Health care beliefs of the German and French Canadian heritages

Transcultural Health Care: A Culturally Competent Approach, 4th Edition French Canadian Culture Larry Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ More than 2.2 million people of French Canadian descent reside in the United States. ▪ Nowadays, French speaking Canadians, unlike those of the 19th century living in the USA, may have been raised within the French culture but descended from a variety of ethnicities. ▪ The Multiculturalism Canada Act of 1988 provides guidelines for implementing policies regarding multicultural diversity. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ Before the latter half of the 18th century, most French immigrating to Canada were Catholics. ▪ French Protestants tended to come directly to the United States. ▪ After the French Revolution, more Catholics sought shelter in the US, most coming via Canada settled in the New England states and later dispersed throughout the United States. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ The Métis, descendants of Native Americans and Europeans, are mainly, though not entirely, Frenchspeaking. ▪ Another major portion of Canada’s French-speaking population are the Acadians who are the descendants of the early French colonists. ▪ Canadians whose first language is French are called Francophones. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ Canada has become an increasingly diverse society composed of various ethnocultural groups with more than 100 different languages as mother tongue. ▪ Much like that of the US, interethnic marriage patterns have dramatically changed from a multiethnic society to multiethnic individuals. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Canada has two official languages, French and English. ▪ In many homes in the US and in Canada English and French may be used equally. ▪ The French-speaking population may lack sufficient knowledge of the English language to access the workforce and other material. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Among French Canadians, a conversation may be conducted with high voice crescendos, which do not necessarily mean anger or violence. ▪ Volume can increase with the importance and the emotional charge invested in the content of the message. ▪ French Canadians encourage sharing thoughts and feelings. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Using hand gestures for emphasis when speaking is common. Health care beliefs of the German and French Canadian heritages

▪ Facial expressions for men and women of all ages are a part of communication, often replacing words. ▪ Spatial distancing for differs among family members, close friends, and the public. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ When in the intimacy zone, people may touch frequently and converse in close physical space; however, they tend to avoid physical contact in public. ▪ When greeting another person, men usually shake hands. ▪ Close female friends and family members may greet each other with an embrace. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Maintaining eye contact is an important French Canadian value. ▪ Most French-speaking Canadians have a past, present, and future orientation in their worldview. ▪ More traditional people, and many from rural backgrounds, attach primary importance to living in the present. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Until the late 1970s, women and children took the father’s surname. ▪ Today, under Quebec law, a woman keeps her maiden name throughout her lifetime, although in other parts of Canada this practice is decided between the spouses. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Québécois family of two spouses and two children may well include four different surname combinations: one child may have the father’s surname or the mother’s surname alone or a hyphenated or non-hyphenated surname composed of those of the father and mother. For a second child, the surnames are the same, but in reverse order. ▪ The decision for using surnames rests entirely with the parents. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck The Métis in Canada are a. Mostly English Speaking. b. Mostly speak an indigenous dialect. c. Descendants of Native Americans and Europeans. d. Descendents of French and Arabic. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: C a. Descendants of Native Americans and Europeans. Health care beliefs of the German and French Canadian heritages

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Many older people with a strong religious background maintain a future worldview regarding life after death. ▪ Many of the younger generation reject past traditions and attempt to maintain a balance by enjoying the present, working, and planning for their future. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Traditionally, in French-speaking Canadian families, the man was seen as the moral authority and responsible for material wellbeing, such as economic provider and purveyor of affection and security. ▪ The woman served as the family mediator and social director as well as being responsible for household activities, child care, and health care. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ With more women working, family roles are becoming more egalitarian. ▪ French Canadians have always attributed great value to family relationships and obligations. ▪ Research reports that Francophones are less committed than Anglophones to with respect to marriage, sexual activity, and non-married parenthood. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ The greatest source of pride for French Canadian families is to see their children well established with a good education. ▪ The French Canadian family is more nuclear and autonomous than its counterpart in France. ▪ French-speaking Canadian family is known for its closeness, and some families are a “closed” family system. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Traditionally, the Catholic Church dictated the parameters of sexual behavior for French Canadians. ▪ There is a growing trend for couples to live together without marrying. ▪ Many young couples answer that they cannot financially afford to get married. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ In 1996, the Canadian government extended health, relocation, and other job benefits to same-sex partners of federal employees. ▪ The Ontario Court of Appeals ruled that samesex couples must be treated as common-law couples under the Family Leave Act. Health care beliefs of the German and French Canadian heritages

