Topic 10 Flashcards
Culture
refers to the learned and shared beliefs, values, norms, and traditions of a particular group, which guide our thinking, decisions, and actions.
unconscious bias
refers to a bias that we are unaware of, and which happens outside of our control which is influenced by our personal background, cultural environment, and personal experiences.
implicit bias
we are aware the bias is present
Culturally congruent care
care that fits a person’s life patterns, values, and system of meaning
Cultural competence
enabling of health care providers to deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients.
health disparity
a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage
marginalized groups
more likely to have poor health outcomes and die at an earlier age because of a complex interaction between individual genetics and behaviors; public and health policy; community and environmental factors; and quality of health care
social determinants of health
The conditions in which people are born, grow, live, work, and age, shaped by the distribution of money, power, and resources at global, national, and local levels
health care disparities
differences among populations in the availability, accessibility, and quality of health care services
what groups are more likely to be impacted by health care disparities
African-Americans, Asians, Hispanics, low- and middle- income groups, the uninsured, some subgroups of the LBGT community
intersectionality
Belonging simultaneously to multiple social groups
oppression
A system of advantages and disadvantages tied to our membership in social groups
-the state of being kept down by unjust use of force or authority
Cultural competence or cultural respect
Meaningful and useful care strategies based on knowledge of the cultural heritage, beliefs, attitudes, and behaviors of those to whom they render care
racial identity
based on one’s self-identification with one or more social groups in which a common heritage with a particular racial group is shared
ethnic and cultural identity
the frame in which individuals identify consciously or unconsciously with those with whom they feel a common bond because of similar traditions, behaviors, values, and beliefs
Acculturation
occurs when an individual or group transitions from one culture and develops traits of another culture
Assimilation
the process in which the individual adapts to the host’s cultural values and no longer prefers the components of the origin culture
Transcultural nursing
the study of various cultures with the goal of providing care specific to each culture
what is the goal of transcultural nursing
to provide culturally congruent care, or care that fits a person’s life patterns, values, and system of meaning.
Illness
The way that individuals and families react to disease
disease
Malfunctioning biological or psychological processes
cultural competency
the enabling of health care providers to deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients.
cultural awareness
process of conducting a self-exam of one’s own biases toward other cultures and the in-depth exploration of one’s cultural and professional background
Cultural knowledge
process in which a health care professional seeks and obtains a sound educational base about culturally diverse groups.
Cultural skill
ability to conduct a cultural assessment of a patient to collect relevant cultural data about a patient’s presenting problem, as well as accurately conducting a culturally based physical assessment
Cultural encounter
encourages health care professional to directly engage fast-to-face cultural interactions
Cultural desire
motivation of health care professional to WANT TO not have to engage in the process of being culturally aware.
what are the universal skills that help HCP work effectively with patients from any culture?
- Respecting a patient’s health beliefs as valid and understanding the effect of the patient’s beliefs on health care delivery
- Shifting a model of understanding a patient’s experience from a disease happening in his or her organ systems to that of an illness occurring in the context of culture (biopsychosocial context)
- Ability to elicit a patient’s explanation of an illness and its causes (patient’s explanatory model)
- Ability to explain to a patient in understandable terms the health care provider’s perspective on the illness and its perceived causes
- Being able to negotiate a mutually agreeable, safe, and effective treatment plan
landmark reports
highlight the importance of patient-centered care and cultural competence.
Crossing the Quality Chasm (IOM, 2001)
identifies patient-centered care as one of six “aims” for high-quality health care.
Unequal Treatment (Smedley et al., 2003)
Unequal Treatment stresses the importance of developing cultural competence among health care providers to eliminate racial/ethnic health care disparities.
Patient-centeredness provides…
individualized care and restores an emphasis on personal relationships
Cultural competence aims to…
increase health equity and reduce disparities by concentrating on people of color and other disadvantaged populations
bias
a predisposition to see people or things in a certain light, either positive or negative.
World view
the way people tend to look out upon the world or their universe to form a picture or value stance about life or the world around them
Emic worldview
an insider perspective of an intercultural encounter
Etic worldview
An outsider’s perspective of an intercultural encounter.
