Cultural Factors
Biological Factors
Provider Culture
Healer Within

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Suggested Readings
(click on selection for reviews and more information)

Barnga: A Simulation Game on Cultural Clashes
 by Sivasailam Thiagarajan

Cross-Cultural Dialogues: 74 Brief Encounters With Cultural Difference
 by Craig Storti

Exploring Culture: Exercises, Stories, and Synthetic Cultures
by Gert Jan Hofstede 

Knowledge, Power, and Practice: The Anthropology of Medicine and Everyday Life (Comparative Studies of Health Systems and Medical Care)

 by Shirley Lindenbaum


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 Cultural Factors


Why should the Western health care system adapt to the needs of other cultural groups? Why don't they learn to speak English?... Most would say, Yes they should adapt to our culture and learn our language.  However, that is not the most compassionate or practical response. Unless cultural differences are taken into account we can not provide optimal health care for all patients. Misunderstandings can often lead to misdiagnoses, as is the case of coin rubbing or danger signals can be overlooked with a stoic Asian patient.

 A nurse who lacks knowledge about biocultural, psycho sociological, and linguistic differences evident in diverse multicultural populations is likely to make inaccurate assessments.  Illness, specially illness that requires hospitalization, is the very time when we are most likely to regress and behave in ways that were reinforced in childhood. These cultural behaviors are a result of adaptation to both the physical and the social environment.

 Cultures develop norms, values, and behaviors that are suited to that environment. Over time, they take on the strength of tradition. Even when circumstances change, traditions often do not, early conditioning is very hard to overcome. Whether patients should speak English and adapt to our ways and customs is irrelevant. The fact is that they do not and may not. The options then are to provide inferior nursing care or to make accommodations so as to provide optimal care. 

In a multicultural society such as ours, nurses are likely to encounter clients from diverse settings.  Projections are that by the year 2000, at least one fourth of the population of the United States will represent an ethnic minority. As nurses we need to develop a cultural insight and a deeper appreciation and respect for the rights of culturally diverse individuals. When cultural beliefs and practices are not appropriately identified, the significance of behavior may confuse the nurse and result in the delivery of inappropriate care. 

The goal of the health care system is to provide optimal care for all patients. In a multiethnic society such as ours, this can be accomplished only if the health care providers understand such things as why Asian patients rarely ask for pain medication whereas patients from Mediterranean countries seem to need it for the slightest discomfort, why Middle Eastern patients will not allow a male physician to examine their women, and that coin rubbing is an Asian form of medical treatment, not a method of child abuse. 

We must keep in mind that culture and ethnicity are strong determinants in an individual's interpretation or perception of health and illness. Religion, ethnicity, and culture interweave into the fabric of each response of a particular individual to treatment and healing. 


Boyle JS, Andrews MM: Transcultural Concepts in Nursing Care. Glenview, IL, Scott, Foresman/Little, Brown College Division, 1989 
Giger JN, Davidhizar RE: Transcultural Nursing: Assessment and Intervention. St. Louis, CV Mosby, 1991 
Galanti G.A.: Caring for Patients from Different Cultures. University of Pennsylvania Press, Philadelphia, 1991



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