range of cultural differences and their importance to individuals. Identify and value the strengths in different cultural values and beliefs rather than becoming critical to them. Develop a strategy for continuing education about predominant culture in a given community or institution Consider the use of other professionals and members of other cultures to learn more about their culture.

Nurse educators who work with multicultural students should consider the following:

Assessing the culturally diverse learner

7 factors in assessing differences between people in cultural groups

Communication Biological Variations Environmental Control Space Social Organization Time

C BESST

Communication
The means by which culture is transmitted and preserved through the generations Cultural pattern consisting of verbal and non verbal expression of each cultural group affect the way the group expresses ideas and feelings, the way they make decisions the way they communicate Example: native americans may value more nonverbal and passive approaches while european americans value more verbal and active

Space
An individuals level of comfort is related to personal space or distance and discomfort is experienced when one personal space is invaded.

Personal space is an individual matter and varies with the situation. The proximity of the comfort zone also varies from culture to culture. Example: Puerto ricans and african americans communicate with closer proximity from european backgrounds

Social Organization
Cultural behavior or how one acts in certain situations, is socially acquired and learned. Patterns of cultural behavior are important to the teacher because they provide explanations for people behavior. Individuals are not generally conscious of their cultural behavior.

Example: european american nursing with core values of individualism, honesty, truthfulness, straightforwardness, self-assuredness self-confidence and self-motivation.

Time
Temporal orientation refers to how time is viewed. It includes the ordering of past, present and future in terms of behavior and outlook. In education, getting assignment done in a specific timw frame is more important for a learner who is present of future oriented.

Environmental control
This refers to the persons ability to plan activities that control nature. It also refers to the persons perception of his or her ability to direct factors in the environment

Biological Variations
Educators should know that learners from different backgrounds have genetic biologica differences that may affect their classroom performance. One such difference maybe susceptible to disease.

It is a model that helps a culturally different patient or client to explain his or her viewpoint or perspective on health and illness. It has relevance for asessing clients, planning care and teaching clinicians to deliver culturally appropriate care.
Kleinman (1980) reported that explanatory models contains any one or all five parts of an illness.

Etiology Time of onset of symptoms Pathophysiology Course of sickness Treatment

Teaching and Learning Process

It begins with assessment. Assessment provides the nurse educator with information about the knowledge and skills needed as well as the learners characteristics within the context of ethnic and cultural consideration. Development of teaching plan Teaching plan is a blueprint for action to achieve the goal and the objectives that have been agreed upon by the educator and the learner. It is also a carefully organized written presentation of what the learner needs to learn and how the nurse educator is going to provide the teaching.

Three reasons for constructing a teaching plan

To force the reader to examine the relationship among the steps of the teaching process To communicate in writing and in an outline format exactly what is being taught,how it will be taught and evaluated. To legally document that an individual plan for each learner is in place and is being properly implemented.

8 basic elements of Teaching Plan

Purpose Statement of the overall goal List of objectives and subobjectives An outline of the related content The instructional methods for instruction Time alloted Instructional resources Methods of evaluations

PLATT SIM

Elements of Teaching Plan

PURPOSE: GOAL:

Objectives and subobjectives

Content Outline

Method of instruction

Time Allotted

Resources

Method of Evaluation

Sample Teaching Plan

PURPOSE: To provide patient with information necessary for self-administration of insulin as prescribed GOAL: The patient will be able to perform insulin injections independently according to treatment regimen
objectives
Following a 20 minute teaching session, the patient will be able to: Identify the five sites for insulin injection with 100% accuracy (cognitice) Demonstrate proper techniques according to procedure for drawing up insulin from a multidose vial (psychomotor) Express any concern about self administration of insulin (affective)

Content outline

Method of instruction

Time allotted

Resources

Method of evaluation

Location of five anatomical sites rotation of sites Accepted technique according to procedure

1:1 instruction

2 minutes

Anatomical chart

Post-testing

Demonstration Return demo

5 min

Alcohol Sponges Sterile SQ needle and insulin syringesmultidose vial of sterile water Video written handouts

