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61 Cards in this Set

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Selected practices pertaining to Buddhist.
-May require sexual segregation.
-Many do not eat meat.
-Religion does not include a belief in healing through faith.
-Many observe daily chanting or meditation.
Selected practices and meaningful symbols pertaining to Catholics.
-Specific life ending procedures are forbidden.
-Birth control and abortion are forbidden.
-Observe sacrament of the sick.
-Communion
-Blessing by a priest.
-Obligated to take ordinary, not extraordinary, means to prolong life.

Symbols: Rosary beads, Catholic Scapular,Images of saints, crucifix, bible.
Selected practices pertaining to Christian Scientist.
-No alcohol or tobacco use.
-Religious structure has full time healing ministers.
-Physicians may be used for childbirth and setting broken bones.
-Healing through prayer.
-Not likely to seek medical help to prolong life.
Selected practices pertaining to Indian Orthodox Christian.
-Routine sexual segregation is mandated.
Selected practices pertaining to Muslims.
-No pork or alcohol.
-Cremation is forbidden.
-Body must be washed by Muslim of same sex.
-Burial within 24 hours
-Some use of herbal remedies.
-Right hand used for eating.
-Left hand used for toileting.
-Sabbath is Friday.
-Prayer five times daily.
Selected practices pertaining to Jehova's Witness.
-Faith healing forbidden.
-No blood or blood products allowed.
-Blood volume expanders okay.
-Medications accepted if not derived from blood.
-Organ donation forbidden.
Selected practices pertaining to Jewish.
-Kosher laws for Orthodox: forbid pork, shellfish, mixing of meat and dairy.
-Burial within 24 hours.
-Medical care is expected.
-If death is inevitable, no new procedures, need be initiated.
Selected practices pertaining to Sikh religions.
-Forbid cutting or shaving any body hair.
-5 outer badges that refelct military history: dagger, hair and beard unshorn, wearing a turban, wearing knee-length pants, and wearing a steel bracelet on the right wrist.
Potentially meaningful symbols important to Mormans.
-The garment: resembles short-sleeved long underwear and ends just above the knee.
It is associated with Gods protection.
Potentially meaningful symbols important to Native Americans.
-Soul catcher
Potentially meaningful symbols important to Cambodians.
-String worn on the wrist to tie in the soul. Known as "Baci"
-The scalp is the seat of life so any openings to it would be an easy exit for the soul.
Potentially meaningful symbols important to Hindu clients.
-Sacred threads around necks or arms
Selected beliefs and practices related to prayer, evil spirits, soul loss, and blood beliefs.
Prayer: internally consistent; if a patient is not cured, it is not because God failed but because the patient lacked sufficient faith.

Evil Spirits: illness due to evil spirit. Some families risk not having surgery in fear of releasing the evil spirit or the entering of an evil spirit.

Soul Loss: pictures take the soul out of the face.

Blood Beliefs: related to soul loss. Losing blood saps strength
Dietary practices for Islam clients.
No eating from sunrise to sunset during month of Ramadan.
Dietary practices for Judaism.
Requires fasting from sundown to sundown during Yom Kippur.
Dietary practices for Hindus and Seventh Day Adventist
Hindus/7thday:No meat consumption.
7thday: No alcohol.
Dietary practices for Mormons.
Prohibit Caffeine, vanilla extract, and some mouth washes.
Comparison of culture and ethnicity and the influence of stereotyping.
Culture describes a particular society's entire way of living, encompassing shared patterns of belief, feeling, and knowledge that guide people's conduct and are passed down from generation to generation.

Ethnicity is a somewhat narrower term, and relates to people who identify with each other because of a shared heritage.

Many variations and subcultures occur within a culture. The difference may be related to status, ethnic background, residence, religion, education, or other factors.
The 6 cultural phenomena evidenced within all cultural groups as described by Giger and Davidhizar.
1.Communication: all verbal and nonverbal behavior: Language, paralanguage, and gestures.

2. Space: where the communication occurs and encompass the concepts of territoriality, density, and distance.

3. Social Organization: acquiring knowledge and internalizing values. Its how the culture teaches itself by providing information and values.

