Life Today in Russia

Today in Russia, life continues to be difficult and frustrating. Anti-Semitism escalates. Railroad stations are crowded with homeless, begging adults and children because of unemployment and underemployment, chemical addictions, mental illness, and lost pensions. Since 1992, a positive downward trend has occurred in Russia’s recorded poverty levels. In 1992, nearly 34% of Russia’s total population had incomes below the subsistence minimum level. This number dropped to 11% in 2013 ( ). Still, the total unemployment levels for Russian youth have reached 15% ( ). An estimated, though largely ignored, 1 to 4.5 million Russian children are homeless (doubled in the last decade), related to three categories of social problems and family dysfunction. First (41%) is that one or both parents have chemical dependency problems. The second is the loss of a mother, a father, or both (e.g., through death, prison, abandonment), and the third is domestic violence. Approximately 2 million Russian children suffer abuse ( ). An estimated 5 million Russians (3.4% of the population) are homeless, and most are men trying to reintegrate into society ( ). Hundreds freeze to death on the streets each winter ( ). They have been forced into the streets by cruelty, alcoholism, neglect, and abandonment. They are beggars, thieves, substance abusers, and prostitutes; many have been viciously attacked or are suffering from hypothermia, malnutrition, and depression and are illiterate. The vast majority of street children have attempted suicide at least once. Suicide rates by Russian children and teens are the highest in Europe with a 36% increase over the past few years and three times the world average. Homeless children and boarding school and orphanage graduates are more likely than others to commit suicide ( ). Crime and fraud are everywhere fueled by a normalized sense of injustice, insecurity, and mistrust ( ). After the dissolution of the Soviet Union, few if any controls enforced homelessness as well as law and order within the country. Thus, crime exploded. Theft and gangs proliferated, along with weapons and explosives. Without Soviet control, murder and crime rates doubled during the early 1990s. Russia’s police force is plagued by low pay, low prestige, and high levels of corruption ( ). Crimes against women (domestic violence, prostitution, and trafficking) are pervasive and severely underreported ( ). Trafficking of girls and young women as foreign brides is pervasive. A Google search using the keywords “Russian women” listed 197,000,000 sites; when the words “mail order” were added, 21,000,000 sites appeared. Although Russian criminal code has laws that protect women from interpartner violence, no clear mechanisms are in place to support the women or enforce these laws ( ; ). According to , most Russian pregnant women decreased their drinking while pregnant, but a full third of the pregnant women studied did not stop drinking.

Russia’s economy and infrastructure have recently shown signs of improvement. After more than a decade of steady decline, Russia is moving to a more market-based and globally integrated economy. Russia’s GDP grew last year by 1.3% ( ). The telecommunications industry has expanded (over 40.9 million Russians use the Internet), airports and airlines are being enhanced, and road construction and maintenance are improving. Importantly, governmental control over the economy and media has been reasserted by the Putin administration ( ; ).

Small economic gains have done little to improve Russians’ health. Health indicators are good social barometers when evaluating the success of any social or political reform. This is especially true during this transition time for Russians. For Russia, population decline and homelessness pose a clear threat to national and economic security as well as the human potential and viability of the nation. In 2014, Russian women of childbearing age had an average of 1.6 children, which means there are about two more deaths than births per 1000 ( ) By the year 2050, Russia’s population will have fallen by 28%. Male life expectancy in Russia dropped from 64 to 57 years between 1989 and 1994 and is currently again at 64 years for men and 76 years for women. Men and women with less education, who are homeless, and who have higher unemployment rates have higher death rates; alcohol plays an ever-increasing role in Russian mortality rates ( ; ; ). Interestingly, the total population includes just 0.86 males for each female ( ). Men, and very troubling, working men, die far sooner than women because of cardiovascular disease, poisonings, respiratory disorders (60% of Russian men and 22% of women smoke), traffic and industrial accidents, alcoholism, and suicide ( ; ). The infant mortality rate is 7.08 per 1000 live births ( ). Externally caused deaths in Russia are increasing and have been described as an epidemic of injury and violence. Rates of transport-related injury, poisoning, falls, burns, and drownings, as well as intentional injuries such as self- and other-inflicted violence have more than doubled since the mid-1980s ( ).

