5/9/05 Mexican-American Death Rituals:

• Mexican-Americans' death rituals are primarily an adaptation of their religion practiced, most commonly Catholicism.
• Mexican-Americans may have a calm acceptance of illness or dying and view death as a natural part of life.
• Family members may arrive in large numbers at the hospital or home in times of illness or an approaching death.
• When a person dies, relatives and friends may gather for a velorio (a festive watch over the body of the deceased person before burial).
• Many Mexican-Americans bury the body of the deceased within 24 hours, which is required by law in Mexico.
• More traditional Mexican-Americans may continue their native practice of erecting altars in their homes to honor deceased relatives on the anniversary of their deaths.
• The dead are [especially] honored [every November 2nd], with candles, decorations, and by bringing the deceased's favorite meal to a picnic at the grave site [where family members may spend the night praying and singing]. This celebration is known as el Día de los Muertos (the day of the dead).

Source:
Purnell, L. D., & Paulanka, B. J. (1998). Transcultural Health Care: A Culturally Competent Approach. Philadelphia, PA: F. A. Davis Company.

4/25/05 Jewish Health Beliefs

• There are three major categories of Judaism: Orthodox, Conservative, and Reform. The difference is primarily dependent upon the degree of adherence to ancient law and practice as opposed to acceptance of more modern ways.
• In Jewish culture, it is expected that people will be very attentive to a person in distress. Family members will often make sure someone stays with the patient, especially a child.
• Expect family members to be very interested in diagnosis, treatment, and personal care of the patient.
• If possible, avoid performing surgery or medical procedures on the Sabbath or holy days. Weekly observance of the Sabbath, for example, begins at sundown on Friday evening and ends at sundown on Saturday. Observance of holy days begins at sunset of the evening before.
• On the Sabbath and days of religion observance, Orthodox Jews will not touch money, will not write, and will not use electrical appliances, including: hospital bed controls, call buttons, light switches, elevators, automatic door openers, cars, etc. A non-Jewish person can operate these controls for the patient.
• Fasting on Yom Kippur (Day or Atonement; most solemn Jewish holy day devoted to prayer, fasting, and repentance; usually 24 hours) is not required of those who are ill, under the age of 13, or with special dietary needs, such as diabetics. Those who need medicine should continue to take it during Yom Kippur.
• Prohibiting the shaving of facial hair is observed by Orthodox Jews who conform most strictly to Jewish law.
• During discharge planning, know that Orthodox Jews should not travel on the Sabbath.

Source:
Ethnic Resource Guide (1999). Workforce Devleopment and Diversity Strategies Division, Corporate Human Resources, Henry Ford Health System.

4/11/05 Chinese and the Patient-Provider Relationship

• Physicians and nurses are viewed as people who can be trusted with the health of a family member.
• Healthcare providers usually receive the same respect as elders in the family.
• Healthcare providers are recognized by Chinese children as authority figures.
• While the physician makes decisions about the type of treatment, the family is expected to oversee the direct care.
• Although Chinese patients may rely on the physician to make medical decisions, if they disagree with the physician, they may not follow instructions.
• Chinese patients might not outwardly contradict healthcare providers because of fear that either they or the provider may suffer a loss of face.
• Chinese patients may question Western practices because of the invasiveness and pain of some treatments.

Source:
Purnell, L. D., & Paulanka, B. J. (1998). Transcultural Health Hare: A Culturally Competent Approach. Philadelphia, PA: F. A. Davis Company.

3/28/05 Cuban Health Beliefs and Practices

• Traditional Cuban culture holds that mind, body, and spirit are inextricably intertwined.
• While biomedical or allopathic medical practices are widespread in Cuba and germ theory is accepted and understood by most Cubans, traditional and other theories of illness causality are also incorporated in health beliefs and practices.
• Stress is thought to cause a variety of physical and mental health problems.
• Supernatural forces (e.g., mal de ojo or evil eye) or a lack of
  balance are thought by some to cause or contribute to physical and mental health problems.
• Amulets may be worn as protection against supernatural harm.
• Regardless of a person's faith, spiritual care/belief is often
  incorporated in treatment or explanation of illness.
• Persons who are sick may tend to take on a passive and dependent role.
• The physician is highly respected and expected to be in a more directive than partnership role.
• Decision-making usually includes older or more respected family members.
• Hospitalized patients are likely to be attended by family around the clock.