Stereotyping
an assumed belief regarding a particular group
Storytelling
Helps identify the real problems affecting a patient’s health status and find culturally appropriate ways to intervene
Iceberg Analogy
most aspects of a person’s world view are hidden
- Just as most of an iceberg lies beneath the surface of the water, most aspects of a person’s world view lie outside of his or her awareness and are invisible to those around the person. Conflict arises when health care providers interpret the behaviors of patients through their own world view lens instead of trying to uncover the world view that guides this behavior.
what kind of questions should you ask during a cultural assessment
Open-ended, focused, and contrasted questions
Cultural assessment model
Using a cultural assessment model will help you focus on the information that is most relevant to your patient’s problems.
Explanatory model
His or her views about health and illness and its treatment. There are five questions in most explanatory models: etiology, time and mode of onset of symptoms, pathophysiology, course of illness and treatment for an illness episode.
LEARN mnemonic
Listen
Explain
Acknowledge
Recommend
Negotiate
LEARN mnemonic: listen
to listen to the patient’s explanation or story of the presenting problem
LEARN mnemonic: explain
explain your perception of the patient’s problem, whether it is physiological, psychological, or cultural.
LEARN mnemonic: acknowledge
acknowledge the similarities and differences between the two perceptions. It is important to recognize differences but build on the similarities.
LEARN mnemonic: recommendations
recommendations that require you to involve the patient and family when appropriate
LEARN mnemonic: negotiate
negotiate a mutually agreeable, culturally oriented, patient-centered plan.
RESPECT mneumonic
Rapport
Empathy
Support
Partnership
Explanations
Cultural Competence
Trust
ETHNIC mneumonic
Explanation
Treatment
Healers
Negotiation
Intervention
Collaboration
C-LARA mnemonic
Calm
Listen
Affirm
Respond
Add
Linguistic competence
The ability of an organization and its staff to communicate effectively and convey information in a manner that is easily understood by diverse audiences.
health literacy
The ability to obtain, process, and understand health information needed to make informed health decisions.
what are common measures of health literacy that are used?
Rapid Estimate of Adult Literacy in Medicine (REALM): which is a word recognition test
Test of Functional Health Literacy in Adults (TOFHLA):which measures reading skills and numeracy.
teach back
An intervention that helps you to confirm that you have explained what a patient needs to know in a manner that the patient understands. The teach-back technique is an ongoing process of asking patients for feedback through explanation or demonstration and presenting information in a new way until you feel confident that you communicated clearly and that your patient has a full understanding of the information presented.
cultural skill
The ability of nurses to effectively integrate cultural awareness and cultural knowledge when conducting a cultural assessment and to use the data to meet the specific client’s needs
cultural encounters
Engaging in cross-cultural interactions that provide learning of other cultures and opportunities for effective intercultural communication development
cultural desire
the motivation of a health care professional to “want to”—not “have to”—engage in the process of becoming culturally competent
What are the 12 domains of culture?
- Overview, inhabited localities—country of origin and current residence
- Communication—interrelationship of verbal language skills, including dominant language, dialects, touch, contextual use of language, and willingness to share information
- Family roles and organization—defines relationship of insiders and outsiders; includes concepts related to head of household, gender roles, family goals and priorities, and developmental goals of family members
- Workforce issues—type of employment, location, autonomy, language barriers
- Biocultural ecology—skin color, heredity, genetics, drug metabolism
- High-risk behaviors—tobacco, alcohol, recreational drugs, physical activity, safety
- Nutrition—meaning of foods, common foods, deficiencies, rituals, limitations
- Pregnancy and childbearing practices—fertility practices, views toward pregnancy, birthing, postpartum
- Death rituals—bereavement, ceremonies
- Spirituality—religious practices, use of prayer, meaning of life
- Health care practices—focus of health care, traditional practices, responsibility for health, self-medication, pain, sick role, barriers
Health care providers—perceptions of providers, folk practitioners, gender, and health care status
Self-concept
an individual’s view of self.
-It is subjective and involves a complex mixture of unconscious and conscious thoughts, attitudes, and perceptions. Self-concept, or how a person thinks about oneself, directly affects self-esteem, or how one feels about oneself.
