Reviewer for Transcultural Nursing

1. What are the dominant cultural practices during pregnancy to birth?

- Formal prenatal care, ultrasonography, hospital delivery, newborn care, postpartum
care.

2. Examples of birthing alternatives, included in-hospital and free-standing birth

centers maintained by nurses and midwives who promote family-centered care
and emphasize pregnancy as a normal process requiring minimal technological
intervention.
- Bars, ropes, wraps, tubs

3. Reasons why there are increased disparities in the United States

- There are several subcultures within the US, and have very different practices, values,
and beliefs about childbirth and the roles of women, men, social support networks, and
health care practitioners.
- Proponents of the “back to nature” movement, who are often vegetarian, use lay
midwives for home deliveries, and practice herbal or naturopathic medicine. African
Americans, American Indians, Hispanics, Middle Eastern groups, Orthodox Jewish
groups, Asians, and recent immigrants. Additionally, religious background, regional
variations, age, urban or rural background, sexual preference, and other individual
characteristics all might contribute to cultural differences in the experience of childbirth

4. Women who are more likely to experience unintended pregnancies nursing

considerations addresses problems related to unintended pregnancy.
- Consider that unintended pregnancy may lead to negative effects like a delay in prenatal
care, increased tobacco/drug use, increased physical abuse during pregnancy-- and any
of these factors can lead to preterm labor or low-birth-weight (LBW) infants. --prevent
these from happening
- Consider assessment of what is influencing unintended pregnancy like changes in social
mores sanctioning motherhood outside of marriage, contraception availability including
abortion, earlier sexual activity, and multiple partners.
- Do interventions that aim to increase access to contraception and target high-risk groups
- Develop programs that build on the cultural meaning of the problem and focus on the
processes women and their partners use to make fertility decisions.

5. Religious groups and contraception

- The religious beliefs of some cultural groups might affect their use of fertility controls
such as abortion or artificial regulation of conception; for example, Roman Catholics
might follow church edicts against artificial control of conception, and Mormon families
might follow their church’s teaching regarding the spiritual responsibility to have large
families and promote church growth.

6. The problems encountered by women in refugee centers

- Women living in refugee situations encounter many barriers to contraceptive use, a
major barrier to unmet health needs was the ethnic distinction/language barrier.

7. Sterility and religion: Muslim and sterility

- A fact that is perhaps of greater significance to fertility in Muslim women is that a
woman’s sterility can be reason for abandoning or divorcing her. Islamic law forbids
 adoption; infertility treatment is allowed, but is limited to artificial insemination using the
couple’s own sperm and eggs
8. Hinduism and contraception
- Cultural practices tend to arise from religious beliefs, which can influence birth control
choices. For example, the Hindu religion teaches that the right hand is clean and the left
is dirty. The right hand is for holding religious books and eating utensils, and the left
hand is used for dirty things, such as touching the genitals.

9. Muslim and abortion

- There is a Muslim belief that abortion is “haram” unless the mother’s life is in danger;
consequently, unintended pregnancies are dealt with by praying a miscarriage will occur.

10. In some African cultures and birth spacing, some women leave their home for as
long as 2 years to avoid pregnancy. What potential problem shall this practice
give to family?
- In some African cultures, there are strongly held beliefs and practices related to birth
spacing. Because postpartum sexual activity has traditionally been taboo, some women
leave their home for as long as 2 years to avoid pregnancy.

11. Why African couples still maintain a large number of children although they are
aware that this puts a large burden on the woman’s health and risk of maternal
death?
- Maternal mortality remains high and the culture expects women to bear many children.
Although this places a large burden on women’s health and increases a lifetime risk of
maternal mortality, cultural and religious hesitance toward family planning persists.

12. Factors affecting maternal role attainment

- Many factors can affect maternal role attainment, including separation of mother and
infant in cases such as illness, incarceration, or adoption, to name only a few.

13. Nursing management for taboo foods for a pregnant woman

- Spicy, cold, and sour foods are often believed to be foods that a pregnant woman should
avoid during pregnancy.