Source:
http://www3.baylor.edu/~Charles_Kemp/cuban_refugees.htm

3/14/05 Jehovah Witness Health Beliefs & Practices

The following information describes some Jehovah Witness health beliefs and practices:

• Jehovah's Witnesses do not accept blood transfusions. Instead, they request nonblood alternatives. Jehovah's Witnesses carry on their person a Durable Power of Attorney for healthcare document that provides a written statement of an individual's medical choices and wishes.
• Autotransfusion techniques such as hemodilution and cell salvage are a personal decision.
• A Witness may accept immune globulins or serums made with a blood fraction based on personal conscience.
• In a rare situation, if court advice is deemed necessary, the patient, the parents or the guardian should be notified as soon as possible of such intended action. This will allow for due process of law and for the court to hear both sides so as to weigh all factors in reaching a decision, including alternative medical nonblood management.
• Jehovah's Witnesses provide spiritual comfort and practical assistance to fellow Witnesses during periods of illness or hospitalization.
• The use of tobacco and addictive drugs is prohibited. However, the medical use of drugs, including narcotics for severe pain, under the supervision of a physician is a personal decision.
• Jehovah Witnesses are opposed to eating foods that contain blood, such as certain types of lunch meats and sausages.
• Birth control is acceptable. Gestational surrogacy is considered to be unacceptable.
• Abortion is unacceptable. If, at the time of childbirth, a choice must be made between the life of the mother and the life of the child, it is up to the individuals involved to make that decision
• Circumcision is acceptable.
• Organ transplantation is an individual decision.
• Autopsies are acceptable.
• Body donation is acceptable and is an individual decision.

Sources:
Detroit Hospital Liaison Committee for Jehovah Witnesses (2005).

Watch Tower Bible and Tract Society of Pennsylvania (2001). "Jehovah's Witnesses Religious and Ethical Position on Medical Therapy, Child Care, and Related Matters."

Dobbins Andrews, J. (1995). Cultural, ethnic & religious reference manual for health care providers (2nd ed.). Winston-Salem, NC: JAMARDA Resources, Inc.

2/28/05 Korean Norms about Meeting/Greeting

• When understanding Korean norms about meeting/greeting, you may want to consider the following:
  • Sustained direct eye contact should not necessarily be expected.
  • When first meeting, a patient may frequently look at you when you are not looking to become more comfortable.
  • Handshakes are appropriate between men.
  • Women do not shake hands.
  • Respect is shown to authority figures by giving a gentle bow.

Please also keep in mind that cultural differences are based on age, ethnic group, generation, migration wave, and length of time away from Korea.

Source:
Culture clues: Communicating with your Korean patient. (Online). University of Washington Medical Center. http://depts.washington.edu/pfes/pdf/KoreanCultureClueDec00.pdf

2/14/05 Muslim Birth Customs

Muslim birth customs are deeply symbolic and serve to remind new parents that a fresh chapter is about to unfold. The following are only four of many Muslim birth customs.

• Adhan - A call to prayer including two pronouncements:
  • It is only proper that the first word a baby hears is the name of his creator, 'Allah'.
    
  • Followed by the Declaration of Faith, 'There is no deity but Allah; Muhammad is the Messenger of Allah'.
    
    • Both of these fundamental pronouncements serve as the pivot around which the life of a Muslim rotates, hence their symbolic significance at birth.
      
    • The father whispers the Adhan into the baby's right ear, serving as a reminder that the father also has a key responsibility in the months and years ahead.
    • Ideally, the Adhan should be completed as soon as possible after birth.
      
• Iqamah - A second call to prayer performed shortly after the Adhan; 'Our stay on earth is short' - the equivalent of the few minutes separating the Adhan from the Iqamah, 'so life then should be spent wisely and diligently, and not wasted'.
• Tahneek - Performed soon after birth and preferably before being fed, a small piece of softened date is gently rubbed onto the infant's upper palate.
  
  • Where dates are not easily available, substitutes such as honey are used.
  • A respected member of the family often performs this customwith the hope that some of his positive qualities will be imparted onto the infant.
• Taweez - A black string with a small pouch containing a prayer, tied around the baby's wrist or neck.
  • This is particularly common among Muslims from the Indian subcontinent, with many believing that it protects the baby from ill health.

Source:
Caring for Muslim patients: Birth customs: meaning and significance. Primary Care Online.
http:www.primarycareonline.co.uk/humaneffect/muslim/chap3.htm (disabled) (2003, Mar. 31).

