On completion of this chapter the reader will be able to: • Define culture, cultural competence, ethnocentrism, and cultural relativity. • Describe the subcultural influences on child development. • Discuss the population of minority children in the United States. • Identify the impact of culture on health. • Identify the impact socioeconomic influences have on health. • Identify areas of potential conflict of values and customs for a nurse interacting with different cultural and ethnic groups. evolve.elsevier.com/wong/essentials Cultural humility is a “commitment and active engagement in a lifelong process that individuals enter into on an ongoing basis with patients, communities, colleagues, and themselves” (Tervalon and Murray-Garcia, 1998, p. 118). It requires that health care providers participate in a continual process of self-reflection and self-critique that recognizes the power of the health care provider role, that views the patient and family as full members of the health care team, and that does not end after reading one chapter or attending one course but is an evolving aspect of being a health care provider. “Cultural competency is not an abdominal exam” (Kumagai and Lypson, 2009, p. 783). It is not a static endpoint to be checked off the list but an ongoing process that promotes deeper thinking and knowledge of oneself, others, and the world (Kumagai and Lypson, 2009). It is also important to understand nursing’s contribution to culturally congruent care. A holistic view of care was first described by Madeleine Leininger, the recognized founder of transcultural nursing, in her culture care diversity and universality theory (Leininger, 2001; Munoz and Luckmann, 2005). The theory provides an intellectual framework and a research methodology for providing culturally congruent patient care. Nurses must remain aware that every family, child, and health care provider comes to a clinical encounter with a cultural lens through which they see and interpret the world. The manner and sequence of the growth and development phenomenon are universal and fundamental features of all children; however, children’s varied behavioral responses to similar events are often determined by their culture. Culture plays a critical role in the parenting behaviors that facilitate children’s development (Melendez, 2005). Children acquire the skills, knowledge, beliefs, and values important to their own family and culture. Cultural backgrounds can influence the pace of acquisition of cognitive and motor skills as well as the child’s social and emotional development (Trawick-Smith, 2006). Culture influences a child’s sense of self-esteem (Trawick-Smith, 2006). Some cultures are more collective in thought and action. A child from a collective culture will hold an inclusive view of him- or herself. Self-evaluation is related to the accomplishments or competencies of the entire family or community. School experiences that focus on personal achievement may promote positive self-esteem in some children but not in others who are more dependent on the success of a whole family or peer group. Their sense of control may not come from individual self-reliance but rather from a feeling of worth in their family or community (Trawick-Smith, 2006). Families and culture also influence the criteria children use to evaluate their own abilities. Additionally, cultures vary in whether they instill an internal locus of control (a belief in the ability to regulate one’s own life). Effects on self-esteem are minimal if these beliefs are directed by parents and are in accordance with cultural customs (Trawick-Smith, 2006). Ethnic pride can help children to maintain a positive self-image and counteract the effects of prejudice, which can have a negative impact on emotional health (Trawick-Smith, 2006). 1. Working on changing one’s world view by examining one’s own values and behaviors and working to reject racism and institutions that support it 2. Becoming familiar with core cultural issues by recognizing these issues and exploring them with patients 3. Becoming knowledgeable about the cultural groups one works with while learning about each individual patient’s unique history 4. Becoming familiar with core cultural issues related to health and illness and communicating in a way that encourages patients to explain what an illness means to them 5. Developing a relationship of trust with patients and creating a welcoming atmosphere in the health care setting 6. Negotiating for mutually acceptable and understandable interventions of care The U.S. 2010 census revealed more than 300 million people in the United States. The Hispanic population included 16.3% of the total population (Humes, Jones, and Ramirez, 2011). Currently, Hispanics are the fastest growing minority in the United States and have many health needs that are not being met (Murdock, 2005). In 2050, almost 30% of the U.S. population is expected to be Hispanic (Murdock, 2005). Historically, schools have participated in devaluing Native American languages, cultures, and traditional ways of learning and knowing. Unfortunately, Native American children have been deficient in their preparation for school (Beaulieu, 2000). Also, children of Native American nations have been at risk for low achievement, overrepresentation in special education, and dropping out (Demmert, 2001). Many regional dialects and variations in language usage must be considered when communicating with persons from these groups. English words that sound like words in a foreign language can cause considerable misunderstanding. Children of some cultural groups fare less well in school. They come from underrepresented groups, including African-American, Mexican American, Puerto Rican, and Native American children (Trawick-Smith, 2006). These cultural variations can be attributed to high rates of poverty, different cognitive styles, ineffective schools, and parents’ views of schools as oppressive to cultural and traditional values (Trawick-Smith, 2006). 