7. ANGLO-AMERICANS

Anglo-Americans take for granted their culture as part of their lifeways and fail to recognize its unique features. Some of the greatest problems of Anglo-American nurses has been ethnocentrism and cultural blindness in which nurses fail to recognize cultural variations among Americans. Anglo-Americans tend to be lumped together as all alike without awareness of subtle and major differences. Cultural awareness of this population is essential to develop nursing competencies, for it is difficult to be effective without understanding the value system of the client. The values listed below are identified with the dominant Anglo-American middle and upper class cultural value system.

COMMUNICATING ACROSS CULTURES GUIDELINES

Individualism and self-reliance
Unquestionably, Anglo-Americans like their individualistic freedom to speak, act and be on their own, and generally dislike being treated as a collective group. They not only want to be recognized as individuals, but viewed as self-reliant, independent, and self-determined, as well.
Independence and freedom
Anglo-Americans dislike being constrained or having their freedom infringed upon by others, especially government and institutional policies and practices. Speaking openly about almost any matter is valued, defended, and protected, hence policies that limit such expressions are often resisted, avoided, or responded to negatively.
Competition, assertive ness, and achievements
Competition and achieving measurable outcomes are valued. For example, Anglo-American nurses may pursue their competitive and assertive efforts to achieve available rewards by competing with other nurses for recognition. Cultural strain and conflicts can occur when working with nurses from non-Western cultures who value cooperation, interdependence, and are likely to avoid open competition.
Materialism
Anglo-Americans value having material goods and a great variety of high-technology products as conspicuous items in their homes and work environments. This value contrasts sharply with those who live in poverty and other cultures who have little or no material goods and technologies.
Dependence on technology
Technology is relied upon in hospitals, clinics, and more recently in homes where many kinds of high-technological electric equipment such as computers, special instruments and a great variety of powerful technologies to assess and promote medical treatments. Since not all cultures believe in and use such technologies, the nurse must carefully assess the influence of their use on the total well-being of the client. For example, the Amish have a simple, rural lifestyle and avoid "modem" conveniences such as; electricity and will use candles or kerosene lights. Because Amish individuals are not familiar with technology, they are more likely to feel uneasy and fearful when confronted with the technological procedures used in healthcare settings.
Equal gender roles and rights
Another dominant Anglo-American value is that males and females would be treated with equal respect, rights, and role opportunities in the home or work place. For some non-Anglos the push by women for equal rights with men is frightening as gender differences are important in other cultures. It is an ethical responsibility to assist clients within the framework of their cultural value system.
Instant time and action
Time is a dominant value in American culture. Maintaining time schedules and expectations can lead to being seen as competent, successful, and efficient. Anglo-Americans often become angry, frustrated, and restless if they perceive that their time is not being respected or used appropriately. The concept of time is closely related to another Anglo-American value, action (doing). Nurses are often evaluated on how much they do, what activities they have completed, or how many things they have done. Doing is related to success, acceptance, and satisfying persons in authority. This is in contrast to caring nursing concepts which value listening to, giving time, and offering presence to clients of different cultures.
Youth and beauty
These values can be noted with extra attention given to infants, small children, and young adults receiving health care in hospitals and other health agencies. These practices may be quite different from those experienced by non-Western elderly who are deeply respected, valued, and cared for with kindness and affection.
Reliance on "scientific facts" and numbers
Getting facts in quantifiable numbers and logical or objective means is greatly valued by Anglo-Americans. Subjective, symbolic, non-numerical, or spiritual qualities of life and living may not be viewed as reliable or accurate. Knowing and understanding the realities of non-Western cultures is essential when providing nursing care to culturally diverse clients.
Generosity and help fulness in crises
Anglo-Americans are known for being generous with their time and money to others whenever crisis, suffering, gross neglect, disability, or in tragic situations that occur. They are known to give direct help to persons of other countries in times of loss, famine, war, earthquakes, floods, and other catastrophes. These are positive values which give Anglo-Americans an altruistic and caring image that can be seen in the expectation of both Americans and the world at large that money, material goods, and direct assistance will be given in time of need.

It would be an inaccurate perception to lump all Anglo-Americans in one category without taking into account such factors as education, geographical location and socioeconomic status. We are all a product of out environment which can be defined as all phenomena, tangible and symbolic, that influence development, beliefs, and behaviors. Environment can be divided into three parts: physical, social, and symbolic.

The physical environment is an important factor in development of any culture and includes such phenomena as climate, geography, housing, sanitation, air quality, and the effect of these factors on human behavior.

The social environment involves all the structures associated with the socialization of a person into a group in society. This includes family, community', church and state institutions, as will as the roles and functions of each. Studying the dynamics of the family is a crucial part of learning the cultural background of any individual since the family is the primary source of socialization. Religious orientation is a large part of a person's culture as is education (formal or informal) which helps impart the cultural beliefs and values of the group. The economic and political systems of the group are social in nature and culture specific. The health care deliver)' system is also an aspect of the social environment.

The symbolic environment refers to the music, art, history, language, and other symbols that provide a common means of communication and identification with a group's values and norms.

It is important to view all cultures within the context of environment and this must also be considered when providing health care to Anglo-American clients.

Class in America plays a decisive factor in what opportunities and resources are available to the client despite a commonly held belief that class distinctions in the United States are largely irrelevant today. With this belief in mind, one would suppose that everyone, rich or poor, are equal in the eyes of the law, and basic needs such as housing, health care and education are available to those who are willing to work hard in order to succeed. The fact is that the wealthiest 20 percent of the American population holds 79 percent of the total household wealth in the country while a total of 15 percent of the American population (one in seven) live below the government's official poverty line (calculated in 1992 at $7,143 for an individual and $14,335 for a family of four). Despite the belief that the United States is a middle-class nation, nearly a quarter of all children under the age of six live in poverty. The reality is that there are enormous class differences in the life-style among the haves, the have-nots, and the have-littles. From cradle to grave, class standing has a significant impact on our chance for survival with the lower-class having higher rates of infant mortality, mental illness, and disease, with less access to health care than the rich or middle-class insured individual. (Bureau of Census, 1993, Series P-60, No. 185).

With this in mind, it is essential that nurses consider the following factors when working with low-income Anglo-American clients and low-income clients across all cultures.

Lack of finances including insurance coverage.
Different value orientations than middle- or upper-class clients.
Eligibility "means test" that may be seen as a humiliating experience by the client.
Fragmentation of care that depersonalizes care and often results in confusion on the part of the client.
Operational features in the provision of services such as inconvenient locations or hours that preclude clients from accessing care.
Lack of understanding, trust, and commitment on the part of some health care providers.
Lack of personnel or adequate facilities.