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8. AFRICAN-AMERICANS

Studying health care with reference to the African-American worldview and social structures is challenging, yet can be a stimulating learning experience. In the U.S. there are 29.9 million African Americans who make up 12.1% of the population. (U.S. Department of Commerce, Bureau of Census, 1993a). Of the number of African-Americans residing in this country, 53.0% live in the South. 19% live in the Midwest, 19% live in the Northeast, and 9.0% live in the West. (U.S. Department of Commerce, Bureau of Census. 1993b).

AFRICAN-AMERICAN: ETHNOHISTORICAL VIEW

Nurses who practice transcultural nursing consider it important to know the history of a people in order to understand the way in which they view their world and their health care. For example, since there were no physicians and nurses available to slaves, they had to depend on remedies that were brought with them from Africa. This system of folk healing then passed down from generation to generation and these remedies are still being used today.

The history of African slavery began in 1444 when Henry the Navigator took 165 African to Portugal on a slave ship. From the sixteenth to the ninetieth century more than 10 million Africans were brought to the United States and bonded into slavery which is based on dehumanization in which Africans were defined as non-human. This history of chattel slavery, segregation, and racial prejudice provides obstacles that have burdened African Americans. Early slaves were thought of as untamed savages, mistreated, abused, and violated with no rights under the Declaration of Independence. By 1860, most of the slaves were born in the United States and the racial stereotypes changed to reflect a paternalistic view of slaves as children that needed to be cared for and harshly disciplined so they would continue to serve the master of the plantation without trouble. After the Civil War in 1865, the end of slavery promised to bring freedom to all, when in fact, "Jim Crow" laws were set up to limit choices of jobs, living location, and the right to vote.

Over a quarter of a century later, some claim that the mistreatment of the African-American has finally ended, pointing to civil rights laws, affirmative action programs and to numerous gains in education, elected offices, and the general standard of living. On the other hand, in spite of enormous evidence to the contrary, African-Americans are still viewed by some of the majority population in stereotypical terms such as poor, lazy, violent, and more recently as rich when one considers sports, music, and media stars. The danger in accepting this exaggerated view of African-Americans at either end of the spectrum is that the needs of the other segments of the community, such as the struggling middle class, are often ignored.

Throughout American history, African-Americans were viewed in a manner that reinforced stereotypes of that era. These beliefs were necessary to continue the oppression of the .African-American within the context of that era. For instance, previous to the Civil war, slavery was justified by mainstream culture as necessary to "protect" uncivilized and dependent Blacks.

Below is a time frame of American history with the predominant belief held in mainstream culture.

Attitudes Toward Blacks in American History
Period of American History Predominant Belief in History Mainstream Culture
Slavery and Racial Oppression
-1650 English Heritage
1650-1760 Colonial America 		Black is evil in the eyes of God .Black's "animalistic" nature needs control.
1760-1820 Revolutionary era Slavery is necessary because Blacks cannot manage freedom.
1820-1860 Pre-Civil War Slavery is good for the development of the nation and is a means to "protect" uncivilized and dependent Blacks.
Racial Oppression
1860-1914 Civil War and Reconstruction The "failure" of Blacks to achieve positive advancement in mainstream culture confirms basic inferiority. Their inability to use available opportunities necessitates supervision and control to prevent degeneration to a primitive state.
1914-1941 World War I to World War II The inferiority of Blacks is confirmed by scientific research. For example, in the area of evolutionary theory and psychological testing. Continued racial segregation is necessary.
Civil Rights "Promises"
1941-1948 World War II Segregation is rejected as national survival needs takes precedence. Public revulsion is felt toward the Nazi idea of a "pure race."
1948-1968 Postwar Civil Rights Years Blacks are not genetically , inferior to Whites. Equal opportunities are necessary to counteract past discrimination and to maintain tranquillity in the United States.
Moderation and "Readjustment"
1968-1997 Inferiority of Blacks is due to themselves and their motivational level. Change has been too sudden and adjustments are necessary in previous concession areas of housing, jobs, education. desegregation, welfare, and financial assistance.
1997-1998 Welfare reform forever changes government assistance programs to the poor, affecting all populations especially Blacks who fall into the generational welfare category. Little tolerance for affirmative action, educational concessions, and perceived lack of taking advantage of opportunities granted during previous years.

AFRICAN-AMERICAN FAMILY SOCIAL STRUCTURE

No matter where in the United States African-Americans live, one of the most important social structure features in this group is the extended family and its kinship ties. The extended family is one that includes not only people related "by blood" but also those who are brought into it as fictive kin, such as boyfriends, preachers, family friends, and many others. Close friends from organizations such as sororities, fraternities, and church are considered "brothers" and "sisters" or "aunts" and "uncles." The concept of "my brothers and sisters" and "my aunts and uncles" must therefore be considered to include many who may not be related by biological ties. Research indicates that values related to family are: a high value placed on children, the approval of strong, protective mothers, the emphasis on strict discipline and respect for elders, the strength of family bonds, and the ideal of an independent spirit. African-American family members and the closeness they have for each other, often goes beyond geographical, legal, political, and economic borders. Members of the extended family may lend support to one another by gifts, childcare, financial help, home repairs, and advice for personal problems. Swapping goods and services within the kinship system is used as a strategy for survival. This especially holds true when poverty is part of the African-American family dynamics.

A number of family researchers have been interested in studying healthy .African American families and have identified the following six strengths.

