CHAPTER 2
• FOUR TYPES OF ASSESSMENT DATABASES
O COMPLETE (TOTAL HEALTH)
▪ COMPLETE HEALTH HISTORY AND FULL PHYSICAL EXAMINATION
• DESCRIBES
... [Show More] CURRENT AND PAST HEALTH STATE
• FORMS A BASELINE AGAINST WHICH ALL FUTURE CHANGES CAN BE
MEASURED
▪ THIS WOULD BE DONE IN A PHYSICIAN’S OFFICE/FIRST PATIENT
▪ TAKES ABOUT HALF AN HOUR TO GET ALL THIS INFO
O FOCUSED OR PROBLEM-CENTERED DATABASE
▪ USED FOR A LIMITED OR SHORT-TERM PROBLEM
▪ COLLECT A MINI DATABASE
• SMALLER IN SCOPE AND MORE TARGETED
▪ COLLECT INFORMATION REGARDING THAT ACUTE INCIDENT
O FOLLOW-UP DATABASE
▪ COMPLICATIONS?
▪ ARE MEDICATIONS WORKING?
▪ BLEEDING? STILL HURT? ANY BETTER?
O EMERGENCY DATABASE
▪ URGENT, RAPID COLLECTION OF CRUCIAL INFORMATION
▪ NAME?
▪ AS MUCH INFO AS YOU CAN?
• CAB
O CIRCULATION – MOST IMPORTANT
O AIRWAY
O BREATHING
O WHAT’S HAPPENING?
▪ CALL 911 AND EXPLAIN
• EVIDENCE-BASED ASSESSMENT
O CLINICAL DECISION MAKING DEPENDS ON ALL FOUR FACTORS
▪ BEST EVIDENCE FROM A CRITICAL REVIEW OF RESEARCH LITERATURE
▪ THE PATIENT’S OWN PREFERENCES
▪ THE CLINICIAN’S OWN EXPERIENCE AND EXPERTISE
▪ PHYSICAL EXAMINATION AND ASSESSMENT
• ASSESSMENT SKILLS MUST BE PRACTICED WITH HANDS ON
EXPERIENCE AND REFINED TO A HIGH LEVEL
• CULTURAL COMPETENCY QUESTIONS
O WHEN MEETING A PATIENT FOR THE FIRST TIME
• HEALTH
▪ WHERE DOES THE PATIENT COME FROM?
▪ WHAT IS HIS/HER HERITAGE?
▪ WHAT IS HIS/HER CULTURAL BACKGROUND?
▪ WHAT LANGUAGE IS THE PATIENT FAMILIAR WITH?
▪ WHAT ARE HIS/HER HEALTH AND ILLNESS BELIEFS AND PRACTICES?
O BALANCE OF A PERSON IS A COMPLEX, INTERRELATED PHENOMENON
▪ WITH ONE’S BEING: PHYSICAL, MENTAL, AND SPIRITUAL
▪ IN OUTSIDE WORLD: NATURAL, COMMUNAL, AND METAPHYSICAL
• ILLNESS
O LOSS OF A PERSON’S BALANCE
• ALMOST 40% OF US RESIDENTS IDENTIFY AS OTHER THAN NON-HISPANIC WHITES
• EMERGING MINORITY GROUPS
O YOUNGER WITH LOWER MEDIAN AGES
O HIGHER PROPORTIONS UNDER 18 YEARS OLD O HOUSEHOLDS WITH MULTIPLE GENERATIONS O POVERTY LEVEL
▪ TRANSPORTATION
▪ ACCESS TO CARE
▪ LITERACY
• IMMIGRATION AND HEALTH CARE CONCERNS
O MANY NEW IMMIGRANTS HAVE ONLY MINIMAL UNDERSTANDING OF THE
FOLLOWING
▪ MODERN HEALTH CARE DELIVERY SYSTEM
▪ MODERN MEDICAL AND NURSING PRACTICES AND INTERVENTIONS
▪ ENGLISH LANGUAGE
O IMPERATIVE THAT THE NURSE’S CARE IS TAILORED TO MEET THE PERSON’S
PERCEIVED NEEDS
• NATIONAL CULTURAL AND LINGUISTIC STANDARDS
O FIRST AND LANDMARK STANDARD
▪ HEALTH CARE ORGANIZATIONS ARE LEGALLY REQUIRED TO ENSURE THAT PATIENTS RECEIVE EFFECTIVE, UNDERSTANDABLE, AND RESPECTFUL CARE
THAT IS PROVIDED IN A MANNER COMPATIBLE WITH THEIR CULTURAL HEALTH BELIEFS AND PRACTICES AND PREFERRED LANGUAGE
O EFFECTIVE CARE
▪ POSITIVE OUTCOMES AND SATISFACTION FOR PATIENT
O RESPECTFUL CARE
▪ CONSIDERS VALUES, PREFERENCES, AND EXPRESSED NEEDS OF PATIENT
O CULTURAL AND LINGUISTIC COMPETENCE
▪ CONGRUENT BEHAVIORS, ATTITUDES, AND POLICIES THAT COME TOGETHER IN A SYSTEM AMONG PROFESSIONALS THAT ENABLES WORK IN CROSS-
CULTURAL SITUATIONS
• LINGUISTIC COMPETENCE
O TITLE VI OF CIVIL RIGHTS ACT OF 1964
