Transcultural Nursing January 20, 2017 Madeleine Leininger founded Transcultural Nursing in the 1960s -there was not a lot of tolerance for diversity -respect didn’t happen till 1980sIf you want to learn more check out nursing fundamentals exam 2
We also discuss several other topics like transcription study guide
If you want to learn more check out neuropharmacology utd
Don't forget about the age old question of vispassana
We also discuss several other topics like give the genotypes of progeny plants in this experiment. drag the appropriate items to their respective bins.
Don't forget about the age old question of Enuemrate the types of authority.
and 90s There is now a Transcultural Nursing Society Global Health -there is global nursing -would want to be certified as a transcultural nurse -would work with AIDS groups, WHO -have global health program at RU -graduate students can work in global health Purpose of Nursing Journals? -disseminate information -see what their colleagues are doing in terms of research What is Culture? -with your social religious imprinting culture, artistic expressions -be able to identify art -embedded in everything even religion Ex: Buddhism we think of Asian cultures -there are certain associations -how we engage in healthcare -defines how we engage in healthcare -group of beliefs, values, to guide your thinking and your action Culture is different from ethnicity, and ethnicity (biological background) is different from race (superficial) Ethnicity can tell you a lot about medical dispositions -more to do with genetic makeup -using genetics to determine what medicine we should give them -that’s why genetics is so important-pharmacogenetics Race is something we impose on people Giger says 2070 there will be no pure race Stereotype is what we impose on people Ex: all Latina women don’t work and are slaves to their husbands Ex: can’t go in urban areas cause you’ll get hurt Ex: all nurses work at the bedside Cultural associations are things like your music and foods you eat, rituals that are celebrated Ex: Quinceanera for Latin groups Ex: dedication is for Pentecostal, protestant conservative Christian groups Ex: baptism is a choice -there are bigger things within Cultural associations Giger did a lot of research with David Heiser -developed Transcultural nursing model -turn to page 6 -6 phenomenon that you’re going to be looking at The first is communication -the language that the person speaks -there is slang, about every culture has slang -some people use a lot of silence -we might perceive them as being rude, depressed, meditating -nonverbal communication: eye contact, headache, stress The second is space -it means different things to different cultures -some cultures where there are right up close in your face -if one enters a space too quickly it may be a problem -there is personal space: you have to ask, or tell them what you are doing -with kids you tell -if a kid says no, then that’s itThe third is social orientation -culture, race, ethnicity, and role in family -from the American culture, it is a role reversal for man to stay at home -if you have gay and lesbian couples, who assumes which role? The 4th is environment -what are the cultural health practices within a person’s environment -is It efficacious? -ex: mom using home remedies, some weren’t efficacious (had lead in it) -values are part of environment -what does that person think of definition of sickness? The 5th is time -it means different things to cultures -why is it important in healthcare? -appointment: when they show up at 3:45 instead of 3. -if we tell a patient that your surgery is at 6am and comes early and doesn’t have surgery yet, it can become tense -time perspectives: are the future oriented? Past oriented? -important when teaching about health promotion Ex: smoker who is present oriented Ex: adolescents are present-oriented -can be hard to engage in healthy behaviors Ex: homeless are present-oriented The 6th is biological variations -stature, skin color, skin type, hair color, enzymes and gut bacteria -nutritional preferences/differences Ex: a lot of African Americans are lactose intolerance -difficult to afford -that’s where social determinants come in -I don’t’ have a store in my neighborhood that sells that kind of milkWhat’s your patient’s life like? -Gonna need to know these 6 phenomena What is culturally competent care? -having an awareness in the differences of other people by healthcare professionals that allows you to meet their needs -you need to develop an awareness of yourself before you can do this -unconscious bias Website: projectimplicit -take this test and it’s going to test your unconscious bias -doctors tend to discriminate which affects treatment of patients -we all have biases and we cannot begin to care for people unless we understand what that bias is -take test on race -make 2 copies of it. One you’ll keep and one you’ll turn inCulture January 27, 2017 Communicate -“to make common, share, participate, or