Introduction to Medical-Surgical Nursing, 6th ed.
6
Lesson Plans for
Cultural Aspects of Nursing Care
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 6.1:
2. Identify traditional health habits and beliefs of major ethnic groups in the United States.
4. Discuss cultural considerations in providing culturally sensitive nursing care.
5. Discuss ways in which planning and implementation of nursing interventions can be adapted to a
patient’s ethnicity.
CHAPTER TEACHING FOCUS
• In this chapter, the student will be introduced to topics related to cultural aspects of nursing, including
religious beliefs and practices affecting health care, and the traditional health habits and beliefs of
major ethnic groups in the United States.
• Furthermore, the cultural influences on patient and family interactions with the health care system will
be discussed.
• The student will also have the opportunity to become acquainted with cultural expressions and their
implications for nursing care.
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for
each concept have been tailored specifically to correspond to the Linton textbook.
THEME: Personal Preferences
• Concept: Culture
• Exemplar: Developmental / Family Roles, p. 68
2 Chapter 6 Cultural Aspects of Nursing Care ____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) Which of the following reflects current thinking about cultural diversity in America?
a) “Melting pot”
b) Area of growing concern c) Homeland Security alerts
d) “Salad bowl”
2) All cultures include __________.
a) unique symbols
b) a two-parent family structure c) the belief in a supreme being
d) a written language
3) In the United States today, how many people have difficulty reading and writing?
a) One out of two
b) One out of three c) One out of four
d) One out of five
4) A kosher diet requires __________.
a) vegetarian meals
b) dessert to be eaten first c) no mixing of meat and milk at a meal
d) fasting 1 hour before each meal
5) Seventh-Day Adventists celebrate the Sabbath on __________.
a) Monday
b) Wednesday c) Friday
d) Saturday
6) Artificial birth control is regarded as a personal matter by the __________.
a) Orthodox Christian church
b) Church of Jesus Christ of Latter Day Saints
c) Jehovah’s Witnesses
d) Roman Catholic church
7) The first phase of “culture shock” associated with a hospitalization is __________.
a) sense of humor
b) questioning c) disenchantment
d) acceptance
8) A hospitalized patient in the second phase of culture shock would likely __________.
a) request a television
b) experience depression c) ask about visiting hours
d) request to go outside for fresh air
9) In the Asian culture, communication patterns tend to be __________.
a) direct
b) indirect c) direct or indirect
d) boisterous
10) Learning about customs, beliefs, and values as you grow up is referred to as __________.
a) immigration
b) ethnicity c) enculturation
d) assimilation
___________________________________________________ Chapter 6 Cultural Aspects of Nursing Care 3
Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: A 58-year-old woman from Mexico was visiting her family in the United States when she fell
and fractured her hip, requiring surgical repair. It is her first postoperative day. She does not speak
English and her adolescent grandson is staying with her to serve as translator. It is time for the nurse to
perform care for the patient and her indwelling urinary catheter. How can the nurse be sensitive to the
woman’s privacy without causing embarrassment to the patient or her grandson?
Answer: The nurse can perform a brief physical assessment of the patient’s level of consciousness and
Question: An Islamic family is tending to a gravely ill family member in the intensive care unit. They have
asked that the bed be oriented toward the east, toward Mecca, so the Imam may hear the confession of
sin and request for forgiveness. To orient the bed toward the east would require disconnecting it from the
wall unit, including the oxygen valve and monitors for the arterial line. How should the nurse try to solve
this problem?
Answer: Orientation toward Mecca is an important part of the Islamic faith, and the nurse should make
