African American Cultural Assessment Essay

Abstract In order to provide culturally appropriate care, an examination of one’s personal views, beliefs, and prejudices must be examined. The first portion of this paper will examine my personal values, beliefs, biases, and prejudices. The remaining paper will analyze the African American culture relating to the Ginger and Davidhizar’s Transcultural Assessment Model cited in Hood (2010). This model uses six key cultural elements that include communication, space, social organization, time, environment, and biological variations. This model provides a systematic approach for assessing culturally diverse clients. I will also discuss an aspect of care that I would advocate a change in my clinical practice for the African American population. Cultural Self-Assessment Culture is one of the most basic elements that makes up the identity and personality of each individual. Every individual has their own culture rooted from the community they lived in and the family they grew up making up the personal identity people have in the general society Personal views, aspects of reasoning and judgment and the general logical thinking of an individual are affected significantly by the culture he or she has. In this aspect, the entire well-being of a person depends greatly on his or her culture. Becoming aware of how your actions and cultural beliefs affect the patients that you deal with is important. Thus, a person must regularly assess himself because an action or a mere word done or spoken by a nurse can be misunderstood by these patients coming from different cultures Being an American born and lived all my life in New Bedford, Massachusetts, culture has really affected me as a person. My mother and grandparents were born in Portugal and this gave me a variety of culture since we all know that New Bedford is a melting pot of cultures. Portugal possesses rich cultural inheritance from European, African, and North American cultures. Aside from that, mainly Portuguese and Hispanic people populate the community where I live in. These further made me grow as an individual that is rich in cultural inheritance. I am a person who has a Portuguese lineage, since my grandparents were natives of Portugal and a person who grew up in a community wherein Portuguese people mainly inhabits the land. Having an ethnic identity as a Portuguese American who acquiring the Portuguese cultures and practices surrounding me molded me as to who I am now. This ethnic affiliation will always be a part of me, my friends, and my family. Each cultural belief that I introjected within has already affected how my mentality works, and how my feelings reacts. Family and friends have always served as my fortress in time of trials and difficulty. They remain as my comfort zone whenever I feel so down. They are the main support people in my life from which I extract my energy from. Adopting this belief from my parents and from the community I live in is one of the proofs that the culture of the people around me had affected me well. Living with people who provide high regards to friends and families will make you have the similar perspective too. My culture does not affect much my preferences with medical treatments. In line with this, being an independent person, the decisions for my health mainly comes from me since I am the owner of this body. My family and friends will surely voice out their concerns, but it does not mean that I have to follow them, I might consider it but what would really matter will be my decision for my own health. As of what I have observed in my family, especially among my grandparents, the family is mainly a patriarch form of family. Decisions mainly depend on my grandfather since he is the father and the man in the family. Especially among Portuguese, it was noted that people in Portugal gives higher regards to male than to female. They still have this belief that a woman shall always be better than woman. However, in my case, growing as an American with a Portuguese lineage, things were far more different. I grew up having giving importance to democracy and equality. Voices of the female are now more heard, and I think male and female are both equal. This is because I think they have equal abilities, as well as, equal rights. Living in a community filled with Portuguese people made me learn English and Portuguese. Aside from that, my grandparents required me to learn those languages too, especially Portuguese which is their main language in their main land. However, the primary language that I utilize in everyday conversation is English and the secondary language that I know is Portuguese. However, most of the time, I am comfortable with non-verbal forms of communication, especially doing hand gestures. I am more expressive with this form of communication because I think it can bring many messages to the people that I interact with. With a mere wave of a hand, it can show joy, respect, accommodation, or even comfort to those people you interact with. Being a Roman Catholic is very importance to my daily life because this gives me support, comfort, and security whenever difficult situations occur. This belief helps me to cope with the trials I face by knowing that there is a supreme being up there that is in control of everything. That the God whom I know as my