Cultural Nursing Paper

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Italian American Culture Larry Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage Italian American immigrant groups include ▪ First-generation, traditional older Italians primarily living in enclaves ▪ Second-generation, less traditional Italians living in suburban and urban neighborhoods with ethnic enclaves ▪ Third-generation, more educated Italians primarily living in the suburbs ▪ A relatively small group of newer immigrants with strong ties to their homeland Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ This presentation describes the beliefs and practices of Italian Americans from the mainland of Italy, although some of these characteristics may be shared by Italian Americans with a heritage from Sicily and Sardinia. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview ▪ Italy is famous for the marvels of ancient Rome, such as the Coliseum, Parthenon, museums. Also famous for St. Peter’s Square, the Leaning Tower of Pisa, the canals and Piazza in Venice, the ruins of Pompeii, artists, and the Portofino lace makers, wineries, and marble. ▪ New York City has the largest Italian population of any city in the country. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ In addition to New York, other states with high Italian populations are New Jersey, Massachusetts, Pennsylvania, and California. ▪ Major cities in addition to NYC hosting large Italian Americans populations include Chicago, New Orleans, Philadelphia, Boston, Newark, New Jersey, and San Francisco. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ Italian enclaves, or “Little Italy’s” as they are called, can be found in New York City, Boston, Cleveland, and other major cities in the US. ▪ The current Italian American population of almost 16 million ranks fifth in the United States, preceded by German, Irish, English, and African Americans. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ The official language of Italy is Italian, a Romance language derived from Latin. ▪ All socioeconomic groups in the 19 regions of Italy speak different dialects. ▪ The dialects of northern Italy contain numerous German words. Spanish, French, and German languages influence Neapolitan Italy. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Piedmontese is strongly affected by the French and Spanish languages, whereas the dialects of Sicily have been strongly influenced by French, Spanish, Greek, Albanian, and Arabic languages. ▪ Sardinia has its own language, Sardinian. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ First-generation Italians who immigrated to America bring the dialects of their region with them. ▪ Today, in some second-generation and thirdgeneration Italian homes, these dialects are still spoken. ▪ Many second-generation Italian Americans do not speak Italian well or at all. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Either their parents encouraged them to learn English, or more often, the children refused to speak the mother tongue. ▪ Often the next generation becomes curious about its background and tries to recover parts of its heritage. ▪ A number of third-generation Italian Americans are studying Italian in an effort to reconnect with their Italian heritage. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Grammatically correct Italian is musical and romantic because vowels predominate over consonants, expressing the many subtleties of thought and feeling in a delicate manner. ▪ In many Italian households, discussions can become quite passionate with vocal volume raised and many people speaking at once. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ The willingness to share thoughts and feelings among family members is a major distinguishing characteristic of the Italian American family. ▪ Positive and negative emotions and sentiments are permissible, encouraged, and color their daily lives. ▪ Many times a fluctuating emotional climate exists within the family with expressions of affection erupting briefly into what may appear to an outsider as anger or hostility. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Conflict is usually confined to periodic outbursts and does not usually cause resentment or open and permanent ruptures. ▪ In fact, emotional neutrality to Italians denotes noninvolvement or the absence of affection. ▪ Italians are sentimental and not afraid to express their feelings. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Traditional Italian Americans value close family ties, express warmth freely, and have heart and feeling for each other. ▪ The emotional bond among Italian Americans is reaffirmed by frequent kissing Cultural Nursing Paper

. ▪ The “typical” kiss is eastern European style, with a kiss on each cheek. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ They frequently touch and embrace family and friends. Touching between men and women, between men, and between women is frequently seen during verbal communication. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ It is said that the Italians from southern Italy are capable of carrying out a conversation without saying a single word. ▪ Gestures convey a range of feelings from poetic eloquence to intense anger. ▪ Italians are past, present, and future oriented. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Past orientation is evidenced by the pride they take in their rich Roman heritage. ▪ Within the context of fatalism, they do not allow their imagination to stray too far, occupy themselves with concrete problems and situations, and accept things. ▪ They are future oriented as evidenced by the importance given to planning ahead and saving financially for the future. Copyright © 2013 F.A. Cultural Nursing Paper

Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Time orientation varies by immigrant group. ▪ First-generation and newer immigrants view time as an approximation rather than categorically imperative. ▪ Second-generation and third-generation Italian Americans adhere to clock time at least in the work situation and for appointments. For this group, deadlines and commitments are considered important and adhered to firmly. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Before the Napoleonic era, last names were not commonly used in southern Italy. ▪ After the Napoleonic era ended in 1814, the French often assigned to a family, or sometimes an entire village, the name of that village. ▪ The contadini peasant custom was to name first children for their grandparents and later children for their godparents. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ To avoid confusion, they instituted a practice of assigning nicknames according to some physical characteristic or their occupation. ▪ For example, Giovanni Pelo is translated as “Johnny one hair”. This nickname was given because his body was covered with dark hair. ▪ This practice of assigning nicknames continues with many Italian American families. Copyright © 2013 F.A. Davis Company Transcultural Health Care:

A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ In the past, an Italian father’s decision may have been accepted as law even among his married children. ▪ To criticize one’s father is considered a sacrilege. ▪ In many traditional Italian American families today, the father continues to dominate family decisions as long as he remains in good health and is the chief breadwinner. ▪ He is known as the Padrone or capo di famiglia, the “head of the family.” Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ In old age and illness, the eldest son supersedes the father, but even then, the father retains much of his prestige. ▪ The “typical” traditional Italian father frequently demonstrates public and private affection for his children, but such demonstrations are less frequent in public for his wife. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Many husbands turn over their paychecks to their wives to run the home, and thus Italian women tend to have more power in economic decisions. ▪ Women also dominate decision making on childbearing issues and family social events. Cultural Nursing Paper

▪ A trend toward more egalitarian relationships is evolving. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Italian American children are taught to have good manners and respect for their elders. ▪ Both male and female children are encouraged to be independent and expected to contribute to the family’s support as soon as they are old enough to work. ▪ This work ethic continues in second-generation and third-generation families. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ L’ordine della famiglia, “family order,” a system of social attitudes, values, and customs, has proven to be impenetrable to the exploitation of strangers and is the main tie that holds the Italian American household together. ▪ The rules governing family membership are simple and explicit: Fear God and respect the saints. The father is the father, and he is experienced. Always honor and obey your parents. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Italian American families maintain close relationships. ▪ Love and warmth, security, and the expression of emotions are the most common characteristics of the Italian American family. ▪ Daughters have close ties with both parents, particularly as they approach old age. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Although many second-generation and thirdgeneration Italian Americans no longer live in an immediate Italian enclave, they return home frequently to maintain family, community, and ethnic ties. Cultural Nursing Paper

▪ While parents are alive, their home is most often the focus of kinship gatherings. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Italian Americans are almost twice as likely as other ethnic groups to see a parent daily or at least several times a week. ▪ If personal contact is not possible, frequent telephone contacts are made, sometimes several times a day. ▪ Continuity in parental roles is an important factor in maintaining the high status of older people. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ The loss of the work role does not noticeably affect their central role in the family. Instead, the absence of the work role permits greater family involvement. ▪ Italian Americans have an actively functioning kinship and extended family system that is the primary focus of solidarity for the nuclear family. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Social status for most Italian Americans families comes from family lineage. ▪ Titles are more important than names. ▪ Despite values clearly defined around family obligations, Italian Americans generally do not reject another family member because of an infraction or alternative lifestyle. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues ▪ Italians believe strongly in the work ethic, are punctual, and rarely miss work commitments owing to a cold, headache, or minor illnesses. ▪ If completing their work requires staying later, they do so. ▪ Although the family is of utmost importance to Italians, work takes priority over family unless serious family situations arise. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues ▪ Among Italian Americans, work is viewed as a matter of pride, demonstrating that one has become a man or woman and is a full functioning member of the family. ▪ So strong is this ethic that it governs behavior apart from monetary gain derived from employment. ▪ To Italian Americans, it is morally wrong not to be productively occupied. Poveri si, ma perche lognisi? (Poor yes, but why lazy?) Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues ▪ Even though Italian Americans have the utmost respect for their employer, they are emotional and passionate people, and when a confrontation arises, Italians are likely to get involved. ▪ Italians born and educated in the United States usually have little difficulty communicating with others in the workforce. Cultural Nursing Paper

