NUR 232 Chapter 27
The nurse is planning care for a patient with a cultural background different from that of the nurse. What is an appropriate goal? 1. Adapt as necessary cultural practices to health needs 2. Attempt in a nonjudgmental way to change cultural beliefs 3. Strive to keep cultural background from influencing health needs 4. Encourage continuation of cultural practices in the hospital setting
1. Adapt as necessary cultural practices to health needs Whenever possible, nursing care should facilitate the integration of cultural practices into health needs. The cultural background is part of the individual; it would be very difficult to eliminate its influence or change cultural beliefs. The cultural practices need to be evaluated within the context of the health care setting to determine whether they are conflicting.
The nurse is caring for a child of Yemenite Jewish parents. The child is admitted to the hospital with a high fever. The parents tell the nurse that they followed their traditions and used garlic to try to cure the child. What would the nurse notice on assessment as a result of this treatment? 1. Blisters 2. Swelling 3. Abrasions 4. Lacerations
1. Blisters Application of garlic irritates the skin and may cause garlic burns. It may also cause blisters on the skin. Swelling may be indicative of an allergy. Abrasions may result from falling while playing. Lacerations may be caused by a motor vehicle collision.
The nurse is caring for a 7-year-old child. The child wears an amulet because the family believes that it will protect the child from the evil eye. For a diagnostic procedure, the nurse has to take this amulet off. What should the nurse do? 1. Get permission from the family to remove it for the procedure and replace it afterwards 2. Allow the child to continue to wear the amulet for comfort during all aspects of the procedure 3. Do not perform the prescribed procedure because removing the amulet will hurt the family's feelings 4. Ask the family to remove the amulet and not to let the child wear it because it obstructs medical care
1. Get permission from the family to remove it for the procedure and replace it afterwards The nurse should try to avoid hurting the family's feelings. If the amulet is an obstacle to medical care, the nurse should explain that to the family and obtain their permission to remove the amulet for the procedure. The nurse should replace it as soon as the procedure is over. Continuing the procedure without taking off the amulet may interfere with the procedure or hurt the child. The nurse should not cancel the procedure because it is essential for the child's care. The nurse should not ask the family to remove the amulet permanently because it does not impede all medical care; it affects only this procedure.
The parent of a hospitalized child tells the nurse, "We do not eat meat. We are practicing Buddhists and strict vegetarians." What is the most appropriate intervention by the nurse? 1. Order the child a meatless tray 2. Tell the parent to take off any meat on the child's meal tray 3. Ask the parent if he or she would like to have a Buddhist priest visit. 4. Explain to the parent that meat provides protein needed to heal the child
1. Order the child a meatless tray It is essential for the nurse to respect the religious practices of the child and parent. The nurse should be culturally sensitive to the religious practices of the child and parent and ensure that nutritionally complete vegetarian meals are prepared by the dietary department. Asking the parent if he or she would like a Buddhist priest is not addressing the vegetarian diet and not being respectful of the child and parent's religious beliefs. The nurse should not encourage the child and parent to go against their religious beliefs.
How should the nurse respond to a 53-year-old woman who appears anxious and distressed who wants to have children and approaches the nurse for counseling? 1. Refer her to local adoption agencies 2. Advise the woman to attend prenatal classes 3. Explain the consequences of having children later in life 4. Explain the process of having children through surrogate mother
1. Refer her to local adoption agencies A 53-year-old woman is likely to have attained menopause and may be able to have children only through adoption. Therefore, the nurse should refer the woman to a local adoption agency. Prenatal classes are recommended for women who are of childbearing age. Explaining the woman's inability to have children after menopause might not solve the problem. The woman likely will have attained menopause and would be unable to produce ovum, so surrogacy is not possible.
The nurse is caring for a patient who follows Orthodox Judaism. The patient is scheduled for surgery on Saturday morning, but the patient refuses to get the surgery done. What is the most probable cause for this reluctance? 1. The patient is observing the Sabbath. 2. The patient is not comfortable with the surgeon. 3. The patient is scared of the surgery and outcomes. 4. The patient does not want to be there on a weekend.
1. The patient is observing the Sabbath. People following Orthodox Judaism observe a weekly Sabbath day, which lasts from Friday sundown to Saturday sundown. It is against their beliefs to do any work during this time. It is unlikely that the patient is scared or does not want to have surgery on a weekend. The patient's reluctance is unlikely to be caused by concerns about the surgeon performing the surgery.