Tuberculosis (TB) is a major concern, killing more than 18,400 per year. In 2013, TB prevalence was 160,000. Significantly, over 19% of TB cases (50,000) are multidrug resistant (MDR), 36% of newly identified cases are drug resistant, and 4% of all new cases are for children under the age of 15 ( ; ; ). Poverty, unemployment, crime, and homelessness contribute to TB’s spread to 320 new TB cases each day. Importantly, children from these groups contract TB 10 to 20 times more frequently; among all TB cases in Russia, 12% occur in prisoners ( ). Russian prisons are filled with TB-afflicted and HIV-infected persons, in part because of severe overcrowding, and when released, they spread these infectious diseases to the general population ( ). HIV/AIDS is also a growing but often secret epidemic, with the number of infected Russians doubling within the past decade ( ). Among world populations, Russia and the Ukraine are believed to have the greatest HIV growth rates, with prevalence doubling every year ( ). More than half (60%) of all new HIV-positive cases in Russia are among injection drug users (IDUs), with 83,118 IDUs in St. Petersburg alone ( ). Since 1990, the number of IDUs has increased 20-fold ( ; ). Unfortunately, many, perhaps most, IDUs have not been tested or treated for HIV status ( ). The main infected persons are drug users and sex workers. By 2005, sex workers became a leading cause of HIV transmission (partly due to the government’s unwillingness to address and document the problem), and the international sex industry’s use of Russian women makes Russia’s rapidly rising HIV rates an international problem. In addition to prison transmission, HIV and TB infections have spread rapidly among young male Russian populations. The number of Russians infected with HIV has more than doubled since 2001 ( ; ). On December 8, 2005, thousands of Russian hospital patients learned that they may have been treated with HIV-infected blood. Hospitals are incredibly understaffed, with as few as 3 nurses to 40 surgical patients. Nearly all supplies are reused, including suture needles, gloves, drapes, basins, urinals and bedpans, and intravenous (IV) bottles ( ). Medications are expensive and access is tenuous. For example, use of modern, efficient, and effective forms of contraception among sexually active Russian women did not increase between 1994 and 2003 ( ).

For every 1000 people, Russia has 4.9 physicians, 8 nurses (an increase of 0.3% since 2000 and totaling 1.9 nurses per physician), 0.3 dentist, and 0.1 pharmacist. Russia has 62,000 hospitals (down from 126,000) and 9.3 hospital beds per 1000 population (down from 13.1 in 1992), with an average hospital stay of 11 days. Importantly, in 1992 Russia had 207,000 outpatient facilities; this number has dropped to 165,000 ( ; ). Compare these health care worker numbers with those in the United States, which has 2.5 physicians, 11.1 nurses, 1.6 dentists, and 4 hospital beds (with an average length of stay of 6 days) for every 1000 people ( ; ). Despite a negative population growth, the morbidity rate from all diseases increased from 106,328 in 2000 to 113,688 in 2012 ( ). The general health status of Russians is complex and fluctuates based on political and economic variables. Since 2000, morbidity levels of injuries and poisonings, respiratory and cardiovascular disorders, obesity, cancer, diabetes, and all other recorded parameters are increasing, yet deaths from all causes have, since 1992, increased only marginally; external causes of mortality such as homicides and transport injuries are in decline. Life expectancy for men in 2005 was 58.9 years, which increased to 64.6 years in 2012. Between ages 0 and 4, there are only 949 females for every 1000 males. This ratio dramatically changes by the age of 30 when there are more females than males; between ages 35 and 39, there are 1048 females for every 1000 males; by ages 60 to 64, there are 1424 females per 1000 males. Thus, the current difference in life expectancy for women and men is 11.3 years, down from 13.6 years in 2005 ( ). Russia’s health care system remains mostly public supported via a nationalized budget and, on record, is free. It does, however, suffer from the problems of inefficiency, incompetence, low salaries, and bribery ( ; ). Hospital staff often expect extra payment for medications, disposable needles, and extra services. Quality medical care depends on the patient’s ability to pay for these extras. Hospitals hope for additional government reforms that would improve care and system-wide efficiency, and visitors to Russia are warned of long waiting lines for care and strongly encouraged to obtain insurance coverage for medical evaluations prior to their arrival ( ). Hospitals and clinics are poorly managed, equipped, and maintained. Most physicians and nurses are paid low salaries ( ). Thus, there is a steady shortage of skilled and specialized nurses as well as other health care personnel. There is also a shortage of medical supplies and updated equipment ( ; ). In a study of the fragmented Russian health care system, confirm the absence of processes that Russia could use to bring about additional change. As evidence of poor health outcomes, the number of surgical site infections in St. Petersburg hospitals is 3.5 times the rates in the United States, much greater than expected or reported. Possible contributors to these high rates include inadequate antibiotic prophylaxis as well as poor or ineffective infection control practices ( ).