4. Time: importance of values based on the clock. Acknowledgement of punctuality and efficiency
-Determined in part by sources from which food and other items necessary for existence are obtained:
-Agricultural communities have slower paces
-Industrialized nations more clock-time focused
-Orientation:Past, Present, Future

5. Environmental control: the degree to which individuals perceive that they have control over their environment.

6. Biological variations: include body structure, skin color, physiological responses to meds, electrocardiographic patterns, susceptibility to disease, and nutritional preferences and deficiencies.

See page 97-98
Potential Nursing diagnoses associated with symptomatology of clients different from the dominant American culture.
-Impaired verbal communication related to cultural differences evidenced by inability to speak the dominant language.

-Anxiety related to entry into an unfamiliar health care system and separation from support systems evidenced by apprehension and suspicion, restlessness, and trembling.

-Imbalanced nutrition, less than body requirements, related to refusal to eat unfamiliar foods provided in the health care setting, evidenced by loss of weight.

-Spiritual distress related to inability to participate in usual religious practices because of hospitalization, evidenced by alteration in mood.
Nursing interventions in the management of care of a client with a culture-related nursing diagnosis.
-Interpreter if necessary
-Make allowances
-Ensure that the individuals spiritual needs are being met.
-Be aware of the differences in concept of time.
-Be aware of different beliefs about health care
-Follow the health care practices that the client views as essential.
-Be aware of favorite foods
-Psych nurses must realize that psychiatric illness is stigmatized in some cultures.
Methods of evaluation nursing actions pertaining to clients with a culture related diagnosis.
Evaluation of nursing actions is directed at achievement of the established outcomes.

Continuous reassessment to ensure that the selected actions are appropriate and the goals and outcomes are realistic.

Include the family and extended support systems.

Modify plan if needed.
Steps of cultural competence.
1. Understanding your own culture and biases, becoming sensitive to the cultures of others, and appreciating the differences.

2. Acquiring knowledge and understanding of other cultures, especially their values and beliefs.

3. Apply that knowledge.
Model for understanding patient's cultural perspective of a health problem (the 4 Cs)
1. Call: its to getting at the patient's perception problem. (e.g. What do you CALL your problem?)

2. Cause: this gets at the patient's beliefs regarding the source of the problem. (e.g. What do you think CAUSED your problem?)

3. Cope: this will give the health care provider important info on the use of alternative healers and treatments. (e.g. How do you COPE with your condition?)

4. Concerns: Understand patients perception of the problem. (e.g. What CONCERNS do you have regarding the condition?)
Definition and characteristics of subcultures.
Within most cultures, smaller groups of people share certain characteristics not shared by the culture at large.

Subcultures may be based upon a variety of things, including ethnicity, occupations, activity, or sexual orientation.
Difference and potential effects between stereotyping and generalization.
The difference lies in the usage of the information.

Stereotype is an ending point. No attempt is made to learn whether the individual in question fits the statement. Stereotyped patients can lead to negative results.

Generalization is a beginning point. It indicates common trends, but further information is needed to ascertain whether the statement is appropriate to a particular individual. Generalizations can be inaccurate when applied to specific individuals.
Common values associated with U.S. culture and with American health care culture.
Common values: money, freedom, independence, privacy, health and fitness, and physical appearance.
The effect of one's worldview on their health care behavior.
Peoples worldview consist of their basic assumptions about the nature of reality which become the foundation for all actions and interpretations.

An example of an important influence on his or her health care behavior: someone with a scientific worldview might perceive birth defects as a mistake in the transcription of DNA during the process of meiosis, while someone whose worldview encompasses the notion of reincarnation might see it as resulting from improper behavior in a past life, and someone who believes that God rewards good behavior and punishes bad behavior might interpret it as punishment for one's sins.
Potential distinction within a culture's perceptions of time, social structure, family groups, models of disease, and causes of disease.
Time: one's focus regarding time, varies in different cultures. No individual or culture will look exclusively to the past, present, or future, but most will tend to emphasize one over the others.

Social Structure: American culture is organized according to an egalitarian model (equality). Many Asian cultures are based on a hierarchical model (no equality).

Family groups: family of orientation and family of procreation.

Models of disease: 1.Magico-religious model (supernatural forces dominate); 2. Biomedical model (life is seen as being controlled by a series of physical and biochemical processes which can be studied and manipulated); 3. Holistic model (The forces of nature must be kept in balance or harmony, both within the body and between the individual and the physical and metaphysical universe)

Causes of Disease: Upset in body balance (originated in China), soul loss, soul theft, spirit possession, breach of taboo, object intrusion, and germs.
Potential cultural variations in relation to the dying process and the event of death.
Potential cultural variations include whether or not to reveal the diagnosis to the patient, attitudes toward removing life support, expression of grief at the time of death, attitudes toward organ donations and autopsies, and beliefs and customs surrounding the moment of death.
Cultural approach to defining mental illness.
Definition: behavior that deviates significantly from the norm.

