Lesson 1, Topic 1
In Progress

Culture Defined

May 3, 2021

The United States has been described as a “melting pot” of people from many different countries. This description implies that people are so completely blended together that everyone shares the same values, beliefs, health practices, communication styles, and religion. A better description is to say the country is like a pot of vegetable soup—many different, but distinct, pieces are combined to form a rich assortment. This assortment makes up our society (a nation, community, or broad group of people who establish particular aims, beliefs, or standards of living and conduct). What’s more, the “soup recipe” is no longer what it was; as a result, our societal “flavor” is changing. At the beginning of the 20th century, most immigrants to this country were of European ancestry. Today, according to the 2010 U.S. Census, 34.6% of the population is of African, Asian, Hispanic, American Indian, or some other non-European ancestry (U.S. Census Bureau, 2010).

Culture Defined

Culture is a set of learned values, beliefs, customs, and practices that are shared by a group and are passed from one generation to another. Because of the influx of diverse cultures, the United States is rapidly becoming multicultural and multilingual. Many immigrants have come from areas of the world devastated by wars, natural disasters, famine, and poverty. They have had little preparation or time to learn English or American culture before arriving. Many of these immigrant populations have formed subcultures in United States society.

Often, separate subcultures exist within a given group. A subculture shares many characteristics with the primary culture but has characteristic patterns of behavior and ideals that distinguish it from the rest of a cultural group. Even among Americans who have lived here for several generations, these subcultures exist. For example, a person who grew up in the mountains of Appalachia has very different cultural practices than a person from New York City. Understanding of these variables and acceptance of each person as an individual is the first step in giving holistic care to patients.

Although cultures often differ considerably from one another, they share certain basic characteristics. Box 6-1 identifies four common characteristics of all cultures.
All members of a culture do not exhibit the same behaviors. These variations within a cultural group occur because of individual differences. Examples of these differences are as follows:

•Dialect or language spoken

•Gender identity and roles
•Socioeconomic background
•Geographic location of country of origin or current residence
•Amount and type of interaction between younger and older generations
•Degree to which values in current country are adopted

Cultural influences vary with each individual. It is best to deliver culturally competent care and avoid stereotyping behaviors. Culture influences each person in various ways. The nurse is advised to avoid stereotyping members of any cultural group. A stereotype is a generalized expectation about forms of behavior, an individual, or a group. An ethnic stereotype is a fixed concept of how all members of an ethnic group act or think. Stereotypes sometimes do and sometimes do not have any relationship to reality.

Cultural Competence and Transcultural Nursing

Most people look at the world from their own cultural viewpoint. They often believe that the beliefs and practices of their particular culture are best. This belief is called ethnocentrism. The nurse must learn to value the beliefs of others and realize that practices of other cultures can be valuable in health care.

In the care of patients from many different cultures, the licensed practical/vocational nurse (LPN/LVN) is called on to develop cultural competence: the awareness of one’s own cultural beliefs and practices and their relation to those of others, which may be different. One way to identify these beliefs and practices is through a self-assessment. This self-assessment is

important. Personal beliefs and practices influence, and sometimes put some limitations on, the ability to care for those from other cultures. Understanding personal beliefs enables one to respond to those from different cultures with openness, understanding, and acceptance of cultural differences.

The nurse needs to accept that it is not possible to act the same with all patients and still give effective, individualized, holistic care. Rather than ignore the differences, the nurse should include questions about cultural practices during the nursing process. This information is critical and is important in developing a plan of care to meet patient needs. Box 6-2 gives some guidelines for cultural information that can be gathered in the patient assessment.

Because of the many variations in cultural and subcultural practices, culturally appropriate nursing care is a challenge in the 21st century. Understanding

these variables and integrating an understanding into all aspects of nursing care is referred to as transcultural nursing. The LPN/LVN should strive to achieve a high level of transcultural nursing in day-to-day practices.

It is important to understand that people from different cultures have a variety of practices related to health care, treatment methods, and responses to illness and death (see the Evidence-Based Practice box). In many cases, these differences extend to practices related to childbirth and the ways people of different age groups are cared for (Life Span Considerations for Older Adults box). In addition, cultural beliefs frequently affect diet and nutrition. Remember to assess areas that are potentially influenced by cultural factors.

In addition to caring for people from various cultures, nurses find that many other health care providers come from different ethnic, cultural, and religious backgrounds

than their patients. Some of these nurses have received their education in foreign countries and have moved to the United States for better opportunities. Others were born in this country but are part of a different cultural or racial group.

Learning about cultural differences that exist improves working relationships between members of the health care team. In much the same way that this kind of openness helps in caring for patients, it helps in understanding and accepting differences among nurses and their colleagues.

Race and Ethnicity

There are various reasons why a given individual demonstrates a given cultural practice. Perhaps the person is from a foreign country or a region of the United States where that practice is common. Perhaps the person’s practice is related to race (a group of people who share biologic physical characteristics) and hereditary factors. Ethnicity refers to a group of people who share a common social and cultural heritage based on shared traditions, national origin, and physical and biologic characteristics. They often share social practices such as language, religion, dress, music, and food. Factors related to culture, race, and ethnicity often overlap, and many people combine a variety of practices related to several of these factors. It is important to understand that not everyone in a cultural, racial, or ethnic group has identical practices and that each person should be treated in an individual, holistic manner.

Ethnic and Racial Groups in the United States

The United States is home to people from many cultures. The LPN/LVN must not make assumptions about a patient’s beliefs or practices based on the person’s name, skin color, or language.

Assumptions are commonly made about the predominant cultures and subcultures in our country based on one’s own family or community. A larger view of our society is necessary for a better understanding of our country.

Changes in the nation’s demographic are illustrated in Table 6-1. Significant decreases are noted with the white population accompanied by increases in most other racial groups. The largest increase has occurred in the Hispanic population, which rose from 12.5% to 16.3% of the population between 2000 and 2010. Predictions for the future indicate that this trend will continue and that the minority cultures will, in combination, make up a majority of the U.S. population by the middle of this century (U.S. Census Bureau, Census 2010).

One significant aspect of this diversity is the language used to communicate. Many new immigrants from these diverse cultures may not speak English or have a limited grasp of the language. Often the younger members of the family are the ones who help the adults communicate with others outside of the cultural community. Adults frequently bring a young child along as a translator when shopping or seeking health care. A professional translator is preferable as opposed to a friend or family member to prevent bias, inaccuracy, or compromises in confidentiality.