What nursing interventions enhance the care provided to the infants immediately after birth? Select all that apply. 1. Setting aside the cultural beliefs 2. Providing personal care to the infant 3. Providing personal care to the family 4. Providing family-oriented intervention 5. Encourage breastfeeding after 2 days
2, 3, 4 The nurse should provide family-oriented intervention taking all culture and behaviors into consideration. When a baby is born, the nurse should provide personal care for both the family as well as for the infant. The nurse should always respect the cultural views of the family and plan the interventions accordingly. Breastfeeding is encouraged right from birth.
The nurse is counseling a married couple with a child. How should the nurse respond if the couple says that they are opting for divorce? Select all that apply. 1. Initial disclosure of the divorce should be done by the third party. 2. Initial disclosure of the divorce should include both parents and child. 3. Custody will be given to the parent best able to provide for the child's welfare. 4. The mother can provide the best care for the child and should take custody of the child. 5. The discussion should be healthy, and arguments are to be avoided during the discussion.
2,3,5 Custody should be given to the parent best able to provide for the child's welfare while permitting visitation of the other parent. Initial disclosure of the divorce should include both parents and child so that information is transparent to all family members. The discussion during the divorce should be healthy. Arguments between the spouses should be avoided during the discussion. It is not always true that the mother can provide the best care to the child. Careful assessment regarding which parent is best able to provide for the child's welfare should be done to decide about the custody of the child. Parents themselves rather than third party are preferred for initial disclosure of divorce as the information given by the third party cannot be relied upon.
A Mexican-American adolescent states to the nurse, "I have cancer because it is God's will. It will make me stronger." What is the most appropriate response by the nurse? 1. "I'll contact the hospital chaplain for you." 2. "Tell me how you feel about the treatment plan." 3. "You're too young to think that way. You still have many years to live." 4. "I'll move your family into the waiting area to give you some quiet time."
2. "Tell me how you feel about the treatment plan." Asking the patient an open-ended question to assess how the patient feels about the treatment plan will provide the nurse with more information about what the patient understands about the illness and exactly what treatment measures the patient desires. It is very common in the Mexican-American culture for patients to feel that health is controlled by environment, fate, and the will of God. The nurse should not provide false reassurance. Family and strong kinship is important in this culture. Separating a family member is not the most appropriate action. The nurse should ask about religious preferences first before assuming the patient would like to speak with a chaplain.
A couple has a 3-year-old child whom they adopted at 6 months old. What advice is most appropriate for the nurse to give the couple about explaining the child's adoption to him? 1. "It's better if the child doesn't know about the adoption." 2. "The child can be informed, but at an age when he can understand." 3. "You are legally required to inform the child about the adoption at some point." 4. "The child can be told, but it's best to wait until he is old enough to start school." 5. "You can tell your son that you found each other through fate or that God sent him to you."
2. "The child can be informed, but at an age when he can understand." Though there are no strict guidelines for telling a child about his or her adoption, most authorities suggest that child should be informed at an age young enough to avoid conflicts in relationship but old enough to understand. Explaining the adoption in a way that makes the child an active participant in the process can help alleviate feelings of abandonment. Concealing the adoption information is not advisable and may weaken the relationship; however, there is no legal requirement to tell the child. If the child is old enough to enroll in school, there is a chance of the child learning about the adoption from third parties, so parents should discuss the adoption before that time, if they choose to do so. The nurse should not offer specific explanations of the adoption for the parents to give to the child, because these decisions are deeply personal and should be made by the parents directly.
Which example appropriately describes kinship care? 1. A 3-year-old girl staying in a group home 2. A 4-year-old girl living with grandparents 3. A 2-year-old boy living with a stepparent 4. A 6-year-old girl living with a single mother
2. A 4-year-old girl living with grandparents Kinship care is the arrangement in which a child is taken care of by a relative. The most appropriate example here is the child staying with the grandparents. Staying in a group home or with a single mother are not examples of kinship care. A child living with a stepparent is an example of a reconstituted family.