what health problems threaten self concept and self esteem
The loss of bodily function, decline in activity tolerance, and difficulty managing a chronic illness
Erikson’s Psychosocial Theory
each stage builds on tasks of the previous stage, successful mastery leads to sense of self
Trust vs. Mistrust
(Birth to 18 months)
-develops trust following consistency in caregiving and nurturing interactions
-distinguishes self from environment
Autonomy vs. Shame
(18-24 months to 3 years)
-begins to communicate likes and dislikes
-increasingly independent in thoughts and actions
-appreciates body appearance and function
Initiative vs. Guilt
(3 to 5 years)
-identifies with gender
-enhances self-awareness
-increases language skills, including identification of feelings
Industry vs. Inferiority
(6 to 11 years)
-incorporates feedback from peers and teachers
-increases self-esteem with new skill mastery (reading, math, sports, music)
-aware of strengths and limitations
identity vs. role confusion
(12 to 18 years)
-accept body changes/maturation
-examines attitudes, values, and beliefs; establishes goals for the future
-feels positive about expanded sense of self
Intimacy vs. Isolation
(Late teens to mid-40s)
-has stable, positive feelings about self
-experiences successful role transitions and increased responsibilities
Generativity vs. Self-Absorption
(Mid 40s to Mid 60s)
-able to accept changes in appearance and physical endurance
-reassess life goals
-shows contentment with aging
Ego Integrity vs. Despair
(late 60s to death)
-feels positive about life and its meaning
-interested in providing legacy for the next generation
When is self-esteem highest?
childhood (preschool)
When is self-esteem typically at its lowest?
adolescence
identity
one’s sense of self or living an authentic life is the basis of true identity.
an individual first identifies with _____ and later identifies with _______
parenting figures
other role models such as teachers or peers.
body image
involves attitudes related to the body, including physical appearance, structure, or function.
-Feelings about body image include those related to sexuality, femininity and masculinity, youthfulness, health, and strength.
what are factor that can influence body image
o Cognitive growth and physical development (puberty and aging)
o Hormonal changes during adolescence
o Cultural and societal attitudes and values influence body image.
what is body image issues often associated with
impaired self-concept and self-esteem.
role performance
the way in which individuals perceive their ability to carry out significant roles.
self esteem
an individual’s overall feeling of self-worth or the emotional appraisal of self-concept
what are behaviors of altered self-concept
avoidance of eye contact, slumped posture, unkempt appearance, overly apologetic, hesitant speech, overly critical or angry, frequent or inappropriate crying, negative self-evaluation, excessively dependent, hesitant to express views or opinions, lack on interest in what is happening, passive attitude, difficulty in making decisions, self-harm behavior
sexual development: infancy and early childhood
The first 3 years of life are crucial in the development of gender identity. The child identifies with the parent of the same sex and develops a complementary relationship with the parent of the opposite sex.
sexual development: school-age years
School-age children generally have questions regarding the physical and emotional aspects of sex. They need accurate information from home and school about changes in their bodies and emotions during this period and what to expect as they move into puberty.
sexual development: puberty/adolescence
Emotional changes during puberty and adolescence are as dramatic as the physical ones. Adolescence is often time when individuals explore their primary sexual orientation. Adolescents may identify with a sexual minority group such as lesbian, gay, bisexual, or transgender (LGBT).
sexual development: Young adulthood
Although young adults have matured physically, they continue to explore and mature emotionally in relationships. Intimacy and sexuality are issues for all young adults whether they are in a sexual relationship, choose to abstain from sex, remain single by choice, are homosexual, or are widowed.
sexual development: Middle adulthood
-Changes in physical appearance in middle adulthood sometimes lead to concerns about sexual attractiveness. Decreasing levels of estrogen in perimenopausal woman lead to diminished vaginal lubrication and decreased vaginal elasticity. Both of these changes often lead to dyspareunia
-Later in the adult years some individuals have to adjust to the social and emotional changes associated with children moving away from home, which may result in renewed intimacy.
dyspareunia
the occurrence of pain during intercourse
sexual development: Older adulthood
Studies show a positive correlation between sexual activity and physical health in older adults. Research indicates that many older adults are more sexuality active than previously thought and engage in high-risk sexual encounters, resulting in a steady increase of human immunodeficiency virus (HIV) and STI rates over the past 12 years
sexual orientation
describes the predominant pattern of a person’s sexual attraction over time.
Sexual identity
how a person thinks about himself or herself sexually
Gender identity: person’s private
Gender identity
person’s private view of maleness or femaleness and gender role is the feminine and masculine behavior exhibited
how are STIs transmitted
Through sexual fluids & skin to skin contact, transmitted from infected individuals to partners during intimate sexual contact.
