Kathleen Jennings-Dozier, RN, PhD, MPH, CS,
	Team Leader
	Gloria Juarez, RN, MSN Ayda G. Nambayan, RN, DSN
	Ann M. Smith, RN, BSN, OCN® Joan Such-Lockhart, RN, PhD, CORLN Lynne Suhayda, RN, MSEd, ONS Staff

	Ethnic identity
	Communication
	Time and space
	Social organization
	Workforce issues
	Health beliefs and practices
	Nutrition
	Biologic variations
	Sexuality and reproductive fears
	Religion and spirituality
	Death and dying

	The Wu family recently migrated from Taiwan. Two months after their arrival in Denver, CO, grandmother Wu fell ill and was diagnosed with a metastatic gastric ulcer. The granddaughter, who was instrumental in bringing the family to Denver, is a nurse who is employed in the coronary care unit.
	The oncologist and the oncology nurse
	were perturbed when the family asked
	them to relay all the information to the
	granddaughter rather than to the patient.
	Communication:  Dominant language and any dialects, usual
	volume/tone of speech, willingness to share thoughts/feelings/ideas,
	meaning of touch, use of eye contact, control of expressions and
	emotions, spokesperson/decision maker in the family

	Mr. Jones is a 72-year-old African American, who has prostate cancer.  As a result, he is receiving chemotherapy.  The clinic nurse noted that Mr. Jones is late for his chemotherapy appointments and sometimes comes on the wrong day. The nurses in the clinic prepared a calendar for Mr. Jones, but the schedule did not seem to help him keep his appointments.
				Time & Space:  Past, present, or future time orientation; preference for personal space and distance

	While visiting her children in the United States, Mrs. Juana Pereira was diagnosed with inoperable pancreatic cancer. She was admitted to the hospital for chemotherapy. Mrs. Pereira’s daughter, Anna, took charge of her care, pampering her with attention and services which often interfered with appropriate care.
	Social Organization:  Family structure, head of household, gender roles, status/roles of elderly, roles of children, adolescents, husbands/wives, parents, extended family, influences on decision-making process, importance of social organization and network

	Anna would refuse to have her mother sit on a chair or ambulate, saying that Mrs. Pereira was too ill and weak. She insisted that her mother continue taking an herbal tea from Bogota. Even though Anna took charge of her mother’s care, Mr. Pedro Pereira, made all the decisions regarding the treatment plan for Mrs. Pereira.
	Social Organization:  Family structure, head of household, gender roles, status/roles of elderly, roles of children, adolescents, husbands/wives, parents, extended family, influences on decision-making process, importance of social organization and network

	The urban cancer center maintains a satellite oncology clinic in rural Kentucky.  The oncologist and nurse drive 45 miles to the clinic once  a week and to treat approximately 40 patients. For the last two years, the clinic patient schedule generally drops by 50% during the planting and harvest season.  The drop in the patient population is causing financial difficulties for the clinic.
	Workforce Issues:  Primary wage earner, impact of
	illness on work, transportation to clinic visits,
	health insurance, financial impact, importance of work

	A nurse is working in a low-income, predominantly African American community. Though the community has verbalized the need for cancer screening programs, these programs are not well attended.
	When the nurse asked a community leader why the screenings are not well attended, the community leader replied, “What is the use of a screening?  There is nothing we can do anyway.”
	Health Beliefs, Practices, and Practitioners:  Meaning/cause of cancer and illness/health living with life threatening illness, expectations and use of Western treatment and health care team, religious/spiritual beliefs and practices, use of traditional healers/practitioners, expectations of practitioners, loss of body part/body image, acceptance of blood transfusions/organ donations, sick role and health-seeking behaviors

	Mrs. Sanchez is a 75-year-old Puerto Rican woman living in New York. She has had a colostomy for colon cancer. The home health nurse noted that Mrs. Sanchez adds brandy to her black coffee and takes several variety of herbal teas.
	Nutrition: Meaning of food and mealtimes,
	preferences and preparation of food, taboos/rituals,
	religious influences on food preferences and
	preparation

	For the Nurse in Practice
	What are some culture-related behaviors concerning the use of alcoholic beverages for health reasons?
	For the Educator
	Evaluate differential diagnosis between  alcohol dependence and the use of alcohol because of health beliefs.
	For the Administrator
	Revisit the policies and procedures regarding alcohol use in the hospital.
	For the Researcher
	Consider drug, herbs and food/alcohol interactions.
	Reference: Lipson, J., Dibble, S., & Minarek, P. (1996). Culture & nursing
	care: A pocket guide. San Francisco CA: UCSF Nursing Press.

		Mrs. Lowenstein was diagnosed with ovarian cancer.  Her genetic profile also showed specific mutation of BRCA 1 and BRCA  2, indicating that her female descendants may be at high risk for breast and ovarian cancers.
				Biologic Variation:  Skin/mucous membrane color, physical variations, drug metabolism, laboratory data and genetic variations-specific risk factors and differences in incidence/survival/mortality of certain cancers

	Sarah is a devout Catholic, educated in Catholic schools and now, is the principal of a Catholic high school.  She sought medical  attention because she felt tired, bloated, and was losing weight.
	After her gynecologist told Sarah that she had ovarian cancer, Sarah became very silent and withdrawn. The nurse noticed that Sarah was crying and saying repeatedly, “It’s my fault. This cancer is God’s punishment because I had an abortion when I was in high school.”
		Sexuality and  Reproductive Fears:  Beliefs about sexuality and reproductive/childbearing activities, taboos, privacy issues, interaction of cancer diagnosis/treatments with beliefs about sexuality

	Dr. de la Cruz is a Filipino physician employed as a family practitioner in New Jersey.  She was admitted to the hospital for surgery for breast cancer.  While caring for Dr. de la Cruz, the nurse noticed a statue of the Virgin Mary, a prayer book, and a rosary on her table.  Dr. de la Cruz also had a crucifix pinned to her gown.
				Religion and Spirituality: Dominant religion, religious beliefs, rituals, and ceremonies; use of prayer, meditation or other symbolic activities, meaning of life, sources of strength

	Abu Fulani has terminal pancreatic cancer.  Mr. Fulani is an immigrant from Saudi Arabia and practices the Islamic faith.  Although he states that he has severe pain, he believes that pain and suffering are manifestations of Allah’s will. He refuses pain medications because he believes that they will hasten his death.The family has rearranged the room so that Mr. Fulani faces east at all times.
	When Mr. Fulani died, his son insisted on washing and dressing his body, while the family retired to another room.
	Death and Dying:   Meaning of dying, death, and the afterlife; belief in          fatalism, rituals, expectations, and mourning/bereavement
	practices