4 Chapter 6 Cultural Aspects of Nursing Care ____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 6.1
Instructor Preparation
Textbook Objectives Covered
2. Identify traditional health habits and beliefs of major ethnic groups in the United States.
4. Discuss cultural considerations in providing culturally sensitive nursing care.
a patient’s ethnicity.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speaker: nurse who is from one of the cultural groups discussed in this chapter
• Student performance evaluation of all entry-level skills required for student comprehension of the
Materials and Supplies
Key Terms
• enculturation (p. 68)
___________________________________________________ Chapter 6 Cultural Aspects of Nursing Care 5
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 6.1
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 67–81)
ANSWER – Text
ANSWER – Study Guide
• Part IA: 1-7 (p. 27)
• Part IB: 1 (p. 27)
• Part IID: 8 (p. 28)
• Part IIIE: 3 (p. 29)
2
• Part IID: 5, 6 (p. 28)
READ – Textbook (pp. 75–76)
REVIEW
• Figure 6-1: People living in the United States represent many different subcultures (p. 68)
ANSWER – Text
• Review Questions for the NCLEX Examination: 3, 8, 10 (pp. 81-82)
ANSWER – Study Guide
3
ANSWER – Study Guide
READ – Textbook (pp. 78–79)
REVIEW
• Table 6-1: Religious beliefs and practices affecting health care (pp. 69-75)
4
READ – Textbook (pp. 79–81)
ANSWER – Text
ANSWER – Study Guide
• Part IC: 1-6 (p. 28)
• Part IID: 2 (p. 28)
• Part IIIE: 4, 7, 9 (p. 29)
6 Chapter 6 Cultural Aspects of Nursing Care ____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 6.1
5
READ – Textbook (pp. 79–81)
REVIEW
• Table 6-2: Traditional dietary practices in various cultures (p. 80)
ANSWER – Text
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 6
Cultural Aspects of Nursing Care
1
Slide 2
Characteristics of Culture
• Culture
• Integrated system of learned values, beliefs, and practices that guides behavior
• Includes the arts, beliefs, customs, folk practices, habits, institutions, and all other
TALKING POINTS:
• These values and beliefs are the foundation for setting standards and rules of behavior
Slide 3
Characteristics of Culture (cont.)
• Values and beliefs: foundation for setting standards and rules of behavior that members of
a society consider acceptable and proper
TALKING POINTS:
• What are some of the values and beliefs that form the culture in which you live?
___________________________________________________ Chapter 6 Cultural Aspects of Nursing Care 7
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 6.1
Slide 4
• People living in the United States represent many different subcultures.
Cultural Diversity
• The existence of many cultures in a society
• The United States has rich cultural diversity: result of a large number of immigrants over
the past 200 years
TALKING POINTS:
• Why has there been a shift in terminology in the U.S. from “melting pot” to “salad bowl”?
Slide 5
Cultural Concepts
• Subcultures
• Individuals within certain cultures who share different beliefs, values, and attitudes
TALKING POINTS:
• What are subcultures that you recognize within your culture?
Slide 6
Cultural Concepts (cont.)
• Similarities
• Learned
• Passed down from parent to child to grandchild
• Affects personality development of each generation.
• People learn what is expected of them and how they should behave, dress, and
interact
• Shared
TALKING POINTS:
• What is enculturation?
• Individual behavior does not reflect a particular culture unless it is manifested by other
people in the cultural group.
8 Chapter 6 Cultural Aspects of Nursing Care ____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 6.1
Slide 7
Cultural Concepts (cont.)
• Differences
• May occur among various groups
• Family
• Religion
Slide 8
how they influence behavior rather than being judgmental about family behaviors.
Family
• Cultural attitudes, values, and behaviors are primarily transmitted through the family
• Structure may vary among and within cultures
TALKING POINTS:
• The family provides a major means for reproducing the population and rearing its children.
• Who makes up the traditional family? Extended family?
Slide 9
• Nonverbal communication
Communication
• Language
• Certain cultural and ethnic groups speak different languages
• The speed with which people speak and their tone and inflections vary according to
cultural background
Educational Background and Economic Level
• Educational level is strongly tied to ethnicity and economic background
• Affects how people perceive the world, health and illness, and the health care system
TALKING POINTS:
• Approximately 60 million Americans have literacy skills below the eighth-grade level.
• Does poverty cause illness?
• What are some of the challenges in health teaching that occur in relation to educational
and economic background?
___________________________________________________ Chapter 6 Cultural Aspects of Nursing Care 9
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 6.1
Slide 11
Cultural Beliefs Related to Health and Illness
• Many beliefs have developed regarding the onset, course, and cure of disease, as well as
the process of death and dying
• Some believe illness is a type of divine punishment
TALKING POINTS:
• Health and illness have different meanings for different people and cultural groups.
• What is believed to happen if there is an imbalance between the hot and the cold areas of
the body?
Slide 12
physiologic problems.
Cultural Beliefs Related to Health and Illness (cont.)
