Cultural Practices Affecting Health Assessments PDF

CULTURAL PRACTICES AFFECTING HEALTH ASSESSMENTS Nicholas Bachman, MSN, RN Nursing Instructor N113 Medical Surgical Nursing Los Angeles County College of Nursing and Allied Health 1 Objectives Explains cultural variations that will influence physical assessment. Discusses the various techniques of co...

CULTURAL PRACTICES AFFECTING HEALTH ASSESSMENTS Nicholas Bachman, MSN, RN Nursing Instructor N113 Medical Surgical Nursing Los Angeles County College of Nursing and Allied Health 1 Objectives Explains cultural variations that will influence physical assessment. Discusses the various techniques of communication that can inhibit or enhance a health assessment. Describes the nursing implications when interviewing a client from a different cultural background. 2 Cultural Concepts Culture – Thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups Diversity – Refers to the state of being different Factors include sex, gender, age, culture, ethnicity, socioeconomic status, educational attainment, and religious affiliation Occurs between cultural groups but also within a cultural group Cultural Competence – Caregiver’s ability to work effectively within the cultural context of the patient. Includes cultural desire, awareness, knowledge, skills, and encounters 3 1 Cultural Concepts cont’d Race – Social construct which groups humans based on ancestry and cultural & social characteristics, holds no scientific merit Racism – Refers to assumptions held about other groups such as that race is biologically discrete and unequal Can exist at an individual level or at an institutional level Assimilation/Acculturation – Process of developing a new cultural identity Incorporation of traits from another culture, often from the host society or dominant culture 4 Cultural Concepts cont’d Ethnicity – Relationship among individuals who believe they share cultural characteristics that make them a distinct group Often used interchangeably with the term race Ethnography – Study of human cultures with a focus on cultural patterns of behaviors and thoughts. Ethnocentrism – Belief in the superiority of one’s own culture and lifestyle Generalization – Statements of common cultural patterns May not hold true at an individual level which leads to stereotypes 5 Cultural Concepts cont’d Stereotyping – Assumptions that an individual reflects all characteristics of a larger group Prejudice – Preconceived notion that is not based on sufficient knowledge which can lead to discrimination Can be positive or negative Health Disparities – Differences in care experienced by one population compared with another population Diversity, Equity, and Inclusion (DEI) – In Healthcare, increasing access to care in order to decrease disparities in care while reflecting and representing the community more fully 6 2 Transcultural Nursing Madeleine Leininger (1925-2012) is the founder of the worldwide Transcultural Nursing movement Theory of Culture Care: Diversity and Universality Strives for culturally responsive care which takes into account the context in which the client lives. “That the culture care needs of people in the world will be met by nurses prepared in Transcultural Nursing”. “The ultimate goal of the theory is to provide cultural congruent nursing care practices”. 7 Cultural Competence Cultural Desire – Having the motivation to become more culturally aware, knowledgeable, and skillful Cultural Awareness – Examining your own prejudices and biases but also understanding your own cultural background Cultural Knowledge – Obtaining a solid foundation on various cultures around the world Cultural Skills – Ability to collect culturally relevant data in a culturally sensitive manner Cultural Encounters – Face-to-face encounters with individuals from diverse backgrounds and adapting your previously held beliefs to prevent stereotyping 8 Culturally Responsive Care Care centered on integrating client’s values & beliefs into the plan of care Recognize clinical differences among different ethnic and racial groups Know how the patient communicates best (verbal/body language; space/time orientation) Respect other’s belief systems and the effects those beliefs have on well-being Build trust…through honesty, respect, and acceptance of others’ points-of-view/needs 9 3 Verbal Communication Vocabulary, grammar, tone, rhythm, speed, pronunciation, and silence Wide diversity in style within each language Use interpreter if patient doesn’t understand English – in the Hospital call Health Care Interpreter Network (HCIN) 323-2263600 or use the LanguageLine InSight (Interpreter) App Translator – converts written material from one language to another Interpreter – transforms a spoken or signed source language into the equivalent in a target language maintaining the original intent Cultural broker – an effective interpreter engages both the speaker and the listener to effectively transmit the nuances present in each language 10 Nonverbal Communication Majority of communication occurs with body language Facial expressions Touch Eye contact Body position Arm placement Hands/fingers Personal space Silence 11 Personal Space Proxemics is the study of distance between people in their interactions Intimate zone – 0-1 ½ ft Personal zone – 1 ½-4 ft Social zone – 4-12 ft Public zone – 12 ft and beyond Caregivers are often working in a patient’s intimate zone so must be aware at all time of the client’s response 12 4 Nutritional Patterns Staple foods – readily available foods within a certain culture or region Each culture defines what foods to eat or not eat for certain illnesses Be aware of holiday foods for different cultures Be aware of Religious practices associated with foods When in doubt, ask the patient or his/her family Compare ordered diet type with culture 13 Family Relationships Include a cultural assessment of the client and family as part of your overall assessment Roles of specific family members Discuss the client’s wishes in regard to family involvement Do not make assumptions about beliefs or practices of family members Use the richness