A newborn has had a fever and cough for 3 weeks. The mother is worried and suspects that the fever is caused by the "evil-eye." The mother asks the nurse to pray for the child. Which is the best nursing action in this situation? 1. Praying for the health of the mother and baby 2. Calling the hospital's department of chaplaincy 3. Informing the mother that it is against the nurse's culture 4. Explaining to the mother that "evil-eye" is a superstition
2. Calling the hospital's department of chaplaincy If the patient asks for specific religious rituals, the nurse should call the hospital's department of chaplaincy for further arrangements. While some nurses may be comfortable engaging in prayer with the mother, the nurse is not obligated to do so; however, the nurse should facilitate fulfillment of the patient's spiritual needs by seeking out the appropriate resources. The nurse should seek to learn about and understand the patient's cultural practices rather than approaching the situation from his or her own personal cultural predisposition. Though "evil-eye" concept is not scientifically recognized, it is not appropriate for the nurse to raise the issue, especially when the mother is in spiritual distress. Text Reference: p. 718
A camp nurse is assessing a group of children attending summer camp. Based on the nurse's knowledge of special parenting situations, which group of children is at risk for a sense of belonging? 1. Children adopted as infants 2. Children recently placed in foster care 3. Children whose parents recently divorced 4. Children who recently gained a stepparent
2. Children recently placed in foster care Children placed in foster care are at greater risk to have problems perceiving a sense of belonging. Children adopted at birth have fewer problems with acceptance when parents follow preadoption counseling about disclosure. Children of divorced parents often fear abandonment. Children who gain a stepparent are at risk for having trust problems with the new parent.
The nurse is caring for a Vietnamese patient who says she uses an ancient healing process in which jars containing steam are held against the skin. Which procedure is the patient describing? 1. Burning 2. Cupping 3. Coining 4. Steaming
2. Cupping Cupping is an ancient practice in an attempt to cure the sick and drive evil forces out of the body. In this process jars containing steam are held against the skin, and the heat forms blemish-like lesions on the skin. Burning involves burning small areas of the skin to treat enuresis and temper tantrums. Coining involves repeatedly rubbing the edge of a coin lengthwise on the oiled skin to rid the body of disease. There is no Vietnamese ritual called steaming.
A 6-year-old child is brought to the hospital with a fever. The family tells the nurse that they also take advice from a folk healer. What would be the most appropriate nursing intervention? 1. The nurse should ask the family to continue only the traditional medicine. 2. The nurse should respect the family's choice and continue with the medical care. 3. The nurse should ask the family to stop seeing the folk healer because it can be harmful. 4. The nurse should withhold medications because the family is already following one form of treatment.
2. The nurse should respect the family's choice and continue with the medical care. Many families follow traditional practices and consult folk healers. The nurse should respect the family's culture to provide culturally competent care. The nurse should respect the family's decision and be neutral in approach. The nurse should not judge the family. As long as the practices are not harmful to the child, the nurse should not ask the family to avoid traditional medicine. Traditional medicine alone may not be sufficient for treatment. The nurse should not withhold the medications because doing so may hamper the child's treatment.
The nurse is caring for a dying boy whose religion is Islam (Muslim/Moslem). What is an important nursing consideration related to his impending death and religion? 1. There are no special rites. 2. There are specific practices to be followed. 3. The family is expected to "wait" away from the dying person. 4. Baptism should be performed if it has not been done previously.
2. There are specific practices to be followed. Islam has specific rituals for bathing and wrapping the body in cloth before it is to be moved. The nurse should contact someone from the person's mosque to assist. Family may be present. No baptism is performed at this time.
An expectant couple tells the nurse about some of the family's religious rituals they would like to perform directly following the birth of their infant. Which nursing actions are appropriate? Select all that apply. 1. Allowing only the rituals that will benefit the baby's health 2. Objecting to the practices the nurse does not fully understand 3. Facilitating the family's cultural rituals when there is no legal conflict 4. Listening to the father while neither agreeing or disagreeing with him 5. Requesting that the family refrain from practicing their religion in the health care unit
3, 4 Understanding the different religious and cultural beliefs of patients is important to integrate spiritual care into pediatric nursing practice. The nurse helps facilitate the practice of cultural rituals when feasible in the hospital setting and when no legal conflict exists. The nurse should listen to the couple without passing judgment, neither agreeing nor disagreeing with the religious practice. The nurse can ask questions to better understand the patient's religious beliefs, but should not deny the rituals based solely on his or her lack of understanding. The nurse does not need to restrict the rituals to only those that benefit the baby's health because many religious rituals are meant to bond families rather than improve health. Similarly, the nurse does not need to restrict all religious practice in the hospital, particularly those practices that do not interfere with the health care being provided.
