People of Russian, Polish , and, Thai Heritage.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish American Culture Larry Purnell, PhD

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, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Overview/Heritage ▪ Over 9 million people in the United States and 800,000 people in Canada identify their ancestry as Polish. ▪ Displaying fierce patriotism, courage, and determination to resist another occupation, Poland was the only country to combat Germany from the first day of the Nazi invasion until the end of the war in Europe. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Overview/Heritage ▪ Between the 1939 Nazi invasion and the end of World War II in 1945, nearly six million Poles, comprising over 15 percent of Poland’s total population, perished. ▪ Many Polish Jews were exterminated by the Nazis in the Holocaust, prisoners killed in concentration or forced labor camps, soldiers, and civilians. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Overview/Heritage ▪ After Stalin’s death, Polish communism vacillated between repression and liberalization until about 1970. ▪ Poland’s resistance to Communist rule began in 1970 with the emergence of Lech Walesa, the leader of a strike in the Gdansk shipyards. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Overview/Heritage ▪ The 1980 emergence of Solidarity and the election of a Polish Pope rekindled a religious rebirth in the Poles, an increased sense of self, social identity, and the realization of their collective strength. ▪ Solidarity became a major social movement and phenomenon unheard of within the Soviet bloc’s political system. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Overview/Heritage ▪ In July, 1989, the newly elected Parliament changed the country’s name and constitution, establishing the Third Republic of Poland and a democratic system of government. ▪ Polish immigrants have maintained their ethnic heritage by promoting their culture, attending Catholic churches, attending parades/festivals, maintaining ethnic food traditions, speaking the Polish language. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Overview/Heritage ▪ Newer immigrants are less concerned with raising consciousness over Polish American issues as they are with financially helping families who remain in Poland and raising concerns over the political/economic climate in their homeland. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Overview/Heritage ▪ Like any other group that perceives themselves as unaccepted, displaced, and different, Polish immigrants established a geographically and socially segregated area which was called a “Polonia”. ▪ Polish immigration to America continues today; many come to earn money then return to Poland. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Overview/Heritage ▪ At the peak of Polish migration, Chicago was considered the most well-developed Polish community in the United States. ▪ Poles are a heterogeneous group. As such, they were slow to assimilate into multicultural America. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Overview/Heritage ▪ Even after displaying a sense of duty, honor, and patriotism during wartime, Polish Americans often experienced discrimination during and after the war. ▪ Poles were passed over for jobs because they had difficulties speaking English and their names were difficult to pronounce or spell. ▪ Name changes became common for Polish Americans seeking upward mobility. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Overview/Heritage ▪ Many Polish Americans still experience discrimination and ridicule through ethnic Polish jokes, which are similar in scope to those about Irish, Italian, and Mexican Americans. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Communication ▪ The dominant language of people living in Poland is Polish, although there are some regional dialects and differences. ▪ Generally, most Polish speaking people can communicate with each other. ▪ Recently, a resurgence of interest in learning to speak the Polish language has occurred among Polish Americans. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Communication ▪ Touch is common among family members and friends, but Poles may be quite formal with strangers and health-care providers. ▪ Handshaking is considered polite. In fact, failing to shake hands with everyone present may be considered rude. ▪ Most Poles feel comfortable with close personal space: distances increase with Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Communication ▪ First-generation Poles and other people from Eastern European countries commonly kiss “Polish style.” That is, once on each cheek and then once again. For Poles, kissing the hand is considered appropriate if the woman extends it. ▪ Two women may walk together arm in arm, or two men may greet each other with an embrace, a hug, and a kiss on both cheeks. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Communication ▪ Many consider the use of spoken second person familiarity rude. Polish people speak in the third person. For example, they might ask, “Would Martin like some coffee?” rather than “Would you like some coffee?” ▪ Many Polish names are difficult to pronounce. Even though a name may be mispronounced, a high value is placed on the attempt to pronounce it correctly. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Communication ▪ Polish Americans use direct eye contact when interacting with others. ▪ Many Americans may feel uncomfortable with this sustained eye contact and feel it is quite close to staring, but to Poles, it is considered ordinary. ▪ Poles tend to share thoughts and ideas freely, particularly as part of their hospitality. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Communication ▪ Americans talk of sports while Poles speak of their personal life, their jobs, families, spouse, aspirations, and misfortunes. ▪ Punctuality is important to Polish Americans. To be late is a sign of bad manners. ▪ Even in social situations, people are expected to arrive on time and stay late. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Communication ▪ Polish Americans are both past and future oriented. ▪ The past is very much a part of Polish culture, with the families passing on their memories of WW II, which still haunt them in some way. ▪ A strong work ethic encourages Poles to plan for the future. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Communication ▪ Traditional Polish names are often a description of a person (e.g., John Wysocki means John the tailor), or a profession (e.g. the surname Recznik means butcher), or a place (e.g., Sokolowski means one from a town named Sokoly, Sokolka, etc.) Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Communication ▪ Changes in surnames may have been made during the country’s record keeping process or during the immigration processing on Ellis Island. ▪ The transfer of information from emigrant to official records was highly dependent on the pronunciation, spelling, and writing skills of both the recorder and the applicant. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Family Roles and Organization ▪ Life in the Polish culture centers on family. ▪ Each family member has a certain position, role, and related responsibilities. ▪ All members are expected to work, make contributions, and strive to enhance the entire family’s reputation, social, and economic position. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Family Roles and Organization ▪ Individual concerns and personal fulfillment are afforded little consideration and sacrifices for the betterment of the family are expected. ▪ In most Polish families, the father is perceived as the head of the household. ▪ Depending on the degree of assimilation, the father may rule with absolute authority Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Family Roles & Organization ▪ Among some third- and fourth–generation Polish Americans and second- and third–wave immigrants, more egalitarian gender roles are becoming the norm. ▪ Historically, large families were commonplace. ▪ Polish women, following the Roman Catholic Church’s teachings, often experienced between 5 and 10 pregnancies. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Family Roles & Organization ▪ The most valued behavior for Polish American children is obedience. ▪ Taboo childhood behaviors include any act that undermines parental authority. ▪ Parents are quite demonstrative with children. ▪ Many parents praise children for self-control and completing chores. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Family Roles & Organization ▪ Little sympathy is wasted on failure but doing well is openly praised. ▪ Children are taught to resist feelings of helplessness, fragility, or dependence. ▪ For many, important family priorities are to maintain the honor of the family in the larger society, to have a good jobs, and to be good Catholics. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Family Roles & Organization ▪ Older people are highly respected. ▪ They play an active role in helping grandchildren learn Polish customs and in assisting adult children in their daily routine with families. ▪ For some families, one of the worst disgraces, as seen through the eyes of the Polish community, is to put an aged family member in a nursing home. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Family Roles & Organization ▪ Third- and fourth–generation Polish Americans may consider an extended-care or assisted living facility. ▪ Extended family, consisting of aunts, uncles, and godparents, is very important to Poles. ▪ Longtime friends become aunts or uncles to Polish children. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Family Roles & Organization ▪ Alternative lifestyles are seen as part of assimilation into the blended American culture. ▪ Same-sex couples are frowned upon and may even be ostracized, depending on the level of assimilation. ▪ The Polish value for family solidarity is strong and divorce is truly seen as a last resort. ▪ When divorce does result, single heads of households are accepted. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Workforce Issues ▪ Polish Americans have extensive social networks and their strong work ethic enables them to gain employment and assimilate easily into the workforce. ▪ Some Poles entering America are underemployed and may have difficulty working with authority figures who are less educated than themselves. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Workforce Issues ▪ Poles are usually quick learners and work hard to do a job well. ▪ The Polish characteristic of praising people for their work makes Poles strong managers, but some lack sensitivity in their quest to complete tasks. ▪ Foreign-born Poles may have some difficulty understanding the subtle nuances of humor. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Workforce Issues ▪ Because Poles learn deference to authority at home, in the church, and in parochial schools, some may be less well suited for the rigors of a highly individualistic, competitive market. ▪ Polish immigrants who worked under a communist bureaucratic hierarchy may have some difficulty with the structure, subtleties, and culture of the American workplace. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Biocultural Ecology ▪ Most Poles are of medium height with a mediumto-large bone structure. ▪ As a result of foreign invasions over the centuries, Polish people may be dark and Mongol looking or fair with delicate features with blue eyes and blonde hair. ▪ Poles consider themselves tough and be able to tolerate pain from injuries, illness, and disease. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Biocultural Ecology ▪ In 1986, the Chernobyl radiation incident in Russia contaminated the land and water systems of eastern Poland. ▪ The full impact of this disaster on the incidence of cancer in Poland, as well as for Poles emigrating to other parts of the world, remains unknown. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Biocultural Ecology ▪ Health conditions common among Poles include cardiovascular disease, stroke, obesity, and cervical cancer. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish High-Risk Behaviors ▪ Alcohol misuse, with its subsequent physiological, psychological, and sociological effects and its related financial impact, continues to be an ongoing concern among Polish Americans. ▪ Illicit drug use is becoming more commonly used by Polish urban residents. ▪ Cannabis is the most popular illicit drug. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Nutrition ▪ Most Poles extend the sharing of food and drink to guests entering their homes. ▪ Eating and/or drinking with the host is perceived as social acceptance. ▪ Polish foods and cooking are similar to German, Russian, and Jewish practices. ▪ Staples of the diet are millet, barley, potatoes, onions, radishes, turnips, beets, beans, cabbage, carrots, cucumbers, tomatoes, and apples. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Nutrition ▪ Common meats eaten are chicken, beef, and pork. ▪ Traditional high-fat entrees include pigs’ knuckles and organ meats such as liver, tripe, and tongue. ▪ Kapusta (sauerkraut), golabki (stuffed cabbage), babka (coffee cake), pierogi”(dumplings), and chrusciki”(deep-fried bowtie pastries) are common ethnic foods. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Nutrition ▪ The Polish American diet is frequently high in carbohydrates, sodium, and saturated fat. ▪ Except for individuals living near the Baltic Sea in northern Poland who consume fish regularly, Poles are in danger of developing nutritional problems related to the lack of iodine in their diet. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Pregnancy & Childbearing Practices ▪ Because family is very important, most Poles want children. ▪ In Poland, the Catholic Church strongly opposes abortion, which is the prevailing attitude of many Poles in America. ▪ Fertility practices are balanced between the needs of the family and the laws of the Church. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Pregnancy & Childbearing Practices ▪ Pregnant Polish Americans are expected to seek preventive health care, eat well, and rest adequately to ensure a healthy pregnancy and baby. The emphasis is on “eating for two”. ▪ Many consider it bad luck to have a “baby shower.” Polish grandmothers may be reluctant to give gifts until after the baby is born. Birthing is typically done in the hospital. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Pregnancy & Childbearing Practices ▪ Pregnant women usually follow the physician’s orders carefully. ▪ The birthing process is considered the domain of women. ▪ Newer Polish immigrants may feel uncomfortable with men in the birthing area or with family-centered care. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Pregnancy and Childbearing Practices ▪ Women are expected to rest for the first few weeks after delivery. ▪ For many, breastfeeding is important. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Death Rituals ▪ Most Poles have a stoic acceptance of death as part of the life process and a strong sense of loyalty and respect for their loved ones. ▪ Family and friends stay with the dying person to negate any feelings of abandonment. ▪ The Polish ethic of demonstrating caring by doing something means bringing food to share, caring for children, and assisting with household chores. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Death Rituals ▪ Most Polish women are quick to help with the physical needs of the dying. ▪ Home hospice care is acceptable to most Poles. ▪ Polish American family members follow a funeral custom of having a wake for 1 to 3 days, followed by a Mass and religious burial. ▪ Most Poles honor their dead by attending Mass and making special offerings to the Catholic Church on All Souls Day, November 1. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Spirituality ▪ The Catholic Church requires attendance at Mass on all Sundays and holy days of obligation and is an integral part of the lives of most. ▪ There are “holy days” in almost every month of the year in addition to the rituals of baptism, first holy communion, confirmation, marriage, sacrament of the sick, and burial. ▪ Birthdays are important religious events. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Spirituality ▪ One very popular song is “Sto Lat,” which conveys wishes that the celebrant live 100 years. ▪ Primary spiritual sources are God and Jesus Christ, the Virgin Mary, saints, and angels to ward off evil and danger. ▪ Honor and special attention is paid to the Black Madonna or Our Lady of Czestachowa Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Spirituality ▪ Many older Polish people believe in the special properties of prayer books, rosary beads, medals, and consecrated objects. ▪ Polish Americans commonly exhibit devotions to God in their homes, such as crucifixes and pictures of the Virgin Mary, the Black Madonna, and Pope John Paul II. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Health-care Practices ▪ Most Poles put a high value on stoicism and doing what needs to be done. ▪ Many only go to health-care providers when symptoms interfere with function; then they may consider the advice provided carefully before complying. ▪ Many Poles are reluctant to discuss their treatment options and concerns with physicians and routinely accept the proposed care plan. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Health-care Practices ▪ If Poles believe they are unable to pay the medical bill, they may refuse treatment unless the condition is life-threatening. ▪ Many have a strong fear of becoming dependent and resist relying on charity. ▪ Since many Poles consider Medicare, Medicaid and managed care as forms of social charity, they are reluctant to apply for them. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Health-care Practices ▪ Poles usually look for a physical cause of disease before considering a mental disorder. ▪ If mental health problems exist, home visits are preferred. ▪ Talk oriented interventions/therapies without pharmaceutical or suitable psychosocial strategies are dismissed unless interventions are action oriented. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Health-care Practices ▪ Given the continuation of limited access to care and the strong work ethic of this cultural group, health promotion practices are often undervalued by Polish Americans. ▪ Older Polish Americans and newer immigrants commonly smoke and drink, engage in limited physical exercise outside of work, and receive poor dental care. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Health-care Practices ▪ Attention to health promotion practices among Polish American women may be complicated by their sense of modesty and religious background. ▪ Breast self-examination and Pap smear tests are poorly understood by many women, depending on the assimilation into American culture. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Health-care Practices ▪ The Polish ethic of stoicism discourages the use of over-the-counter medications unless a symptom persists. ▪ Most Poles refuse to take time off from work to see a health-care provider until self-help measures have proven ineffective. ▪ Herbs and rubbing compounds may also be used for problems associated with aches, pains, and inflammation from overworked joints. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Health-care Practices ▪ Being unable to speak and understand English, the cost of health care, and the complexity to navigate the US system are the greatest barriers to health care for Polish immigrants. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Health-care Practices ▪ Due to their strong sense of stoicism and fear of being dependent upon others, many Polish Americans use inadequate pain medication and choose distraction as a means of coping with pain and discomfort. ▪ When asked, many Poles either deny or minimize their pain or level of discomfort. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Health-care Practices ▪ Few Poles turn to psychiatrists or mental health providers for help. Those who seek help from mental health professionals do so as a last resort. ▪ Many individuals choose their priest or seek assistance from a Polish volunteer agency before going to a health professional for psychiatric help. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Health-care Practices ▪ Given the ethic of being useful, independent and a good Catholic influences one to refrain from using extraordinary means to keep people alive. ▪ The individual or family determines what means are considered extraordinary. Receiving blood transfusions or undergoing organ transplantation is acceptable. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Health-care Practitioners ▪ Immigrant Poles often assess health-care providers by their demeanor, warmth, and displays of respect. ▪ Health advice may be sought from chiropractors and local pharmacists as well as neighbors and extended family. ▪ Biomedical advice is sought when a symptom persists and interferes with daily functions of life. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Health-care Practitioners ▪ Physicians are held in high regard in Polish communities. ▪ Poles may change physicians if they believe their recovery is too slow or if a second opinion is needed. ▪ Educated Poles are more willing to follow medical orders and continue with prescribed treatment than those less educated. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Polish Health-care Practitioners ▪ Polish women are modest and self-conscious. They may refuse health care when asked to disrobe in front of a male health-care provider. ▪ In some cases, it may be critical to request a female provider. ▪ Poles expect health-care providers to appear neat and clean, provide treatments as scheduled, administer medications on time, and enjoy their work. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian American Culture Larry Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Overview/Heritage ▪ This presentation focuses on Russians who are immigrants to the United States. ▪ The Russian Federation, the largest country in the world, is composed of 21 republics and covers parts of two continents, Asia and Europe. ▪ Under communism all media were controlled, disseminating only information that the government wanted people to know. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Overview/Heritage ▪ Under Communism, everyone could attend higher education institutions, resulting in a welleducated population. ▪ Many scientists, physicians, and other professionals who have immigrated to the United States find difficulty in continuing to practice their profession, necessitating employment in occupations that lower self-esteem. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Communication ▪ The official language of Russia is Russian. ▪ Most educated Russians in the United States speak English to some extent because professional literature in Russia was printed in English. ▪ Many do not understand medical jargon and have difficulty communicating abstract concepts. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Communication ▪ Many older Russian Jewish immigrants speak Yiddish. ▪ Younger Jewish immigrants usually do not speak Yiddish because it was strongly discouraged in Russia. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Communication ▪ Punctuality is the norm, and many arrive early. ▪ Temporality is toward present and future orientation. ▪ In Russia, many people concerned themselves with having food and other necessities, not just for that day, but also for the following days and weeks ahead. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Communication ▪ Direct eye-to-eye contact is the norm among family, friends, and others without distinction between genders. ▪ Some may avoid eye contact when speaking with government officials, a practice common in Russia where making eye contact with government officials and other people in hierarchal positions could lead to questioning. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Communication ▪ Most individuals accept touch regardless of age and gender. ▪ Vocal volume may be loud, extending to those nearby who are not part of the conversation. ▪ Russians do not appreciate when others stand with their hands inserted into pockets, cross arms over their chests, and slouch. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Communication ▪ Until trust is established, many Russians stand at a distance and are aloof when speaking with health-care providers. ▪ Many educated women keep their maiden names when they marry. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Family Roles & Organization ▪ Family, children, and older adults are highly valued. Russians, accustomed to extended family living in their home country, continue the practice when they emigrate. ▪ Decision-making among current immigrants is usually egalitarian with decisions being made by the parents or by the oldest child. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Family Roles and Organization ▪ While parents work, grandparents care for grandchildren. ▪ Older people live with their children when selfcare is a concern. ▪ Nursing homes are rare and are of poor quality in Russia; thus, children may fear placing parents in long-term care facilities. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Family Roles & Organization ▪ Children of all ages are expected to do well in school, go on for higher education, help care for older family members, and tend to household chores, according to traditional gender roles. ▪ Teens are expected not to engage in sexual activity. ▪ Sex and contraceptive education are not traditionally provided. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Family Roles & Organization ▪ Single and divorced relationship statuses are accepted without stigma. ▪ Gay and lesbian relationships are not recognized or discussed and are still stigmatized by a large part of the population. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Workforce Issues ▪ The concept of teamwork is new to Russian nurses as is critical thinking and sensitive caregiving. ▪ When communicating in the workplace, Russians promote the value of positive politeness, a technique that employs rules of positive social communication. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck The nurse is conducting an intake assessment on a 76 year old Russian immigrant. She does not maintain eye contact with the nurse. The lack of eye contact is most likely due to a. Respect for the nurse. b. Lack of trust. c. Does not want to tell the truth. d. Most Russians do not maintain eye contact when conversing. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: B Many older Russian immigrants do not maintain eye contact with governmental officials or people in hierarchal positions because they could not be trusted. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Workforce Issues ▪ The employee, using positive politeness, will say nice things that show that the person is accepted, while simultaneously providing support, empathy, and avoiding negative discourse with coworkers. ▪ When negotiating compromise, Russians express emotion and invest considerable time and effort into supporting decisions. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Workforce Issues ▪ With colleagues and friends, Russians communicate directly, which is considered a sign of sincerity. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Biocultural Ecology ▪ Russians in the US are predominately white making them prone to skin cancer. ▪ Common health conditions of Russians include alcoholism, depression, gastrointestinal disorders, respiratory diseases, cardiovascular diseases, cancer due to radiation, dental disease, tuberculosis, diabetes mellitus, and hyperlipedemia. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Biocultural Ecology ▪ Many who come from Eastern Europe were exposed to the radiation effects of the Chernobyl disaster in 1986, resulting in a high incidence of cancer among this immigrant group. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian High-Risk Behaviors ▪ Both men and women have high smoking rates. ▪ Domestic violence is common and is related mostly to high rates of alcohol consumption. ▪ Domestic violence support services are not available in Russia; thus, patients are reluctant to report or seek help for domestic violence in the United States. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Nutrition ▪ Common foods include cucumbers in sour cream, pickles, hard-boiled eggs as well as eggs served in a variety of other ways, marinated or pickled vegetables, soup made from beets (borscht), cabbage, buckwheat, potatoes, yogurt, soups, stews, and hot milk with honey. ▪ Cold drinks are not favored. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Nutrition ▪ Meat choices include pickled herring, smoked fish, anchovies, sardines, cold tongue, chicken, ham, sausage, and salami. ▪ Bread is a staple with every meal. ▪ The diet overall is high in fat and salt. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Pregnancy and Childbearing Practices ▪ Many new immigrants may not be aware of different methods of fertility control. ▪ Abortion is very common in Russia, and some may choose this option in the United States. ▪ Russian condoms are made of thick rubber, discouraging their use by men. ▪ Pregnant women have regular prenatal checkups, which are mandatory in Russia. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Pregnancy and Childbearing Practices ▪ During pregnancy, women are discouraged from heavy lifting and from engaging in strenuous physical activities; they are also protected from bad news that can be harmful to the fetus. ▪ They are encouraged to eat foods that are high in iron, calcium, and vitamins. ▪ Strawberries, citrus fruits, peanuts, and chocolate are avoided to prevent allergies in the newborn. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Pregnancy and Childbearing Practices ▪ As labor approaches, women take laxatives and enemas to facilitate delivery. ▪ Traditionally in Russia, husbands and relatives could not participate in the delivery or visit the hospital postpartum. ▪ There are no cultural restrictions for fathers or female relatives not to participate in delivery. ▪ The delivery room should not have bright lights because many individuals believe that bright lights will harm the newborn’s eyes. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Pregnancy and Childbearing Practices ▪ Many women breast-feed until the infant reaches the toddler stage. ▪ Many women believe the breasts must be kept warm during feeding lest the mother get breast cancer later in life. ▪ Peri-care with warm water is important, and a binder is worn to help the mother’s figure return to its state prior to pregnancy. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Pregnancy and Childbearing Practices ▪ In Russia, women were accustomed to 8 weeks of maternity leave before delivery and up to 3 years leave following delivery. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Death Rituals ▪ Families want to be notified about impending death first, before the patient is told. ▪ Most families prefer to have the dying family member cared for at home. ▪ Do-not-resuscitate orders are appropriate; many families want their loved one to die in comfort. ▪ Few believe in cremation; most prefer interment. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Death Rituals ▪ Both men and women may wear black as a sign of mourning. ▪ Black wreaths are hung on the door of the deceased’s home. ▪ Expression of grief varies greatly. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Spirituality ▪ Most who practice a religion are Eastern Orthodox or Jewish, with smaller numbers of Molokans, Tartar Muslims, Seventh Day Adventists, Pentecostals, and Baptists. ▪ Sixty percent of Russian people are nonreligious. ▪ The state-controlled Russian Orthodox Church was the only accepted religion in Russia (other religions were prohibited) until perestroika and glasnost. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Spirituality ▪ Russian Americans pray in their own way, which may be different from that of the dominant religion with which they identify. ▪ Because Judaism was forbidden in Russia, many Jewish Russian in the US are unfamiliar with many of the Jewish religious practices. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Health-care Practices ▪ Because health care is free at the point of entry in Russia, newer immigrants might not be aware of the need for insurance in the United States. ▪ Hospital stays in Russia average 3 weeks. Some clients may expect this in the United States. ▪ Unmarried women are not accustomed to Pap tests because in Russia only married women get them. Mammography is uncommon in Russia. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Health-care Practices ▪ Many individuals are preoccupied with remaining warm to prevent colds and other illnesses. ▪ Most do not want breezes from fans or drafts from an open window to blow directly on them. ▪ They may also be reluctant to apply ice at the recommendation of a health-care provider. ▪ Most Russians are stoical with pain and may not ask for pain medicine. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Health-care Practices ▪ Some individuals may be reluctant to wash their hair for fear of catching a cold if the room is not warm or has a draft. ▪ Because of high radiation in parts of Russia, many fear having an x-ray. ▪ Clients are not accustomed to being told about cancer, terminal illnesses, or grave diagnoses; many believe it makes the condition worse. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Health-care Practices ▪ A primary treatment for a variety of respiratory illnesses is cupping. ▪ A small glass cup, a bonzuk or bonki, has alcohol-saturated cotton or other materials in it. ▪ The material is lighted and then the cup is turned upside down on the patient’s back. The skin is drawn into the cup, leaving round ecchymotic areas when it is removed. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Health-care Practices ▪ Common cultural practices include taking vodka with sugar for a cough; soaking one’s feet in warm water for a sore throat; aromatherapy for a variety of respiratory illnesses; mud and mineral baths to promote healing; and herbs and teas for fever, colds, and minor ailments. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Health-care Practices ▪ People are accustomed to not telling healthcare providers about depression or any other emotional or mental health concerns because mental illness carries a significant stigma and mental health facilities are very poor in Russia. ▪ Inadequate screening of blood in Russia creates fear of contracting HIV from blood transfusions. ▪ Most do not believe in organ donation. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Russian Health-care Practitioners ▪ Health-care providers are respected. ▪ Because nurses function in higher roles in the United States than in Russia, they may be mistaken for physicians. ▪ Men and women are accustomed to living together in very small physical quarters; thus, most do not have a problem with privacy. ▪ Gender is not generally a concern in care. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck A 42 year old Russian immigrant has been ordered a chest x-ray suspected pneumonia. He is very reluctant to have the x-ray. A probably reason for his reluctance is a. High radiation in some parts of Russia. b. He is unaware of the procedure. c. He is modest and does not want to disrobe. d. The physical environment is cold. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: A Many Russians, especially recent immigrants, are fearful of x-rays because of high radiation levels in parts of Russia. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Thai Culture Larry Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ Siam, the land of the musical The King and I, is the former name of Thailand. ▪ Thailand is the only Southeast Asian country that has never been colonized by westerners. ▪ In 1939, the name of the country was changed from Siam to Thailand, which literally means “the land of the free.” Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ The first people who are culturally considered “Thais” probably migrated from the south of China. ▪ Over 150,000 Thais live in the United States. ▪ The first two Thai immigrants in the United States were Eng and Chang, the famous Siamese twins who captured the world’s attention because of their conjoined chests. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Many Thais with graduate degrees work in the United States in professional fields such as medicine, nursing, and engineering. ▪ Others own Thai restaurants or grocery stores and provide work for other Thais at their businesses. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ The standard Thai dialect, derived from Pali and Sanskrit (ancient South Asian languages,) is the official language in Thailand. ▪ The Thai language is a fixed tonal language and has five tones. ▪ The written alphabet is a complicated system of 44 letters with over 33 vowels or vowel combinations. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Although English is taught in Thai schools, the English proficiency of Thai people in general is not very high. ▪ A younger person is expected to show respect for an older person through his or her gestures and language. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ A Thai female uses the word, “Kah,” while a Thai male uses “Kraab” at the end of a sentence to add politeness in a conversation. ▪ Looking in a person’s eyes and conversing quietly reflect respect and politeness. ▪ A distance of 11/2 to 2 feet between two speakers is preferable. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Kisses and hugs between a male and female are not traditional in the Thai culture. ▪ Thais usually greet each other with the ‘Wai’ motion —putting the palms of both hands together in a prayer-like gesture and bowing the head slightly. ▪ This gesture is used by both men and women of all age groups. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Most Thais have long first and last names. A Thai is usually referred to by his or her first name, even in an official setting like school or work. ▪ Their names usually have clear meanings. ▪ A first name is often given by a Buddhist monk or a fortune-teller based on the date, day of the week, and time of a newborn’s birth. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ When married, a woman usually uses her husband’s last name. A couple’s children also use their father’s last name. ▪ When Thai names are written in English, the spelling is merely a kind of phonetic translation from its real spelling in the Thai alphabet. ▪ Almost all Thais have a short nickname used by their family and close friends. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles & Organization ▪ A man is the head of the household in a traditional Thai family. ▪ In most Thai families, responsibilities involving house chores and taking care of children belong to a woman. ▪ However, more Thai families today have begun to divide house chores between men and women. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles & Organization ▪ Thai children are taught to respect elders. ▪ Talking back to elders is discouraged. ▪ Thai female adolescents have traditionally been expected to protect their virginity until marriage. Dating with a chaperone present is preferable to parents. ▪ Children are the center of the family for Thais. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles & Organization ▪ Traditional Thai families are nuclear in nature. Today, however, single families are becoming more common in Thailand. ▪ It is not uncommon for a single Thai to live with his or her sibling(s), cousin(s), aunt(s), uncle(s), grandparent(s), and/or parent(s). Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles & Organization ▪ Many Thai children sleep with their parents from birth until some point in time before they reach adolescence. ▪ Thai parents do not feel comfortable leaving their infants in a separate bedroom. ▪ Often children are spoon-fed by adults until they are 6 to 7 years old. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles & Organization ▪ Education is so vitally important for Thais that westerners are often amazed when a Thai spouse will leave his or her partner or children behind for years to further studies aboard. ▪ Marriages in Thailand used to be mainly arranged by the parents. ▪ Today, young Thais have more freedom to select a spouse. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Respect for older people, an important aspect of Thai culture, is always signaled by a younger person gesturing with the ‘Wai’ to the older person first. ▪ When the elders in a Thai family become too old to take care of themselves, younger members are morally required to care for them. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles & Organization ▪ Approximately 20 years ago, commercial lounges and bars were the main or only places for gays and lesbians for social gatherings. ▪ Gays and lesbians in Thailand are more accepted today than in the past. ▪ At present, same sex marriages are not supported by Thai laws. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues ▪ Most Thais usually try to avoid personal conflicts at work and are hard workers. ▪ Although the family is deemed very important for Thais, in many circumstances, especially for economic reasons, work comes before family. ▪ Thai Americans tend to socialize among themselves rather than be exposed to Americans or peoples from other cultures. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues ▪ Thai Americans respect their supervisors because seniority is strongly valued in their culture. ▪ Thus, they might not be assertive at work. ▪ Communication in the workplace with Thai Americans who are learning English as their second language should be clear. Slang expressions should be avoided. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ An estimated 75 percent of the population in Thailand is pure “Thai.” ▪ Chinese represent 14 percent of the population ▪ 11 percent of the population is made up of Malay, Lao, Mon, Cambodian, Vietnamese, Asian Indian, Caucasian, or hill-dweller tribes (Karen, Lisu, Ahka, Lahu, Mien, & Hmong.) Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Regardless of mixed heritages, skin color, and facial profile, the Thais’ size and body structure are usually much smaller than those of Caucasians. ▪ Lower doses of indinavir/ritonavir is preferable than using larger doses as used among Caucasians due to the smaller body size of the Thais. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Common genetic conditions among Thais include Gucose-6-phosphate dehydrogenase deficiency, and Thalassemia. Transcultural Health Care: A Culturally Competent Approach, 4th Edition High-Risk Behaviors ▪ Recent surveys of Thais health conditions showed that unsafe sex (12.7%) is the leading high-risk behavior, followed by ▪ Smoking, Alcohol consumption, illicit drug use, nonuse of helmet while driving motorcycle/motorbike, hypertension, high body mass index, high cholesterol, inadequate vegetable and fruit consumption, physical inactivity. Transcultural Health Care: A Culturally Competent Approach, 4th Edition High-Risk Behaviors ▪ Thailand has been commended for its response to HIV/ AIDS. ▪ However, Thailand has in large measure ignored the problems of HIV/AIDS among men who have sex with men. ▪ The problem is interrelated with Thailand’s commercially successful male sex industry. Young male sex workers sell their services—negotiating with sex, condoms, work, and social stigma while living with the ever-present danger of an HIV infection. Transcultural Health Care: A Culturally Competent Approach, 4th Edition High-Risk Behaviors ▪ Smoking and alcohol consumption follow unsafe sex as the second and third most common risk factors found in the behavior of Thai people. ▪ The amount of alcohol consumed by Thais is found to be higher than that consumed by the French, Americans, Japanese, and Filipinos. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ “We should eat to live, not live to eat” is not only a famous saying in Latin, but also in Thai, reflecting the central importance and meaning of food in the Thai culture. ▪ A Thai balanced diet usually includes low-fat/lowmeat dishes with a large percentage of vegetable and legumes. ▪ Rice and fish are main staples. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Vegetables and meats are usually fried or grilled and prepared in many combined variations to supplement rice. ▪ Overall, pork or chicken is eaten more than beef. Fish, and other forms of seafood, are also regularly enjoyed. ▪ Communal eating is an essential part of the Thai culture. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Noodle recipes are much loved by Thais and prepared with the noodles already mixed in with meats and vegetables. ▪ For all foods, seasonings are critical to the Thai artistry of accommodating different palettes. ▪ Fish and oyster sauces are very often combined with soy sauce as a basic starting point for many recipes. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Many Thais love very spicy food, but not all. Tom-Yum is a traditional spicy Thai soup that is gaining popularity worldwide. It has been found to have positive effects on people’s health because of its ingredients, which include lemon grass, galangal roots, kaffir lime leaves, hot chilies, red onions, and garlic Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Som-Tum is a famous spicy Thai salad originating from the northeast of Thailand. ▪ Most Thais living in the United States consume enough fruits and vegetables; not enough bread and milk; and too much meat, fats, oils, and sweets. ▪ Hot or warm foods or drinks are considered healthier than cold ones. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Many types of herbs are considered to promote health and work against cancer development. ▪ Some herbs are considered as an overall panacea. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck The leading high-risk behavior among Thais is a. Alcohol consumption. b. Unprotected sex. c. High fat diet. d. Lack of physical activity. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: B Research reports that the leading high-risk behavior among Thais is unprotected sex. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Thai women view pregnancy as a special time in their lives when they need extra care physically and emotionally. ▪ Ideally, the age of 20 is the optimal time for pregnancy due to the women’s physical and emotional maturity. ▪ Thai women want their husbands and their mothers to be supportive of their pregnancies. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Due to modesty, especially during a vaginal examination, Thai women prefer female healthcare providers over their male counterparts. ▪ They do not feel comfortable exposing their bodies to male providers. ▪ The pregnant woman’s most significant person who directs their practices during this time in her mother. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Pregnant women are advised not to complain or get upset so that newborns will be. ▪ They should not to sit on stairs or door sills to avoid a difficult labor and delivery. ▪ When a pregnant mother blocks other people from going up and down stairs or in and out of a doorway, the unborn baby could be blocked inside the mother’s uterus. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ In general, Thai pregnant women are discouraged from visiting a hospitalized person (regardless of the kind of sickness), attending a funeral ceremony, or visiting a house where there has been a death. ▪ Some women believe that eating eggs may result in having smelly newborns. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Drinking coconut juice can cause too much vernix caseosa. ▪ Others drink a lot of the juice, believing that it will help their newborns to have smooth and beautiful skin texture. ▪ Consuming chocolate or drinking coffee will cause a newborns to have a darker skin texture. ▪ Most Thais view lighter skin as more favorable. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ A safety pin on their outfit over their belly works against a kind of ghost who always wants to steal the unborn baby from a mother’s womb. ▪ After a child is born, the mother is left cold and wet. Therefore, the mother should gain some heat to dry out her body, especially her uterus. ▪ Warm/hot drinks and foods are consumed; ice chips or ice cubes are avoided. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Some avoid chicken postpartum because a chicken likes to scratch the ground to look for food. The chicken meat, therefore, could scratch open the perineum. ▪ Eggs are avoided by some mothers, believing that they could cause a big scar on the perineum. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Some postpartum Thai women drink Ya Dong, a Thai nonalcoholic or alcoholic drink infused with herbs. ▪ The drink helps with blood production and drying out the uterus quickly. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ Because most Thais are Buddhists, only the funeral rites in connection with Buddhism are addressed here. ▪ Like other Buddhists, Thai Buddhists believe that after a person dies, the person will be reborn somewhere else based on that person’s Karma. ▪ Karma means ‘action’ and refers to the process by which a person’s moral behavior or actions have consequences for the person’s future, either in the present or later life. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ Thai Buddhists follow the custom of cremation. ▪ In the funeral ceremony, oftentimes Buddhist monks are invited to chant verses to the dead and the family. ▪ Food and candles are offered to the monks. ▪ The sons of the deceased are expected to be ordained for a short period of time, ranging from a week to three months. ▪ The ordination is believed to help the dead go to heaven. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ Female relatives normally wail quietly. ▪ The family members pray quietly to the dead before the cremation to ask for forgiveness and wish the dead to be reborn in a happy and peaceful home. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ The vast majority of Thais are Buddhist, while the rest are Muslim, Christian, and Hindu or other. ▪ In the United States, over three million people are Buddhist. ▪ Although not in agreement with all other religious beliefs, Thai Buddhists are free to incorporate any other religious values and/or animism to their beliefs and practices when deemed good. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ Most Thais in all socioeconomic strata to some degree incorporate animism, fortune telling, and astrology. ▪ Many families in Thailand have a spirit house where they believe that the ancient spirits of the land (Pra Poom) dwell. ▪ For most Thais, family support along with Buddhism is a crucial source of strength. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ When coping with difficulties or illnesses, many Thai lay people and health-care professional follow Buddha’s teaching. ▪ They believe that the illness can be improved by following the Five Precepts so that their present or next life. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ The Five Precepts are comparable to half of the Christian Ten Commandments and stress abstinence from killing, stealing, lying, sexual misconduct, and illicit drugs and alcohol consumption. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ Four Noble Truths reflect tenets about life. ▪ The First Noble Truth maintains that life is suffering, and that suffering as such is found in four unavoidable life moments; namely birth, illness, aging, and death. ▪ The Second Noble Truth maintains that the cause of all suffering is Tanha, or personal desire. ▪ The Third Noble Truth is a belief that overcoming Tanha is attainable. ▪ The Fourth Noble Truth outlines paths to end suffering. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ Meditation and prayer are ways for many Thais to cope with an illness. ▪ Meditation is a means for Thai older people to enhance their self-awareness, peace of mind, sleep, and physical health. ▪ Spiritual concepts of Karma, Nirvana, the Five Precepts, the Middle Way, and the Four Noble Truths are all important for Buddhist Thais. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Health promotion and disease prevention behavior among the Thais is very limited. ▪ Bad Karma and/or negative supernatural power causes mental illness. ▪ Therefore, folk therapies from traditional healers are the first resource for many Thai families. ▪ When such therapies do not seem to work, they go to contemporary medical facilities as their second resource. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Folk therapies may include healing ceremonies, using shamans (as a mediator) to converse with supernatural beings (such as black magic, evil beings, and/or ancient/natural spirits), negotiating with them that the sick person might be released from their illness. ▪ In such ceremonies, holy water or oil is usually used to anoint the sick. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Some Buddhist Thais may not seek health care until their symptoms become severe. ▪ Stigmatization attached to mental illness and beliefs in animism and Karma tend to prevent some Thais from seeking professional help when mental health problems arise. ▪ Many Thais may appear stoic in trying to withhold expressions of pain or suffering from their illness. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ No religious beliefs against blood transfusion exist for Thais. ▪ However, donating and receiving organs is another matter. Although acceptable among many Thais, belief in their rebirth might prevent some from donating their organs, believing that they might not have the organ when needed in the next life. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practitioners ▪ Thais in the United States and elsewhere tend to consult their family and friends first when they feel ill or have medical problems. ▪ Thai women usually seek female practitioners for childbearing care and gynecologic problems due to their modesty and their culture. ▪ However, if female practitioners are not available, they are generally willing to accept male practitioners. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practitioners ▪ Respect for seniority is a strong cultural value among Thais. Thus, less experienced health professionals in Thailand are expected to respect those with more experience in the same profession. ▪ Thai physicians receive the most respect, followed by the head nurses and junior nurses. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck A common belief among Thais is that mental illness is caused by a. Eating too much pork. b. Eating too much chicken. c. Bad blood. d. Bad karma. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: D Many Thais believe that mental illness is caused by bad karma.
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