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**********APA *********Read content chapter 25, 37 and 38 in Davis Plus Online Website and review the attached PowerPoint presentation. Once done present a 900-word essay without counting the first and last page discussing the cultural health care beliefs of the study heritages and how they influence the delivery of evidence-based health care.You must cite at least 2 evidence-based references without counting the class textbook.
cultural_nursing_ch37__1_.pptx

cultural_nursing_ch38.ppt

cultural_nursing_ch25.ppt

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Turkish Culture
Larry Purnell, PhD, RN, FAAN
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview/Heritage
▪ Türkiye, as it is written in Turkish, means “land
of Turks.” Referred to as a geographic, religious,
and cultural crossroads, the Republic of Türkiye
is situated at the geographic intersection of
Europe, Asia, the Middle East, and Africa.
▪ While Turks have emigrated throughout the
world, many live in Western Europe, largely as a
result of “guest worker” programs.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview/Heritage
▪ Today, the Republic of Türkiye is politically stable
and continues to adapt economically to reforms.
▪ Türkiye remains strategically important to the West
and is a strong ally of the United States.
▪ The Turkish immigrant population in the US differs
significantly from most of the Turkish population in
Europe, both in terms of demographic makeup
and socioeconomic status and integration.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview/Heritage
▪ Over 202,000 people of Turkish descent live in
the United States.
▪ They live in 42 states, with over half living in New
York, California, New Jersey, and Florida.
▪ Just over half of the individuals in this group were
born outside the United States.
▪ Most arrived in the US before 1980.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview/Heritage
▪ A high proportion of Turks in the United States
come from the elite and upper-middle classes,
interspersed with smaller groups of middle-class
students and skilled laborers who are supported
privately or by the government.
▪ Many Turks sought advanced American
education in highly technical fields, leading to
more abundant employment opportunities in the
United States upon completion of their studies.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ A Uralic-Altaic language, Turkish is spoken by 90% of
the population and has approximately 20 dialects.
▪ Differences in some of the dialects are so great that
they are considered different languages.
▪ The Turkish alphabet is much like the English
alphabet, although it does not have a “w” or an “x”
and additional sounds are symbolized by an diacritical
mark over vowels.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ The Turkish language does not distinguish
gender pronouns (ie, “he” from “she” or
“her” from “his.”) Therefore, Turks when
learning English may inadvertently confuse
these pronouns.
▪ Turkish distinguishes a formal from an
informal “you,” signifying the importance of
status in Turkish society.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ Speaking in loud voices is common; this does not
always signify anger but rather excitement or deep
involvement in a discussion.
▪ More than one person may speak at the same time
or interrupt another person; this is not necessarily
considered rude.
▪ However, someone of lower status should not
interrupt someone of higher status.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ Group affiliation is valued over individualism
in Turkish society. In fact, identity may be
determined by family membership or group,
school, and work associations.
▪ Turks generally do not desire much privacy
and tend to rely on cooperation between
family and friends, although competition
between groups can be fierce.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ Turks value harmony over confrontation.
▪ The outward show of feelings is less restrained.
▪ For women, expressions of anger are usually
acceptable only within same-sex friendships and
kinship networks or toward those of lower social
status.
▪ Generally, women are not free to vent their anger
toward their husbands or other powerful men.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ Touching, holding hands, and patting one
another on the back are acceptable
behaviors between same-sex friends and
opposite-sex partners.
▪ Same-sex friends, especially among the older
generations, are commonly seen holding
hands or linking arms while walking.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ Very strict Muslims may not shake hands or
touch members of the opposite sex, especially
if they are not related.
▪ When interacting with someone of higher
status, one is expected to maintain occasional
eye contact to show attention; however,
prolonged eye contact may be considered
rude, or may be interpreted as flirting.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ Turkish people tend to dress formally; men
wear suits rather than sports jackets and
slacks on social occasions.
▪ Women tend to dress modestly, wearing
skirts and dresses rather than slacks. More
traditional Muslim women may wear very
modest clothing and cover their heads with a
scarf, either black or a colorful print.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ However, styles continue to change, and denim jeans
and casual dress are becoming common among
young people for less formal occasions.
▪ Turks openly display emotions such as happiness,
disgust, approval, disapproval, and sadness through
facial expressions and gestures.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ No” is indicated by raising the eyebrows or
lifting the chin slightly, while making a
snapping or “tsk” sound with the mouth.
