Sociocultural Midterm studyguide

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What is the concept of health literacyonly 12% of the US population is proficient in health literacy health literacy is affected by age poverty, uninsured or publicly insured, racial and ethnic minority groups with limited English proficiency as wellConcept and characteristics of individualism- focus on individuals (separate but distinct) - encourage self expression (opinions and personal questions) - informal -productive member of society, achievement driven - identity based on personal accomplishments and careers - European Americans, US, Norwegian, SwedishConcept and characteristics of collectivism- Focus is on group, relationship driven - Do not ask probing questions of others, no open disagreements - Priorities connections, interpersonal relationships - Authority figures respected - Parents/ elders may have final word on career choice/ spouse - Mental/ physical disability is hidden - Arabs, Chinese Filipino, Korean, ThaiWhat is culture universal, and an example of itbiological and physiological needs shared by every culture ex- the need to eat food in generalWhat is culture specific? Example?determines methods, rules, guideline, and patterns of behavior. Ex- items that are edible; acceptable methods used to prepare and eat meals, rules concerning who eats with whom, the frequency and time of mealsInterpreter Guidelines- strive to have trained medical interpreter - should have proficient health literacy - same gender preferred - should be older than patient - avoid interpreters from rival tribes, states, regions, or nationsWhat is chronemics?Time orientationwhat is future chronemics-concerned with long range goals (preventative care) - punctuality and prioty of schedules and organization -North Americans, British Monochronic approach** --time is money, wasted time is lost time -- function on clock time -- focus on one thing in a systematic waywhat is past or present chronemics-concerned with here and now/ karma - prioritizing may conflict with relationship building -punctuality not important, just general time frame - Asians and Hispanics ** Polychronic approach -- time is flexible and cannot be controlled -- Focus on event, not the clock time -- events begin when everyone has arrived.what is proxemicsphysical spaceWhat cultures expect most personal space and which expect least personal spaceMost: North Americans, British Least: Latin Americans, Japanese, ArabsWhat are the meanings of silence and which cultures adhere to each belief路 Respect: English, Arabs, native Americans, Asian cultures 路 Agreement: French, Spanish, Russian 路 Consider content: Japanese Chinese 路 Question perceived as inappropriate: African AmericansWhat are the different types of eye contact and which cultures adhere to each belief路 Sign of interest and active engagement (US, Canada, W. Europe, Australia) 路 Direct eye contact is impolite/disrespectful/aggressive/challenging authority (Arab, Asia, Native Americans, Africa, Middle East) 路 Downcast eyes, especially with elders, figures of authority and gender related (Hispanic, Asian, Arab, Hasidic Jews) 路 In general, prolonged eye contact is uncomfortableWhat are some gender and age factors a nurse should be aware of?-prefer same gender HCP -sometimes improper to touch or be alone with client of opposite gender and may need a 3rd party present - protection of bad news from very young and elderlywhat are general assumptions about modesty and toucho Modesty - behavior, manner, or appearance intended to avoid impropriety or indecency. o Touch- gender related touch taboos, age taboos, reserved affection expression, Always ask what is acceptableWhat is Low context communication路 Specific and Direct communication preferred and viewed as honest and sincere 路 Direct requests preferred 路 No age, status or gender hierarchy in communication - use of first names 路 Use of words such as 'absolutely, certainly' 路 Upward communication is valuedwhat cultures use low context communication?Swiss, German, Scandinavian, American, English Canadianwhat is high context communication路 Direct communication is viewed as confrontational and avoided 路 Indirect suggestions preferred 路 Definite hierarchies in communication - use of titles and honorifics 路 Use of qualifiers such as 'maybe, probably' 路 Compliance encouragedwhat cultures use high context communicationJapanese, Chinese, Thai, Mexican, Greek, ArabWhy is the cultural self assessment important?- It is a process of critical reflection of ones own culturally biased, attitudes, beliefs and practices - It enables o you to use personal life experiences to gain insights into your health related... attitudes, values, beliefs, and practices -Makes us aware of unconscious bias, ethnocentrism, and cultural imposition - The expected nursing outcome of an effective cultural self-assessment is...The prevention of prejudice and discrimination in the care of any ethnic groupWhat are health disparitiespopulation-specific differences in the presence of disease, health outcomes, or access to careWhat populations are affected by Healthcare disparities and what happens路 Racial and ethnic minorities 路 Residents of rural areas 路 Women, children, and the elderly 路 Persons with disabilities 路 Other special populations such as the deaf ***they receive lower quality health services, less like to receive routine medical procedures, and have higher morbidity and mortality rateswhat is an emic perspective of deaf culture- see their body as whole, well, and unimpaired -self-identify as a linguistic minority NOT a disabilityWhat is an Etic perspective of deaf culture?