Why info on white culture omitted from cultural compence in textbooks?

[ArrowRN]

This is more an observation or comment I've noticed about nursing textbooks. They all emphasize cultural competence yet all omit information on white/Caucasian culture. Why is this? How am I to be a culturally competent nurse if the schools do not teach about the major cultural population in the USA?

I remember the first time I was all excited about learning cultural competence and thought it would be a great way to further understand the American culture. Boy was I disappointed. All books seem to think the culture means either being African American, Native Indian, Asian or Hispanic. Even chapters that refer to nutrition omit the tastes of the Caucasian culture. The forces that be who write these books needs to give information about all cultures being reasonable. Granted the fact that most the the writers are white, at least from the books I've had thus far. Also the majority of people represented as clients or residents or patients are also white, how then can one learn about their culture when it is never taught?

One of the white dudes in my class made the same observation which is how this topic first came to light. With him having an immigrant wife and me being an immigrant, both of us were surprised at the lack of available information. Thoughts? comments?

[tag2007]

Yeah, my nursing textbook had the section on cultural awareness too. How to care for Hispanic patients. Chinese patients. Native American patients, etc.

The upshot always seemed to be that these groups (as opposed to white people, I guess) placed a heavier emphasis on family and on "traditional" medicine.

Really, it was just stereotypes. And not very good advice to give a nursing student. It's pretty much telling us to make assumptions based on race. That we should expect South Asian families to refuse medicine and that they'll bring their own home concoctions. Or that we should be all touchy-feely with Hispanic patients 'cause apparently they like that.

But maybe your patient from India is highly educated and would be insulted if you tried to incorporate "folk" medicine. Maybe your Hispanic patient would be totally skeeved out by the nurse putting their arm around him or holding his hand.

It's amazing that modern nursing textbooks encourage students to make such assumptions.

I didn't get the impression that teaching cultural awareness in the healthcare field was teaching nurses to be stereotypical, but rather aware of various traditions and cultures that might effect patients health status or the type of care or communication we provide. So no, our textbooks never said "we should be touchy feely with Hispanic patients" but they may have taught that some cultures may communicate differently than others, and that we as nurses should be ok with that and learn to adapt to different cultural needs. For example, knowing not to be offended or worried when an asian patient who just moved to the US doesn't give as much eye contact. It may be helpful to know that this is often normal in that culture. Not always, but often. In another culture, not having as much eye contact might be abnormal and be more indicative of depression or trauma history maybe. This is not stereotyping. Its just cultural awareness that has some research behind it. Stereotyping is a belief about of types of people or ways of doing things that usually "does not reflect reality."

Also I never got the impression that our nursing instructors wanted us to push folk medicine on certain groups and not others, but did want us to be aware, non judgmental, nor shocked, if it was requested. Hence, teaching us about it.

[BrandonLPN, LPN]

I didn't get the impression that teaching cultural awareness in the healthcare field was teaching nurses to be stereotypical, but rather aware of various traditions and cultures that might effect patients health status or the type of care or communication we provide. So no, our textbooks never said "we should be touchy feely with Hispanic patients" but they may have taught that some cultures may communicate differently than others, and that we as nurses should be ok with that and learn to adapt to different cultural needs. For example, knowing not to be offended or worried when an asian patient who just moved to the US doesn't give as much eye contact. It may be helpful to know that this is often normal in that culture. Not always, but often. In another culture, not having as much eye contact might be abnormal and be more indicative of depression or trauma history maybe. This is not stereotyping. Its just cultural awareness that has some research behind it. Stereotyping is a belief about of types of people or ways of doing things that usually "does not reflect reality."

Also I never got the impression that our nursing instructors wanted us to push folk medicine on certain groups and not others, but did want us to be aware, non judgmental, nor shocked, if it was requested. Hence, teaching us about it.

Yes, but what the text books refer to as "cultural differences" are little more than sterotypes. Intentional or not, that line of thinking leads to assumptions being made.

