Week 3 Flashcards
Culture
Thoughts, communication, actions, beliefs, values and institutions of racial, ethnic, religious or social groups
Characteristics of culture
Learned Shared Adapted/associated Dynamic Universal
Ethnicity
Describes a group united by... Common geographic region Migratory status Religion Race Language Shared values, traditions, or symbols Food preferences
Religion
Belief in divine or superhuman power, or powers to be obeyed and worshipped as creator/ruler of universe
System of beliefs, practices, and ethical values
Shared experiences of spirituality
Socialization
Process of being raised within a culture and acquiring characteristics of that group
Acculturation
Process of adapting to and acquiring another culture
Assimilation
Process of developing a new culture identity and becoming like members of dominant culture
Biculturalism
Dual pattern of identification and often of divided loyalty
Stereotyping
All members of a particular culture expecting group members to hold the same beliefs and behave the same way
Ethnocentrism
Perception that ones worldview is the only acceptable truth and that ones beliefs, values and sanctioned behaviors are superior to all others
What is cultural competence?
Knowledge and understanding of another persons culture; adapting interventions and approaches to health care to the specific culture of the patient, family and social group
Culturally sensitive
Possessing basic knowledge of and constructive attitudes toward diverse cultural populations
Culturally appropriate
Applying underlying background knowledge necessary to provide the best possibly health care
Culturally competent
Understanding and attending to total context of patients situation including:
- immigration status
- stress and social factors
- cultural similarities and differences
National Cultural and Linguistic Standards: First Landmark Standard
Healthcare organizations should ensure that patients receive from all staff members effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language
Title VI of Civil Rights Act of 1964
Services cannot be denied to people of limited English proficiency
Why are patients who have limited English proficiency (LEP) at risk for poor health care outcomes
Due to the barrier that language presents during healthcare delivery interactions
Steps to cultural competence
- Understand ones own heritage-based values, beliefs, attitudes and practices
- ID meaning of “health” to patient
- Understand how HC system works
- Acquire knowledge about social backgrounds of clients
- Become familiar with languages, interpretive services, and community resources available to nurses and clients
What must the nurse assess first when providing culturally competent health care to an Asian American patient?
The nurses heritage-based cultural values, beliefs, attitudes and practices
Spirituality
A search for meaning and purpose in life. Seeks to understand life’s ultimate questions in relation to the sacred
Defining characteristics of spirituality
Informal Non organized Self-reflection May involved spiritual experiences Subjective, as in difficult to consistently measure (e.g., daily spiritual experiences, spiritual well-being, etc.)
What are modifications to be considered for a culturally competent interview?
Communication
- time
- space
- eye contact and face positioning
- body language and hand gestures
- silence
- touch
Family violence
The controlling, coercive behaviors seen through the intentional actions of violence inflicted on those in familial or intimate relationships; includes intimate partner violence, child abuse and elder mistreatment
Intimate Partner Violence (IPV) - defined by CDC
Physical or sexual violence, use of physical force, or threat of such violence
Psychological or emotional abuse or coercive tactics after prior physical violence between persons who are spouses or non-marital partners of former spouses or non-marital partners
What does the Child Abuse and Prevention Treatment Act (CAPTA) do?
Dictates minimum standards that must be incorporated into state statutes
— most state statutes include neglect, physical abuse, sexual abuse, emotional abuse
Child Abuse State Statutes: Neglect
Failure to provide for a child’s basic physical, educational, medical and emotional needs
Child Abuse State Statutes: Physical abuse
Physical injury due to punching, beating, kicking, biting, burning, shaking, or otherwise harming a child; even if parent or caretaker did not intend harm, such acts are considered abuse when done purposefully
Child Abuse State Statutes: Sexual Abuse
Includes fondling child’s genitals, incest, penetration, rape, sodomy, indecent exposure, and exploitation through prostitution or production of pornographic materials
Child Abuse State Statutes: Emotional Abuse
Any pattern of behavior that harms child’s emotional development or sense of self-worth; includes frequent belittling, rejection, threats, and withholding of love and support
CDC definition for adolescent dating violence
Physical, sexual or psychological/emotional violence within a dating relationship that includes stalking
— in person or electronically
— present or former partner
Elder Abuse and Neglect Defined:
Almost every state has some form of mandatory reporting of abused elderly and other vulnerable patients
What do you need to have in order to call as a mandatory reporter
You only need to have suspicion that elder abuse or neglect may have occurred to call authorities
American Medical Association (AMA) Definitions of Elder Abuse and Neglect: physical abuse
Violent acts that result or could result in injury, pain, impairment or disease
American Medical Association (AMA) Definitions of Elder Abuse and Neglect: physical neglect
Failure of family or caregiver to provide basic goods and services such as food, shelter, health care and medications
American Medical Association (AMA) Definitions of Elder Abuse and Neglect: psychological abuse
Behaviors that result in mental anguish
American Medical Association (AMA) Definitions of Elder Abuse and Neglect: psychological neglect
Failure to provide basic social stimulation
American Medical Association (AMA) Definitions of Elder Abuse and Neglect: Financial abuse
Intentional misuse of elderly person’s financial and material resources
American Medical Association (AMA) Definitions of Elder Abuse and Neglect: Financial neglect
Failure to use elderly persons assets to provide needed recourses
Health Effects of Violence: Women
Abused women have more chronic health problems (neurological, gastrointestinal, gynecologic, and chronic pain)
Forced sex contributes to reproductive issues (chronic pelvic pain, pregnancy, STIs, HIV, UTI)
Higher mental health issues (depression, SI, PTSD, substance abuse)
Abuse during pregnancy = problems for both mother and child (low birth weight, increased risk for child abuse)
Health effects of elder abuse:
A. Bleeding from trauma —> changes in circulatory homeostasis and fluctuations in BP and pulse, shock and death
B. Infections —> sepsis or death in immunocompromised
C. Cardiac complications from stress
D. STIs and related complications for younger women are present in older sexually assaulted women
Abuse of the elderly is often coupled with what?
