People of Indian Heritage. People of Turkish Heritage. People of Vietnamese Heritage. Text book(Transcultural Health Care. A Culturally Competent Approach (4th ed.)Purnell, L.D.Publisher: F.A. Davis Company; 4th edition) chapter 25, 37 and 38 in Davis
Michelle_MichyTurkish Culture
Larry Purnell, PhD, RN, FAAN
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
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Overview/Heritage
Türkiye, as it is written in Turkish, means “land of Turks.” Referred to as a geographic, religious, and cultural crossroads, the Republic of Türkiye is situated at the geographic intersection of Europe, Asia, the Middle East, and Africa.
While Turks have emigrated throughout the world, many live in Western Europe, largely as a result of “guest worker” programs.
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Overview/Heritage
Today, the Republic of Türkiye is politically stable and continues to adapt economically to reforms.
Türkiye remains strategically important to the West and is a strong ally of the United States.
The Turkish immigrant population in the US differs significantly from most of the Turkish population in Europe, both in terms of demographic makeup and socioeconomic status and integration.
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Overview/Heritage
Over 202,000 people of Turkish descent live in the United States.
They live in 42 states, with over half living in New York, California, New Jersey, and Florida.
Just over half of the individuals in this group were born outside the United States.
Most arrived in the US before 1980.
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Overview/Heritage
A high proportion of Turks in the United States come from the elite and upper-middle classes, interspersed with smaller groups of middle-class students and skilled laborers who are supported privately or by the government.
Many Turks sought advanced American education in highly technical fields, leading to more abundant employment opportunities in the United States upon completion of their studies.
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Communication
A Uralic-Altaic language, Turkish is spoken by 90% of the population and has approximately 20 dialects.
Differences in some of the dialects are so great that they are considered different languages.
The Turkish alphabet is much like the English alphabet, although it does not have a “w” or an “x” and additional sounds are symbolized by an diacritical mark over vowels.
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Communication
The Turkish language does not distinguish gender pronouns (ie, “he” from “she” or “her” from “his.”) Therefore, Turks when learning English may inadvertently confuse these pronouns.
Turkish distinguishes a formal from an informal “you,” signifying the importance of status in Turkish society.
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Communication
Speaking in loud voices is common; this does not always signify anger but rather excitement or deep involvement in a discussion.
More than one person may speak at the same time or interrupt another person; this is not necessarily considered rude.
However, someone of lower status should not interrupt someone of higher status.
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Communication
Group affiliation is valued over individualism in Turkish society. In fact, identity may be determined by family membership or group, school, and work associations.
Turks generally do not desire much privacy and tend to rely on cooperation between family and friends, although competition between groups can be fierce.
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Communication
Turks value harmony over confrontation.
The outward show of feelings is less restrained.
For women, expressions of anger are usually acceptable only within same-sex friendships and kinship networks or toward those of lower social status.
Generally, women are not free to vent their anger toward their husbands or other powerful men.
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Communication
Touching, holding hands, and patting one another on the back are acceptable behaviors between same-sex friends and opposite-sex partners.
Same-sex friends, especially among the older generations, are commonly seen holding hands or linking arms while walking.
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Communication
Very strict Muslims may not shake hands or touch members of the opposite sex, especially if they are not related.
When interacting with someone of higher status, one is expected to maintain occasional eye contact to show attention; however, prolonged eye contact may be considered rude, or may be interpreted as flirting.
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Communication
Turkish people tend to dress formally; men wear suits rather than sports jackets and slacks on social occasions.
Women tend to dress modestly, wearing skirts and dresses rather than slacks. More traditional Muslim women may wear very modest clothing and cover their heads with a scarf, either black or a colorful print.
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Communication
However, styles continue to change, and denim jeans and casual dress are becoming common among young people for less formal occasions.
Turks openly display emotions such as happiness, disgust, approval, disapproval, and sadness through facial expressions and gestures.
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Communication
No” is indicated by raising the eyebrows or lifting the chin slightly, while making a snapping or “tsk” sound with the mouth.