What is considered normal in one culture may not be normal for another culture.

For instance, in a culture that values emotional control, expressiveness can be seen as a sign of instability; whereas, a culture that values independence, the desire to live with one's family after adolescence may be seen as something that needs to be worked on in therapy.
Differing cultural approaches in identifying and treating the mentally ill.
Psychotherapy is not common in most cultures. In traditional, non Western societies, mind and body are not seen as separate. The same healer-be it shaman or curandero will treat the problem, without distinguishing between emotional and physical ailments.
Potential impact of the supernatural on the health/mental health of a client from a culture different from the dominant American culture.
Whatever one's personal worldview, it is far more effective to treat patients in the context of their belief system rather than just one's own.
Strategies for recognizing, addressing, and incorporating traditional remedies into the care of clients from specific cultures including coining, cupping, treatment of fever, and specific medication use.
Coining aka Cao Gio: (Asian technique)Heating or oiling the coin or other metal object, such as a spoon, but involve vigorously rubbing the body with a coin. This produces red welts on the affected area, which is believed that the illness has been brought out; however, this can distract health professional from the real problem or be mistaken for abuse.

Cupping: (Armenian) heated cups placed on the body to act as a suctioning device to relieve muscle, Pain, GI, Lung disease, Paralysis, Infertility, Menstrual cramps.

Treatment of fever: Many cultures believe the best way to treat a high temperature is to "sweat it out"

Specific Medication Use: Many cultures use medication differently, are unfamiliar of how prescriptions work, lack of knowledge of dangerous substances
Influence of folk diseases.
Folk diseases are diseases that are specific to a culture.

One common one in particular is the Ojo.

Widespread throughout Central America, Middle East, Africa, the Mediterranean, and parts of Asia.

Defined as an evil that one person puts on another that causes the victim to fall ill.

Other folk diseases are Empacha, Caida de Mollera.
Traditional healers and medicines from specific cultures.
Culturally competent practitioners realize that collaboration between traditional healers and medical doctors can often result in better care for their patient
Strategies for implementing methods of delivering culturally competent care.
To provide more culturally sensitive care in language, diet, respecting cultural beliefs/practices, flexible scheduling, and showing commitment to cultural competence.

LANGUAGE:
-CLAS standards instituted in 2001 require language access services in all federally funded health care facilities.
-Train bilingual staff to serve as interpreters; post a list on every unit of staff who can provide interpretation services.
-When using telephonic interpreters, use dual receivers/handsets.
-Have signs and forms in multiple languages reflecting the populations served.
-Offer television stations in multiple languages.
-Ask family members to donate books and magazines in their language.

DIET:
-Serve ethnically appropriate foods and utensils.
-When medically appropriate, allow family members to bring food from home and provide facilities for storage and reheating.

RESPECTING CULTURAL BELIEFS/PRACTICES:
-Offer more modest patient gowns to women.
-Make sure any religious icons on the wall can be removed.
-Allow a place for patients to place religious symbols.

FLEXIBLE SCHEDULING:
-Extend visiting hours and add visitor chairs
-Allow for flexible scheduling in clinics.