A parent brings a child to the clinic for a regular checkup. The health care provider begins to ask questions about the family's medical history. The parent privately explains that the child is adopted, and does not want the child to know. What is the most appropriate advice for the nurse to give this parent? 1. Instruct the parent to never reveal the information to the child 2. Divulge the information to the child in a very sensitive manner 3. Advise the parent to speak openly to the child and tell the truth 4. Ask the parent to withhold the information until the child is an adult
3. Advise the parent to speak openly to the child and tell the truth The adopted child should be made aware of his or her adoption status. It helps the child develop a trustful relationship with the parents. The sooner the child knows the truth, the better. The parents should tell the children as soon as the children are old enough to understand rather than waiting until they are adults. This information should not come from a nurse or any other person. Getting this information from a third person may be detrimental to the relationship between the parents and the adopted child. The nurse should never instruct the parents to keep the secret forever.
The nurse is assessing a 14-year-old child who has recently discovered he or she is adopted. What may be a sign that the child is not handling this information well? 1. Nausea and vomiting 2. Changes in elimination 3. Decline in school grades 4. Increased thirst and polyuria
3. Decline in school grades Teenagers do not always verbalize their feelings, so one sign may be a decline in school grades. The child's temper and social behaviors may also be altered. Nausea and vomiting may be a sign of a viral infection. Increased thirst and polyuria are signs diabetes mellitus. Disturbances in elimination are common in infants after stress; however, they are uncommon in adolescence.
A parent tells a 13-year-old child that he is adopted. What could happen as a result of telling the child at this age? 1. Sympathy 2. Happiness 3. Depression 4. Excitement
3. Depression The earlier the child knows of his adoption status, the better. Generally, older children display anger and sadness. This can often be manifested as depression. The child may feel abandoned, but a feeling of sympathy is rare. Similarly, happiness and excitement are not what a child feels after learning about being adopted.
A patient asks the nurse what a consanguineous relationship is. What is the most appropriate example that the nurse can give to answer this query? 1. The relationship between a child and a teacher 2. The relationship between a husband and a wife 3. The relationship between a father and a stepchild 4. The relationship between a father and a daughter
4. The relationship between a father and a daughter Consanguineous relationships are blood relations. The best example of a consanguineous relationship is father and daughter. A child and a teacher may not be related by blood. A husband and wife are not related by blood. A father and a stepchild also are not related by blood.
The practice of cultural humility is continual and an important concept in the nursing process. How can nurses facilitate this process? Select all that apply. 1. Integrating cultural knowledge 2. Recognizing cultural differences 3. Acting in a culturally appropriate manner 4. Being aware of their own beliefs and practices 5. Helping the family adapt to the health care practices
1, 2, 3, 4 Integrating cultural knowledge is essential to providing care to families and the community. Recognizing cultural difference is a component of cultural awareness, humility, and competence. Acting culturally appropriate is essential in understanding and being able to deal effectively with families in a multicultural community. Nurses must be aware of their own beliefs and practices before they can begin to understand the varied and numerous cultural influences on the life of children and family. It is essential that nurses make an effort to adapt health care practices to the family's health needs rather the attempting to change longstanding beliefs.
What are the ways the nurse may help a family meet its needs based on family strength and functioning styles? Select all that apply. 1. Providing individualized support 2. Strengthening the family resources 3. Helping to delineate the individualized work 4. Training the family members to avoid stressful events 5. Building on qualities that make family function in a better manner
1, 2, 5 Providing individualized support, strengthening the family resources, and building on qualities that makes the family work better are the ways a nurse may help the family to meet its demands. Efforts should be made to share work in groups rather than delineating work. Families actually cope and respond to stressful events, which has to be identified and appreciated.
A community health nurse works closely with a foster care home. What are the concerns of the nurse in allocating a child to foster care? Select all that apply. 1. Potential foster parents need 27 hours of training. 2. Foster parents should meet all the standards of law. 3. A child entering into foster care needs 12 hours of training. 4. The nurse should take measures to improve the health of parents. 5.Foster parents should meet health standards as per the guidelines.
1, 3, 5 Parents need 27 hours of training before entering into the contract of fostering a child. Each state has standards that the foster parent has to meet for fostering a child. Each state also has health standards set, which the parents are supposed to maintain. The child entering into foster care does not require any training; instead parents require 12 hours of continuous education per year. Foster children are at risk of acute and chronic diseases; hence,the nurse should take measures to improve the health of foster children as opposed to the parents.
