Learning Objectives
By the end of this section, you will be able to:
- Describe family development and roles and how culture impacts the family as a unit
- Describe the components of a family assessment
- Describe health beliefs, approaches, and norms of families
Family development refers to the life cycle of a family and how it adapts to change. Culture plays a large part in defining a family and family roles. When discussing a person’s health history, the nurse also takes a thorough family history to look for possible genetic issues but also to understand traditions and roles that are important to the person.
Ideas of health and health care differ in certain cultures and families. Many cultures and religions have spiritual healers and traditions that nurses must respect. Childbirth and childbearing are especially steeped in tradition; religious rituals are carried out by families or religious leaders. The nurse can inquire about these traditions prior to the birth to help facilitate the customs.
Family Development
Family development has been studied for many years. Family development was defined in the 1950s as “the systematic and patterned changes experienced by families as they move through their life course” (International Encyclopedia of Marriage and Family, 2023, p.1). The family development theory was developed after World War II, with family stages defined as early marriage, families with young children, the launching of children out of the home, and the empty nest (International Encyclopedia of Marriage and Family, 2023). Family development has adapted throughout the years to include many different positions, norms, roles, stages, and variations.
Family Assessment
The family assessment is an important part of a person’s health assessment. The nurse understands that the family plays an important role in a person’s personal, emotional, mental, and physical health. Table 2.2 lists the components of a family assessment.
| Family Assessment by Nurse | Questions |
|---|---|
| Describe the family |
|
| Determine family resources |
|
| Assess family education, lifestyle, and beliefs |
|
| Determine teaching needs |
|
Cultural Influences on Families
Families respond to their environment through learned cultural experiences. Culture influences how families communicate, love, deal with stress, and even feel pain. Each family member is a combination of their individualism and their culture.
Physiologic Differences
Certain ethnocultural groups are at higher risk for specific diseases. (See Chapter 3 Health Promotion, Disease and Injury Prevention, and Well-Person Care for a discussion of social determinants of health.) Certain ethnicities are prone to ancestry-based genetic diseases, and people with these ethnicities are more likely to carry the recessive genes that cause these diseases. (See Chapter 4 Influences on Fertility for a discussion of genetic diseases that may impact people of certain ethnicities.)
Psychologic Differences
One main psychologic distinction between cultures that affects how people think and make decisions is individualism versus collectivism. In individualism, people respect independence and view themselves as separate from others, with personal ideals and goals (Hampton & Varnum, 2020). People from individualistic cultures are encouraged to make choices for their own benefit and to emphasize independence and self-reliance. Health care tends to be viewed as a personal responsibility. Most Western countries, such as the United States, the United Kingdom, and other parts of Western Europe, have individualistic cultures (Fatehi et al., 2020). Knowledge that the patient and their family are from these regions assists the nurse in developing a plan of care with specific self-efficacy tasks.
In contrast, in collectivism, people believe in interconnectedness with others and respect relationships (Hampton & Varnum, 2020). Collectivist cultures place an emphasis on community and cooperation. Decisions are made for the benefit of the collective. These cultures believe that it is best for society when everyone works together as a group, and the needs of the individual come secondary to the needs of the greater good. Some countries that practice cultural collectivism include China, Japan, India, Brazil, and Guatemala (Collectivist Countries 2024, 2024). The nurse can use this information to include other family members and community resources in the planning of care.
Cultural Influences on Pain
Different cultures have varying views on pain, including how to express it, how to treat it, and what it means. Pain is a universal physical experience, but it involves emotions and behaviors that are influenced by the patient’s cultural viewpoint (Givler & Bhatt, 2022). Pain is a subjective experience. In many cultures, childbirth is seen as an event that is challenging, but the intense sensations are not the same as “pain.” Ideally, the nurse should discuss pain management for labor prior to the person experiencing pain; however, the nurse should not assume the person’s pain level strictly by their outward appearance. Misunderstandings about pain due to cultural differences can result in overtreatment or undertreatment of the patient’s pain and should be avoided.