Amjad, Moiz. (2000, Dec. 18) General Muslim Customs & Traditions. Understanding Islam. (disabled).  http://www.understanding-islam.com/related/text.asp?type=article&aid=35&sscatid=177

Alternate sources:
Gathrad, AR, A. Sheikh. Muslim Birth Customs. Arch Dis Child Fetal Neonatal Ed 2001;84:F6-F8 (January). (Online). http://fn.bmjjournals.com/cgi/content/full/84/1/F6#SEC2

1/31/05 Chinese Buddhist Beliefs about Death and Dying

• According to Chinese Buddhist beliefs, death is not always a one-way passage but sometimes a revolving door. Death may be considered a revolving door through which the consciousness departs from one's life and begins the journey to another new life.
• Another Chinese Buddhist belief is that human life is concurrent and inseparable from two factors: consciousness and warmth. Dying is a gradual process whereby the consciousness gradually separates from the body. Death occurs when the body has completely lost its consciousness and warmth.
• A dying Chinese Buddhist should stay in a peaceful and comfortable environment, preferably accompanied by the chanting of Amitabha, which may be sung by people or played by audio tapes.
• When a person's pulse and brain waves have ceased, traditional U.S. practice is to pronounce the person dead. However, the Buddhist belief is that the person is still actively dying; the consciousness is still in the process of separating from the body.
• During active dying, it is very important to avoid movement of the body or abrupt environmental changes. Therefore, it is preferred to not disturb the body in any way for at least eight additional hours, preferably until the body is cold all over.

Source:
Lin, Y. (1995, Jun. 17). Crossing the Gate of Death in Chinese Buddhist Culture. (Online). Buddhist Yogi C. M. Chen's Homepage. http://www.yogichen.org/efiles/mbk16.html

1/17/05 African-American Illness Beliefs

Some African-Americans may have some of the following illness beliefs:

• Causes of physical illness:
  • Natural causes
  • Improper diet and eating habits
  • Exposure to cold air/winds
  • Supernatural causes: God's punishment for improper behavior or not living according to God's will
• Home and folk remedies:
  • Teas, herbs, warm medicated compresses to the chest for colds
  • Advice/prescriptions from folk healers who are stable, respected and powerful resources

Source:
Locks, S. and Boateng, L.A. Black/African Americans. In Lipson, J.G., Dibble, S.L. and Minarik, P.A., eds. (1996). Culture and Nursing Care: A Pocket Guide . San Francisco, CA: University of California San Francisco Nursing Press.

1/3/05 Greek Fertility Beliefs and Practices

• In American Greek populations, limiting family size is stressed. The trend in Greece for smaller families has been noted since at least the turn of the century.
• In large part, this decrease has resulted from the desire of parents to provide adequately for their children and to have them educated so they can achieve professional status (Friedl, 1962).
• The method of limiting pregnancies has changed from control of gestation to control of conception.
• In Greece, abortions were not legal but were commonly performed by physicians. In the United States, a wide variety of birth control measures, such as intrauterine devices, birth control pills, and condoms are now used (Tripp-Reimer, 1982, as cited in Purnell, L. D., & Paulanka, B. J., 1998).
• The Greek Orthodox Church has issued encyclicals expressing strong disapproval of birth control; however, each local priest may interpret these differently. Although the attitude of the church is generally lenient and practical with regard to birth control, abortion is still regarded as murder.
• Furthermore, adoption is rare among Greeks, both in Greece and in the United States.

Source:
Purnell, L. D., & Paulanka, B. J. (1998). Transcultural health care: A culturally competent approach. Philadelphia, PA: F. A. Davis Company.

12/20/04 Japanese Beliefs of Brain Death

• Some Japanese patients approach death with quiet restraint based on Buddhist tradition.
• Unlike members of Western society, some Japanese people believe that the body is as holy as the mind.
• Japanese tradition views the mind and body as one. This belief has led to a reluctance to accept the concept of brain death.
• Although the brain may have irreversibly lost its function, some Japanese people may be hesitant to believe that a person is completely dead when the body shows obvious signs of life.
• Pronouncing such a person as "dead" could be viewed as disrespectful to a future ancestor.

Source:
Sichina, E. S. (2000, Jul. 18). Japanese culture: Religious influences on health beliefs. (Online). University of North Carolina, Greensboro. http://www.uncg.edu/phe/immigrant/japanese/japanreligion.html (disabled) (2002, Feb. 13).

Alternate source:
Yoshida, Masayuki, BA, MA, PhD. Reconsidering the Japanese Negative Attitude Toward Brain Death and Organ Transplantation. Eubios Journal of Asian and International Bioethics 14 (2004), 91-95. (Online).
http://www.biol.tsukuba.ac.jp/~macer/EJ143/ej143f.htm (disabled)

Redirected to: http://www.lifestudies.org/japanese.html

12/6/04 Orthodox Jewish Birthing Rituals

• Due to laws dictating separation of men and women during any type of vaginal bleeding, some Orthodox Jewish husbands may believe in restraining themselves from touching their wives during labor.
  
