NURSING MODULE 4

. Mourning often involves rituals, which are __________. Examples of rituals include: -a way to process emotions around death -cremate -lanterns -throwing flowers or dirt on casket -dio des los muertos -wearing white (south asian cultures) /black (USA) -disposing of the body after death/unless infectious disease -always support rituals unless hinders safety ex-burning incense would set off fire alarms and possibly irritate other patients

" Restitution involves the rituals surrounding loss; with death, it includes religious, cultural, or social expressions of mourning, such as funeral services. Resolving the loss involves dealing with the void left by the loss. Idealization is the exaggeration of the good qualities of the person or object, followed by acceptance of the loss and a lessened need to focus on it.

Homeopathy

"Like cures like": The notion that a disease can be cured by a substance that produces similar symptoms in healthy people. "Law of minimum dose": The notion that the lower the dose of the medication, the greater its effectiveness. Many homeopathic remedies are so diluted that no molecules of the original substance remain. Homeopathic remedies are derived from substances that come from plants, minerals, or animals, such as red onion, arnica (mountain herb), crushed whole bees, white arsenic, poison ivy, belladonna (deadly nightshade), and stinging nettle

Ayurveda

(medical system) integrate and balance the body, mind, and spirit. Key concepts include universal interconnectedness among people, their health, and the universe; and the body's constitution and life forces Using these concepts, Ayurvedic practitioners prescribe individualized treatments that include herbs, metals, minerals, and other materials; diet and exercise; and lifestyle recommendations Ayurvedic products are regulated as dietary supplements in the United States, and some have the potential to be toxic

Holistic Nursing What do we know about the meaning of healing? What can we do each day to facilitate healing? How can we be an instrument in the healing process?

**Goal is healing the whole person** •Can be found in any nursing setting •Frequently add CHA to their practice Person-centered

Most types of meditation have four elements in common *A quiet location: Meditation is usually practiced in a quiet place with as few distractions as possible. This can be particularly helpful for beginners. *A specific, comfortable posture: Depending on the type being practiced, meditation can be done while sitting, lying down, standing, walking, or in other positions. -----Patients seeking inpatient care might have a meditation practice they want to continue. Nurses should provide the time necessary for this to occur. Nurses could benefit from a meditation practice as well and could practice a brief meditation during breaks from patient care activities------

*A focus of attention: Focusing one's attention is usually a part of meditation. For example, the meditator may focus on a mantra (a specially chosen word or set of words), an object, or the sensations of the breath. Some forms of meditation involve paying attention to whatever is the dominant content of consciousness. *An open attitude: Having an open attitude during meditation means letting distractions come and go naturally without judging them. When the attention goes to distracting or wandering thoughts, they are not suppressed; instead, the meditator gently brings attention back to the focus. In some types of meditation, the meditator learns to "observe" thoughts and emotions while meditating.

Transcultural Nursing

- both a specialty and a formal area of practice, Dr. Leininger-Theory of Cultural Care Diversity and Universality provides the foundation for providing culturally respectful care for patients of all ages, as well as families, groups, and communities. A nurse who is culturally respectful has the knowledge and skills to adapt nursing care to cultural similarities and differences. combines competence/humility

ethnocentrism

- the belief that the ideas, beliefs, and practices of one's own culture are superior to those of another's culture. Cultural imposition in health care is the tendency for health personnel to impose their beliefs, practices, and values on people of other cultures. different populations are affected by disparities, including racial and ethnic minorities; residents of rural areas; women, children, and the older adult; and persons with disabilities.

Loss occurs when a valued person, object, or situation is changed or becomes inaccessible such that its value is diminished or removed.

-- Actual loss can be recognized by others as well as by the person sustaining the loss —for example, loss of a limb, a child, a valued object such as money, and a job. --Perceived loss, such as loss of youth, financial independence, or a valued environment, is experienced by the person but is intangible to others. A person who loses an arm in an automobile crash suffers from both the physical loss of the arm and the psychological loss that may be caused by an altered self-image and the inability to return to his or her occupation or other activities. These losses are simultaneously physical, psychological, and actual. A person who is scarred but does not lose a limb may suffer a perceived and psychological loss of self-image.

1. Nurses can provide care with cultural humility by:

-never assume a client will behave like the textbook -get to know your community ,that ethnicities,cultures and races are around -will you need to learn another language -does your hospital make people feel welcome -what are the disparities in your hospital -how would you obtain an interpreter -ask pronouns,backround,religion,health related beleifs -support desired religious practices -

How to Learn About Your Client's Model Kleinman's Eight Questions 1.What do you call your problem? What name does it have? 2.What do you think caused your problem? 3.Why do you think it started when it did? 4.What does your sickness do to you? How does it work?

