155-Wk3 Lecture In Cultural, Spiritual, And Social Considerations In Health Assessments-Jannah U-C

Front 1

Culturalism?

Back 1

-a process of conceptualizing, in fairly narrow terms, that people act in a particular way because of their culture

-assuming people act in a certain way because of their culture. i.e.. not ALL Italians love spaghetti, or not ALL Asians love rice

Front 2

Describe what a critical cultural perspective is.

Back 2

-With this view we understand culture as a relational aspect of ourselves that shifts and changes over time, depending on our history, social context, past experiences, gender, professional identity, etc.

-Paying attention to peoples' values, beliefs, and practices are highly significant and intersect with broader social determinants of health and the power relationships that shape health.

-This perspective prompts us to see what people eat is equally influenced by income, access to food, geographic location, education level, and affordability (i.e.. rural and remote areas, fast food costs less than fresh milk, fruit and veges.

-Defining culture from a critical cultural perspective helps counter culturalism

Front 3

Ethnicity?

Back 3

-Inferring geographic and national affiliation.

-social group within social system claims to possess variable traits-common geographic origin, migratory status, religion, race, language, shared values, traditions, symbols, food preferences.


Acculturation-adapting to another culture
Assimilation-new cultural identity, becomes like member of dominant culture
Biculturalism-dual pattern of identification, often divided loyalty

Front 4

Socialization?

Back 4

Being raised within culture and acquiring characteristics of that group

Front 5

Acculturation

Back 5

Adapting to another culture.

Front 6

Assimilation?

Back 6

New cultural identity, becomes like member of dominant culture

Front 7

Biculturalism?

Back 7

Dual pattern of identification, often divided loyalty.

Front 8

Ethnic Group?

Back 8

Shared heritage, culture, language.

Front 9

Race?

Back 9

“A socially constructed category used to classify humans according to common ancestry and reliant on differentiation by such physical characteristics …”

(Henry et al, 2005)

Front 10

What are examples of some important cultural considerations you my encounter in the clinical setting?

Back 10

-Eye contact-some patients may find direct eye contact impolite/aggressive. May also show respect when they do not look directly at you.

-Time orientation-past-ancestors, ask for guidance

-Present-difficulty planning for discharge

-Future-”latest treatment”

-Touch-touching the head-spirit resides. Females-not able to care for males, and males not able to care for females.

-Diet-fasting, avoid pork-derived insulin.

Front 11

What does cultural care include?

Back 11

-Cultural sensitivity
-Culturally appropriate
-Cultural competence
-Cultural safety

Front 12

How can RNs apply cultural sensitivity in their care?

Back 12

- be sensitive to peoples values, beliefs, customs and practices (i.e.. smoke rooms, St.Pauls hospital).

-Have some basic knowledge of and constructive attitudes towards diverse cultural populations found in settings in which they’re practicing (don’t need to know everything!)

Front 13

How can RNs be culturally appropriate in their care?

Back 13

-Apply background knowledge that must be possessed to provide person with best healthcare.

Front 14

What does practice in culturally competence include?

Back 14

–Embraces a more active role for you as an RN to develop knowledge in:

-your own ethnocultural and social background

-culture of nursing, and related professions

-culture of healthcare

-significance of social/economic and cultural contexts with your ability to examine your own assumptions

-Understand and attend to total context of individuals situation, including awareness of immigration status, stress factors, social factors, cultural similarities, and differences.

Front 15

How to become culturally competent?

Back 15

-Aware of OWN cultural values and beliefs. Attitudes and practices relevant to health and illness.

-Confront own biases, preconceptions, and prejudices about certain racial, ethnic, religious, sexual, socioeconomic groups.

- Identify meaning of health to OTHER person. Understand healthcare delivery system, how it works, what it does, meanings of various procedures, costs, consequences to patients and you as a nurse.

-Knowledge about social backgrounds of your patients-meanings of immigration, racism, socioeconomic status, welfare reform, aging, etc. familiar with language and/or how to access interpreters and resources in community.

Front 16

What does cultural safety mean to provide care?

Back 16

To provide care to individuals or groups, consider the social, economic, political and historical positions within society

For example:

-Western healthcare culture – attribute illness to individual behaviors/factors such as bacteria, viruses, poor lifestyle practices or failure to exercise.

-Within health assessment – focus on an individuals understanding, explanations, values, practices r/t health and illness. This will help you to obtain relevant information towards their health to provide culturally safe care.

