Meanings and Expressions of Care Meanings and Expressions of Care and Caring For Self and Others by and Caring For Self and Others by Somali Adolescents attending an Somali Adolescents attending an urban American School: urban American School: A Mini-A Mini-

Ethno Nursing StudyEthno Nursing Study

Rose NambozoRose NambozoThesis DefenseThesis Defense

December 10, 2010December 10, 2010

PurposePurpose

To increase understanding of the To increase understanding of the meanings and expressions of care meanings and expressions of care and caring for self and others as and caring for self and others as identified by Somali adolescents, age identified by Somali adolescents, age 15-17, who are attending an urban 15-17, who are attending an urban American school. American school.

ObjectivesObjectives To identify patterns of health and health seeking To identify patterns of health and health seeking

behaviors among Somali adolescentsbehaviors among Somali adolescents

To respect the importance of the lived experiences To respect the importance of the lived experiences as expressed by the Somali adolescents who are as expressed by the Somali adolescents who are attending an urban American schoolattending an urban American school

To respond competently to cultural differences and To respond competently to cultural differences and similarities among the Somali adolescents similarities among the Somali adolescents

To provide insights as to how the educational To provide insights as to how the educational system can support culturally congruent models of system can support culturally congruent models of wellness and health promotion among a diverse wellness and health promotion among a diverse student bodystudent body

Why was this Study Done?Why was this Study Done? Am a mother of an adolescentAm a mother of an adolescent Somali adolescents have a higher than Somali adolescents have a higher than

average rate for failing in school when average rate for failing in school when compared to Caucasian students compared to Caucasian students

Immigrant and refugee students are at a Immigrant and refugee students are at a disadvantage educationally & more disadvantage educationally & more vulnerable to of health and wellness vulnerable to of health and wellness concerns directly related to cultural tension concerns directly related to cultural tension and cultural clashes and cultural clashes

Cross-cultural concerns expressed by Cross-cultural concerns expressed by teachers and school nurses related to teachers and school nurses related to social, health and educational needs of a social, health and educational needs of a diverse student populationdiverse student population

((Masney & Ghahremani-Ghajar, 1999; Blake et al., 2001; American Masney & Ghahremani-Ghajar, 1999; Blake et al., 2001; American Academy of Pediatrics, 1997; Carlsten & Jackesen, 2003)Academy of Pediatrics, 1997; Carlsten & Jackesen, 2003)

Diverse Population in MinnesotaDiverse Population in Minnesota

MN is home to the MN is home to the country’s largest country’s largest population of Somalis population of Somalis

Most live in metro areaMost live in metro area Somali children attend Somali children attend

urban schoolsurban schools Somalis have moved to Somalis have moved to

Rochester, Owatonna, Rochester, Owatonna, and other Minnesota and other Minnesota communities communities

Attitudes and behaviors Attitudes and behaviors of Somali youth of Somali youth influenced & shaped by influenced & shaped by cultural worldviewcultural worldview

Augsburg-Augsburg-Fairview Fairview Academy Academy for Health for Health CareersCareers

Horn of Africa• Somalia is in East Africa Somalia is in East Africa along the Indian Ocean. It along the Indian Ocean. It borders Djibouti to the borders Djibouti to the north, Ethiopia to the west, north, Ethiopia to the west, and Kenya to the south.and Kenya to the south.• The country is a desertThe country is a desert• The population estimate is The population estimate is unknown unknown • Civil war is on-goingCivil war is on-going• There has been no There has been no officially language in officially language in Somalia, though some Somalia, though some Somali people speak Arabic, Somali people speak Arabic, Oromo, and English. Oromo, and English. • Islam is a dominant Islam is a dominant religion of Somalia religion of Somalia

Statement ProblemStatement Problem

The American Academy of Pediatrics The American Academy of Pediatrics ( 1997) noted that immigrant and ( 1997) noted that immigrant and refugee children could have refugee children could have difficulties in adapting to school due difficulties in adapting to school due to stress induced by resettlement to stress induced by resettlement challenges. This leads to learning challenges. This leads to learning disabilities affecting their disabilities affecting their performance in school.performance in school.

Dr. Leininger’s Theory of Culture Dr. Leininger’s Theory of Culture Care Diversity and UniversalityCare Diversity and Universality

Provided the theoretical framework for this study

- Leininger - Leininger (2006)(2006)

Dr.Leininger’s WordsDr.Leininger’s WordsGo to the people live among them;Go to the people live among them;Learn from them;Learn from them;Love them, start with what they know, Love them, start with what they know, Build on what they have; but of the best Build on what they have; but of the best

leaders when their task is done, the leaders when their task is done, the people will remark: “We have done it people will remark: “We have done it ourselves.”ourselves.”