Father, my King, and my Savior loves me so much and will never forsake me whatever happens. Daily life gives us opportunities to grow with our spiritual relationship with God by walking each day with him, and applying his will and commandments in everything that we do. Foods are one of the things that I truly enjoy. I do not have any prohibitions whenever it comes to food. I know how to eat a variety of foods. I do not have any food allergies that might prohibit me from eating other foods. As long as it is clean and digestible, I can definitely give it a shot. Currently, I am in a relationship with my boyfriend of eight years who is interracial himself. My work provides me career growth and financial security that I definitely need to support myself. I have no issues with the job that I have right now, since it suffices the finances that I have. Nevertheless, of course, like anyone else, an opportunity for greener pastures will be much appreciated and entertained when it comes. Being a nurse, I am aware of all the possible medical treatments that can be done to each person experiencing illness. Even though I know how much these practices could help me survive various predicaments in health, I still prefer not to undergo through some of it in case I will encounter them in my life one day. I do not have problems taking medications and intravenous lines; however, I really do not want to be intubated at end of life decisions. I know how awful it seems, and how difficult is it having a tube being attached to me. I also do not want to live on life support because I think that such modalities only prolongs the agony that you feel. It has been my personal belief ever since that when the time comes that God wants to take the life He has given me, nothing can prevent that. As a Catholic, I believe that birth is a gift of life from God. Thus, I definitely go against with abortion, which kills an innocent child’s life. With regards to death, I believe that after death, the soul goes to purgatory, and God will judge you whether you will go to heaven or to hell. However, with regards to miracles and afterlife, I do not think that these are rational. As a person, I give high regard to a person’s hope. I believe that hope is essential for a person to live the life we have, and to fight the everyday battles that we face. Without hope in our lives, we lose the chance of living and enjoying the life we received from God. Instead, we become a living corpse, a person who is literally living physically yet the inside of the heart is as cold as a corpse, because he has no hope and no joy for anything. Cultural Assessment and Analysis Paper on African American Population The population that interested me to do additional research is African American population. The total population including all races and ethnicities in the United States is 308 million. After researching on the U. S. Census Bureau, I found 39 million African Americans live in the United States. One of the most glaring disparities is apparent in the African. American community, where 48% of adults suffer from a chronic disease compared to 39% of the general population (Health Reform, 2009). The CDC states that in 2004, African Americans had the highest age-adjusted all-causes death rate of all races/ethnicities (CDC, 2008). African Americans have become susceptible to many diseases and health problems throughout the last number of years. The male and female citizens of the African American population have been struggling with high rates of cardiovascular disease, hypertension, cancer rates, stroke, diabetes, asthma and HIV/AIDS just to name a few. African Americans have numerous health risks as well such as; higher incidence of homicide, lower physical activity levels, obesity, cigarette smoking, alcohol abuse, incarceration, unintended pregnancy, and untreated dental carries (Hood, 2010). Despite remarkable improvements in the overall health of our nation during the past couple of decades, compelling evidence suggests that our nation’s racial and ethical minority African Americans suffer increasing disparities in the incidence, prevalence, mortality, and burden of diseases and adverse health outcomes compared with white Americans (Copeland, 2005). The predominant barriers to accessible health care services for African Americans include inability to pay for services, lack of transportation and childcare, decrease understanding of treatment plans and inability to incorporate prescribed health plans into daily living patterns (Russell & Jewell, 1992). Furthermore, the African American population’s cultural beliefs and health practices have a significant impact upon their well-being regardless of their educational levels and income. Therefore, these health beliefs and practices affect utilization of contemporary health-care service delivery systems even when other barriers have been eliminated. Differences in health beliefs and practices can be observed among African Americans in varying age groups, socioeconomic levels, and geographic locales. The commonalities include religious orientation, social support networks, and inform health care systems (Russell & Jewell, 1992). Religion is a focal point within the lives of African Americans. Many African Americans characterize health as a continuum evolving around mind, body, and spirit. African Americans