Preventive health care is a low priority, but the Russian Ministry of Health wants to change that by raising the bar for who qualifies for hospital admission, decreasing the number of hospital beds in Russia, and encouraging more doctors to specialize in preventative medicine ( ; ). As evidence of these changes, the total GDP spent on health care has risen from just over 3% to 6.2% ( ).

Many of the old Soviet-era system-wide health care challenges remain. Russian health care consists of outpatient clinics and emergency and in-patient care services. The need for primary care by the Russian population far outweighs the current system’s treatment abilities. Although primary care strategies are getting government attention, disorganization of district-level physicians, ineffective epidemiological monitoring, and poor payment structures actually prevent primary care providers from preventing disease. Instead, patients use expensive emergency care for their outpatient care needs. Rural areas have also seen dramatic shortages of skilled health care professionals, including nurses. Importantly, Russia has not developed a system by which highly skilled, community-based nurses would provide primary care services. If primary care is indeed a national priority and the need to reduce expensive inpatient and emergency care is addressed, community-based nursing care is essential to the improvement of health and health care in Russia ( ).

Russian children, when compared to their U.S. counterparts, begin drinking and smoking earlier, receive fewer prevention messages, and have fewer prevention programs available to them ( ; ). Nearly 60% of Russians smoke, with a dramatic increase among women under age 30 to nearly 30% ( ). New government efforts recently passed may help curb this trend with a bill passed in 2013 to ban smoking in public places and a new law identifying beer as an alcoholic drink rather than a food and banning the sale of beer in curbside booths ( ).

Russian nurses are learning to expand their roles as independent practitioners into community health areas ( ; ) with the help of the RNA, established in 1992. The RNA became a member of the International Council of Nurses in 2005 and has over 180,000 members in 56 Russian regions. Nurses’ goals include role advancement, professional development, economic and professional protection, and important health care system influence. The mission of this hugely important nursing association includes “Assisting the growth of the quality and accessibility of nursing care in Russia and improving the criteria indicating the health of the nation” ( ). Accomplishment of these goals will be essential if the steady increase in tobacco, IV drugs, and alcohol use in Russia is to change course, and Russian nurses express hope that, although the Russian health care system struggles, the life of a Russian nurse is better than it was 10 years ago. They express hope that modern advances will move Russian health care forward ( ). For example, in 2012 the RNA received a $149,946 grant to upgrade the quality of care received by cancer patients experiencing chemotherapy at different care settings. The organization will help develop a nursing education curriculum to educate 60 nurses who in turn will educate an additional 1200 nurses within inpatient, outpatient, ambulatory, and home care settings. Evidence-based practice standards will also be implemented and evaluated ( ).

History

Historically, Slavic tribes began migrating into Russia around the fifth century, and the first Russian state was established in the ninth century by Scandinavians. Mongols overran the country until 1480, and Ivan the Terrible became the first tsar in 1547. Peter the Great (1682–1725) tried to Westernize Russia, but the pace was slow. Russia had no universities until 1755. In 1917, after Tsar Nicholas II abdicated (and during the October Revolution), Lenin and the Bolsheviks overthrew the government. Between 1918 and 1924, the tsar and his family were murdered, the Bolsheviks declared ideological war on Europe, Joseph Stalin (Josif V. Dzhugashvili) became general secretary, and the Union of Soviet Socialist Republics (USSR) was established.