Clinical Judgment Measurement Model
Take Action—Culturally Sensitive Nursing Interventions for Pain
Even though the ways in which people experience and express pain are influenced by their cultural background, pain is an individual experience. As a nurse, it is important to be aware of cultural differences so that you can treat a person in a way that best suits their pain. Culturally sensitive nursing interventions for pain may include the following:
- Ensure translation services are available as needed.
- Ask the person about their expectations of pain during labor. Their beliefs may be representative of their cultural background, or they may not—do not make assumptions without listening to the person.
- Provide thorough education on pain assessment to the patient; this is necessary. Do not rely on nonverbal cues.
- Use a pain scale tool to determine the patient’s individual response to pain and thereby establish the patient’s pain level (Dydyk and Grandhe, 2023).
- Allow the person to incorporate traditional remedies whenever possible. Make sure to gather a thorough history of all medicines, herbs, plants, and foods the patient ingests to avoid any possible interactions.
- Assure the patient that you are there to help treat their pain in a way that is the most appropriate and suitable for them.
- Adjust the patient’s care plan to reflect their cultural needs.
(Givler & Bhatt, 2022)
Family Roles
Family roles are individual to each family. The nurse should never assume what role each member plays without asking. Family roles do not include just mother, father, and child. Family roles could include the nurturer (a person who is empathetic and nurturing to their partner and/or children), the cheerleader (a person who is supportive and encouraging to their other family members), and the truth teller (a person who is able to critically share their thoughts, hopefully in an appropriate way) (Applebury, 2020). Other family roles might include the troublemaker, peacemaker, caretaker, doer, or martyr. In most families, the parents are expected to be the leaders, and the children are expected to follow that leadership. However, parents and children can play many roles. According to the role and personality of the person, the nurse may need to change their approach to education and care.
Health Beliefs and Practices in the Family
Health beliefs and health practices can differ because of cultural, familial, and socioeconomic influences. Religion and spirituality also determine health-care decisions. Beliefs may be due to negative past experiences or discrimination. Some families are unfamiliar with the health-care system and how to navigate it. Families coming from a country with universal health care will lack an understanding of the U.S. health-care system. Nurses should assist families in understanding the role of the health-care system.
Religion and Spirituality’s Influence on Maternal-Child and Women’s Health
Religion and spirituality are prominent cultural elements that influence values and beliefs and can influence pregnancy, birth, and women’s health. Spirituality is the individual beliefs and practices in which a person finds meaning and value; it is separate from religion. The nurse can inquire what spiritual beliefs are important surrounding pregnancy, birth, contraception, and preventive health care, and ask what accommodations would help support those beliefs.
Many topics in maternal-child and women’s health are influenced by religious or cultural norms. Circumcision decisions are often made based on religious beliefs. Taboos regarding menstruation can be influenced by religion, and some religious ceremonies are prohibited while a person is menstruating. Fasting during pregnancy is a decision based on religious beliefs. Other reproductive health topics related to religion include abortion, sex, baby care, pregnancy, and postpartum traditions. Some patients prefer traditional healers to modern health-care providers or refuse recommended treatment because it goes against their religious beliefs. The American College of Obstetricians and Gynecologists (2019) released a committee opinion stating that pregnancy does not give a health-care provider reason to coerce, manipulate, or threaten a person to “save” a fetus if a patient refuses treatment. Nurses should ask what religious beliefs are important to the patient and how they can tailor their care to respect those beliefs.
