Ch06

Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis CompanyCopyright © 2008 F.A. Davis Company

African Americans

Larry Purnell, PhD, RN, FAAN



African American Second largest “minority” group in the United States. Negro, black, Black American, person of color, and

colored: Depends on the individual. African American does not necessarily mean you have

black skin—it is a term to denote that the person has pride in both the African and American heritage



African American

Much diversity among this group in terms of the variant cultural characteristics.

Half live in the Southern United States with large numbers living in large cities in the North.

Most came to the United States involuntarily with the slave trade from Africa.



Education and Occupation

Great inequities in educational opportunities in the past, and this still continues in some areas of the United States with inferior schools and lack of economic and human resources.

High drop-out rates from school due to pregnancy, socioeconomics, and family responsibilities.



Education and Occupation Continued

Less well represented in managerial and professional occupations.

High employment in “blue collar” positions and factories increase risks for cancer and poorer health status—steel and tire industries and other hazardous occupations.



Communications Black English dialect where the “th” is

pronounced like “de” = dese for these. Gullah, a Creole language spoken by African

Americans who come from the Georgia Coast and South Carolina. A dialect originating from Africa and is really a combination of two other languages.

Spoken in other places in the world.



Communications Continued Highly verbal and expressive with family and

trusted friends. Do not air your dirty laundry. Dynamic loud speech pattern may be

perceived as aggression or anger. Touch easily among family and trusted friends.



Communications Continued Expressive nonverbal communications. Comfortable with close physical distance between conversants. Direct eye contact can be seen as aggression, especially by

elders and lower socioeconomic persons—can be a way of protection, especially in times past.

Culture of “being in becoming” and relaxed with time and have a linear sense of time and are polychronic.



Communications Continued

More formal with names in the beginning. Use appropriate titles. Family name is highly respected. People respected by community may be called

aunt, uncle, cousin, mother, etc.



Family Traditionally matriarchal out of necessity during times

of slavery. Now more egalitarian but great variation. Single parenting creates more matriarchal families. Gender roles are easily inter-changeable. Cooperative teamwork is valued and the “norm”.



Family Continued Value self-reliance and education. Families try to protect their children from street

violence, but society prevails during teen years and attempts may be seen as futile.

Employment at an early age is encouraged to develop self-survival and self-reliance skills—also help with chores.



Family Continued

Many see the future as having limited opportunities if from the lower educational and socioeconomic levels.

Value the Afrocentric Framework—although some do not know them by name.



Afrocentric FrameworkNguzo Sabo

Umojo—unity Kujichagula—self-determination Ujimaa—cooperative economics Ujima—collective work and responsibility Kuumba—creativity Nia—purpose Imani—faith



Family Continued

Elders, especially grandmothers, are respected. Not uncommon for grandparents to assist with

and/or raise grandchildren. Extended family is important and cousins and

nephews, etc. are considered nuclear family—so are “non-blood relatives”.



Family Continued

Minimal to no stigma for single parenting. High HIV and AIDS occurrence due to IV drug

use and sexual activity. Lesbians and gays accepted but not talked

about for fear of increased stigma and rejection.



Biocultural Ecology Different assessment techniques required to

detect cyanosis, pallor, rashes, and jaundice. Overgrowth of connective tissue leading to

keloids. Long bones are longer, bone density is greater

than that of Asians, Hispanics, and European-Americans.

Greater incidence of birthmarks.



Biocultural Ecology Continued Leading cause of death among males is

homicide. Violence in inner city neighborhoods. High morbidity and mortality due to

hypertension —renin-angiotensin syndrome. Cirrhosis and diabetes rates are also high.



Biocultural Ecology Continued Sickle cell anemia Glucose-6-phosphate-dehydrogenase

deficiency Lactose deficiency Prostate cancer due to enzyme level detection Colon tumors are deeper within the colon



Biocultural Ecology Continued Less responsive to beta-blockers More responsive to monotherapy Less responsive to mydriatic dilation High frequency for psychosis and low frequency for depression Higher doses of neuroleptics Higher incidence of side effects for psychotropics and tricyclics



Nutrition Symbol for health and wealth Accept food; otherwise you reject the person Food considered important for controlling high

blood and low blood Soul food is high in fat and sodium with fatback

used frequently



Nutrition Continued Children introduced to solid food early Milk, vegetables, and meat are strength foods Diet frequently low in Vitamins A and C and

iron High-carbohydrate diet leads to obesity Overweight is seen as positive



Childbearing Practices Oral contraceptives is the most common

method of birth control Mother and grandmother are the primary

advisors for pregnancy and childbearing practices

Consume your craving during pregnancy or the baby will be marked



Childbearing Practices Continued Geophagia, eating non food substances, can

lead to iron and potassium deficiency A few believe that a pregnant woman should

not have her picture taken because it will capture the baby’s soul

Do not take pictures while pregnant because it can cause a stillbirth



Childbearing Practices Continued

After delivery avoid cold air and get plenty of rest

Umbilicus may be wrapped or have a coin placed on it to prevent protruding outward—for some it is a means of protection from evil. Practice is rare but still occurs among some.



Death Rituals Death does not end the connection between

people, can communicate with the dead person’s spirit

Some believe in voodoo death in that death or illness can come to a person through supernatural forces

Voodoo is also known as root work, mojo, spell, fix, or black magic



Death Rituals Body must be kept intact after death—I came into this world

with all of my body parts and I intend to leave this world with all of my body parts

Falling out due to extreme emotional response. However the person can still hear and understand

Express grief openly and publicly with eulogies at funerals is common



Spirituality The Black Church is the Black Community Religion is taken seriously; expect to receive a

message in church Group singing and public testimonials Most are Baptist or Methodist although they

belong to all religious groups including Nation of Islam and Seventh Day Adventist



Spirituality Continued Use prayer for all situations Many believe in laying on of hands while

praying—power of being able to heal May speak in tongues Inner strength comes from faith in God—it is

“God’s Will” —fatalism



Healthcare PracticesHealth-Seeking Behaviors

The world is a very hostile and dangerous place to live

The individual is open to attack from external forces

The individual is considered to be a helpless person who has no internal resources to combat such an attack and therefore needs outside assistance



Healthcare Practices May be suspicious of outsider healthcare

professionals and therefore see a physician or nurse only when absolutely necessary

Natural and unnatural illnesses May receive care from a “root doctor”

simultaneously with biomedical practitioners



Healthcare Practices Continued Have a tendency to take medicine on an “as-

needed” basis Barriers to health care include affordability,

accessibility, acceptability, adaptability, and past discrimination

Some believe “no pain, no illness” Able to enter the sick role with ease



Healthcare Practices Continued

Illness brings the family together Low rates of organ donation due to lack of

information, racism, religion, distrust, and fear of organ being taken prematurely

Blood transfusion acceptable unless religion forbids it



Healthcare Practitioners Folk practitioners can be grandmothers,

respected women or elders in the community, church leaders, root doctors, or voodoo priests and priestesses, who remove hexes

Some may prefer a care provider of the same gender



Healthcare Practitioners Continued Folk practitioners are held in high esteem and

used by all socioeconomic levels of African Americans

Prefer Western healthcare providers who are known to the family or community

Must establish trust to be effective in return visits

Ch06

Documents

Transcript of Ch06