21.4 Overview of Cultural Views and Practices

Communication

Culture influences everything from language and nonverbal communication to communication styles and the values and beliefs that underlie communication. Communication is learned, transmitted, universal, and inclusive of human interaction and behavior. Although two individuals may speak the same language, differences can exist in communication patterns and understandings because of cultural orientation. Culture influences linguistic patterns, how feelings are expressed, and the appropriateness of verbal and nonverbal expressions (Giger & Haddad, 2021).

Verbal communication is associated with languages, including vocabulary and grammatical structure (Halliday, 2006). Language is a form of verbal and written communication and a key component of culture, with different cultures having different languages, dialects, and accents. Language affects what one says and how they say it, so cultural language differences have an impact on how people communicate. For example, some cultures may emphasize formality and politeness in their language use, while others may be more blunt and more direct.

In comparison, body language or motion (kinetic behavior) is an example of nonverbal communication. Nonverbal communication conveys messages without words. Different cultures may use different nonverbal cues to convey meaning or express emotion. In some cultures, direct eye contact may be seen as a sign of respect and engagement. For example, some Haitian Americans use direct eye contact to gain attention and respect during communication. In comparison, others may see this as disrespectful or confrontational. For example, among some Vietnamese Americans and Native Americans, avoidance of eye contact is a sign of respect. Among other cultures, such as Mexican Americans, looking at and admiring a child without touching them can be viewed as giving the child the “evil eye” (Giger & Haddad, 2021). In Buddhist cultures, the head is considered sacred, as it is the highest part of the body, and patting the head is considered rude, while the feet are considered dirty. Table 21.2 lists examples of verbal and nonverbal forms of communication.

Different cultures may also have different communication styles, such as whether communication is more direct or indirect or whether emotions are expressed openly or kept hidden. These communication styles can impact how messages are received and interpreted by others.

Cultural values and beliefs can influence what is considered appropriate or acceptable to talk about. For example, in some cultures, it may be considered impolite to criticize others openly or to express strong emotions. In others, it may be seen as necessary for honest communication (Giger & Haddad, 2021).

Understanding these cultural differences is essential for effective communication across cultures. Cultural practices affect how people interact with each other. For example, some Alaska Natives seldom disagree publicly with others and may nod yes to be polite, even if not in agreement. In some cultures, it is customary to bow or shake hands when greeting someone, while in others, people may kiss each other on the cheek or give a hug. Among Orthodox Jews and Hasidim, touching, particularly from members of a different sex, is offensive (Giger & Haddad, 2021).

Nurses must be aware of a client’s preferences and practices to avoid miscommunication. Nurses should monitor body language and clients closely to detect meaning.

Space

Space is the setting where communication occurs and includes the space surrounding a person’s body and the objects in the space. An individual’s comfort level is related to inner and outer personal space, which can vary from culture to culture.

Human perception of social and personal space is culturally bound. For example, in Western culture, space is viewed as having four dimensions, or zones: the intimate zone (0 to 18 inches), the personal zone (18 inches to 3 feet), the social zone (3 to 6 feet), and the public zone (6 feet or more) (Figure 21.5) (Hall, 1976). Each dimension or zone has a different purpose. For example, the intimate dimension is associated with comforting, protecting, and counseling. The personal dimension is best illustrated as the “friend zone,” in which communication with less intimate but still familiar companions occurs. Touch is an essential feature of both the intimate and personal dimensions. The social dimension is considered the impersonal business zone and is associated with people working together. Sensory involvement, such as touch, is generally less intense in the social dimension (Giger & Haddad, 2021).

Figure 21.5 Western culture has four dimensions of physical distance between people, depending on the situation. Other cultures view personal space differently. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Color can have symbolic cultural implications. For example, in some Asian cultures, white is associated with a funeral, while in some African cultures, red symbolizes death (Giger & Haddad, 2021). The color red may be associated with luck, love, and prosperity in some cultures, while in others it may be seen as a symbol of danger or warning.

