Acculturation

When people with different cultural backgrounds meet, learning and growth occur. Acculturation is the process of learning cultural behaviors from one group or person. It is an unconscious fusion of attitudes and beliefs. This does not occur quickly; rather, it occurs over years. Because the United States is a melting pot of many different cultures, acculturation is always occurring. Each cultural group contains many subcultures, which can be as broad and varied as the whole group. The U.S. Census Bureau collects data every 10 years about the population in the United States. Besides population statistics, the bureau also collects data about various races, religions, and ethnic groups in the United States (Table 5-1).

Defining each culture’s characteristics in a simple box is impossible because of acculturation. Patients cannot be put into culturally specific boxes or given labels on the basis of race, religion, or ethnic background. Health care workers should not assume that one criteria or belief of a certain cultural group is true for every patient in that bracket. However, some consistent beliefs and attitudes exist. Being aware of those beliefs and attitudes and being willing to accept the patient’s beliefs to care for him or her are important. Health care providers may not always agree with a patient’s beliefs, but it is important to understand that various beliefs exist and to find ways to work within those belief systems.

Ethnography

Ethnography is a branch of anthropology that studies and records various human cultures. Health care educators look at the research information from ethnographic studies and teach providers to become culturally competent. Cultural competence is the ability to meet the health care needs of patients while meeting and adhering to their cultural values, beliefs, and practices. It requires sensitivity to the patient’s needs and wants and a deep understanding of their views and values.

Wellness and Health Prevention

Americans are focused on healthy living and disease prevention (Box 5-2). The general view is that it is important to eat right, get enough sleep, exercise, and have preventive medical visits (e.g., annual Pap tests, mammograms, immunizations). An illness is seen as interference with one’s schedule, and thus it must be overcome quickly. Other cultures disagree with these beliefs. For example, some American Indian tribes view weight gain as a normal occurrence in adulthood; jogging and aerobic activities are seen as senseless.

Many cultures view thinness as a sign of wasting away and sickness. What may be considered overweight to one group is healthy and normal for another.

Various national organizations have studied ethnic groups and cultures to see the differences in their approach to preventive medicine. Breast cancer mammography screening is known to be effective against early detection, but Chinese Americans are reluctant to make visits for such preventive care. Studies suggest that cultural beliefs warn against “looking for trouble” and see it as senseless medical care.

Some cultures do not value immunizations, and other cultures perceive immunizations as injecting poison or harm into the body. According to the CDC, 60.6% of whites receive the pneumococcal vaccination, but only 23.8% of Hispanics and Latinos have that immunization. Most Americans view immunizations as basic preventive health care.

Touch and Physical Space

In some cultures, close touching and human contact is a sign of respect and friendship. A simple handshake with a smile and “Hi, I am going to be your nurse today,” shows warmth and caring. Yet in other cultures direct hand contact is not welcomed and is seen as an invasion of privacy. For example, Muslim women cannot be touched by men who are not immediate family members. Always ask permission first before touching any patient, regardless of cultural differences.

Most Americans prefer to keep a physical distance of 3 feet between peers and acquaintances. Yet other cultures see that distance as lack of personal caring and closeness. They may view distance as “cold.” Be alert to positive or negative signs that tell whether the patient is comfortable with the amount of physical space allowed.

Communication

Communication is vital to our survival. Obviously language barriers affect our ability to communicate. According to the U.S. Census Bureau, 82% of households speak only English, but 10% of Spanish households do not speak English at all, and 18% speak English in only small amounts. Language is a form of cultural connection. It ties a group of people together. Volunteer interpreters may help translate, but they also can help with cultural assimilation. Assimilation is the process of accepting and exchanging cultural information.

The ability to communicate has far more importance than language alone. For example, discussions about sexual activity may be considered taboo and insulting to certain cultural groups (Fig. 5-2). Yet other cultural groups, like Americans, are willing to discuss sexual habits and activities more freely. Asking a patient, “When did you have your last bowel movement?” may be appropriate in the United States, but to some cultures discussing elimination patterns is inappropriate.

Asking young women about menstruation may be viewed as intruding and inappropriate in some cultures. Yet in other cultures women willingly and openly discuss it and even joke about it.

In matriarchal societies and cultures, the oldest woman in the home makes all the decisions, including health care choices, but in patriarchal societies, the oldest male makes the decisions. Most Americans have a strong cultural belief in their independence and make solo decisions. It may seem peculiar or even upsetting to see a woman look to her husband for permission to speak or act. Respecting such beliefs and traditions, and not interfering with them, is important.

Answers to Case Studies

are available on the Evolve website: http://evolve.elsevier.com/Gerdin