of diversity within a family group as an asset to your practice 14 Religious & Spiritual Practices Important to the patient? Helps the patient cope? Influences or conflicts with medical decisions? Degree of involvement with spiritual community LAC/USC Chaplains: Spiritual Care Department #409-4715 15 5 Complementary & Alternative Medicine (CAM) Complementary medicine – CAM used together with conventional medicine Alternative medicine – CAM used instead of conventional medicine Western medical practices - Conventional medicine, biomedicine, & allopathic medicine CAM based on practices handed down over thousands of years Examples Egyptian, Chinese, Indian, Greek, and Native American traditional medicine Other therapies are more recent such as bioelectromagnetics, chiropractic, and mind-body approaches 16 Concepts in Alternative Healing Holism - Combination of mental, emotional, spiritual, relationship, & environmental components Humanism - Perspective that mind and body are indivisible; well-being is a combination of personal satisfaction and contributions to the large community Balance - A desirable point between mental, physical, emotional, spiritual, and environmental components 17 Concepts in Alternative Healing Spirituality - Involves relationship with self, others & higher power. Gives us meaning & purpose in life. Energy - The force that integrates mind, body & spirit Healing Environments – Created by empowering patients with the knowledge, skills, & support to help them make healthy decisions 18 6 Healing Modalities Ayurveda - Traditional Indian system of medicine Focus on balance between individual health and quality of life uses individualized diet, herbal treatment, and yogic breathing practices Traditional Chinese Medicine (TCM) – Focus on the uninterrupted flow of body energy or Qi using acupuncture, acupressure, massage, herbal medicine, qi gong, and t’ai chi Qi (pronounce chi) – vital force, vital energy, energy 19 Healing Modalities Native American Healing – The Great Power or Divine Spirit is the only one who heals; a Medicine man or woman can use ceremonial treatments such as a sweat lodge, singing, dancing, vision quests, smudging, or herbs to help the sick individual achieve balance of mind and body Curanderismo - a traditional Latin American healing system – Curanderos or Curanderas use religious rituals, herbs, cleansing rites, and prayers in their healing therapies. 20 Botanical Healing Herbal Medicine - Using plants to treat illness and promote health –Important to discuss with use of herbal supplements with client because of possible side effects or interactions with medication Aromatherapy - Therapeutic use of plant-derived, aromatic essential oils to promote physical and psychological well-being. –Sometimes used in combination with massage and other therapeutic techniques as part of a holistic treatment approach 21 7 Botanical Healing Homeopathy - A system of therapeutics based on the use of natural substances which produce symptoms similar to the disease being treated – Stimulates the self-healing capacity of the client Naturopathy – Naturopaths mix and match different approaches potentially using all CAM therapies to customize a treatment plan for each individual. Rare use of prescription drugs with a focus on supporting the body’s natural healing processes using a wide variety of therapies, such as hydrotherapy, heat, massage, and herbal medicine. 22 Manual Healing Chiropractic – Practitioner performs adjustments to the spine & other parts of the body to correct alignment Massage therapy - scientific manipulation of soft tissues of body that loosens muscles, improves blood flow & movement of lymph fluid, and improves flexibility & range of motion Acupuncture - Involves use of sharp, thin needles that are inserted at acupuncture points to relieve pain and cure illness – moderates the flow of qi 23 Manual Healing Acupressure - Same points on body used as in acupuncture, but are stimulated with finger pressure instead of needles Reflexology - Therapeutic method of relieving pain by stimulating predefined pressure points on feet, hands, and ears Hand-Mediated Biofield Therapy - Involves Therapeutic Touch, Healing Touch, and Reiki 24 8 Mind-Body Therapies Yoga – Breathing exercises with body poses but also a way of life or philosophy - can be used as ethical guide towards enlightenment Meditation – Relaxing the body & easing the mind to cope with stress or feel oneness with God or the universe Hypnotherapy – Hypnosis used to treat medical or psychological disorders Guided Imagery - Use of focused attention to change behavior and reactions to stressors 25 Mind-Body Therapies Biofeedback – Uses visible or audible evidence to help a client control physiological responses Qi gong – Chinese discipline uses breathing and mental exercises combined with body movements T’ai chi – Combines physical fitness, medication, and selfdefense Pilates - Series of nonimpact exercises to develop strength, flexibility, balance, and lung capacity – developed in a WWI prison camp 26 Spiritual Therapy Faith – Belief in a 'higher' power or being, often linked to adherence to a particular religion or belonging to the congregation or church Power to accept the nature of life as it is and life in the present Prayer – Communication and fellowship with the Creator, a Deity, nature, or in a more general spiritual sense Provides clients comfort, increases hope, and promotes healing and psychological well-being 27 9 Miscellaneous Therapies Music Therapy – Relaxation and distraction during procedures, reduces both pain intensity and distress Humor & Laughter - Relieves tension/anger, establishes rapport or relationship, helps learning, helps coping with difficult feelings Bioelectromagnetics - Living organisms interacting with electromagnetic fields – magnet therapy Detoxifying Therapies – Detoxification – Hydrotherapy, Colonics, Chelation therapy (EDTA for lead poisoning) Animal-assisted therapy - Used for physical or psychological conditions Horticultural Therapy - Gardening as adjunct therapy to occupational and physical therapy 28 10