▪ Canada is one of the few countries in the world where same-sex marriage is legalized. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues ▪ Opportunities for Francophone nurses to function successfully outside Quebec and in the US are limited if they have not mastered the English language. ▪ Because Francophone culture is more collevistic than individualistic, some may initially have difficulty adapting to an environment where autonomous decision-making is required. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Canadians of French descent are white or Caucasian; however, Francophones, as a linguistic group, represent a mosaic of ethnocultural characteristics, including racial differences prompted by acculturation, adoption, and the children of mixed marriages. ▪ Assess individuals for biological risks according to their racial and cultural heritage. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Higher incidences of prostate and breast and ovarian cancers have been seen among Francophones. ▪ A high rate of suicide and suicidal ideation, particularly among Francophone adolescents and young adult males, is seen in Canada. It is unknown if this extends in the US. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Genetic and hereditary diseases include spastic ataxia Charlevoix-Saguenay type, cystic fibrosis, tyrosinaemia, cytochrome lipase deficiency, familial chylomicronemia resulting from the lipoprotein lipase (LPL) deficiency, hyperlipoproteinemia type I which has been traced to migrants from the Perche region of France. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ An increased incidence of cystic fibrosis and muscular dystrophy occurs among Frenchspeaking Canadians. ▪ Sickle cell anemia is also higher among Francophones than the general population. Transcultural Health Care: A Culturally Competent Approach, 4th Edition High-Risk Health Behaviors ▪ Misuse of alcohol, tobacco, marijuana, and psychotropic drugs are major health problems. ▪ Tobacco and alcohol use is highest among French-speaking males and is associated with masculine sex roles, higher self-esteem, and an external locus of control. ▪ The rate of individuals who do not exercise on a regular basis has increased over the last decade. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ For French Canadians, food is associated with hospitality and warmth. Food is part of all meetings and celebrations. ▪ Common vegetables enjoyed by French Canadians include potatoes, turnips, carrots, asparagus, cabbage, lettuce, cucumbers, and tomatoes. Health care beliefs of the German and French Canadian heritages

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Meat choices are mainly beef, pork, and poultry. Lately, however, lamb has gained popularity. ▪ In Acadia, due to the proximity of the coastal areas, fresh fish and seafood are part of the diet. ▪ Common foods include fricot (stew made with a special spice called summer savory). ▪ French Canadians do not escape the overall trend toward being overweight. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Until the middle of the 20th century, French Canadians maintained high fertility rates, which is uncommon for a population living in an industrialized country. ▪ This phenomenon, called the “revenge of the cradles,” has never been explained. ▪ The number of children per family has been declining since the mid-1960s. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Effective contraception and family planning methods such as the pill, intrauterine devices, and tubal ligation have become available to all women. ▪ The pill remains the primary reversible method for birth control. ▪ On the basis of relative frequency, tubal ligation and vasectomy follow the pill as nonreversible methods of fertility control. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Diaphragms, foams, and creams are not commonly used for birth control, partially because perceptions imply that women are not supposed to, or do not like to, touch their genitals. ▪ The beliefs that condoms reduce the level of sexual feeling during intercourse, or that contraception is not a man’s responsibility, are inversely proportionate to the age of men. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Few French Canadians practice natural childbirth. ▪ Men are welcomed and encouraged to be in the delivery room with their wives. ▪ Breastfeeding has regained importance after years of bottle feeding. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ In Canada, maternity and paternity leaves are available with pay for a period ranging from 6 to 20 weeks. ▪ Although the movement used in washing a floor resembles that of an exercise aimed at strengthening the perineal muscles, this activity in the past was associated with the onset of labor and early or preterm deliveries. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ French Canadians do not differ from Canadians and others of European origins on issues related to death and death rituals. Expectations are closely related to Christian religious practices, in particular, those of the Roman Catholic Church. ▪ Whether one is an active church-goer or not, religious funerals are the norm. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals Health care beliefs of the German and French Canadian heritages