5.How severe is it? Will it have a long or short course? 6.What do you fear most about your disorder? 7.What are the chief problems that your sickness has caused for you? 8.What kind of treatment do you think you should receive? What are the most important results you hope to receive from treatment?

cultural respect

: enables nurses to deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients; critical to reducing health disparities and improving access to high-quality health care

integrative health

A person who uses integrative care uses some combination of allopathic medicine and CHA. There are several types of integrative care models used throughout the United States that can be housed in virtually all health care delivery structures. Optimally, these models include sensitive and knowledgeable health care providers who work with patients to design a care plan that is responsive to the patient's preferences and combines the best of allopathic medicine and CHA while avoiding harmful interactions.

Conventional Medicine and Complementary Health Approaches

Allopathic medicine (or conventional medicine) has been dominant for about 100 years in the United States and has spearheaded remarkable advances in biotechnology, surgical interventions, pharmaceutical approaches, and diagnostic tools. Allopathic medical care is particularly effective when aggressive treatment is needed in emergency or acute situations.

Holism differs from allopathic medicine in these ways:

Allopathic medicine constantly treats the disease, not the individual whereas "alternative" holistic approaches maintain the connectedness of the human being to its environment, both internal and external;

Both palliative care and hospice care are discussed in Chapter 11. Established in 1986, the HPNA (www.hpna.org) is the nation's largest and oldest professional organization dedicated to promoting excellence in palliative nursing care.

Among its aims are assisting members of the nursing team with ensuring quality nursing care delivery, managing complex symptoms along with grief and bereavement, and having difficult conversations.

cultural destruction

Attitudes, policies, and practices that are destructive to cultures and consequently to the individuals within the culture -obliterate diversity -when whites colonized america and tried to wipe out native americans

Mourning is the actions and expressions of that grief, including the symbols and ceremonies outward expression of grief that can be seen by others (e.g., a funeral or final celebration of life) that make up the outward expressions of grief.

Bereavement is a state of grieving due to loss of a loved one. -process of experiencing grief

Sylvia Puentes, the anxious patient scheduled for surgery. The nurse's knowledge of CHA would be important in helping this patient to reduce her preoperative anxiety. The nurse could discuss various methods available, allowing the patient to select the one that seems best for her. Such actions help develop a trusting nurse-patient relationship and foster a sense of self-esteem in the patient by allowing her to participate in the care plan and decision making.

COMPLEMENTARY AND INTEGRATIVE HEALTH APPROACHES -Acupuncture to appropriate areas to reduce sinus congestion -Rest and fluids ALLOPATHIC APPROACHES -Decongestant over-the-counter medications -Rest and fluids In this example, adding herbs and/or acupuncture to a typical allopathic approach would represent integrative care.

Chapter 28 - Complementary and Integrative Health

Chapter 28 - Complementary and Integrative Health

Chapter 43 - Loss, Grief, and Dying

Chapter 43 - Loss, Grief, and Dying

Chapter 5 - Cultural Diversity

Chapter 5 - Cultural Diversity

yoga involves the combination of physical movements, breathing practices, and relaxation practices. The various physical postures that are practiced promote strength and flexibility, increase endurance, promote relaxation, and reduce a person's response to stress. Breathing exercises, posture awareness, spiritual practices, and mind-body centering can be added to the basic postures.

Common types of yoga include: Iyengar, which focuses on proper alignment of the body and use of poses and breathing to address specific needs of the practitioner Kripalu or "gentle yoga," which focuses on relaxation and coming into balance Ashtanga, which focuses on synchronizing breathing with a fast-paced series of postures Bikram, which is done in a studio heated to 105°F and involves 26 set postures

-cultural imposition, which is the belief that everyone else should conform to your own belief system, and -cultural blindness, which occurs when one ignores differences and proceeds as though they do not exist.

Cultural imposition and cultural blindness can be observed within the health care system, especially in regard to nontraditional methods of care. -Culture conflict occurs when people become aware of cultural differences, feel threatened, and respond by ridiculing the beliefs and traditions of others to make themselves feel more secure about their own values

Energy Healing Therapies

Healing touch (HT) uses a collection of energy techniques to assess and treat the human energy system, thus effecting physical, emotional, mental, and spiritual health and healing. The goal of HT is to restore wholeness through harmony and balance, enhancing the person's ability to self-heal (Hausladen Foley, Anderson, Mallea, Morrison, & Downey, 2016). Treatment involves the health care provider placing their hands either on or near the body in patterns identified by Healing Touch International and/or the Healing Touch Program

common health problems in specific populations Native Americans and Alaska Natives Heart disease Cirrhosis of the liver Diabetes mellitus Fetal alcohol syndrome African Americans Hypertension Stroke Sickle cell anemia Lactose intolerance Keloids Asians Hypertension Cancer of the liver Lactose intolerance Thalassemia

Hispanics Diabetes mellitus Lactose intolerance Whites Breast cancer Heart disease Hypertension Diabetes mellitus Obesity Eastern European Jews Cystic fibrosis Gaucher's disease Spinal muscular atrophy Tay-Sachs' disease

ALLOPATHIC THERAPIES

Illness occurs in either the mind or the body, which are separate entities. Health is the absence of disease. The main causes of illness are considered to be pathogens (bacteria or viruses) or biochemical imbalances. Curing seeks to destroy the invading organism or repair the affected part. Emphasis is on disease and high technology. Drugs, surgery, and radiation are among the key tools for dealing with medical problems.