also have large support systems including nuclear and extended families. They would rather rely on someone who may not be related by blood or marriage than to receive help from community agencies. Informal health care systems within the African Americans community often are consulted. A study showed that African Americans used an informal social network rather than receiving professional health care. Instead of consulting appropriate personnel, they are consulting family members and friends in regards to their personal health problems. This could be a factor in why the health disparities in this particular population are greater than any other race or ethnicity. The Ginger and Davidhizar’s Transcultural Assessment Model focuses on cultural elements. The model includes six cultural phenomena: communication, time, space, social organization, environmental control, and biological variations. These provide a framework for patient assessment and from which culturally sensitive care can be designed. In the following paragraphs, I will begin to talk about each key element and how it corresponds to the African American population. Communication is meaningful because of the culture that frames it, and culture must be expressed to exist. Communication is seen as a problematic part of cultural affiliation and not as caused or predicted by affiliation. Miscommunication is a frequent problem in hospitals. The most obvious is when the patient and hospital staff does not speak the same language. Although the dominant language spoken among African Americans is English, there is a way of speaking among some African Americans that sociolinguists refer to as African American English (AAE) (Campinha-Bacote, 2009). These terms include Black English, Ebonics, Black Vernacular English (BEV), and African American Vernacular English (AAVE) (Campinha-Bacote, 2009). They also prefer the use of nonverbal communication. Therefore, as nurses we should be able to provide care to African Americans without there being a language barrier present. In addition, a head nod does not necessarily mean agreement and when asked personal questions on initial contact with a person it may be viewed in their eyes as intrusive. Space refers to the distance between individuals when they interact. All communication occurs in the context of space. There are four distinct zones of interpersonal space: intimate, personal, social and consultative, and public. Research on use of space among African Americans is mixed. Some studies indicate that, in race-matched pairs, black children will stand closer to each other during conversation than white children do. Other research has shown that African American adults employ a greater public distance from each other than compared when interacting with family and friends. They also prefer close personal space and touching another’s hair is considered improper. African Americans tend to be late for appointments because relationships and events may be deemed more important than being on time. Social organization refers to the manner in which a cultural group organizes itself around the family group. Family structure and organization, religious values and beliefs, and role assignments may all relate to ethnicity and culture. African American’s have many female single-parent families. They are also known for large extended families, in which elders are respected. There preferred religion is Protestant (Baptist), majority of African Americans have a strong church and social affiliations. In 2005, the National Institutes of Health urged African Americans to use family reunions as venues for discussions about diabetes and kidney disease—diseases that disproportionately affect this group (McCoy, 2011). Time is an important aspect of interpersonal communication. Time orientation varies according to age, socioeconomics, and subgroups and may include past, present, or future orientation. Preventive health care requires some future time orientation because preventive actions are motivated by a future reward. African Americans time orientation is present over future. Environmental control refers to the ability of the person to control nature and to plan and direct factors in the environment that affect them. African Americans have traditional health and illness beliefs. They also are known to use folk medicine; the folk healers are root workers. Some African Americans, particularly of Haitian background, may believe in sympathetic magic. Sympathetic magic assumes everything is interconnected and includes the practice of imitative and contagious magic. Contagious magic entails the belief that once an entity is physically connected to another, it can never be separated. This type of belief is seen in the practice of voodoo, when an individual will take a piece of the victim’s hair or fingernail and place a hex, which they believe will cause the person to become ill (Campinha-Bacote, 2009). To African Americans God is thought to be the spiritual healer. Biological differences, especially genetic variations, exist between individuals in different racial groups. Although there is as much diversity within cultural and racial groups as there is across and among cultural and racial groups, knowledge of general baseline data relative to the specific cultural group is an excellent starting point to provide culturally