Further political change in Russia has been dramatic and historic. The current political situation began on March 11, 1985, when the former USSR KGB chief, Secretary Konstantin Chernenko, died and was replaced by Mikhail Gorbachev.

Between 1985 and 1990, the Gorbachev–Shevardnadze team created a new human rights movement within the USSR. Gorbachev’s reforms, identified as perestroika (restructuring) and glasnost (openness), swept the country with promises of a modern democracy and freedom. However, Gorbachev inherited an inefficient, centralized, and decaying empire ( ; ). Gorbachev believed that free enterprise and a carefully controlled form of democracy could be the overhaul needed for communism. To help him with this plan, he heralded a known reformer, Boris Yeltsin.

Yeltsin proved to be forceful, authoritarian, proud, chaotic, and critical of Gorbachev’s leadership. Therefore, in a powerful control move, Gorbachev publicly humiliated and fired his former protégé. This embarrassing termination triggered Yeltsin to campaign against the Communist Party and to run as a candidate for a parliamentary seat as the people’s deputy from Moscow. Yeltsin achieved enormous popularity among the people, 90% of the vote, and leadership of a growing group of people who opposed communism ( ).

In February 1990, the USSR’s Central Committee eliminated a constitutional clause that guaranteed the leading role of the Communist Party. Independence from the Soviet Union is identified as occurring on August 24, 1991 ( ). Yeltsin left the Communist Party in 1990. After confrontations with the Baltic republics, Gorbachev began discussions that would lead to the creation of a “voluntary” union of the republics.

In May 1991, Soviet citizens were given the right to emigrate. The law titled “On the Procedure for the Exit from the USSR and Entry into the USSR of Citizens of the USSR” came into full effect in January 1993. This law was heralded as one of the most significant steps toward an open Russian society and marked the end of Communist-enforced isolation ( ). This law restored the rights of the Russian people to travel freely.

In a historic move and by democratic vote, the citizens of the Russian Republic (highest population and most wealthy republic) elected Boris Yeltsin (June 12, 1991) as its first president, with a 57% vote ( ; ). However, shortly thereafter, Gorbachev was overpowered in a dramatic conspiracy coup. After that time, there were ongoing struggles over rulership of this land as power passed back and forth between Yeltsin and coup forces. Yeltsin had great power but failed to use this power to make immediate and necessary reforms. Yeltsin’s popularity declined dramatically as a result of internal fighting among the 1033-member parliament (also called Congress of People’s Deputies ).

The Congress (or Duma), Russia’s highest legislative body, was formerly dominated by an anti-Yeltsin majority of ex-Communists ( ). During Yeltsin’s tenure, his economic policies received much criticism, and by the spring of 1993, eight attempts on his life had been reported ( ). However, Yeltsin continued to push for democratic reform ( ), including opening classified Soviet archives, allowing Russians the right to own property and businesses, and attempting to stabilize the unit of Russian currency, the ruble. Other reforms included increasing social care for the needy, formalizing a system of granting benefits and privileges ( ), enforcing public disclosure of environmental accidents, dismantling state economic controls, and cutting the military by half, including dramatic nuclear arms cuts, to invest resources in other areas. Vladimir Putin (Yeltsin’s hand-picked successor) was president from 2000 to 2008 and again took office on May 7, 2012. Putin has inherited the conflict in Chechnya, which continues to draw international and national criticism. Universal suffrage occurs at age 18 ( ). The military draft in Russia includes males ages 18 to 27, and the length of required service is 1 year. In 2013, only 65% of the Russian men called up for military service were healthy enough to serve ( ).

