OFFICIAL COURSE DESCRIPTION: TOP
Relationship between cultures
of diverse groups and health/illness. Emphasis on cross-cultural communication,
including awareness of own cultural influences and indigenous and complementary
ABSTRACT OF DIVERSITY INFUSION WITHIN
This course expands on the original content by focusing on the global
aspects of heritage, health, illness and healing. The world is presented
as a community in order for
students to increase their awareness of the internationalization of health care
needs and services. Students are offered an opportunity to see beyond
their limited world views to a whole far greater than themselves. This
global exchange occurs through direct verbal one-on-one encounters, via
exploration of literature, geographic
and demographic research and other didactic and experiential assignments.
Spector, R. (2000). Cultural
diversity in health and illness. Upper Saddle River, NJ: Prentice-Hall.
Purnell, L. & Paulanka, B. (1998). Transcultural health care: A
culturally competent approach. F.A. Davis: Philadelphia.
OF DIVERSITY-RELATED MATERIAL:TOP
Weekly lecture topics covered diversity content related to culture,
health or related topic. Lectures were in more of an informed discourse
style with students participating equally and bringing in required
items that added to the topic of the day; i.e., magico-religious
or sharing a health practice they had grown up using. Powerpoint
was not utilized in this class. Written materials included: the
required textbooks, handouts and readings from the classic text: “Culture,
Curers and Contagion.” Visible aspects of multi-culturalism
were introduced in the student’s group presentations through
the artifacts they shared, music they played from other countries
during the presentations, a film shown depicting the Bosnian-Serbian
conflict from the people’s perspective, a film on shamanistic
healing , book reports depicting both ethnic and non-ethnic subgroup’s
experiences. Guest speakers were a sociologist who was an expert
on Gypsy culture and a Japanese-American nurse whose mother was
a nurse following the Hiroshima bombing. Several attempts were made
to find a curandera(o) to speak to the class, but
this did not materialize.
Description of Student
Assignments/Activities Related to Diversity:
for the following assignments and activities are available in the
attached syllabus for the course. In class discussions were weekly,
on the topic being studied as well as personal value systems and
biases. Students collaborated and worked in groups for the majority
of the course requirements; i.e., presentations. There were no
individual class presentations—only the individual contributions
toward the final group projects.
All students interviewed
one representative member of a major ethnic group and a sub-culture.
The ethnic group assessment was was written and submitted. Self-awareness
questionnaires included in-class values clarification assignments,
case studies, and a heritage assessment questionnaire. Students attended
two diversity-related events with the instructor: teacher from China
presenting on the status of women in present day China, noted speaker,
lawyer and civil rights activist who discussed the future of race
relations in the U.S. and Native American film writer and Executive Director
Honor Forums lecture. The capstone event in the course is the multi-cultural
feast where students bring dishes to serve that are representative
of their own ethnic backgrounds or of the group they have studied
presentation. The students are required to interview an adult female
member of their family for a heritage review and to obtain a cultural
assessmentof a member of a major ethnic group, other than the one
they are a member of.
This course explores the relationship between various components of culture
and the dynamics of health and illness, and focuses on concepts of health and
illness in non-U.S. countries (e.g. Mexico, China, Latin American countries)
as well as cultures within the U.S. (immigrants, Native Americans, African
Americans, etc.). The contributions of traditional systems of medicine (e.g.
Mexico, China) to the Western health care delivery system are examined along
with the reasons why Western health care providers often do not meet minority
culture consumers? health care expectations. Students analyze their own feelings,
beliefs and values in relation to their own culture and will utilize a generic
framework to deliver culture-specific care to diverse groups. Ways to overcome
intercultural communication barriers are also explored. This course has been
approved by the ASU General Studies Council, and fulfills the global awareness
At the completion of this course the student will be able to:
1. Evaluate the importance of the role culture plays in determining how different
people perceive and shape their world.
2. Identify cultural influences on one’s own beliefs and values.
3. Describe the impact of US and non-U.S. cultural definitions of health, illness
and disease causation on an individual’s health maintenance practices and
response to healers.
4. Compare and contrast healing and treatment methods of various cultures with
those of the Western health care delivery system and assess their influence upon
5. Identify cultural strengths and barriers that influence utilization of health
6. Explore variations in family structure and dynamics across U.S. and non-U.S.
7. Explore cultural components of the aging process, and dying and death across
8. Apply models for assessing client cultural orientations, health care expectations,
psychosocial structures, language, and communication patterns to individuals
from different ethnic groups.
9. Identify strategies for delivery of culture-specific care based on the evaluation
of cultural assessment data.
