NURS 3450 Module 1 CH 2 PDF

Chapter 2 The Family & Culture 1. Define family. Family forms a social network that acts as a potent support system for its members. The family has traditionally been viewed as the primary unit of socialization—the basic structural unit within a community. 2. Family Configurations: Type Nuclear Ext...

Chapter 2 The Family & Culture 1. Define family. Family forms a social network that acts as a potent support system for its members. The family has traditionally been viewed as the primary unit of socialization—the basic structural unit within a community. 2. Family Configurations: Type Nuclear Extended Multi-generational Marriage-blended Single-parent Alternative Description has long represented the traditional American family, in which husband, wife, and their children (either biologic or adopted) live as an independent unit, sharing roles, responsibilities, and economic resources (Fig. 2.1). These extended family members include grandparents, aunts, uncles, or other people related by blood. Members of extended families can also live in close proximity to the nuclear family (Fig. 2.2). Owing to societal changes, internet access, and increased mobility, these families may also be a long-distance unit. The extended family is becoming more common as American society ages. The extended family provides social, emotional, and financial support to one another. Multigenerational families, consisting of three or more generations of relatives (grandparents, children, and grandchildren), make up 3.8% of all households; 2.7 million grandparents were found to be raising their grandchildren (US Census Bureau, 2020c). This type of arrangement can create stress, as adult children must care for their parents as well as their own children. Other types of multigenerational families consist of grandparents supporting their children and grandchildren or as sole caregivers for their grandchildren. Married-blended families, those formed as a result of divorce and remarriage, consist of unrelated family members (stepparents, stepchildren, and stepsiblings) who join to create a new household. These family groups frequently involve a biologic or adoptive parent whose spouse may or may not have adopted the child. Single-parent families comprise an unmarried biologic or adoptive parent who may or may not be living with other adults. The singleparent family may result from the loss of a spouse by death, divorce, separation, or desertion; from either an unplanned or planned pregnancy; or from the adoption of a child by an unmarried woman or man. This family structure is on the rise. In 2016, 15.3 million (21%) children lived with their mother only, 3 million (4%) lived with their father only, and 3.3 million (5.5%) lived with neither of their parents (US Census Bureau, 2020c). Single-parent families tend to be more vulnerable economically and socially, which can create an unstable and deprived environment for the children. This in turn affects health status, school achievement, and high-risk behaviors for these children. Some families become more stable with the absence of drugs, alcohol, and/or physical/emotional abuse. Usually formed by same-sex couples, they can also consist of single LGBTQIA parents or multiple parenting figures. Children in LGBTQIA families may be the offspring of previous heterosexual unions, conceived by one member of a lesbian couple through natural or therapeutic insemination, conceived by a gay couple using a surrogate, or adopted. Which of the above families is most vulnerable economically and socially? Single-parent families tend to be more vulnerable economically and socially, which can create an unstable and deprived environment for the children. 3. What is culture? What do cultural beliefs and traditions encompass? The culture of an individual and a group is influenced by a variety of factors including religion, customs, environment, and historic events and plays a powerful role in the behavior and patterns of human interaction of the individual and group. Culture is dynamic and influences a woman throughout her entire life, from birth to death. Culture is an essential element of what defines us as people. 4. Define acculturation Acculturation refers to the changes that occur within one group or among several groups when people from different cultures come into contact with one another. People may retain some of their own culture while adopting cultural practices of the dominant society. This familiarization among cultural groups results in overt behavioral similarity, especially in mannerisms, styles, and practices. Dress, language patterns, food choices, and health practices are often much slower to adapt to the influence of acculturation. 5. Define assimilation Assimilation occurs when a cultural group loses its cultural identity and becomes part of the dominant culture. Assimilation is the process by which groups “melt” into the mainstream, thus accounting for the notion of a “melting pot,” a phenomenon that has been said to occur in the United States. This is illustrated by individuals who identify themselves as being of Irish or German descent, without having any remaining cultural practices or values linked specifically to that culture such as food preparation techniques, style of dress, or proficiency in the language associated with their reported cultural heritage. Spector (2017) asserts that in the United States the melting pot, with its dream of a common culture, is a myth. Instead, a mosaic phenomenon exists in which we must accept and appreciate the differences among people. 