Usually curable STIs
syphilis, gonorrhea, chlamydia, trichomoniasis
Viral STIs
human papillomavirus (HPV) and herpes simplex virus (HSV) type II, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS).
which STIs caused by viruses cannot be cured
genital herpes, human papillomavirus (HPV), and human immunodeficiency virus (HIV)
common symptoms of STI
discharge from the vagina, penis, or anus; pain during sex or when urinating; blisters or sores in the genital area; fever.
why do people sometimes not seek treatment for STIs
because they are embarrassed to discuss sexual symptoms or concerns. They are often hesitant to talk about their sexual behavior if they believe that it is not “normal.” Any sexual behavior that embarrasses the patient may hinder detection of an STI.
what are the primary routes of transmoission for HIV
contaminated IV needles, anal intercourse, vaginal intercourse, oral-genital sex, and transfusion of blood, blood products
what kind of pathogen is HIV and where is it mostly present?
bloodborne pathogen, present in most body fluids
what are the three HIV stages
-primary infection stage
-clinical latency phase
-last stage
HIV stage: primary infection stage
lasts for about a month after contracting the virus. During this time the person often experiences flulike symptoms.
HIV stage: clinical latency phase
at this time there are no symptoms of infection. HIV antibodies appear in the blood about 6 weeks to 3 months after infection.
If left untreated, people who are infected with HIV live about…
10 years.
HIV stage: the late stage
acquired immunodeficiency syndrome (AIDS), happens when a person begins to show symptoms of the disease
what is the most common STI in the US?
Human papillomavirus infection (HPV)
How does HPV spread?
spread through direct contact with warts, semen, or other fluids
what is HPV also known as
genital warts
what does HPV look like
textured warts often have a cauliflower appearance and are most common on the penis and scrotum in men and the vagina and cervix in women.
What does chlamydia cause?
Causes infertility, pelvic inflammatory disease (PID), and neonatal complications
how is chlamydia spread?
by contact with fluids from the infected site.
-infection can be transmitted during the birthing process and cause conjunctivitis and pneumonia in newborn babies.
factors the influence contraception effectiveness
method of contraception, understanding of the method, consistency of use, compliance with requirements.
abortion
termination of pregnancy
-Be aware of personal values related to abortion. If caring for a patient contemplating abortion, provide an environment in which the patient is able to discuss the issue openly, allowing exploration of various options with an unwanted pregnancy. Discuss religious, social, and personal issues in a nonjudgmental manner with patients.
what is the only 100% effective STI prevention
abstinence
infertility
Inability to conceive after 1 year of unprotected intercourse
if a patient is infertile, what are some choices available to them
pursuit of adoption, medical assistance with fertilization, and adapting to the probability of remaining childless.
what does the nurse do if they suspect sexual abuse
Nurses must report suspected abuse to the proper authorities
what are some behavioral symptoms of sexual abuse in adults
facial grimacing, absence of facial response or flat affect, anxiety, depression, panic attacks, difficulty sleeping, slow, unsteady gait
what are some physical symptoms of sexual abuse in adults
welts, bruises, etc, wounds that don’t match “story” bruises at multiple stages of healing, vaginal or rectal bleeding, fractures to face nose ribs or arms, trauma to labia, vagina, cervix, anus, vomiting or abdominal tenderness
what illnesses can cause sexual dysfunction
Diabetes, cancer, neuropathy, spina bifida, spinal cord injury, heart disease, COPD, HIV, substance abuse, depression, anxiety
what medications can cause sexual dysfunction
Antibiotics and antivirals, antihyperlipidemic, antihypertensives, antiglycemic, antiarthritics, antiparkinsons, analgesics, antidepressives, anxiolytics, antiphsychotics, diuretics
PLISSIT Assessment of Sexuality
PERMISSION to discuss sexuality issues
LIMITED INFORMATION related to sexual health problems being experienced
SPECIFIC SUGGESTIONS—only when the nurse is clear about the problem
INTENSIVE THERAPY—referral to professional with advanced training if necessary
what age do you offer the 9-valent HPV vaccine to males and females
between 11 and 26 years of age.
what strategies enhance sexual functioning
Avoid alcohol or tobacco
eat well-balanced meals
plan sexual activity when couple feels rested
take pain medication if needed before intercourse
use pillows and alternate positioning to enhance comfort
encourage tactile stimulation
communicate concerns and fears with partner.
Spirituality
defined as an awareness of one’s inner self and a sense of connection to a higher being, nature, or some purpose greater than oneself.
Self-transcendence
A sense of authentically connecting to one’s inner self.
-It allows people to have new experiences and develop new perspectives that are beyond ordinary physical boundaries.