People will forget what you say, they will People will forget what you say, they will forget what you do, but they will never forget what you do, but they will never forget how you make them feel.forget how you make them feel.

Goal of TheoryGoal of Theory Culturally Congruent Care that Culturally Congruent Care that

contributes to the health and well contributes to the health and well being of peoplebeing of people

Culture Care preservation and /or Culture Care preservation and /or maintenancemaintenance

Culture Care Accommodation and /or Culture Care Accommodation and /or NegotiationNegotiation

Culture Care Repatterning and/or Culture Care Repatterning and/or Restructuring.Restructuring.

Domain of inquiryDomain of inquiry

The meanings and expressions of The meanings and expressions of care and caring for self and others as care and caring for self and others as identified by the Somali adolescents identified by the Somali adolescents age 15-19 who are attending an age 15-19 who are attending an urban American school”urban American school”

Key Inquiry FocusKey Inquiry Focus

Caring strengths expressed and Caring strengths expressed and sustained by culture, society, and sustained by culture, society, and environmentenvironment

Nursing care practices support Nursing care practices support Somali adolescents in caring for Somali adolescents in caring for themselvesthemselves

Research QuestionsResearch Questions What does health mean to Somali adolescents What does health mean to Somali adolescents

in an American culture?in an American culture? What activities do Somali adolescents believe What activities do Somali adolescents believe

keep them healthy?keep them healthy? What role does Somali culture play in shaping What role does Somali culture play in shaping

adolescent health and illness behaviors?adolescent health and illness behaviors? What is the most difficult challenge integrating What is the most difficult challenge integrating

into American culture?into American culture? What are the transcultural health challenges in What are the transcultural health challenges in

meeting the wellness care needs of Somali meeting the wellness care needs of Somali students in an urban school setting?students in an urban school setting?

Study Design & Key Participants Study Design & Key Participants

Somali adolescents as Key Somali adolescents as Key Participants/InformantsParticipants/Informants

Somali adults as general informantsSomali adults as general informants School personnel who know the School personnel who know the

culture as general informantsculture as general informants

Theory Assumptive PremisesTheory Assumptive Premises Key participants can talk about their Key participants can talk about their

caring experiences caring experiences Beneficial nursing care occurs when Beneficial nursing care occurs when

meanings and expressions of Somali meanings and expressions of Somali adolescents are known and applied in adolescents are known and applied in culturally appropriate ways.culturally appropriate ways.

Culture care concepts, meanings, and Culture care concepts, meanings, and patterns vary transculturally with patterns vary transculturally with commonalities and differencescommonalities and differences

Culturally congruent care occurs when Culturally congruent care occurs when patterns are known and used in patterns are known and used in meaningful waysmeaningful ways

Literature Review: Cultural Social Literature Review: Cultural Social Structure Dimensions/FactorsStructure Dimensions/Factors

Cultural values and life stylesCultural values and life styles Kinship and social factorsKinship and social factors Technological factorsTechnological factors Economic factorsEconomic factors Educational factorsEducational factors Political factors Political factors Religious and philosophical factorsReligious and philosophical factors Worldview and healthWorldview and health

Life WaysLife WaysGender roles are highly respected Gender roles are highly respected

within this culture groupwithin this culture group. .

Cultural ValuesCultural Values

Nutrition and FoodNutrition and FoodSomali diet prohibits pork according to Islamic tradition. Lunch is the heaviest Somali diet prohibits pork according to Islamic tradition. Lunch is the heaviest

and most important meal of the day whereby family members eat together. and most important meal of the day whereby family members eat together. Depending on the socio-economic status of the family.Depending on the socio-economic status of the family.

                                                            Ingredient

Kinship and Social factors

An extended family structure often provides a cooperative path to

economic stability and advancement for the Somali.

Children in the FamilyChildren in the Family

Child Rearing Practices Child Rearing Practices

Technological Factors Technological Factors

Educational factorsEducational factors

Economic factorsEconomic factorsMost Somalis women are farmers; men cattle keepersMost Somalis women are farmers; men cattle keepers

Economic Factors Economic Factors

Religious / PhilosophicalReligious / Philosophical

Mosque- IslamMosque- Islam

Islam RespectIslam Respect

                                                       

Traditional healingTraditional healing Practices Practices

CircumcisionCircumcision

Both male &Female Children are Both male &Female Children are circumcisedcircumcised

Political Political FactorsFactors

                              

FindingsFindings

IsolationIsolation Loneliness/StressLoneliness/Stress Language/Communication Language/Communication

BarriersBarriers Economic dependenceEconomic dependence TimeTime Settling in and copingSettling in and coping

Isolation Isolation Cultural Cultural

changechange Affected Affected

by warby war Moving to Moving to

another another countrycountry

Culture shockCulture shock

Not everyone experiences Not everyone experiences culture shock. culture shock.