Cultural traditions and religious beliefs can also influence color choices. For example, in some African cultures, bright, bold colors are often used in clothing and textiles, reflecting these regions’ vibrant and colorful environments. In Christianity, purple is associated with Lent and is often used in liturgical decorations during this season.

Social Organization

As discussed in Cultural Groups and the Formation of a Cultural Identity, social organization refers to the ways in which groups organize themselves. The social organization of societies influences culture, and the social organization of a cultural group, including family structure and organization, religious values and beliefs, and role assignment, is a part of that group’s culture (Giger & Davidhizar, 2002).

The family is discussed in more detail in Caring for Families. Family structure and organization are culturally bound, which means that culture affects the attitudes, practices, or behaviors of the family.

Family structure and organization and religious values and beliefs inform gender norms and role assignment in group settings. Children are socialized into gender roles. As a social construct, gender roles vary from society to society and can change over time (World Health Organization, 2023, para. 1). Additionally, gender roles are generally associated with a social hierarchy that gives different statuses to different group members. Cultural expectations around gender roles can also impact family organization and function.

Different cultures may have different expectations for family structure, such as the number of generations living together or the role of extended family members. In many cultures, it is common for multiple generations to live together in a single household, while in others, the nuclear family is emphasized.

Often, decisions about health care are made by the family rather than solely by the individual. Family organization can impact how health care decisions are made and who participates in decision-making. Family members can also play a role in communication with health care providers. In cultures where family members are heavily involved in health care decision-making, they may be more likely to accompany the individual to medical appointments and participate in discussions with health care providers.

Time Perception

Cross-cultural research indicates that there are two types of time: clock time, where an external timepiece dictates action and events, and social time, which is governed by the flow of activity or when “the time is right.” The view of social time vs. clock time differs globally (Begic & Mercer, 2017). For example (Giger & Haddad, 2021):

• Khasi people, an ethnic group in the state of Meghalaya in northeastern India, have an 8-day week.
• Some Amish people keep slow time, in which they set clocks a half hour ahead when others convert from daylight saving time to standard time.
• Many people of Asian origin view time as flexible.

Perspectives on time may be oriented to past, present, or future (Begic & Mercer, 2017). Here are a few examples of how different cultures may perceive time (Giger & Haddad, 2021):

• Past orientation: Some cultures place a strong emphasis on the past and may view time as cyclical or circular rather than linear. These cultures may prioritize traditions and rituals passed down through generations and may view the present and future as interconnected with the past.
• Present orientation vs. future orientation: Some cultures may have a more present-oriented perspective, focusing on enjoying the moment and responding to immediate needs. Other cultures have a strong focus on planning for the future and investing time and resources in long-term goals.

Cultures may also be influenced by biological rhythms, such as the cycle of day and night. Some cultures may emphasize waking and sleeping at particular times or may have cultural practices tied to natural cycles, such as farming or hunting.

Environmental Control

Environmental control describes an individual’s control over nature and environmental factors. Views of environmental control affect illness and health-seeking behaviors, which are influenced by one’s sense of locus of control. Locus of control (Rotter, 1966) refers to an individual’s beliefs about the extent of their control over the environment and what happens to them. Locus of control can be external or internal:

• Internal locus of control:
  • Individuals believe that they are responsible for their success/outcomes.
  • Individuals are more likely to take independent action to manage disease symptoms.
• External locus of control:
  • Individuals believe that external forces, like luck or fate, determine outcomes.
  • Individuals are more likely to depend on others to manage disease symptoms.

Whether the cause of illness is believed to be natural or unnatural further influences health behavior. Natural events are considered an inherent aspect of the world, resulting from causes such as environmental sanitation, personal hygiene, poverty, or biological or psychological factors. They are perceived to have some degree of predictability and to be subject to some element of control (Kahissay et al., 2017). In comparison, unnatural events are viewed as the consequence of disharmony in nature. They are not predictable and are beyond human control (Giger & Haddad, 2021). For example, some cultures may attribute illness to supernatural causes, such as curses or evil spirits, and may use spiritual or religious practices to address these causes (Kahissay et al., 2017).