• If the husband participates in the delivery, support may be shown through verbal means instead of touching.
• If possible, male nurses should not be assigned to female patients.
• However, laws are waived so male physicians are allowed to attend to female patients.
• A family member or friend of the family will usually stay with the hospitalized newborn at all times.

Source:
Cultural, Ethnic, and Religious Reference Manual for Health Care Providers, 1995 Edition, by Janice D. Andrews

11/22/04 Native American Healing Practices

• Many Native American healing practices come from the belief that mind, body, spirit, and emotions must be balanced to be fully healthy.
• Some Native Americans believe that spirits of plants and animals sent by the Creator are sources for healing.
• Although healing beliefs may differ from tribe to tribe, various ceremonies are similar nationwide.
• Many tribes profess the burning of cedar leaves, sweet grass, or sage chases away negative energy, summons positive forces and cleanses the mind, body, spirit and emotions.
• Spiritual ceremonies and tribal counseling can also be used to treat physical illness.

Sources:
Hall, Lori. "Health Center healing room is Michigan's first" Detroit Free Press. 11 June 1999:1.

Mehl-Madrona, Lewis, MD., Ph.D. Traditional (Native American) Indian Medicine. Center for Health and Healing Beth Israel Medical Center.
http://www.healing-arts.org/mehl-madrona/mmtraditionalpaper.htm

11/8/04 Hindu Dietary Practices

• In keeping with their belief in non-violence towards all living things, many Hindus are vegetarian.
• Hindus may be offended by any form of meat from cows, since cows are considered sacred animals.
• A customary eating schedule for many Hindus would include a light meal in the morning, heavy meal at midday, and another light meal in the evening.
• According to Hindu dietary law, the right hand is used for eating, while the left hand is used for toileting and hygiene.
• Personal hygiene is very important and bathing is required every day; bathing after a meal may be viewed as injurious.
• Various Hindus may fast on different days depending upon the god they choose to worship. Fasting may refer to no food or to one meal a day.

Sources:
Minarik, P. A. (1996). Culture and Nursing Care: A Pocket Guide. California: University of California.

Workforce Development and Diversity Strategies Division, Corporate Human Resources. (1999). Ethnic Resource Guide. Hinduism. p.71. (3rd. ed.) Michigan: Henry Ford Health System.

10/25/04 La cuarentena and Mexicans/Mexican-Americans

• La cuarentena is the 40-day postpartum period during which the mother is to rest and adjust to having a new infant.
• During this recuperation period, the mother is discouraged from getting out of bed for the first few hours after birth, unless she needs to use the bathroom. She is also discouraged from taking showers for several days.
• La cuarentena is also a time of special bonding between the mother and her newborn. Breastfeeding is one way of developing this bond.
• Although breastfeeding is more common among new Mexican immigrants, it is becoming increasingly popular among Mexicans/Mexican-Americans who have lived in the United States for an extended period of time.
• To provide for this mother-newborn bonding time, family members usually take care of household chores.

Sources:
De Paula, T., Lagañá, K., & González-Ramírez, L. (1996). Mexican Americans. Culture and
nursing care: A pocket guide. San Francisco: University of California.

Kemp, C. (2002). Hispanic health beliefs and practices: Mexican and Mexican-Americans (clinical notes). Hispanic Health. (Online).
http://www3.baylor.edu/~Charles_Kemp/hispanic_health.htm

Maternal and reproductive health beliefs. (2002). (Online). American Public Health Association.
http://www.apha.org/ppp/red/labeliefs.htm

10/11/04 Muslims and Fasting

• During the sacred month of Ramadan (this year beginning approximately October 15), Muslims traditionally abstain from food, drink and sexual activity from sunrise to sunset.
• At sunset, this fast is broken by drinking water, eating three dates, and performing special 'taraweeh' prayers after the daily night prayer.
• Fasting serves various purposes:
  • While hungry and thirsty, Muslims are reminded of the suffering and poor.
  • While abstaining from sexual activity, the body and mind are symbolically cleansed.
• Since not all fasting Muslim patients will mention their ritual, healthcare providers may want to offer a discussion of how to fast safely and successfully.
• Those who cannot fast due to chronic illness, such as diabetes, necessitating frequent medications or are too weak to fast give to charity instead of fasting.
• Women who are pregnant, breast-feeding or menstruating do not fast.

