GROUP FGroup members

Mushtaq AliGulsher solangiShahzeb khanM. siddique

Rajesh kumarAsif mehmood

Noureen Musarat shaheen

Sajida sahar1

3rd year 5th semester batch 2010-11

Faculty Manzoor Ali

LecturerPNS LUMHS

Jamshoro

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TOPIC

Special Issues In The Delivery Of Trans Cultural Nursing Care

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OBJECTIVES:At the end of this presentation the learners will be able to;1.Assess cultural specific aspects of pain experience

a. Discuss various treatment for pain (home remedies)2.Explore dietary beliefs and practices of clients from different cultures

a. Identify strategies to facilitate dietary change3.Demonstrate an understanding of health maintenance and disease prevention models

a. Utilize health belief model in client careb. Identify reasons for non-adherence to treatmentc. Explore religious beliefs and practices related to prevention and healing in illness

4.Demonstrate an understanding regarding attitudes of society towards stigmatized diseases.

a. Discuss societal knowledge regarding infectious diseases b. Discuss societal attitudes towards infectious diseases

5.Describe spirituality and its relation with health and illnessa. Differentiate between healing and careb. Identify different methods of spiritual healing

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Culture•Set of values, beliefs and traditions, that are held by a specific group of people and handed down from generation to generation.•Culture is also beliefs, habits, likes, dislikes, customs and rituals learn from one’s family.•Culture is the learned, shared and transmitted values, beliefs, norms and life way practices of a particular group that guide thinking, decisions, and actions in patterned ways.•Culture is learned by each generation through both formal and informal life experiences.

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Transcultural nursing:•Transcultural nursing is how professional nursing interacts with the concept of culture. •Based in anthropology and nursing, it is supported by nursing theory, research, and practice. •It is a specific cognitive specialty in nursing that focuses on global cultures and comparative cultural caring, health, and nursing phenomena. •It was established in 1955 as a formal area of inquiry and practice. •It is a body of knowledge that assists in providing culturally appropriate nursing care.

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Description

•According to Madeleine Leininger, the pioneer of transcultural nursing, transcultural nursing is a substantive area of study and practice that focuses on the comparative cultural values of caring, the beliefs and practices of individuals or groups of similar or different cultures•According to MEDLINE, transcultural nursing is an area of expertise in nursing that responds to the need for developing global perspective within nursing practice in a world of interdependent nations and people. As a discipline, it centers on combining international and transcultural content into the training of nurses. It includes learning cultural differences, nursing in other countries, international health issues, and international health organizations.

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Goals•The goals of transcultural nursing is to give culturally congruent nursing care, and to provide culture specific and universal nursing care practices for the health and well-being of people or to aid them in facing adverse human conditions, illness or death in culturally meaningful ways.

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Transcultural nurses

•Nurses who practice the discipline of transcultural nursing are called transcultural nurses. Transcultural nurses, in general, are nurses who act as specialists, generalists, and consultants in order to study the interrelationships of culturally constituted care from a nursing point of view. •They are nurses who provide knowledgeable, competent, and safe care to people of diverse cultures to themselves and others.

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1. Cultural specific aspects of pain experience:1.1 Pain response and culture•It is well established that pain is a highly complex phenomenon that involves biological, psychological, and social variables.•Patients’ culturally-based responses to pain are often divided into two categories: stoic and emotive. •Stoic patients are less expressive of their pain and tend to “grin and bear it.” They tend to withdraw socially. •Emotive patients are more likely to verbalize their expressions of pain, prefer to have people around and expect others to react to their pain so as to validate their discomfort.

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Cont……• If we use such broad generalizations to help understand

human behavior, however, we must always keep in mind that while culture is a framework that directs human behavior, not everyone in every culture conforms to a set of expected behaviors or beliefs.

• Any individual’s experience of pain will manifest itself in emotional and behavioral responses particular to his or her culture, personal history, and unique perceptions

• In many cultures around the world where belief is fates are strong, people believe illness and injury are caused by higher power.

• For example: in Filipino patient hospitalized for shoulder surgery admitted to his nurse that he was in severe pain. However he was not taking his pain medication because he believed that it was GOD’s will that he had such pain and GOD would give him strength to bear it.

