WK14 Cultural Nursing Paper

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Italian 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 Overview/Heritage Italian American immigrant groups include ▪ First-generation, traditional older Italians primarily living in enclaves ▪ Second-generation, less traditional Italians living in suburban and urban neighborhoods with ethnic enclaves ▪ Third-generation, more educated Italians primarily living in the suburbs ▪ A relatively small group of newer immigrants with strong ties to their homeland Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ This presentation describes the beliefs and practices of Italian Americans from the mainland of Italy, although some of these characteristics may be shared by Italian Americans with a heritage from Sicily and Sardinia. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview ▪ Italy is famous for the marvels of ancient Rome, such as the Coliseum, Parthenon, museums. Also famous for St. Peter’s Square, the Leaning Tower of Pisa, the canals and Piazza in Venice, the ruins of Pompeii, artists, and the Portofino lace makers, wineries, and marble. ▪ New York City has the largest Italian population of any city in the country. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ In addition to New York, other states with high Italian populations are New Jersey, Massachusetts, Pennsylvania, and California. ▪ Major cities in addition to NYC hosting large Italian Americans populations include Chicago, New Orleans, Philadelphia, Boston, Newark, New Jersey, and San Francisco. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ Italian enclaves, or “Little Italy’s” as they are called, can be found in New York City, Boston, Cleveland, and other major cities in the US. ▪ The current Italian American population of almost 16 million ranks fifth in the United States, preceded by German, Irish, English, and African Americans. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ The official language of Italy is Italian, a Romance language derived from Latin. ▪ All socioeconomic groups in the 19 regions of Italy speak different dialects. ▪ The dialects of northern Italy contain numerous German words. Spanish, French, and German languages influence Neapolitan Italy. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Piedmontese is strongly affected by the French and Spanish languages, whereas the dialects of Sicily have been strongly influenced by French, Spanish, Greek, Albanian, and Arabic languages. ▪ Sardinia has its own language, Sardinian. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ First-generation Italians who immigrated to America bring the dialects of their region with them. ▪ Today, in some second-generation and thirdgeneration Italian homes, these dialects are still spoken. ▪ Many second-generation Italian Americans do not speak Italian well or at all. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Either their parents encouraged them to learn English, or more often, the children refused to speak the mother tongue. ▪ Often the next generation becomes curious about its background and tries to recover parts of its heritage. ▪ A number of third-generation Italian Americans are studying Italian in an effort to reconnect with their Italian heritage. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Grammatically correct Italian is musical and romantic because vowels predominate over consonants, expressing the many subtleties of thought and feeling in a delicate manner. ▪ In many Italian households, discussions can become quite passionate with vocal volume raised and many people speaking at once. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ The willingness to share thoughts and feelings among family members is a major distinguishing characteristic of the Italian American family. ▪ Positive and negative emotions and sentiments are permissible, encouraged, and color their daily lives. ▪ Many times a fluctuating emotional climate exists within the family with expressions of affection erupting briefly into what may appear to an outsider as anger or hostility. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Conflict is usually confined to periodic outbursts and does not usually cause resentment or open and permanent ruptures. ▪ In fact, emotional neutrality to Italians denotes noninvolvement or the absence of affection. ▪ Italians are sentimental and not afraid to express their feelings. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Traditional Italian Americans value close family ties, express warmth freely, and have heart and feeling for each other. ▪ The emotional bond among Italian Americans is reaffirmed by frequent kissing. ▪ The “typical” kiss is eastern European style, with a kiss on each cheek. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ They frequently touch and embrace family and friends. Touching between men and women, between men, and between women is frequently seen during verbal communication. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ It is said that the Italians from southern Italy are capable of carrying out a conversation without saying a single word. ▪ Gestures convey a range of feelings from poetic eloquence to intense anger. ▪ Italians are past, present, and future oriented. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Past orientation is evidenced by the pride they take in their rich Roman heritage. ▪ Within the context of fatalism, they do not allow their imagination to stray too far, occupy themselves with concrete problems and situations, and accept things. ▪ They are future oriented as evidenced by the importance given to planning ahead and saving financially for the future. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Time orientation varies by immigrant group. ▪ First-generation and newer immigrants view time as an approximation rather than categorically imperative. ▪ Second-generation and third-generation Italian Americans adhere to clock time at least in the work situation and for appointments. For this group, deadlines and commitments are considered important and adhered to firmly. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Before the Napoleonic era, last names were not commonly used in southern Italy. ▪ After the Napoleonic era ended in 1814, the French often assigned to a family, or sometimes an entire village, the name of that village. ▪ The contadini peasant custom was to name first children for their grandparents and later children for their godparents. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ To avoid confusion, they instituted a practice of assigning nicknames according to some physical characteristic or their occupation. ▪ For example, Giovanni Pelo is translated as “Johnny one hair”. This nickname was given because his body was covered with dark hair. ▪ This practice of assigning nicknames continues with many Italian American families. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ In the past, an Italian father’s decision may have been accepted as law even among his married children. ▪ To criticize one’s father is considered a sacrilege. ▪ In many traditional Italian American families today, the father continues to dominate family decisions as long as he remains in good health and is the chief breadwinner. ▪ He is known as the Padrone or capo di famiglia, the “head of the family.” Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ In old age and illness, the eldest son supersedes the father, but even then, the father retains much of his prestige. ▪ The “typical” traditional Italian father frequently demonstrates public and private affection for his children, but such demonstrations are less frequent in public for his wife. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Many husbands turn over their paychecks to their wives to run the home, and thus Italian women tend to have more power in economic decisions. ▪ Women also dominate decision making on childbearing issues and family social events. ▪ A trend toward more egalitarian relationships is evolving. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Italian American children are taught to have good manners and respect for their elders. ▪ Both male and female children are encouraged to be independent and expected to contribute to the family’s support as soon as they are old enough to work. ▪ This work ethic continues in second-generation and third-generation families. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ L’ordine della famiglia, “family order,” a system of social attitudes, values, and customs, has proven to be impenetrable to the exploitation of strangers and is the main tie that holds the Italian American household together. ▪ The rules governing family membership are simple and explicit: Fear God and respect the saints. The father is the father, and he is experienced. Always honor and obey your parents. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Italian American families maintain close relationships. ▪ Love and warmth, security, and the expression of emotions are the most common characteristics of the Italian American family. ▪ Daughters have close ties with both parents, particularly as they approach old age. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Although many second-generation and thirdgeneration Italian Americans no longer live in an immediate Italian enclave, they return home frequently to maintain family, community, and ethnic ties. ▪ While parents are alive, their home is most often the focus of kinship gatherings. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Italian Americans are almost twice as likely as other ethnic groups to see a parent daily or at least several times a week. ▪ If personal contact is not possible, frequent telephone contacts are made, sometimes several times a day. ▪ Continuity in parental roles is an important factor in maintaining the high status of older people. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ The loss of the work role does not noticeably affect their central role in the family. Instead, the absence of the work role permits greater family involvement. ▪ Italian Americans have an actively functioning kinship and extended family system that is the primary focus of solidarity for the nuclear family. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Social status for most Italian Americans families comes from family lineage. ▪ Titles are more important than names. ▪ Despite values clearly defined around family obligations, Italian Americans generally do not reject another family member because of an infraction or alternative lifestyle. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues ▪ Italians believe strongly in the work ethic, are punctual, and rarely miss work commitments owing to a cold, headache, or minor illnesses. ▪ If completing their work requires staying later, they do so. ▪ Although the family is of utmost importance to Italians, work takes priority over family unless serious family situations arise. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues ▪ Among Italian Americans, work is viewed as a matter of pride, demonstrating that one has become a man or woman and is a full functioning member of the family. ▪ So strong is this ethic that it governs behavior apart from monetary gain derived from employment. ▪ To Italian Americans, it is morally wrong not to be productively occupied. Poveri si, ma perche lognisi? (Poor yes, but why lazy?) Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues ▪ Even though Italian Americans have the utmost respect for their employer, they are emotional and passionate people, and when a confrontation arises, Italians are likely to get involved. ▪ Italians born and educated in the United States usually have little difficulty communicating with others in the workforce. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Italians as a group have varied physical characteristics. ▪ Those from a predominantly northern background have lighter skin, lighter hair, and blue eyes, whereas those from the south of Rome, particularly from Sicily, have dark, often curly hair, dark eyes, and olive-colored skin. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ People of Italian ancestry have some notable genetic diseases, such as familial Mediterranean fever, Mediterranean-type glucose-6-phosphate dehydrogenase deficiency (G-6-PD), thalassemia, and recurrent polyserositis. ▪ Italian Americans have a high incidence of hypertension and coronary artery disease related to smoking and perhaps their type A behavior. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Italian Americans have significantly higher risks of nasopharyngeal, stomach, liver, and gallbladder tumors. ▪ Females exhibit a low risk for cancer of the oral cavity, esophagus, colon, rectum, and pancreas. ▪ Males exhibit a low risk for cancer of the larynx, lung, melanoma, breast, prostate, bladder, and non-Hodgkin’s lymphoma. Transcultural Health Care: A Culturally Competent Approach, 4th Edition High-risk Behavior ▪ Although there is much education in the general population regarding the risks of smoking, many Italian Americans immigrants continue to smoke. ▪ Alcohol misuse also presents a risk in this group. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ To the Italian Americans, food is symbolic of life and the principal medium of life, particularly family life. ▪ Respect for food as the medium of life is upheld even among the poor. ▪ The ceremony of eating is honored by Italian Americans who convey to their children that the waste or abuse of food is a sin. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ In an emotional sense, food is a connection between an Italian child and the parents, representing the product of the father’s labor and prepared with care by the mother. ▪ In a symbolic sense, meals are a communion of the family, and food is sacred because it is the tangible medium of that communion. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ An Italian mother may demonstrate her affection by feeding her family and anyone else she likes. ▪ To the average Italian mom, love is a four letter word. ▪ The Italian diet, rich in vegetables, pasta, fruit, fish, and cheese, varies according to the region of Italy from which the individual originated. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Northern Italian foods are rich in cream and cheese, resulting in a potential high intake of fat. ▪ Southern Italian foods are prepared in red sauces, spices, and added salt. ▪ The staples of the Italian Americans diet are spaghetti, lasagna, ravioli, pasta with pesto, and manicotti. ▪ Vegetables, fresh fruit, and beans are common. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Popular Italian foods include lentils, sausage, eggplant parmigiana, salami, olive oil, espresso and cappuccino coffee, wine, ice cream (gelato), pastries such as cannoli and bisciotti, and cheeses such as provolone, ricotta, romano, and parmigiana. ▪ Other common dishes include escarole, Caesar salad, calzone, and pizza. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Dinner is a gathering of the family. Italian wine is taken at almost every meal, and a mixture of water and wine is given to children. ▪ Breakfast has never been an important meal for southern Italians. ▪ Eating a fresh raw egg every morning, keeps the person strong. ▪ Fresh dandelions are used to make a salad or are boiled to make soup to give the person strength. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ One of the most common practices for health promotion is eating a clove of garlic every night before going to bed to prevent upper respiratory infections. ▪ Garlic may also be worn around the neck when there is an epidemic of influenza or other upper respiratory ailments to prevent the wearer from getting the infection. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck Genetic conditions common Italians and Italian Americans is a. Hemophilia b. Polydactylism c. Bi-polar disorders d. Thalassemia Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: D Thalassemia is a common genetic disorder among Italians and Italian Americans. The other conditions are not. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Many third-generation Italian Americans use birth control from the beginning of the marriage, and sex is commonly discussed in the family. ▪ There continues to be a weakened external restriction on premarital sex, but internal inhibitions remain strong. ▪ In the past, adultery was often seen as unacceptable but sometimes excusable. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Italy has some of the lowest birth rates in the world, which is surprising for a predominantly Catholic country. ▪ Traditional ideas among Italian Americans regarding pregnancy have undergone slight but significant variations in the United States. ▪ The belief that a mother does not conceive while nursing continues to be held by many Italian women. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Traditional beliefs related to pregnancy include the following: coffee spills may result in the baby being born with a birthmark where the coffee was spilled; the women must abstain from sexual relationships while pregnant; and if the expectant mother’s cravings for a particular food are not satisfied, a congenital anomaly may occur or the baby will be marked. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ If a pregnant woman is not given the food she smells, the fetus moves and a miscarriage results. ▪ If she turns or moves in a certain way, the fetus does not develop normally ▪ She should not reach over her head because harm may come to the baby. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Among traditional Italian Americans, a postpartum woman is not allowed to wash her hair, take a shower, or resume her domestic chores for at least 2 or 3 weeks after birth so she can rest. ▪ The woman’s mother and other female family members tend to the chores and assist with the care of the new baby. ▪ New mothers are expected to breastfeed, restoring the health of the reproductive organs and keeping the mother and baby free of infections. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ In the Italian Americans family, death is a great social loss and brings an immediate response from the community. ▪ Sending food and flowers (chrysanthemums), giving money, and congregating at the home of the deceased is expected. ▪ As for other life events, among the first responses to death is food, which is brought by friends and distant relatives. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ Italian death rituals can be very demonstrative. ▪ The funeral procession to the cemetery is a symbol of family status. ▪ There is great pride in the size of the event, which is determined by the number of cars in the procession. ▪ Although there is a tendency today to decrease the elaborateness of the funeral, it remains very much a family and community event. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ Grief over the deceased is eased if a biomedical explanation for the cause of death is given and if it is explained that the death was inevitable. ▪ Within the context of fatalism in Catholicism, many Italian Americans view death as “God’s will;” thus, a fatal diagnosis may not be discussed with the ill family member. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ Emotional outpourings can be profuse and the activities around a funeral provide distinct examples of the Italian Americans way of ritualizing life events. ▪ Women may mourn dramatically, even histrionically, for the whole family. ▪ They do not merely weep; they may rage against death for the harm it has done to the family. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ Family members may moan and scream for the deceased throughout the church. Screaming is an effort to ensure that Jesus, Mary, and the saints hear what the bereaved are thinking and feeling. ▪ Family members get up constantly to touch and talk to the deceased loved one. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ Children are taught to let the female kin express their feelings for them. ▪ The real time of sorrow comes at the end of the ceremony when the priest and non-family congregation say good-bye to the deceased. At this time, the family is left alone for a time with their loved one. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ Older women may throw themselves onto the casket trying to prevent it from leaving the church. Then, the priest intones the farewell: “May the angels take you into paradise, may the martyrs welcome you on your way.” ▪ While men mourn, they do so in the fashion of pazienza, “patience.” Their constant, silent, and expressionless presence may be their only act of public mourning. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ Today, second-generation and third-generation Italian Americans families still acknowledge the need for the mourning procession and the company of family and friends to grieve the loss of a loved one. ▪ Abundant tears and moaning are still recognized as the proper expression of grief. ▪ To many, giving up these customs means an improper expression of respect for the deceased. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ The predominant religion of Italians and Italian Americans is traditional Roman Catholicism, which includes folk religious practices that have changed little since the birth of Christ. ▪ Italian Americans’ spiritual and religious beliefs have their roots in pagan customs, magical beliefs, Mohammedan practices, Christian doctrines, and Italian pragmatism. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ The center of Roman Catholic worship is the celebration of Mass, the Eucharist, which is the commemoration of Christ’s sacrificial death and of His Resurrection. ▪ Other sacraments are baptism, first holy communion, confirmation, confession, matrimony, ordination, and anointing of the sick. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ Most Italians pray to the Virgin Mary, the Madonna, and a number of saints. Many traditional Italian Americans families display shrines to the Blessed Virgin in their backyards. ▪ Italian Americans view God as an allunderstanding, compassionate, and forgiving being. ▪ Prayer and having faith in God and saints help Italian Americans through illnesses. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ Italian men bypass praying to the Madonna because women are perceived to have a closer relationship with the Madonna. ▪ Family and religious beliefs give strength to Italian Americans, who see themselves first as family members and then as individuals. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices In traditional terms, illnesses are attributable to ▪ a) wind currents that carry disease, ▪ b) contamination, ▪ c) heredity, ▪ d) supernatural (God’s will) or human causes, and ▪ e) psychosomatic interactions. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Within the context of fatalism, diseases largely run their own course. ▪ The condition, evil eye, caused by supernatural human agents is discussed under “Folk Practices.” ▪ Nervousness, hysteria, and many other mental illnesses are attributed to an evil spirit entering the body and remaining in the body until it is cast out by making its abiding place so unpleasant that it is forced to leave. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ The concept of family, the most dominant influence on the individual, is viewed as the most credible source of health-care practices. ▪ Italians believe that the most significant moments of life should take place under their own roofs. ▪ The extended family is the front-line resource for intensive advice on emotional problems. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Mental health specialists are frequently perceived as inappropriate agents for meeting problems that are beyond the expertise of the family and local community. ▪ Most second-generation and third-generation Italians take responsibility for their own health care and engage in health promotion more than those of the first generation. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ The mother assumes responsibility for the health of the children. ▪ Individuals can protect themselves from the evil eye by using magical symbols and by learning the rituals of the maghi, “witch.” ▪ Amulets, that fight off the evil eye, include teeth, claws, and replicas of animal horns that are worn on necklaces or bracelets, held in a pocket, or sewn into clothing. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Cornicelli, “little red horns,” can still be purchased in Little Italies as good luck charms. Italian Americans may bring these amulets with them into the health-care settings. ▪ Common plant items used in folk healing are olive oil, lemon juice, wine, vinegar, garlic, onion, lettuce, and tobacco. ▪ A crown of lemon leaves cures a headache. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ The leaves and flowers of the wild mallow herb, Malva, are used to make tea, providing cool energy and positive effects on the lungs and stomach. ▪ When suffering from a fever, a person is given hot rather than cooling drinks. ▪ For indigestion, a mixture of coffee grounds and sugar is taken. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Some Italian mothers use early morning saliva to bathe the eyes of children with conjunctivitis. ▪ Baldness is treated with an application of warm cow’s urine. ▪ Sulfur and lemon juice are mixed as an ointment for scabies, and potato or lemon slices are bound to the wrists to reduce fever. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Both age and gender mediate ethnic differences in the expression of pain for Italian Americans. ▪ Older Italian Americans, especially women, are more likely to report pain experiences, express symptoms to the fullest extent, and expect immediate treatment. Italians tend to be more verbally expressive with chronic pain than do some other ethnic groups. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Because Italian Americans tend to report more symptoms and report them more dramatically, physicians tend to diagnose emotional problems in Italian patients more frequently than in other ethnic groups. ▪ Most Italian Americans believe that people who have disabilities should be cared for at home by the family; thus, very few are placed in long-term care facilities. ▪ A physical or mental disability is not stigmatized because the condition is believed to be due to God’s will. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ The sick role for many is one not entered into without personal feelings of guilt. ▪ They may keep sickness a secret from family and friends and are not inclined to describe the details because they blame themselves for the health problem. ▪ Families may be ashamed to let neighbors know of an incident that may impair the social status of a family member. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ When a family member is sick, other women in the family take over and assist the sick person until they are well. ▪ Judicious use of medications and blood transfusions are permissible and morally acceptable as long as the benefits outweigh the risks to the individual. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practitioners ▪ The powers of the occult are not limited to saints. ▪ For traditional Italian Americans, certain humans are believed to have immediate and potent access to magical powers. These are the maghi, “male witch” and the maghe, “female witch,” who are granted various degrees of black magic power at birth. ▪ These traditional beliefs hold little value for secondgeneration and third-generation Italian Americans. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practitioners ▪ Italians for the most part respect all health-care providers, irrespective of gender. ▪ Some may prefer a same sex health-care provider for intimate care. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck Mario and Maria Martinelli bring their 7 month old baby to the physician for a well baby check. The baby’s shirt has an amulet with little red horns on it. These horns are called a. Cornecelli. b. Malva. c. Padrone. d. Madrone. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: A The little red horns are called cornecelli and are good luck charms. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Irish American Culture Larry Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ The Republic of Ireland, also known as Eire and the Emerald Isle, covers most of the island bearing its name. ▪ The remainder of the island, Northern Ireland, is part of Great Britain. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ During the potato famine between 1846 and 1848, thousands of Irish died from malnutrition, typhus, dysentery, and scurvy; millions immigrated to America. ▪ Over 38 million people of Irish descent live in the United States. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ Most Irish immigrants initially settled in industrial areas in the northeastern United States along the Atlantic coast. ▪ The Irish attained success in America because they spoke the same language, had the same physical appearance as other European Americans, and mastered the political system. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ The major languages spoken in Ireland are English and Irish (Gaelic); the latter is the official language and is spoken primarily in West Ireland. ▪ The Irish enjoy puns, riddles, limericks, and storytelling. ▪ This Irish accent has a nasal quality, spoken with a strong inflection on the first syllable of Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ When one becomes accustomed to hearing the Irish-accented English used by newer immigrants, there is little difficulty in understanding the speaker. ▪ Irish is low-context English, using many words to express a thought. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Some common Gaelic words and their meanings are shamrock for “emblem,” limer for “folklore character,” colleen or lassie for “girl,” sonsie or sonsy for “handsome,” cess for “luck,” brogue for “shoe,” dudeen for “pipe tobacco,” and paddy for “Irishman.” Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Even though most Irish delight in telling long stories, when discussing personal matters, they are much less expressive unless they are talking with close friends and family. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Humility and emotional reserve are considered virtues. ▪ Displays of emotion and affection in public are avoided and are often difficult in private. ▪ Even then, many are still reluctant to express their innermost thoughts and feelings. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ To many, caring actions are more important than verbal expressions. ▪ Direct eye contact when speaking with each other. ▪ Not maintaining eye contact may be interpreted as a sign of disrespect, guilt, or evidence that the other person cannot be trusted. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Personal space is important to the Irish, who may require greater distance in spatial relationships than other ethnocultural groups. ▪ Although the Irish may be less physically expressive with hand and body gesturing, facial expressions are readily displayed, with frequent smiling even during times of adversity. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ The Irish in America, with their strong sense of tradition, are typically past-oriented. ▪ They have an allegiance to the past, their ancestors, and their history. ▪ While respecting the past, they balance “being” with “doing,” and they plan for the future by investing in education and saving money. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Many Irish see time as being elastic and flexible. ▪ Mac before a family name means “son of,” whereas the letter O in front of a name means “descended from.” ▪ Women usually take the name of their husband when they marry. Some keep their last name and other use both their surname and that of her husband. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ The traditional Irish family is nuclear with parents and children living in the same household. ▪ Irish families emphasize independence and selfreliance in children. ▪ Boys are allowed and expected to be more aggressive than girls, who are raised to be respectable, responsible, and resilient. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Children are expected to have self-restraint and self-discipline and to be respectful and obedient to their parents, elders, church, and community figures. ▪ Adolescent years are a time for experiencing emotional autonomy, independence, and attachment outside the family while remaining loyal to the family and maintaining the traditional Irish belief in the importance of family. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Provisions are made in Irish homes for care of elderly family members, a task that becomes increasingly difficult when both parents work outside the home. ▪ Irish respect the experience of elderly people and seek their counsel for decision-making. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ The Irish value physical strength, endurance, work, the ability to perform work, children, and the ability to provide their children with the needed education to attain respectable socioeconomic status and accomplishments. ▪ Same-sex relationships continue to carry a stigma for some. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues ▪ Because cultural differences between Ireland and the United States are minimal, Irish assimilate into the American workforce easily. ▪ When change is necessary to improve the status quo, the Irish readily relinquish traditional beliefs and adjust to the workforce. ▪ Even though the Irish are typical of past-oriented groups in other ways, they tended to question the status quo of the American workforce. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues ▪ The low contextual use of language, where most of the message is in an explicit mode rather than an implicit mode, enhances pragmatic communications in the workforce. ▪ Personal space is important to the Irish, who may require greater distance in spatial relationships than other ethnocultural groups. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck The Irish are noted for their low-context English. Low contexted language means a. Few words are used to express a thought. b. May words are used to express a thought. c. Nonverbal communication is common. d. Nonverbal communication is rare. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: B Low contexted English means that the majority of the message is verbal and many words are used to express a thought. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Most Irish have dark hair and fair skin or red hair, ruddy cheeks, and fair skin; however, other variations exist in hair and skin color. ▪ The fair complexion of the Irish places them at risk for skin cancer. ▪ The Irish are taller and broader in stature than average European Americans, Asians, or Pacific Islanders. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Because mining is an important economic activity in Ireland, miners are at increased risk for respiratory diseases. ▪ The cool maritime climate of Ireland increases susceptibility to respiratory diseases. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Commonly occurring health conditions for Irish Americans are coronary heart disease, phenylketonuria, osteoporosis, alcoholism, and skin cancer. ▪ The major cause of infant mortality in Ireland is congenital abnormalities. ▪ Other conditions with a high incidence among Irish newborns are phenylketonuria (PKU), neural tube defects, and fetal alcohol syndrome. Transcultural Health Care: A Culturally Competent Approach, 4th Edition High-Risk Health Behaviors ▪ Smoking has been identified as a major risk factor causing premature mortality from cancer in Ireland and among the Irish in America. ▪ The use of alcohol and intravenous drugs are major health problems among Irish Americans. ▪ Alcohol problems in Ireland are among the highest internationally. Transcultural Health Care: A Culturally Competent Approach, 4th Edition High-Risk Health Behaviors ▪ Alcoholism researchers generally agree that Irish ancestry puts individuals at risk for developing drinking problems. ▪ Irish pubs are popular establishments that have become synonymous with alcohol intake, lively music, and a vivacious time. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Irish food is unpretentious and wholesome if eaten in recommended proportions. ▪ Food is an important part of health maintenance and celebrations. ▪ Vitamins are commonly used as a dietary supplement. ▪ Meat, potatoes, and vegetables are dietary staples. ▪ Lamb, mutton, pork, and poultry are common meats. ▪ Seafood includes salmon, mussels, mackerel, oysters, and scallops. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Popular Irish dishes include Irish stew made with lamb, potatoes, and onions. ▪ Potatoes are used in a variety of ways. Colcannon is made with hot potatoes, mashed with cabbage, butter, and milk, and seasoned with nutmeg. This dish may be served at Halloween. ▪ Champ is a popular dish made with mashed potatoes and scallions. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Potato cakes, made with mashed potatoes, flour, salt, and butter, are shaped into patties and fried in bacon grease. ▪ Potato cakes are served hot or cold with butter and sometimes with molasses or maple syrup. ▪ Another popular dish is Dublin coddle, made with bacon, pork sausage, potatoes, and onions. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Oatmeal is popular in Ireland. ▪ Soda bread, another popular food, is made with flour, baking soda, salt, sugar, cream of tartar, and sour milk. ▪ Mealtimes are important occasions for Irish families to socialize and discuss family concerns. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Meals are eaten three times a day with a large breakfast in rural areas, lunch around noon, and a late dinner. ▪ Some Irish Americans continue the afternoon tradition of “tea,” a light sandwich or biscuit with hot tea. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck Health conditions with a high prevalence among Irish and Irish Americans include all of the following except a. Alcohol misuse. b. PKU c. Skin cancer d. Aortic anyerisms Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: D No documentation exists that indicate Irish and Irish American have an increased risk for Aortic aneurysms. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Not eating a well-balanced diet or not eating the right kinds of food may cause the baby to be deformed. ▪ A belief common to many other ethnic groups is that the mother should not reach over her head during pregnancy because the baby’s cord may wrap around its neck. ▪ A taboo behavior in the past, which some women still respect, is that if the pregnant woman sees or experiences a tragedy during pregnancy, a congenital anomaly may occur. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Eating a well-balanced diet after delivery continues to be a prescriptive practice for ensuring a healthy baby and maintaining the mother’s health. ▪ Plenty of rest, fresh air, and sunshine are also important for maintaining the mother’s health. ▪ Going to bed with wet hair or wet feet causes illness in the mother. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ The Irish are fatalists and acknowledge the inevitability of death. ▪ The American emphasis on technology and dying in the hospital may be incongruent with the Irish American belief that family members should stay with the dying person. ▪ Whereas men are expected to be more stoical in their bereavement, women are more expressive. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ A wake continues as an important phenomenon in contemporary Irish families and is a time of melancholy, rejoicing, pain, and hopefulness. The occasion is a celebration of the person’s life. ▪ Cremation is an individual choice, and there are no proscriptions against autopsy, if required. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ The predominant religion of most Irish is Catholicism, and the church is a source of strength and solace. ▪ Other religions common among Irish in America include various Protestant denominations, such as the Church of Ireland, Presbyterian, Quaker, and Episcopalian. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ In times of illness, Irish Catholics receive the Sacrament of the Sick, which includes anointing, communion, and a blessing by the priest. ▪ The Eucharist, a small wafer made from flour and water, is given to the sick as the food of healing and health. ▪ Family members can participate if they wish. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ Attending Mass daily is a common practice among many traditional and devout Irish Catholic families. ▪ Prayer is an individual and private matter. ▪ In times of illness, the clergy may offer prayers with the sick as well as with the family. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ For Catholics, holy day worship begins at 4 PM the evening preceding the holy day of obligation; all Sundays are considered holy days. ▪ The obligation to fast and abstain from meat on specified days is relinquished during times of illness. ▪ Some Irish may wear religious medals to maintain health. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Many Irish use denial as a way of coping with physical and psychological problems. ▪ The Irish view of life is illustrated in the belief that life is black with long suffering, and the less said about it, the better. ▪ Many Irish ignore symptoms and delay seeking medical attention until symptoms interfere with the ability to carry out activities of daily living. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Irish Americans limit and understate problems and handle problems by using denial. ▪ Because Irish people may not be very descriptive about their symptoms, treatment may be more difficult. ▪ Illness or injury may be linked to guilt and considered to be the result of having done something morally wrong. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Most Irish believe one is obligated to use ordinary means to preserve life. ▪ Extraordinary means may be withheld to allow the person to die a natural death. ▪ The sick person and family define extraordinary means; finances, quality of life, and effects on the family usually influence the decision. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ In most Irish families, nuclear family members are consulted first about health problems. ▪ Mothers and older women are usually sought for their knowledge of folk practices to alleviate common problems, such as colds. ▪ Having a strong religious faith, keeping one’s feet warm and dry, dressing warmly, eating a balanced diet, getting enough sleep, and exercising are important for staying healthy. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices Irish practices include— ▪ ▪ ▪ ▪ ▪ ▪ Wearing religious medals to prevent illness Using cough syrup made from honey and whiskey Taking honey and lemon for a sore throat Drinking hot tea with whiskey and eating toast for a cold Drinking hot tea for nausea Putting a damp cloth on the forehead for a headache. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ The behavioral response of the Irish to pain is stoic, usually ignoring or minimizing it. ▪ One explanation for high rates of mental illness may be associated with the Irish having difficulty describing emotions and expressing feelings. ▪ Blood transfusions are acceptable to most Irish Americans. ▪ Many participate in organ donation and indicate their willingness to do so on their driver’s licenses. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practitioners ▪ The Irish respect all health-care professionals. ▪ Although the Irish are not noted for being overly modest, some may prefer to receive intimate care from someone of the same gender. ▪ In general, men and women may care for each other in health-care settings as long as privacy and sensitivity are maintained. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Culture Larry Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Overview/Heritage ▪ Puerto Ricans are the 3rd largest Hispanic cultural subgroup with a population of approximately 3 million living in the continental United States. ▪ Most Puerto Ricans on the mainland live in metropolitan areas in the northeastern United States, such as Connecticut, Florida, Illinois, and New York. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Overview/Heritage ▪ Puerto Ricans have a unique pride in their country, culture, and music. ▪ They self-identify as Puertorriqueños or Boricuans (Taíno Indian word for Puerto Rican), or Niuyoricans for those born in New York. ▪ Puerto Ricans have been migrating to mainland United States for decades to seek employment, education, and a better quality of life. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Overview/Heritage ▪ In 1917, Puerto Ricans were granted U.S. citizenship through the Jones Act, and in 1952 Puerto Rico became a Commonwealth. ▪ From the jíbaros (peasants) to educated political leaders, the perception of many is that the Americanos, their culture, and politics are a potential threat to the Puerto Rican culture, language, and political future. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Overview/Heritage ▪ Puerto Ricans select geographic areas to reside where they can preserve their culture, enhance assimilation into the US dominant culture, and increase employment and social support opportunities. ▪ Citizenship status has created a controversial Va y Ven (go and come) migration. Individuals and families are often caught in a reverse cycle of immigration. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Overview/Heritage ▪ Historically, many Puerto Ricans have valued private rather than public education. ▪ Many parents make great financial sacrifices to enable their children to attend private educational organizations, which most often are Catholic schools. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Overview/Heritage ▪ Private schools are often referred to as colegios (colleges), creating confusion with the American English translation of undergraduate institutions. ▪ Instead of “college,” the term universidad (university) is most commonly used to refer to 4-year college institutions. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Communication ▪ Children, beginning in kindergarten, learn to read and write English and Spanish. ▪ The issue of two official languages, English and Spanish, is a sensitive one for some Puerto Ricans who, after the U.S. occupation in 1898, were forced to learn English. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Communication ▪ Puerto Ricans use the standard form of Spanish, speaking with no dialects or indigenous languages, although some rural people may speak with a different accent. ▪ Puerto Ricans frequently use the phrase !Ay bendito! to express astonishment, surprise, lament, or pain. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Communication ▪ Puerto Ricans speak with a melodic, highpitched fast rhythm. ▪ This pitch and these inflections are maintained when speaking English. ▪ Puerto Ricans are known for their hospitality and the value placed on interpersonal interaction, such as simpatia, a cultural script where an individual is perceived as likeable, attractive, and fun loving. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Communication ▪ They often expect the health-care provider to exchange personal information when beginning a professional relationship. ▪ The health-care provider may wish to set boundaries with discretion and personalismo, emphasizing personal rather than impersonal and bureaucratic relationships. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Communication ▪ Most Puerto Ricans readily express their physical ailments and discomforts to healthcare providers with the exception of taboo issues, such as sexuality. ▪ If confianza (trust) is established, health-care providers can establish open communication channels with individuals and family. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Communication ▪ Spatial distancing varies with age, gender, generation, and acculturation. ▪ Personal space may be a significant issue for some older women, particularly those from rural areas of Puerto Rico who may prefer to maintain a greater distance from men. ▪ Puerto Ricans born on the mainland may be less self-conscious about personal space. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Communication ▪ Young Puerto Rican women may take offence to verbal and nonverbal communications that portray women as nonassertive and passive. ▪ Most Puerto Ricans are very expressive, using many body movements to convey messages. ▪ During conversations, hand, leg, head, and body gestures are commonly used to augment messages expressed by words. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Communication ▪ Greeting Puerto Ricans with a friendly handshake is acceptable. ▪ Puerto Rican women greet each other with a strong familiar hug and, if among family or close friends, a kiss is included. ▪ Men may greet other men with a strong right handshake and a left hand stroking the greeter’s shoulder. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Communication ▪ Nonverbal communications may include an affirmative nod with an aha response, but this does not necessarily mean agreement or understanding related to the conversation. ▪ Most Puerto Ricans are present oriented, having a relativistic and serene view and way of life. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Communication ▪ Among younger Puerto Ricans and those born on the mainland, eye contact is maintained and is often encouraged among those who believe in a nonsubmissive and assertive portrayal. ▪ However, among more traditional Puerto Ricans born and raised in rural areas of Puerto Rico, limited eye contact is preferred as a sign of respect, especially with older people who are seen as figures of respect and great wisdom. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Communication ▪ Rather than Señora (Mrs.) and Señor (Mr.), children and adults are expected to use the term Doña (Mrs.) and Don (Mr.) for most adults. Aunts and uncles have their name preceded by tití or tío (auntie/uncle) and madrina or padrino (godmother or godfather). ▪ These prefixes are symbols of respect and position in the family. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Communication ▪ A single woman may use her name as follows: Sonia López Mendoza with López being her father’s surname and Mendoza her mother’s. ▪ When she is married, the husband’s last name, Pérez, is added with the word de to reflect that she is married. This woman’s married name would be Sonia López de Pérez; the mother’s surname is eliminated. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Communication ▪ Younger or more acculturated women may change their last names to that of their husbands. ▪ The importance and respect given to the above prescriptive name formalities are perpetuated when friendly verbal and nonverbal gestures accompany the greeting. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Family Roles and Organization ▪ Despite many socioeconomic changes and changes in the position and role of Puerto Rican women, many traditional patriarchal values still define women in terms of their reproductive roles. ▪ Gender role expectations are strikingly different among more acculturated families ▪ Traditional men demand respect and obedience from women and the family. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Family Roles & Organization ▪ The Puerto Rican family is moving toward more egalitarian relationships. ▪ More Puerto Rican families are sharing the economic and social responsibilities of the household. ▪ Machismo and gender roles continue to be the source of confrontations. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Family Roles and Organization ▪ From childhood through adolescence, children are socialized to have respect for adults, especially the elderly. ▪ Great significance is given to the concept of familism, and any behavior that shifts from this ideal is discouraged and may be perceived as a disgrace to the family. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Family Roles and Organization ▪ Many families believe that a healthy child is one who is gordita or llenito (diminutive for fat or overweight) and has red cheeks. ▪ Young mothers are often encouraged to add cereal, eggs, and viandas to their infant’s milk bottles. ▪ Many families socialize male children to be powerful and strong. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Family Roles and Organization ▪ Girls are socialized to be modest, sexually ingenuous, respectful, and subservient to men, a cultural script related to marianismo. ▪ Discussions about sexuality are considered taboo for many families. ▪ Modesty is highly valued: menstruation, birth control, impotence, sexually transmitted diseases, and infertility, are rarely discussed. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Family Roles and Organization ▪ Most families expect their children to stay home until they get married or pursue a college education. ▪ Children are expected to follow family traditions and rules. ▪ The mother is expected to assume an active role disciplining, guiding, and advising children. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Family Roles and Organization ▪ La familia is the nucleus of the community and the society. ▪ The family structure may be nuclear or extended. ▪ Family includes grandparents, married children, aunts, uncles, cousins, and even divorced children with their children. ▪ Two families may live in the same household. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Family Roles and Organization ▪ Most Puerto Rican families want a daughter because traditionally daughters are caretakers when parents reach advanced ages. ▪ Male children, who are usually more independent, are valued because they continue the family name. ▪ Grandparents assume an active role in rearing grandchildren. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Family Roles and Organization ▪ During the past 2 decades, Puerto Rican families have experienced an increased incidence of pregnancy among teenagers and unmarried women. ▪ Homosexuality continues to be a taboo topic that carries a great stigma among Puerto Ricans. ▪ Same-sex behavior is often undisclosed to avoid family rejection and preserve family and support. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Workforce Issues ▪ In general, Puerto Rican men and women readily assimilate into the dominant U.S. work environment. ▪ Most Puerto Ricans are hardworking, like competition, and often make extended efforts to please their employers. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Workforce Issues ▪ While most migrant Puerto Ricans are task oriented and meticulous about the presentation of their work, some have a relativistic view of time and may not value regular attendance and punctuality in the workforce. ▪ Most Puerto Ricans are cheerful, have a positive attitude, and value personal relationships at work. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Workforce Issues ▪ Men are socialized to display confidence at work and assume leadership positions with autonomy. ▪ Less educated immigrants are more likely to conform to the behavioral norms of the workplace and avoid personal conflict or confrontations in an effort to maintain positive relationships. ▪ Some women find themselves in conflict with traditional values when in a competitive, assertive work environment. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Biocultural Ecology ▪ Given the heritage of Puerto Ricans, who are a mixture of Native Indian, African, and Spanish heritage, some may have dark skin, thick kinky hair, and a wide flat nose; others are white skinned with straight auburn hair and hazel or black eyes. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Biocultural Ecology ▪ Puerto Ricans on the mainland face a high incidence of mental illness among younger adults, and cardiopulmonary and osteomuscular diseases afflict the elderly. ▪ Acute conditions among Puerto Ricans include a disproportionate number of acute respiratory illnesses, injuries, infectious and parasitic diseases, and diseases of the digestive system. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Biocultural Ecology ▪ Puerto Rican women in the United States have a high incidence of being overweight. ▪ Dengue, a mosquito-transmitted disease caused by any of the four viral serotypes of the Aedes aegypti mosquito, is an endemic disease that migrants may bring to the mainland. ▪ Puerto Rico has a higher HIV infection rate than any state in the United States. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Biocultural Ecology ▪ Because of the African heritage of many Puerto Ricans, drug absorption, metabolism, and excretion differences experienced by African Americans and Native Americans may hold true for black Puerto Ricans. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican High-risk Health Behaviors ▪ Alcoholism is the precursor of increased unintentional injuries, family disruption, spousal abuse, and mental illness among Puerto Rican families. ▪ The prevalence of smoking among Puerto Ricans is lower than that of European Americans, but higher than that for other Hispanic subgroups. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican High-risk Health Behaviors ▪ Acculturation, as measured by language use, is significantly associated with marijuana and cocaine use. ▪ Many studies have shown that the longer one lives in the United States and the more acculturated one becomes, the higher the use of marijuana, smoking, and cocaine. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Nutrition ▪ Food is used (a) to honor and recognize visitors, friends, family members, and healthcare providers; (b) as an escape from everyday pressures, problems, and challenges; and (c) to prevent and treat illnesses. ▪ Some Puerto Ricans believe that being overweight is a sign of health and wealth. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Nutrition ▪ Traditional Puerto Rican families emphasize having a complete breakfast that begins with a cup of strong coffee or café con leche (coffee with milk). ▪ Some drink strong coffees such as espresso with lots of sugar; others boil fresh milk (or use condensed milk) and then add the coffee. ▪ Many families introduce children to coffee as early as 5 or 6 years of age. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Nutrition ▪ A traditional Puerto Rican breakfast includes hot cereal, such as oatmeal; corn meal; or rice and wheat cereal cooked with vanilla, cinnamon, sugar, salt, and milk. ▪ Although less common, traditional Puerto Ricans may eat corn pancakes or fritters for breakfast. ▪ Lunch is served by noon, followed by dinner at around 5 or 6 o’clock in the evening. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Nutrition ▪ Rice and stew beans) are main dishes. ▪ Rice may be served plain or with as many as 12 side dishes. ▪ Rice cooked with vegetables or meat is considered a complete meal. ▪ Gandules (green pigeon peas), a Puerto Rican bean is rich in iron and protein. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Nutrition ▪ Tostones, fried green or ripe plantains, are a favorite side dish served with almost every meal. ▪ Puerto Rican families eat a variety of roots called viandas, vegetables rich in vitamins and starch. ▪ Common viandas are celery roots, sweet potatoes, yams, breadfruit, breadnut, plantains, green bananas, tanniers, cassava, and chayote squash. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Nutrition ▪ Many Puerto Ricans ascribe to the hot-cold classifications of foods for nutritional balance during menstruation, pregnancy, the postpartum period, infant feeding, lactation, and aging. ▪ Chicken soups and caldos (broth) are used as a hot meal to provide essential nutrients during illness. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Nutrition ▪ A mixture of of honey, lemon, and rum are used as an expectorant and antitussive. ▪ A malt drink, malta (grape juice), or milk is often added to an egg yolk mixed with plenty of sugar to increase the hemoglobin level and provide strength. ▪ Ulcers, acid indigestion, and stomach illnesses are treated with warm milk, with or without sugar. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Nutrition ▪ Herbal teas are used to treat illnesses and to promote health. ▪ Most herbal teas do not interfere with medical prescriptions. ▪ Incorporating their use with traditional Western medicine may enhance compliance. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Pregnancy and Childbearing Practices ▪ Puerto Rican women do not commonly use birth control methods such as foams, creams, and diaphragms because the Catholic Church. ▪ Pregnancy is a time of indulgence for Puerto Rican women. ▪ Favors and wishes are granted to women for their well-being and the health of their babies. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Pregnancy and Childbearing Practices ▪ Men are socialized to be tolerant, understanding, and patient regarding pregnant women and their preferences. ▪ Pregnant Puerto Rican women are encouraged to rest, consume large quantities of food, and carefully watch what they eat. ▪ Many young Puerto Rican families prefer to attend birthing classes. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Pregnancy and Childbearing Practices ▪ Some expect women to “get fat” and place little emphasis on weight control. ▪ Strenuous physical activity and exercise are discouraged and lifting heavy objects is prohibited. ▪ Women are strongly discouraged from consuming aspirin, Alka Seltzer, and malt beverages because these substances are believed to cause abortion. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Pregnancy and Childbearing Practices ▪ Many women refrain from tener relaciones, sexual intercourse, after the first trimester to avoid hurting the fetus or causing preterm labor. ▪ Some men view this time as an opportunity for extramarital sexual affairs. ▪ Women welcome their husbands, mothers, or sisters to assist during labor. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Pregnancy and Childbearing Practices ▪ During labor, women may be loud and verbally expressive, a culturally accepted and an encouraged method for coping with pain and discomfort. ▪ Pain medications are welcomed. ▪ Most women oppose having a cesarean section because it portrays a weak woman. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Pregnancy and Childbearing Practices ▪ The first postpartum meal should be homemade chicken soup to provide energy and strength. ▪ Women are encouraged to avoid exposure to wind and cold temperatures, not to lift heavy objects, and not to do housework for 40 days after delivery (the cuarentena). ▪ Some traditional women do not wash their hair during this time. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Pregnancy & Childbearing Practices ▪ Because the mother is believed to be susceptible to emotional and physical distress during the postpartum period, family members try not to contribute to stress or to give bad news to the new mother. ▪ Fathers may be reluctant to tell the new mother about a problem with the newborn. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Pregnancy and Childbearing Practices ▪ Because some Puerto Rican women believe that breastfeeding increases their weight, disfigures the breast, and makes them less sexually attractive, they undervalue the benefits of breastfeeding. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Death Rituals ▪ Death is perceived as a time of crisis in Puerto Rican families. ▪ The body is considered sacred and guarded with great respect. ▪ Death rituals are shaped by religious beliefs and practices and family members are careful to complete the death rituals. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Death Rituals ▪ News about the deceased should be given first to the head of the family, usually the oldest daughter or son. ▪ Because of cultural, physical, and emotional responses to grief, health-care providers should use a private room to communicate such news and have a clergy or minister present when the news is disclosed. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Death Rituals ▪ Traditionally, some Puerto Rican families keep the body in their home before burial. Cultural traditions and financial limitations influence this decision. ▪ For some, funeral homes are viewed as impersonal, financially unnecessary, and detrimental to the mourning process because they detract from family intimacy. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Death Rituals ▪ Cremation is rarely practiced among Puerto Ricans. ▪ Among Catholics, the head of the family or other close family member is expected to organize the religious ceremonies, such as the praying of the rosary, the wake (velorio), and the novenas, the 9 days of rosary following the death of the family member. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Death Rituals ▪ Family may meet at the deceased’s home for several days, sometimes weeks, to support the family and talk about the deceased. ▪ Family of the deceased to freely express themselves through loud crying and verbal expressions of grief. ▪ Some may talk in a thunderous way to God. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Death Rituals ▪ Some believe that not expressing their feelings could mean a lack of love and respect for the deceased. ▪ Similar to other crisis events, some may develop psychosomatic symptoms, and others may experience nausea, vomiting, or fainting spells as a result of a nervousness attack (ataque de nervios.) Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck Tania Miranda has been in labor for 12 hours. The physician is recommending a cesarean section, which she is reluctant to have because some Puerto Rican believe a C-section a. Makes the woman appear weak. b. Leaves an unattractive scar. c. Means that she can never have another child. d. Leave the baby weak. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: A Some Puerto Rican women believe that having a cesarean section makes them appear weak. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Spirituality ▪ Most Puerto Ricans on the mainland are Catholic (85 percent); however, over the past 4 decades, Protestant Evangelical religious movements have converted 35 percent of the Puerto Rican population in the United States. ▪ A few practice espiritismo, a blend of Native Indian, African, and Catholic beliefs that deal with rituals related to spiritual communications with spirits and evil forces. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Spirituality ▪ Many join Evangelical churches because they offer a more personal spiritual approach. ▪ These religious groups provide social support and promote harmony and spiritual–physical well-being. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Spirituality ▪ Espiritistas treat clients with mental health conditions and are often consulted to determine folk remedies compatible with Western medical treatments. ▪ Older adults, those who have limited access to health care, and those who are dissatisfied with or distrust the Western medical system commonly use spiritual healers. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Spirituality ▪ To provide timely and appropriate interventions to Catholic families, health-care practitioners should inquire about the family’s wishes regarding the Sacrament of the Sick. ▪ Special prayers and readings are believed to be necessary at the moment of death, and families expect to be present to recite these prayers. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Spirituality ▪ Many see the quality of life as a harmonious balance among the mind, body, and spirit. ▪ Most Puerto Ricans are very religious and, when confronted with situations related to health, illness, work, death, or the prognosis of a terminal illness, they maintain their trust in spiritual forces. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Spirituality ▪ Rather than a fatalistic approach to life during illness, death, or health promotion, Puerto Ricans use coping mechanisms such as religious practices. ▪ God, who is their highest source of strength, guides life. ▪ For some, scripture readings, praise, and prayer bring inner spiritual power to the soul. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Spirituality ▪ Clergy and ministers are a resource for spiritual wisdom and help with a host of spiritual needs. ▪ An azabache (small black fist) or a rabbit’s foot might be used for good luck, to drive away bad spirits, and to protect a child’s health. ▪ Rosary beads and patron saint figures may be placed at the head or side of the bed or on the client to protect him or her from outside evil sources. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Health-care Practices ▪ Most have a curative view of health. ▪ They tend to underuse health promotion and preventive services, such as regular dental examinations, physical examinations, and pap smears. ▪ Good hygiene is a basic concept for health promotion among Puerto Ricans. ▪ Daily showers are essential for good health and for personal appearance. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Health-care Practices ▪ Most Puerto Ricans believe in “family-care” rather than self-care. ▪ Women are seen as the main caregivers and promoters of family health and are the source of spiritual and physical strength. ▪ Natural herbs, teas, and over-the-counter medications are often used as initial interventions for symptoms of illness. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Health-care Practices ▪ Many consult family and friends before consulting a health-care provider. ▪ Although Puerto Rico is subject to U.S. drug administration regulations and practices, many Puerto Ricans are able to obtain controlled prescriptions from their local pharmacist in Puerto Rico. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Health-care Practices ▪ Over-the-counter medications and folk remedies are often used by Puerto Ricans to treat mental health symptoms, acute illnesses, and chronic diseases. ▪ Puerto Ricans have become accustomed to the use of extended-care facilities and nursing homes. However, they prefer to keep chronically or terminally ill family members at home. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Health-care Practices ▪ Espiritistas solve problems by communicating with spirits. ▪ Santería focuses on health promotion and personal growth and development. ▪ Clients who use folk practices visit bótanicas, folk religious stores, and use natural herbs, aromatic incenses, special bathing herbs, prayer books, and figurines for treating illness and promoting good health. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Health-care Practices ▪ Fanning the face or blowing into the client is believed to provide oxygen and relieve dyspnea. ▪ Some may use tea from an alligator’s tail, snails, or savila (plant leaves) for illnesses such as asthma and congestive heart failure. ▪ Some place a damp cloth on the forehead to refresh the hot inside the body and relieve nausea. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Health-care Practitioners ▪ Mint, orange, or lemon tree leaves are boiled and used as tea to relieve nausea and vomiting. ▪ Puerto Ricans may be loud and outspoken in expressing pain. ▪ This expressive behavior is a socially learned mechanism to cope with pain. Ay! is a common verbal moaning expression for pain (dolor). Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Health-care Practices ▪ Most people prefer oral or intravenous medications for pain relief rather than intramuscular injections or rectal medications. ▪ Herbal teas, heat, and prayer are used to manage pain. ▪ Because mental illness carries a stigma, obtaining information or talking about mental illness with Puerto Rican families may be difficult. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Health-care Practices ▪ A mental illness may result from a terrible experience, a crisis, or the action of evil forces or spirits. ▪ Mental illness results from nerves or failing God’s commandments. ▪ Organ donation is an act of goodwill and a gift of life. Autopsy may be seen as a violation of the body. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Health-care Practices ▪ Although there are no proscriptions against blood donation and blood transfusion, many Puerto Ricans may be reluctant to engage in these procedures for fear of contracting HIV. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Health-care Practitioners ▪ Some espiritismo practices are used to deal with the power of good and evil spirits in the physical and emotional development of the individual. ▪ Santeros, individuals prepared to practice santería, are consulted in matters related to the belief of object intrusion, diseases caused by evil spirits, the loss of the soul, the insertion of a spirit, or the anger of God. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Health-care Practitioners ▪ Modesty is a highly valued quality. ▪ Men prefer male physicians for care and may feel embarrassed and uncomfortable with a female physician. ▪ A few discount the academic and intellectual competencies of female physicians and may distrust their judgment and treatment. Some Puerto Rican women feel uncomfortable with a male physician while a few prefer a male doctor. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Puerto Rican Health-care Practitioners ▪ Older Puerto Ricans may prefer older healthcare providers because they are seen as wise and mature in matters related to health, life experiences, and the use of folk practices and remedies. ▪ Puerto Ricans hold health-care providers in high regard; that is, they are seen as wise figures of authority. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck Mr. Perez, age 76, is seeing his nurse practitioner as followup for asthma. He tells the nurse practitioner that he is also seeing an santero. The nurse recognizes that a santero a. Treats gastrointestinal disorders. b. Cardiovascular disorders. c. Sexual dysfunction disorders. d. Evil spirits. e. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: D Santeros are consulted in matters related to the belief of object intrusion, diseases caused by evil spirits, the loss of the soul, the insertion of a spirit, or the anger of God.
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