For many years following the Soviet collapse, the Russian military experienced disregard. Now, under Vladimir Putin, a shift toward Russian military supremacy and power internally and beyond its borders has occurred. Putin is implementing military reforms to establish a crisis-reaction force and special operations force as well as professionalized and better organized ground forces. As evidence, its military budget has more than doubled within just 10 years. (However, because over half of Russia’s federal budget income is based on oil and gas products, as these commodity prices fall, defense spending will likely follow.) As seen recently in the Crimea, Ukraine, and Georgia, Putin’s administration is using military force to preserve Russia’s hold on border nations. Western sanctions against these military efforts have, however, imposed economic hardships for Russian banks and businesses ( ).

In contrast to continued military restructuring, Russia’s democratic reforms have slowed and in some cases reversed. Today, the greatest danger in Russia is the widespread disregard for democracy and the repression of free speech, such as unbiased radio, television, and newspaper coverage of political issues ( ; ).

Life Today for Russians in the United States

Russian Americans report new and much welcomed freedoms in the United States. For example, Russian American Jews and Pentecostal Christians are often able to fully practice their faith for the first time upon arriving in the United States, and Russian parents commend the skills their children learn in schools. They report no longer feeling like persecuted members of minority groups. Russian Americans especially appreciate creative skills of thinking, analysis, and discussion. Russian women are familiar with working outside the home in well-paying professional positions. In Russia, most health care professionals are women. They are also used to doing the work of the home and are expected to do all or most of the household chores such as cooking and cleaning ( ).

Russian Americans try hard to maintain strong social networks, family stability, and a self-identity that includes their Russian heritage ( ). Within the family, Russian American women have been responsible for nurturing the Russian culture identity among family members, and Russian women counsel strong values of philanthropy and community ( ). Therefore, Russian immigrant communities often provide supportive services such as career and employment guidance, housing assistance, professional networking, technical training programs, classes in English as a second language, and health care. Importantly, Russian Americans have high levels of social participation and interactions within Russian communities.

Americans should understand that in Russia, medical treatment, although limited (at least on record), remains free. Education, including postsecondary university and professional studies, is also often provided at low or no cost, although teachers and university instructors are poorly paid. Therefore, many Russian immigrants, including women, have had some form of technical training or advanced education. Nevertheless, Russian immigrants may have difficulty understanding the concepts of insurance, private pay, medical malpractice, health maintenance organizations, medical referrals, diagnostic-related groups, and reimbursement coding. The large and growing Russian-American population, when compared with other immigrant groups, is better educated and enjoys higher levels of discretionary income. For example, of the number of foreign-born Russian immigrants, 54.7% have attained at least a bachelor’s degree, and 16.5% are self-employed. Russian Americans are also more likely to own their own homes and have health insurance. Almost half of foreign-born Russians (47.4%) own their own home and, along with their U.S.-born children, nearly 80% have health insurance coverage ( ). Over 44% of Russian Americans are over the age of 55, and just 8.6% are between 0 and 24 years old (compared with 21% of all foreign-born U.S. residents). Thus, the age composition of the Russian-born U.S. population is skewed toward elders. Clearly, this group of well-educated people is keenly interested in health promotion; illness prevention; and skillful, culturally competent, health care professionals ( ; ).

Dialect, Style, and Volume

The official language of Russia, and the most widely spoken of the Slavic languages, is Russian. This language has a 33-character Cyrillic alphabet (reduced to 33 characters with the 1917 Soviet revolution) named after the ninth-century apostle to the Slavs, St. Cyril. St. Cyril created the alphabet so that the Bible could be translated for liturgy use in the Slavic countries ( ). In the tenth century, the Cyrillic alphabet was adopted by Russians, simultaneously with Christianity. The Cyrillic alphabet was last renovated in 1918. Russian belongs to the eastern branch of the Slavic linguistic family. More than 250,000,000 people speak Russian worldwide. For most Russian American newcomers, Russian is the language used to connect with family and friends. Additionally, the Russian language helps maintain Russian heritage and identity for Russian Americans. Evidence of this trend is the continued large number of Russian speakers and dramatic increase in Russian-based media (e.g., newspapers, books, television stations, Web sites) ( ).