- Project our thoughts and feelings onto them, they are ill -places unnecessary limitation on the deaf individual - cultural imposition by medical establishment (pushing hearing aids and cochlear implants)what are federal laws about communication and language assistanceCLAS- is an organizational framework that serves the nations diverse communities - HCP that accept Medicare and Medicaid must provide language services FREE of chargeWhat are the 3 major health belief systemsMagico-religious, Biomedical, and HolisticWhat are the attributes of Magico-religious health belief system-world dominated by supernatural forces -fate of individuals is up to god, gods, spirits -health is a reward of gods blessing - illness is the result of sorcery, a breach of taboo, intrusion of a disease object, intrusion of a disease causing spirit or loss of soul - Cultural examples = Latino, AA, Native, middle eastern, African and CaribbeanWhat are the attributes of Biomedical health belief system- health understood by biology, chemistry, and physics -disease and illness are the cause of the breakdown of body systems -specific cause, predictable course, prescribed treatment -cause and effect relationship -cultural examples = US, Canada, Europe, Australia, New ZealandWhat are the attributes of Holistic health belief system- forces in nature must be kept in harmony, imbalance results in illness -health is more than an absence of disease (unemployment, racism, poverty, pollution) - interrelationships of health and spiritual well being - cultural examples = American Indian and AsianHot and Cold Theory of diseaseThere are four body humors that are balanced, treatment of disease is aimed at adding or subtracting substances that affect the humor to maintain the hot/cold balance - foods, beverages, herbs, drugs, and diseases are each classified as either hot or coldInternal Locus of controlthe perception that you control your own fate, events are contingent upon behavior -more likely to engage in preventative care.external locus of controlthe perception that chance or outside forces beyond your personal control determine your fate. -less likely to take action to change future (tend to be more fatalistic)future time orientationFuture is more important than the present or the past, think ahead rather than living in the moment, goal oriented - USpast time orientationpast and tradition is of primary importance, future has minimal significance, resistant to changePresent time orientationSeeing the present as more important than the future or the past -may be ate for appointments, may result in destructive behaviors (YOLO)Folk healing systems and reason for usewhat people do when they are ill not what society says they should do - house calls, less expensive, midwifes and doulas, speak native languages and have traditions, could be more personal carewhat are some examples of complementary and alternative therapies- body touch: osteopathic manipulation, massage, tai chi, yoga, chiropractic - Natural products: Herbs, vitamins, minerals, probiotics - Mind/Body: deep breathing, meditation, hypnosis - Senses: guided imagery, visualization, aromatherapy music - Energy: Tai Chi, electromagnetic fieldswhy does complimentry and alternitive medicine work what is important to education the patient about?There are other ways to treat problems that are not necessarily medical. Alternative methods could be helpful for people with certain chronic conditions, and improve their mental wellness *patients should be education on the practice and guidelines of these alternative practices to ensure they go to safe and licensed providers.What are risk factors for childhood obesity-maternal education, poverty, mother only households, gestationally overweight -could be linked to breast feeding length - lack of activity -Parental FT employment and fast food convivenceWhat are appropriate feeding and eating behaviors of hospitalized children-allow family to bring in familiar foods - maintain habits from home when possible - family present during mealtimes (same mealtimes as home) -CAUTION= cultural practices of fasting as penance for bad behavior could lead to dehydration and malnutritionWhat are examples of child abuse-physical abuse or neglect -molestation -child prostitution - nutritional deprivation -emotional maltreatmentwhat is a well known child abuse disparityAA children are 3x more likely than white children to die of child abuse - this is affected by income, education level, and employmentMexican American sustocaused by frightening experiences, s/s- nervousness, loss appetite, loss sleepMexican American pujos/s grunting and protrusion umbilicus, caused by contact with menstruating womanMexican American Mal ojoevil eye, caused by individual who voluntarily or involuntarily injuries a child by looking at or admiring them. s/s listlessness, crying, fever, vomiting, diarrheaMexican American Caida de la mollerafallen fontanelle - causes: failure of midwife to press on palate after delivery, falling on head, failing to place cap on infants head. s/s crying, fever, vomiting, diarrhea, dehydrationMexican American Empachodigestive condition- caused by adherence of undigested food, chewing gum, to GI tract. s/s excessive thirst, abdominal swellingWhat family structures have risk factors for poverty- single parent family (mother only especially) - 2 unmarried parents -blended family and living with extended families - who is making the HC decisions can put a family at riskEthnopharmacologythe study of medicines derived from naturally occurring substances. How certain groups of drugs act differently in specific ethnic and racial populations.Pharmacogenomicsinherited/acquired genetic variation in drug response (same as ethnopharmacology) can test for genetic variants when prescribing drugsHow are AA affected by pharmacogenomics- AA heart failure trial - adding Bidil med improved survival - ACE inhibitors (antihypertensive) less effective in AA - SSRI antidepressant therapeutic effects at lower doses in AAwho is primarily affected by