1. Support—Young people need to feel support, care, and love from their families, neighbors, and others. They also need organizations and institutions that offer positive, supportive environments. 2. Empowerment—Young people need to feel valued by their community and be able to contribute to others. They need to feel safe and secure. 3. Boundaries and expectations—Young people need to know what is expected of them and what activities and behaviors are within the community boundaries and what are outside of them. 4. Constructive use of time—Young people need opportunities for growth through constructive, enriching opportunities and through quality time at home. 1. Commitment to learning—Young people need to develop a commitment to education and lifelong learning. 2. Positive values—Youth need to have a strong sense of values that direct their choices. 3. Social competencies—Young people need competencies that help them make positive choices and build relationships. 4. Positive identity—Young people need a sense of their own power, purpose, worth, and promise. The media provide children with a means for extending their knowledge about the world in which they live and have helped narrow the differences between groups. However, many people are concerned about the enormous influence the media can have on developing children and on health promotion behaviors. Children and adolescents in the United States spend more than 6 hours per day using entertainment media (Council on Communications and Media, 2009). Increased use of entertainment media has been associated with the epidemic of obesity in children and adolescents and increased aggression in children (Council on Communications and Media, 2009; Jordan, 2004). Anticipatory guidance around media utilization is among the most important a nurse can offer to a family. Because it can influence many areas of concern, such as aggression, sex, drugs, alcohol, obesity, eating disorders, and academic achievement (Strasburger, 2010), two important questions that nurses can ask to open the dialogue are “How much entertainment screen time does your child or teen spend each day?” and “Is there a TV, Internet connection, or wireless connection in the child or teen’s bedroom?” Researchers have established links between mass media and an increase in the use of tobacco, alcohol, and violent behavior in adolescents (Council on Communications and Media, 2009; Strasburger, 2010). The images of risky behavior presented by the media may serve to establish or reinforce teenagers’ perceptions of their social environment. Also, media content may directly influence risk perception; media protagonists seldom experience the adverse consequences of their behaviors despite their grossly distorted experiences with violence, illness, or crime. • Be aware of the content of the child’s media and amount of time spent looking at a screen. • Help young children watching television to find educational programs. • Remove television, Internet-accessible computers, and video game systems from the bedroom to decrease the amount of time spent using these activities. • Limit television viewing to 2 hours a day or less. • Watch age-appropriate programs and play age-appropriate games with children. The medium that has the most impact on children in the United States today is television; it has become one of the most significant socializing agents in the lives of young children. Its programs and commercials provide multiple sources for acquiring information, modeling behaviors, and observing value orientations. Besides producing a leveling effect on class differences in general information and vocabulary, TV exposes children to a wider variety of topics and events than they encounter in day-to-day life. Television always has time to talk to children and is a form of access to the adult world. Positive results occur only when viewing is relatively light, yet the average child in the United States older than the age of 8 years spends more time watching television or using a computer and video games (>6 hours/day) than in any other activity except sleeping (Fig. 4-3) (Council on Communications and Media, 2009).
Social, Cultural, and Religious Influences on Child Health Promotion
Culture
Social Roles
Self-Esteem and Culture
Cultural Shock and Cultural Sensitivity
Subcultural Influences
Minority-Group Membership
Socioeconomic Class
Communication Skills
Schools
Socialization
Communities
Mass Media
Television
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Social, Cultural, and Religious Influences on Child Health Promotion
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