For most Russians, English is the most popular of all the Western languages. This newfound popularity of English on the part of the Russian people is related to media broadcasts, movies, rock video television programs, and Western business opportunities. In addition, pro­fessional literature (including health and medicine) is often in English, and medical students are frequently required to read English-language medical journals. There are 261,900,000 cell phones, 40,853,000 Internet users, 14,865,000 Internet hosts, and 3300 television stations (most controlled by federal or local governments) ( ). Although information is hard to suppress and English is widely used, government-controlled media and propaganda broadcasts flourish under Putin’s grip.

Russian is sometimes referred to as a “house green” language because articles (such as the ) and verbs (such as is ) are often unnecessary. The Russian language is a flexible, beautifully rich language. Paralanguage qualities, such as tone, inflection, speed, vowel emphasis, and verbal pauses, contribute to the variety and meaning of Russian words and sounds. Russians freely use paralanguage and other nonverbal indicators to denote the value being placed on what is said. The spirit of the Russian people, their warmth and love, come through clearly in this dialect ( ). Importantly, just as in the United States, the Russian language carries geographic variances and vernaculars.

Russian Americans’ first language may not be Russian but may instead be from the region where they grew up. Many Russian Americans studied some English while in Russia. However, the English they memorized was boring and often British English, which is significantly different in sound, spelling, and pronunciation from American English, making language comprehension difficult. In addition, American vernacular variances and geographical accents can cause problems.

Although many well-educated Russians studied English at some point in their education, English proficiency is not easy, especially for older Russian American immigrants. However, many elderly Russian Americans speak a mix of Russian and English, using both simultaneously ( ). In the United States, Russian speakers rank fifteenth of total speakers of various languages. Using self-report information, there are about 3.13 million Russian Americans ( ); in 2015, 981,000 people aged five and older speak Russian at home. This number is expected to jump to 1,048,000 by 2020 ( ). However, younger Russian immigrants have made the adjustment to English with less difficulty. For younger Russian immigrants, the first priority on arrival in the United States is to learn conversational English, the second priority is to enroll children in school, and the third priority is to find good employment. Nearly half of all Russian speakers are over age 44 ( ). Most Russian Americans maintain a bicultural identity that varies based on age, employment, newcomer status, and levels of acculturation. Acculturation differences among family members may produce conflict and stress. Compounding this stress is that Russian American parents and elders expect youth to obey authority, bow to parental controls, and perform interdependently with family members. Russian children, by contrast, have absorbed American values of autonomy and independence ( ).

Additional stress occurs when Russian youth are frequently required to act as culture brokers for their older parents and grandparents. Brokering duties, especially prevalent among recent immigrants, such as acting as language and information interpreters for education, government, and health care institutions, are common. For Russian American teens, these brokering tasks have created increased levels of stress and relationship problems with family and friends ( ). Using skilled language interpreters, not friends or family, is important because of potential language barriers, impediments to free and clear communication, and confidentiality and ethics violations. Family, especially younger family members, may be embarrassed and anxious during the crisis of an illness or problem. Elderly Russian Americans with English competence enjoy better mental and physical health and, according to , language was not a significant predictor of health service use among elderly Russian immigrants in Boston. Notably, interpreters translate more than just words. They must also convey paralanguage, nonverbal, and subtle meanings. Thus, an additional advantage to using trained Russian interpreters is that, even when Russian Americans speak English well, they express emotions more fluently and use greater numbers of active verbs (versus adjectives) than when speaking of the same situation in English ( ). Fortunately, many medical, chemical, and scientific terms are cognates, and although the written appearance of the word is different between Russian and English, the sound is similar. A few medical cognates are organ(ism), appetite, function, pulse, doctor, hospital, physical, diagnosis, normal, and problem .

The volume of speech used by Russian Americans is not significantly different from that used by some Irish Americans. In Russia, because loud, aggressive demands were often necessary to receive medical care, some Russians became loud when attempting to be understood or get attention. Thus, even normal conversation may seem loud and boisterous.

