*****APA FORMAT*** People of Appalachian Heritage and People of Arab Heritage.Please read chapter 8 and 9 of the class textbook and review the attached PowerPoint presentations. Once done answer the following questions;1. Give an overview of the Inhabited localities and topography of the Appalachian and Arab heritage.2. Discuss any similarities in the beliefs of the Appalachian and Arab heritages regarding the delivery of healthcare.3. How the religion or folks beliefs influence the delivery of healthcare in these two heritages. You must cite or quote at least two evidence-based references (besides the class textbook) no older than 5 years old.
culture_chapter_8__1_.ppt

culture_chapter_9.ppt

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Appalachians
Larry Purnell, PhD, RN, FAAN
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview
▪ Heritage from England, Wales, Scotland, Ireland,
France, and Germany
▪ Came to the United States for religious freedom
and better economic opportunities
▪ Purposely isolated themselves in the mountains
to live and practice their religions as they chose
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview Continued
▪ Appalachia includes 410 counties in 13 states
and extends from southern New York to northern
Mississippi.
▪ Continuous migration from the country to the city
and vice versa
▪ High proportion of aging in Appalachia
▪ Farming, mining, textiles, service industries, etc.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview Continued
▪ High poverty and unemployment rates
▪ Originally most educated group in America, now
some of the least educated due to isolation
▪ Area still lacks infrastructure
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communications




Carry over from Elizabethan English
Spellin for spelling
Warsh for wash
Badder for bad
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Ethic of Neutrality





Avoid aggression and assertiveness
Do not interfere with others’ lives
Avoid dominance over others
Avoid arguments and seek agreement
Accept without judging—use few adjectives and
adverbs, resulting in less precise description of
emotions and thoughts
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communications
▪ Sensitive about direct questions and personal
issues
▪ Sensitive to hints of criticism. A suggestion may
be seen as criticism.
▪ Cordiality precedes information sharing so “sit a
spell” and chat before doing business, which is
necessary for developing trust
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication Continued
▪ A few may avoid direct eye contact because it
can be perceived as aggression, hostility, or
impoliteness
▪ More being than doing oriented, more relaxed
culture and being in tune with body rhythms
▪ Be formal with name format until told to do
otherwise.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication Continued
▪ Healthcare provider must be flexible and
adaptable
▪ Come early or late for an appointment and still
expect to be seen
▪ Family lineage is important
▪ Formality with respect—Miz Florence or Mr. John
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family
▪ Varied decision-making patterns but the more
traditional Appalachian family is still primarily
patriarchal
▪ Women make decisions about health care and
usually carry out the herbal treatments and folk
remedies
▪ Women marry at a young age and have larger
families than the other white ethnic groups
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Continued
▪ Children are accepted regardless of what they do
▪ Hands-on physical punishment is common
▪ Motherhood increases the status of the woman in
the eyes of the community
▪ Take great pride in being independent and doing
things for oneself
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Continued
▪ Family rather than the individual is the treatment
unit
▪ Having a job is more important than having a
prestigious position
▪ Consistent with the ethic of neutrality, alternative
lifestyles are accepted, they are just not talked
about
▪ Extended family is the norm
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Biocultural Ecology
▪ High incidence of respiratory conditions due to
occupations
▪ Increase of parasitic infections due to lack of
modern utilities in some areas
▪ High incidence of cancer, otitis media, anemia,
obesity, cardiovascular disease, suicide,
accidents, SIDS, and mental illness
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
High-Risk Behaviors
▪ Tobacco is a main farming crop in some areas of
Appalachia
▪ Smoke at a young age
▪ Alcohol use at a young age—binge drinking
▪ Believe in the mind, body, spirit connection
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Ten Steps in Seeking Health Care
▪ Use self-care practices learned from mother or
grandmother
▪ Call mother or grandmother if available
▪ Then trusted female family member, neighbor, or
a nurse
▪ Then go to OTCs they saw on TV
▪ Then use a neighbor’s prescription medicine
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Ten Steps in Seeking Health Care
Continued





