Week 7

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

French Canadian Culture

Larry Purnell, PhD, RN, FAAN

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage

More than 2.2 million people of French Canadian descent reside in the United States.
Nowadays, French speaking Canadians, unlike those of the 19th century living in the USA, may have been raised within the French culture but descended from a variety of ethnicities.
The Multiculturalism Canada Act of 1988 provides guidelines for implementing policies regarding multicultural diversity.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage

Before the latter half of the 18th century, most French immigrating to Canada were Catholics.
French Protestants tended to come directly to the United States.
After the French Revolution, more Catholics sought shelter in the US, most coming via Canada settled in the New England states and later dispersed throughout the United States.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage

The Métis, descendants of Native Americans and Europeans, are mainly, though not entirely, French-speaking.
Another major portion of Canada’s French-speaking population are the Acadians who are the descendants of the early French colonists.
Canadians whose first language is French are called Francophones.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage

Canada has become an increasingly diverse society composed of various ethnocultural groups with more than 100 different languages as mother tongue.
Much like that of the US, interethnic marriage patterns have dramatically changed from a multiethnic society to multiethnic individuals.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communication

Canada has two official languages, French and English.
In many homes in the US and in Canada English and French may be used equally.
The French-speaking population may lack sufficient knowledge of the English language to access the workforce and other material.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communication

Among French Canadians, a conversation may be conducted with high voice crescendos, which do not necessarily mean anger or violence.
Volume can increase with the importance and the emotional charge invested in the content of the message.
French Canadians encourage sharing thoughts and feelings.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communication

Using hand gestures for emphasis when speaking is common.
Facial expressions for men and women of all ages are a part of communication, often replacing words.
Spatial distancing for differs among family members, close friends, and the public.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communication

When in the intimacy zone, people may touch frequently and converse in close physical space; however, they tend to avoid physical contact in public.
When greeting another person, men usually shake hands.
Close female friends and family members may greet each other with an embrace.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communication

Maintaining eye contact is an important French Canadian value.
Most French-speaking Canadians have a past, present, and future orientation in their worldview.
More traditional people, and many from rural backgrounds, attach primary importance to living in the present.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communication

Until the late 1970s, women and children took the father’s surname.
Today, under Quebec law, a woman keeps her maiden name throughout her lifetime, although in other parts of Canada this practice is decided between the spouses.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communication

Québécois family of two spouses and two children may well include four different surname combinations: one child may have the father’s surname or the mother’s surname alone or a hyphenated or non-hyphenated surname composed of those of the father and mother. For a second child, the surnames are the same, but in reverse order.
The decision for using surnames rests entirely with the parents.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck

The Métis in Canada are

Mostly English Speaking.

Mostly speak an indigenous dialect.

Descendants of Native Americans and Europeans.

Descendents of French and Arabic.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer

Correct answer: C

a. Descendants of Native Americans and Europeans.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles and Organization

Many older people with a strong religious background maintain a future worldview regarding life after death.
Many of the younger generation reject past traditions and attempt to maintain a balance by enjoying the present, working, and planning for their future.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles and Organization

Traditionally, in French-speaking Canadian families, the man was seen as the moral authority and responsible for material well-being, such as economic provider and purveyor of affection and security.
The woman served as the family mediator and social director as well as being responsible for household activities, child care, and health care.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles and Organization

With more women working, family roles are becoming more egalitarian.
French Canadians have always attributed great value to family relationships and obligations.
Research reports that Francophones are less committed than Anglophones to with respect to marriage, sexual activity, and non-married parenthood.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles and Organization

The greatest source of pride for French Canadian families is to see their children well established with a good education.
The French Canadian family is more nuclear and autonomous than its counterpart in France.
French-speaking Canadian family is known for its closeness, and some families are a “closed” family system.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles and Organization

Traditionally, the Catholic Church dictated the parameters of sexual behavior for French Canadians.
There is a growing trend for couples to live together without marrying.
Many young couples answer that they cannot financially afford to get married.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles and Organization

In 1996, the Canadian government extended health, relocation, and other job benefits to same-sex partners of federal employees.
The Ontario Court of Appeals ruled that same-sex couples must be treated as common-law couples under the Family Leave Act.
Canada is one of the few countries in the world where same-sex marriage is legalized.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Workforce Issues

Opportunities for Francophone nurses to function successfully outside Quebec and in the US are limited if they have not mastered the English language.
Because Francophone culture is more collevistic than individualistic, some may initially have difficulty adapting to an environment where autonomous decision-making is required.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology

Canadians of French descent are white or Caucasian; however, Francophones, as a linguistic group, represent a mosaic of ethnocultural characteristics, including racial differences prompted by acculturation, adoption, and the children of mixed marriages.
Assess individuals for biological risks according to their racial and cultural heritage.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology

Higher incidences of prostate and breast and ovarian cancers have been seen among Francophones.
A high rate of suicide and suicidal ideation, particularly among Francophone adolescents and young adult males, is seen in Canada. It is unknown if this extends in the US.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology

Genetic and hereditary diseases include spastic ataxia Charlevoix-Saguenay type, cystic fibrosis, tyrosinaemia, cytochrome lipase deficiency, familial chylomicronemia resulting from the lipoprotein lipase (LPL) deficiency, hyperlipoproteinemia type I which has been traced to migrants from the Perche region of France.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology

An increased incidence of cystic fibrosis and muscular dystrophy occurs among French-speaking Canadians.
Sickle cell anemia is also higher among Francophones than the general population.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

High-Risk Health Behaviors

Misuse of alcohol, tobacco, marijuana, and psychotropic drugs are major health problems.
Tobacco and alcohol use is highest among French-speaking males and is associated with masculine sex roles, higher self-esteem, and an external locus of control.
The rate of individuals who do not exercise on a regular basis has increased over the last decade.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition

For French Canadians, food is associated with hospitality and warmth. Food is part of all meetings and celebrations.
Common vegetables enjoyed by French Canadians include potatoes, turnips, carrots, asparagus, cabbage, lettuce, cucumbers, and tomatoes.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition

Meat choices are mainly beef, pork, and poultry. Lately, however, lamb has gained popularity.
In Acadia, due to the proximity of the coastal areas, fresh fish and seafood are part of the diet.
Common foods include fricot (stew made with a special spice called summer savory).
French Canadians do not escape the overall trend toward being overweight.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Pregnancy and Childbearing Practices

Until the middle of the 20th century, French Canadians maintained high fertility rates, which is uncommon for a population living in an industrialized country.
This phenomenon, called the “revenge of the cradles,” has never been explained.
The number of children per family has been declining since the mid-1960s.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Pregnancy and Childbearing Practices

Effective contraception and family planning methods such as the pill, intrauterine devices, and tubal ligation have become available to all women.
The pill remains the primary reversible method for birth control.
On the basis of relative frequency, tubal ligation and vasectomy follow the pill as nonreversible methods of fertility control.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Pregnancy and Childbearing Practices

Diaphragms, foams, and creams are not commonly used for birth control, partially because perceptions imply that women are not supposed to, or do not like to, touch their genitals.
The beliefs that condoms reduce the level of sexual feeling during intercourse, or that contraception is not a man’s responsibility, are inversely proportionate to the age of men.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Pregnancy and Childbearing Practices

Few French Canadians practice natural childbirth.
Men are welcomed and encouraged to be in the delivery room with their wives.
Breastfeeding has regained importance after years of bottle feeding.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Pregnancy and Childbearing Practices

In Canada, maternity and paternity leaves are available with pay for a period ranging from 6 to 20 weeks.
Although the movement used in washing a floor resembles that of an exercise aimed at strengthening the perineal muscles, this activity in the past was associated with the onset of labor and early or preterm deliveries.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Pregnancy and Childbearing Practices

French Canadians do not differ from Canadians and others of European origins on issues related to death and death rituals. Expectations are closely related to Christian religious practices, in particular, those of the Roman Catholic Church.
Whether one is an active church-goer or not, religious funerals are the norm.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Death Rituals

Cremation is an acceptable practice.
Supports for those who have lost a family member include openly acknowledging the family’s right to express grief, being physically present, making referrals to appropriate religious leaders, and encouraging interpersonal relationships.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Spirituality

While most French Canadians identify themselves as Roman Catholic and are baptized at birth, they may or may not remain active church members.
Older adults are more inclined to use prayers for finding strength and adapting to difficult physical, psychological, and social health problems.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Spirituality

In times of illness and tragedy, French-speaking Canadians use prayer to help recovery.
Many of the younger generation are not strongly influenced by religious values, beliefs, and faith practices.
The younger generations turn towards spirituality rather than religion.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Health-care Practices

Canada’s ensures free, universal health coverage at any point of entry into the system.
Many people in the upper socioeconomic classes call on their family physicians instead of the local community service centers.
Many lower socioeconomic individuals many do not seek health care until their health becomes a crisis situation.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Health-care Practices

French-speaking Canadians have joined the current trend toward over-the-counter drug use.
Language differences may be a barrier to accessing health care.
French-speaking subjects rate acute pain as more intense than chronic pain, and more affectively laden than the English-speaking subjects.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck

On issues of death and dying, which religion most influences French Canadian’s decision making?
Baptist
Methodist
Catholic
Islamic

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer

Correct answer: C

The Catholic religion has the most influence on decision making for death and dying issues for French Canadians.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Health-care Practices

As a cultural group, French Canadians have no official proscriptions against receiving blood or blood products.
The decision to donate or receive an organ is an individual decision without cultural influence for French Canadians.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Health-care Practitioners

Health-care providers hold a favorable status in the eyes of French Canadians, especially among older people.
The universal health insurance system in Canada makes the folk practitioners less appealing.
Professionals throughout Canada are vigilant in trying to avoid exploitation by traditional and folk healers, who are viewed as practicing outside the law.