▪ Appreciation may be expressed by holding
the tips of the fingers and thumb together
and kissing them and is commonly used to
express appreciation for food.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ Turkish people take pride in keeping their homes immaculately
clean, and one is expected to remove one’s shoes inside the
home.
▪ Most Turkish hosts in Türkiye and many in the United States
offer slippers to their guests.
▪ Whether wearing shoes or not, showing the sole of one’s foot
is considered to be offensive in Turkish culture.
▪ Women are expected to sit modestly with knees together and
not crossed.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ Turks tend to have a relaxed attitude about
time; social visits can begin late and continue
well into the night.
▪ While punctuality in social engagements is
not highly important, in business
relationships, punctuality among Turkish
Americans is gaining in importance.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ Turks value status and hierarchy.
Demonstrating respect for those of higher
status is mandatory and determines the
quality of interactions with a person.
▪ Strangers are always greeted with their title,
such as Bey (Mr.), Hanim (Mrs., Miss, or Ms.),
Doktor, or Profesör.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ When friends or family members greet, it is
customary for each to shake hands and to
kiss one another on each cheek.
▪ Traditionally, when greeting someone of very
high status or an elderly person, one might
grasp his or her hand and kiss it, and then
bring it to touch one’s forehead in a gesture
of respect.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles & Organization
▪ In a very traditional Turkish home, the
father is considered the absolute ruler.
▪ The concept of izin (permission or leave to
do something specific) captures this
significance.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles & Organization
▪ Less traditional families show more equality
between spouses, especially in nuclear families in
which the wife is well educated.
▪ Yet, remnants of traditional family structure
prevail; the husband often acts as the ultimate
decision maker, especially in financial matters.
▪ Women may work full time outside the home in
addition to assuming full responsibility for running
the daily activities inside the home.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles & Organization
▪ Legal marriage in Türkiye does not permit
polygamy, although some may practice it outside.
▪ A woman’s age, and the number, age, and
gender of her children influence her status in the
family and the community. A young “gelin”
(woman age 15 to 30) has the lowest status. The
“middle-aged” woman (30 to 45) has medium
status while the “mature” woman (45 to 65) has
the highest status.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles & Organization
▪ In “old age” (65 or older), a woman is
highly respected but is not powerful.
▪ However, this status varies according to
education, religious practice,
socioeconomic level, urbanization, and
professional achievement.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles & Organization
▪ Children are held very dear in the Turkish
family and they are expected to act as
young children, not small adults.
▪ They are accustomed to receiving attention
from family, friends, and visitors.
▪ Kissing children and pinching their cheeks
is quite common.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles & Organization
▪ Once children enter school, they are
expected to study hard, show respect, and
obey their elders, including older siblings.
▪ Girls are expected to help care for younger
siblings, to help at mealtimes, and to learn
to cook.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles & Organization
▪ Traditionally, children are not allowed to act
out or talk back to their superiors.
▪ Light corporal punishment is generally
acceptable.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles & Organization
▪ Male circumcision is a major rite of passage.
▪ This is a time of celebration within the extended
family, and newly circumcised boys are honored
with gifts.
▪ Traditionally, boys can be circumcised up to the
age of about 12, although the modern trend is to
perform the circumcision in the hospital shortly
after birth.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles & Organization
▪ Urban adolescents are beginning to date in pairs
in addition to the more traditionally accepted
practice of group outings.
▪ However, sexual interaction is strongly
discouraged among youth and the unmarried,
especially for young women.
▪ Virginity in unmarried women is a strong cultural
value.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles & Organization
▪ A key objective among Turks is socioeconomic
advancement, including education, better
professional opportunities, and material success.
▪ Although financial independence is valued in
Turkish culture, independence from the family is
not encouraged.
▪ Adult children, especially men, remain an integral
part of their parents’ lives, and parents expect
their children to care for them in their old age.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles & Organization
▪ Because respect is highly valued in Turkish
society, maintaining or improving status in
the community is of key importance.
▪ Individuals must always consider what
impact their actions will have on the family
and often they consult parents or other
family members before making major
decisions.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles & Organization
▪ Young people living in Türkiye generally live in
their parents’ home until they are married, unless
school or work necessitates other arrangements.
▪ Family-initiated marriages range from rare
contractual agreements between parents to the
relatively common introduction and gentle
encouragement of a newly formed couple.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles & Organization
▪ Elders in Turkish culture are attributed authority
and respect until they become weak or retired, at
which time their authoritative roles diminish.
▪ Individuals are socialized to take care of elderly
parents, regarding it as normal and not as an
added burden.