Pharmacist or nurse for advice
Physician or Advanced Practice Nurse
Then to a specialist
Then to the closest tertiary medical center
DO NOT BE JUDGMENTAL, if you want to keep
them in the system
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition
▪ Food may be synonymous with wealth
▪ Wide variety of meats, do not trim the fat—low-fat
wild game is also eaten
▪ Organ meats are common
▪ Bones and bone marrow used for making sauces
▪ Preserve with salt
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition Continued
▪ Lots of frying (using lard or bacon grease) and
pickling
▪ Anytime is the time to celebrate with food,
especially in the rural areas
▪ Many teens have particularly poor health
▪ Status symbol to have instant coffee and snack
foods for some
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition Continued
▪ Early introduction of solid foods
▪ May feed babies teaspoons of grease to make
them healthy and strong
▪ Diet is frequently deficient in Vitamin A, iron, and
calcium
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Childbearing Family
▪ Must eat well to have a healthy baby
▪ Do not reach over your head when pregnant to
prevent the cord from wrapping around the neck
of the fetus
▪ Being frightened by a snake or eating
strawberries or citrus can cause the baby to be
marked
▪ Use bands around the belly and asafetida bags
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Death Rituals
▪ Must stay with the dying person
▪ Family should not be left alone
▪ Funerals with personal objects at the viewing and
buried in their best clothes
▪ May take the deceased for viewing at home
▪ After the funeral there is more food and singing
and for some a “wake” to celebrate life
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Death Rituals Continued
▪ Flowers are more important than donations to
charity
▪ Particularly good at working through the grieving
process
▪ Funeral directors are commonly used for
bereavement
▪ Cremation is acceptable and ashes may be
saved or dispersed on the “land”
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Spirituality
▪ Baptist, Pentecostal, Episcopalian, Jehovah’s Witness,
Methodist, Presbyterian
▪ Each church adapts to the community
▪ Most are highly religious even though they do not attend
church
▪ Common to attend Sunday and other days
▪ Preacher has a calling to “preach”
▪ Ministers are trained
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Spirituality Continued
▪ Meaning in life comes from the family and “living
right with God,” which varies by the specific
religious sect
▪ Nature is in control—fatalism
▪ Religion and faith is important in a hostile
environment
▪ I will be there if the “creek does not rise” or if
“God is willing”—fatalism
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Healthcare Practices
Good health is due to God’s Will
Self-reliance fosters self-care practices
Family important for health care
May be very ill before a decision is made to see a
professional resulting in a more compromised
health condition
▪ Direct approaches are frowned upon




Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Healthcare Practices Continued
▪ Herbal medicines, poultices, and teas are
common
▪ See Table 8–1 in the textbook; these practices
are still alive and well
▪ Folk medicines used in conjunction with
biomedical treatments
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Barriers