• Many ethnic groups use healers who practice health care outside of the formal health care
system
• Western societies believe that illness has a known cause that can be treated or cured
if identified
TALKING POINTS:
2
Slide 13
beliefs and practices.
Caucasians (Euro-Americans)
• Generally believe in the work ethic, individualism, and competition
• Values related to health:
• Individual decision-making
• Personal space
• Privacy
TALKING POINTS:
Caucasians (Euro-Americans) (cont.)
• The risk of illness can be reduced by eating a proper diet, getting enough exercise, and
allowing for adequate rest
TALKING POINTS:
• Are there additional things you perceive that are values of Caucasians?
10 Chapter 6 Cultural Aspects of Nursing Care ____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 6.1
African Americans
• Value family, community, religion, health, work
• Some traditional beliefs attribute illness to divine punishment or to an imbalance among
TALKING POINTS:
• What do you think is meant by “keeping the system cleaned out?”
• Tend to attempt self-care before consulting a health care professional when ill
TALKING POINTS:
• Are there additional things you perceive that are values of African Americans?
African Americans (cont.)
• Communication may be direct or indirect, and expressions of pain during illness may
Latinos or Hispanics
• Family-oriented and value harmony in interpersonal relationships
• Traditional beliefs about cause of illness include magical fright, divine punishment, an
Slide 18
Latinos or Hispanics (cont.)
• Communication is usually indirect; however, expressions of pain are open and direct
• Folk health specialists (curanderos) and family members may be consulted along with the
formal health care system
TALKING POINTS:
Asians
• Value self-respect, self-control, respect for elders, family honor, loyalty, and pride
• Emphasize holistic health and harmony between the self and the universe
• Attempt to live in harmony with nature and have deep respect for the environment
American Indians
• Considerable diversity among tribes and groups; important to use caution when
generalizing about American Indians
___________________________________________________ Chapter 6 Cultural Aspects of Nursing Care 11
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 6.1
American Indians (cont.)
• Communication is usually indirect; great emphasis on nonverbal cues
• Pain is usually dealt with stoically
TALKING POINTS:
• How critical do you believe it is to recognize and respect cultural differences when caring
for patients?
• Do you feel it truly makes a difference in outcomes?
3
• How may professional translators help with providing health care?
Hospital Health Care
• Hospital environment is often unfamiliar and frightening
• Patients are separated from family and friends
TALKING POINTS:
• Admission to the hospital may seem like traveling to a foreign country where an entirely
Slide 23
Hospital Health Care (cont.)
• Culture shock associated with hospitalization
• First phase
• Patient asks questions about the hospital routine and the hospital’s expectations
of the patient
TALKING POINTS:
• What components of each phase do you view as critical?
Community and Home Health Care
• Community settings: physicians’ offices, outpatient clinics, community mental health
centers, home health care, hospices, and day care centers
TALKING POINTS:
• What may cause a patient to be inappropriately labeled as “noncompliant” or “difficult”?
12 Chapter 6 Cultural Aspects of Nursing Care ____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 6.1
Slide 25
• If the patient speaks a different language from yours, sometimes a family member is able
to translate.
Community and Home Health Care (cont.)
• When you enter a patient’s home, watch for symbolic objects that may indicate cultural
identity
• Examples: shrines, religious pictures or statues, and special candles
• Assess your patient’s health beliefs and practices that are affected by culture
• Patients and their families may have magical, religious, biomedical, or holistic beliefs
TALKING POINTS:
Long-Term Facility Health Care
• Majority of residents in long-term care facilities are white females
• Some ethnic groups, such as Latinos and Asians, are extremely reluctant to admit older
TALKING POINTS:
• What are functional impairments?
Long-Term Facility Health Care (cont.)
• Different cultural groups have the added strain of communication problems and extreme
4
Slide 28
Cultural Sensitivity
• Cultural sensitivity and valuing alternative ways of dealing with health issues as well as
spiritual beliefs allow you to individualize care
• Avoid labeling patients “difficult” or “uncooperative” because you do not understand their
behavior
TALKING POINTS:
• As a practical nurse, you must be able to accept a wide diversity of beliefs, practices, and
ideas about health and illness, including many that are different from your own.