An individual’s belief about whether an illness has natural or unnatural causes affects the types of cures/treatments they may seek. Alternative therapies are practices intended to promote health that are not represented in traditional Western/modern medical treatment or conventional medical practices. They often represent traditional health practices that are customary to various cultural groups. These therapies can be categorized as energy-based, biologically based, manipulative or body-based, and mind-body-based. These alternative therapies are often embedded in the folk medicine belief system. In many cultures and faiths, alternative therapies and religious practices include blessings from spiritual leaders, healing power, and the use of objects in healing ceremonies.

Folk and traditional beliefs are shaped by culture. For example, traditional Chinese medicine includes practices such as acupuncture, tai chi, moxibustion (burning of herbal leaves on or near the body), cupping (using warmed glass jars to create suction on specific points on the body), and use of herbalists (Figure 21.6).

Figure 21.6 Cupping is an ancient, holistic treatment for various diseases traced back to early Egyptian and Chinese medical practice. (credit: “Cupping” by Alanna Ralph/Flickr, CC BY 2.0)

The rootwork system is a traditional African American folk practice that involves using herbs, roots, and other natural materials to address various health and spiritual concerns. This practice has its roots in African spiritual traditions and was brought to the United States during the period of enslavement of Africans. Rootwork is a holistic practice that encompasses physical, mental, and spiritual health (Mathews, 1987).

Traditional practitioners who deliver care include healers, shamans, and priests. For example, among some Latin Americans, “treatment comes primarily through a variety of healers that include the curandero (healer who uses prayer and artifacts), yerbero (herbalist), espiritista (practitioner of espiritismo, a religious [tradition] concerned with communication with spirits and the purification of the soul through moral behavior), and santero (practitioner of Santería, a religious [tradition] concerned with teaching people how to control or placate the supernatural)” (Giger & Haddad, 2021, p. 110).

A shaman serves as a mediator between the supernatural and the individual. In comparison, the medicine man or woman utilizes traditional techniques to cure disease. Priests perform rituals and ministerial functions as part of particular religions.

Dietary Practices and Nutritional Preferences

The relationship between food and culture is complex and multifaceted. Food is not only a source of nourishment; it also has social, symbolic, and cultural meanings. Food-related traditions and rituals are an essential aspect of many cultures. Holidays and festivals often involve traditional foods and special meals, which can be a way of connecting with one’s cultural heritage and history. Food can also mark important life events such as weddings, funerals, and religious ceremonies.

Cultural practices and beliefs influence what foods are acceptable or desirable and how food is prepared and consumed. Certain foods may be considered taboo or forbidden in some cultures, while in others, they are celebrated and eaten in large quantities. Food can also express cultural or community identity and belonging.

A range of factors, including geography, climate, religion, history, and social norms, shape cultural dietary practices. These practices can vary widely across different regions and communities and significantly impact health. They can also affect health behaviors. For instance, cultural norms may dictate specific dietary restrictions or preferences. These factors can influence the prevalence of obesity, diabetes, and cardiovascular disease.

Some cultures believe that certain nonfood items have medicinal or healing properties. For example, some African and Caribbean cultures believe that consuming clay or dirt (known as geophagia) aids digestion, prevents nausea during pregnancy, and improves overall health (Madziva & Chinouya, 2020). In other cultures, consuming nonfood items such as charcoal, chalk, or ice may be seen as a remedy for various ailments (Sruthi, 2023).

Dietary practices can affect dietary needs and create mineral deficiencies. For example, some Native Americans consume inadequate amounts of protein, calcium, and vitamins A and C. This is due to various factors, including limited access to healthy foods, cultural dietary practices, and historical factors such as the forced removal of Indigenous peoples from their traditional lands and the imposition of Western diets. Traditional Native American diets were often based on locally sourced foods rich in protein, fiber, and nutrients.

Cultural dietary practices are complex and multifaceted. The nurse should approach cultural dietary practices with respect and cultural sensitivity and work with clients to understand their unique dietary needs and preferences.