Touch

Russians often use touch freely with intimate and close friends. It is not unusual to see Russian women embracing and kissing other women, as well as Russian men embracing and kissing other men. Friends who have been separated often greet each other, in public or in private, in this fashion. The technique of kissing each cheek three times seems to be a cultural trait adopted from the Middle East. The gentle kiss of a man on a woman’s hand is a gesture of respect and admiration. Also, a handshake of agreement from a Russian is often more binding than a signed document. Handshakes are welcome when accompanied by direct eye contact, and gloves must not be worn. Prior to any touching, Russians may ask for and need the health care provider to explain what will be done and why ( ).

Context

Russian people are commonly perceived as kind, caring, and generous. When trust has been established, they express these feelings willingly and publicly. They are by nature and experience, however, cautious. Some Russians evaluate situations and people with great care. Emotions are also freely expressed. Russians have a quick appreciation for jokes and satire, often venting their feelings in this form of expression. It has been said that Russian people cry and laugh easily and that genuine expression of emotions is valued. Russians also tend to exhibit less control over negative emotions, especially with strangers ( ).

Russian people who learned English in Russian schools may have learned from a non-native speaker. Therefore, the sound of English will be different. Native Russians who are eager to practice conversational English with a native English speaker often approach tourists traveling in Russia. However, for most new Russian immigrants, conversational English is likely to be unrecognizable.

Russian people have learned through years of government rule to look and act neutrally. With strangers and in crowded places, eye contact is avoided, affect is flat, posture is not erect, and eyes are diverted. Upon arriving in the United States, Russian Americans often express great wonder at the freedom with which Americans make nonverbal connections with strangers. However, Americans tend to be cooler and more distant with close friends and family, avoiding unsolicited advice-giving, than Russians. Historically, a distrust of authority and subsequent reliance on family and friends for help, advice, and care were survival mechanisms. Thus, for Russians, it is common to visit friends and neighbors on a whim, bringing food and gifts without notice, whereas in the United States this practice is uncommon ( ). As interesting evidence, the Russian language includes two ways of saying the plural “you,” one for only the closest of friends and family and a second, more generic, term when speaking with colleagues or strangers.

Kinesics

Russians understand that public behavior needs to be respectful. Disrespect is shown when persons fold their arms across their chest, stand with hands in their pockets, slouch, cross legs so as to expose the sole of the shoe, and walk into a house with shoes on ( ). Smiling at another person must be sincere ( ). Until trust and comfort have been established, Russian Americans’ nonverbal communication style is subtle and with few gestures. They do, however, feel free to maintain eye contact, and they do allow and expect nurses to use touch and gestures freely during the implementation of nursing procedures. Older Russian American immigrants are more entrenched in social amenities, often preferring to express themselves verbally. “Please” and “thank you” are integral to their speech, and they use these words at every possible opportunity. Russian men will courteously open doors for women. Nodding one’s head is a gesture of approval; outstretching one’s hand is a gesture of salute. When compliments are given, they are sincere. Gifts and flowers are presented during important meetings as a gesture of tribute. The person seated first in a room is the one with the most authority or prestige. Nurses should not use the common American-based “OK” sign when speaking with a Russian because this is considered rude. Russian Orthodox followers will cross themselves from the forehead to the upper chest, then the right to the left shoulder ( ).

Implications for Nursing Care

Russian Americans expect the nurse to be warm and caring, to demonstrate empathy, and to help them cope with physical and emotional problems. An often expressed expectation of the nurse by the Russian American is that the nurse be friendly. This expectation is demonstrated by an “inviting,” open posture; a smile; and a low and calm voice. As health care professionals, nurses are expected to show support in word and deed, suggest specific interventions that will improve the patient’s situation, and begin these interventions immediately. Nurses should also anticipate patient needs, even when not expressed directly ( ). Appropriate touch is considered a sign of friendliness and caring. Russian Americans do not appreciate a light, “chatty” approach to health care; they believe appearance and demeanor must always remain professional. Russian Americans want to be certain that the nurse understands them. They can easily become very shy; this is especially true of recent immigrants. Because their English may be tenuous, Russian Americans may hesitate to ask for clarification.