Source:
M. Amir Ali, Ph.D. The Institute of Islamic Information & Education Chicago, Illinois
http://www.iiie.net/Articles/tabid/54/TID/24/cid/1/Default.aspx

9/27/04 Traditional Medical Practices of Vietnamese Subcultures

• The mountain dwelling Mien and H'mong subcultures of the Vietnamese culture intertwine medicine and religion.
• Sickness is believed to come from the wrath of the gods.
• The physician is a priest who negotiates with the gods to remove the sickness. These priests are considered superhuman. If they fail to alleviate the illness it is not their failure, but the will of the gods.
• Conversion to Christianity and urban living has lessened the use of shamans (even before moving to the US), but the belief in external causes of sickness remains.
• The Mien and H'mong groups often resist invasive techniques and see a physician who does not intrude on the body as the best healer.
• Traditional herbal remedies, tonics, massage, and avoidance of excess are seen as the pathways to good health.
• Western health care might be sought after traditional methods prove to be ineffective.

Source:
LaBorde, P. (July 1996). Vietnamese cultural profile. (Online). EthnoMed. http://www.ethnomed.org/ethnomed/cultures/vietnamese/vietnamese_cp.html#traditional

9/13/04 Pain Management among Arabs

• Many Arabs express pain freely, especially in the presence of family members with whom they feel comfortable.
  
• When helping Arab patients manage their pain, it may be useful to keep in mind that:
  • Pain is feared and may cause panic when it occurs.
    
  • Coping with pain may be easier if enough information about its source and prognosis is provided.
    
  • When the benefits of potentially painful medical procedures are understood, a higher pain tolerance may result.
    
  • Some Arab patients may perceive intravenous fluids as an indication of the severity of the situation; thus, an explanation may be needed.
    
  • Injections may be considered more effective than pills.
    
  • Explaining the differences between self-medication and prescribed medication may be valuable if patients are considering self-medication.
    
  • Arab patients may also use metaphoric symbols such as fire, iron, knives and rocks to describe pain. Inquiring about these symbols may be useful to further understand pain management among Arabs.

Source:
Meleis, A. I. (1996). Arab Americans. Culture and Nursing Care: A Pocket Guide. California: University of California. P. 28

8/30/04 Female Modesty as an Islamic Practice

• As defined in the Quran, conservative Muslim women dress to show no more than their faces and hands to anyone other than very close relatives.
  
• Some Muslim women abstain from shaking hands with men they do not know.
  
• Same gender care is an effective way to ensure female modesty. Therefore, Muslim women might require a female provider.
• Modesty in the examination room can be achieved by:
  
  • Providing a long-sleeved gown, ankle-length robe, or bath blanket to conservatively cover the body.
  • Asking permission of Muslim women before examining any covered body part, and allowing them to pull clothing aside as necessary (i.e. hijab/headscarf).
  • Being understanding if husbands or relatives are present for support.

Sources:
"Islam". Ethnic Resource Guide, 3rd. Edition, Copyright Fall 1999. p.73. Workforce Development and Diversity Strategies Division, Corporate Human Resources, Henry Ford Health System.

Culture Sensitive Prenatal Care for a Muslim Woman. Sigma Theta Tau International, Nursing Honor Society. (Online). http://www.nursingsociety.org/education/case_studies/cases/
LD0003.html
(2004, Aug. 30) (disabled)

Alternate source:
Maqsood, Ruqaiyyah Waris. Thoughts on Modesty. Islam For Today. http://www.islamfortoday.com/ruqaiyyah05.htm

8/16/04 Buddhist Beliefs of Suffering and Illness

• According to Buddhist tradition, an unclear mind produces suffering and bad karma (law of cause and effect), leading to repeated reincarnations in unsatisfactory worlds.
  
• Relief from suffering and unsatisfactory reincarnations can be obtained by following the Noble Eightfold Path - a practical guide requiring the development of three concepts: 1- wisdom, 2- ethical conduct, and 3- mental discipline.
• Eight highly interdependent principles encompassing these concepts are:
  
  
  • Wisdom -
    1. Right Understanding
    2. Right Thought
    
  • Ethical conduct -
    3. Right Speech
    4. Right Action
    5. Right Livelihood
  • Mental discipline -
    6. Right Effort
    7. Right Mindfulness
    8. Right Concentration.
    
• The central focus of most Buddhist practices is the achievement of a clear and calm state of mind, undisturbed by worldly actions and full of compassion.
  
• Illness is believed to be an unavoidable consequence of actions in this or a previous life; in other words, it may be the result of karma.
  
• Illness is not considered to be a consequence of punishment by a divine being, but rather a physical state that may be healed and restored through the achievement of spiritual peace and freedom from anxiety.

Sources:
Minarik, P. A. (1996). Buddhist. Culture and Nursing Care: A Pocket Guide. San Francisco: University of California.

