Nursing and Cultural Relativism

The world has become a global village as people migrate from one area to another for various reasons. The United States was once considered a “melting pot’ with people from different cultural and ethnic groups assimilating into a common culture. This concept is no longer accepted and it is now recognized that the United States is comprised of many people who have retained their cultural heritage (Burgess, 1983). As time goes by, cultural practices are transferred from one community to the other so that defining culture is not as easy as we all think it is. Potter and Perry (1997), define culture, as the sum of beliefs, practices, habits, likes, dislikes, norms, customs, and rituals learned from the family during the years of socialization. Simply put, culture could be defined as patterns of learned behaviors and values that are shared amongst members of a designated group and usually transmitted to others in the group through time. As a result of cultural diversity, nurses in an attempt to deliver health care services have to inculcate cultural relativism in their practice. A cultural assessment is always imperative when dealing with patients. Cultural relativism is primarily an attitude that values every group as having beliefs, values and behaviors arising out of its historical background (Woods and Rokosky, 1986). At the same time, being mindful of cultures and groups based on historic definitions can also create a path for stereotyping so there is always the need for nurses to be reminded that every member of a given culture does not fit a textbook definition of the culture’s typical behavior. Hence, cultural relativism demands that nurses develop a nuanced awareness of the diverse populations they serve while never losing sight of the individual. It is a challenge but the result is better care for the patient.

In an attempt to effectively deliver services to all patients, nurses need to learn as much as possible about the health beliefs and behaviors of the people they work with both from literature and individual informants. Some nurses caring for patients from ethnic backgrounds may be categorized as culturally blind, but they may progress to being culturally sighted if an effort is made to learn about ethnic behaviors in response to modern medical care. It is absolutely impossible for nurses to know about all existing cultures in the world but nurses can use cultural relativism as a guiding light in delivering health care services to the masses. Patients can often be wonderful resources for understanding what is considered to be ‘culturally correct’ and appropriate for their particular culture. It is always left to the nurses to decide whether or not to make use of the resources available to them. Most people are willing to provide information about cultural practices, especially when they know that such knowledge would positively affect the provision of health care services. For example, some cultures have historically taken hot and cold phenomena into consideration, i.e., treatment is based on the concept of neutralization so that cold illness is treated with hot food, drugs and herbs and hot illness is treated with cold food drugs and herbs. Fresh vegetables, which are cold, can be used to cure hot illnesses such as constipation and anemia (Woods et al, 1986).

Different cultures believe in various causes and cures for diseases. For many ethnic groups, illness is of greater importance than the disease and the cure for the disease can occur only when the illness is considered. It is for this reason that many cultural groups use the professional and folk system simultaneously recognizing the fact that the professional systems treats and cures disease only (Woods and Rokosky, 1986). Some examples of the cultural causes and the treatment of illness include the hot and cold phenomena. This theory of the hot and the cold phenomena is based on the humoral theory of disease which views health as being a state of balance among the four humors of the body which include body phlegm, black bile and yellow bile (Woods and Rokosky, 1986). Woods et al, state that all of the humors have the characteristics of being either hot or cold and that a balance between hot and cold is considered healthy and an imbalance represents illness. The Asians hold a similar but different yin (cold) and yang (hot) etiology of disease. Yin and Yang are opposing forces that when in balance yield health. White (2001), states that culture has several characteristics and some of these characteristics include the fact that it is learned but not inherited. Culture is shared by everyone who belongs to a cultural group and behavioral patterns are not individually defined but are accepted and practiced by everyone. Finally, culture is unspoken and ever changing and each generation experiences new ideas that may generate different standards of behavior.

Tips for Cultural Friendly Care

• Nurses who are caring for clients who differ from themselves must remember to ascertain the client’s perception of the event (illness), including the significance that the client assigns to the event.
• Remember that each person is first and foremost an individual, secondly, a member of a cultural group. While similarities may exist within an ethnic or cultural group, individual differences must also be respected. The nurse should honor individual differences and understand that culture influences the way clients are viewed and treated within the health care system.
• Many Caucasian Americans do not belong to the mainstream culture but, instead, belong to ethnic subcultures that hold strong values of their own such as Irish, Jewish, German, Italian, Norwegian, Appalachian, and Amish subcultures (White, 2001).
• When interacting with someone who does not understand English well, speak slowly, distinctly and in a normal volume to ensure effective communication.
• Each individual defines family differently and most times these definitions are shaped by personal experience and observation of other families. The nurse must remain objective and nonjudgmental when the patient’s family is different from their own idea of family. Always have the client identify family members so you know who the client considers to be family.
• Accommodate differences if they are not detrimental to health.
• Learn to welcome different opinions and viewpoints and be open to feedback.

References

Burgess, W. (1983). Community Health Nursing; Philosophy, Process, Practice. Appleton-Century-Crofts, East Norwalk, Connecticut
Potter, A. P., Perry, A.G (1997). Fundamentals of Nursing: Concepts Process and Practice. Mosby, St. Louis, Missouri
White, W. (2001). Foundations of Nursing; Caring for The Whole Person. Thompson Learning, Albany, New York
Woods P., Rokosky, C. (1986). Medical Surgical Nursing; Pathophophy-siological Concepts. J.B. Lippincott Company, Philadelphia-PA