METHODS OF INSTRUCTION & EVALUATION:
Various strategies will be employed, including:
Small group discussion/exercises
Community interaction / interviews
Student oral presentations (group)
Poster presentation (group)
OUTLINE OF CLASS SCHEDULE SHOWING DIVERSITY RELATED
I. The role culture plays in determining how different people
across the globe perceive and shape their world.
• Influence of value orientations
• Identification of differences and similarities across-cultures
II. The role of cultural relativism in health care
• Exploration of concepts of health and illness among cultures within
of the United States
• International migration, acculturation, and assimilation
• Making cross cultural judgements in a culturally diverse environment
• Ethnocentrism and cultural imposition
• Moving from tolerance/intolerance, and acceptance/rejection to dialogue,
understanding, and change
III. Cultural definitions
of health, illness and disease causation, including how they affect
an individual’s health maintenance
practices and response to healers.
• Relationship between culture and definitions of health and illness
• Influence of immigration on physical and mental health problems in
IV. Healing and treatment methods of various cultures; how do they
compare with those of the Western health care delivery system; how
do they influence the US health care system.
V. The role of cultural strengths and barriers in utilization of
health care services
Cultural attitudes toward time and their affect on the individual’s
health maintenance practice and interaction with the dominant health
• Ways health care professionals? own prejudices, stereotypes, cultural
assumptions and communication patterns can interfere with effective
health care delivery in a culturally pluralistic society
• Exploring the health care providers culture and the effect it has on
relationships with multi cultural clients
• Communication: interaction styles, utilization of interpreters, recognizing
who is involved in communication and decision making
• Influence of language and communication
VI. Variations in family structure and dynamics across cultures.
Assessing how one’s own assumptions about family structure and
family dynamics have been culturally-conditioned
• Factors which determine the value of children to a society
VII. Cultural components of the aging process, dying, and death across
• Cultural components in the aging process
• Cultural attitudes toward death and how they affect the health care
of the terminally ill
VIII. Models for assessing client cultural orientations, health care
expectations, psychosocial structures, language, and communication
patterns to individuals from different ethnic groups
IX. Assessing the extent
to which one’s own beliefs and values
have been culturally determined.
Assessing the extent to which one’s own concepts of health and
illness have been culturally determined
• Definition of self and non-self (control/non-control) and how these
definitions compare across cultures
X. Strategies for delivery of culture-specific care based on the
evaluation of cultural assessment data.
• Developing interpersonal skills in cross-cultural encounters
XI. Showing respect for diverse values and preferences of other individuals
XII. Participating in interactive
learning strategies to become sensitive to, and respectful of the
mores and preferences of one’s own
culture and those of others, the richness of cultural variations, and
the influence of cultural variables on personal and professional interactions.
|| Topics and Objectives
Upon completion of the assigned learning activities the student will have had
the opportunity to:
Readings & Assignments
|| Introduction to course,
syllabus, assignments and Heritage
Assessments; Get Acquainted Exercises
pp. 78-84; App.
of health and illness; introduction to health assessment tool;
health diary analysis guideline sheet
1. Describe fundamental differences between health care provider’s and
consumer’s belief systems.
2. Discuss the relationship among an individual’s definition of health,
health beliefs and cultural influences and identify how these factors may affect
an individual’s perception of health.
3. Explain and examine health belief model, health traditions, and cultural
phenomena affecting health from the health care provider perspective and consumer
4. Explore various definitions of health and conclude with personal definition
5. Explore various definitions of illness and conclude with personal definition
6. Compare and contrast preventive care and health maintenance.
7. List the two broad goals of Healthy People 2010.
8. Explain the role of public health statistics in determining the health status
of the nation.
|Text: Spector, Chapter
1 Preface: PP. 1-2
Heritage Tool Assignment: 1.Bring
an artifact Jan. 31
Assessment Due Jan 31
||Culture defined and
described (Culture as more than ethnicity)
1. Complete the Heritage Assessment Tool (Spector, pp. 295-297) Considering the
completed Heritage Assessment Tool, decide how closely you identify with your
3. Define natural folk medicine and magicoreligious folk
4. Interview a familial female older adult and collect information regarding
health maintenance, protection, and restoration.
5. Compare and contrast familial health practices with personal health maintenance,
protection, and restoration.
6. Reanalyze the concepts of health and illness considering familial health practices.
7. Identify and explain similarities and differences in health practices across
cultures. Text: Spector, Chapter 2
1. Turn in the Heritage Assessment Tool on yourself
and adult female relative. Collect information regarding health maintenance,
protection, and restoration. Be prepared to discuss in class.