Appreciation may be expressed by holding the tips of the fingers and thumb together and kissing them and is commonly used to express appreciation for food.
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Communication
Turkish people take pride in keeping their homes immaculately clean, and one is expected to remove one’s shoes inside the home.
Most Turkish hosts in Türkiye and many in the United States offer slippers to their guests.
Whether wearing shoes or not, showing the sole of one’s foot is considered to be offensive in Turkish culture.
Women are expected to sit modestly with knees together and not crossed.
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Communication
Turks tend to have a relaxed attitude about time; social visits can begin late and continue well into the night.
While punctuality in social engagements is not highly important, in business relationships, punctuality among Turkish Americans is gaining in importance.
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Communication
Turks value status and hierarchy. Demonstrating respect for those of higher status is mandatory and determines the quality of interactions with a person.
Strangers are always greeted with their title, such as Bey (Mr.), Hanim (Mrs., Miss, or Ms.), Doktor, or Profesör.
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Communication
When friends or family members greet, it is customary for each to shake hands and to kiss one another on each cheek.
Traditionally, when greeting someone of very high status or an elderly person, one might grasp his or her hand and kiss it, and then bring it to touch one’s forehead in a gesture of respect.
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Family Roles & Organization
In a very traditional Turkish home, the father is considered the absolute ruler.
The concept of izin (permission or leave to do something specific) captures this significance.
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Family Roles & Organization
Less traditional families show more equality between spouses, especially in nuclear families in which the wife is well educated.
Yet, remnants of traditional family structure prevail; the husband often acts as the ultimate decision maker, especially in financial matters.
Women may work full time outside the home in addition to assuming full responsibility for running the daily activities inside the home.
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Family Roles & Organization
Legal marriage in Türkiye does not permit polygamy, although some may practice it outside.
A woman’s age, and the number, age, and gender of her children influence her status in the family and the community. A young “gelin” (woman age 15 to 30) has the lowest status. The “middle-aged” woman (30 to 45) has medium status while the “mature” woman (45 to 65) has the highest status.
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Family Roles & Organization
In “old age” (65 or older), a woman is highly respected but is not powerful.
However, this status varies according to education, religious practice, socioeconomic level, urbanization, and professional achievement.
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Family Roles & Organization
Children are held very dear in the Turkish family and they are expected to act as young children, not small adults.
They are accustomed to receiving attention from family, friends, and visitors.
Kissing children and pinching their cheeks is quite common.
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Family Roles & Organization
Once children enter school, they are expected to study hard, show respect, and obey their elders, including older siblings.
Girls are expected to help care for younger siblings, to help at mealtimes, and to learn to cook.
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Family Roles & Organization
Traditionally, children are not allowed to act out or talk back to their superiors.
Light corporal punishment is generally acceptable.
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Family Roles & Organization
Male circumcision is a major rite of passage.
This is a time of celebration within the extended family, and newly circumcised boys are honored with gifts.
Traditionally, boys can be circumcised up to the age of about 12, although the modern trend is to perform the circumcision in the hospital shortly after birth.
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Family Roles & Organization
Urban adolescents are beginning to date in pairs in addition to the more traditionally accepted practice of group outings.
However, sexual interaction is strongly discouraged among youth and the unmarried, especially for young women.
Virginity in unmarried women is a strong cultural value.
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Family Roles & Organization
A key objective among Turks is socioeconomic advancement, including education, better professional opportunities, and material success.
Although financial independence is valued in Turkish culture, independence from the family is not encouraged.
Adult children, especially men, remain an integral part of their parents’ lives, and parents expect their children to care for them in their old age.
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Family Roles & Organization
Because respect is highly valued in Turkish society, maintaining or improving status in the community is of key importance.
Individuals must always consider what impact their actions will have on the family and often they consult parents or other family members before making major decisions.
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Family Roles & Organization
Young people living in Türkiye generally live in their parents’ home until they are married, unless school or work necessitates other arrangements.