Buddhism. The Four Noble Truths, The Eightfold Path. About. (Online). http://buddhism.about.com/library/bleightpath.htm

Oriental Philosophy. Philosophy 312: Oriental Philosophy Buddhism: The Eightfold Path. Phylosophy.lander.edu. (Online) http://philosophy.lander.edu/oriental/eightfold.html

8/2/04 Chinese Medicine and the Rule of Five Elements (Wu-Xing)

• Traditional Chinese medicine is based on the balance of two opposite forces, Yin and Yang, and a philosophy that regards the harmony of nature and its correspondents which are intimately associated with Wu-Xing (Five Elements).
  
• According to this philosophy, everything (including organs of the body) corresponds with the five elements. These five elements, which are earth, wood, water, metal, and fire, are related to each other by the Rule of the Five Elements.
  
• The Rule of the Five Elements states that each of the elements has an effect on the others in a controlling and generative cycle.
  
• The balance of Yin and Yang determines the state of the body; this balance also determines the direction of the five elements' cycle.
  
• One of the assumptions inherent in traditional Chinese medicine is that diseases are due to an imbalance of Yin and Yang, and therefore the degeneration of the five elements' cycle.
  
• Although the qualities of Yin and Yang oppose each other, they complement and cannot exist without each other.
  
• Disease can be treated by correcting the Yin and Yang imbalance, and thereby returning the body to a healthy state, according to traditional Chinese medicine.

Source:
Essential-China.net. Chinese Health
http://www.essential-china.net/07_health.main.htm
(disabled) (2004, Aug. 2) and an Interview with Master Wasentha Young http://www.peacefuldragonschool.com/

Alternate source:
Five Element Theory in Traditional Chinese Medicine. Internal
http://www.sacredlotus.com/theory/elements/index.cfm

7/19/04 Somalian Traditional Medicine Modalities

Three, of many, Somalian traditional medicine modalities are: fire-burning, herbal remedies and healing ceremonies.

• Fire-burning : The practice of heating a stick from a special tree until the stick glows and is then applied to the skin is believed to cure some illnesses.
• Herbal remedies : Herbs and readings from the Koran are used to treat seizures. The herb habakhedi is used to treat stomachaches and backaches, while rashes and sore throats are treated with a tea made from the herb dinse.
• Healing ceremonies : Traditional healers perform ceremonies to cure illnesses such as fever, headache, dizziness and weakness, which are thought to be caused by spirits. These ceremonies, designed to appease the spirits, involve reading from the Koran, eating special foods, and burning incense.

Source:
"Common Beliefs & Cultural Practices". The Provider's Guide to Quality & Culture. Management Sciences for Health
http://erc.msh.org/mainpage.cfm?file=5.3.0b.htm&module=provider&language=english

7/6/04 Russian Patients and Serious Illness

• A Russian patient's family may want to be notified before the patient if the patient has a serious illness.
• The family members can then decide whether to tell the patient of his/her serious illness, condition and prognosis.
• The family's decision reflects their concern that the patient may become anxious about his/her illness, which could add another burden.
• The patient's peaceful state, both physical and emotional, is the intent of the family.

Source:
Lipson, J.G., Dibble, S.L., and Minarik, P.A. (Eds.) (1998). Culture & Nursing Care: A Pocket Guide. California: UCSF Nursing Press.

6/21/04 African Women and Geophagia

• Geophagia is the consumption of soil, clay, or chalk.
• Geophagia is common among pregnant African women, particularly in Kenya and Ghana.
• Consumption of soil has been considered a craving of the developing fetus and a characteristic of pregnancy. It has also been used to alleviate morning sickness.
• Certain soils or clays are chosen depending on taste and/or cravings. For example, termite soil is preferred for its saltiness, and gray clay soil is preferred for its sweetness.
• Soil and clay consumption can cause nausea and diarrhea, while lead found in soil and clay may cause miscarriages and stillbirths.
• Although geophagia is not perceived as deviant behavior among pregnant African women, it may be perceived as a psychological disorder or possession by spirits if great amounts of soil are consumed.

Source:
Africa: Maternal and reproductive health beliefs. American Public Health Association.
(Online). http://www.apha.org/ppp/red/afrbeliefs.htm

6/7/04 Asian Maternal Health Beliefs

• In some Asian populations, it is believed that the fetus absorbs information and develops its personality, disposition and physical appearance in the womb.
• An expectant Asian mother may fear that unless she satisfies her food cravings, her baby will take on (physical) characteristics of the food she craves.
• Therefore, it may be helpful for the patient if healthcare providers accept her dietary choices, when medically appropriate.
• In certain Asian cultures, physical activity is advocated even up until birth. Thus, it may be difficult for some Asian women to accept or follow a healthcare provider's medical recommendation for bed rest.
• Expectant mothers may reunite with their parents in the country of origin to deliver the baby, especially during the first pregnancy.