SHOWING COMMITMENT TO CULTURAL COMPETENCE:
-Educate staff on cultural competence.
-Provide on-site continuing education on cultural diversity issues.
-Create a bulletin board in the break room with information about different cultures and health beliefs.
-Motivate staff to become culturally competent.
-Make cultural assessments which can be included in the charge sheet to ensure it gets passed on from one shift to the next.
-Require culture-specific nursing interventions as part of nursing care plans.
-Make cultural issues a regular topic for discussion at staff meetings. Including "Cultural Question Box"
-Make cultural competence policy part of the job description, and a yearly evaluation.
-Organize potlucks to show diversity of cultures.
-Recognize clinicians who provide culturally competent care.
-Available cultural resources for staff.
-Be curious about other cultures. Don't stereotype!
Retrospective Payment
Hospital services were paid for by Medicaid, Medicare, and private health insurance which encouraged the more services provided, the more payment received.
Prospective Payment
The Reagan administration's proposal of cost containment. It was directed at control of Medicare costs by setting forth pre-established amounts that would be reimbursed for diagnostically related groups (DRGs).
Evolution of mental health care and its major influences before 1840 until the present day.
-Before 1840, there was no known treatment for individuals who were mentally ill.
-In 1841, Dorothea Dix, established hospitals for the mentally ill after a personal crusade across the land on behalf of mental ill clients.
-These hospitals eventually became overcrowded and understaffed.
-In 1940, there was a driving force towards the mental health movement; thus, establishing the National Mental Health Act of 1946. This act developed government grants to the states to develop outpatient clinics and psychiatric units in general hospitals.
-In 1949, the National Institute of Mental Health was established as an outgrowth of the National Mental Health Act in order to have the responsibility for mental health in the US.
-In 1955, the Joint Commission on Mental Health and Illness identified recommendations for improvement in psychiatric care which lead to Action for Mental Health in 1961.
-In 1963, congress passed the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 which the state and federal government would share the community health center costs. This lead to the deinstitualization movement
-In 1984, the Community Mental Health Systems Act was terminated due to budget cuts and the "revolving door" began to intensify, in which costs of care for hospitalized psych clients continued to rise, and individuals with severe and persistent mental illness went back to the hospital once again due to lack of support.
-In 1983, retrospective reimbursement was interrupted by prospective payment.
-Today, deinstitutionalization continues to be the changing focus of mental health care in the United States which leads to the provision of outpatient mental health services of the future.
Distinctions between primary, secondary and tertiary prevention of mental illness and examples of each activity.
Primary Prevention: services aimed at reducing the incidence of mental disorders within the population by (1) assisting individual to increase their ability to cope effectively with stress (2) targeting and diminishing harmful stressors within the the environment.
Example: Teaching a class in parent effectiveness training.

-Secondary Prevention: Interventions aimed at minimizing early symptoms of psychiatric illness and directed toward reducing the prevalence and duration of the illness which is accomplished through early identification of problems and prompt initiation or referral of effective treatment.
Example: Providing support in the emergency room to a rape victim.

-Tertiary Prevention: Services aimed at reducing the residual defects that are associated with severe and persistent mental illness which is accomplished by (1) preventing complications of the illness; (2) promoting rehab that is directed toward achievement of each individual's max level of functioning.
Example: Serving as a case manager for a mentally ill homeless client.
Definition, preparation, responsibilites and employment setting of the RN-PMH
Definition: a RN who demonstrates competence in caring for persons with mental health issues, problems, and psych disorders.

Preparation: Baccalaureate degree

Responsibilities: Health promotion, maintenance, crisis intervention and stabilization, and psychiatric rehabilitation.

Employment setting: Inpatient psychiatric hospital unit, day treatment and partial hospitalization programs, community health centers, home health care, long-term care centers.
Definition, preparation, responsibilites and employment setting of the AP-RNPMH.
Definition: A professional nurse who expands the practice of a RN by demonstrating a greater depth and breadth of knowledge, a greater synthesis of data, increased complexity of skills and interventions, and significant role autonomy.

Preparation: Masters or Doctors degree in the specialty of psychiatric-mental health nursing with an advanced practice specialty certification.

Responsibilities: Same as RN, plus prescribing psychopharmacological agents, integrative therapy interventions, various forms of psychotherapy, community interventions, case management, consultation and liaison, clinical supervision, expanded advocacy activities, education, and research.

Employment setting: inpatient psychiatric hospital units; day treatment and partial hospitalization programs; community mental health centers; private mental health facilities; individual private practice; crisis intervention services; or in the capacity of mental health consultant, supervisor, educator, administrator, or researcher.
Roles and functions of case management and managed care in mental health care.
Case management is a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes.

It functions by increasing the individual's ability to solve problems, improving work and socialization skills, promoting leisure time activities, and endeavoring to diminish dependency on others.

Managed care is a concept designed to control the balance between cost and quality of client care. It exists in Insurance-based programs, Employer-based program, Social service programs, and the Public health sector
Types of clients who benefit from case management.
-The frail elderly
-Developmentally disabled
-Physically handicapped
-Mentally handicapped
-Long-term medically complex problems that require multifaceted, costly care.
-Severely compromised by an acute episode of illness or an acute exacerbation of a severe and persistent illness (schizophrenia)
Identification of populations at risk for threat to mental health through assessing maturational crises: adolescence, marriage, parenthood, midlife, and retirement.
Adolescence: identity vs role confusion

Marriage: each individual has their own inner life structure with its own unusual feature which may cause conflict; additional conflicts include crossovers in religion, ethnicity, social status, or race.