impart” -David Hizar’s model -Communication: -all behavior, verbal or nonverbal in the presence of another -means by which all people connect -continuous process -written, oral, gestures, facial expression Communication -important to overall health -frequently presents barriers between nurses and clients -impaired communication affects health Communication & Culture -culture is transmitted and preserved via communication -culture influences how feelings are expressed -cultural patterns of communication embedded by 5 years old Gibson study 1984 -rates of touch for retrieving or punishing equal -American children touched less for soothing, holding or play Ex: morasma : after not getting picked up, child becomes listless -variations in communication may be limited to specific meaning for small groups (family) -unique patterns found among people from same ethnic and cultural groups -do not assume communication patterns are generalizable -be mindful of communication patterns but treat people as individuals Ex: Asian culture, nodding head sign of respect Linguistics -the structure of communication-grammatically nonequivalent words -may create disparity in social treatment -Cultural and linguistic competence: -congruent behaviors, attitudes and policies that come together in a system, agency or among health professionals that enables work in cross cultural situations Ex: using medical translators Functions of Communication -discloses information -convey respect Process of Communication -Sender, Transmitter (means of communication, talk, send a letter, email), Receiver and then Feedback Factors Influencing Communication -Health -physical/emotional -Situation being discussed -distractions -knowledge of subject matter -communication skills -attitudes -person/subject matter -personal needs -Background: cultural, social, philosophical -sense involved and functional ability -environment (be mindful of where we’re asking questions) -tendency to be judgmental Verbal and Nonverbal Communication Verbal -vocabulary -grammatical structure-voice qualities -intonation -rhythm -speed -pronunciation -silence Nonverbal -touch -facial expression -eye movement -body posture Both -warmth, humor Nonverbal Communication -minimal significance in isolation -adds to communication process/experience -be aware of one’s own NV communication Relating to Differing Cultures -assess and be aware of personal beliefs about other cultures (implicit biases) -assess communication variables from a cultural perspective -plan care based on communicated needs and cultural background -modify communication approaches to meet cultural needs Ex: Ramadan, Muslims fast during the day -respect for the client and communicated needs is central to therapeutic communication -communicate in a nonthreatening manner -develop trust -validate content -be considerate of reluctance to talk when the subject involves sexual/traumatic matters -special approaches for clients who speak other languages-especially for people who speak ESL -use interpreters -professional, medical interpreter = best option -family member- not a child = 2nd best option -translate verbal & nonverbal expressions = ideally CLAS = Culturally and Linguistically Appropriate Services -go to CDC website for multicultural languages on Vaccinations Case Study A 37 year old Black woman who was recently diagnosed as having HTN is admitted for a medical work up examination. Identify the barriers for communication and identify what actions the nurse can take to fix these barriers to communicate with the person Barriers: -language -certain view of the hospital -certain cultural demographic/race -avoid using slang words that may be foreign -have a conversation about her life before diving into the medical diagnosis -be aware of body language -asking for clarification -perfect time to use nonverbal communication Signs of anxiousness: stuttering, avoiding eye contact, more reserved, crying -explore why she is afraid of the hospital -never tell the patient: everything is going to be okay -you can say: I will keep you informed every step of the way, we’re doing the best we canWeek 3: Feb 3, 2017 Concept of Time and Space Time -gradual process -time is not innate -develops early from early experiences -developed from routine (nap time, eat, nap, eat, wake up, etc.) -child then knows and starts getting cranky -tv shows Time is associated with rhythm and change, speed and velocity Time can be concrete or abstract idea Ex: sciences that study biology -view time as concrete -when fetus is born Ex: mathematical and physical science -view time as abstract -idea of infinity Ways to measure time -duration: seizures (how long was it), chest pain, unconscious (how long were they out for), how far apart are the contractions? -specific instances: Ex: at 10:30 we’re gonna have brunch Ex: prepped by 6 because OR is coming at 6:15 Ex: international clock: Greninge meme time 2 standard times -measure by day and year -days broken into