▪ Grandparents play a significant role in raising
their grandchildren, especially if they live in the
same home.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles & Organization
▪ The extended family is very important in Turkish
culture.
▪ Even the apparent increase in nuclear
households does not rule out the networks
among closely related families.
▪ Whether or not they live under the same roof, a
young family may still live under the supervision
of the husband’s parents or at least maintain an
interdependent relationship.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles & Organization
▪ Divorce is becoming more common in Turkish
society, but remains socially undesirable.
▪ Widows, however, are generally taken care of by
their late husband’s family and, depending on
their age and socioeconomic background, may
have the option to remarry.
▪ Premarital cohabitation and unwed motherhood
is strongly discouraged.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles & Organization
▪ Homosexuality is only beginning to be received
“at a distance.” In fact, one of the most popular
entertainers in Türkiye is a homosexual and a
transvestite and is accepted as such.
▪ However, most Turks would be hesitant to
associate themselves with the gay community.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Workforce Issues
▪ Because Türkiye is a group-oriented culture, the
Turkish workplace may be more team oriented.
▪ Turkish relationship orientation may lead to
dependence on personal contacts and networks to
accomplish tasks.
▪ Developing these relationships and networks may
appear as nepotism or as too much socializing from
the American perspective.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Workforce Issues
▪ Hierarchical structure is highly pervasive
throughout Turkish culture, and the
workplace is no exception.
▪ Turkish employees expect an authoritative
relationship between superior and
subordinates.
▪ However, indirect criticism is expected and
appreciated to “save face.”
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Workforce Issues
▪ A Turk may be highly offended if openly
criticized, especially if done in front of other
people.
▪ They may be reticent about asking questions
for fear of exposing a lack of knowledge.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Workforce Issues
▪ Turks perceive that aggressive face-to-face
confrontation may cause relationships to
deteriorate.
▪ The dominant means of conflict resolution is
collaboration reinforced by compromise and
forcing.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Workforce Issues
Many women do not work because it
interferes with child care, the order of the
home, and it requires them to be together
with men from outside the immediate family.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Biocultural Ecology
▪ Turkish population is a mosaic in terms of
appearance, complexion, and coloration.
▪ Appearances range from light-skinned with blue
or green eyes to olive or darker skin tones with
brown eyes.
▪ Mongolian spots, usually found at or near the
sacrum, are common among Turkish babies and
should not be confused with bruising.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Biocultural Ecology
▪ Malaria has not been fully eradicated in Türkiye,
especially in the southeast.
▪ Endemic goiter associated with iodine deficiency
is a major health problem in Türkiye.
▪ Behçet’s disease, a syndrome of unknown
etiology, is prevalent in Mediterranean countries,
the Middle East, and Japan and primarily affects
males between the ages of 20 and 40.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Biocultural Ecology
▪ Common health conditions among Turks are
lactose intolerance, thalassemia, cardiovascular
diseases, cancer, obesity, hypertension,
diabetes, tuberculosis, and conditions related to
high smoking rates among men and women.
▪ The most prevalent food- and water-borne
diseases are infectious hepatitis and sporadic
cases of salmonellosis and dysentery.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
High-risk Health Behaviors
▪ Cigarette smoking is widespread in Türkiye and
tends to start at an early age. Türkiye, a major
producer of tobacco in the world, has instituted
very limited anti-tobacco activities.
▪ Turks tend to consume less alcohol than
Americans or Europeans, perhaps as a result of
the Muslim culture that discourages more than
moderate alcohol use.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
High-risk Health Behaviors
▪ The tendency of Turkish men to view
themselves as strong/immune to disease
and the traditional cultural view
condoning male promiscuity increases
the danger for both the man and his wife.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition
Turkish cuisine is influenced by the many
civilizations encountered by nomadic
Turks over the centuries, as well as by a
mixture of delicacies from different
regions of the vast Ottoman Empire.
Therefore, food choices are varied and tend
to provide a healthy, balanced diet.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
ClickerCheck
A common genetic/hereditary condition among
Turks is
a. Hemophilia.
b. Thalassemia.
c. Anemia.
d. Sickle cell anemia.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: B
A common genetic/hereditary condition among
Turks is thalassemia.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition
▪ Tea and a snack is always on hand for visitors,
and dinner guests may have difficulty finishing
everything on their plates
▪ Turkish hostesses may relentlessly offer to
replace what has been eaten.
▪ Polite guests refuse the first offer, but the
hungry need not worry; offers are made again
and again.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition
▪ Turkish …
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