Front 17

What does ASKED stand for (in terms of culturally competency)

Back 17

A-awareness-am I aware of my personal biases and prejudices towards cultural groups different than mine?

S-skill-Do I have the skill to conduct a cultural assessment and perform a culturally-based physical assessment in a sensitive manner?

K-knowledge-Do I have knowledge of the patient’s world view and the field of biocultural ecology?

E-encounters-How many face to face encounters have I had with patients from diverse cultural backgrounds?

D-desire-what is my genuine desire to “want to be” culturally competent?

Front 18

What does RESPECT stand for (in terms of cultural competency?)

Back 18

R – realize you must know and understand your own heritage and your patients

E – examine patient within context of his/her cultural health and illness practices

S – select questions not complex, do not ask rapidly

P – pace questions throughout physical exam

E – encourage patient to discuss meanings of health and illness

C – check for patients understanding and acceptance of recommendations and build on cultural health practices

T – touch patient within cultural boundaries of heritage

Front 19

What are major Canadian demographics?

Back 19

-33 million people

-Majority are Canadian-born
Population increase attributed to international migration.

-70% of immigrants do not speak English or French as primary language.

-Live primarily in urban areas.

-Canada’s population as a whole is aging.

-Median age is 39.5 years.

-Canada’s population diverse in terms of where people live, languages spoken, age distributions, and ethnocultural identities.

-Canada’s 2 official languages entrenched in our history.

-25 million urban, 6 million rural.
65+=13.7% of population record high!

-Under 15=17.7% population. Lowest ever!

-Canada has never had so many persons aged 80 years and over with 2/3 of this population women.

Front 20

Explain the health status of Aboriginal people in Canada. What historical contexts have impacted their health status?

Back 20

-Indian Act – assimilating and governing Indians. 1876. Classifies First Nations into registered status or non-status Indians (20% do not have status).

Why does Indian act effect health? Status receive limited healthcare benefits not covered by provincial health insurance plans.

-Reserves and residential schools attempts at assimilation

-Inequities of past continue to influence health status in present.

-Life expectancy 68.9 years men, 76.6 years women, differences 7.4 and 5.2 years less than that of total Canadian population.

-Heart disease 1.5 times higher; Type 2 diabetes 3 to 5 times higher; TB infection rates 8 to 10 times higher (Stats Canada)

Poverty rate among first nations children double national average
Infant mortality twice as high
Keep in mind - social, historical, political, and economic contexts when assessing patients.

Front 21

In order to provide culturally safe healthcare, what knowledge do health professionals require?

Back 21

knowledge pertaining to immigrants and Aboriginal persons.
Diversity within society requires healthcare policies and practices that support professionals to work across differences.
Standards – p.40 Jarvis (i.e.. interpreters, continuing education, written materials).

Front 22

Why do you think we would not ask family to interpret?

Back 22

They may not understand medical jargon; might not relay correct info, as its not good news; not getting all of the information…

Front 23

What do you need to assess cultural understanding & practices

Back 23

-Build trust

-Listen

-Respect

-Pay attention to social & economic contexts

Jarvis(2009)pgs.46-47

Front 24

What role does trust play in assessment?

Back 24

Patients should not be expected to share sensitive information until trust has been established. Must be non-judgemental (i.e.. Have you found anything else that has helped you?)

Front 25

How will listening help you in assessment?

Back 25

Listening and engaging in conversations with families and patients will help you understand their world and approaches to healing

Front 26

What does conveying respect for differences do in assessment?

Back 26

Respect-conveying respect for differences builds trust and welcomes patients to share their understanding.

-Patients are quick to sense when they are judged negatively

-Examples of questions to ask are on pg. 46 & 47 Jarvis. i.e.. Have you found any treatments or medications that have worked for you in the past?

Front 27

What are some important social and economic considerations in assessment?

What is an example?

Back 27

-Important to consider how people are managing-jobs, housing, childcare, finances, transportation, etc.

-This offers an opportunity to assess person’s overall health in a non-judgemental way.

Example: Aging-many people caring for elderly family members in their homes (decreased time in hospital, lack of long term care facilities)-social circumstances can have a PROFOUND effect on how people can manage illness and the changes associated with aging.

Older adults-finances (pension? Old-age?)

Front 28

Spirituality?

Back 28

More central to the human experience & refers to the search for meaning in one’s life.

Front 29

What is important to convey when discussing spirituality in assessment?

What are some things that can help you accomplish this?

Back 29

Important for healthcare professionals to convey:
-openness
-interest
-acceptance,

which therefore invites patients to identify what it most important to them.