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Asian culture and pain response •Patients from Asian cultures may often exemplify stoicism in the face of pain, which relates directly to strong cultural values about self-conduct. •This behavior might be tolerated in very small children, but not in adolescents and adults. In traditional Asian cultures, preserving harmony in interactions with others is very important, so an individual should never draw attention to himself, especially in negative ways. •Though an individual may feel sadness or pain, it is not customary to make this obvious. On a related note, some Asian patients will be socialized to observe status differences between people and will avoid making demands of health care professionals for this reason. •Asian societies have traditionally emphasized status differences between people based on variables such as age, sex, education, and occupation. •A doctor or nurse will most surely be seen as a person of high status, not to be questioned or bothered with complaints about discomfort.

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Use of Protective Objects;•Protective objects are wearied and hanged at home or chain around neck, wrist used to protect from evil.Use of Substances;•In some cultures it is believed that certain food substances can prevent from illness. For example eating raw garlic or onion can prevent from illness.Religious Practice:•In some cultures burning of candles, rituals of redemption are done to prevent illness.Healer:•Within a community, specific people are known to have power to heal.

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1.2 Various Treatment for Pain (Home Remedies)

•Pain is unpleasant feeling which can be reduced by exercise as a remedy. It strengthens muscles, helping prevent re-injury and further pain. •Chronic back pain is extremely discomforting for any individual. Majority of people around the world suffer from back pain or neck pain. For effective back pain treatment at home one must first understand the problem. •Predominant cause of back pain is the improper posture that most of these individual follows during their work at home. •Another prominent cause is the obesity among majority of population. •By correcting posture both during work and sleep one can get immediate relief. Correct posture will not only provide relief but also ensure that the problem stay away from you.•In different cultures several treatments are given to the patient in home

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Cont………..• Icepacks can help reduce swelling and numb muscles and

joint pain • In some cultures prefers moist heat to reduce aches and

pain, for this process follow these guide lines• Use ice, never heat in first 48 hrs. After an injury and make

sure never to place an ice pack directly over the skin. Use proper towel or cotton lining, after the 48hrs. Use heat or alternate heat with cold.

• Deep breathing not only reduces the stress associated with chronic pain but it may also help to fight pain itself. You can use deep breathing as an emergency pain or stress reducing measures.

• In some cultures religious rituals are done to treat disease.• Happy mood can also reduce anxiety.• Along with some home remedies it is important to follow

doctor’s recommended pain medication plan.15

2. DIETARY BELIEFS AND PRACTICES OF CLIENT FROM DIFFERENT CULTURES•DIET: in nutrition, diet is sum of food consumed by a person or another organism.•Dietary habits are the habitual decisions an individual or culture makes when choosing what food to eat.•Proper nutrition requires ingestion and absorption of the fiber, vitamins, minerals, carbohydrates and proteins. Religious and Cultural Dietary Choices•Some cultures and religions have restrictions concerning what foods are acceptable in their diet.•For example only halal foods are permitted by Islam. Buddhists are generally vegetarians. The practice varies and eating meat may be permitted depending on the people.•Many people choose food from animal sources to varying degree for health reasons.•Raw foodies are another contemporary trend. These diets may require tuning or supplementation such as vitamins to meet ordinary nutritional needs

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2.1 Strategies to Facilitate Dietary Changes•As adult grow older, they have greater chances of developing certain diet related disease such as hypertension, heart disease, cancer and osteoporosis.•Older adults are more likely to require diet modification to control diseases than younger adults but the diet should still reflect the preference of the old adults.

Hypertension•It is estimated that 50-60% of the adults are at the risk of developing high blood pressure. Untreated hypertension can lead to:

– Stroke– Kidney failure– Heart failure– Heart attack

•A high sodium intake is generally believed to increase risk of having high blood pressure. Some people are able to lower their elevated blood pressure by restricting sodium consumption. Other may significantly decrease their blood pressure by increasing their calcium intake. Some people need to control hypertension with medication which usually is a diuretic. Fruits are usually rich in potassium.

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Heart Disease:•Heart attack is the leading cause of death and illness. At the root of the cause for heart attack is a disease called arteriosclerosis which is the accumulation of plaque (cholesterol, fatty deposit) on the inner lining of artery. Diet and nutrition are the focus of attention in heart disease.