6. How do these areas where cultural differences exist affect women’s health? Access to Healthcare Pain perception of Health and Illness Preventative Care Reproductive Health Cultural Competency Health Education and Communication How can the nurse intervene in a culturally competent manner? Build Trust Cultural Assessment Effective Patient Education Empathy and Respect Advocacy and Collaboration Patient Centered Care Environment Continuing Competence Training a. Childbearing beliefs & practices Nurses working with childbearing families care for families from many different cultures and ethnic groups. To provide culturally sensitive care, the nurse must assess clients’ beliefs and practices. When working with childbearing families, a nurse considers all aspects of culture, including communication, personal space, time orientation, and family roles. Communication often creates the most challenging obstacle for nurses working with clients from diverse cultural groups. Communication is not merely the exchange of words. Instead, it involves (1) understanding the individual’s language including subtle variations in meaning and distinctive dialects, (2) appreciating individual differences in interpersonal style, and (3) accurately interpreting the volume of speech as well as the meanings of touch and gestures. For example, members of some cultural groups tend to speak loudly when they are excited, with great emotion and with vigorous and animated gestures; this is true whether their excitement is related to positive or negative events or emotions. Therefore it is important for the nurse to avoid rushing to judgment regarding a client’s intent when the client is speaking, especially in a language not understood by the nurse. Instead, the nurse should withhold an interpretation of what has been expressed until it is possible to clarify the client’s intent. The nurse needs to enlist the assistance of a person who can help verify with the client the true intent and meaning of the communication. b. Personal space Cultural traditions define the appropriate personal space for various social interactions. Although the need for personal space varies from person to person and with the situation, the actual physical dimensions of comfort zones and taboos differ from culture to culture. Actions such as touching, placing the woman in proximity to others, taking away personal possessions, and making decisions for the woman can decrease personal security and heighten anxiety. Conversely, respecting the need for distance allows the woman to maintain control over personal space and supports personal autonomy, thereby increasing her sense of security. Nurses must touch clients. However, they frequently do so without any awareness of the emotional distress they may be causing. It is important that nurses ask permission to touch their clients before doing so. c. Time orientation Time orientation is a fundamental way in which culture affects health behaviors. People in certain cultural groups may be relatively more oriented to the past, present, or future. People who focus on the past strive to maintain tradition or the status quo and have little motivation for formulating goals. In contrast, individuals who focus primarily on the present neither plan for the future nor consider the experiences of the past. These individuals do not necessarily adhere to strict schedules and are often described as “living for the moment” or “marching to their own drummer.” Individuals oriented to the future maintain a focus on achieving long-term goals. The time orientation of the childbearing family can affect nursing care. For example, talking to a family about bringing the infant to the clinic for follow-up examinations (events in the future) may be difficult for a family that is focused on the present concerns of day-to-day survival. Because a family with a futureoriented sense of time plans far in advance, thinking about the long-term consequences of present actions, they may be more likely to return as scheduled for follow-up visits. Despite the differences in time orientation, families can be equally concerned for the well-being of their newborns. d. Family roles Family roles involve the expectations and behaviors associated with a member’s position in the larger family system (e.g., mother, father, grandparent). Social class and cultural norms also affect these roles, with distinct expectations for men and women clearly determined by social norms. For example, culture may influence whether a man actively participates in the pregnancy and birth, yet maternity care practitioners working in the Western health care system expect fathers to be involved. This can create a significant conflict between the nurse and the role expectations of very traditional Mexican or Arab families, who usually view the birthing experience as a female affair (see Cultural Considerations). The way that health care practitioners manage the care of such a family molds its experience and perception of the Western health care system. Implicit bias must be addressed by nurses themselves as they develop greater cultural sensitivity. The Evidence-Based Practice box provides updated information on nursing care and implicit bias. e. Influence of family on decision making 7. What does culturally competent care look like? How does a nurse develop cultural competence? 