Accommodate Cultural Practices in Health Care

Incorporate factors from the patient's cultural background into health care whenever possible if the practices would not be harmful to the patient's health. To ignore or contradict the patient's background may result in the patient refusing care or failing to follow prescribed therapy. Modify care to include traditional practices and practitioners as much as possible, and be an advocate for patients from diverse cultural groups.

1. Intersectionality refers to the interaction between identities (gender, ethnicity, sexual orientation, etc.) and the outcomes of these identities in terms of power.

It is these interactions that create privilege and discrimination, and both greatly influence health care. These influences are often called social determinants of health.

Key Concepts The term complementary health approaches (CHAs) refers to interventions that can be used with conventional medical interventions and thus complement them. The term integrative health (IH) refers to the combination of complementary health and conventional health approaches in a coordinated way. Nurses need to be knowledgeable about CHA for several reasons: patients, families, health care providers, and institutions increasingly expect practicing nurses to be knowledgeable about CHA; nurses are expanding their clinical practice by incorporating CHA; many state Boards of Nursing recognize select CHA modalities as part of nursing practice; and nurses play an important role in educating the public about how CHA therapies can be used safely and effectively. The CHA and allopathic systems differ fundamentally in several ways.

Many CHA are based on a theory and philosophy of holism, upon which holistic nursing also is based. Many practitioners and consumers of health care choose to combine allopathic modalities and CHA using an integrative approach. Holistic nursing is nursing practice built on a holistic philosophy. Healing the whole person is its goal. A person who employs integrative care uses some combination of allopathic medicine and CHA. The National Center for Complementary and Integrative Health classifies the major CHA into three categories: mind-body practices, natural products, and other CHA. Patient education about CHA is essential. Patients and the public need to know about the safe and effective use of CHA. Numerous resources exist to educate health care professionals and the public.

Complementary Health Approach Categories Whole (or alternative) medical systems are similar to the Western allopathic model, in that they are complete systems of theory and practice. They consist of a set of beliefs about the origin of diseases, ways to promote health, and types of treatment. Mind-body practices use a variety of techniques designed to enhance the mind's ability to affect bodily function and symptoms. Examples include yoga, meditation, acupuncture, energy medicine, manipulative and body-based practices (e.g., chiropractic), and others.

Natural products include the use of botanicals (herbs), animal-derived extracts, vitamins, minerals, fatty acids, amino acids, proteins, prebiotics and probiotics, whole diets, and functional foods.

Categories of CHAs Mind-body practices that are movement-based:

Physical exercises and practices -Musculoskeletal pain, joint pain, and lower-back pain By strengthening muscles, supporting joints, improving alignment, and releasing endorphins Physical therapy: Specialized movements to strengthen weak areas of the body, often through resistance training • Yoga: An Indian practice of meditative stretching and posing • Pilates: A resistance regimen that strengthens core muscles • Tai chi: A slow, flowing Chinese practice that improves balance • Feldenkrais: A therapy that builds efficiency of movement

Indicators for hospice referral

Poor performance status Declining cognitive status Advanced age Poor nutritional intake Pressure injuries Comorbidities Previous hospital admissions for acute decompensation

Explain concepts of cultural diversity and respect. Describe influences that affect culturally respectful health care. Discuss examples of how diversity affects health and illness care, including culturally based traditional care. Identify factors commonly included in a transcultural assessment of health-related beliefs and practices.

Practice cultural respect when assessing and providing nursing care for patients from diverse cultural groups. Discuss factors in the health care system and in nursing that facilitate or impede culturally competent nursing care.

Key Concepts Society in the United States is increasingly made up of people from many diverse backgrounds. Cultural diversity includes, but is not limited to, people of varying cultures, racial and ethnic origin, religion, language, physical size, biological sex, sexual orientation, age, disability, socioeconomic status, occupational status, and geographic location. The knowledge and skills for understanding cultural diversity and providing culturally respectful care have become essential components of nursing practice. Culture may be defined as a shared system of beliefs, values, and behavioral expectations that provides social structure for daily living. Culture influences roles and interactions with others as well as within families and communities and is apparent in the attitudes and institutions unique to particular groups. Ethnicity is a sense of identification with a collective cultural group, largely based on the group's common heritage. One belongs to a specific ethnic group or groups either through birth or through adoption of characteristics of that group. Racial categories are typically based on specific physical characteristics such as skin pigmentation, body stature, facial features, and hair texture. Because of the significant blending of physical characteristics through the centuries, however, race is becoming harder to define. Cultural influences on health care are many and varied: physiologic variations, reactions to pain, mental health, biological sex roles, language and communication, orientation to space and time, food and nutrition, family support, and socioeconomic factors. People's values and beliefs about health, illness, and care for an illness develop as a direct result of cultural and ethnic influences. People from different cultures may also have different beliefs about the best way to treat an illness or disease.