The nurse is caring for a Vietnamese child and observes various marks on the child's body. When completing a thorough assessment, which applicable cultural practices should the nurse keep in mind? Select all that apply. 1. Coining 2. Burning 3. Cupping 4. Forced kneeling 5. Topical garlic application
1,2,3 Cultural practices possibly considered abusive by the dominant culture are: Coining—A Vietnamese practice that may produce weltlike lesions on the child's back when the edge of a coin is repeatedly rubbed lengthwise on the oiled skin to rid the body of disease; Cupping—An Old World practice (also practiced by the Vietnamese) of placing a container (e.g., tumbler, bottle, jar) containing steam against the skin surface to "draw out the poison" or other evil element. When the heated air within the container cools, a vacuum is created that produces a bruiselike blemish on the skin directly beneath the mouth of the container; Burning—A practice of some Southeast Asian groups whereby small areas of skin are burned to treat enuresis and temper tantrums; Forced kneeling—A child discipline measure of some Caribbean groups in which a child is forced to kneel for a long time; Topical garlic application—A practice of Yemenite Jews in which crushed garlic cloves or garlic—petroleum jelly plaster is applied to the wrists to treat infectious disease. The practice can result in blisters or garlic burns.
What social support and community resource needs of a single-parent family should the nurse be aware of? Select all that apply. 1. Need for respite child care centers 2. Need for parent enhancing centers 3. Concern for sexual deprivation of the parent 4. Promoting translocation of a child to foster care 5. Need for evening and weekend health care services
1,2,5 The social supports and community resources needs of a single-parent family include the need for parent enhancing centers to improve the parenting techniques. Evening and weekend health care services would help to meet the health care needs of the family. Respite child care should be used to relieve parental exhaustion. Sexual deprivation of the parent should not be a major concern, and can be managed with mutual discussion. Foster care is not a good practice over single parenting.
A 10-year-old child of divorced parents frequently complains of stomachaches. The nurse learns that the child also has frequent temper tantrums, has declining grades in school, and seems to be intent on punishing his father. Which signs and symptoms in the child might be attributed to be the effect of parental divorce? Select all that apply. 1. Stomachache 2. Hearing voices 3. Temper tantrums 4. Declining school grades 5. Desire to punish the father
1,3,4,5 Signs and symptoms in children due to parental divorce depend on their age and growth. At age 10 years, the child can develop somatic symptoms such as stomachaches and headaches; behavioral problems such as temper tantrums; declining grades in school; feelings of wanting to punish one or both of the parents; as well as lying, stealing, and loneliness. Hearing voices is a hallucination and is not related to the effects of parental divorce
What instructions should the nurse give to parents who have adopted a child? Select all that apply. 1. "You should always be honest and open toward the child." 2. "You should never reveal to the child that the child is adopted." 3. "You should ask a third party to reveal the adoption information." 4. "You should reveal the adoption information as soon as possible." 5. "Revealing adoption information causes concern and anxiety in children."
1,4,5 Discussing adoption with the adopted child requires utmost care. The parents should always be honest with their children. This strengthens the relationship between the parents and the adopted child. Revealing information early leads to less chance of misunderstanding and better continuance of relationship. Adoption information causes concern and anxiety in children but should not be avoided. Information about the adoption has to be revealed before any third party reveals it. Adoption information should not be withheld; the child has the right to know about the parents.
A parent is interested in obtaining information about foster care. What is the most appropriate explanation the nurse can give the parent? 1. Foster care is another name for an orphanage where many children stay together. 2. Foster care is when children stay with grandparents away from their own parents. 3. Foster care is placing the child in an approved living situation away from the family. 4. Foster care is when a child is adopted by somebody else and resides with them.
3. Foster care is placing the child in an approved living situation away from the family. By definition, foster care is an approved living situation where the child is placed away from the family. These people are generally unrelated to the child, and this arrangement is for a fixed period of time. An orphanage is an institution for children without parents. Many children live with their relatives or grandparents if parents are unable to care for the children or if the parents have died. This is not considered foster care. Adoption is when a child is permanently placed in a new home and the new parents adopt the child.