As GrnTea said earlier, treat each patient as their own person. Assess the patient and ask them if they have any prefrences in regard to their care.

In a sense, these textbooks are suggesting we tailor our care based on the last name and/or skin color, which is a very outdated way of thinking.

As for thinking that new nurses need to be "warned" that there are other cultures with different norms.... I find that a little offensive on their part. Like they assume we're a bunch of rubes.

[Esme12, ASN, BSN, RN]

Yes, but what the text books refer to as "cultural differences" are little more than sterotypes. Intentional or not, that line of thinking leads to assumptions being made.

As GrnTea said earlier, treat each patient as their own person. Assess the patient and ask them if they have any prefrences in regard to their care.

In a sense, these textbooks are suggesting we tailor our care based on the last name and/or skin color, which is a very outdated way of thinking.

As for thinking that new nurses need to be "warned" that there are other cultures with different norms.... I find that a little offensive on their part. Like they assume we're a bunch of rubes.

I don't think so.....I don't think anyone thinks you're

a bunch of rubes

but at one time there was cultural intolerance and it needed to be discussed.

I agree assessment MOST be apart of the process and TOLERANCE/ACCEPTANCE/RESPECT is key to understanding.

[NurseCrespoEm]

I think that exposure to other cultural practices either through immersion or study is another way for a health care worker to be prepared for anything. While I had the same feeling about "Cultural Competency" as many of you do; that it is basically putting forth stereotypes, I took a month long program immersion in "Cultural Competency for Health Services" in Oaxaca, Mexico while getting my B.A. and I learned so much. We visited a juvenile center, a traditional curandero, a hospital, an old folks home, an orphanage, a young women's program, churches, traditional medicine markets, clinics and more. It was interesting to say to least, to study one of the larger cities in Mexico to get a baseline for how patients with Mexican heritage would have logistically perceived a health care system. Being in Mexico City City as well, and talking with even more metropolitan adults, there are levels of modern care expected that really would not be the same as down in Oaxaca. But none of this really does tell you how much a particular Mexican Latino/Latina would like to be touched, or how Machismo really is integrated into a Latino perspective on pain. Having this experience only becomes a baseline for possible understandings being achieved more quickly between caregiver and patient. For example; in the hospital in Oaxaca it is common for the families to sleep on the floor in the patient's room for the longest time and for them to be responsible for bringing the patient food. This is a pretty big city too but the surrounding areas are extremely rural. In Mexico City, the hospitals have more modern standards of care. One might have an easier time understanding what a patient's expectations are if they are capable of considering stereotypes as possible comfort zones to look out for ahead of time. I think this is probably the best reason to have "Cultural Competency" coursework in health care education. You'd be surprised how many young people lack basic geographical knowledge, or awareness of languages, customs, and religions of the world. It's good to bring any and all these aspects of global life under the umbrella of how to best serve the diverse patients a provider might encounter. While I agree with GrnTea, and the idea that one must ask each patient, and deeply relate to the frustration that there is no way to really know what a garlic farmer in CA and those living in slums of B. Aires might have in common, it is that you are aware of these places and conditions, that makes you more able to communicate with anyone at all. And lastly, the original concern about white culture is an interesting concern but there are so many opportunities to learn about North American life here in North America. See LCD SoundSystem's song "North American Scum" to hear one perspective, or just talk to individuals everywhere around you as though you were an anthropologist. Much of what is to be learned about any people is learned by conversation and stretching your boundaries; going into people's homes and eating with them. White people really are a very diverse bunch especially, as it was said previously, across socioeconomic and geographic barriers. I love this conversation. It is important. :)

[SNB1014, RN]

As a " white person" , I say who cares. I hate hate haaaaated the cultural competency stuff because they always sound so stereotypical to me. To lump the way you interact with a young fillipino catholic lady may be totally different compared to an elderly Hindu man....or exactly the same! Because who cares , really? China alone has a billion or so people and they are not all the same.