Providing culturally competent, or in newer terms, culturally respectful nursing care means that care is planned and implemented in a way that is sensitive to the needs of individuals, families, and groups from diverse populations within society. Becoming culturally competent is a lifelong challenge. Nurses should strive to be culturally humble—recognizing what we don't yet know about those entrusted to our care and being willing to learn what we need to know. Nurses who value cultural competence strive to enhance their understanding of the following: --Beliefs, values, traditions and practices of a culture --Culturally defined, health-related needs of individuals, families and communities --Culturally based belief systems of the etiology of illness and disease and those related to health and healing --Culturally based attitudes toward seeking help from health care providers Nursing care can become complicated when the patient and the nurse have distinctly different cultural norms. Cultural imposition in health care is the tendency for health personnel to impose their beliefs, practices, and values on people of other cultures. Closely related to cultural imposition is ethnocentrism, the belief that one's own culture's ideas, beliefs, and practices are the best, superior, or most preferred to those of another culture. Cultural competence takes time. It involves developing awareness, acquiring knowledge, and practicing skills.

HOLISTIC APPROACHES TO FOOD CHOICES

Reduce amounts of processed foods. -lower nutritional value Reduce/eliminate soft drinks (carbonated/sugar-sweetened beverages). Avoid eating foods with preservatives. Consider adopting a vegetarian diet. Animals are increasingly fed antibiotics and potentially contaminated foods. Increasingly, fish are being contaminated with mercury and other pollutants. Eat foods in season. Foods produced "out of season" are treated with chemicals to ripen them, since they are picked before ripening. Be aware of genetically engineered, radiated food.

Engel's Six Stages of Grief ´Shock & disbelief - usually defined as refusal to accept the fact of loss,followed by a stunned or numb response: "No, not me." Developing awareness -physical and emotional responses such as anger, feeling empty, and crying: "Why me?" Restitution -rituals surrounding loss; with death, it includes religious, cultural, or social expressions of mourning, such as funeral services.

Resolving the loss -dealing with the void left by the loss. Idealization -exaggeration of the good qualities of the person or object, followed by acceptance of the loss and a lessened need to focus on it. Outcome -final resolution of the grief process, includes dealing with loss as a common life occurrence.

Energy Healing Therapies

SOUND HEALING Sound is an ancient form of healing. Examples include the central importance of drum and flutes for American Indians and Tibetan singing bowls. Sound, using the vibrational energy of tones, music, chants, song, and a variety of sound-producing instruments, is used to promote relaxation and healing

Maturational loss is experienced as a result of natural developmental processes. As examples, a first child may experience a loss of status when a sibling is born, and the parent of a single child may experience a sense of loss when the child begins school.

Situational loss is experienced as a result of an unpredictable event, including traumatic injury, disease, death, or national disaster. Anticipatory loss occurs when a person displays loss and grief behaviors for a loss that has yet to take place Anticipatory loss is often seen in the families of patients with serious and life-threatening illnesses and may lessen the effect of the actual loss of the family member.

nurses must be familiar with CHAs because Complementary Health Approaches and Nursing CHA consists of a large variety of therapies that are based on a set of beliefs different from those of allopathic medicine. .

Some of these modalities have developed fairly recently (e.g., guided imagery), while others have been used for thousands of years as components of ancient healing systems (e.g., Ayurveda or traditional Chinese medicine). some therapies can be used effectively without assistance (e.g., nutritional approaches, deep breathing exercises), while others (e.g., naturopathy, acupuncture) are more effective when used with guidance from practitioners who have particular knowledge and expertise. Many people use CHA for stress management/reduction. Techniques such as relaxation with focused breathing, meditation, imagery, biofeedback, and massage are used in all stages of health and illness to promote healing and/or manage symptoms. Because stress can contribute to illness, CHA can sometimes be effective in reducing symptoms and enhancing quality of life. Nurses can assist patients—and themselves—with these therapies

The goal of the TCM diagnostic process is to arrive at the pattern of disharmony that is being manifested by the person.

TCM practitioners obtain a holistic history; observe particular parts of the body, such as the tongue; and palpate pulses. TCM includes energy medicine and biology-based practices; treatment may consist of acupuncture, with or without moxibustion (burning an herb above the acupuncture needle), dietary prescriptions, herbs, massage, and energy exercises, such as qi gong.