Check your own assumptions and biases

-Avoid making assumptions about people

-Might ask-do you have any religious beliefs or practices that you would like me to know about in relation to your health care? i.e.. Jehovah witness-no blood transfusions

Front 30

Explain the TRUST model?

Back 30

-Traditions (spiritual and/or religious practices. Individually or in community, current and/or past)

-Reconciliation? (Unresolved issues and explorations of how/if these might be reconciled.

-Understandings? (Personal beliefs and how they influence well-being positively and/or negatively).

-Searching? (Existential &/or faith questions prompted by current challenges

-Teachers? (Spiritual/religious mentors & external resources the individual trusts to help sort out relevant issues

Front 31

Describe spiritual wellness

Back 31

Meaning to life-having a purpose in life is essential in order to look forward to each day. What drives you? Motivates you? Brings you joy?

Relationship with higher power-Do you communicate with a higher power?

Hope-What gives you strength to go on? (i.e.. Dr. Duggleby’s Hope at the end of life study. Palliative patients).

Encouragement-From whom do you seek support? What personal resources are available to you?

Caring-Caring for self and others

Meditation

Strive for growth-What goals do you have for yourself?
Forgiveness-Yourself and others?

Front 32

Spiritual wellbeing?

Back 32

Is a state of wholeness or health. Spiritual health is enhanced when people find a balance between their life values, goals, and belief systems and their relationship within themselves and with others.

Front 33

Explain intimate Partner Violence. What is a key risk?

Back 33

-IPV-spousal violence and violence committed by current/former dating partners

-Women are in greater danger of experiencing violence

-Gender is a key risk

Front 34

Spousal violence?

Back 34

-Violence or abuse within current and formal marital/common law relationships (intimidation, stalking, verbal abuse, imprisonment, humiliation, denying access to finances, shelter or services

-Can be physical, sexual, psychological or financial

Front 35

Child abuse?

Back 35

-Violence mistreatment, or neglect that a child or adolescent may experience while in the care of someone they trust and depend on (parent, sibling, relative)

Front 36

Elder Abuse?

Back 36

-Abuse and neglect-violence, mistreatment or neglect that older adults may experience at the hands of their spouses, children, family members, caregivers, service providers, or other individuals in situations of power and trust.

-Elder abuse/neglect-manifested as dehydration, malnutrition.

*Financial abuse quite common with the elderly.

Front 37

What are three effects of violence?

Back 37

Physical injury:
-bruises, fractures, abusive head trauma, (shaken baby syndrome).

*most common-head and neck injuries, musculoskeletal sprains and fractures

Chronic physical health problems:

-headdaches, STIs, hypertension, viral infections, visual problems, unexplained dizziness, unwanted pregnancies, gynecological symptoms, irritable bowel disease

Mental health problems:

-health-depression, acute/chronic anxiety, serious sleep disturbances, post traumatic stress disorder


-Neglect can be Intentional/unintentional

Front 38

What should nurses do for a violence assessment?

Back 38

1. Listen-
(validation of women’s worth as a human being and abuse as undeserved are the most important aspects of effective response and trust relationship).

-Non-judgemental, private area, any patient may have a history.

*women often don’t report, as they are afraid of being judged/no one will believe them.

2. Anticipating abuse-

(high index of suspicion for abuse, especially when present with signs or factors known to increase vulnerability (disabilities, economic dependence, isolation).

-50% women patients have experienced 1 incidence of physical/sexual assault in their lifetime.

3. Collaboratively-

follow lead of women-being willing to listen and be trustworthy. Listen to and for cues that might suggest abuse. Self-observation-pay attention to your own assumptions and biases.

-Assessment involves pattern recognition, collaborative knowledge development, naming and supporting capacity focusing on women’s strengths.

*inquiring about relationships and their impact on health should be included in the assessment of every patient.

*Reporting suspected child abuse is MANDATORY* *Report if suspected abuse in adults that are not competent*

*Reporting if someone is a harm to themselves/someone else MANDATORY*

Front 39

What is considered in pain assessment?

Back 39

-Sources
-Types
-Most reliable indicator
-Behaviors

Front 40

What are sources of pain?

Back 40

-Nocioceptive-tissue injury

-Somatic-derived from skin surface and subcutaneous tissues.

-Visceral-from larger internal organs d/t injury, resolves as healing occurs

-Constant or intermittent and poorly localized

Front 41

What are sources of pain (part II)

Back 41

Neuropathic-caused by injury to peripheral/central nervous system or both.