BRCA1 and BRCA2(breast cancer gene) Ashkenazi Jewswho is primarily affected by Sickle cellinflammation, ischemia, vaso-occulusion, organ damage - African, Mediterranean, middle eastern, Indian -trait present in 1/12 black -disease present in 1/365 blacksWhat meds,allergies,herbs do you need to ask your patient about?Need to ask about rx and OTC medications -need to ask about herbal remedies and vitamins they are commonly unregulated and clients don't consider themnursing implications for herbal remedies, vitamins, and supplementsin general need to know about other remedies and supplements because they can interact with medications - ex ginseng can potentiate effects of antihypertensiveultra rapid metabolizersprocess too quickly (inadequate pain relief)poor metabolizersprocess too slowly and can develop drug toxicitywhat racial group is most affected by Alcoholism- American Indians are 2x more likely than whites - 12% of all Native American deaths are alcohol relatedwhat racial group is most affected by Cancer Colorectal-AA are 40% higher than whites -Ashkenazi Jews are the highest in the worldwhat racial group is most affected by Diabetes- 3x as prevalent in Filipinos than in whites -higher in Hispanics than blacks and whites - death rates and complication rates vary by ethnicitywhat racial group is most affected by Sickle cell disease- African, Mediterranean, middle eastern, Indian - trait 1/12 blacks, disease 1/365 blacksWhat are cultural normsunconscious behavior patterns typical of specific groups -dictate healthcare patterns and behaviors - can be healthy or unhealthyWhat are culture bound syndromesthey are recognized disorders related to malfunctioning biological or psychosocial processes within a culture - can only be understood within the context of cultureAfrican Americans and how they are affected by HTN-AA have 2x incidence of HTN than whites and also highest incidence in world (main contributor of cardiovascular disease) - BP of AA is higher than those living in Africa- suggests that genetics are not the only reason it has environmental and lifestyle implications - ACE inhibitors (antihypertensive) are less affective in hypertensive AAWhat is pain assessment and treatment influneced by?-race and ethnicity -types of rating scales used - environmental context -nurses background and experiences -stereotyping and bias -race concordance between client and HCP -mistrust in the HC system -Underreporting of pain by minority ethnicitiesWhat is the importance of race concordance?It is important that there are HCP that are the same race and ethnicity as the client. It helps the client to feel understood, comfortable, and develop trust.Skin assessment- best places for observing cyanosischeck conjunctiva, oral mucosa, nailbedsSkin assessment- best places for observing Jaundicecheck sclera, darkly pigmented people may have fat deposits that mimic jaundiceSkin assessment- best places for observing pallorAssess mucous membranes, lips, nailbeds, conjunctivaSkin assessment- best places for observing erythema and petechiaemore easily seen in mouth and conjunctivaAntihypertensive blacksfat soluble drugs asian americansPsychotropics asians and pacific islanderstranquilizers blacksFGM conceptsNursing implications of Birth and Culture- Nontraditional support systems (nurses help develop prenatal care plan) - Pica hunger for nonfoods - Substance abuse or alcohol drinking in pregnant women that could affect baby - Supernatural forces that affect pregnancy - Many cultures believe the first child should be male. Place higher importance on male children.African American infant feeding practices搂 It takes a village 搂 Real-world issues (work and pain) 搂 Personal issues (freedom and ease of bottle feeding) 搂 Historical stigma (choices and slavery) 搂 Negative body image 搂 Breastfeeding described as NASTYBirth cord cutting rituals- placenta buried in specific location - child's future health linked to placenta -Placenta must roast to provide heat to stimulate moms healing -cord cutter cannot go to prayer for 40 daysBirth rest and seclusion rituals- Mom cannot go into kitchen for 9 days. Then scent to another home for 10-15 days, can stay up to month. - Mom and baby massaged with mustard oil to reax mother's muscle -Mom cared for and fed diet of lentils and spices to stimulate milk production -Isolate in stable/shed during menstruation and pregnancyBirth Purification/ naming/ and weaning rituals-Religious cleansing rituals to welcome new mothers back into church -Naming ceremony at specified intervals - Jewish women allowed back into temple 33 days after birth of son and 66 days after the birth of daughter - Many cultures- women and or babies isolate for 40 days, sometimes in specific locationsNutrition and breast feeding rituals-Hot/Cold foods throughout process -Without water for 2-3 days after birth Burmese and Turkish women - Specified lengths of time and specific foods for breastfeeding - Colostrum specifications priest approved, not given (dirty milk, no nutritional value)Post partum depression characteristics搂 1/9 woman affected by postpartum depression 搂 May be unacceptable in some nonwestern cultures 搂 s/s may be viewed as spirit possession or supernatural occurrence 搂 common in women who lack social support, have history of depress, and relationship issues or negative life experiencesdietary postpartum nursing implications- Pregnancy is a Hot condition; cultures may not drink or eat cold foods and avoid cold air 路 Nursing implication: offer warm drinks rather than ice post-partum, replace icepacks with heat lamps and heat packsActivity Postpartum路 Seclusion period, limited activity permitted 路 Help and support with minimal activity, rest and relaxIPV risk factors Hispanic- Immigration status - Lower SES levels - Machismo - Avoid anger expressions, internalize fear, fail to report IPV