Chapter 6: Transcultural and Genetic Considerations: I. The Purnell Model For Cultural Competence

NURS 222 Chapter 6 Notes Chapter 6: Transcultural and Genetic Considerations Ethnopharmacology- a relatively new domain that integrates
tes pharmacodynamics (drug concentrations and its effects on the body) and pharmacokinetics (drug movement through the body) with genetic and ethnic variations. Racial, hereditary, and genetic influences have a profound effect on the way clients metabolize drugs as well as experience and tolerate side effects of medications. Ethnocultural- combination of ethnic and cultural variables. These perceptions and beliefs of illness play an important role in the clients acceptance and adherence to prescriptive therapy and understand of medical treatment. Health care professionals need to have an understanding of the variables that influence medication usage, differences in physiologic responses to meds, and the clients beliefs regarding medication. The Purnell Model for Cultural Competence A circle with an outlying rim that represents global society, a second rim represents community, a third rim represents family, and an inner rime represents the person: the aforementioned are macroaspects of the model. The interior of the circle is divided into 12 pie-shaped wedges depicting cultural domains and their concepts. Domains have bidirectional arrows showing that each domain relates to and is affected by all the other domains: these are the microaspects. Center is empty and represents unknown aspects about the cultural group. Along bottom of the model is a jagged line representing the nonlinear concept of cultural competence. Represents degree of cultural competence attained by the healthcare provider/organization. The Domains of Culture The following are the domains: 1. Overview/Heritage o Includes concepts related to origins, topography, economics, and education. o There are different prevalence rates for different diseases for different ethnic groups. o Topography is the landscape and surface configuration of terrain which may affect clients physiologically (high-altitude=increased RBC counts). o Socioeconomic status impacts a clients ability to afford expensive prescription drugs; lack of access to resources impacts their ability to purchase prescriptive drugs. o Nurses can recommend generic equivalents or other acceptable drugs more affordable.
I.
II.
o Educational status may determine how the nurse gives information to the client 2. Communication o Includes concepts related to language, dialect, contextual use of the language, volume, and tone. o Culturally competent nurses should be aware of communication variations: a) Language Detailed written instructions are helpful because some can read the language, but cannot speak it. Need to be aware of the contextual use of languages to better understand and communicate with culturally diverse clients. In low-contextual languages (English, French, Spanish, Italian, Portuguese, and Romanian) verbal skills are important In high-contextual languages (American Indian, Chinese, Vietnamese) message is in nonverbal mode: silence= important Some languages dont have all the tenses that the English language has, so directions should be precise: take one pill at 9pm b) Paralanguage Some languages are spoken in louder volumes while others are spoken softly. Eye contact is maintained with European American whereas Asians/Pacific Islanders do not maintain eye contact with those in a higher social status. c) Spatial Distancing Spatial distancing- the physical proximity between people conversing. European Americans maintain 18-24 in. Germans prefer to stand at a distance greater than 2 feet. Arabs and Hispanics may stand less than 18 in. apart. d) Temporality Temporality- the perspective of time (determines whether the client stresses a past, present, or future orientation). Haitians and Hispanics are present-oriented: whatever is happening now is most important: nurse needs to stress importance of taking meds, especially preventative and implement a follow-up. Future-oriented are more likely to comply with prescription regimens.
3.
4.
5.
6.
7.
