NUR 205 Week 3

Culture-a pattern of shared attitudes, beliefs, self-definitions, norms, roles, and values that can
occur among those who speak a particular language or live in a defined geographical region

Health disparity- a particular type of health difference that is closely linked with social,
economic, and/or environmental disadvantage

Social Determinants of health- conditions in which people are born, grow, live, work, and age

Marginalized groups – people who are more likely to have poor health outcomes and die
earlier because of complex interaction among their individual behaviors, environment of the
communities in which they live, and the clinical care which they receive

Scope of Culture

 Casual beliefs about illness

o Cultural difference can result in different explanations for illnesses
o Western cultures are more likely to endorse solely biomedical causation theories
o Non-Western cultures have theories of disease causation involving natural,
social, or spiritual realms in addition to biomedical causation
 Symptoms and expression of illness
 Taboos

Development of cultural competence

 Cultural desire- the interest and intent to understand people who are different from
oneself
 Self-awareness
 Knowledge
 Skill
Cultural Assessment (what data should be collected?)
 Origins and Family
o Where born (if outside the country how long have they resided in the US)
o Decision making with family
o Cultural group identified with, presence of social network
o Important cultural practices
 Communication
o Language spoken at home; skill in speaking, reading, writing, and writing in
English
o Preferred methods to communicate with patient and/or family members
o Ways respect is shown
o Eye contact, interpersonal space
 Personal Beliefs about health, illness
o Meaning and belief about cause of illness
o Perception of control over health
o Practices or rituals used to improve health
o Perception of severity of illness
o Expectations for treatment; use of folk medicine, remedies, alternative medicine
o Practices that violate beliefs
o Concerns or fears about illness or process of treatment
 Daily Practices
o Dietary preferences and practices; forbidden foods
o Beliefs about food that pertain to health and illness
o Spiritual beliefs; religious practices
o Special rituals

Teach-Back

Interrelated Concepts
Health Disparities adversely affect groups of people who have systemically experienced greater
obstacles to health based on their racial, ethnic, or cultural group. Culture affects Family
Dynamics in many ways including the manner in which sick family members receive care,
beliefs about sharing information with outsiders, gender roles, and beliefs about appropriate
childrearing practices. Ethics is interrelated because of the different interpretations and values
around what may be appropriate may be considered unethical in others. Spirituality is
individualistic and subjective and can be entangled into culture. Communication is because
communication patterns, both verbal and nonverbal are determined by cultural norms. Stress
and Coping involves dealing with life’s difficulties and are to a large extent culturally
determined. Mood and Affect have a strong interrelationship to culture. Certain populations
are more prone to depression and mood driven impairments.

Clinical Exemplars (look up definitions in book for flashcards)

 Language preference
 Decision making
 Taboo
 Power Distance
 Symptoms of Illness
 Beliefs about illness control

BATHE
 B-background
 A- affect
 T-Troubles
 H-handling
 E-Empathy

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Spirituality- a dynamic and intrinsic aspect of humanity through which people seek ultimate
meaning, purpose, and transcendence and experience relationship to self, family, others,
community, society, nature, and the significant or sacred

Attributes of Spirituality
 Spirituality is universal
 Illness impacts spirituality
 Patient and/or family must be willing to share and act on spiritual beliefs
 Spiritual beliefs and practices are impacted by family and culture
 Nurses must be willing to assess and integrate patient beliefs into care
 Nurses must be willing to consult with/refer to appropriate spiritual experts
 Community-based religious organizations can provide spiritual support/resources
Context to Nursing and Healthcare

 Professional mandates to provide spiritual care

o The Joint Commission mandates that healthcare facilities provide spiritual care
to every patient
o ANA (American nurses’ association) code of ethics includes a statement
regarding nursing responsibilities to address spiritual concerns
 Assessment of Spirituality
o Staring conversations about spiritual beliefs is a way to assess spiritual care

 Nursing Interventions for spiritual care

 Communication
 Action
 Presence
o Keeping vigil with a family as a loved one struggles to recover
o Crying with a family member who’s loved one died
o Supporting a newly-diagnosed chronically ill patient

Spiritual History Tool

F.I.C.A.
Interrelated Concepts
Family Dynamics, Culture, Stress and Coping, Development, Communication

Clinical Exemplars
 Faith
 Hope
 Prayer
 Sacraments
 Mindfulness

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Assessment

Why do we do physical assessment? (NTK)

