Culture in Health Carethe Koreans and the Arab AmericansMisty WallaceTrinity Valley Community CollegeAbstractHow does culture come to play in health care? What is the definition of cultural competence? How can we as nurses help improve quality of care and contribute to better outcomes? If we take the time to educate ourselves more about other cultures, we can adapt our nursing care to understand the different lifestyles. The two cultures that I chose to compare and contrast are Koreans and Arab Americans communication, family roles, biophysical aspects, nutrition, death rituals, spirituality and health care practices. I will share examples of how they are similar and how they differ from one another. I will also give examples oh how we as nurses can help understand the different cultures and in turn deliver better care to these patients with asking appropriate questions to get the information that we need to better care for patients of other cultures. Also, some ways to accommodate these different cultures and build better relationships with patients from other cultures.Culture in Health CareThe definition of culture competence is developing an awareness of one’s own existence, sensations, thoughts, and environment without letting it have an influence on those from other backgrounds (Zerweck & Garneau, 2018, p.486). The concept of culture is an important aspect of understanding peoples beliefs, religions, relationships, family dynamics, family roles and organization, the way they communicate, spirituality, their diets, decision making process, self-care and illness, and death (Giddens, 2017, p.34) Part of being a good nurse is being able to adapt effectively to different cultures and to be able to individualize care accordingly. Thorough physical assessments and asking the appropriate questions to get the information needed to provide the patients care according to their patient’s customs and beliefs. We need to be able to adapt and treat the patient accordingly, to give the patient the best care to recover. Being familiar with and educating ourselves with different cultures, spiritual and cultural beliefs can help nurses to communicate and have a better understanding to provide better care in the health care setting (Zerweck & Garneau, 2018, p.486). The United States is only increasing in our exposure to different races, cultures, religions and beliefs, so educating ourselves as nurses about all of these different aspects would improve our effectiveness to provide care for any and all patients. Cultural Assessment and Implications for Health CareCommunicationArab Americans official language is Arabic and Koreans language is han’gul, both of these cultures use English as a second language. As a nurse, when communicating with either of these cultures speak slowly to give time for translation and make sure that the patient understands what you are telling or asking them, as they may shake their head as if they understand you but really do not. (Purnell, 2014). Koreans consider touching disrespectful from strangers, unless for examination purposes, in Arab Americans they are only comfortable with same genders touching but not opposite genders. When performing assessments, the nurse should be mindful and tell the patient what they are going to do and explain why to try and build a relationship with the patient. Arab Americans and Koreans are similar in the fact that they do not make direct eye contact, as it is considered rude and unwanted (Lipson & Dibble, 2005). Nonverbal communication between Koreans that are family members is quite different, touching and hugging are accepted. In Arab Americans, they are shy and modest and prefer only to be close in the same space with the same sex. Arab Americans value their privacy and do not like their personal business disclosed, but among friends and family they express their feelings more freely (Purnell, 2014). The nurse should be mindful if there are other people in the patient’s room before speaking about the patients’ medical condition or any details regarding the patient’s condition or treatment. Family Roles and Organization Both of these cultures are alike in the fact that men are the dominant figure in the family. They are the breadwinners and make the decisions of the family. The women stay home and take care of the home, cook, clean, and nurture and educate the children. When speaking about the patient’s condition and decisions that need to be made, speak to the family as a whole and don’t bring your own bias to the decisions made and the particular roles of the family (Purnell, 2014). Koreans often consult advice from elder members of the family as a sign of respect for their life. (Purnell, 2014) In Arab culture, homosexuality is highly stigmatized, and in some countries considered a crime. Many of them never expose their sexual orientation due to fear of the family shaming them and, in some countries even killed. Make sure not to reveal the patient’s sexual preference or ask questions pertaining to sexual orientation in front of the family, maintain their privacy. (Purnell, 2014). Koreans also look down on lesbian and gay relationships, while the consequences are not as extreme as Arabs, same as with Koreans any disclosure of their sexual preference could bring shame to their family name and could lead to them being ostracized