Family-initiated marriages range from rare contractual agreements between parents to the relatively common introduction and gentle encouragement of a newly formed couple.
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Family Roles & Organization
Elders in Turkish culture are attributed authority and respect until they become weak or retired, at which time their authoritative roles diminish.
Individuals are socialized to take care of elderly parents, regarding it as normal and not as an added burden.
Grandparents play a significant role in raising their grandchildren, especially if they live in the same home.
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Family Roles & Organization
The extended family is very important in Turkish culture.
Even the apparent increase in nuclear households does not rule out the networks among closely related families.
Whether or not they live under the same roof, a young family may still live under the supervision of the husband’s parents or at least maintain an interdependent relationship.
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Family Roles & Organization
Divorce is becoming more common in Turkish society, but remains socially undesirable.
Widows, however, are generally taken care of by their late husband’s family and, depending on their age and socioeconomic background, may have the option to remarry.
Premarital cohabitation and unwed motherhood is strongly discouraged.
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Family Roles & Organization
Homosexuality is only beginning to be received “at a distance.” In fact, one of the most popular entertainers in Türkiye is a homosexual and a transvestite and is accepted as such.
However, most Turks would be hesitant to associate themselves with the gay community.
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Workforce Issues
Because Türkiye is a group-oriented culture, the Turkish workplace may be more team oriented.
Turkish relationship orientation may lead to dependence on personal contacts and networks to accomplish tasks.
Developing these relationships and networks may appear as nepotism or as too much socializing from the American perspective.
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Workforce Issues
Hierarchical structure is highly pervasive throughout Turkish culture, and the workplace is no exception.
Turkish employees expect an authoritative relationship between superior and subordinates.
However, indirect criticism is expected and appreciated to “save face.”
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Workforce Issues
A Turk may be highly offended if openly criticized, especially if done in front of other people.
They may be reticent about asking questions for fear of exposing a lack of knowledge.
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Workforce Issues
Turks perceive that aggressive face-to-face confrontation may cause relationships to deteriorate.
The dominant means of conflict resolution is collaboration reinforced by compromise and forcing.
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Workforce Issues
Many women do not work because it interferes with child care, the order of the home, and it requires them to be together with men from outside the immediate family.
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Biocultural Ecology
Turkish population is a mosaic in terms of appearance, complexion, and coloration.
Appearances range from light-skinned with blue or green eyes to olive or darker skin tones with brown eyes.
Mongolian spots, usually found at or near the sacrum, are common among Turkish babies and should not be confused with bruising.
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Biocultural Ecology
Malaria has not been fully eradicated in Türkiye, especially in the southeast.
Endemic goiter associated with iodine deficiency is a major health problem in Türkiye.
Behçet’s disease, a syndrome of unknown etiology, is prevalent in Mediterranean countries, the Middle East, and Japan and primarily affects males between the ages of 20 and 40.
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Biocultural Ecology
Common health conditions among Turks are lactose intolerance, thalassemia, cardiovascular diseases, cancer, obesity, hypertension, diabetes, tuberculosis, and conditions related to high smoking rates among men and women.
The most prevalent food- and water-borne diseases are infectious hepatitis and sporadic cases of salmonellosis and dysentery.
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High-risk Health Behaviors
Cigarette smoking is widespread in Türkiye and tends to start at an early age. Türkiye, a major producer of tobacco in the world, has instituted very limited anti-tobacco activities.
Turks tend to consume less alcohol than Americans or Europeans, perhaps as a result of the Muslim culture that discourages more than moderate alcohol use.
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High-risk Health Behaviors
The tendency of Turkish men to view themselves as strong/immune to disease and the traditional cultural view condoning male promiscuity increases the danger for both the man and his wife.
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Nutrition
Turkish cuisine is influenced by the many civilizations encountered by nomadic Turks over the centuries, as well as by a mixture of delicacies from different regions of the vast Ottoman Empire.