I. The differences between Ayurveda and Traditional Chinese medicine are: _____________________________________

TCM-perception of humans as microcosms of the larger surrounding universe—interconnected with nature and subject to its forces. -health and disease relate to balance of the functions. ayurveda-universal interconnectedness among people, their health, and the universe; and the body's constitution and life forces

An effective way to identify specific factors that influence a patient's behavior is to perform a cultural assessment When caring for patients from a different culture, it is important to first ask how they want to be treated based on their values and beliefs. The primary informant should be the patient, if possible. If the patient is not able to respond to the questions, a family member or a friend can be consulted.

The Giger and Davidhizar model takes into account six cultural phenomena: communication, space, social orientation, time, environmental control, and biologic variations. The Campinha-Bacote Model of Cultural Competence (2011) emphasizes becoming culturally competent and integrating cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire.

Energy Healing Therapies Energy-healing therapy techniques are based on the belief that they can affect this primary life force and thus contribute to physiologic healing. These techniques involve channeling healing energy through the hands of a practitioner into the patient's body to restore a normal energy balance and, therefore, health

Therapeutic touch (TT) is the use of the hands on or near the body with the intent to help or heal. The TT process consists of centering, assessing the energy field, and rebalancing the field using modulation, "unruffling," and other techniques (Krieger, 1993). TT uses four primary scientific premises (Krieger, 1993, pp. 12-13): All the life sciences agree that, physically, a human being is an open energy system. Anatomically, a human being is bilaterally symmetrical. Illness is an imbalance in a person's energy field. Human beings have natural abilities to transform and transcend their conditions of living.

Identity refers to personal characteristics

These markers may be self-assigned or assigned by subcultures or the larger culture.

Meditation -mind body intervention medicine

This practice is believed to result in a state of greater calmness and physical relaxation, as well as psychological balance. Practicing meditation can change how a person relates to the flow of emotions and thoughts.

Types of Loss -------------------------- Taylor et al. (2019) ´Actual loss ´Perceived loss ´Physical loss ´Psychological loss -self esteem,body image ´Maturational loss ´Situational loss Anticipatory loss

Videbeck (2019) --uses maslovs hierarchy to frame loss -when needs are taken away or not met we experience loss ´Physiologic loss -loss of limb,mobility, ´Safety loss -domestic violence, child abuse ,loss of safe environment = psychological loss, perceived loss, situational loss ´Loss of security/sense of belonging -loss of loved one, affects need or love and being loved, normal development=perceived loss, psychological loss,maturational loss ´Loss of self-esteem -change in how someone is valued true/perceived=psychological loss, perceived loss ´Loss related to self-actualization -loses hope in plans that will never happen=perceived loss -grieve what will never happen that you always imagined would

cultural assimilation or acculturation.

When a minority group lives within a dominant group, many members may lose the cultural characteristics that once made them different, and they may take on the values of the dominant culture. For example, when people immigrate and encounter a new dominant culture as they work, go to school, and learn the dominant language, they often move closer to the dominant culture.

traditional Chinese medicine (TCM) is a unique view of the world and the human body that is different from Western medicine concepts This view is based on the ancient Chinese perception of humans as microcosms of the larger surrounding universe—interconnected with nature and subject to its forces. The human body is regarded as an organic entity in which the various organs, tissues, and other parts have distinct functions but are all interdependent. The goal of the TCM diagnostic process is to arrive at the pattern of disharmony that is being manifested by the person. TCM practitioners obtain a holistic history; observe particular parts of the body, such as the tongue; and palpate pulses. TCM includes energy medicine and biology-based practices; treatment may consist of acupuncture, with or without moxibustion (burning an herb above the acupuncture needle), dietary prescriptions, herbs, massage, and energy exercises, such as qi gong.

Yin-yang theory—the concept of two opposing, yet complementary, forces that shape the world and all life—is central to TCM. In the TCM view, a vital energy or life force called qi circulates in the body through a system of pathways called meridians. Health is an ongoing process of maintaining balance and harmony in the circulation of qi. The TCM approach uses eight principles to analyze symptoms and categorize conditions: cold/heat, interior/exterior, excess/deficiency, and yin/yang (the chief principles). TCM also uses the theory of five elements—fire, earth, metal, water, and wood—to explain how the body works; these elements correspond to particular organs and tissues in the body

Cutaneous stimulation by massage, vibration, heat, cold, or nerve stimulation reduces the intensity of the sensation of pain. Therapeutic touch is an intentional act that involves an energy transfer from the healer to the patient to stimulate the patient's own healing potential.

acupuncture, long used in China, is a method of preventing, diagnosing, and treating pain and disease by inserting special needles into the body at specified locations. Acupressure involves a deep-pressure massage of appropriate points of the body.

Acupuncture

addresses a person's qi. Qi (chi in Japanese) is believed to flow vertically in the body through an intricate structure of 12 primary meridians, energy circuits that nourish and support all cells and organs of the body balance of yin and yang.

