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During the early years of communism and food shortages in Russia, the main concern was eating enough calories to stay alive. Meals were heavy, fatty, and salty, though otherwise bland. The ideal meal for a working peasant included boiled buckwheat with lard and a fermented drink made from dense, sour, black bread—food that would “hold you to the earth” and last a full working day. Conventional wisdom dictated that the richer and more fatty the food, the harder one would work. Traditional meals eaten by some Russian Americans today include pickled and dried meats, fish, bread, potatoes, dumplings, porridge, cabbage and beet soup, and vegetables.

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Because of the importance of family in American Indian culture, immediate and extended family members should be informed of an impending death. A family-centered approach is recommended for conveying serious medical information and explaining issues such as autopsy and organ donation. Organ donation may be viewed as a desecration of the body. The entire family may be included when making decisions and signing documents. Due to the misuse of signed documents throughout the history of the American Indian, some Indian patients may be unwilling to sign informed consents, advance directives, and durable power of attorney forms. Patients may perceive verbal agreement as sufficient.

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The following guides emphasize information that can be used to stimulate thinking about cultural differences and prompt questions that will help providers understand how their patients identify with and express their cultural backgrounds. These are not fact lists to apply indiscriminately. An apt analogy to keep in mind is that learning about a specific model of car is helped by referencing the operator 8767 s manual, but reading and even memorizing that manual doesn 8767 t replace learning how to drive a car.

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Taken together, 66% of all American adults have done one or both of these activities and are classified as “online daters.” In terms of demographics, online dating is most common among Americans in their mid-75’s through mid-95’s. Some 77% of 75-89 year olds and 67% of 85-99 year olds are online daters. Online dating is also relatively popular among the college-educated, as well as among urban and suburban residents. And 88% of Americans who are single and actively looking for a partner have used online dating at one point or another.

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Vietnamese Americans are at risk of poor health due to language barriers, lack of financial resources, inexperience with American culture, and under utilization of health care services. Many Vietnamese had severe health problems on arrival in the US from poor living conditions, starvation, and abuse during the Vietnam War and in refugee camps. Medical problems seen in this population include TB, hepatitis B, malaria, malnutrition, trichinosis, anemia, leprosy, and intestinal parasites. The most common cancers seen are prostate, breast, lung, and colorectal. Because of exposure to Agent Orange during the war, older Vietnamese immigrants are potentially at risk for cancers, immune deficiency, endocrine disruption, and neurological damage.

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A typical Vietnamese diet is generally healthy, with rice or noodles, fresh vegetables, and fish or meat. However, the diet also can be high in sodium from fish sauce and MSG, and low in fiber from lack of whole grains. Dairy and soy products are not part of a typical Vietnamese diet, although most children drink milk. Many adults are lactose intolerant and lack calcium. Women generally believe that formula is more nutritious than nursing for their infants.

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Many older African Americans believe that death is at God’s will, but tend to believe that life support should be continued as long as necessary. A family-centered approach is recommended for conveying serious medical information, seeking consents, and explaining issues such as autopsy and organ donation. Cremation is generally avoided in this community and organ donation may be viewed by some as a desecration of the body. Because of the importance of family in the African American culture, the family should be informed of an impending death so that extended family members who live out of state can be notified.

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Culture is essential in assessing a person’s health and well-being. Understanding a patient’s practice of cultural norms can allow providers to quickly build rapport and ensure effective patient-provider communication. Efforts to reduce health disparities must be holistic, addressing the physical, emotional, and spiritual health of individuals and families. Also important is making connections with community members and recognizing conditions in the community. Get to know your patients on an individual level. Not all patients from diverse populations conform to commonly known culture-specific behaviors, beliefs, and actions. Generalizations in this material may not apply to your patients.

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The majority of Somalis are Sunni Muslims. For Somalis, Islamic religious teachings provide meaning for living, dying, health, child rearing, and family life. In Islam, prayer is performed five times a day: at dawn, noon, mid-afternoon, sunset, and in the evening. Prayer can take place at home, at school, in the workplace, outdoors, or in a mosque. Hands, face, and feet are washed before prayer. Islam forbids eating pork, drinking alcohol, and touching or being near dogs. Ramadan is observed as the most important Islamic holiday, a month long holiday during which people refrain from taking medications, and eating and drinking during daylight hours, with the exception of pregnant women, the very ill, and children.

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According to the University of California School of Nursing, in Culture and Clinical Care, many aspects of African American culture today reflect the culture of the general US population. The structure in African American families is often nuclear and extended with non-related “family” members. The family may be matriarchal, although father or mother may take on the decision-making role. For African Americans, women more than men tend to remain unmarried, and more women have been educated at the college level.