▪ Cremation is an acceptable practice. ▪ Supports for those who have lost a family member include openly acknowledging the family’s right to express grief, being physically present, making referrals to appropriate religious leaders, and encouraging interpersonal relationships. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ While most French Canadians identify themselves as Roman Catholic and are baptized at birth, they may or may not remain active church members. ▪ Older adults are more inclined to use prayers for finding strength and adapting to difficult physical, psychological, and social health problems. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ In times of illness and tragedy, French-speaking Canadians use prayer to help recovery. ▪ Many of the younger generation are not strongly influenced by religious values, beliefs, and faith practices. ▪ The younger generations turn towards spirituality rather than religion. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Canada’s ensures free, universal health coverage at any point of entry into the system. ▪ Many people in the upper socioeconomic classes call on their family physicians instead of the local community service centers. ▪ Many lower socioeconomic individuals many do not seek health care until their health becomes a crisis situation. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ French-speaking Canadians have joined the current trend toward over-the-counter drug use. ▪ Language differences may be a barrier to accessing health care. ▪ French-speaking subjects rate acute pain as more intense than chronic pain, and more affectively laden than the English-speaking subjects. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck ▪ On issues of death and dying, which religion most influences French Canadian’s decision making? ▪ Baptist ▪ Methodist ▪ Catholic ▪ Islamic Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: C The Catholic religion has the most influence on decision making for death and dying issues for French Canadians. Health care beliefs of the German and French Canadian heritages

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ As a cultural group, French Canadians have no official proscriptions against receiving blood or blood products. ▪ The decision to donate or receive an organ is an individual decision without cultural influence for French Canadians. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practitioners ▪ Health-care providers hold a favorable status in the eyes of French Canadians, especially among older people. ▪ The universal health insurance system in Canada makes the folk practitioners less appealing. ▪ Professionals throughout Canada are vigilant in trying to avoid exploitation by traditional and folk healers, who are viewed as practicing outside the law. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German American Culture Larry Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German American Overview/Heritage ▪ Over 50 million Americans are of Germans heritage. ▪ The first wave of German immigrants came to the USA for religious freedom. ▪ The second wave arrived between 1840 and 1860 and was fleeing political persecution, poverty, and starvation. ▪ Many worked as indentured servants. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German American Overview/Heritage ▪ The 1930s and 1940s saw a third wave because of the rise of fascism in Germany. ▪ Germans receive a stronger education than Americans. ▪ The German undergraduate degree is equal to the American master’s degree, except for nursing which is at a lower level than that of the USA. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ German is the official language of Germany. ▪ German is a low-contextual language, with a greater emphasis on verbal than nonverbal communication. ▪ A high degree of social approval is shown to people whose verbal skill in expressing ideas and feelings is precise, explicit, and straightforward. Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ For traditional Germans, sharing one’s feelings with others often creates a sense of vulnerability or is looked on as evidence of weakness. ▪ Expressing fear, concern, happiness, or sorrow allows others a view of the personal and private self, creating a sense of discomfort and uneasiness. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ “Being in control” includes harnessing one’s emotions and not revealing them to others. ▪ Newer generations are more demonstrative in sharing their thoughts, ideas, and feelings with others. ▪ In families where the father plays a dominant role, little touching occurs between the father and children. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication Health care beliefs of the German and French Canadian heritages

▪ Affection between a mother and her children is more evident. ▪ Germans generally are careful not to touch people who are not family or close friends. ▪ Most individuals place a high value on privacy. People may live side by side in a neighborhood and never develop a close friendship. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ Germans would never consider dropping in on another German neighbor because this behavior is incongruent with their sense of order. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition German Communication ▪ Even looking into a room f … Health care beliefs of the German and French Canadian heritages