e) Greetings Some cultures require formal greeting such as Miss, Ms., and Mr.; nurses should always greet clients formally unless told otherwise. The nurse needs to ask the client his or her family name and given name. Family organization o Concepts of head of household and gender roles must be considered. o In cultures in which men are expected to make most decisions, the nurse may be expected to direct questions to the man. Biocultural Ecology o Biocultural ecology- includes concepts related to biologic variations, heredity, genetics, endemics, and drug metabolism. o Genetic background can affect a clients response to drugs: African Americans have high rates of bp. o Greek and Chinese: glucose-6-phosphate dehydrogenase deficiency may have hemolysis if given quinine/chloramphenicol. o Asians/Pacific Islanders: increased side effects of alcohol o Slow inactivation of isoniazid in 60% of European and African Americans, 10-40% of Native Americans, and 10-20% of Asians. o Alaskan Eskimos: greater risk for atypical form of pseudocholinesterase (inactivates succinylcholine) and suffer from prolonged muscular paralysis. High-Risk Behaviors o Includes use of tobacco, alcohol, sex practices, and recreational drugs. o Tobacco causes more rapid elimination of medicines from body. o Alcohol interferes with some psychotropic meds and enhances analgesics. o Marijuana, antihistamine meds, and cocaine may potentiate the effects of other meds (increased side effects, enhanced therapeutic response, or overdose may occur). Nutrition o Includes common foods, eating rituals, limitations in obtaining nutritious foods, enzyme deficiencies, and how foods are used for health promotion and wellness. o Dietary consideration must be taken into account when prescriptions are given. o Nurse must ask the client their food preferences. o All societies have prescriptions for what is considered a normal diet: Jews cant eat kosher and dairy in the same meal, foods can be defined as hot or cold and must be taken together/cant be taken together. Spirituality o Includes concepts related to religious preference, meaning of life, and individual sources of strength. o Religious practices may prescribe acceptable diet, choice of contraceptive methods, or acceptability for genetic counseling.
o Be aware of fasting and schedule medication dosages accordingly. o Some religions believe illness is a punishment and results from past sins. o May need to involve the family and be aware of a person perceiving medication as artificial or interfering with a higher power. 8. Health Care Practices o Includes the focus of health care, traditional medical practices, selfmedicating practices, barriers to accessing health care, the sick role, and perceptions of mental illness. o Undergoing a paradigm shift from acute care to wellness, with the current focus being health promotion/maintenance and disease/illness prevention. a) Complementary, Alternative, and Traditional Medicine Many prefer traditional medical practices either as complementary to or as an alternative to allopathic medicine. Need a thorough health history to obtain natural medicines (herbs, etc) as well as OTC and prescriptions. Need to make sure they take medication for the full amount of time and not stop when symptoms disappear. b) Self-Medicating Practices Everyone self-medicates to some degree; for initial symptoms, many use OTC or folk remedies. Some bring medicines from home countries that are illegal in the U.S. Get complete history of any drugs they are taking. c) Sick Role Among some cultures, clients are required to carry out obligations unless severely ill (nurse should provide culturally appropriate counseling). d) Pain Primary reason most people see a health professional. Expressed differently among ethnocultural groups: Asians/Pacific Islanders reluctantly express pain; Arabs express openly and expect immediate relief. e) Mental Illness Culture-bound phenomenon; it may be perceived as something in one culture, but as nothing in another. May be gender differences in antipsychotic drug therapy (related to hormones, differing amounts of body fat, and comorbidity problems). 9. Health Care Practitioners o Includes the status of health care providers, folk practitioners, gender, and the health care system.
o For some, the most experienced health-care provider is a middle-aged to elderly male physician. a) Folk Practitioners May be preferred over allopathic educated physicians because of less invasive treatments. Do not treat symptoms, but remove the cause of the illness. b) Gender and Health Care Be aware that some prefer same-gender practitioners. Koran sanctions use of male health care provider if female unavailable and male should only perform physical exam through a layer of clothes while wearing gloves to avoid skin contact.

Chapter 6: Transcultural and Genetic Considerations: I. The Purnell Model For Cultural Competence

Uploaded by

Copyright:

Available Formats

Chapter 6: Transcultural and Genetic Considerations: I. The Purnell Model For Cultural Competence

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Chapter 6: Transcultural and Genetic Considerations: I. The Purnell Model For Cultural Competence

Uploaded by

Copyright:

Available Formats

NURS 222 Chapter 6 Notes Chapter 6: Transcultural and Genetic Considerations Ethnopharmacology- a relatively new domain that integrates

You might also like