Textbook of Medical-Surgical Nursing 3e

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Chapter 2   Thoughtful practice

Time Attitudes about time vary widely between people of different cultures, and this can be a barrier to effective communication. Views about punctuality and the use of time are culturally determined, as is the concept of waiting. For example, for most Western, as opposed to traditional, healthcare providers, time and promptness are extremely important; for example, nurses usually expect patients to arrive at a specific time for an appointment. In some cultures, however, time is a relative phenomenon, not one that is assessed or counted in hours or minutes. For example, in traditional Aboriginal and Torres Strait Islander and Ma¯ori cultures the conception of time is marked by an emphasis on cyclical continuity, not lineal change: the past and the future may be seen as integral parts of the present. Consequently, events of the time, such as a partic- ular family business, illness, and funerals, may take precedence over any previously made healthcare appointment. The value placed on particular events, and hence their priority within a framework of time, should be explored by the nurse. Being flexible in regard to schedules is a positive way of accommodating cultural differences in this regard. For example, scolding or expressing annoyance at a patient for being late may be seen as an expression of a nurse’s ethnocentrism. This could undermine the patient’s confidence in the healthcare system, and result in further missed appointments or the rejection of the system. Touch The meaning people give to touch is a cultural construction. In some cultures (e.g. traditional Arab, Aboriginal and Torres Strait Islander and Ma¯ori cultures), male healthcare providers may be prohibited from touching or examining certain parts of the female body. The concept of shame may also be impli- cated in a preference for gender-specific healthcare providers. Similarly, it may be inappropriate for females to care for males. Among some Ma¯ori, care of certain areas of the body is con- sidered tapu (sacred), while among traditionally orientated Australian and Torres Strait Islanders the propriety of such Hinduism All meats Animal shortenings Islam Pork Alcoholic products and beverages (including extracts such as vanilla and lemon) Animal shortenings Gelatin made with pork, marshmallow and other confectionary made with gelatin Note: Halal food is lawful food that may be consumed according to tenets of the Koran, whereas Haram is food that is unlawful to consume. Judaism Pork Predatory fowl Shellfish and scavenger fish (e.g., shrimp, crab, lobster, escargot, catfish). Fish with fins and scales are permissible. CHART 2-5

close interaction is based on kinship relations. Among many Asian peoples, it is considered impolite to touch a person’s head because their spirit is believed to reside there. Therefore, assessment of the head or evaluation of a head injury may require alternative approaches. For other patients, a sense of modesty may be implicated in the use of touch, and so this must be considered when providing nursing care. Observance of holidays People from all cultures celebrate civil and religious holidays. Nurses should familiarise themselves with the major holidays for members of the cultural groups with whom they work. Routine health appointments, diagnostic tests, surgery, and other procedures should be scheduled to avoid those holidays a patient identifies as significant. Efforts should also be made to accommodate patients, their family, or significant others, when not contraindicated, as they perform holiday rituals in the healthcare setting. Diet and the meaning of food The cultural meaning of food and those practices associated with it vary widely. Usually the meaning of food is related to one or more of the following: relief of hunger; promotion of health and healing; prevention of disease or illness; expression of caring for another; promotion of interpersonal closeness among individuals, families, groups, communities, or nations; and promotion of kinship and family alliances. Food may also be associated with solidification of social ties; celebration of life events (e.g. birthdays, marriages, funerals); expression of gratitude or appreciation; recognition of achievement or accomplishment; validation of social, cultural, or religious ceremonial functions; facilitation of business negotiations; and expression of affluence or social status. Cultural dictates or preferences determine which foods are served and when they are served, the number and frequency of meals, who eats with whom, and who is given the choicest portions (Chart 2-5). Beliefs and values also determine how foods are prepared and served; how they are eaten (with chop- sticks, hands, or cutlery); and where people obtain or purchase Note: Packaged foods will contain labels identifying kosher (‘properly preserved’ or ‘fitting’) and pareve (made ­without meat or milk) items. Mormonism (Church of Jesus Christ of Latter-Day Saints) Alcohol Beverages containing caffeine stimulants (coffee, tea, colas, and selected carbonated soft drinks). Seventh-Day Adventism Alcohol Beverages containing caffeine stimulants (coffee, tea, colas, and selected carbonated soft drinks) Pork Certain seafood, including shellfish Fermented beverages Note: Optional vegetarianism is encouraged. Mixing milk and meat dishes at same meal Blood by ingestion (eg, blood sausage, raw meat).

Prohibited foods and beverages of selected religious groups