  1. Strong kinship bonds
    The extended family is very important to many African American families, and African Americans tend to take relatives (grandparents and children) into their households.
  2. Strong work orientation
    Dual-job households are common among strong two-parent African American families.
  3. Adaptability in family roles
    Role flexibility serves as an effective coping mechanism in healthy African American families. Because it has been necessary for many mothers to work outside the home, African American mothers tend to have more power in me family.
  4. Strong motivation to achieve
    African American parents commonly believe education is important, and many would like to see their children go to college.
  5. Strong religious orientation
    African American churches provide emotional, spiritual, and intellectual satisfaction to African American families. Church work has provided meaning and purpose for many African Americans.
  6. Good and caring parenting
    Child mistreatment rates among middle-and upper income African-Americans and whites are equal and relatively low. Child mistreatment rates among lower income African-Americans and whites are relatively high but the rate is substantially higher for lower income whites than for lower income African-Americans. It may be that African-American parents are better than whites at staying cool when facing economic stress and social disadvantage. (Olson and DeFrain. 1994).

HEALTH CARE BELIEFS AND AFRICAN-AMERICAN FAMILIES

The life expectancy for African-Americans is 71.0 years, compared with 76.4 years for Whites. African-Americans continue to have a higher infant mortality (11.2 per 1000 live births in 1993), compared with White Americans (9.4 per 1000 live births in 1993). Although life expectancy for African-Americans at birth edged to the low 70s, it is important to note that the life expectancy for the African-American male born between 1986 and 1988 actually shrank. A portion of the disparity is due to infant mortality, which is twice as high for African-American babies, compared with White babies. Yet another portion is due to disparities in health concerns, especially chronic illnesses, that contribute significantly to premature deaths before 65 years of age among African-American males. In fact, during 1987 the rate of deaths for African-American males was 55% higher for heart disease, 26% higher for cancer, 180% higher for lung disease than for the rest of the U.S. population- Perhaps the greatest disparity was the rate for deaths due to homicides, which was 630% higher compared with White males. African-American women do not fare much better than their male counterparts in health status disparities. When the life expectancy of White women in compared with the life expectancy of African-American women, the data suggest that African American women have a shorter life expectancy compared with their White female counterparts. (73.4 years versus 78.9 years) (National Center for Health Statistics, Healthy People 2000 Review, 1993).

AFRICAN-AMERICAN COMMUNICATION PATTERNS

The first African brought to American as slaves were systematically separated during transportation, and this separating continued after arrival. As a result of this calculated attempt to keep African-Americans separated various African languages combined with the languages of other cultural groups in the New World fostered the need for a common language for African-Americans. This ultimately led to the restructuring of grammar of all language, including English. The dialect that is spoken by many African-Americans is sufficiently different from Standard English in pronunciation, grammar, and syntax so as to be classified as "Black English." The speech of some African-Americans is very colorful and dynamic, involving a wide range of body movement, such as facial gestures, hand and arm movements, expressive stance, handshakes, and hand signals, along with verbal interaction. On the other hand, the nurse needs to be aware that direct eye contact, nodding, and smiling are not essential indications that the African-American client is listening. Nurses must develop sensitivity to communication variances as a prerequisite for accurate nursing assessment and intervention in multicultural situations. The nurse who works with African-Americans, especially those speaking in Black English must make an effort to understand as much of the context of the dialect as possible. The nurse should avoid chiding and correcting the speech of African-Americans, since this behavior can result in the client's becoming quiet, passive, and, in some cases, aggressive or hostile. One the other hand, while the nurse should attempt to use words common to the client's vocabulary, mimicking the client's language can be interpreted as dehumanizing. When working with persons who speak Black English, the nurse must keep in mind that the client may use slang to convey certain message. However, slang terms often have different meaning between individuals and especially between cultural groups. For example, an African-American client's response to an inquiry about a diagnostic test might be "It was a bad experience." and actually mean that it was a unique and yet a positive experience. Communication is essential to effective nursing and the nurse working with African-American clients would do well to become familiar with Black English. One cannot discuss working with African-American clients unless they fully understand the definition of racism. It is the individual and institutional expression of the superiority of one group's cultural heritage over another and the possession of power to impose those standards broadly upon the less powerful group. Since minorities in general don't possess a share of economic, social, and political power equal to that of whites in our society, they are by definition unable to be racist. Therefore, when the culturally different nurse faces an African-American client who is hostile and angry it would be incorrect to say that the incident is a result of "reverse racism". It would be best to continue to treat the client with respect, acknowledging to oneself that the history of oppression may be the instigating factor in the client's inappropriate response to nurses who are attempting to provide appropriate, culturally specific healthcare services to African-American clients. Below7 are guidelines the transcultural nurse can use to provide effective care when working with this population.

STRATEGIES FOR PROVIDING EFFECTIVE HEALTH CARE FOR AFRICAN-AMERICAN CLIENTS

  1. Become aware of the historical and current experience of being an African-American in the United States.
  2. Consider the way personal values influence the way the client is viewed and the resulting standard of care given to the client.
  3. Be sensitive to spiritual values and the value of the family and the church when making a health care plan.
  4. Be sensitive to variations in African-American norms due to normal adaptations to stress and be flexible enough to accept these variations.
  5. When working with African-American clients, it is important to become familiar with Black English and accept its use by the client.
  6. Learn to acknowledge and to be comfortable with die client's cultural differences.
  7. Do not generalize information gathered through research to all African-American clients. Use this information as a base of knowledge, treating each client as an individual.