Chapter 3 Cultural Competence In The Health History And Physical Ex ✓ Solved

Chapter 3: Cultural Competence in the Health History and Physical Examination 1 Cultural Assessment #1 Customized or tailored to the client’s unique background. Health history and physical exam interrelated. With growing diversity comes the need for nurses to develop knowledge and skills in cultural assessment. 2 Cultural Assessment #2 Assessments form the foundation for the plan of care. Tend to be broad and comprehensive.

Cultural assessment usually integrated into the overall assessment. Health History #1 The purpose of the health history is to collect subjective data. This is combined with the objective data from the physical exam for both well and ill clients. 4 Question #1 Is the following statement true or false? Subjective data refers to things that people say or relate about themselves, whereas objective data result from the physical examination and the laboratory findings.

5 Answer to Question #1 True Rationale: Subjective data come from the client and is information only they can give and confirm; objective data are observable and confirmed through sources other than the client. 6 Health History #2 Major data categories to be considered when conducting a culturally competent health history: 1. Biographic data and history 2. Genetic data 3. Review of medications and allergies 4.

Reason for seeking care 7 Health History #3 Major data categories to be considered when conducting a culturally competent health history (cont.): 5. Present health and history of present illness (culture-bound syndromes) 6. Past health 7. Family and social history 8. Review of systems 8 Question #2 Is the following statement true or false?

Most cultures recognize the difference between prescribed medications and over-the-counter medications including herbs. 9 Answer to Question #2 False Rationale: It is important to note all prescription and over-the-counter medications, including herbs, that clients might purchase or grow in home gardens. Because of cultural differences in peoples’ perceptions of which substances are considered medicines, it is important to ask about specific items by name. 10 Physical Examination #1 Accurate assessment and evaluation of clients require: Knowledge of normal biocultural variations among healthy members of selected populations Assessment skills that will enable you to recognize variations that occur in illness 11 Physical Examination #2 Biocultural variations in: Measurements Height, body proportions, weight (see Table 3-5) Vital signs, including pain General appearance 12 Physical Examination #3 Skin Mongolian spots Vitiligo Hyperpigmentation Cyanosis Jaundice Pallor Erythema, petechial, ecchymoses Addison’s disease, uremia, albinism 13 Physical Examination #4 Body secretions Apocrine glands Eccrine sweat glands Head Hair (texture, color) Eyes (structure, color, visual acuity) Ears (size, shape, cerumen, hearing loss) Mouth (pigmentation, cleft lip/palate, leukoedema) Teeth (developmental, hygienic, nutritional indicators) 14 Physical Examination #5 Musculoskeletal system Bone composition Bone density Bone curvature Body composition 15 Question #3 Where is the most reliable location to assess for petechiae in a person with darkly pigmented skin?

Palms of the hands Soles of the feet Lining of the mouth Upper chest and shoulders 16 Answer to Question #3 C. Lining of the mouth Rationale: In dark-skinned clients, petechiae are best visualized in the areas of lighter melanization, such as the abdomen, buttocks, and volar surface of the forearm. When the skin is black or very dark brown, petechiae cannot be seen in the skin. Petechiae are most easily seen in the mouth, particularly the buccal mucosa, and in the conjunctiva of the eye. 17 Laboratory Tests Biocultural variations occur with some lab test results, such as: Hemoglobin Hematocrit Cholesterol Serum transferrin Blood glucose 18 Clinical Decision Making and Actions The three major modalities to guide nursing judgments, decisions, and actions are: Cultural care preservation or maintenance Cultural care accommodation or negotiation Cultural care repatterning or restructuring 19 Question #4 Which is an example of cultural care accommodation?

Arranging the client’s dressing changes to avoid scheduled prayer times Providing the client with foods that are aligned with his/her religious dietary concerns Explaining to the client the need to reduce fat content from his or her ethnic high-fat diet Arranging for an interpreter to facilitate communication 20 Answer to Question #4 A. Arranging the client’s dressing changes to avoid scheduled prayer times Rationale: Cultural care accommodation or negotiation refers to professional actions and decisions that help people of a designated culture to adapt to or to negotiate with others for beneficial or satisfying health outcomes with professional care providers. 21 VIDEO TRANSCRIPT The following video focuses on identifying and describing how community values and expectations influence personal values and dispositions.

ID: 02-VIDEO-53a9ae4cdd7d03bc8b9c17c6 Parent Teacher Relationships Dilemma RECORDED ON Sep 24, 2017 TAGS Ethics, teaching, ADMIN/555, EDU/215, CUR/525, EDU/315 Speakers: Host, Janet Keegan, David Lawry HOST: Thunder High School is known for its excellent teachers and social studies teacher David Lawry is no exception. But recently Department Coordinator Janet Keegan became concerned about David at a recent parent/teacher conference. JANET KEEGAN: David is a great teacher and his students love him but he is a very private person. He has been here three years and we still don’t know much about his personal life. Not that it’s any of my business.

I just like to know my staff. At our spring parent/teacher conference, I noticed David talking with one of the mothers for an extended period of time. If I had to describe their conversation, I would say private. Whatever they were talking about, they didn’t want anyone else to hear. I decided to check back later and see if there was a problem with one of David’s students.

Then I saw that mother was back, again talking to David. This time they were giggling together almost like a couple of teenagers. When I asked him if everything was okay with the mother, he became really nervous and said it was all good. She was just concerned about her son. His behavior was just odd.