Practitioners and Traditions outside Mainstream Medicine
Every culture develops its own ways of dealing with health and illness. The various medicines and healing practices around the world that differ from the modern, Western health-care system is called traditional healing (World Health Organization, 2023). Traditional healing encompasses a vast range of traditions and practices that differ across regions and cultures. During pregnancy and breast-feeding, asking about traditional healing regimens is important to assess for safety to the fetus and newborn. Table 2.3 reviews different healing traditions and their characteristics.
| Healing Tradition | Chief Characteristics |
|---|---|
| Traditional Chinese medicine (TCM) | Belief in the idea of balance as the root of health; based in concepts of qi and yin and yang; practices include acupuncture, cupping, herbs, tai chi |
| Ayurveda | Hindu form of medicine from India, based on the idea that disease is caused by imbalance; seeks to cure imbalances using Ayurvedic medicine, including diet, herbal medicines, yoga, and meditation |
| African traditional healing | Extremely diverse and varies by tribe; some believe that ancestral spirits are closely involved in the lives of the living; healers offer spiritual education and care and function as counselors and social workers |
| American Indian traditions | Believe that spiritual and physical health are intertwined; the healer’s role is to help the person as they help themselves; ritual and ceremony have key roles in healing |
| Hispanic traditions | Curanderismo is a holistic practice rooted in beliefs that health is achieved through the right balance of mind, body, and spirit; healers focus not only on the person’s physical health but also on their mental health, diet, personal relationships, and more; use various healing methods including prayer, oils, herbs, special diets, and other spiritual rituals |
| Western European traditions | Role of patient at the center of the patient-healer relationship is crucial; has a strong foundation in using medicines created from natural elements, including herbs, plants, minerals, and animals |
Childbearing and Childrearing Practices
The American Psychological Association (n.d.) defines child-rearing as “a pattern of raising children that is specific to a particular society, subculture, family, or period in cultural history. Child-rearing practices vary in such areas as methods of discipline, expression of affection, and degree of permissiveness” (para 1). Health beliefs regarding childbearing and child-rearing are dependent on cultural and family practices. Many cultures see birth as a natural, nonmedical event and tend to use midwives. After a birth in Iran, mothers, sisters, and aunts traditionally “shower” the birthing person with special oils, give them a facial, and paint them with henna as a reward for their hard work (Boggan, 2015). Andean communities in Argentina place importance on care of the placenta, which is revered as a younger sibling. Parents must care for and bury the placenta properly (Colangelo, 2020). Many Hispanic people celebrate cuarentena, 40 days of recuperation and rest after the birth. In the Muslim culture, parents celebrate the birth by performing tahnik and aqiqah rituals in which a small amount of date or honey is placed on the baby’s palate and the dua is recited (Gatrad & Sheikh, 2001).
Some parents place a heavy emphasis on achievement in childhood. Chinese American and Taiwanese Chinese parents rate persistence, politeness, concentration, and precision as important parenting goals (He et al., 2021). Indian parenting styles focus on interdependence of all family members, where shared goals and the focus on the family is a priority (Sahithya et al., 2019). In Hinduism, couples without children are stigmatized as barren, but having a son is celebrated for allowing the family line to continue (V, n.d.).
Legal and Ethical Issues
Jehovah’s Witnesses and Blood Products
Jehovah’s Witnesses belong to a Christian sect that prohibits the use of blood transfusions or blood products. Their beliefs are based on verses of the Bible, including the following:
- Genesis 9:4: “But flesh meat with blood shall ye not eat.”
- Leviticus 17:12–14: “No soul of you shall eat blood, whosoever eateth it shall be cut off.”
- Acts 15:29: “That you abstain from blood …”
- Acts 21:25: “Gentiles keep themselves from things offered to idols and from blood.”
Some Witnesses will accept minor blood products such as cryoprecipitate and immunoglobulins. Elders of the church can be useful consultants for members deciding which products they agree to accept. Health-care providers can use iron replacement, erythropoiesis-stimulating agents, tranexamic acid, recombinant factor VIIa, prothrombin complex concentrate, and other agents to help prevent the need for blood products during planned surgeries. The nurse should take a detailed history of any previous complications from surgery, bleeding complications, or genetic predisposition for clotting or bleeding. The nurse will also document what measures the person agrees to if bleeding does occur. Health-care providers and nurses must be nonjudgmental in their discussions of blood products and hemorrhage.
(DeLoughery, 2020)