Observation of return demo

Summarize common concerns Explorations of feelings

Discussion

3 min

Question and answer

Other teaching approaches have been found to be effective with culturally and ethnically diverse learners
Negotiations of learning
Providing for immediate application and learning to help reinforce newly learned content Creating opportunities for learners to test their own ideas and be creative. These activities ehnace selfesteem

Cross-Cultural Issues in Computer based Learning

Morgan (2000) reports that cross cultural consideration can be a major influence in the successful understanding of educational and instructional concepts. Therefore, interactive learner designers need to be address cross cultural consideration in software development as follows: Symbols Behavior stereotyping Sounds Selection of human voices Directional Flow Color Selection of words and phrases gestures Words, sounds and mistranslation Handedness

Symbols Care should be taken with the use of symbols or icons in the presentation of simulations. Example: Symbol for the human or animal eye can be disturbing to many cultures as a symbol of evil. Sounds The use of sound within a system adds life and interest to the learning situation. Example: The cries of some animals can denote evil to some cultures Directional Flow The designer should be aware of the national directional flow that language takes in the users cultures Example: Asian writes from right to left

Selection of words and Phrases The tone and use of language has a major impact on the effect of communication and on the interactiv elearning environment. Example: The words kill and abort are highly emotive words and can be replaced with descriptive words end and cancel. Words, sound and mistranslation Caution should be used when making direct translations of words and also to the meaning of the sounds used within the system Selection of human voices An increasing number of simulations include human voices to add impact and realism to the interactive learning environment. Example: Female voice would not be as effective of female

Behavior stereotyping One in which individual of certain gender age occuppation, religion or ethnic background are consistently shown to behave or dress in a particular way. Colors Certain colors are associated with death in certain culture. Example: White is associated with death in some asian countries Gestures In some culture a nod can be taken as a sign of a negative response. A sole of the feet can be highly offending in some middle eastern countries Handedness In some culture, passing or touching items using the left hand can be highly offensive.

Communication Issues
Cross-Cultural Communication with Nursing Students Cross cultural Communications and In service Education 5 areas of concern when recruiting and hiring international nurses 1. Releiving psychological stress 2. Overcoming the language barriers 3. Accepting US nursing practice 4. Incorporating the styles of US Problem solving strategies 5. Implementing the styles of US interpersonal re;ationship Cross Cultural Communication with Patients and Clients

Gender Differences in Communication

Mulac (1998) 2 abiding truth with uneasy agreement 1. Men and women speak the same language 2. Men and women speak that language differently Mulac, Bradac and Gibbons (2001) defined culture as the social system that reinforces behavioral expectation for group members wether they are national, ethnic or gender groups.

Gudykunst and Ting-Toomey (1998) 4 stylistic modes of verbal communication between gender DIRECT VS INDIRECT STYLE The dimension represents the degree to which speakers show their intention through explicit verbal communications. DIRECT STYLE is characterized by openness, straightforwardness and honesty INDIRECT STYLE is more ambiguous,tactful and concern with saving face of the individual in the interest of the harmony. Male style is characterized by relatively direct and female style are relatively indirect Male Its good to write this down Female Im not sure what do you think

Succinct VS Elaborate style

This dimension addresses the quantity of talk that is valued in different culture. Salient silence and understatement often mark the succinct styles. Example: Male uses elliptical setences Great Picture Descriptive metaphor and similes and flowery words the elaborate style that is more characteristic of women. The elaborative style potentially protects relational harmony. Which is especially important for a women.

Personal VS Contextual style

The personal style is individual centered language and enhances I identity. The contextual is role centered language and enhances role identity. The personal style stresses equality, whereas the contextual style stresses the speaker and hearer positions within a hierarchy, Men are more contextual female personal

Instrumental vs affective style

Male use of the instrumental continuum is seen references to quantity (below 32 D Farenht) and locatives in the center of the pictures
Women use the affective end of the continuum, referring more often to emotions (Shell feel terrible and focusing on peoples feeling.

Thanks For Listening

I would like to thank my sponsors:

Mainstreet for my pants Daniel Hecter for my sleeves Darlington for my socks Mario de boro for my shoes Sansan for my make-up