14. Problems associated with Female Genital Mutilation during pregnancy and
childbirth

15. Nursing consideration for the Special needs of the lesbian couple
- Focus on the positive aspects of the experience and the reasons why they were positive
for the mother.
- Prepare of the nursing staff before the couple’s arrival
- Inclusion of the mother’s partner in the labor and delivery process,
- Acknowledge the approaching parenthood and allow the partner to assist with newborn
care after delivery
- Convey support by using comforting gestures, checking with the couple frequently,
answering questions, and just “being there” for them
- Be mindful of research findings
- Exercise increased sensitivity when providing care
- Establishing evidence-based practice standards and policies, in order to meet the needs
of the expanding view of “family.”
16. The Maternal Role Attainment theory
- Microsystem: Made up of the groups that have direct contact with the individual
- Mesosystem: The relationships between the groups from the first system.
- Macrosystem: Contains those cultural elements that affect the individual and everyone
around them.
- Phases of the maternal role Attainment
o 1. Commitment and preparation of Pregnancy (Anticipatory stage): includes the
social and psychological adjustments to pregnancy. The woman have
expectations and seeks information from others in the role and visualizes herself
as a mother.
o 2. Acquaintance, practice, and physical restoration (Formal stage)This begins
with the birth of the infant and includes recovery from birth. In this role-taking
stage, the woman learns from others in the role or from professionals and
replicates their behavior. She gains competence through practice.
o 3. Approaching normalization (Informal stage)--begins as the woman structures
the maternal role to fit herself based on past experiences and future goals. The
woman learns infant cues and develops her own unique style of mothering;
described as “settling in” and becoming a new family
o 4. Integration of maternal identity 4 months and beyond (Personal stage) This
stage begins as the woman integrates mothering into her self-system,
internalizes the role, and views herself as a competent mother.

17. Prescriptive beliefs

- Remain active during pregnancy to aid the baby’s circulation (Crow Indian)
- Keep active during pregnancy to ensure a small baby and an easy delivery (Mexican
and Cambodian)
- Remain happy to bring the baby joy and good fortune (Pueblo and Navajo Indian,
Mexican, Japanese)
- Sleep flat on your back to protect the baby (Mexican)
- Continue sexual intercourse to lubricate the birth canal and prevent a dry labor (Haitian,
Mexican)
- Continue daily baths and frequent shampoos during pregnancy to produce a clean baby
(Filipino)

18. Mal ojo, the evil eye;

- The traditional belief that baby shower will invite bad luck, or mal ojo, the evil eye. Gifts
during baby showers were thought to draw the attention of dark spirits, marking the child
for disaster

19. "The ultra-Orthodox Jewish practice called metzitzah b'peh

- Practice of metzitzah b'peh requires a practitioner, called mohel, to orally suck the blood
from the baby's newly circumcised penis to 'cleanse' the open wound.

20. Asian cultures, like the Philippines “pag lilihi” of pregnant women

21. Pica, ingestion of nonfood substance of pregnant women

- Some pregnant women experience pica: the craving for and ingestion of nonfood
substances, such as clay, laundry starch, or cornstarch. Some Hispanic women prefer
the solid milk of magnesia that can be purchased in Mexico, whereas other women eat
the ice or frost that forms inside refrigerator units.
 - In the United States, pica is common in African American women raised in the rural
South and in women from lower socio-economic levels.
- It is not uncommon to see small balls of clay in plastic bags sold in country stores in the
rural South. The phenomenon of pica has also been described in other countries
including Kenya, Uganda, and Saudi Arabia (Boyle & Mackey, 1999).

22. Nursing consideration for Muslim women who will have a vaginal examination.
- Explain health regimens so that they have meaning within the cultural belief system.
- Conduct home visits
- Group prenatal visits might be made based on self-care models instituted by nurses in
local community centers (example: mothers’ class)
- Incorporate significant others into the plan of care.
- Provide information on normal fetal growth and development,
- Discuss how the health and behavior of the mother and those around her can influence
fetal outcome.