A nurse is interviewing a newly admitted patient. Which question is considered culturally sensitive? "Do you think you will be able to eat the food we have here?" "Do you understand that we can't prepare special meals?" "What types of food do you eat for meals? ""Why can't you just eat our food while you are here?"

c. Asking patients what types of foods they eat for meals is culturally sensitive. The other questions are culturally insensitive.

relaxation

can be useful whether a patient is experiencing a single stressful event, such as surgery or chronic stress. Patient benefits include reduced anxiety, reduced muscle tension and pain, improved functioning of the immune system, enhanced sleep and rest, and an improved overall sense of well-being.

cultural competence

care delivered with an awareness of the aspects of the patient's culture —recognizing what we don't yet know about those entrusted to our care and being willing to learn what we need to know

sterotyping

categorizing events, objects, and people without regard to different characteristics and qualities

Cultural Diversity •Think about where you are from. •How many cultures do you fit into? •Has this changed over time? •You will be interacting with unfamiliar cultures in nursing. •How will you interact with a minimum of bias?

coexistence of different ethnic, biological sex, racial, and socioeconomic groups within one social unit These groups include people of varying religion, language, physical size, sexual orientation, age, disability, occupational status, and geographic location. be sensitive to cultural factors in order to provide culturally respectful care to people from diverse backgrounds.

What does CAM stand for?

complementary and alternative medicine

cultural ambivalence

cultural blindness: the process of ignoring differences in people and proceeding as though the differences do not exist - -one manifestation is color blindness

Naturopathy

dynamic state of being that provides abundant energy for people to deal with life in our complex society. Naturopathic practitioners use many different treatment approaches, including dietary and lifestyle changes, stress reduction, herbs and other dietary supplements, manipulative therapies, and practitioner-guided detoxification

Implicit bias implies that social behavior is largely influenced by unconscious associations and judgments. These biases can be favorable or unfavorable Some examples of implicit bias are

favouring or being more receptive to familiar-sounding names than those from other cultural groups. Implicit bias doesn't mean that inclusivity is not one of our values. It means that we are not aware of how our own implicit bias can impact our actions and decisions. -discriminate by race,ethnicity,

Guided imagery

focuses on evoking pleasant images to replace negative or stressful feelings and to promote relaxation. Guided imagery involves using all five senses to imagine an event or body process unfolding according to a plan.

Health Disparities

health differences between groups of people; they can affect how frequently a disease affects a group, how many people get sick, or how often the disease causes death

palliative care -do not have to be dying to receive care -curative care

hospice care; taking care of the whole person—body, mind, spirit, heart and soul—with the goal of giving patients with life-threatening illnesses the best quality of life they can have through the aggressive management of symptoms Care designed not to treat an illness but to provide physical and emotional comfort to the patient and support and guidance to his or her family. - *symptom management* - *maintain quality of life living with the conditions you have* -can be up to 10yrs -chronic lung disease -can get this before hospice

Shamanism

illness and other forms of distress are thought to originate in the spirit world. The shaman or medicine man/woman possesses the ability to access the spirit world, which is done on behalf of people or the community, and return to "ordinary reality" with information on the proper treatment.

Nutritional supplements are chemical compounds that contain ingredients (vitamins, minerals, enzymes, amino acids, essential fatty acids) believed to promote health. These products have a wide range of safety and effectiveness.

information about certain herbs adds an aspect of safety to their practice. For example, some herbs and/or supplements may interact with prescribed medications patients are taking. Ginkgo biloba, the most widely sold herb in Europe and used by many to improve memory, affects platelet function and thus should not be used concurrently with warfarin or aspirin -vit K and leafy greens mixed with some meds can cause blood clots

Chiropractic health care

is a profession that focuses on the relationship between the body's structure—mainly the spine—and its functioning perform adjustments (manipulations) to the spine or other parts of the body with the goal of correcting alignment problems, alleviating pain, improving function, and supporting the body's natural ability to heal itself low-back pain and may also be helpful for headaches, neck pain, upper- and lower-extremity joint conditions, and whiplash-associated disorders

Ethnicity

is a sense of identification with a collective cultural group, largely based on the group members' common heritage. One belongs to a specific ethnic group or groups either through birth or through adoption of characteristics of that group.

Qi Gong and Tai Chi

is a system of postures, exercises (both gentle and dynamic), breathing techniques, and visualization The majority of qi gong exercises or meditations enhance systemic health. They are designed to restore the healing system, the body's innate intelligence, so it knows how to correct and heal itself. Tai chi, a martial arts, that likely developed from qi gong, --improve balance and reduce falls in older adults and has been used successfully to promote balance and coordination in other age groups both have origins in China and involve physical movement, mental focus, deep breathing, and relaxation

Loss is normal and essential to human life

it accompanies growth and development fulfill innate human potential loss can be planned, expected, or sudden -can be hard but beneficial -other times debilitating and devastating