Meet the patient where they are in terms of pain, personal preferences, ability to speak English or not, etc.

African Americans and people who are recently immigrated from Nigeria are not to be painted with the same wide brush, you know?

I am chatty, I smile, I make eye contact, I sit down if they are sitting, I hug, I shake hello, hold hands, I explain what I'm doing etc to everyoneeeeee until I sense that this individual person or their family isn't feeling the same vibe.

Italians and English are both white Europeans......not the same in terms of food, demeanor, whatever.

Funny story, I speak juuuust enough Spanish to get by working in Texas, and the majority of coworkers and pt who speak Spanish are indeed Mexican.....so I tried to be nice to an elderly Hispanic pt and tell her about my sister doing a summer abroad in mexico city and asking her when the last time she was " home" to mexico, etc. She smiled and says in broken English , " oh no no Nicaragua!"

Oops.

Another time when working with an Asian family the son nodded his head in agreement with me, but I thought, oh, maybe he is bowing to me? So, I bowed down in return , hands clasped, whole thing and when I looked up he had a look of sheer confusion on his face. I couldn't help but crack up, apologize and pat his shoulder, and things were okie dokey after. But I felt dumb!

Bottom line, if you treat every one professionally and with respect and proper nursing care, you can tweak your style to what fits that pt and family in that moment. You'll always be in good graces with that formula, I believe.

[NewbieNurse4U]

I agree with the original post this is a huge disparity.

[nsti]

I'm of mixed heritage, and not like Heinz 57 mixed, I mean rainbow coalition mixed. I grew up with Turks, African-Americans, and Asians. I'm from Chicago, so I spent time with everyone from everywhere you can think of. Every time I read one of those stupid cultural competence sections, none of it was intuitive to me, because NONE of it seemed accurate. I talked to a variety of my friends and family about the various stereotypes paraded in those chapters, and all of them agreed how ridiculous they were. I wouldn't be terrible offended about them not mentioning Caucasians, because at least that saves Caucasians from the insult of being stereotyped. Personally, I think an excellent way to teach cultural competence would be to make nursing students volunteer in communities with people from a different culture. For example, I really wanted to go spend time on the reservations around my school, as in Arizona there are tons of Native American communities with a rich cultural heritage to learn from. They had cancelled the rotation because people in previous semesters had felt "uncomfortable" in that community, and none of my classmates or I could convince the instructors to change it. We need to throw our nursing students into uncomfortable situations, how else will they be competent with dealing with other cultures when they are afraid of them? Long story short, teach nursing students to use a culturally competent approach, and NOT to assume anything about anyone, and that is how they will become excellent nurses. You should always be asking your patients questions to assess what they want from their treatment.

[MassED, BSN, RN]

Unfortunately, it's okay to be uncultrually competent to white people because they are the majority and so they are considered privileged and therefore, are supposed to be okay with how people from different backgrounds chose to interact with/treat them even if that treatment is unacceptable by traditional European decent standards.

can we stop using "white" people? I'm Caucasian, or a hodge podge of European ancestry, whatever you want to call it but my skin isn't like paper. I take offense to the term "white" and I wish others would as well.

[tag2007]

Everyone is talking about how ridiculous the "stereotypes" are when culture is being discussed in nursing textbooks. Can anyone give me an example of a "stereotype" taught in a nursing textbook that they are referring to?

There is a big difference between teaching culture, and teaching stereotypes. Stereotypes are over simplistic opinions about things that have no basis. So, I would really like an example of a stereotype that's been taught in your nursing school that has no basis in reality.

[MassED, BSN, RN]

I'm of an origin, which is considered western perspectives. The best way to show the dilemma is an example.