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Khmer are generally respectful, polite, and speak softly, communicating carefully and indirectly. Sompeah is a gesture of greeting with both palms brought together with fingers pointed upward. The higher the sompeah, the higher the status of the person being greeted. Khmer often raise large families if financially able to do so, with extended family members living together or nearby. The spokesperson for the family may be the father, or the eldest son or eldest daughter. Men are generally recognized as head of the family with women expected to be care givers—although roles are changing as Khmer become acclimated to American society and values. Women now often work outside the home. Elders are important in decision making and often take care of their grandchildren. Men and women protect and care for the disabled in the community.

End of life in the Ethiopian community is marked by religious traditions, rituals, prayers, and gatherings. A religious person may be called to administer a sacrament to the patient. After a person dies, Ethiopian men may cry out loud and grow a beard as a sign of respect. Some women may wear black for at least a year and shave their heads or cut their hair very short. Women often cry uncontrollably, tear their clothes, and beat their chests.

Major medical conditions in Somalia and among recent immigrants to the US are malnutrition, iron deficiency anemia, Vitamin A deficiency, and scurvy. Common infectious diseases are diarrheal disease, measles, malaria, and acute respiratory illness. At least 97 percent of recent arrivals to the US are affected by intestinal parasites. In 6997, Somalia’s HIV infection rate was percent—well below that of other African nations. Depression and anxiety are common to Somali refugees, who may have lost family members or were separated from them. An estimated 85 percent of Somali refugees have been victims of torture they have experienced horrific events and may be suffering posttraumatic stress. There is no word for stress in the Somali language.

The diet in Latin American countries is healthy with high amounts of fruits, vegetables, corn tortillas, whole grains, and eggs. The diet of assimilated Hispanics/Latinos in the US tends to be low in fruits and vegetables and high in flour tortillas, white rice, and processed foods and Hispanics/Latinos in the US usually do not get as much exercise as they did in their native countries. Traditionally, meals are often eaten with the nuclear and extended family, with a large meal at noon and a lighter meal in the evening. Many acculturated Hispanics/Latinos are beginning to replace traditional meals with fast food meals, contributing to an increase in obesity, diabetes, and hypertension in this population. Over consumption of alcohol is also a health consideration. Preferred drinks include coffee with breakfast and aguas frescas (fresh fruit coolers), made with tamarind, cataloupe, or watermelon. Some traditional Hispanics/Latinos believe in treating a cold with hot foods and in preserving health by balancing hot and cold foods.

Culture is essential in assessing a person’s health and well-being. Understanding a patient’s practice of cultural norms can allow providers to quickly build rapport and ensure effective patient-provider communication. Efforts to reduce health disparities must be holistic, addressing the physical, emotional, and spiritual health of individuals and families. Also important is making connections with community members and recognizing conditions in the community. Get to know your patients on an individual level. Not all patients from diverse populations conform to commonly known culture-specific behaviors, beliefs, and actions. Generalizations in this material may not apply to your patients.

Health care providers should be aware of dermabrasive procedures used by Vietnamese patients that leave marks on the skin—and not misinterpret the marks as a sign of physical abuse. Dermabrasive procedures based on the Chinese philosophy of hot/cold physiology are often used to treat headache, cough, nausea, and other maladies. Cutaneous hematomas are made on the face and trunk by pinching and pulling the skin to release excessive air, by rubbing oiled skin with a coin or spoon, or by cupping—heating air in a cup with a flame, then placing the cup on the skin. As the air cools, it contracts and pulls on the skin, leaving a purple mark. Moxibustion, often combined with acupuncture, is the process of making circular superficial burns on the skin with ignited incense or other material placed directly on the skin.

Religious beliefs influence perceptions of death and dying. Roman Catholics may request a visit by a priest or the hospital chaplain to anoint the sick. Rosary beads and religious medallions are often kept near the patient. If the patient dies before the priest arrives, a sacrament still takes place before the body is removed. The elderly especially may wish to die at home. Some Mexicans believe that the spirit may become lost in the hospital. The family requires a supportive atmosphere and may need time and a private place to deal with the loss.

Vietnamese patients may smile easily and often, regardless of underlying emotions in situations other cultures find inappropriate. Because Vietnamese people value politeness and respect for authority, patients may not ask providers questions or voice concerns. If they disagree or do not understand, they may simply listen and answer yes, then not comply with recommendations or return for further care. They may not take appointment times literally, arriving late so as not to appear overly enthusiastic.

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