Cancer:•The high fat diet is associated with heart disease also may cause certain cancers.•Studies have shown that when a diet contains high amount of fat and cholesterol, intestinal bacteria break down these food stuffs into the substance that can cause cancer directly or that promote the action of the other cancer causing chemicals.

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Osteoporosis:•Osteoporosis is one of the most common problems among older. Calcium is gradually lost from the bones. It can be prevented by increasing calcium intake in addition to getting plenty of exercise. While large amount of calcium supplements are used by the older women, such supplements can prevent from osteoporosis.•Fluoride is also important to bone strength. Osteoporosis is significantly less common in communities served by fluoride water.•Vitamin C improves calcium absorption•Oxalic acid in spinach also prevents from osteoporosis

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3. HEALTH MAINTANENCE AND DISEASE PREVENTIOM MODELSInjury Model:•Injury is the leading cause of death in children aging 1-5 years. Motor vehicle accidents, violence, drowning and fall are leading cause of injuries in this age group. 1-3 years old are particularly at risk of death from drowning. Burns and fires are serious cause of death and injuries.Nutrition: •Balances dietary calories with physical activity to maintain normal growth, sixty minutes of moderate to vigorous play or physical activity daily, eat vegetables and fruits daily.

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3.1 Health Belief Model in Client Care

• The health belief model was one of the first and remains one of the best known social cognition models. It is health behavior change and psychological model that was designed to predict behavioral responses to the treatment to the treatment received by acutely and chronically ill patients, but in more recent years the model has been used to predict more general health behaviors, the health belief model suggests that your belief in the effectiveness of the proposed behavior will predict the like hood of the behavior.

• An example of health belief model would involve an individual’s opinion about a certain disease and behavior to disease.

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3.2 Reasons for Non Adherence to Treatment:

•Reasons for patient’s non adherence are complex. Researchers have found that the relationship between information given to patients and the extent to which instructions are followed is not always string. Information alone does not see to affect the degree to which patients follow recommendations given by health professionals. Situational, personality or socioeconomic factors often play a more important race in the extent to which patient follow recommendations than do the knowledge and understanding about what they are to do.•Both internal and external factors seen to influence weather a patient follows health care advice. Internal factors include patient characteristics such as age, culture, social background, values, attitude and emotions caused by the disease.•External factors include a relation between patient and physician or nurse. Support from family, health care personnel and friends and the impact of health education.

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3.3 Religious Belief and Practices Related To Prevention and Healing IllnessFaith Healing:•Faith healing is healing through spiritual means. Believers assert that the healing of the person can be brought about by the religious faith through prayer or the rituals that according to adherent stimulate a divine presence and power towards correcting disease and disability. •Belief in divine intervention or healing is related to religious belief. In common usage, faith healing refers to intervention in initiating spiritual healing. Research of Belief about Miraculous Healing:•A study of beliefs about miraculous healing among more religiously committed has indicated that there are significant differences in beliefs about miraculous healing even among people within the same domination.

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In Christianity:•One use of term faith healing is in reference to the belief some Christians that GOD heals people through the power of Holy Spirit often involving the laying of hands. It is also called divine healing.•Christian’s physician Reginald B cherry views faith healing as pathway of healing in which in which God uses both the natural and supernatural to heal. In Islam:•The Prophet serves as a primary model for how to live a healthy life. Illness and suffering are the part of way GOD made the world. Muslim generally does not see illness as divine punishment. GOD purpose or a mean of cleaning away sins. Some Muslims also believe that jinn or invisible spirit may inhibit the body and cause sickness.•During sickness, Muslims are to seek God’s with patience and prayers, increase the remembrance of GOD to attain peace, ask for forgiveness, given more in charity.•And read or listen more QURAN.

