Spain and France consider a firm handshake a sign of
strength and good character (Bechtel et al., 1998).
While Western cultures view direct eye contact
as positive, Native American and Asian cultures may
find it rude, and people from these backgrounds may
avoid looking strangers in the eye when talking to
them. People from Middle Eastern cultures can main-
tain very intense eye contact, which may appear to
be glaring to those from different cultures. These dif-
ferences are important to note, because many people
make inferences about a person’s behavior based on
the frequency or duration of eye contact.
Chapter 6 provides a detailed discussion of com-
munication techniques.
PHYSICAL DISTANCE OR SPACE
Various cultures have different perspectives on what
they consider a comfortable physical distance from
another person during communication. In the United
States and many other Western cultures, 2 to 3 feet
is a comfortable distance. Latin Americans and peo-
ple from the Middle East tend to stand closer to one
another than do people in Western cultures (Bechtel
et al., 1998). People from Asian and Native American
cultures are usually more comfortable with distances
greater than 2 or 3 feet. The nurse should be conscious
of these cultural differences in space and should allow
enough room for clients to be comfortable.
SOCIAL ORGANIZATION
Social organizationrefers to family structure and
organization, religious values and beliefs, ethnic-
ity, and culture, all of which affect a person’s role
and, therefore, his or her health and illness behavior
(Bechtel et al., 1998). In Western cultures, people may
seek the advice of a friend or family member or may
make most decisions independently. Many Chinese,
Mexican, Vietnamese, and Puerto Rican Americans
strongly value the role of family in making health care
decisions. People from these backgrounds may delay
making decisions until they can consult appropriate
family members. Autonomy in health care decisions
is an unfamiliar and undesirable concept because the
cultures consider the collective to be greater than the
individual.
TIME ORIENTATION
Time orientation,or whether or not one views time
as precise or approximate, differs among cultures.
Many Western countries focus on the urgency of time,
valuing punctuality and precise schedules. Clients
from other cultures may not perceive the importance
of adhering to specific follow-up appointments or pro-
cedures or time-related treatment regimens. Health
care providers can become resentful and angry when
these clients miss appointments or fail to follow spe-
cific treatment regimens such as taking medications
at prescribed times. Nurses should not label such
clients as noncompliant when their behavior may be
related to a different cultural orientation to the mean-
ing of time. When possible, the nurse should be sen-
sitive to the client’s time orientation, as with follow-
up appointments. When timing is essential as with
some medications, the nurse can explain the impor-
tance of more precise timing.ENVIRONMENTAL CONTROL
Environmental controlrefers to a client’s ability
to control the surroundings or direct factors in the en-
vironment (Bechtel et al., 1998). People who believe
that they have control of their health are more likely
to seek care, to change their behavior, and to follow
treatment recommendations. Those who believe that
illness is a result of nature or natural causes (person-
alistic or naturalistic view) are less likely to seek tra-
ditional health care because they do not believe it can
help them.BIOLOGIC VARIATIONS
Biologic variations exist among people from different
cultural backgrounds, and research is just beginning
to help us understand these variations (Bechtel et al.,
1998). For example, we now know that differences
related to ethnicity/cultural origins cause varia-
tions in response to some psychotropic drugs (dis-
cussed earlier). Biologic variations based on physical
makeup are said to arise from one’s race,whereas
other cultural variations arise from ethnicity. For
example, sickle-cell anemia is found almost exclu-
sively in African Americans, and Tay-Sachs disease
is most prevalent in the Jewish community (Bechtel
et al., 1998).Socioeconomic Status
and Social Class
Socioeconomic statusrefers to one’s income, edu-
cation, and occupation. It strongly influences a per-
son’s health including whether or not the person has
insurance and adequate access to health care or can
afford prescribed treatment. People who live in poverty
are also at risk for threats to health such as inade-
quate housing, lead paint, gang-related violence, drug
trafficking, or substandard schools (Ostrove, 1999).
Social class has less influence in the United
States,where barriers among the social classes are
loose and mobility is common: people can gain access7 CLIENT’SRESPONSE TOILLNESS 145