Ok so I'm learning maternity right now. The text goes into how this groups being dominant group while minorities usually follow the dominant group. Then they go on to state various factors which could be stereotypes, depending on how you look at it. So African Americans - use lots of oil on newborns scalp and skin, Asian American - pregnancy is a natural happy time, Arab Americans - breast feeding delayed 2 to 3 days after birth, Hispanic - loud during labor (ha who isn't?).

There is no info on White American. Which I could only guess could do any of the above actions? It's just remains a mystery.

Now for myself, being black yet not being American, however the American society deems me "African American" even though I am not, could be confusing to some. So I've "assimilated" into the African American culture and great American culture as a whole but I guess this more relates to immigrants since we did not grow up here. Its particularly difficult when we move here as an adult. The assimilation process is hampered by our own engrained traditions, cultures and values. The only course I really learned anything about white Americans or the dominant US culture was in my sociology classes.

I read somewhere that one professor (white nurse MSN) refused to teach from a cultural perspective textbook because she believed the book was derogatory to minorities and mainly presented stereotypes rather than the actual culture of those groups. I believe she resigned. I guess cultural competence in itself is a difficult topic and its best to just be open minded.

wow, all excellent points. I am glad that you pointed out that the term "African American" encompasses all into one group, when in fact, one may be from Honduras, South America, etc. This is why I take offense to the word "white" for Caucasian people.

I do believe to be "culturally competent" one must look at each person and their culture and learn from that. Learn what is around you, don't just read from a book and take that as the truth. Be discerning. The problem is that this country (USA) is so focused on race and everyone is so quick to jump on opinions as being "racist" when everyone comes from somewhere. Everyone has their own culture and story. People should not take such offense when learning about others. We are all different. I think awareness is key and knowing that we are all different helps one to learn about others. Being open-minded IS key and not personalizing YOUR own experience and applying that to everyone else. Try to separate your biases from your learning. That is essential in nursing. Cultural bias is a part of your cultural competence.

[MassED, BSN, RN]

Actually, Leininger's books describe several white cultures in the modern USA. WASPs, Appalachians and, say, Eastern Europeans are all technically "white" (or, if you so prefer, Caucasians). In reality, the difference between these three are more than profound and they shouldn't be treated similarly just because they're "white" in skin color.

Race is such a hot button topic in our popular culture right now, it's ridiculous. We are traveling backward in progress.

And to be correct, Caucasian: characteristic of a race of humankind native to Europe, North Africa, and southwest Asia and classified according to physical features --used especially in referring to persons of European descent having usually light skin pigmentation.

Here is another interesting article on origin of "Caucasian" if interested. Based on this article, those that say they are "Caucasian" (such as our census) means you are from the Middle East.

Stop using the word "Caucasian" to mean white - Gene Expression | DiscoverMagazine.com

Anyway, the point being is that race is individual. Whichever race a person ascribes to is what the learner should be learning and trying to understand. It doesn't matter what "we" (the person learning to be culturally competent) wish to assign a person, it is what the person IDENTIFIES as their culture.

[NurseDirtyBird]

My nursing instructor in school who was teaching the "Cultural Competency" part of the class was very knowledgeable. She told us pretty much to take this cultural competency crap with a grain of salt. Then she told us a story: An older Korean woman who spoke very little English was admitted to the hospital. A well-meaning nurse ordered her Korean meals from the cafeteria. The patient hardly ate anything at meal times. The nurse became concerned, but since there was a language barrier, she wasn't able to figure out what the problem was. When the patient's family was there, the nurse brought up her concerns about her patient's lack of appetite. They asked the patient, who replied, "All I want is a bowl of mashed potatoes and gravy."

Your "cultural competency" lesson for the day: Do not make assumptions. Do not assume the person who identifies as Irish Catholic wants to eat fish on Fridays. Do not assume the Caucasian patient with tattoos and piercings has a drug problem and a long rap sheet. Do not assume the young teenage mother-to-be is a ****. ASK QUESTIONS and check your preconceived notions at the door.