23. Women screaming and shouting during labor

- Japanese, Chinese, Vietnamese, Laotian, and other women of Asian descent maintain
that screaming or crying out during labor or birth is shameful; birth is believed to be
painful but something to be endured.
- Guatemalan women in labor tend to vocalize their pain

24. Women positions during labor and childbirth

- Mexican American women seated position in a birth chair
- Laotian Hmong women choose squatting position

25. Why home birth is still accepted in the US government. What are the nursing
implications of this?
- A dependence on self-management
- A belief in the normality of labor& birth
- Tradition of delivery at home
- A long distance to the closest hospital

26. Children co-sleeping with parents’ beliefs and practices

- The practice of a child sleeping with another person on the same sleeping surface for all
or part of the night. Although bed sharing may be born out of financial necessity, it is a
cultural phenomenon in many societies that emphasize closeness, togetherness, and
interdependence.
- Research has found that the majority of parents bring their children into bed with them at
some time. Parents bring their children into bed with them to facilitate breast-feeding, to
comfort the child, to improve the child’s sleep or parent’s sleep, to monitor the child, to
improve bonding or attachment, and for other reasons; the constellation of reasons for
bed sharing depends largely on the culture of the family.

27. Bedwetting of children and beliefs and practices

- Of primary concern to parents of toddlers and preschoolers is bowel and bladder control.
Toileting or toilet training is a major developmental milestone and is taught through a
variety of cultural patterns.
- In some cultures, children are not expected to be dry until 5 years of age. Generally
speaking, “Girls typically acquire bladder control before boys, and bowel control typically
is achieved before bladder control”
28. While teenage pregnancy and beliefs and practices

29. Menstruation beliefs and practices, of Islam, Nepali, Mexican Americans

- For example, in traditional Mexican American families, girls and women are not
permitted to walk barefooted, wash their hair, or take showers or baths during menses.
o In encouraging hygienic practices, respect cultural directives by encouraging
sponge bathing, frequent changing of sanitary pads or tampons, and other
interventions that promote cleanliness
- Some Mexican Americans believe that sour or iced foods cause the menstrual flow to
thicken, and some Puerto Rican teenagers have been taught that drinking lemon or
pineapple juice will increase menstrual cramping.
- Many cultural groups treat menstrual cramping with herbs and a variety of home
remedies.
- In Islamic law, the blood of menstruation, as well as blood lost during childbirth, is
believed to render the female impure. Because one must be in a pure state to pray,
menstruating girls and women are forbidden to perform certain acts of worship, such as
touching the Koran, entering a mosque, praying, and participating in the feast of
Ramadan.
- During the menstrual period, sexual intercourse is forbidden for both men and women.
When the menstrual flow stops, the girl or woman performs a special washing to purify
herself, called the Gushl bath in Islam for women.

30. Use whipping, spanking and physical punishment of children why it is permitted
in some culture
- The use of physical acts, such as spanking or various restraining actions, is connected
with discipline in many groups, but can sometimes be interpreted by those outside the
culture as inappropriate and/or unacceptable.
- Physical punishment of Native North American children is rare. Instead of using loud
scolding and reprimands, Native North American parents generally discipline with a quiet
voice, telling the child what is expected. During breast-feeding and toilet training, or toilet
learning, Native North American children are typically permitted to set their own pace,
and parents tend to be permissive and nondemanding.
- Some African American parents tend to point out negative behaviors of a child and may
use spanking and physical punishment as a strategy to quickly gain the child’s attention
and rapidly get him or her to behave, especially in public (Whaley, 2013)

31. African nations ritual circumcision—of both boys and girls—is performed without
anesthesia. What is the cultural consideration why this is permitted?
- Many African nations continue to practice rites of initiation for boys and girls, usually at
the time of puberty. In some cases, ritual circumcision—of both boys and girls—is
performed without anesthesia, and the ability to endure the associated pain is
considered to be a manifestation of the maturity expected of an adult.

32. Coining is a traditional technique used to treat illnesses since ancient times that is
widely practiced in China (also called Gua sha) and other South East Asian
countries such as, Indonesia (referred to as Kerikan) Vietnam (referred to as Cao
gio)
- Coining is a traditional techniques used to treat illnesses since ancient times that is
widely practiced in China (also called Gua sha) and other South East Asian countries
such as, Indonesia (referred to as Kerikan) Vietnam (referred to as Cao gio). The
intention of coining is to rid the body of so called “heatiness and “negative energies”