Therefore, food choices are varied and tend to provide a healthy, balanced diet.
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ClickerCheck
A common genetic/hereditary condition among Turks is
Hemophilia.
Thalassemia.
Anemia.
Sickle cell anemia.
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Correct Answer
Correct answer: B
A common genetic/hereditary condition among Turks is thalassemia.
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Nutrition
Tea and a snack is always on hand for visitors, and dinner guests may have difficulty finishing everything on their plates
Turkish hostesses may relentlessly offer to replace what has been eaten.
Polite guests refuse the first offer, but the hungry need not worry; offers are made again and again.
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Nutrition
Turkish cooking is not terribly spicy and is prepared artfully and fastidiously, as Turkish appetites tend to be discriminating.
Breakfast is typically a simple meal of white feta cheese (beyaz peynir), olives, tomatoes, eggs, cucumbers, toast, jam, honey, and Turkish tea.
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Nutrition
Hot midday or evening meals may include any of the foods described below:
Çorba (soups) range from light to substantial.
Meze (hors d’oeuvres) include a great variety of small dishes, either hot or cold, such as yaprak dolma (stuffed grape leaves in olive oil), olives, circassian or çerkez tavuğu (chicken with walnut sauce), çiroz (dried mackerel), leblebi (roasted chick peas), or sigara böreği (a savory cheese pastry fried until crispy).
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Nutrition
Salads include lettuce, tomatoes, cucumbers, onions, and other raw vegetables with a dressing of olive oil and lemon juice or vinegar.
Olive oil and lemon are staples in Turkish culinary preparation.
Turks generally prepare meat in small pieces in combination with other vegetables, potatoes, or rice.
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Nutrition
Famous Turkish cuisine includes köfte, small spicy meatballs, and kebab, skewered beef or lamb and vegetables.
While poultry is less common, fish has a special place in Turkish cuisine.
Türkiye is the birthplace of yogurt, which is an essential part of the Turkish diet and is generally served with hot meals rather than as cold breakfast food.
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Nutrition
Vegetables are served cooked or raw, hot or cold, as part of a stew or casserole, or stuffed (dolma) with meat, rice, and currants.
Rice and börek are important parts of Turkish culinary tradition. Börek is made by wrapping yufka (thin sheets of flour-based dough) around meat, cheese, or spinach and then frying or baking until the dough is flaky.
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Nutrition
Turkish desserts fall into 4 categories:
Rich and sweet pastry, such as baklava
Puddings
Komposto (cooked fruits)
Fresh fruits. In fact, most meals are concluded with fresh fruit and coffee or tea.
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Nutrition
Turkish kahve, from which the English word coffee is derived, is famous for its dark, thick, sweet taste.
The Muslim religion requires abstinence from eating pork and drinking alcohol, but not all Muslims abstain, depending on their degree of religious practice.
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Nutrition
The Islamic tradition of Ramazan, or Ramadan in Arabic countries, is a month of fasting (oruç tutmak) observed by practicing Muslims throughout the world.
During Ramazan, one is not allowed to eat or drink anything from sunrise to sunset as a test of willpower and as a reminder of the preciousness of the food provided by a gracious Allah (God).
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Nutrition
Generally, pregnant and postpartum women, travelers, and those who are ill are excused from fasting but may be required to make up lost time at a later date.
The evening meal, iftar, is something to which all look forward with great anticipation, and Turkish women, who almost invariably do all the cooking, create veritable feasts each night.
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Pregnancy and Childbearing Practices
Motherhood is accorded great respect, and pregnant women are usually made comfortable in any way possible, including satisfying their cravings.
Pregnant women may continue their daily activities or work as long as they are comfortable.
In traditional Turkish culture one of the most important desires of a married woman is to have a child.
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Pregnancy and Childbearing Practices
A woman who has not had a child is faced with social pressure and accusations and thus may try to use some traditional practices to increase fertility.
Some women damage their bodies by using these traditional practices and sometimes the damage is permanent.