Fatalism
Self-reliance
Lack of infrastructure
Health profession shortages
Culture of “being”
Poverty and unemployment
Care not acceptable from outsiders
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Responses to Health and Illness
▪ Take care of our own and accept the person as
whole individual
▪ Not mentally ill, the person has “bad nerves” or
are “odd turned”
▪ Having a disability with aging is natural and
inevitable—if you live long enough
▪ Must establish rapport and trust
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Responses to Health and Illness
Continued
▪ Pain is something that is to be endured
▪ Some may be stoical
▪ Pain legitimizes not working or fulfilling one’s
responsibilities
▪ Withdraw into self when ill
▪ Culture of being works against rehabilitation
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Healthcare Practitioners
▪ Lay and trained nurses and midwives still provide
much of the care in some parts of Appalachia
▪ Breckenridge Frontier Nursing Service
▪ Prefer people known to the family and community
—the insider versus outsider concept
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Healthcare Practitioners Continued
▪ Culture of “being” says the healthcare provider
should not give the perception of being rushed
▪ Physicians may not be trusted due to outsidedness, not to being foreign
▪ Must ask the clients what they think is wrong
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab American Culture
Larry Purnell, PhD, RN, FAAN
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Overview/Heritage
▪ Arabs, coming from 22 countries, are united
by a common language, Arabic.
▪ No U.S. census category for Arabs; they are
absorbed into the White category.
▪ Most earlier Arab immigrants in the late 1880s
to 1913 were Christians, educated, and settled
in the Northeastern United States
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Overview/Heritage
▪ Post-1965, Arabs in the US were Muslims,
highly educated and professional or
immigrated for higher education.
▪ Arabism, Muslim, and Islam are intricately
interwoven and share basic traditions and
beliefs.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Communication
▪ Arabic is the official language of the Arab world.
▪ English is a common second language among
Arabs throughout the world.
▪ Communication is highly contextual.
▪ Conversants stand close and maintain rather
intense eye contact.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Communication
▪ For traditional Arabs, touch is only accepted between
members of the same sex.
▪ Speech is generally loud and expressive with
repetition and gesturing.
▪ Privacy is valued so sharing outside the immediately
family is not common.
▪ Etiquette requires handshaking upon arrival and
departure but only between same sex individuals.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Communication
▪ Titles are important and are used in
combination with the person’s first name as in
Mr. Ali.
▪ Punctuality is not always valued except in
cases of professional or business meetings.
▪ Explain the importance of timeliness in healthcare appointments.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Family Roles and Organization
▪ Traditional Arab families are highly patrilineal.
▪ In public, a wife’s interactions with her husband is
formal and respectful. At home, the woman may
have tremendous influence in matters pertaining
to the home and children.
▪ Gender roles are clearly defined: men are
decision-makers, protectors, and breadwinners.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Family Roles and Organization
▪ The authority structure and division of labor
within Arab families are often misinterpreted,
fueling common stereotypes of the overtly
dominant male and the passive and oppressed
woman.
▪ Children are dearly loved, indulged, and included
in all family activities.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Family Roles and Organization
▪ Children are dearly loved, indulged, and included
in all family activities.
▪ Children are raised not to question elders and to
be obedient to older brothers and sisters.
Discipline may include physical punishment and
shaming.
▪ Adolescents are pressed to succeed
academically.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Family Roles and Organization
▪ • Adolescents are pressed to succeed
academically.
▪ Academic failure, sexual activity, illicit drug use,
and juvenile delinquency bring shame to the
family. For girls in particular, chastity and
decency are required.
▪ Family members live nearby and sometimes
intermarry with first cousins.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Family Roles and Organization
▪ Devout Muslim women value modesty.
▪ Many Muslim women view the hijab, “covering
the body except for one’s face and hands,” as
offering them protection in situations in which the
sexes mix. It is a recognized symbol of Muslim
identity and good moral character.
▪ Many Americans associate the hijab with
oppression rather than protection.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Family Roles and Organization
▪ Sons are held responsible for supporting elderly
parents.
▪ Elderly parents are almost always cared for
within the home.
▪ Homosexuality is usually highly stigmatized. In
some Arab countries, it is considered a crime,
and participants may be killed.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Workforce Issues
▪ Discrimination such as intimidation, being treated
suspiciously, and negative comments about their
religious practices have been reported as a
major source of stress among Arab Americans.
▪ Muslim Arabs who wish to attend Friday prayer
services and observe religious holidays may
encounter job-related conflicts.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Workforce Issues
▪ Impassioned communication may incorrectly be
assumed that Arabs are argumentative,
confrontational, or aggressive.
▪ Criticism is often taken personally as an affront to
dignity and family honor.
▪ Whereas such direct praise may be somewhat
embarrassing for Americans, Arabs expect and
want praise when they feel they have earned it.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Biocultural Ecology
▪ Most Arabs have dark or olive-colored skin, but
some have blonde or auburn hair, blue eyes, and
fair complexions.
▪ Infectious diseases such as tuberculosis,
malaria, trachoma, typhus, hepatitis, typhoid
fever, dysentery, and parasitic infestations are
common with newer immigrants.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Biocultural Ecology
▪ Glucose-6-phosphate dehydrogenase deficiency,
sickle cell anemia, and the thalassemias are
extremely common in the eastern Mediterranean.
▪ High consanguinity rates (roughly 30 percent of
marriages in Iraq, Jordan, Kuwait, and Saudi
Arabia) occur between first cousins and
contribute to the prevalence of genetically
determined disorders in Arab countries.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Biocultural Ecology
▪ Some Arabs have difficulty metabolizing
debrisoquine, antiarrhythmics, antidepressants,
beta blockers, neuroleptics, and opioid agents.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab High-Risk Health Behaviors
▪ Smoking and nonuse of seat belts and helmets
are major issues among Arabs in the US.
▪ Some Arab women may be at high risk for
domestic violence, especially new immigrants,
because of the high rates of stress, poverty, poor
spiritual and social support, and isolation from
family members.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab High-Risk Health Behaviors
▪ Sedentary lifestyle and high fat intake among
Arab Americans place them at higher risk for
cardiovascular diseases.
▪ The rates of breast cancer screening,
mammography, and cervical Pap smears among
Arab Americans are low because of modesty.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Nutrition
▪ Spices and herbs include cinnamon, allspice,
cloves, ginger, cumin, mint, parsley, bay leaves,
garlic, and onions.
▪ Skewer cooking and slow simmering are typical
modes of preparation. All countries have rice and
wheat dishes, stuffed vegetables, nut-filled
pastries, and fritters soaked in syrup.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Nutrition
▪ Consumption of blood is forbidden; Muslims are
required to cook meats and poultry until well
done. Some Muslims refuse to eat meat that is
not halal (slaughtered in an Islamic manner).
▪ Muslims are prohibited from eating pork and pork
products which includes ingredients
mouthwashes, toothpastes, alcohol-based syrups
and elixirs, and gelatin coated capsules.
However, if no substitutes are available, Muslims
are permitted to use these preparations.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Nutrition
▪ Grains and legumes are often substituted for
meats; fresh fruit and juices are especially
popular, and olive oil is widely used.
▪ Food is eaten with the right hand because it is
regarded as clean.
▪ Eating and drinking at the same time is viewed
as unhealthy.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Nutrition
▪ During Ramadan, the Muslim month of fasting,
abstinence from eating, drinking (including
water), smoking, and marital intercourse during
daylight hours is required.
▪ Although the sick are not required to fast, many
pious Muslims insist on fasting while hospitalized.
▪ Lactose intolerance is common among Arab
Americans.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Pregnancy and Childbearing
Practices
▪ Fertility practices are influenced by traditional
Bedouin values, which support tribal dominance
and beliefs that “God decides family size.”
▪ Procreation is regarded as the purpose of
marriage; high fertility rates are favored.
▪ Sterility in a woman can lead to rejection and
divorce.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Arab Pregnancy and Childbearing
Practices
▪ Many reversible forms of birth control are undesirable but
not forbidden. They should be used when t …
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