Connectedness
Being intrapersonally connected within oneself; interpersonally connected with others and the environment; and transpersonally connected with God, or an unseen higher power
-Through connectedness patients move beyond the stressors of everyday life and find comfort, faith, hope, and empowerment.
faith
Allows people to have firm beliefs despite lack of physical evidence
hope
usually refers to an energizing source that has an orientation to future goals and outcomes
spiritual well-being
has two dimensions:
-One dimension supports the transcendent relationship between a person and God or a higher power.
-The other dimension describes positive relationships and connections that people have with others.
athiest
person who does not believe in the existence God
agnostic
one who believes that the existence of a god can be neither proven nor disproven
religious care
Helping patients maintain faithfulness to their belief system and worship practices
spiritual care
Helping people identify meaning and purpose in life, look beyond the present, and maintain personal relations as well as a relationship with a higher being or life force
how do people gain spiritiality?
by finding a balance between their values, goals, and beliefs and their relationships within themselves and with others
spiritual distress
a state of suffering related to the impaired ability to experience meaning in life through connections with self, others, the world, or a superior being
chronic illness and spirituality
Many chronic illnesses threaten a person’s independence, causing fear, anxiety, and spiritual distress.
terminal illness and spirituality
Terminal illness causes fears of physical pain, isolation, the unknown, and dying. It creates an uncertainty about what death means, making patients susceptible to spiritual distress. Some patients have a spiritual sense of peace that enables them to face death without fear.
near-death experience (NDE)
psychological phenomenon close to clinical death or recovered after declared death
patients who experience an NDE describe feeling…
totally at peace, having an out-of-body experience, being pulled into a dark tunnel, seeing bright lights, and meeting people who preceded them in death.
what are some assessment tools used for spirituality
o Listening to a patient’s story is an essential method for obtaining a spiritual assessment.
o Asking direct questions requires you to feel comfortable asking others about their spirituality.
o The FICA assessment tool spirituality
o Spiritual well-being (SWB) scale
FICA stands for the following criteria:
F—Faith or belief
I—Importance and Influence
C—Community
A—Address
Spiritual well-being (SWB) scale
scale has 20 questions that assess a patient’s relationship with God and his or her sense of life purpose and life satisfaction.
what kind of questions do you ask about faith and beliefs
Ask about a religious source of guidance
what kind of questions do you ask about life and self-responsibility
ask about a patient’s understanding of illness limitations or threats and how the patient will adjust
what kind of questions do you ask about connectedness
ask about the patient’s ability to express a sense of relatedness to something greater than self
Life satisfaction
Spiritual well-being is tied to a person’s satisfaction with life and what he or she has accomplished, even in the case of children. When people are satisfied with life and how they are using their abilities, more energy is available to deal with new difficulties and resolve problems.
what kind of questions do you ask about culture
ask about faith and belief systems to understand culture and spirituality relationships
Fellowship and community
Explore the extent and nature of a person’s support networks and their relationship with the patient. It is unwise to assume that a given network offers the kind of support that a patient desires.
Ritual and practice
Rituals include participation in worship, prayer, sacraments (e.g., baptism, Holy Eucharist), fasting, singing, meditating, scripture reading, and making offerings or sacrifices.
what kind of questions do you ask about vocation
ask whether illness or hospitalization has altered spiritual expression
what should a nurse do to support a healing relationship look beyond isolated patient problems, and recognize the broader picture of a patient’s holistic need
-Realistically mobilizing hope for the nurse and patient
-Finding an interpretation or understanding of the illness, pain, anxiety, or other stressful emotion that is acceptable to the patient
-Helping the patient use social, emotional, and spiritual resources
support systems
provide patients with greatest sense of well-being and serve as a human link, connecting patient, nurse, and patient’s lifestyle before an illness; family, friends, and pastoral care are sources of faith and hope. Connectedness and fellowship with other persons are a source of hope for a patient.
diet therapies
Foods and rituals are often an integral part of patient’s beliefs and spirituality.
how can nurses support rituals
provide patients with greatest sense of well-being and serve as a human link, connecting patient, nurse, and patient’s lifestyle before an illness; family, friends, and pastoral care are sources of faith and hope. Connectedness and fellowship with other persons are a source of hope for a patient.
Prayer
can be an opportunity to renew personal faith and belief in a higher being.
-Prayer is an effective coping resource for physical and psychological symptoms.
Meditation
Creates a relaxation response to reduce daily stress.