The nurse is assessing a 4-year-old child who came for a regular checkup. The nurse learns that the child's parents are adopting a baby and that the child feels that the parents' love will be divided. What is the most appropriate action by the nurse? 1. Comfort the child and continue with the checkup 2. Ignore this remark and continue with the checkup 3. Have the parents speak to the child to alleviate fears 4. Teach the child to speak to the parents and clarify things
3. Have the parents speak to the child to alleviate fears It is very common for children to worry when their parents decide to adopt another baby. The parents should make sure the child understands that there will be no change in their love. Merely comforting the child may not be enough because the child would still need reassurance from the parents. Ignoring the child may make the child feel more insecure. Asking the child to speak to parents may not be appropriate because the child may not readily express these feelings.
During preoperative preparation, the nurse finds that an unconscious woman of Indian origin has a yellow thread tied around the wrist. Her partner says that it a sacred thread. However, the nurse fears that the yellow thread may become a source of infection. Which is the most appropriate nursing action? 1. Remove it in a paper bag and hand it to her partner 2. Retain the yellow thread but clean it with antiseptic liquid 3. Remove it and replace it after the procedure is completed 4. Remove and replace it with a safe one before the procedure
3. Remove it and replace it after the procedure is completed The nurse should respect the beliefs of patients and their families as long as it is not harmful to them. The thread can hamper the procedure; therefore, it should be removed and replaced once the procedure is done. Because the patient's partner considers the yellow thread sacred, the nurse should not remove and hand it to the partner, clean it with antiseptic liquids, or replace it after the procedure with another one.
A couple with a 7-year-old child get divorced. Who would be given custody of the child? 1. The child will be placed in foster care unless the parents reach a settlement. 2. The custody will be given to the father because the father earns more money. 3. The custody is given to the parent who is best able to provide for the child's welfare. 4. The custody will be given to the mother because the mother can provide better care.
3. The custody is given to the parent who is best able to provide for the child's welfare. The child's welfare is always the prime deciding factor to determine the child's custody. Custody is given to the parent who is best able to provide for the child's welfare. This parent may be the mother or the father. The child is not placed in foster care.
The nurse is caring for a Hindu patient who wears a thread around his body. What should the nurse do while caring for this patient? 1. Remove the thread because it is not therapeutic 2. Tell the patient that wearing the thread is unnecessary 3. Remove and replace the thread with a new one every day 4. Do not remove the thread as long as it does not obstruct medical care
4. Do not remove the thread as long as it does not obstruct medical care The nurse should not remove the thread. Many Hindus wear thread, which they consider sacred, around the body. Unless it obstructs medical care, it should not be removed. The nurse should respect the patient's religion and beliefs and should not tell the patient that wearing the thread is unnecessary. It should not be removed and replaced because it is considered sacred.
A single working parent says that caring for a child and managing work is becoming difficult. The nurse determines that the patient is exhausted by these responsibilities. Which is the most appropriate service that would benefit the patient? 1. Hospital 2. Change of job 3. Adoption service 4. Respite child care
4. Respite child care Respite child care is a service available to help parents to relieve exhaustion and avoid burnout. Therefore, the patient should seek respite child care services. Hospitals are for patients who need medical attention. It would not be appropriate to change jobs because the stress of working would still be there. Adoption services are inappropriate in this situation.
The nurse works in a hospital with patients from different cultural backgrounds. The nurse understands that certain practices in some cultures may be considered abusive by a dominant culture. Which cultural practice is considered nonabusive? 1. Applying garlic over the skin 2. Forced kneeling for a long time 3. Cupping against the skin surface 4. Saying words into a newborn's ears
4. Saying words into a newborn's ears Islamic people utter few religious words into the ears of a newborn, and this practice is considered to be nonabusive. Cupping is an old world practice where a container with steam is placed on the body surface to draw out the poison or evil elements in the body. Forced kneeling is a measure of disciplining children practiced in some Caribbean families. Some Yeminite Jews apply crushed garlic cloves on to the wrist to prevent infectious diseases.
What is the most overwhelming adverse influence on health? 1. Race 2. Customs 3. Genetic constitution 4. Socioeconomic status
4. Socioeconomic status Although children of different racial groups have differing health issues, socioeconomic status is a key predictor. Customs do not usually have an adverse effect on health. A higher percentage of lower-class individuals have some health problem at any one time than other individuals in different classes. There is a high correlation between poverty and poor nutrition. On a population basis, genetic constitution is not an overwhelming adverse influence.