___________________________________________________ Chapter 6 Cultural Aspects of Nursing Care 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 6.1
Slide 29
Cultural Sensitivity (cont.)
• Gather information regarding the cultural background of a patient
• Communication, including language spoken and touching and gesturing, may differ
among patients
• Health beliefs
TALKING POINTS:
• How may reactions to pain differ among cultures?
• No matter how different your beliefs are from your patient’s beliefs, you must respect each
person’s values and cultural beliefs and respond in a nonjudgmental way.
• Maintain an open and inquiring, respectful attitude regarding cultural differences
• During an initial encounter with patients, speak softly and in an unhurried manner to put
them at ease
Therapeutic Relationship
• Environment of acceptance and respect for the beliefs and behaviors of culturally different
patients should be established
Therapeutic Relationship (cont.)
• As a culturally competent nurse, you can respond to diversity with respect based on
accurate knowledge, an accepting attitude, and a belief in the value of each individual
TALKING POINTS:
• For many patients, changes in health patterns often require some major changes in
5
Slide 32
Basic Physiologic Needs
• Cultural attitudes may affect patients’ perceptions of personal hygiene and the role of the
nurse in assisting with and caring for basic bodily needs
• Show sensitivity to these feelings
TALKING POINTS:
• During the bath, do not remove a patient’s charms, crosses, medals, or other objects
without permission.
• What measures may help to alleviate the stress and anxiety associated with entering the
hospital environment and to fulfill cultural expectations for both patients and family
members?
14 Chapter 6 Cultural Aspects of Nursing Care ____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 6.1
Basic Physiologic Needs (cont.)
• Nutrition
• Modifications in diet must take culture into account
TALKING POINTS:
• What are some dietary cultural considerations that you are aware of?
Slide 34
Drug Therapy
• Factors contribute to differing responses
• Environmental
• Drug absorption, metabolism, and action include diet, smoking, and alcohol use
• Cultural
TALKING POINTS:
• What are some cultural issues that alter the effects of medications?
Drug Therapy (cont.)
• Genetic factors
• Liver enzymes determine the rate and extent of drug metabolism
Patient Teaching
• Patients and their families may not understand health and illness information in English
even if they have some command of the language
TALKING POINTS:
• Communication between the nurse and patients and families of different cultures may be
especially difficult in the context of teaching.
• What should be the first approach when communicating with people of other cultures?
Patient Teaching (cont.)
• Using oral and written communication can help to reinforce what has been taught
• Written communication in the native language of patients and families greatly aids in
TALKING POINTS:
• Health care facilities should have a list of interpreters available.
___________________________________________________ Chapter 6 Cultural Aspects of Nursing Care 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 6.1
Slide 38
Patient Teaching (cont.)
• Consider the timing of patient and family teaching in culturally diverse populations
• Many groups do not work by the clock and schedules
• People from these groups may not appear for appointments or may come several
hours late
TALKING POINTS:
Complementary and Alternative Therapies
Complementary and Alternative Therapies (cont.)
• Research is beginning to support the use of some folk treatments and to dispel the value
of others
TALKING POINTS:
• What are some complementary therapies you have heard of?
• Do you know of anyone who uses complementary therapy?
Slide 41
Question 1
• Which group is thought to have the strongest extended family unit and family ties?
A. Polish
B. Latinos
C. French
D. Japanese
TALKING POINTS:
Introduction to Medical-Surgical Nursing, 6th ed.
Slide 42
Question 2
• Health literacy has been found to be highest in:
A. males.
B. adults older than 60.
C. Caucasians.
D. Latinos.
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
DISCUSS
• Discuss the concept of “culture” and its
characteristics. What characteristics do all
cultures share? What are some of the ways
in which they differ?
• Discuss some of the ways that different
religious beliefs and practices affect health
care. How might nursing care need to adapt
to differing beliefs related to health and
illness?
• Ask students to choose a value, belief, or
cultural practice that symbolizes their own
upbringing. Have each student write a
paragraph about what the symbol represents
and the reason for its importance. Then call
on students to share and discuss with the
class how a nurse could incorporate the
symbol into daily patient care.
