Acculturation also may be referred to as assimilation, the process by which an individual develops a new cultural identity. Assimilation means becoming in all ways like the members of the dominant culture. The process of assimilation encompasses various aspects, such as cultural or behavioral, marital, identifica- tion, and civic. The underlying assumption is that the person from a given cul- tural group loses this cultural identity to acquire the new one. In fact, this is not always possible, and the process may cause stress and anxiety (LaFrombose et al., 1993). Assimilation can be described as a collection of subprocesses: a process of inclusion through which a person gradually ceases to conform to any standard of life that differs from the dominant group standards and, at the same time, a process through which the person learns to conform to all the dominant group standards. The process of assimilation is considered complete when the foreigner is fully merged into the dominant cultural group (McLemore, 1980, p. 4).

There are four forms of assimilation: cultural, marital, primary structural, and secondary structural. One example of cultural assimilation is the ability to speak excellent American English. It is interesting to note that, according to the 2010 American Community Survey estimates, 79.4% of the American population over 5 years old speak only English; and 20.6% speak a language other than English (U.S. Census Bureau, 2010). Marital assimilation occurs when members of one group intermarry with members of another group. The third and fourth forms of

32 ■ Chapter 2

assimilation, those of structural assimilation, determine the extent to which social mingling and friendships occur between groups. In primary structural assimila- tion, the relationships between people are warm, personal interactions between group members in the home, the church, and social groups. In secondary struc- tural assimilation, there is nondiscriminatory sharing—often of a cold, impersonal nature—between groups in settings such as schools and workplaces (McLemore, 1980, p. 39).

The concepts of socialization, assimilation, and acculturation are complex and sensitive. The dominant society expects that all immigrants are in the pro- cess of acculturation and assimilation and that the worldview we share as health care practitioners is shared by our patients. Because we live in a pluralistic society, however, many variations of health beliefs and practices exist.

The debate still rages between those who believe that America is a melt- ing pot and that all groups of immigrants must be acculturated and assimilated to an American norm, and those who dispute theories of acculturation and believe that the various groups maintain their own identities within the Ameri- can whole. The concept of heritage consistency is one way of exploring whether people are maintaining their traditional heritage and of determining the depth of a person’s traditional cultural heritage.

■ Ethnocultural Life Trajectories Generational differences have been described as deep and gut-level ways of experiencing and looking at the cultural events that surround us. “The differences between generations—and the determination of who we are—are more than distinct ways of looking at problems and developing solutions for problems” (Hicks & Hicks, 1999, p. 4). Changes in the past several decades have created cultural barriers that openly or more subtly create misunderstandings, tensions, and often conflicts between family members, co-workers, and other individuals— as well as between patients and caregivers, especially in the practice of gerontology. The cycle of our lives is an ethnocultural journey and many of the aspects of this journey are derived from the social, religious, and cultural context in which we grew up. Factors that imprint our lives are the characters and events that we interacted with at 10 years of age, more or less (Hicks & Hicks, 1999, p. 25). Table 2–3 provides examples of seminal events that occurred from 1928–2001 and examples of workplace ethics, lifestyle, and social values of various generations.

One example of generational conflict between health care providers and patients is within institutional settings where the patients are cared for not only by people who are immigrants but also by those who are much younger and have limited knowledge as to what has been a patient’s life trajectory. The patient may also be an immigrant who experienced a much different life trajectory than others of the same age and the caregivers. Imagine your life today and what it may have been like to live without a computer, a cell phone, an iPod, or an iPad. Many people may see today’s commonplace objects as “strangers” rather than “friends,” and could be “digital immigrants,” not “digital natives.”

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