Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company
Iranian
Larry Purnell, PhD, RN, FAAN
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview/Heritage
Over 400,000 in the United States with about ½ living in California
Currently about 76 million in Iran with 75% under the age of 30
Much diversity in Iran (Persia) among its inhabitants and also much diversity among Iranians in the United States
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview/Heritage Continued
The reform institutions of current Iran are colored by religious traditions and ideology of Islam.
Current industrialization of Iran has been from the outside, not from the inside and is due to the oil production industry.
Political instability continues with clashes between conservatives and liberals.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview/Heritage Continued
First wave of immigration between 1950 and 1970 were mostly students and professionals from the social elite and many stayed in the United States.
Second wave between 1970 and 1978 were varied in their background, but most were still affluent and urban and came for education and to be with family.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview/Heritage Continued
Not a major influence in the United States because they did not live in ethnic enclaves and assimilated into the United States culture easily
The third wave of immigration began in 1979 at the time of the Islamic revolution and included voluntary and involuntary political exiles and others who come for economic and personal security
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview/Heritage Continued
The hostage crisis between 1979 and 1981 increased ethnic tension of Iranians in the United States
Many are unable to find work in the United States that is compatible with their education in Iran
Most highly educated immigrant group in the United States
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communications
Farsi (Persian) is the national language of Iran but half speak another language with the educated group speaking three or more languages, including English
Invasions by numerous other nations have caused a mistrust and suspicion of foreigners resulting in not sharing one’s feeling with strangers
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communications Continued
Tell stories rather than being blunt and to the point in conversations leading to politeness and sometimes disguised as modesty
Hierarchical relationships dictate politeness and social communication resulting in a public self and a personal self
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communications Continued
Family affairs remain within the family
Self-control is valued and therefore do not show anger or emotions
Men can show affection for men and women for women in public, but not men and women
Stand close in conversations, regardless of social status between conversants
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communications Continued
Maintain intense eye contact between intimates, but avoid eye contact with superiors and elders
Expressive gesturing
Balance in temporality
Clock time is meaningless, even with appointments unless well acculturated
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communications Continued
Formality in addressing each other unless close friends
More traditional men do not mention their wives’ names in public
Man should wait for woman to extend her hand for a greeting
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Name Format
Order of the name is the same as the Western method with the given name followed by the surname.
Traditional women do not take their husband’s last name although some in the United States and elsewhere may upon immigration.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles
Society is patriarchal and hierarchical
Oldest son takes over if father is not present or unable to carry out decision-making
Male children are more desirable than female children—true in other cultures as well
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles Continued
Men deal with finance and matters outside the home.
Women care for the home and children.
Before 1960s social reform, women were legally expected to be obedient and submissive to their husbands.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles Continued
Marry early and have children. New law says women cannot marry until age 14—was 12 and marriages may still be arranged, but less so in the United States
Respect elders and never speak rudely to them
Children rarely left with babysitters
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles Continued
Traditional do not allow dating; women are expected to remain virgins until married, but not men
Strong intergenerational ties and family life together or nearby
May dress conservatively outside the home but less so while at home
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles Continued
Divorce uncommon in Iran and carries a stigma—if divorce, it is the woman’s fault, never the man’s—varies in the United States
Pregnancy before marriage can have devastating outcomes and is not talked about, it does not happen—it is just taken care of
Gay and lesbianism highly stigmatized and is a capital crime punishable by death in Iran
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Biocultural Ecology
Wide variations in skin color, hair color, and eye color and depends on heritage from previous domination by other countries and cultures
Common illnesses in Iran include malaria, hypertension, meningitis, hookworms, and parasitosis
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Biocultural Ecology Continued
Great numbers with genetic disorders brought on by close sanguinity marriages resulting in blindness, epilepsy, anemias, hemophilias
Glucose-6-phosphate dehydrogenase deficiency —fava bean allergies can cause hemolytic crisis
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition
Food is a symbol of hospitality; serve the best food for guests who are expected to eat several servings.
Polite to refuse snacks and beverages when first offered—accept it on the third offering
Rarely eat fast food; fresh food is greatly preferred, and many hours are spent preparing meals
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition Continued
Strict Muslims avoid pork and alcohol and meat must be prepared with ritual slaughter called halal.
Food should be eaten with the right hand (clean hand) and food should be passed with the right hand or both hands.
Traditional prefer family to bring food from home if hospitalized.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition Continued
Balance food between garm (hot) and sard (cold) —if balance does not occur, one may become “chilled” or “overheated.”
Women are more susceptible to these conditions than are men.
Newer immigrants may have protein and vitamin deficiencies.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Childbearing Family
Menstruating women are not allowed to touch holy objects, have intercourse, exercise, or shower.
Iran is changing from openly discouraging birth control to now cautiously and secretly encouraging birth control because of the population explosion.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Childbearing Family Continued
Cravings must be satisfied because the fetus needs the craved food
Avoid fried foods or foods that cause gas
Eat lots of fruits and vegetables
Balance garm and sard foods
Pregnant woman should not work after the sixth month
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Childbearing Family Continued
The father should not be present at birth in the traditional family
30- to 40-day postpartum period where other women are to care for the new mother
Ritual bath after this period so religious obligations can continue
Eat different foods if a boy baby versus girl baby
Eat an herbal extract (taranjebin) to have a boy
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Death Rituals
Okay to begin life support, but usually not okay to end life support
Multiple family members come to bedside of the dying person and recite/read prayers
Bed should be turned to face Mecca
More traditional want to return to Iran to die
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Death Rituals Continued
Even though death is seen as a beginning, not an end, mourning and grief are displayed openly and even dramatically to encourage letting go
After death, relatives and friends gather on days 3, 7, and 40 to pray and grieve with family and friends
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Death Rituals Continued
All wear black for mourning and women should not wear makeup
On the anniversary of the death, family and friends again gather to express grief and pay respect to their loved one
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Death Rituals Continued
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