Mexican-American folk beliefs include:

• "Mal de ojo" (evil eye): an illness usually affecting children, caused by excessive admiration or covetous looks by others without touching the child.
• "Caida de mollera" (fallen fontanelle): believed to be caused by handling an infant improperly, such as bouncing roughly, dropping, or removing from the breast or bottle abruptly.
• "Antojos" (cravings): the belief that an infant may have characteristics of an object that the mother craves during pregnancy if the craving is not satisfied (e.g., the infant may have strawberry spots if the mother craves but does not eat strawberries).
• "Cuarentena" (40 days): the period following birth during which certain dietary and activity restrictions are observed to allow the mother time to recover from pregnancy, to bond with the newborn, and to prevent certain illnesses from occurring later in life.

Source:
Kurzon, Vanessa R. (2000). Mexican American Culture and Antepartum Management. Graduate Research On Line Journals, volume 2, number 1, January / February 2000
http://www.graduateresearch.com/kurzon.htm

5/10/04 Mexican/Mexican-Americans and Folk Beliefs: Part 1

• Several Mexican-American folk beliefs are culturally associated with an imbalance between nature and the supernatural.
• It is believed that exposure of a pregnant woman to an eclipse can cause her infant to have a cleft lip or palate.
• This belief originated with the Aztecs, who thought an eclipse occurred because a bite had been taken out of the moon. Hence, if a pregnant woman viewed the eclipse, her infant would have a bite taken out of its mouth.
• As a treatment, an obsidian knife was placed on the Aztec woman's abdomen before going out at night to protect her.
• This belief remains intact among many Mexican-Americans even after hundreds of years. The only difference of today's practice is that a metal key or safety pin is used for protection.

Source:
Kurzon, Vanessa R. (2000). Mexican American Culture and Antepartum Management. Graduate Research On Line Journals, volume 2, number 1, January / February 2000
http://www.graduateresearch.com/kurzon.htm

4/26/04 Russians and Causes of Illness

• Some Russians may be concerned with staying warm, and have a fear of cold temperatures, because they feel cold could cause illness.
• Russian patients may resist a health care provider's suggestion to ice a sore part of their body.
• When Russian patients get the flu, they might blame it on exposure to a draft rather than on exposure to a virus.
• One common Russian remedy for colds and flu is the use of "bonki". Glass cups are pressed on a sick person's back and shoulders to ease fever and flu symptoms, often leaving behind bruises and welts. Such practices have been misinterpreted as abuse.

Source:
St. Elizabeth Family Medicine Residency Program. ALANA Culture Center, Colgate University, Hamilton, NY
(disabled) (2004, Apr. 26)
http://offices.colgate.edu/alanaculturalcenter/communityservice/
utica/cultures/russian/belief_practice.htm

4/12/04 Traditional Judaic Dying Customs

• In traditional Judaism, the spirit leaves the body at the time of death.
• If possible, the dying person is encouraged to recite the confessional or the affirmation of faith (shema) before death.
• A family member may wish to perform this ritual if the dying person is unable to do so.
• By religious law, someone should stay with the dying person so the soul will not feel alone.
• Judaic law also requires the body not be left alone after death. If death occurs on the Sabbath, the family may request that the body be moved until the Sabbath is over.
• The entire body is prepared as soon as possible, preferably within 24 hours, for burial.
• The body may be ritually washed after death by members of the Ritual Burial Society; the son or nearest relative may desire to close the eyes and mouth of the deceased; and arms and hands are extended at the sides of the body, incisions covered, and the body draped with a sheet.
• Beginning with a 7-day mourning period called shiva, mourning extends over one year and includes practices that influence all aspects of life.

Sources:
Purnell, L. D., & Paulanka, B. J. (1998). Transcultural Health Care: A Culturally Competent Approach . Philadelphia, PA: F. A. Davis Company.

Lipson, J.G., Dibble, S.L. & Minarik, P.A. (eds). (1998). Culture and Nursing Care: A Pocket Guide . San Francisco: University of California San Francisco Nursing Press.

3/29/04 SFRY Health Beliefs

• The SFRY was formed in 1945 and comprised the states of Bosnia- Herzegovina, Croatia, Macedonia, Montenegro, Serbia and Slovenia.
• Patients from these states may be likely to want detailed explanations of tests and procedures.
• Treatment may not be considered complete without medication.
• Patients can be encouraged to communicate about suffering.
• Some patients may have a fear of serious disease - approaching phobia.
• Healthcare providers may be expected to give high significance to discussions of symptoms and complaints.
• Relatives play an important role by giving moral and physical support.