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Pregnancy and Childbearing Practices
The pregnant woman is always encouraged to keep up her strength by eating foods that are rich in nutrients.
Many pregnant women take prenatal vitamins, drink a lot of milk, and apply salves such as Vaseline to avoid stretch marks.
Light exercise, such as walking, is encouraged.
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Pregnancy and Childbearing Practices
It is acceptable, though not common, for the husband and the birth mother’s father to be present during the birthing process.
Expressions of discomfort and pain are quite acceptable.
However, Laz women from the Black Sea area tend to be stoic.
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Pregnancy and Childbearing Practices
The postpartum period can last up to 40 days.
Light exercise is encouraged during this period and bathing, an important part of the Muslim tradition, is strongly encouraged.
A special food called log˘usalik is served to the postpartum woman to increase milk production.
Breastfeeding women drink hot soups and other fluids such as milk.
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Pregnancy and Childbearing Practices
At birth, a small blue bead called a nazar boncuk, believed to protect the child from the “evil eye,” is usually placed on the child’s left shoulder.
Other traditional practices include placing iron under the baby’s mattress to protect against anemia, tying a yellow ribbon to the crib to ward against jaundice, and placing a red bow on the crib to distract any envy or negativity.
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Pregnancy and Childbearing Practices
Practices used to make childbirth easier include unlocking places that are open, untying the woman's hair ribbons, unbuttoning buttons, standing straight and turning so the child will move, drinking water that has been prayed over by religious leaders, enclosing the woman around her waist and rocking her three times, and putting her in a blanket and rocking her three times.
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Pregnancy and Childbearing Practices
Water is not given to a newborn infant until the call to prayer has been announced three times; otherwise, the infant will have bad breath.
At the end of the 40 days, she returns to normal life.
She is bathed with abundant water and prayers are read.
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ClickerCheck
The home health nurse found an iron under the mattress of a two month old baby. The iron prevents the baby from
The evil eye.
Thalassemia.
Anemia.
Jaundice.
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Correct Answer
Correct answer: C
Placing an iron under the baby’s mattress prevents anemia.
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Death Rituals
When death occurs, the deceased individual's next of kin cry in the most natural manner.
Neighbors who hear about the death gather at the home of the deceased to share in the suffering of the next of kin, to console them, and to help with the initial preparations.
Having prayers said is a common practice.
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Death Rituals
Turkish Muslims do not generally practice cremation because the body must remain whole.
Frequently, the body is displayed in the home for a day or two; it is then placed in a coffin and taken to the cami (mosque) to be visited primarily by men.
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Death Rituals
Preparations for burial include three important procedures: bathing, wrapping in a shroud, and funeral prayers said outside a mosque.
If someone dies in the morning, they are buried after the mid-afternoon prayers; those who die during the night are buried in the morning.
The funeral may be delayed for distant relatives.
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Death Rituals
Common rituals after death are closing the eyes of the deceased, tying the chin, turning the head towards Mecca, putting the feet next to each other, putting the hands together on the abdomen, and removing clothing.
In some places the bed is changed; a knife, iron or other metal object is placed on the abdomen of the deceased; the Koran is read at the head of the deceased.
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Death Rituals
After the burial, a meal honors the deceased, which signifies moving the deceased into the afterlife.
If these rituals are not completed, the spirit of the deceased will be left behind.
The traditional mourning period is 40 days, during which time traditional women may wear black clothes or a black scarf.
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Death Rituals
Although Muslim Turks believe in the afterlife, death is always an occasion of great mourning.
An expression of sympathy to one who has just lost someone to death is Basiniz sag˘ olsun (may your head be healthy), hoping that one is not overwhelmed with grief.
Mourning is the most important and careful behavior after a death occurs.
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Spirituality
Ninety-eight percent of Turks are Muslim, but freedom of religion is mandated by the Turkish secular state.
Most are Sunni Muslims, with a minority from the Alevi Muslim group.
Other religious minority groups include Jews (mostly Sephardic) and Christians.