8. What are four examples of vulnerable populations with whom the women’s health nurse interacts? Racial and Ethnic People of Color In addition to social, economic, and cultural barriers to optimal health, women who are in racial and ethnic minorities experience a disproportionate burden of disease, disability, and premature death. Significant health disparities continue to exist in the health of women and their infants. Although positive trends are evident, disparities persist among racial and ethnic groups in early prenatal care, an important factor in achieving healthy pregnancy outcomes. Minority women, many of whom live in poverty, also have higher rates of chronic disease including heart disease, cancer, hepatitis, and acquired immunodeficiency syndrome (AIDS) as well as mental health issues. Women with underlying health conditions are at especially high risk for poor obstetric outcomes for themselves and their infants. They have high rates of preterm labor and gestational hypertension and often have intrauterine growth restriction, resulting in the birth of infants who are small for gestational age. Although disease incidence and health outcomes are often stratified by race, it is critical to recognize the impact of racism and discrimination rather than genetics on disease and health outcomes (McMillian-Bohler & RichardEglin, 2021). These are the women for whom the community-based perinatal nurse will be providing care, and their needs are complex, demanding high levels of expertise and skill. Adolescent Girls The adolescent population in the United States is generally considered healthy. However, adolescents participate in riskier behaviors, and their health is often compromised as a result. Although adolescents are concerned about becoming pregnant, many still engage in unprotected sex. They use a variety of sources for health information such as the media, friends, and sex education, yet they are misinformed, particularly about sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) transmission. These findings have significant implications for perinatal outcomes and emphasize the importance of aggressive prevention programs and community outreach related to sexuality, consent, teen pregnancy, and substance use. It is crucial that nurses engage adolescents in health education programs that will encourage them to make informed decisions about their sexual health. It is also vital that nurses be a resource to these adolescent girls. Older Women Although women have a longer life expectancy than men, they are more likely to have chronic illnesses, less likely to use preventive services, and ultimately spend more on health care. Discussions about sexual health and satisfaction are often avoided with middle-aged and older adults. Sexual health is a component of wellness and should be a component of well visits across the life span (https://www.healthinaging.org/a-z-topic/sexualhealth). As nurses, it is important that we engage this population at all levels of prevention, from primary to tertiary. Incarcerated Women The number of incarcerated women has been growing twice as fast as that of men since 1980. Incarcerated women often have histories of intimate partner violence including physical and/or sexual abuse, history of HIV and substance use disorder, and emotional problems owing to absence from family (The Sentencing Project, 2018). Because their relationship histories are often unstable, and because they often lack the support of family, incarcerated women or women with a history of repeated incarceration frequently have difficulty providing emotional stability, secure housing, and health promotion role modeling for their children. The lifestyle choices of this group, including risky sexual relationships, illicit drug use, and smoking, place them at high risk for HIV/AIDS, other STIs, other chronic and communicable diseases, and complicated pregnancies, including giving birth during incarceration. Immigrant, Refugee, and Migrant Women As of 2020, 44.8 million people living in the United States were born in another country, representing 13.7% of the US population (PEW Research Center, 2020). This accounts for a rapidly growing diverse population for which nurses will be providing care. An immigrant is an individual who moves from one country to another in an effort to take up legal residency, whereas a refugee is an individual who is forced to leave his or her home country, often in search of a safer and more stable living environment. Both populations are often challenged with not being able to easily access health care because they are not US citizens. These women often do not seek medical care for fear of deportation. Access to care is further limited by health care policies that restrict Medicaid eligibility for these groups, although a number of states provide some prenatal, birth, and postpartum care. Along with their profound resilience and