Caution: These are broad generalizations and should not be used to stereotype any individuals.

Please read note at bottom first.

Prejudice and Discrimination
Due to the history of slavery, followed by racial discrimination, African American patients may not trust white institutions such as hospitals. For this reason, along with the memory of such horrors as the infamous Tuskegee syphilis experiment (where African American men with syphilis were left untreated), children who are hospitalized may have an adult (mother or grandmother or aunt) stay in or near the child's room at all times.

They may also be very sensitive to what they perceive as discrimination, even when it is not intended. Be especially sensitive.

Do not use the term "gal" to refer to African American women. Particularly for those from the South, it has the same negative connotations as "boy" does for an African American male.

Address as Mr. or Mrs. or by professional title and last name.

Religion
Religion is an important part of the lives of many African Americans. Clergy should be allowed to participate when appropriate. Privacy for prayer is important. Healthcare practitioners may offer to pray with patient if all parties involved feel comfortable with it.

Family/Gender Issues
Family structure may be nuclear, extended, or matriarchal. Close friends may be part of kin support system.

Father or eldest male may be the spokesperson.

Egalitarian decision-making outside the household; father may make final decisions within the household.

Time Orientation: Present
Many have a present time orientation, which may impede use of preventive medicine and follow-up care. Special care should be taken when prescribing preventive measures (such as medication for hypertension) to explain their importance, as well as the need for continuing to take medication (such as antibiotics) even when the symptoms have disappeared.

Due to time orientation & economic factors, they may put off seeing a physician until problems are advanced.

Expression of Pain
Varies widely. May be equally acceptable to be loud or stoic.

Pregnancy & Birth
Traditionally, only females attend birth, but will vary.

May delay bathing & hair washing until post-partum bleeding stops. Offer sponge bath.

Traditionally, African American women in the South would get cravings for red clay dirt when pregnant (pica). Outside of the South, this craving has been replaced by Argo starch. In large amounts, it can cause constipation. In small amounts, it may provide an important comfort measure.

Since menstruation thought to rid the body of dirty and excess blood, any interference with normal menstrual pattern may be feared. Too little flow -- fear bad blood may back up in the body; too much flow -- can weaken the body. Keep in mind when discussing birth control methods.

End of Life Issues
May be taboo to donate organs or blood unless to immediate family member, lest own death be hastened.

Health Related Beliefs & Practices
Natural causes of disease can include improper diet, exposure to cold/wind; unnatural causes can include God's punishment for sin, and voodoo. Treatment should be appropriate to cause.

Rich foods (red) may be thought by some (particularly those in the South) to cause "high" blood, which may be confused with high blood pressure. "High" blood may be treated with clear, white foods to "lower" blood. Since this can include such things as pickle juice, which is very high in sodium, this should be discussed in detail with the patient. "Low" blood is thought to result from too much vinegar, lemon juice, garlic, and not enough red meat. Be sure to clarify the difference between "low" blood, low blood "count," and low blood pressure.

Blood or organ donation may be seen as taboo with the exception of immediate family's needs (may hasten own death if donor).

There is a rich tradition of herbal remedies in the African American culture. Health care providers should be sure to discuss the use of home or herbal remedies to avoid potential drug interactions.

For those who believe in voodoo (usually from South or in rural areas), gastrointestinal (nausea, vomiting, diarrhea, loss of appetite) and unusual behavioral symptoms may be interpreted as a sign of voodoo poisoning, which must be treated by a voodoo practitioner (root doctor).

Note: there is wide variation in cultural practices. The material is drawn mainly from the work of Loudell Snow, and applies largely to lower class Blacks, especially those in the South. Additional material from Locks, S. and Boateng, L. (1996) Black/African Americans. In JG Lipson, SL Dibble, and PA Minarik (Eds.), Culture and Nursing Care: A Pocket Guide (pp. 37-43). San Francisco: UCSF Nursing Press.

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