hours, min, sec, nanosec -we have a circadian rhythm and associated with are hormones -sleeping during night is better than sleeping during the day International Date Line-where you can change days by crossing the line Clock and calendar time (more concrete) -when are they going to therapy? Do they need a new dressing? Social Time -not exact Temporal Orientation: Past-oriented -elderly: don’t want any change Ex: don’t move the sofa Ex: talk about past a lot because of dementia Ex: eating habits, affect motivation to change, affect grieving process Ex: with medication Ex: kids with shots and going to doctor’s office Present-oriented Ex: “catching asthma” Health professionals are a sub value -we have values -Discharge begins on admission Read the Zimbardo article on past-negative, past-positive, etc. Past-negative -“I don’t want to talk about my past.” -they think a lot about the fast which influences their ability to live in the future Past-positive -things that have happened influence how they feel about future -nostalgic memories, good memories about past Present Hedonistic -risk-takers When health-teaching, may be harder -normally girls with type 1 diabetes, deliberately go into ketosis when they want to lose weight -those who have seizure problems smoke weekPresent Fatalistic -little control of their future -hopeless attitude toward future and life The future -who have good success doing coaching with -teaching how to prick a finger -all in when learning how to improve themselves KNOW THE DISTANCE ZONES****February 10, 2017/ Week 4 Touch and Space Structural Boundaries -separates person from others and defines a person’s space -doors, curtains, walls, desks, chairs, etc. -can help person adapt to internal and external stresses -way things are arranged can facilitate or hinder our communication and increase or decrease stress -territoriality over structural boundaries -clients have need to control physical space sleeping area, space for personal belongings -nurses must control their space -lounges, medication room -conference rooms, nurses’ station -restrooms, locker rooms Patient Care Implications -respect client’s requirements -allow client’s use of and control over personal space -insure privacy when in intimate zone, during physical exam -avoid looking down on patient – sit down for interview and education -arranging chairs, wheelchairs corner-to-corner or face to face to encourage interaction -respect eye contact cultural norms when performing intimate procedures (staring into space one way of coping with intrusion) Diversity: Today’s Topic -inclusion of different people from different backgrounds 2012 Census choices: -non-Hispanic white -black (AA, continent, Haitians, Sudanese, Ethiopian, SA, Nigerian) -Hispanic -Asian -American Indians -other pacific islanders -native Hawaiians -Census has occurred since 1700’s -U.S. Census Bureau -Authority: Title 13 & Title 26 of the U.S. Code -Population & housing census every 10y -Next 2020 -Economic census every 5 y -U.S. is made up of mostly people whose ancestors were immigrants and slaves -people groups native to the U.s -American Indians -Aleuts -Inuit (Eskimo) Why do people immigrate to the U.S.? Safety, religious/political freedom, economic mobility Where does socialization of immigrants occur? -school is really important for children to be socialized into the culture -many countries don’t have public schools, when immigrants come they can’t afford private schools Who is a citizen? -someone who is born here in the U.S. -native born -foreign-born child of a U.S. citizen -naturalized person -How does immigration impact healthcare in the U.S.? -do the jobs that U.S. citizens don’t want to do -it affects everyone -most people who are in poverty are not the immigrants but the Latinos and blacks -fair wages for everyone, wage disparity = capitalist societyDiversity -poverty: the state or condition of having little or no means of support -poverty has ubiquitous consequences -violence: battering, bullying, spouse and child abuse -gaming/gambling -obesity -aspects of poverty -mental -physical -spiritual -Rates of poverty vary by age, gender, race and ethnicity -24.1 Blacks -21.4 Hispanics 9.1 non-Hispanic white 19.7 children 8.8 seniors =/> 65Y -Federal Poverty Programs (“safety nets”) -Cash Aid (temporary assistance for needy families) -food and nutrition (food stamps, WIC) (SNAP) -WIC: women, infants, and children =eligible when they’re pregnant, because of nutritional deficiencies -Medical (Medicaid) -not everyone accepts Medicaid -housing (section 8 low income housing assistance) -HUD -Personal Finances and Health -poverty -limits access -financial means-increased access to health care -better living conditions -safer locations (environmentally and socially) -traffic area, violence, lot of bars -better opportunities to engage in health promoting behavior Health & Illness -Health “The state of complete physical, mental and social well-being and not merely the absence of