Parenthood: the child's birth brings finality to many highly valued privileges and a permanence of responsibilities. The addition of a child influences all parts of the system as a whole.

Midlife: an alteration in perception of the self, others, and time.

Retirement: our society places a great deal of importance on productivity and on earning as much money as possible at as young an age as possible, so adjustment to retirement becomes more difficult.
Identification of populations at risk for threat to mental health through assessing situational crises: poverty, high rate of life change events, environmental conditions, and trauma.
Poverty: has a correlation to emotional illness possibly due to inadequate and crowded living conditions, nutritional deficiencies, medical neglect, unemployment, or being homeless.

High rate of life change events: tend to decrease a person's ability to deal with stress, and physical or emotional illness may be the result.

Environmental conditions: Tornados, floods, hurricanes, and earthquakes have wreaked devastation on thousands of individuals and families in recent years.

Trauma: participation in military combat, being a victim of violence, undergoing torture, being taken hostage or kidnapped, or being the victim of a natural or manmade disaster are situations that are at risk for emotional illness.
Screening for evidence of compromised mental health in situations of maturational crises: adolescence, marriage, parenthood, midlife, retirement.
Adolescence: disruptive and age-inappropriate behaviors become the norm, and the family can no longer cope adaptively with situation.

Marriage: Problems that are not uncommon to the disruption of a marriage relationship include substance abuse on the part of one or both partners and disagreements on issues of sex, money, children, gender roles, and infidelity, among others.

Parenthood: physical, emotional, or sexual abuse of a child; physical or emotional neglect of a child; birth of a child with special needs; diagnosis of a terminal illness in a child; death of a child.

Mid-life: the individual is unable to integrate all of the physical and biological changes that are occurring during this period. Other changes include changes in relationship.

Retirement: depression resulted from being unable to satisfactorily grieve for the loss of this aspect of their lives. Occurs often in those that derived most of their self-esteem from their employment.
Alternative treatments available for community mental health.
Case management has become a recommended method of treatment for individuals with severe and persistent mental illness.

-Community mental health centers—designed to improving coping and prevent exacerbation of symptoms
-Assertive community treatment (ACT)—comprehensive, local treatment with a team approach
-Day or evening treatment programs—ease transition to community living
-Community residential facilities—residential programs designed to facilitate transition to community
Demographics of the homeless.
Age: 39% are younger than 18 years of age, 25% are 25-34, 6% are 55-64.

Gender: More men(51%) than women.

Families: the fastest growing segments of the homeless population. 30%

Ethnicity: in descending order: African American, Caucasian, Hispanic, Native American, and Asian.
Factors contributing to homelessness among the mentally ill.
Deinstitutionalization

Poverty

Scarcity of Affordable Housing

Lack of affordable health care

Domestic violence

Addiction Disorders
Types of community resources available for the homeless.
Homeless shelters

Health care centers and storefront clinics

Mobile outreach units
Health issues affecting the homeless population and potential obstacles to continued care.
Exposure to the elements, poor diet, sleep deprivation, risk of violence, injuries, and little or no health care.

Those who abuse alcohol are at greater risk of developing neurologic impairment, heart disease, HTN, chronic lung disease, GI disorders, hepatic dysfunction and trauma.

Thermoregulation is a health problem.

Spread of tuberculosis due to crowded shelters.

Dietary deficiencies

STDs such as gonorrhea, syphilis, and HIV(the most prevalent STD).

Children have higher rates of asthma, ear infections, stomach problems, speech problems, anxiety, depression, and withdrawal.
The 6 cultural phenomena evidenced within Northern European Americans: England, Ireland, Germany, etc..
Communication: More verbal than nonverbal. Commonly English, but there are national language variations. Many dialects.

Space: Uncomfortable with close contact, territory is important.

Social organization: Nuclear and extended families. Christian and Jewish religions (“Judeo-Christian”). Organized by social communities.

Time: High value on punctuality. Future oriented.

Environmental control: Preventive medicine is valued. Traditional health care system.

Biological variations:Cardiovascular disease, cancer, diabetes.