• Divide the class into small groups and have
each group discuss the meanings of the
following life events:
• Birth
ASSESS BASELINE
• Post the Pretest and the Background
___________________________________________________ Chapter 6 Cultural Aspects of Nursing Care 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 6.1
2
DISCUSS
• Discuss the traditional health habits and
beliefs of the major ethnic groups in the
United States. What is the significance of
these habits and beliefs to a nursing
assessment?
• Lead a class discussion on how patients’
POST AND COMMENT
• Post the following discussion topic online
and have students comment. How do you
believe being aware of cultural differences
will make you more prepared to care for a
multicultural set of patients?
• Post the following discussion topic online
3
nursing intervention. Reconvene the class
and have each group present its discussion.
DISCUSS
• Discuss why culturally different patients may
be labeled “difficult” or “noncompliant.” What
cultural factors might be at the source of
such labels?
• Divide the class into three groups. Assign
one of the following topics to each group:
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe
challenges you think you will face as you
care for persons of other cultures.
• Post the following discussion topic online
and have students comment. What cultures
4
DISCUSS
• Discuss ways that a patient’s health
practices and beliefs might conflict with
those of the health care system. How would
students handle this conflict?
• Divide the class into small groups, and have
each group identify three important pieces of
data to collect for a patient requiring
culturally sensitive care. Have the groups
discuss how cultural differences affect the
kind of information that needs to be gathered
from patients. How might this information be
used in providing care?
POST AND COMMENT
• Post the following discussion topic online
and have students comment. When have
you seen or heard of a patient’s beliefs
affecting their health care decisions?
18 Chapter 6 Cultural Aspects of Nursing Care ____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 6.1
5
DISCUSS
• Discuss the role of cultural attitudes in caring
for basic bodily needs.
• Discuss the influence of ethnicity on drug
therapy. What is the role of the liver in the
effectiveness of drug therapy?
• Invite a nurse who is from one of the cultural
POST AND COMMENT
• How will you deal with cultural conflicts as a
nurse?
• How will you encourage patients in
integrating cultural differences into their plan
of care?
Critical Thinking Question
A young Jewish couple recently relocated from a major city to a smaller city in a new state.
The pregnant wife goes into labor and delivers a premature baby. The couple has requested
a rabbi for spiritual support and prayer, but there are few Jewish people in the area and the
nearest Jewish synagogue is approximately 60 miles away. How can the nurse be sensitive
to the needs of the couple?
Discussion Guidelines: The nurse should first ask the couple if they would prefer an Orthodox,
Conservative, or Reformed rabbi. The nurse should also ask whether they would accept a rabbi
Instructor Notes/Student Feedback
___________________________________________________ Chapter 6 Cultural Aspects of Nursing Care 19
Introduction to Medical-Surgical Nursing, 6th ed.
6
Assessments for
Cultural Aspects of Nursing Care
CHAPTER OBJECTIVES
Lesson 6.1:
2. Identify traditional health habits and beliefs of major ethnic groups in the United States.
4. Discuss cultural considerations in providing culturally sensitive nursing care.
5. Discuss ways in which planning and implementation of nursing interventions can be adapted to a
patient’s ethnicity.
Assessments by Lesson & Objective
Lesson 6.1
1
• Part IID: 8 (p. 28)
Study Guide
• Part IA: 1-7 (p. 27)
Evolve Instructor Resources
• Test Bank: 2, 10, 15, 18, 19, 22, 24-26
Evolve Student Resources
• NCLEX Review: 1, 2, 7
2
Study Guide
• Part IID: 5, 6 (p. 28)
• Part IIIE: 1, 2, 8 (p. 28)
Evolve Instructor Resources
• Test Bank: 4, 8, 9, 11, 17, 27
Evolve Student Resources
• NCLEX Review: 3
• Prioritization: 2
3
Study Guide
• Part IB: 2 (p. 28)
Evolve Instructor Resources
• Test Bank: 7, 12, 13, 23
Evolve Student Resources
• NCLEX Review: 4, 5
20 Chapter 6 Cultural Aspects of Nursing Care ____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
4
Study Guide
• Part IC: 1-6 (p. 28)
• Part IID: 2 (p. 28)
• Part IIIE: 4, 7, 9 (p. 29)
Evolve Instructor Resources
5
Study Guide
• Part IID: 1, 7 (p. 28)
• Part IIIE: 5, 6 (p. 29)
Evolve Instructor Resources
Instructor’s Notes/Student Feedback