Subculture

large group of people who are members of the larger cultural group but who have certain ethnic, occupational, or physical characteristics that are not common to the larger culture. For example, nursing is a subculture of the larger health care system culture, and -- teenagers and older adults are often regarded as subcultures of the general population in the United States. -some viewed positive/negative bc of sterotypes/ethnocentrism -muslims are a subculture within america

When nurses practice with cultural humility, that means

learn about the cultures you will be dealing with but it does not end there -think about bias you bring to interactions -how does this affect nursing care

The S-T-O-P technique is used to

mindfulness s-stop what your doing t-take some deep slow breaths o-observe thoughts feelings assumptions p-proceed patient care after cleared mind and focus

Complementary Health Approaches •CHA

refers to interventions that can be used with conventional medical interventions and thus complement them. •The term integrative health (IH) refers to the combination of complementary health and conventional health approaches in a coordinated way. •If there is a non-mainstream practice that is used instead of conventional medical care, it is considered an alternative modality; however, it is rare that people use only alternative approaches. •CHA and IH are not "medicines" and people without medical degrees practice CHA/IH.

Race

the term ethnicity is often used interchangeably with race, these terms are not the same. Racial categories are typically based on specific physical characteristics such as skin pigmentation, body stature, facial features, and hair texture.

which is a type of CAM that uses energy fields -ostepathic manipulation -therapeutic touch -meditation -naturopathic medicine

therapeutic touch

hospice care focuses on the needs of the dying,

treatment of the terminally ill in their own homes, -or in special hospital units - or other facilities, with the goal of helping them to die comfortably, without pain -terminal diagnosis -<6 months - *focus on good death* -no actual treatment -comfortable/maintain dignity

aromatherapy

used in delivery helps naseua improve physical, emotional, and spiritual well-being. The fragrance of these oils is believed to ultimately affect the very sensitive amygdala of the limbic system in the brain, where emotional memories are stored and released. antibacterial, antiviral, antifungal, calming, and energizing effects **ginger or peppermint for nausea** **lavender or chamomile for insomnia** **eucalyptus energy**

alternative modality

used instead of traditional medical care

love to ask questions like what is the nurses best response

usually answer is the definition from the book

culture shock

when placed in a different culture he or she perceives as strange. may result in psychological discomfort or disturbances, because the patterns of behavior a person found acceptable and effective in his or her own culture may not be adequate or even acceptable in the new culture. The person may then feel foolish, fearful, incompetent, inadequate, or humiliated.

Kübler-Ross' Stages of Grief *prudent student* grief is not linear you do not go in an orderly fashion -go back and forth -jump and skip stages -provide support -any stage is normal for grief -ppl will respond differently to cope w pain

´Denial -shock and disbelief ´ Anger -may be with God,relatives,friends,healthcare providers or even the deceased ´ Bargaining -person asks god or fate to delay the inevitable loss ´ Depression -acceptance of the loss becomes acute Acceptance -evidence of coming to terms with the death

Grief

´Internal emotional reaction to loss caused by separation or by death ´Grieving, or bereavement, refers to the process of experiencing grief ´Content (what) ´Process (how) ´Mourning is the outward expression of grief ´Mourning influenced by culture, religion, and spirituality Loss of a body part, job, house, or pet may also cause grief.

Intersectionality

•A framework for understanding how identities and cultural/ethnic membership(s) combine to create different types of privilege and discrimination (Crenshaw, 2017). •Using intersectionality helps us identify how discrimination affects the health of patients, families, and communities

Allopathic Medicine

•AKA "Western medicine" and biomedicine •Illness occurs in either the mind or body, which are separate entities. •Health is the absence of disease. •The main causes of illness are pathogens. •Emphasis on cure of disease using technology—drugs, surgery, radiation - particularly effective when aggressive treatment is needed in emergency or acute situations. -curing illness/eliminating disease -not totally effective with chronic illness

Categories of CHAs

•Alternative (whole) medical systems •Mind-body practices -For example, students may experience insomnia related to anxiety the night before a major examination -.use a variety of techniques designed to enhance the mind's ability to affect bodily function and symptoms. Examples include yoga, meditation, acupuncture, energy medicine, manipulative and body-based practices (e.g., chiropractic), and others. •Mind-based •Energy healing •Natural products •Botanicals •Nutritional supplements •Nutritional therapy

Culture •Shared system of beliefs, values, and behavioral expectations •Provides social structure for daily living •Defines roles and interactions with others and in families and communities

•Apparent in the attitudes and institutions unique to the culture •Language is the primary means of transmitting culture *****•Culture has the greatest influence on health beliefs and practices •People remain individuals, even within a culture*****

Inhibitors of Cultural Diversity

•Cultural assimilation •Culture shock •Ethnocentrism •Stereotyping •Cultural ambivalence •Cultural imposition •Cultural destruction

Nursing Implications of CHAs

•Dissatisfaction with allopathic therapy •CHAs not regulated •Opportunities for nurses to expand practice •Nursing professional development •Patient education—when CHAs may be harmful

What is Your Client's Model?