Culture: Its effect on the perception of health and illness
1. List the four basic characteristics of culture.
2. Define and describe culture in terms of personal experience and expectation.
3. Analyze theories relating to the Americanization of health and illness beliefs.
4. Define and discuss socialization, acculturation, assimilation, and heritage
5. List and explain the three major components of heritage consistency.
6. Define and explain the health-care provider’s culture.
7. Define epidemiology.
8. Explain epidemiology’s relationship to illness and disease.
9. Explain the role culture has on an individual's response to pain.
|Text: Spector, Chapter
Feb. 7 Introduction to the Purnell Model
1. Define, and identify the components of cultural competence
2. Describe the progression from unconscious incompetence to unconscious competence
in relation to culture.
3. Define: worldview, subculture, acculturate, assimilate, transcultural
4. Identify the macroaspects and microaspects of the Purnell Model for Cultural
5. Describe the twelve domains of the Purnell model.
Purnell Model (Cont.)
1. Identify cultural subcultures that are not based on ethnicity.
2. Form groups to study selected subcultures.
3. Using the Purnell model, develop questions for interviews with cultural
1. Discuss the process of working with an interpreter.
Compare translator and interpreter.
2. Describe effective techniques for communicating with patients who do not
3. Describe effective techniques for communicating with patients who speak
English as a second language.
4. Describe common errors in communicating with patients who have limited or
no English speaking ability.
5. Describe the purpose and process of "back translation."
Purnell & Paulanka, Chapter 2
||1. Define values
and describe how values influence our health behaviors.
2. Define norms.
3. Define ethnicity.
4. List six functions of values.
5. Analyze how values serve to influence health care providers.
6. Analyze how values serve to influence health care consumers.
7. Compare and contrast the values of health care consumers with the values of
health care providers.
8. Define subculture and minority group.
9. Compare and contrast subculture and minority group.
10. Explain major value orientations in the United States.
11. Debate the statement: The United States is a “melting pot” culture.
12. Define worldview.
13. Identify and explain your personal worldview.
14. Explain how worldviews relate directly to culture and health.
15. Describe the process of moving from tolerance/intolerance, and acceptance/rejection
to dialogue, understanding, and change Assignment: Values exercises will be conducted
in class (2% of course grade)
Barriers to health care delivery
1. Describe historical trends of the health care system in the United States
2. Describe common problems in the US health care delivery system that may be
barriers to care
3. Discuss influence of demographics on health care
4. Describe the role of medicine as an institution of social control
5 Describe barriers to health care
6. Identify barriers to healthcare related to the health care providers, including
the status of the providers
7. Identify strengths and barriers for selected cultural groups in relation to
8. Considering class readings and class discussions determine if health care
is a right or privilege.
|Text: Spector Chapters
3 & 7
||Feb. 21 Presentations
on non-ethnic culture
Exam #1 Exams are taken in HTC-1 Rm. 142 Computer Room
1. Define healing.
2. Identify and describe modern healing practices.
3. Identify and describe traditional healing practices derived from one’s
4. Compare and contrast modern healing practices and traditional healing practices.
5. Discuss and describe common health beliefs and practices prior to World
6. Define and give an example of homeopathic medicine.
7. Define and give an example of osteopathic medicine.
8. Define and give an example of chiropractic healing.
9. Define and give an example of eclectic medicine, hydrotherapy, mesmerism,
hypnotism, mind cure, and Christian Science.
10. Determine the role of natural remedies and alternative health care in today’s
health care arena.
11. Explain how natural healing is associated with nursing.
Video and/or Guest
| Text: Spector, Chapter
1. Distinguish between spiritual and religion
2. Describe rituals which were used by ancient human beings
3. Describe the extension of ancient rituals to today's health practices
4. Describe objects and substances that are used to protect health
5. Describe religious practices that are used to protect health
6. Describe the following forms of healing: herbalists, bone setters, midwives,
leeching, witchcraft, religious beliefs, prayers, incantations
7. Identify healing practices that persist today.
8. Compare and contrast the following types of healing: spiritual healing,
inner healing, physical healing, deliverance or exorcism, auric healing, pilgrimages. Video
Text: Spector, Chapter
1. Bring a magico-religious
item to class (1% of course grade)
1. Define cultural relativism and cultural imposition
2. Distinguish between cultural relativism and ethnocentrism
3. Describe examples of situations in which cultural relativism may become an
issue for health care providers.
Discuss ethnic group
projects; select groups
April 4 Groupwork on Ethnic Presentations
1. Explain why socio-economic status may influence the culture of African (Black)
2. Describe the role of historic problems on the African (Black) community.
3. Define African (Black) American's traditional definitions of health and
illness, including how they view death.
4. Define and describe traditional methods of healing among African (Black)
Americans--voodoo, healers, eating of starch or clay, religious beliefs and
other methods of healing.
5. Define and give examples of current health practices employed by Black Americans
to prevent illness by maintaining and protecting health.
