Ppt chapter 12

Chapter 12
Culture and Inherited Traits:
Considerations in Drug Therapy
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
• People who emigrate to North America tend to adopt the
norms of the culture.
– A. True
– B. False

Answer
• B. False
• Rationale: North America is considered the
“melting pot” of the world because people who
emigrate to North America blend into society while
retaining their individuality in terms of their
culture.

Chapter Summary
• customs and traditions, norms and values, institutions,
arts, history, and folklore of a group.
• Similarly, ethnicity refers to a group that shares a
common cultural heritage and that is linked by race,
nationality, or language. An ethnic group is part of a
larger social group.
• The United States is becoming an increasingly
multicultural society.
• Nurses today are being challenged to learn more about
how cultural differences affect health.

Biomedical Health Beliefs
• In general, North Americans describe health from the
scientific point of view.
• Life and life processes are controlled by physical and
biochemical processes that can be manipulated by
humans.

Magicoreligious Health Beliefs
• Predominant themes of magicoreligious health focus on
the concept of supernatural forces controlling health and
illness.
• Illnesses are the result of “being bad” or “opposing God’s
will.”
• Those who subscribe to these views perceive health as a
gift from God and illness as an opportunity to realign with
God.
• Prayer to God is used to cope with disease and to seek
intervention for healing.

Question
• What culture’s health beliefs are based on the
magicoreligious health model?
– A. African Americans
– B. Chinese Americans
– C. Native Americans
– D. Mexican Americans

Answer
• D. Mexican Americans
• Rationale: Mexican American and other Latin
American groups believe that illness results from the
evil eye. The person seeks treatment from a
traditional or folk healer. The person’s subscription
to magicoreligious health beliefs influences his or
her approach to health care.

Holistic Health Beliefs
• A harmonious balance of the forces of nature is the basis
of holistic health beliefs.
• Everything in the universe has a place and a function to
perform according to natural laws that maintain order.
• Disturbing these laws creates imbalance, chaos, and
disease.
• There are four facets of the person’s nature—physical,
mental, emotional, and spiritual.
• Traditional Native American and Chinese American
cultures have a holistic belief system.

Purnell’s Model for Cultural Competence
• To understand any culture thoroughly, examining it with
the use of a conceptual framework is helpful.
• Purnell and Paulanka’s model is an example of a
conceptual framework that is geared specifically to health
care providers.
• This model identifies 12 aspects (or domains) of every
culture that health care providers should consider.
• Communication is an important part of culture for the
nurse to assess.

Pharmacogenetics, Pharmacogenomics,
and Drug Therapy
• Different people respond to a particular drug in different
ways.
• Pharmacogenetics is the study of individual inherited
differences in response to clinical drug therapy.
• Pharmacogenomics is the study of patterns of human
genome variations that are in or near genes known to
influence drug action.
• Although many diseases are carried genetically,
individual variation can still occur in a person’s genetic
makeup.

Relationship Between Genes and Drug
Therapy

White Americans
• The most prevalent culture in the United States is that of
whites.
• The people in this cultural group trace their ancestors to
various European countries.
• White Americans tend to be future oriented.
• White Americans have a linear sense of time.

White Americans (cont.)
• Married white Americans generally live in traditional
nuclear families of a man and woman and their children.
• The predominant religious belief is Christianity.
• They practice a bioscientific view of disease and health
management.
• White Americans have been found to have more acid
glycoproteins than other ethnic groups.

Black Americans
• The largest group of black Americans is African American.
• African Americans trace their ancestors to Africans who
were brought to North America as slaves.
• African Americans tend to be more present oriented than
past or future oriented.
• African Americans have a circular view of time.

Black Americans (cont.)
• African Americans may have extended families.
• Historically, access to traditional health care for African
Americans was poor.
• As a result, folk medicine became a necessity for treating
illness.
• In general, African Americans respond to some drugs
differently than whites.

Asian and Pacific Islander Americans
• Asian and Pacific Islander Americans have their ancestral
origins in China, Japan, Korea, Vietnam, Cambodia, and
other Asian countries and various Pacific Islands.
• The Chinese concept of time is related to the natural
cycles of birth, life, and death.
• Traditional Chinese Americans place great significance on
family and family roles.