Russian American patients need to be assessed for their level of acculturation, English language skills, and education and social status. When doing histories or intake screenings on Russian Americans with English literacy, nurses need to understand that if they are speaking and thinking in English, they will describe symptoms and events differently than when speaking and thinking in Russian. ( ). Even if a Russian American is fluent in English, communicating in English during times of pain, stress, and anxiety will be difficult. Knowledge of this difficulty is especially important when working with elder Russian Americans. Nurses must always avoid using family and friends as language interpreters and culture brokers.

Russian Americans expect the nurse to speak slowly and clearly and to choose simple words when needed. Russian Americans may demonstrate limited listening skills, perhaps because of language barriers, and may be unwilling to make independent health care decisions. Russians may assume the nurse and physician will tell them everything they need to know about their health problem and often prefer a more direct, versus indirect, approach to their care needs. However, gestures and demonstrations, to clarify and promote understanding, are expected and appreciated. “Look at my eyes,” explained one Russian American. “My eyes will tell you that I do not understand because I will have a stupid expression!”

In most instances, Russian Americans will comply with medical directives and teachings if they believe that the nurse is trustworthy, honest, caring, sincere, and competent. Nurses will not be believed or trusted by Russian Americans if they are perceived to be mask-like, robotic, insincere, or phony in their caring behaviors. Nurses should address Russian American clients by “Mr.” or “Mrs.” followed by the family name. However, use of the first name, followed by the patronymic (their father’s first name plus a feminine or masculine ending, depending on the person’s sex) may be an acceptable alternative. Well-educated and professional Russian American women often retain their maiden names. Using this formal method of address will convey the nurse’s respect. To address a Russian by his or her first name only is improper and presents a grave social error. Russians also object strongly to terms of endearment, such as “dear,” “hon,” “sweetie,” “darlin’,” “dude,” and “hi, guy,” when used by health care workers ( ). As explained by one Russian American, “I want you to believe me when I tell you I have a problem. Here the nurses are perfect. We will respect them and listen to them. They know their job, and they know what they are supposed to do.”

Russian Americans tend to speak freely regarding physical problems. Once language is no longer a concern, the nurse will find that clients respond warmly. However, Russian Americans may be uncomfortable using gestures when speaking to the nurse. The nurse must be aware that although younger Russian immigrants adapt well to English, older Russian immigrants may not. Often, elderly Russian immigrants choose to associate only with Russian-speaking friends and relatives, which presents a difficult problem if an interpreter is unavailable. To add to this difficulty, Russian Americans may allow only Russian to be spoken at home. Because many Russian Americans are multilingual (Yiddish, German, French, Polish, etc.), it is an advantage if the nurse understands another language familiar to the client. One way to convey respect and an understanding of Russian culture is to provide avenues for client teaching through Russian literature. Health literature written in Russian, in addition to Russian-language audio and video presentations, may prove to be great teaching aids. Additionally, cognate words and trained interpreters should be used at all times. found that Russian Americans occupied an additional 5.6 minutes of physician time for each visit. These authors believed this time was spent because of the extra demands for interpreting health information. Therefore, nurse managers will need to adjust workload requirements for nurses working with Russian American clients.

The challenge for nurses is to expand their own culture to care effectively for members of the Russian American ethnic group. These skills can strengthen the nurse as a person and as a culturally competent health care professional.

Implications for Nursing Care

The nurse who cares for Russian American clients will generally find that health-assessment procedures done in the intimate areas such as the genitalia are accepted without argument or problem, provided that adequate information and justification have been given before the procedure, the nurse is perceived as a trusted health care professional, and permission from the client has been professionally requested and provided. The nurse should be aware that, for the most part, Russians prefer to remain at a social distance rather than an intimate distance with caregivers. If personal distance must be invaded to provide therapeutic assistance, the nurse should provide a careful explanation before the intervention to alleviate the stress and anxiety created by the violation of space. As with all aspects of care, it is important for the nurse to modify approaches based on a careful assessment of the individual client and family.