Peripheral-diabetic neuropathy
CNS-stroke, MS, spinal cord injury

Front 42

What are types of pain?

Back 42

Referred-pain felt at site but originates in another location

Duration-acute-short term and self limiting. i.e.. post-op pain, injury-sprain, fracture, trauma

Persistent/chronic-pain that has been present for 6 months of longer than the time of expected tissue healing. Persistent can be categorized as malignant (cancer, growing tumour) or non-malignant (musculoskeletal injuries-back very common). i.e.. Musculoskeletal-back pain, neuropathic. May or may not have a direct cause identifiable by imaging studies.

Front 43

What is the most reliable indicator?

Back 43

-Patient’s self report! Ask the patient specifically how they can BEST describe their pain.

-Use multiple methods of assessing pain.

-May even need to use descriptors i.e.. “cutting with a knife”; “like a burn from a stove”; “crushing sensation, like someone is standing on your chest”.

Front 44

What are acute behaviours patients in pain?

Back 44

behaviours-guarding, grimacing, vocalizations, moaning, agitation, restlessness, stillness, diaphoresis, changes in vital signs, altered sleep

Front 45

What are chronic behaviours of patients experiencing pain?

Back 45

-Person adapts over time. patients with this persistent pain typically give little indication that they are in pain and are at increased risk for underdetection

Front 46

What are some things to observe to determine if an unconscious patient who may be in pain?

Back 46

-Facial expression, body movements, muscle tension, vocalization

(p. 191 Critical Care Pain observation tool).

Front 47

What are the pain assessment tools?

Back 47

-Initial Pain Assessment, Jarvis pg.186

-Descriptor
(List words that describe different levels of pain)

-Wong Baker faces pain scale

-Faces Pain Scale, Jarvis pg.870
Numeric p.189

-0 – 10 scale

-PQRST

Front 48

What are questions to ask in the initial pain assessment?

Back 48

Subjective:
-Where is your pain? When did the pain start? What does your pain feel like?

Neuropathic-Burning/tingling
Nocioceptive-aching/cramping/throbbing

How much pain do you have now? At rest/movement?
What makes your pain worse/better?

How does pain limit your function or activities?

How do you usually behave when you are in pain? How would others know you’re in pain?

What does this pain mean to you? Why do you think you’re having pain?

Front 49

What do you ask for the descriptor pain assessment?

Back 49

-No pain, mild, moderate, or severe

Front 50

Describe what happens in a Wong Baker faces pain scale?

Back 50

-For Infants/children

- Child asked to choose a face that shows “how much hurt you have now”

Faces pain scale-children (see Jarvis p. 870)

Front 51

What is scale is used in the numeric pain assessment?

Back 51

Numeric-

0 means no pain, 10 means worst pain

Front 52

What do you look for in an objective pain assessment?

Back 52

-Swelling, redness, laceration, deformities, bleeding, fractures, asymmetry, masses, decreased mobility…

Front 53

What does PQRST stand for?

Back 53

PQRST
P-provoking/precipitating factors,
Q-quality of pain (what words does the patient use to describe pain),
R-radiation of pain (extend from site, i.e.. MI chest, shoulder, left arm),
S-Severity of pain (intensity, 0-10 scale),
T-timing (occasional, intermittent, constant)

Front 54

Why do you need to consider physical, psychological, and sociocultural when assessing pain?

Back 54

-Everyone’s pain is different. How you or I experience pain can be a huge difference.

-Need to take into account physical (adult, child); psychological (mental capacity); and sociocultural aspects when assessing pain

Front 55

When/how often should you assess pain?

Back 55

-Assess pain on a regular basis.

- Reassess with each new report of pain and new procedure, intensity increases, pain not relieved by previously effective strategies
.
-Assess pain after each intervention reached peak effect (analgesia)

-Acute post op pain-as determined by procedure or operation (although different for everyone) severity of pain, each new report, instance of unexpected pain, after each analgesic according to peak effect

Front 56

What are some analgesic alternatives for pain?

Back 56

-Ice, massage, acupuncture, chiropractor, meditation, yoga…ensure safe use with patients medications.

-Environment (loud, too many visitors-don’t do it to be mean, rather to let the patients rest), reduce anxiety.

Front 57

When should you document pain assessment and who should have access to it?

Back 57

-Document pain assessment regularly and routinely-accessible to all hcp involved in care

Front 58

When should you advocate for your patient (in regards to pain)?