determination, refugees and immigrants have brought rich diversity to the United States in several important dimensions, including cultural heritage and customs, economic productivity, and enhanced national vitality. In general, refugees are more likely to live in poverty than are immigrants. Over time, measures of health and well-being actually decline for the immigrant population as they become part of American society. Many of the conditions or illnesses that they acquire contribute to the persistence of disparities in maternal and neonatal health outcomes for both immigrants and refugees. Migrant workers are individuals who work outside their home country or travel within their own country seeking seasonal work. Migrant laborers and their families face many problems, including financial instability, child labor, poor housing, lack of education, language and cultural barriers, and limited access to health and social services. Poor dental health, diabetes, hypertension, malnutrition, tuberculosis, skin diseases, and parasitic infections are common health issues among migrant populations. Primary health care services are largely provided by the more than 175 migrant health centers located throughout the United States. Although it is difficult to accurately calculate, it is estimated that there are between 1 million and 3 million seasonal and migrant workers. In 2019 more than 1,031,049 seasonal and migrant farm workers and their families received care at a migrant health center (Health Resources & Services Administration [HRSA], 2021). Routine prenatal care and screening and treatment for hypertension and diabetes are provided at migrant health centers. Community health nurses frequently encounter challenges of providing culturally and linguistically appropriate care while facing numerous health issues. Numerous reproductive health issues exist for migrant women, including less consistent use of contraception and increased rates of STIs. Migrants are less likely to receive early prenatal care and have a greater incidence of inadequate weight gain during pregnancy compared with other poor women. Rural Versus Urban Community Settings About 60 million people (19.3% of the population) live in rural areas (US Census Bureau, 2019). Generally, rural residents are older, less educated, and in poorer health than their urban counterparts. Rural communities are disproportionately affected by poverty and poor access to health care services. Fewer physicians choosing to practice in rural areas and lack of insurance present additional factors contributing to poor health in rural areas. Rural women are especially vulnerable to financial and transportation barriers to health care. Although women in rural counties report only fair to poor health, they pay considerably more for their health care. In rural communities, women have less access to prenatal care, which contributes to higher rates of adverse pregnancy outcomes including higher rates of preterm birth, LBW, and infant mortality. The disproportionate distribution of poverty and of variations in race/ethnicity, age, education, and availability and access to medical resources may be linked to infant mortality in rural areas. Homeless Women Homelessness among women is an increasing social and health issue in the United States. Although exact numbers are unknown because of the difficulty in tracking individuals without a permanent address, it was estimated that in 2020, approximately 580,000 people were experiencing homelessness in the United States. That is, for every 10,000 people in the United States, 18 were experiencing homelessness. Women make up 39% of the homeless population and often become homeless to escape domestic violence (US Department of Housing and Urban Development, 2018). Families with children make up the fastest-growing group of the homeless population. Adults and children in families make up about 30% of the homeless population. Of these families, 84% are headed by women (National Alliance to End Homelessness, 2020). Health issues among the homeless population are numerous and result primarily from a lack of preventive care and a lack of resources in general. Health problems include chronic illness, infectious diseases, asthma, circulatory problems, diabetes, substance use, and mental illness. Lifestyle factors and the vulnerability resulting from being homeless contribute to health problems. Women are at increased risk for illness and injury; many have been victims of domestic abuse, assault, and rape. Although little is known about pregnancy in this population, women do become pregnant while experiencing homelessness. In addition to risk factors related to inadequate nutrition, inadequate weight gain, anemia, bleeding problems, and preterm birth, women experiencing homelessness face multiple barriers to prenatal care including transportation, distance, and wait times. Most of these women underutilize available prenatal services. The unsafe environment and high-risk lifestyles often result in adverse perinatal outcomes (American College of Obstetricians and Gynecologists [ACOG], 2021). Practice question Chapter 2: 1. In what form do families tend to be most socially vulnerable? a. Married-blended family b. Extended family c. nuclear family d. Single-parent family