Neglect
Family or others working with aging persons may be responsible for actions of neglect whether it is ______ or _______.
Intentional or unintentional
Self-neglect is what
Mandatory reportable activity
Health Effects of Violence: Child Abuse
- Immediate consequences (bruises, fractures, lacerations, shaken baby syndrome)
- Severe mistreatment can lead to long-term disability such as blindness, developmental delay, physical disability or death
- Poor bond with child and caregiver
- Abused children will likely abuse their own children
- Immediate behavioral issues, developmental delays, regression behaviors
Risk factors that may contribute to child maltreatment
- Disabilities/developmental delays in children that may increase caregiver burden
- Social isolation of families
- Parents lack understanding of child needs / development
- Parents history of domestic abuse
- Poverty and socioeconomic disadvantages
- Family disorganization / violence
- Substance abuse
- Young, single, non-biological parents
- Community violence
- Parental stress
Routine Screening for Intimate Partner Violence (IPV)
Routine, universal screening for IPV means asking every woman at every health care encounter if she has been abused by a husband, boyfriend or other intimate partner / ex-partner
- required by most nursing professional organizations
- US Preventative Task Force has issued a policy statement supporting the positive benefits of routine screening for IPV
How to assess for intimate partner violence
Many precede questions with an introduction
Ex. “Because domestic violence is so common in our society…”
This alerts women that questions about domestic violence are coming and makes sure they know they are not being singled out for these questions
What should you do if a women answers yes to any of the Abuse Assessment Screen (AAS)
Ask questions to assess how recent and how serious the abuse was
How do you assess for adolescent relationship violence?
No validated screening tool
— observe for risk factors and be aware that it occurs in both genders (alc. abuse, substance abuse, early onset of sexual activity, signs of mental illness or poor performance at school)
What are some examples of asking pertinent questions relative to assessing risk when assessing for adolescent relationship violence
Have you felt unsafe in relationships?
Is a partner from a previous relationship making you feel unsafe now?
Etc.
Why is the assessment of abuse or neglect in cognitively challenged persons complicated?
Physical findings inconsistent with history provided by patient, family, or caregiver are red flags of possible abuse and neglect
- problems can exist at multiple levels, both physically and cognitively
The nurse is assessing a patient who admits to being physically abused by her spouse. The patient says, “I wish I would have agreed with my husband, because then I would not have been hit”. What is the nurses best response?
It is not your fault that your husband lost control. Changing your actions will not prevent him from abusing you again
Physical examination: IPV or Elder Abuse
Important components of physical examination of known survivor of IPV or elder abuse include the following:
A. Complete head to toe visual examination, especially is patient is receiving health services for reported abuse
B. Health evaluations for know or suspected elder abuse and neglect should include baseline lab tests, including a CBC with platelet level, basic blood chemistries, serum liver function tests, a coagulation panel and urinalysis
Physical examination: children
Head to toe examination
- significant injuries can be hidden under clothing, diapers, socks and long hair
- bruising in atypical places such as buttocks, hands, feet back and abdomen are exceedingly rare and should arouse concern
- any bruise in the shape of an object should be considered higher specific for abuse
- bruising found in non-mobile children should raise concern for further injury, including fractures and intracranial injury
Documentation of IPV, child abuse and elder abuse must include:
- Detailed, non biased progress notes
- Use of injury maps
- Photographic documentation
- Other aspects of abuse history
- Written documentation of histories of IPV and elder abuse needs to be verbatim but within reason
- Critical to document exceptionally poignant statements made by victims that identify perpetrator and severe threats of harm by perpetrator
Adipose tissue
F
Areola
G
Breasts
G
Colostrum
By
Cooper’s ligaments
GI
Glandular tissue
G
Gynecomastia
G
Inframammary ridge
G
Menarche
G
Nipple
G
Premature Thelarche
G
Supernumerary nipple
G
Tail of Spence
G
Tanner Staging
G
Acinus
G
Anterior axillary
G
Apex
Gf
Apgar Scoring System
V
Base
V
Bronchi
G
Costochondral Junction
G
Costo-diaphragmatic recess
F
Crackles
G
Crepitus
G
Diaphragm
G
Dyspnea
G
Fissures
G
Hypercapnia
G
Hyper resonance
G
Hypoxemia
F
Kyphosis
G
Mediastinum
F
Medaxillary
G
Midclavicular
G
Midsternal
F
Oblique
F
Orthopnea
F
Parietal
F
Paroxysmal nocturnal dyspnea
F
Physiologic dyspnea
F
Pleurae
G
Pleural cavities
G
Posterior axillary
G
Pulse oximeter
G
Resonance
Gf
Ribs
H
Scapular
G
Spirometer
G
Sternum
G
Surfactant
G
Thoracic cage
G
Trachea
G
Vertebrae
G
Vertebral
G
Visceral
G
Wheezes
G