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Spirituality
Traditional prayer is practiced five times each day and can take place anywhere, as long as one is facing the holy city of Mecca.
A special small rug, called seccade, is used for praying.
When entering the cami, shoes are always removed and women must cover their heads.
Men and women go to separate parts of the cami for prayer.
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Spirituality
One prepares for prayer by ritual cleansing called abdest, which, at minimum, includes washing the face, ears, nostrils, neck, hands to the elbow, and feet and legs to the knee, three times each.
A woman does not enter into a religious activity unless she is ritually pure: women who are menstruating or who have recently given birth are excluded.
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Spirituality
Turks rely on their religious beliefs and practices and their family and friends for strength and meaning in life.
Spiritual leaders or healers are sought most often for assistance with relationship or emotional problems and, less frequently, for physical problems.
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Health-care Practices
Most Turks rely on Western medicine and highly trained professionals for health and curative care. However, remnants of traditional beliefs continue to have an impact on health-care practices.
A common explanation for the cause of illness is an imbalance of hot and cold. For example, diarrhea is thought to come from too much cold or heat; pneumonia results from extreme cold.
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Health-care Practices
Terminally ill clients are generally not told the severity of their conditions.
Informing a client of a terminal illness may take away the hope, motivation, and energy that should be directed toward healing, or it may cause the client additional anxiety related to the fear of dying and concern about those being left behind.
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Health-care Practices
In general, women are responsible for the actual care taking of the ill and the elderly in the home.
In traditional households, the mother-in-law or father-in-law, depending on who controls the finances in the family, makes decisions about going to the physician.
The person who is respected as the most educated has primary input into decisions about health care.
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Health-care Practices
Türkiye has one of the highest rates of consumption of over-the-counter antibiotics and painkillers; aspirin is commonly used as a panacea for a variety of ailments, including gastric upset.
Turks commonly consult a pharmacist before visiting a physician.
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Health-care Practices
Using rubbing alcohol or a wet cloth to bring down a fever and warming the back to treat coughing.
Türkiye encourages health tourism at their 1500 thermal spas, which are frequented for treating conditions, such as rheumatism, respiratory and digestive problems, diabetes, skin conditions, gallstones, female diseases, kidney and heart conditions, nerves, obesity, and hyperlipidemia.
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Health-care Practices
The concept of the “evil eye” is prevalent.
Speaking too well of one’s health may incur misfortune through others’ envy or nazar.
Cologne is sprinkled on the hands of guests before and after eating to provide cleanliness and a fresh lemon scent.
Inhaling from a cloth or handkerchief doused with cologne may be used for relief from motion sickness.
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Health-care Practices
Turkish culture allows freedom to express pain, either through emotional outbursts or through verbal complaints.
Although stigma is attached to mental illness, many families seek treatment or care for the client at home.
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Health-care Practices
Seriously ill people are expected to conserve their energy to allow their minds and bodies to fight their illnesses; thus, reducing their energy expenditure.
During hospitalization, refakatçí refers to the person who stays overnight with the client, providing emotional and physical support and comfort.
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Health-care Practices
Turkish people usually prefer to receive blood from family members.
Muslims traditionally prefer that the body remain intact after death; thus, organ donation and transplantation remains controversial among some Turks. However, former Prime Minister and President Turgut Ozal and his wife promoted organ donation by publicly signing donor cards to encourage others to do so too.
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ClickerCheck
Mr. Oktay, age 66 years, is alert and oriented and has terminal heart failure. His wife does notwant him to know. The nurse should
Abide my the wife’s wishes.
Directly tell Mr. Oktay.
Consult his children.
Ask Mr. Oktay what he knows about his condition.
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Correct Answer
Correct answer D
The first step is to determine what Mr. Oktay knows about his condition.
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Health-care Practitioners
When modern medicine is not available, accessible, or affordable, or when it has not worked, Turks may seek the care of a traditional healer.
Physicians, and to a lesser extent nurses and midwives, have historically been held in very high esteem.
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