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4. UNDERSTANDING REGARDING ATTITUDES OF SOCIETY TOWARDS STIGMATIZED DISEASES. The Impact of Stigma•The stigma has a significant negative impact on psychosocial function of people with mental illness through both experienced and anticipated discrimination.•In the workplace, researchers have found that the people who have received the label “mentally ill”•Are underemployed and earn less income than people, anticipate of negative responses can also lead people with mental illness to withdraw from or limit their social and occupational functions.•The impact of stigma is psychological as well people who have been treated for mental illness, report emotional reactions to stigma experiences ranging from anger and hurt to sad and discourage.•Negative impact contributes to the lower self-steam, social withdrawal and reduced trust in others. Contacts with people with mental illness to less stigmizing attitudes towards people with mental illness, it seems that through these encounters members of public learn that people with mental illness are not the dangerous.•Both personal and professional contact with people with mental illness has been linked to reduce stigma.

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4.1 Societal knowledge regarding Infectious Diseases:•Infectious disease also known as transmissible disease or communicable disease, comprise clinically evident illness resulting from infection, presence of pathologic agent in an individual host organism Major Infectious Diseases•Food Or Water Borne Diseases:– Bacterial diarrhea– Hepatitis A and E– Typhoid

•Vector Norn Diseases:– Dengue fever– Malaria

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• Animal Contact Disease:– Rabies

• Bacterial Diseases:– Diphtheria– Pertussis– Tetanus– Tuberculosis– Leprosy–Meningitis

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• Protozoan Disease: Malaria Cholera Typhoid

• Sexual Transmitted Diseases (STDs): HIV/AIDS Syphilis Gonorrhea

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4.2 Societal Attitudes towards Infectious Diseases:

•Negative public reaction to emerging infectious disease can adversely affect population health.•The ability to public health institutions diseases, negative reactions may vary from denial to panic to stigmatization.•Denial or minimization of threat of an infectious disease by the population can increase transmission. Alternatively, an overreaction to the threat of infectious disease can over whelm public health systems and leads to sever economic loses in areas affected by the disease. Stigmatization can increase problems of person with disease and facilitate transmission because person with or at risk for the disease may avoid seeking health care.•The quantity of information conveyed to the public by various epidemiological characteristics of the disease e.g. mode of transmission is important.

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5. SPIRITUALITY AND ITS RELATIONSHIP WITH HEALTH AND ILNESS:

•We pray because we believe in God answers prayers and God can directly intervene in human affairs. He is also the great physician who can cure us with or without help of a skilled medical doctor.•There are also scientific explanations about the connection between spirituality and health. Here are just a few of the scientific findings. Prayer increases our hope, which strengthens of immune system and lead to health enhancing actions.•A religious life style reduces risk factor and increase protective factors.•Faith contributes to our sense of meaning and purpose, which is important for optimal functioning, physiological and psychologically.•Traditional prescription of daily devotions and weekly prayer meeting may not be enough to reap the full health benefits.

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5.1 Difference Between Healing And Cure:

•We may not be able to cure every disease but people can indeed be healed.•Cure is focused on a disease and healing is related to individual as whole when we seek cure a disease and healing is related to individual as whole.•When we seek to cure a disease our focus is on the disease and process of eliminating that disease. Since a healing involves improving the quality of life for the individuals as a whole, a disease may still be targeted but in concert with the intent to improve the quality of one’s daily life.•An example of healing would be the process where a disease is controlled or reduced to a point where a person’s quality of life may be such that the disease no longer interferes with their daily productivity.•Healing includes liberation from the disease even if the disease still be present.•We are a lifestyle, health and healing co-operative because each of those concepts is at the heart of what we do every day. Healing is the process of cultivating quality of life and quality of life is our mission.

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5.2 Methods of Spirituality:•Spiritual healing is defined as overcoming the spiritual root causes of problems by spiritual means.•There are two generic methods of spiritual healing. There are two choices that apply to all who have a problem that has its root cause in spiritual healing. Spiritual Remedies•This is where either someone else or the affected person himself performs a certain specific act to alleviate a certain problem at a spiritual level. The benefit of this rapid relief is brought to the affected person. Spiritual remedies include application of holy ash, holy water, healing through mantras. Spiritual Practices:•When person does spiritual practice, he builds his own ability to protect himself against harmful elements in the spiritual dimensions •The first method of healing mostly brings about cure of root cause spiritual problems.

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References:•http://en.wikipedia.org/wiki/Transcultural_nursing•http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/•http://en.wikipedia.org/wiki/Social_stigma•http://www.wikihow.com/Deal-With-the-Stigma-of-Mental-Illness

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