6. Define and give examples of current health practices by Black Americans
that focus on treating illness and restoring health.
7. List the leading causes of death of African (Black) Americans.
8. Compare current health-care problems of African (Black) Americans with White
Americans, conclude why there are differences.
9. Describe African (Black) American health statistics.
10. List and describe physiological problems, skin problems, and hair-care
needs that need to be considered when assessing an African (Black) American.
11. Choose appropriate guidelines that can be followed in caring for African
12. Explain why an appreciation of African (Black) American culture perception
and meaning of health and illness are needed by the nurse.
13. Explain why there is a low number of African (Black) Americans enrolled
in health programs or practicing in the health care field. Text: Spector, Chapter
10; Purnell & Paulanka Chapter 3
American Indian, Aleut
1. Describe traditional American Indian definitions of health and illness
2. Describe traditional American Indian beliefs about health, wellness and
3. Describe various healing techniques used by traditional American Indian
4. Discuss issues related to morbidity and mortality in the American Indian
5. Describe the role of Indian Health Service.
6. Describe American Indian health statistics.
7. Describe cultural and communication issues that may be problematic in health
8. Discuss issues related to the number of American Indian health care providers.
|Texts: Spector, Chapter
8; Purnell & Paulanka Chapter 17
1. Describe the historical aspects of the Chinese-American experience.
2. Describe the concepts of Taoism, the five elements, the holistic concept,
and yin and yang, and explain how they relate to the Chinese philosophy of
health and illness.
3. Compare the Asian religious teachings of Buddhism, Confucianism, Taoism
and Shamanism, and describe how these cultural values may affect the health
4. Describe traditional methods of prevention and health maintenance.
5. Describe traditional methods of healing and health restoration, including
traditional healers, pediatrics, acupuncture, Moxibustion, and herbal remedies.
6. Identify the major health problems of the Asian/Pacific Islander American
population in the United States.
7. Describe Asian/Pacific Islander American health statistics.
8. Discuss issues related to the number of Asian/Pacific Islander American
health care providers.
9. Explain why environmental conditions may affect the health of a person migrating
or immigrating to the United States from Asian countries.
1. Describe the demographics of the European American population in the United
2. Describe the history of migration for Italian Americans
3. Identify traditional beliefs of Italian Americans related to health and
4. Identify the two genetic diseases commonly seen in Italian Americans.
5. Describe the potential effects of communication and time in the health care
6. Compare and contrast the health and illness beliefs of the German and Polish
7. Explain why environmental conditions may affect the health of a person migrating
or immigrating to the United States from European countries.
|Texts: Spector Chapter
9; Purnell & Paulanka Chapters 7, 18
1. Define the term Hispanic Americans.
2. Define Chicanos.
3. Define Chicanos traditional definitions of health and illness.
4. Identify and explain the five major categories of the causes of illness among
5. Describe the role religious rituals and folk healers play in the health of
6. Compare and contrast a curandero and physician.
7. Distinguish differences and similarities between factors explaining the continuing
belief in curanderismos and your personal health beliefs.
8. Compare and contrast Chicano and Puerto Ricans perceptions of health and illness
and use of folk healers and remedies.
9. Explain why environmental conditions may affect the health of a person migrating
or immigrating to the United States from Puerto Rico, Cuba or Mexico.
10. Compare and contrast similarities and differences between a Puerto Rican's
general progression of seeking health care and your personal progression of seeking
11. Identify barriers experienced by Hispanics seeking health care and develop
solutions to minimize these barriers.
12. Describe Hispanic American health statistics.
13. Explain why there is a low number of Americans of Hispanic origin enrolled
in health programs or practicing in the health care field.
14. Explain why an appreciation of Americans of Hispanic origin perception and
meaning of health and illness is needed by the nurse.
15. Discuss the pros and cons of the use of a midwife.
16. Explain the paradoxical view the medical and public health professions take
of the practicing lay midwife.
|Texts: Spector Chapter
Purnell & Paulanka: Chapter 16
|| Role of culture with
health care providers
1. Identify strategies for delivery of culture-specific care.
Course wrap-up and evaluations
||May 9 FINAL EXAM HTC1
SUCCESSES AND DIFFICULTIES
Instruction: The major difficulty encountered was that I did not have
the time over the past two semester to really infuse the course with
all of the new ideas I had in mind. For example, one thing I wanted to
get going, at least during spring semester, was to have a type of chat
room identified so the students could discuss with other pre-nursing
students around the world what their experiences were as students and
in their respective cultures. In addition, I wanted to have a large number
of web sites available for students to use to research international aspects
of health and illness.
My suggestions to future
applicants is to make your manageable, realistic, and be very clear
and specific about your objectives.