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Italians as a group have varied physical characteristics. ▪ Those from a predominantly northern background have lighter skin, lighter hair, and blue eyes, whereas those from the south of Rome, particularly from Sicily, have dark, often curly hair, dark eyes, and olive-colored skin. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ People of Italian ancestry have some notable genetic diseases, such as familial Mediterranean fever, Mediterranean-type glucose-6-phosphate dehydrogenase deficiency (G-6-PD), thalassemia, and recurrent polyserositis. ▪ Italian Americans have a high incidence of hypertension and coronary artery disease related to smoking and perhaps their type A behavior. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Italian Americans have significantly higher risks of nasopharyngeal, stomach, liver, and gallbladder tumors. ▪ Females exhibit a low risk for cancer of the oral cavity, esophagus, colon, rectum, and pancreas. ▪ Males exhibit a low risk for cancer of the larynx, lung, melanoma, breast, prostate, bladder, and non-Hodgkin’s lymphoma. Transcultural Health Care: A Culturally Competent Approach, 4th Edition High-risk Behavior ▪ Although there is much education in the general population regarding the risks of smoking, many Italian Americans immigrants continue to smoke. ▪ Alcohol misuse also presents a risk in this group. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ To the Italian Americans, food is symbolic of life and the principal medium of life, particularly family life. ▪ Respect for food as the medium of life is upheld even among the poor. ▪ The ceremony of eating is honored by Italian Americans who convey to their children that the waste or abuse of food is a sin. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ In an emotional sense, food is a connection between an Italian child and the parents, representing the product of the father’s labor and prepared with care by the mother. ▪ In a symbolic sense, meals are a communion of the family, and food is sacred because it is the tangible medium of that communion. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ An Italian mother may demonstrate her affection by feeding her family and anyone else she likes. Cultural Nursing Paper

▪ To the average Italian mom, love is a four letter word. ▪ The Italian diet, rich in vegetables, pasta, fruit, fish, and cheese, varies according to the region of Italy from which the individual originated. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Northern Italian foods are rich in cream and cheese, resulting in a potential high intake of fat. ▪ Southern Italian foods are prepared in red sauces, spices, and added salt. ▪ The staples of the Italian Americans diet are spaghetti, lasagna, ravioli, pasta with pesto, and manicotti. ▪ Vegetables, fresh fruit, and beans are common. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Popular Italian foods include lentils, sausage, eggplant parmigiana, salami, olive oil, espresso and cappuccino coffee, wine, ice cream (gelato), pastries such as cannoli and bisciotti, and cheeses such as provolone, ricotta, romano, and parmigiana. ▪ Other common dishes include escarole, Caesar salad, calzone, and pizza. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition

▪ Dinner is a gathering of the family. Italian wine is taken at almost every meal, and a mixture of water and wine is given to children. ▪ Breakfast has never been an important meal for southern Italians. ▪ Eating a fresh raw egg every morning, keeps the person strong. ▪ Fresh dandelions are used to make a salad or are boiled to make soup to give the person strength. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ One of the most common practices for health promotion is eating a clove of garlic every night before going to bed to prevent upper respiratory infections. ▪ Garlic may also be worn around the neck when there is an epidemic of influenza or other upper respiratory ailments to prevent the wearer from getting the infection. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck Genetic conditions common Italians and Italian Americans is a. Hemophilia b. Polydactylism c. Bi-polar disorders d. Thalassemia Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: D Thalassemia is a common genetic disorder among Italians and Italian Americans. The other conditions are not. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Many third-generation Italian Americans use birth control from the beginning of the marriage, and sex is commonly discussed in the family. ▪ There continues to be a weakened external restriction on premarital sex, but internal inhibitions remain strong.

▪ In the past, adultery was often seen as unacceptable but sometimes excusable. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Italy has some of the lowest birth rates in the world, which is surprising for a predominantly Catholic country. ▪ Traditional ideas among Italian Americans regarding pregnancy have undergone slight but significant variations in the United States. ▪ The belief that a mother does not conceive while nursing continues to be held by many Italian women. Transcultural Health Care: A Culturally Competent Approach, … Cultural Nursing Paper