• In general, the Vietnamese culture values respect for authority, avoidance of shame and conflict, and politeness.
• Some patients may not ask questions, may not voice disagreement or concern, and may not reveal intentions or actions that seem in contrast to a physician's wishes.
• If patients disagree or do not understand, they may simply listen and respond with a "yes" out of respect for authority (aka: saving face), but then not return for further care or comply with recommendations.
• It can be helpful to ask for further feedback from patients to ensure understanding and agreement, especially when obtaining consent to treatment.
• Asking patients to share alternatives could increase treatment compliance while acknowledging cultural values.

Source:
Pamela LaBorde, MD, Vietnamese Cultural Profile, EthnoMed, University of Washington, Seattle, WA July, 1996.
http://healthlinks.washington.edu/clinical/ethnomed/vietnamesecp.
html#interpersonal (disabled) (2004, Mar. 15)
Redirected to:
http://ethnomed.org/ethnomed/cultures/vietnamese/vietnamese_cp.html#interpersonal

3/1/04 Muslims and Death and Dying

• Death and dying can be extremely important spiritual times for Muslim patients.
• Some Muslims may prefer to face Mecca (approximately northeast from Ann Arbor) and may appreciate the company of family and friends who recite prayers and verses from the Qur'an (the Muslim holy book).
• After a Muslim patient dies, burial should take place as soon as possible.
• Family and/or community members may want to prepare the body by washing it and then wrapping the body in unsewn white cloth.
• Post-mortem examinations are discouraged - unless required by law.
• Most scholars, however, approve of the transplantation of organs from the deceased - with family permission.

• Normative cultural values contribute to the patient-provider relationship.
• These values are defined as the beliefs, ideas, and behaviors that a particular cultural group (or subculture) values and expects in interpersonal interactions.
• One value, "simpatía", which in Spanish means kindness, is a value placed on politeness and pleasantness.
• In clinical settings, "simpatía" includes the normative cultural idea that a health care provider will have an encouraging approach - noticeably polite and pleasant.
• The relatively neutral approach of some U.S. providers may be viewed as negative by some Latino patients.
• Lack of "simpatía" in a clinical setting could potentially decrease patient satisfaction with care, impact disclosure for a complete patient history, discourage adherence to treatment, and decrease making follow-up visits.
• Health care providers can ensure simpatía by emphasizing social courtesies, extending an encouraging approach, and being sensitive to other cultural values.

• Some African Americans believe in a direct connection between their health and God's plan.
• Good health is the product of keeping spiritual harmony between mind, body and soul.
• Illnesses can be treated not only with medical intervention but also with spiritual approaches such as prayer and supportive visits from church ministers and members.
• Asking patients what they think caused their illness and what treatments they plan to or have already used can help with understanding their health beliefs and practices.

Source:
Diversity and Health Care Resource Center (1999). Culture-Sensitive Health Care: African Americans. http://www.diversityresources.com/health2k/health/indexaf.html (disabled) (2004, Feb. 2) Redirected to: http://www.diversityresources.com/rc_sample/african.html (disabled)
Redirected on 2/06 to: http://depts.washington.edu/pfes/pdf/AfricanAmericanCultureClue4_05.pdf

1/19/04 Yin & Yang - Chinese Health Practices

• Chinese medicine is based on the concept that health is achieved through balance of different kinds of energy (Yin & Yang) that affect the life force (Qi or Chi) of each person.
• Diagnosis of imbalance is described in terms of energy (Chi) deficiency or excess - "hot or cold," "dry or damp," or a combination of these.
• These conditions refer to energy properties of the body, foods, and activities - rather than actual temperatures or moisture levels.
• The Chinese concept of balance, represented by Yin & Yang, is reflected in many Asian traditional healing practices.
• Foods are used as therapeutic treatments.
• Foods are either "hot or cold" - depending not on their temperatures but on their use in balancing the body's basic energies.

Source:
Henry Ford Health System (1999). Ethnic Resource Guide . Workforce Development and Diversity Strategies Division, Corporate Human Resources, Henry Ford Health System. Detroit, MI

1/5/04 Traditional Japanese Childbirth Customs

• Customarily, after the fifth month of pregnancy, a Japanese woman will wear a cotton abdomen band called an "Iwata-obi." This is given to her by her family for protection, good luck and an easy birth.
• A month before birth, she will leave her husband and return to her parents' home to give birth.
• Her family will then care for her for one month and she will return to her husband with the child.

Source:
Traditional Japanese Childbirth Customs. http://www.hawcc.hawaii.edu/nursing/Japan_text02.html (disabled) (2004, Jan. 16).
Redirected to: http://www.hawcc.hawaii.edu/nursing/tradjapan2.htm