disease” -health is fluid and not static -health is somewhat subjective -health in chronicity? -Health Maintenance and Protection -Societal shift from acute care to preventive care -disparities in overall health, access and utilization of health care exists -blacks and Hispanics deal with the biggest problems of poverty -Determinants of health: A range of personal, social, economic and environmental factors that influence health status Spector, p 68 -circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness. WHO -Healthy People 202 -objectives for the nation’s health -important for HCP to work within these limits -Health Belief Model can help explain health behavior -pg 71**** -know parts of model and be able to give examples and interpret them Sick Role -Sick person is exempt from social obligations -Sick person is exempt from certain responsibilities d/t their state -legitimization -seek help (assume patient role)-illness experience -determined by what illness means to the sick individual -four stages of illness (p. 79) -initial experience of symptoms -diagnosis (illness is sanctioned) = it’s legitimized -patient status -recovery (depends on the illness) Next slide: Race is different from ethnicity but related to biology. -members of the same race share distinguishing physical features (skin color, hair texture) -regardless of race all people share a cultural heritage that makes them ethnic Ethnicity often used to refer to race which in erroneous -members share a common social and cultural heritage that has is passed on to successive generations Bicultural term used to describe a person who crosses two cultures, lifestyles and sets of values Biracial an individual who crosses two racial and cultural groups Minority not synonymous with numbers. Refers to group that is underrepresented and has less social power Stereotyping assumption that all people in a similar culture, racial or ethnic group are alike and share the same values and beliefs. -all Lebanese people only eat halal food -all Jewish people eat kosher -all islams wear hijabs Family Structures -traditional nuclear family: one man and one woman of the same race, reiligion and age who are of sound mind and body and who marry during their middle 20s,, are monogamous and raise their own children -nuclear dyad consists of one generation and is made up of a married couple without children -extended family is multigenerational and includes all relatives by birth, marriage, or adoption-skip generation family is a family that has the grandparents taking care of the grandchildren. This Is and increasing phenomenon -represented in minority communities, poverty communities Religious Groups -please read pages 73-84 in Giger -religious practices are rooted in culture. Each religious culture typically has a set of beliefs that define and govern health beliefs and the way members do or do not access healthcare -religious belief systems are either monotheistic (belief that there is one mane deity: Judaism, islam, jewish) or polytheistic (belief that several deities govern) -relgious structures fall into one of two types: church type and withdrawal group Jehovah’s witnesses -Major beliefs that could affect health care and nursing care -sinners will perish and not go to heaven if they do not believe in Jehovah -there will be a second coming of the kingdom -conscientious objectors and will not serve in the military -government institutions are under the control of Satan -will not accept homologous blood transfusions -certain types of autologous transfusions are accepted. If the blood does not get processed outside of the body it may be used. Hemodilution techniques are acceptable -Many JW’s carry a blood product instruction card -be familiar with alternatives on p. 77 on Giger*** Seventh Day Adventists -the body is a temple of God and man should keep it healthy. -practicing members of the faith usually do not smoke, consume alcohol, use recreational drugs, consume caffeine, eat seafood or certain meats. -their Sabbath begins on Friday evening and goes through Saturday evening therefore they may refuse obligations outside of church during these times. -seafood that is rich in iodine may be absent in the diets of strictly observant members therefore they may have issues with iodine deficiency -some or all meats may also be absent from diets of strictly observant members and they may have issues with protein deficiency Islam-islam is one of the three major monotheistic religions in the world -the life and writing of Muhammad found in the Qur’ an is the foundation of their beliefs. -tenents of Islamic life are described as the Five Pillars of Islam 1. Declaration of faith 2. Daily prayers five times a day 3. Fasting during Ramadan (28 day period) pregnant women, ill persons and children are excluded Other Ethnic Groups American Indians/Native Americans -highest rates of suicide and alcohol abuse -pipeline aka eminent domain -this group is powerless -extended family is very important