 Triage for emergency care
 Routine screening to promote health and wellness
 To determine eligibility for
o Health insurance, military service, a new job
 To admit a patient to a hospital or long-term care facility
Types of Physical/Health Assessment (NTK)

 Complete Assessment-includes complete health history and physical examination and

forms a baseline database
 Focused Assessment- focuses on a limited or short-term problem, such as a client’s
complaint
 Episodic/ Follow-Up Assessment- focuses on evaluating a client’s progress
 Emergency Assessment- involves the rapid collection of data, often during the provision
of lifesaving measures

Healthy History
 General state of health
 Chief complaint and history of present illness
 Patient and family history/ review of systems
 Personal and social history
 Domestic violence screening

Mental Status exam (can be taken during health history)

 Obtained through subjective data during health history interview
 Appearance- note posture, movements, dress, hygiene, grooming, etc.
 Behavior
 Cognitive level of functioning

Physical Examination Overview

Preparation for examination

 Infection control
 Environment (be aware of privacy)
 Equipment
 Physical Preparation of the patient (physical comfort needs like restroom and privacy
regarding hospital gown)
 Psychological preparation of the patient (thorough explanation before proceeding)

Organization of the exam

 Assessment of each body system
 Systemic and organized
 Head to toe approach
o Compares sides for symmetry
o If patient is critically ill, assess body systems most at risk for being abnormal
o Offer rest periods as needed
o Be specific when recording assessments
Techniques of physical assessment
 Inspection- look, listen, and smell to distinguish normal from abnormal
 Palpitation- involves using the sense of touch to gather information
o Two types of palpitation
1. Light- place hand or fingertips on body part being examined, used to
identify areas of tenderness (approx. 1cm deep)
2. Deep- used to examine condition of organs such as those in the abdomen
(approx. 4cm) can use one or both hands
 Percussion- involves tapping the skin with fingertips to vibrate underlying tissues and
organs and results in sound
o the denser the tissue the quieter the sound
 Auscultation- involves listening to sounds of the body makes to detect variations from
normal
o Internal body sounds are created by blood, air, or gastric contents as they move
against the body structures
General Survey
 General appearance and behavior
 Vital signs
 Height and Weight
 Signs of distress
 Posture
 Gait
 Affect and mood
 Gender and race
 Body movement
 Hygiene and grooming

Skin, Hair, and Nails

 Skin
o Cyanosis (mottled, bluish color)
o Erythema (redness)
o Pallor (pale whitish color)
o Jaundice (yellow coloration)
 Dark-skinned patient
o cyanosis check lips and tongue
o jaundice- check oral mucosa
o bleeding- look for skin swelling and darkening
o inflammation- check for warmth

 Hair
o Inspection of color, distribution, quantity, thickness, texture, and lubrication of
the body hair
  Nails
o Nail bed for color, length, symmetry, cleanliness, and configuration

Head and Neck

 Inspection and Palpitation
o Facial features
o Looking into eyelids
o Eyebrows
o Nasolabial folds
o Mouth for shape and symmetry
Eyes
 Pupillary response –
o Light reflex
o Accommodation
o Looking PERRLA
 P-pupils
 E-equal
 R-round
 RL- reaction to light
 A- reactive to accommodation
 Visual acuity (the ability to see small details)
 Extraocular movements
 Visual Fields

Glasgow Coma scale-

Responsible for testing eye opening response, verbal response, and motor response

Ears
 Difficulty hearing
 Earaches
 Inspect and palpate external ear
 Note size, shape, symmetry, skin color, and presence of pain

Head, neck and lymph nodes

Nose, mouth, throat

 Nose-ask about discharge, facial and sinus pain history of colds, sense of smell
 Mouth and throat- ask about presence of sores or lesions, bleeding from gums or
elsewhere, altered send of taste, toothaches , use of dentures or other appliances

Respiratory Assessment
 Cough, SOB, chest pain, smoking history, history of respiratory disease
 Inspection, palpation, percussion, auscultation
 Abnormal breath sounds
o Wheeze-
 occurs in small airways, such as asthma
 high pitched, usually heard on expiration
o Rhonchi-
 heard in disorders causing obstruction of trachea or bronchus, such as
chronic bronchitis
 lowered pitched, usually heard on expiration
o Pleural friction rub-
 heard in individuals with pleurisy (inflammation of the pleural surface)
 heard with pleurisy, sounds like rubbing hands together
o Fine Crackles
 High pitched, popping sounds
o Course Crackles
 Low pitch, moist sounding