•How does your client define "health" and "illness?" •What personal and social meaning do they attach to their illness? •What are their expectations for care? •What are their therapeutic goals •What are their expectations for you, as a nurse?

Providing Care with Cultural Humility

•Identify personal implicit biases. •Develop cultural self-awareness. •Develop cultural knowledge. •Accommodate cultural practices in health care. •Respect culturally based family roles. •Practice mindfulness. Use the S-T-O-P technique. •Avoid mandating change. •Seek cultural assistance.

Cultural Humility cultural competence comes with bias so we steer away from that

•Involves entering a relationship with another person with the intention of honoring their beliefs, customs, and values (Stubbe, 2020). •Requires openness, self-awareness, willingness to equalize power, supportive interaction, and self-reflection and critique (Foronda et al., 2015) •Positive results include mutual empowerment, partnerships, respect, optimal care, and lifelong learning •First step is identifying one's own implicit biases •Cultural humility is a way to address intersectionality

Identity

•Markers or labels for personal characteristics -some are self assighned -some assighned by subculures and larger culture •Some identities exist from birth —male, female, skin color, etc. •Others appear over time —gender identity, sexual orientation, religion, politics, education, etc. •Some identities are viewed as positive and others as negative -by members of dominant culture

Most Frequently Used CHAs

•Nonvitamin, nonmineral, natural products (17.7%) •Deep breathing exercises (10.9%) •Yoga (14.3%)*term-77 •Chiropractic or osteopathic manipulation (10.3%)* -perform adjustments (manipulations) to the spine or other parts of the body with the goal of correcting alignment problems, alleviating pain, improving function, and supporting the body's natural ability to heal itself •Meditation (14.2%)* •Massage (6.9%) •Among U.S. adults, the use of some mind-body therapies involving gentle physical activity, specifically yoga, tai chi, and qi gong, increased between 2012 and 2017

Cultural Influences on Health Care •Physiologic variations -certain racial and ethnic groups are more prone to certain diseases and conditions. For example, a hereditary disorder, Tay-Sachs' disease, is associated with people of Eastern European Jewish descent •Reactions to pain -Some cultures allow or even encourage the open expression of emotions related to pain, whereas other cultures encourage suppression of such emotions. •Mental health -many ethnic groups have their own norms and acceptable patterns of behavior for psychological well-being, as well as different normal psychological reactions to certain situations. For example, many Hispanic people deal with problems within the family and consider it inappropriate to tell problems to a stranger •Gender roles -the man is the dominant figure and generally makes decisions for all family members. For example, if approval for medical care is needed, the man may give it regardless of which family member is involved. •Language and communication -When people from another part of the world move to the United States, they may speak their own language fluently but have difficulty speaking English -*informed consent must be conducted in the clients language by a medically certified interpreter*

•Orientation to space and time area around a person regarded as part of the person. This area, individualized to each person and to different cultures and ethnic groups, is the area into which others should not intrude during personal interactions. •Food and nutrition Food preferences and preparation methods often are culturally influenced. Certain food groups serve as staples of the diet based on culture and remain so even when members of that culture are living in a different country. •Family support In many cultural and ethnic groups, people have large, extended families and consider the needs of any family member to be equal to or greater than their own •Socioeconomic factors Access to financial resources affects how individuals and families meet their basic needs and maintain their health. Poverty often leads to problems such as lack of health insurance, inadequate care of infants and children, lack of access to basic health care services, and homelessness.

Reasons for Using CHA

•Part of cultural practices •Having a holistic philosophy •Wanting greater control over health •Seeking ways to improve health and well-being •Seeking relief from symptoms of illness or medical therapy -stress management -enhance quality of life - relieve symptoms associated with chronic, even terminal, illnesses or the side effects of conventional treatments for them -holistic health philosophy or a transformational experience that changes one's worldview and wanting greater control over one's own health

Why Nurses Need to Know CHA

•Patients, families, physicians, and institutions increasingly expect practicing nurses to be knowledgeable about CHA. •Many patients use these types of therapies as outpatients and want to continue their use as inpatients. •Patients/family members may expect nurses to administer herbal preparations/nutritional supplements. •Many nurses are expanding their clinical practice by incorporating CHA. •Many institutions now provide complementary therapies to inpatients as part of total patient care in an effort to provide integrative health care.

Communication is Key!

•Start with relationship •Be aware of verbal, nonverbal, and written communication •Culture influences communication styles & interpretation of communication •Adapt your communication to each client •Use simple language—NO medical jargon! Be specific & use pictures ask client for comprehension-if they understood

Holism

•Whole is greater than the sum of the parts •Focuses on connections and interactions between parts of the whole •All living organisms, including humans, are continuously connecting and interacting with their environment. •Parts of the organism, whether they are systems, subsystems, or cells, are also continuously interacting and changing. -unified dynamic-whole -healing the mind therefore body