Asian and Pacific Islander Americans
(cont.)
• Many Chinese Americans consider formal religion to be
superstition.
• Chinese Americans believe that harmony with nature is
essential for physical and spiritual well-being.
• Chinese American health care practices vary.

Question
• Chinese Americans require the same dosage of lithium as
European and White Americans.
– A. True
– B. False

Answer
• B. False
• Rationale: Chinese Americans require lower levels of
lithium to achieve a therapeutic response. Part of the
explanation for the differences in drug responses lies
in the number and type of drug receptors present.

Hispanic Americans
• Hispanic Americans are a large minority in the United States.
• Historically, Mexican Americans have been more present
oriented than future oriented.
• Mexican American families tend to be patriarchal.
• Although some Mexican Americans tend to view life as
chance, others have a dominant fatalism and hold the opinion
that God is responsible for delivering health or illness.
• People are expected to maintain equilibrium by eating and
working properly.
• Some studies have shown that Hispanics may metabolize
some drugs differently than other cultural groups.

Native Americans and Alaska Natives
• The Native American and Alaska Native population in the
United States consists of more than 500 tribes that are
recognized by the federal government.
• The Navajo tribe lives in a large reservation that consists
of portions of Arizona, Utah, and New Mexico.
• A nomadic people, the Navajo tribe travels great
distances searching for adequate grazing grounds for
their sheep.

Native Americans and Alaska Natives
(cont.)
• Navajo Indians view time in a present–past–future
sequence.
• The Navajo, like most other Native Americans, are
matrilineal.
• Type 2 diabetes is very common among Navajo people.
• Other health problems common to the Navajo people are
severe combined immunodeficiency syndrome.

Nursing Management of Culturally Diverse
Groups
• It is necessary to respect each patient’s cultural
heritage, beliefs, and practices.
• A health care provider not fully aware of a patient’s
background may be unable to understand many of the
patient’s health beliefs and practices.
• Lack of knowledge or misunderstanding may
unintentionally turn what should be a therapeutic
experience into a degrading and humiliating experience
for patients.

Nursing Management of Culturally Diverse
Groups (cont.)
• When caring for patients, be conscious of ethnocentrism,
stereotyping, and cultural blindness.
• Because culture influences people so strongly in the way
they feel, think, act, and judge the world, people often
subconsciously restrict their view of the world to the
point of being unable to accept other cultures.

Nursing Diagnoses and Outcomes
• When developing nursing diagnoses, be aware of cultural
beliefs, values, and behaviors that may influence the
patient’s situation.
• Although all nursing diagnoses may have related cultural
factors, some can be specifically identified as having
strong cultural implications.
• Patients with identified genetic polymorphisms are at risk
for alterations in the effectiveness of a drug and
increased risk of adverse effects from drug therapy.

Nursing Diagnosis

Maximizing Therapeutic Effects
• When drug therapy is recommended, make an effort to
determine whether prescribed therapies are consistent
with the patient’s overall needs.
• Then incorporate these aspects into nursing practice
whenever possible and when they are not contraindicated
for health reasons.

Minimizing Adverse Effects
• Nurses and patients need to be aware that certain
cultural practices may create drug toxicity.
• Conventional prescribed drugs may have similar or
antagonistic actions to those of an herb or herbal
product.
• Some foods may also interact with some drug therapies.

Providing Patient and Family Education
• The communication style of the patient should be
considered when preparing to provide patient education.
• The reasons for a treatment plan must be shared with
patients and families and explained in language and at
levels they can understand.
• When planning educational materials for patients whose
primary language is not English, make every effort to
obtain interpreters or translations of written materials.

Providing Patient and Family Education
(cont.)
• If the patient is present oriented, his or her
understanding of acute and chronic illness may be
affected by the perception of time.
• Consider gender roles and the importance of various
family relationships to the patient when teaching about
drug therapy.

Ongoing Assessment and Evaluation
• Determine the extent to which the goals have been met
by comparing the patient’s current status with the
identified outcome criteria.

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