from their family (Purnell, 2014). Maintain the patient’s privacy, and don’t judge the patient for their sexual orientation, set any beliefs that you may have or judgements to the side and care for your patient in an un-biased manner. Biopsychosociocultural Aspects Genetic disorders of Koreans are renal failure, hypertension, lactase deficiency, and autoimmune deficiency disease. (Purnell, 2014). Arab Americans genetic disorders Whereas Arab Americans genetic disorders are sickle cell anemia, thalassemia’s, epilepsy, hypercholesterolemia, and cardiovascular disease are the most common (Purnell, 2014). As a nurse we need to make sure we are looking for the clinical manifestations leading to the disorders and monitor for any changes that could lead to a decline in the patients’ health. High risk behaviors of the Arab Americans and Koreans include smoking, tobacco use has long been apart of the Arabic culture. Arabs like Koreans don’t like to wear seat belts, we could remind them of the safety and that state laws require us to use them. Also encourage smoking cessation and educate the patient to the health risks associated with choosing not doing so. (Purnell, 2014). Koreans and Arab Americans alike are very modest. Make sure to provide multiple gowns and blankets to keep them covered appropriately. While Koreans are very clean, Arabs do not shower daily, they don’t like to use foreign bathrooms, and some believe that it will delay their recovery. Offer plenty of toiletries to Koreans and also offer and maybe leave cleaning supplies for Arab Americans so if they do decide to clean themselves, they have the supplies readily available to do so. Koreans and Arab Americans alike prefer to wash their hair once a week. (Lipson & Dibble, 2005). Koreans prefer to keep their nails trimmed and clean while Arab Americans do not have a particular nail routine. Koreans if younger, perform their own self-care, elders may have family members perform their bathing or shower this is expected as a duty of the children. Opposite of that, the Arab Americans believe in complete rest. They expect hospital staff or family members to care for them. Nurses should always ask if the family wants to assist the patient with their grooming care or can hospital staff help them and we need to explain why being clean is important in the patient’s recovery and progress (Lipson & Dibble, 2005). NutritionKoreans usual diet is high in fiber and spicy, consisting primarily of rice, bean curd, vegetables, fruits, seafood, lean meats, occasionally pork, pickled vegetables like Kim-chee, these are high in sodium so some education about some low sodium options might help. Many meals consist of spicy soups. Dinner is usually the main meal of the day and when most family members gather to socialize. They prefer water with their meals but will not drink it from the faucet, they boil the water first to remove impurities and then store it in the refrigerator. They normally don’t drink cold beverages; as they believe that the cold is what causes sickness. Dairy products are not common as many Koreans are lactose intolerant. Ginseng is commonly used for colds. They believe that different soups have therapeutic effects when they are sick, they add onions, garlic and spices to help relieve sinuses and breath better Lipson & Dibble, 2005). Arab Americans diet consist of vegetables cooked in tomato sauces, chicken, lamb, beef, fish, rice, bread and pickles. They consume their largest meal at 2:00 p.m. You can’t mix dairy with fish, sweet with sour or hot with cold. They like fruits and desserts. To Arab Americans eating is imperative in recovering from an illness. They like to drink mint teas and chicken soups for illness. For Arab Americans sharing food and offering of food is showing caring and nurturing, it’s a way to build trust and acceptance. They like to drink water and orange juice. Alcohol is prohibited among the Muslims. Most will not eat any pork products. Meats have to be cooked well done. We as nurses need to be cognizant of these food preferences and rituals so that we can make sure that our patient is eating and drinking to achieve their optimal health (Lipson & Dibble, 2005). Some families may even prepare the patients food at home according to their customs and bring it to the hospital. Nurses need to be aware of what the patient is eating so it is beneficial to the patient’s health and not detrimental, and also be aware of how much or little the patient is eating and drinking to know they are getting enough nutrition. Ask the patient or family members what they have ate or drink for each meal of the day. As nurses we can check with the cafeteria to make sure that they can accommodate the diets and food preferences for both of these cultures.Death RitualsDeath in both of these cultures is accepted well. In Arab American culture, once the person dies, they are washed three times by someone of the same sex. They are then wrapped in a white material and buried as soon as possible in a brick or cement lined grave with their heads turned to face Mecca. Koreans on the other hand never leave the patient, family is always surrounding the patient, tending to and caring for the person. They want to stay with the person even after death. As a nurse caring for this patient, check in with the family to see if they need