Back 58

Advocate for your patient if pain not well controlled. Advocate for simplest dosage and least invasive, tailor to situation and care setting (i..e post op-IV PCA)

Front 59

When should a referral be made (in regards to pain?)

Back 59

Referral-may need to refer to pain management expert if pain unresponsive to standard treatment, multiple sources of pain, mix of neuropathic and nocioceptive, history of substance abuse***

Front 60

What are some areas where pain management may differ across cultures?

Back 60

-Stoic/expressive:

-Expression of pain varies greatly – stoic/expressive. Cultures vary in what is considered acceptable expression of pain

Male vs. female:

-Some men may not verbalize or express pain-masculinity may be questioned

Lack of verbal/facial expression:

-Lack of verbal/facial expression-does not mean lack of pain-ASK patient level or how much pain relief they think they might need.

Spiritual/religious considerations:

-Several faiths may not take pain relief on religious fast days-Yom Kippur-a day/Ramadan-a month!

-Some religions forbid narcotic use. Others may prefer a certain route-oral, IV, IM

Alternative treatment:

-Herbals, massage, acupuncture, breathing exercises.

Front 61

When is optimal nutrition status achieved?

Back 61

-Optimal nutrition status achieved when sufficient nutrients are consumed to support day to day body needs and any increased metabolic demands due to growth, pregnancy or illness.

Nutrient intake adequate
Undernutrition-when reserves are depleted
Overnutrition-consumption of nutrients in excess of body needs

Front 62

What are some reasons we need nutritional assessments?

Back 62

-23% Canadians obese (5.5 million) and another 36% overweight.

-Over half of Canadians at risk for heart disease, diabetes, hypertension, stroke, sleep apnea, cancer, osteoarthritis, gallbladder disease.

-Need to identify those individuals that are malnourished, provide data for designing a nutrition plan of care, establish baseline data for evaluating efficacy of nutritional care.

www.statcan.gc.ca

-26% Canadian children and adolescents aged 2-17 overweight/obese, and 8% obese.

-Over the past 25 years, overweight/obese category doubled, and obese category tripled.

-Increases with the amount of time spent watching tv, playing video games, and computer.

Front 63

What are some tools for nutritional screening?

Back 63

-Admission nutrition screening tool

-24-hour diet recall

-Food frequency questionnaire

-Food diaries

-Direct observation

Front 64

What are examples of nutritional health history (also subjective data)?

Back 64

-Eating patterns
-Usual weight
-Changes in appetite, taste, smell, chewing, swallowing
-Recent surgery, trauma, burns, infection
-Chronic illnesses
-Vomiting, diarrhea, constipation
-Food allergies or intolerances
-Medications and/or nutritional supplements
-Self-care behaviors
-Alcohol or illegal drug use
-Exercise and activity patterns
-Family history

Front 65

What is some tools for objective data for a nutritional assessment?

Back 65

-Equipment-scale, tape measure, skin calipers, BMI & Waist to Hip Ratio

-Lab Studies p.208-210
(Hemoglobin, Hematocrit, Cholesterol, Triglycerides, Total Lymphocyte Count, Serum Albumin)

Nutrition Assessment – Canada Food Guide

Front 66

What do you inspect in a nutritional assessment?

Back 66

Inspect-skin, hair, nails, eyes, tongue, lips, gums, musculoskeletal, neurological (p.206-207)

Front 67

Describe some of the equipment/tools used in a nutritional assessment?

Back 67

BMI-weight in kgs/height in meters sqaured or weight in pounds x 703/height in inches squared. 18.5-24.9 “normal” 1 foot=12 inches

Waist to hip ratio-waist circumference/hip circumference. 1.0 or > men upper body obesity. 0.8 or > women

Waist circumference->35 inches women, >40 men-at risk for CV and metabolic illness

Front 68

Describe what you look for in lab studies on nutritional assessments.

Back 68

-Hemoglobin-iron deficiency anemia; fluid retention-low, dehydration-high

-Hematocrit-another indicator of iron status

-Cholesterol-fat metabolism; assess risk of cardiovascular disease

-Triglycerides-screen for hyperlipidemia; risk of coronary artery disease

-TLC-visceral protein status, cellular immune function.
Serum albumin-visceral protein status

Front 69

What is the key to a healthy diet?

Back 69

Variety of food from ALL basic food groups; consume recommended fruits and veges, whole grains and milks; limit fat intake, sugar, starch, salt, alcohol.

-Match caloric intake with calories expended; 30-60 minutes activity, heart rate increased; follow food guide for handling and preparing, storing foods.