Some people overcome culture Some people overcome culture shock rather quickly, others may shock rather quickly, others may take longer to make a positive take longer to make a positive adjustment to their new adjustment to their new surroundingssurroundings

Language Barrier/CommunicationLanguage Barrier/Communication

Settling and CopingSettling and Coping

Immigrants don’t only learn traditional “American” customs: they co-mingle with other immigrant groups

Like other immigrants not yet fluent in EnglishSomali adolescents are working hard to improve their

language skills.

ELL Somali female students in a classroom

Somali adolescents in Englishlanguage classes

Adjusting to a new way of life, Somali adolescents begin to participate in and exercise their civic privileges, from voting and volunteerism

to running for elected office

Time-ChangesTime-Changes

SignificanceSignificance

Study will lead to increase understanding Study will lead to increase understanding by educators and community nurses, of by educators and community nurses, of the meanings of health and illness, and the meanings of health and illness, and the caring behaviors that Somali the caring behaviors that Somali adolescents practice to stay healthy in a adolescents practice to stay healthy in a school setting. school setting.

Findings will relate to how the education Findings will relate to how the education system can support culturally congruent system can support culturally congruent models of wellness and health promotion models of wellness and health promotion for Somali adolescents.for Somali adolescents.

SignificanceSignificance

Will add to the body of transcultural Will add to the body of transcultural nursing knowledge about the nursing knowledge about the worldview of Somali adolescents in worldview of Somali adolescents in an American education system and an American education system and their health and illness behaviors. their health and illness behaviors.

Culture Care AccommodationCulture Care Accommodation Develop educational tools on finding comprise with cultural Develop educational tools on finding comprise with cultural

differences that affect family and community.differences that affect family and community. Recognize Somali Adolescents as instrumental and vital for Recognize Somali Adolescents as instrumental and vital for

health of familyhealth of family Promote practice built on shared responsibility for health, Promote practice built on shared responsibility for health,

promote relationship as primary to healthpromote relationship as primary to health Incorporate caring for Somali adolescents as influential on Incorporate caring for Somali adolescents as influential on

health and well-being.health and well-being. Develop care models with philosophies supporting Somali Develop care models with philosophies supporting Somali

culture i.e. care of generosity.culture i.e. care of generosity. Health staff and teachers to be aware of the potential for Health staff and teachers to be aware of the potential for

situations where cultural practices intersects with health to situations where cultural practices intersects with health to influence learning and what accommodations can be made influence learning and what accommodations can be made to incorporate both cultural practice and western medicine to incorporate both cultural practice and western medicine to ensure adherence. to ensure adherence.

Culture Care RepatterningCulture Care Repatterning

Organize forums and invite dialogue on Organize forums and invite dialogue on caring modalities in support of healthcaring modalities in support of health

Build trust and establish rapport with Build trust and establish rapport with Somali adolescents who are gatekeepers Somali adolescents who are gatekeepers for health and cultural issues in their for health and cultural issues in their schools.schools.

Recognizing health and illness as integral Recognizing health and illness as integral to cultural oriented beliefs and practicesto cultural oriented beliefs and practices

Maintain the strength of cultural values for Maintain the strength of cultural values for adolescents in School settings.adolescents in School settings.

SummarySummary Research is needed in health field, with emphasis in Research is needed in health field, with emphasis in

school health, to study the influence of culture on school health, to study the influence of culture on behaviors as it intersects with health and education behaviors as it intersects with health and education of Somali students in a western culture of Somali students in a western culture

More Somali involvement in school health programsMore Somali involvement in school health programs Government involvement in such study will be Government involvement in such study will be

beneficial due to the size of funding and resource beneficial due to the size of funding and resource that will be needed for such a study that will be needed for such a study

The concept of education needs to be defined in the The concept of education needs to be defined in the Somali perspective and applicable goals set to Somali perspective and applicable goals set to reduce or eliminate confusion created in educators reduce or eliminate confusion created in educators assisting Somali students with a main stream culture assisting Somali students with a main stream culture backgroundbackground