anything for the patient or for themselves. Try not to be intrusive and allow the family members to care for them, tell them to let you know if you can help facilitate or accommodate any needs that the family or patient may have. Like the Arab culture, Koreans are also faced a certain direction when buried, they place them facing North or South. For both of these cultures allow them privacy to carry out their rituals. The Koreans morn and pay respect by viewing photographs of the individual instead of viewing the body, while the Arab Americans gather at the deceased persons home and recite the Qur’an. Women ordinarily don’t attend the burial unless it is a close relative or her husband. (Purnell, 2014). As nurses we need to be mindful and respectful in these situations. We need to offer any assistance or utilize any outside resources that we can to make the patient and family feel at peace in the situation.SpiritualitySpirituality is different from religion in that religion is an organized hierarchy that has certain beliefs and spirituality is believing in a higher power (Giddens, 2017). Koreans can sometimes have different faiths within the same household. Koreans that believe in Buddhism, believe that when someone dies that their spirit starts a new life as a person or animal. Koreans that are Christians believe that a deceased person goes to heaven. (Purnell, 2014). Opposite the Arab Americans have an official religion, Muslim. They require a certain amount of participation in religious activity. There is an inman who acts as the leader of prayer and is considered a spiritual counselor. Muslims believe in combining spiritual medicine, daily prayer and reading or listening to the Qur’an (Purnell, 2014). Strict Muslims pray 5 times a day, they prefer to pray in silence. They may need to wash their hands before prayer so make sure that they have a sink or water to wash before prayer and some may want to face Mecca when praying so make sure that they are able to or maybe assist them. If the patient is sharing a room, find them a private room to pray. (Purnell, 2014). In either of these spiritual beliefs if the patient is immobile and not able to perform these rituals, maybe find someone within the hospital or call someone locally that is of that religion to come and pray with the patient. Maybe the family can assist with someone from their spiritual entity to come and see the patient. Communicate with the patient and family to make sure that the patients spiritual needs are met. Health Care Practices Both cultures are open to receiving health care, and both cultures believe that physical illness is caused by bad luck, misfortune or evil. They are also alike in the fact that they believe the cause of physical illness is from sudden shifts from hot to cold, wind and drafts. (Lipson & Dibble, 2005). While Koreans believe in both Western and Eastern medicine, Arabs only seek health care from Western health care systems (Lipson & Dibble, 2005). While most medications in the United States require prescriptions, medications are readily available over the counter for both Koreans and Arab Americans. (Purnell, 2014). Koreans use herbal remedies with Western medicine such as, ginseng and seaweed soup. Arab Americans believe in special prayer, and simple foods such as dates, honey, salt and olive oil (Purnell, 2014). Complementary practices such as acupuncture is used in Korean cultures and Arabs use cupping (Purnell, 2014). Health promotion in Korean culture is eating a healthy diet and walking daily. Because some of the foods in their diet are high in sodium such as soy sauce and kim-chee (Lipson & Dibble, 2005). The nurse could educate the patient about their sodium intake and use low sodium soy sauce or consume smaller amounts of foods that are high in sodium. For Arab Americans, health promotion is to stay warm, dry, avoid cold & drafts (Lipson & Dibble, 2005). The nurse should educate the patient as to why exercise and a healthy diet is important to their health and adverse effects if not adhered to. Pain management in both cultures alike can be difficult. Some don’t believe in showing or expressing pain so you don’t really know their true pain. The nurse needs to be sure and pay close attention to facial expressions and non-verbal communication when trying to assess their pain levels. Also, a thorough physical assessment could help determine the patients true pain level. (Purnell, 2014). The Koreans and the Arab Americans are alike in that they do not agree with organ donation. Both cultures believe that it tampers with the body, soul and spirit. They believe that the body should be whole for the after life (Lipson & Dibble, 2005). Don’t try to persuade or judge the patients or the family for their beliefs in not doing so. ConclusionIn conclusion, when caring for patients that have different or unfamiliar cultures, take the time to become familiar and know how to care for these patients. A cultural assessment of your patient should give you information needed to guide you in providing them the best healthcare possible. As you can see with these two cultures that I have compared, providing care for these patients is not difficult. You just need to educate yourself about the particular cultures (Lipson & Dibble, 2005; Purnell, 2014).
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