The next morning, David asked if he could speak with me in private. DAVID LAWRY: The woman you saw me with last night was Gina. We’ve been dating for four months and yes, her son is one of my students. We actually met through a friend and didn’t even make the connection until the second date. I’ve been meaning to talk to you but I wasn’t sure what to say or how you’d take it. [End of Audio]

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Cultural Competence in Health History and Physical Examination

Cultural competence is a vital skill for healthcare providers, particularly for nurses, as it directly affects patient outcomes and the effectiveness of care. In an increasingly diverse society, there’s a pressing need for nurses to understand and implement culturally aware practices in health history taking and physical examinations. This chapter discusses the significance of cultural assessments, the collection of subjective and objective health data, and the nuances required for a competent healthcare approach.

Importance of Cultural Assessments

Cultural assessments serve as a crucial foundation for effective nursing care. This involves tailoring assessments to meet the unique backgrounds and beliefs of each client, ensuring a holistic understanding of their health needs (Campinha-Bacote, 2002). A culturally competent approach recognizes that health history and physical examination are interrelated processes requiring sensitivity to the patient’s cultural context.
Moreover, comprehensive assessments incorporate not just the medical history but also social and familial contexts which impact health. It is essential to identify various data categories such as biographic information, genetic predispositions, medication usage, and the reasons for seeking care to understand the patient's unique perspective (McNaughton et al., 2020).

Understanding Health History Components

The purpose of gathering a health history is to collect subjective information directly from the client, supplemented by objective data obtained through physical examinations. Subjective data encompass what the patient reports, while objective data is derived from observable findings or test results (Bickley & Szilagyi, 2017).
As health care providers, it's critical to ask culturally relevant questions and to validate the client's responses. This might involve understanding culturally bound syndromes—specific conditions recognized predominantly in certain cultures that might not align with Western medical conventions (Kleinman, 1980).

Biocultural Variations in Assessment

Studies indicate significant biocultural variations across different demographics, which affect how health conditions present themselves and how they should be assessed (Bennett et al., 2009). For instance, variations in skin tone impact how certain symptoms, like petechiae, manifest. In darker-skinned individuals, petechiae may be most visible in non-pigmented areas like the buccal mucosa or conjunctiva rather than on the skin's surface (Keith et al., 2013).
Furthermore, factors such as family history and social determinants greatly contribute to understanding a patient's health status. It’s important to include questions concerning family history and lifestyle in a culturally competent health history. For instance, the dietary patterns linked to one's culture might reveal predispositions to certain health conditions (González et al., 2018).

Application of Cultural Competence in Nursing

A culturally competent nursing practice enables the application of culturally sensitive interventions and adjustments in care decisions. This is categorized into three modalities:
1. Cultural Care Preservation or Maintenance: This entails supporting clients in retaining their cultural practices that are beneficial to their health.
2. Cultural Care Accommodation or Negotiation: This involves making necessary adjustments in healthcare procedures to align with the client's cultural practices (e.g., arranging medication schedules around prayer times).
3. Cultural Care Repatterning or Restructuring: In certain situations, cultural practices that may harm health are identified and restructured in a way that is respectful yet health-promoting (Leininger, 2002).
As an example, when considering dietary practices, a nurse may need to explain the health risks associated with high-fat diets while working collaboratively to find acceptable alternatives that respect the client’s cultural preferences (Spector, 2009).

Enhancing Communication and Trust

Effective communication is the cornerstone of building trust in culturally diverse patient populations. Nurses should strive to establish rapport by using interpreters when language barriers exist. In addition, they should employ culturally tailored communication techniques to foster a strong therapeutic relationship with patients (Schim et al., 2003).
Creating an environment where patients feel respected and understood can significantly improve their engagement in their health management. This involves active listening and validating the patient’s cultural beliefs and practices as part of their healthcare decisions.

Conclusion

Cultural competence in health history taking and physical examination is not just a desirable skill; it is a necessity in providing equitable and effective healthcare. As nurses engage with diverse populations, they must commit to continued education and self-reflection regarding their own cultural biases and beliefs. By implementing comprehensive cultural assessments, understanding biocultural variations, and fostering respectful communication, nurses can significantly improve patient outcomes and enhance the quality of care.

References

1. Bennett, M. C., et al. (2009). Health disparities among racial and ethnic groups: A review of the literature. American Journal of Health Studies, 24(1), 30-34.
2. Bickley, L. S., & Szilagyi, P. G. (2017). Bates' Guide to Physical Examination and History Taking. 12th ed. Lippincott Williams & Wilkins.
3. Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing, 13(3), 181-184.
4. González, S., et al. (2018). Cultural competence in healthcare: A review of the literature. Healthcare Quarterly, 21(1), 56-63.
5. Kleinman, A. (1980). Patients and their context: An overview of the concept of illness. American Journal of Psychiatry, 137(5), 676-682.
6. Keith, K., et al. (2013). The importance of recognizing different skin tones in assessing physical symptoms. International Journal of Women's Dermatology, 1(4), 149-152.
7. Leininger, M. (2002). Culture Care Diversity and Universality Theory. In: Transcultural Nursing: Concepts, Theories, Research & Practice. 3rd ed. McGraw Hill.
8. McNaughton, P. A., et al. (2020). Approaches to conducting culturally competent health histories. BMC Health Services Research, 20(1), 1-10.
9. Schim, S. M., et al. (2003). Culturally competent nursing care: A model for nursing practice. Journal of Nursing Education & Practice, 3(2), 76-82.
10. Spector, R. E. (2009). Cultural Diversity in Health and Illness. 7th ed. Pearson.