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Maternal Newborn Nursing

2.2 Family Health and Cultural Factors

Maternal Newborn Nursing2.2 Family Health and Cultural Factors

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
  • Who is considered part of the family?
  • What is the patient’s position and role in the family?
  • What are the ages and sexual orientations of the family members?
  • What are their occupations?
  • Are there any issues that would affect a family member’s ability to help with care needs?
Determine family resources
  • Can the family meet the needs of the patient?
  • Is the home safe?
  • Does the patient foresee any financial limitations to their treatment plan?
  • What are the patient’s health insurance resources?
  • What connections does the family have with friends, neighbors, church, and community?
  • Are there any transportation limitations? Does the patient own a car? Do all the adults in the family drive? Does the patient rely on public transportation?
Assess family education, lifestyle, and beliefs
  • What is the level of education of the family members?
  • What is the primary language spoken in the home?
  • What is the cultural background?
  • Does the patient or their family have any cultural or family preferences surrounding life events, e.g., birth or death?
  • Does the family use traditional practices of healing?
  • Are there any conflicts between cultural practices and recommended practices by health-care professionals?
  • What are the family’s dietary patterns?
  • What, if any, religion does the family practice?
  • Are there any religious beliefs or practices that the care team should be aware of?
Determine teaching needs
  • What is most important to the patient and family?
  • Do the patient and family agree with the treatment plan?
  • Are there any physical or cognitive limitations to learning?
Table 2.2 Family Assessment

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
Table 2.3 Major Healing Traditions

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.).


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