▪ SERVICES CANNOT BE DENIED TO PEOPLE OF LIMITED ENGLISH PROFICIENCY
O MOST COMMON NON-ENGLISH LANGUAGE IS SPANISH
O PATIENTS WHO HAVE LIMITED ENGLISH PROFICIENCY (LEP) ARE AT RISK FOR POOR HEALTH CARE OUTCOMES DUE TO THE BARRIER THAT LANGUAGE PRESENTS DURING HEALTH CARE DELIVERY INTERACTIONS
• CULTURAL COMPETENCE
O CULTURALLY SENSITIVE
▪ POSSESSING BASIC KNOWLEDGE OF AND CONSTRUCTIVE ATTITUDES TOWARD DIVERSE CULTURAL POPULATIONS
O CULTURALLY APPROPRIATE
▪ APPLYING UNDERLYING BACKGROUND KNOWLEDGE NECESSARY TO PROVIDE THE BEST POSSIBLE HEALTH CARE
O CULTURALLY COMPETENT
▪ UNDERSTANDING AND ATTENDING TO TOTAL CONTEXT OF PATIENTS SITUATION INCLUDING THE FOLLOWING
• IMMIGRATION STATUS
• STRESS AND SOCIAL FACTORS
• CULTURAL SIMILARITIES AND DIFFERENCES
• STEPS TO CULTURAL COMPETENCE
O UNDERSTAND ONE’S OWN HERITAGE-BASED VALUES, BELIEFS, ATTITUDES, AND
PRACTICES
O IDENTIFY MEANING OF “HEALTH” TO PATIENT
O ACQUIRE KNOWLEDGE ABOUT SOCIAL BACKGROUNDS OF PATIENTS
O BECOME FAMILIAR WITH LANGUAGES, INTERPRETIVE SERVICES, AND COMMUNITY RESOURCES AVAILABLE TO NURSES AND PATIENTS
• FOUR BASIC CONCEPTS OF CULTURE
O LEARNED O SHARED O ADAPTED O DYNAMIC
• RACE AND ETHNICITY
O SELF-IDENTIFICATION
O SOCIAL GROUP
• ACCULTURATION
O ASSIMILATION IS ONE DIMENSIONAL
O BICULTURALISM/INTEGRATION IS DIMENSIONAL
• CULTURE
O THOUGHTS, COMMUNICATIONS, ACTIONS, BELIEFS, VALUES, AND INSTITUTIONS OF
RACIAL, ETHNIC, RELIGIOUS, OR SOCIAL GROUPS
• RELIGION
O BELIEF IN DIVINE OR SUPERHUMAN POWER, OR POWERS TO BE OBEYED AND
WORSHIPPED AS CREATOR/RULER OF UNIVERSE
O SYSTEM OF BELIEFS, PRACTICES, AND ETHICAL VALUES
O SHARED EXPERIENCE OF SPIRITUALITY
O PEOPLE HOLD RELIGION VERY DEAR
▪ YOU CANNOT DISCREDIT THEIR RELIGION OR THE IMPORTANCE OF THEIR SPIRITUALITY
• SOCIALIZATION
O PROCESS OF BEING RAISED WITHIN A CULTURE AND ACQUIRING CHARACTERISTICS OF THAT GROUP
• ACCULTURATION
O PROCESS OF ADAPTING TO AND ACQUIRING ANOTHER CULTURE
• ASSIMILATION
O PROCESS OF DEVELOPING A NEW CULTURAL IDENTITY AND BECOMING LIKE MEMBERS OF DOMINANT CULTURE
• BICULTURALISM
O DUAL PATTERN OF IDENTIFICATION AND OFTEN OF DIVIDED LOYALTY
• HEALTH-RELATED BELIEFS AND PRACTICES
O BALANCE AND BELIEFS ABOUT CAUSES OF ILLNESS
O BIOMEDICAL OR SCIENTIFIC THEORY
▪ BIOMEDICAL
• ASSUMES CAUSE AND EFFECT
• VIEWS THE BODY AS A MACHINE
• LIFE CAN BE DIVIDED INTO PARTS
• ENDORSES GERM THEORY
O NATURAL OR HOLISTIC THEORY
▪ NATURALISTIC
• FORCES OF NATURE MUST BE KEPT IN BALANCE
• EMBRACES IDEAS OF OPPOSING CATEGORIES OR FORCES
O YIN AND YANG
O HOT AND COLD
O MAGICORELIGIOUS PERSPECTIVE
▪ SUPERNATURAL POWERS PREDOMINATE IN AREA OF HEALTH AND ILLNESS
• VOODOO ETC
O TRADITIONAL BELIEFS AND HEALTH HEALERS
▪ SOME CULTURES JUST GO TO THEIR LOCAL “DESIGNATED NOT OFFICIAL” HEALTH CARE PROVIDER
▪ SOME ETHNIC GROUPS BELIEVE THAT CURE IN INCOMPLETE UNLESS HEALING IS CARRIED OUT FOR THE BODY, MIND, AND SPIRIT
• HEALTH-RELATED BEHAVIORS AFFECTED BY RELIGION
O MEDITATING
O EXERCISE
O SLEEP
O VACCINATIONS
O STRESS
O GENETIC SCREENING
O CARE FOR CHILDREN
• FOLK HEALERS
O HISPANIC
▪ HERBALISTS [Show Less]