appropriate care. Nutritional preferences for African Americans include fried foods, and among pregnant women pica ingestion. African Americans are susceptible to many health conditions such as; keloid formation, lactose intolerance, sickle cell anemia, glucose-6-phosphate dehydrogenase deficiency, thalassemia, sarcoidosis, hypertension, coccidioidomycosis, esophagus and stomach cancers. African Americans are at greater risk for many diseases, especially those associated with low income, stressful life conditions, lack of access to primary health care, and negating health behaviors (Campinha-Bacote, 2009). The greatest risk factor for cardiovascular disease and heart attacks amongst African Americans is hypertension. Compared with hypertension in other ethnic groups, hypertension among African Americans is more severe, more resistant to treatment, and begins at a younger age, and the consequence is significantly worse, including organ damage (Brewster, Van Montfrans, & Kleijnen, 2004). African Americans also have an overall higher cancer incidence and mortality rate than any other race African Americans suffer from certain genetic conditions. Sickle cell disease is the most common genetic disorder among the African-American population, affecting one in every 500 African Americans. In addition to sickle cell disease, glucose-6-phosphate dehydrogenase deficiency, which interferes with glucose metabolism, is another genetic disease found among African Americans (Caminha-Bacote, 2009). African Americans also metabolized certain drugs differently such as immunosuppressants, antihypertensive, cardiovascular, antiretroviral, psychotropic drugs. After reading through several articles and journals regarding African Americans there are many areas that I would advocate for change but if I had to choose just one, I would pick HIV/AIDS. Many African-Americans are at high risk for HIV infection, not because of their race or ethnicity, but because of the behaviors, they may engage in. As with other ethnic/racial groups, HIV risk depends not on who you are, but on whether you engage in risk-taking behaviors with an HIV positive partner, and whether you have access to care, education and prevention services. The greater number of people living with HIV in African American communities and the fact that African Americans tend to have sex with partners of the same race/ethnicity means that they face greater risk of HIV infection with each new sexual encounter (CDC, 2011). Lack of awareness of HIV status can affect HIV rates in communities. Late diagnosis of HIV infection is common, which creates missed opportunities to obtain early medical care and prevention of transmission to others (CDC, 2011). This disease/illness can be prevented if maximizing the effectiveness of current HIV prevention methods. Implementing programs that teach individuals how to get tested for HIV and prevent the spread of the infection to others. The CDC has set up numerous activities within the communities to address prevention and spread of HIV. For example, The Act against AIDS campaign encourages African American women to get tested for HIV. In 2010, the CDC also began an Expanded Testing Initiative (ETI) for individuals to be tested for HIV. Even though there are multiple resources available to the African American population, I believe stigma, fear, and discrimination are a risk factor in which why they are afraid to be tested. Working in a hospital facility for almost over a year already, I have only been across two individuals who were tested for HIV/AIDS. After learning so much about African Americans and their numerous health disparities this particular infection, can be prevented. It amazes me that in 2009, black men accounted for 70% of the estimated new HIV infections among all blacks. By the end of 2008, an estimated 240,627 blacks with an AIDS diagnosis had died in the U. S. (CDC, 2011). After researching African Americans this particular race/ethnicity bares the most health disparities of all. A major aspect is the quality of the relationship with a health care provider, which is linked to patient satisfaction, adherence, and health outcomes. If African Americans feel that their provider has been, disrespectful they may not return for treatment, may try another provider, or may change their health care plans. This may be an enormous reason why the health disparities are the way they are in African Americans. Success in eliminating disparities in health care access and utilization requires all professionals to critically examine their own biases and to adopt the values and behaviors needed for social change. References Brewster, L. , Van Montfrans, G. , & Kleijnen, J. (2004). Systematic review: Antihypertensive drug therapy in Black patients. Annals of Internal Medicine, 14(18), 614-627. Campinha-Bacote, J. (2009). Culture and Diversity Issues: A Culturally Competent Model of Care for African Americans. Urologic Nursing, 29(1), 49-54. Center for Disease Control and Prevention. (2008). Highlights in Minority Health & Health Disparities. Retrieved from http://www. cdc. gov/omhd/Highlights/2008/HFeb08. htm Center for Disease Control and Prevention. (2011). HIV among African Americans. Retrieved from http://www. cdc. gov/hiv/topics/aa/PDF/aa. pdf Copeland, V. C. (2005). 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