Family’s role in health care: Health care is a service best provided by professionals.
The 6 cultural phenomena evidenced within African Americans.
Communication:Verbal and nonverbal. National languages with many dialects.

Space:Close personal space, frequent touch. Greetings are often formal.

Social organization: Large extended families, many female head of households, strong religious orientation.

Time: Present oriented. Adhere to schedules and conscious of being on time.

Environmental control: Rely on home remedies before seeking traditional health care. Do not usually question doctors. Passive role with acute sick care.

Biological variations: Cardiovascular disease, hypertension, sickle cell disease/trait, diabetes.

Family’s role in health care: encouraged to assist with care and act as advocates. Some bring food daily.
The 6 cultural phenomena evidenced within Native Americans:North America, Alaska
Communication: Many tribal languages. Comfortable with silence. Direct eye contact considered rude.

Space: Extended space important. Uncomfortable with touch.

Social organization: Nuclear and extended families. Tradition is important. Tribe and family are most important.

Time: Present-oriented. Casual concept of time. Future less important than past, present.

Environmental control: Religion and health are blended. May use shaman who works with medical provider.

Biological variations: Alcoholism, tuberculosis, diabetes, cardiovascular disease, accidents.

Family’s role in health care: “Elders” are leaders who advise others and are involved in care.
The 6 cultural phenomena evidenced within Asian/Pacific Island Americans:
Japan, China, Korea, Vietnam, India
Communication: Multiple different languages. Comfortable with silence. Potential for misunderstanding nonverbal communication (stoic faces)

Space: Large personal space, uncomfortable with touch. Bowing may be customary.

Social organization: Nuclear and
extended families. Family loyalty
and tradition. Many religions.

Time: Present oriented. Punctuality is important.

Environmental control: Traditional health care delivery. Some may prefer folk practices.

Biological variations: Hypertension, cancer, diabetes, thalassemia.

Family’s role in health care: Nurses are responsible for hospitalized family members, family provides support.
The 6 cultural phenomena evidenced within Latino Americans
Communication: Spanish with many dialects

Space: Close personal space. Touching, embracing common. Group oriented.

Social organization: Nuclear and large extended families, strong religious ties.

Time: Present oriented. Relaxed concept of time, unconcerned about the future.

Environmental control: Traditional health care system, some prefer folk practitioners. Patient takes a passive role. Severity of illness may be determined by presence of pain or blood.

Biological variations: Heart disease, cancer, diabetes, accidents, lactose intolerance.

Family’s role in health care: Family is expected to be involved, accompany hospitalized patients.
The 6 cultural phenomena evidenced within Western European Americans:
France, Greece, Italy
Communication: National languages with dialects

Space: Close personal space with lots of touching.

Social organization: Nuclear and large extended families.

Time: Present-oriented. Delays for appointments of 5 to 10 minutes acceptable. “Fashionably late” (30 minutes) is expected.

Environmental control: Traditional health care. Lots of home remedies. Health care driven by doctors.

Biological variations: Heart disease, cancer, diabetes, thalassemia.

Family’s role in health care: Patients receive extensive care from family members and friends. Frequently bring in food. Tremendous nursing shortages in countries of origin.
The 6 cultural phenomena evidenced within Arab Americans
Communication: Arabic, English.

Space: Behave conservatively in public. Large personal space between members of opposite sex outside the family. Touching common between members of same sex.

Time: Past and present oriented. Schedules, deadlines, punctuality are important. Financial and economic constraints may be barriers to focusing on the future.

Environmental control: Traditional health care system. Some superstitious beliefs. Authority of physician is seldom challenged. Nurses’ knowledge, expertise often discounted.

Biological variations: Multiple. Thalassemia, cardiovascular, obesity.

Family’s role in health care: Families are main source of support and assume many roles when a family member is ill
The 6 cultural phenomena evidenced within Jewish Americans
Communication: English, Hebrew, Yiddish.

Space: Touch may be forbidden between opposite genders in Orthodox. Handshaking and hugging common among friends.

Social organization: Nuclear and extended families, community social organizations.

Time: Past, present and future oriented.

Environmental control: Active involvement, prevention is important. Great respect for physicians.

Biological variations: Tay’s Sachs, Crohns, cancer.

Family’s role in health care: One usually stays with the patient at all times. Often bring in food because of dietary laws. Patient washed daily, linens changed.