Cultural Competence in Health History and Physical Exam

Chapter 3:
Cultural Competence in the History and Physical Examination
Copyright © 2020 Wolters Kluwer • All Rights Reserved
1
Cultural Assessment #1
Customized or tailored to the client’s unique background.
Health history and physical exam interrelated.
With growing diversity comes the need for nurses to develop
knowledge and skills in cultural assessment.
2
Cultural Assessment #2
Assessments form the foundation for the plan of care.
Tend to be broad and comprehensive.
Cultural assessment usually integrated into the overall

assessment.
Health History #1
The purpose of the health history is to collect subjective data.
This is combined with the objective data from the physical
examination for both well and ill clients.
4
Question #1
Is the following statement true or false?
Subjective data refer to things that people say or relate about
themselves, whereas objective data result from the physical
examination and the laboratory findings.
5
Answer to Question #1
True
Rationale: Subjective data come from the client and are

information only they can give and confirm; objective data are
observable and confirmed through sources other than the client.
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Health History #2
Major data categories to be considered when conducting a
culturally competent health history:
Biographic data and history
Genetic data
Review of medications and allergies
Reason for seeking care
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Health History #3
Major data categories to be considered when conducting a
culturally competent health history (cont.):
Present health and history of present illness (culture-bound
syndromes)
Past health
Family and social history
Review of systems

8
Question #2
Most cultures recognize the difference between prescribed
medications and over-the-counter medications including herbs.
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False
Rationale: It is important to note all prescription and over -the-
counter medications, including herbs, that clients might
purchase or grow in home gardens. Because of cultural
differences in peoples’ perceptions of which substances are
considered medicines, it is important to ask about specific items
by name.
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Physical Examination #1
Accurate assessment and evaluation of clients require:

Knowledge of normal biocultural variations among healthy
members of selected populations
Assessment skills that will enable you to recognize variations
that occur in illness
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Biocultural variations in:
Measurements
Height, body proportions, weight (see Table 3-5)
Vital signs, including pain
General appearance
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Skin
Mongolian spots
Vitiligo
Hyperpigmentation
Cyanosis
Jaundice
Pallor
Erythema, petechial, ecchymoses
Addison’s disease, uremia, albinism

Normal age-related skin changes
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Body secretions
Apocrine glands
Eccrine sweat glands
Head
Hair (texture, color)
Eyes (structure, color, visual acuity)
Ears (size, shape, cerumen, hearing loss)
Mouth (pigmentation, cleft lip/palate, leukoedema)
Teeth (developmental, hygienic, nutritional indicators)
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Musculoskeletal system
Bone composition
Bone density
Bone curvature
Body composition

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Question #3
Where is the most reliable location to assess for petechiae in a
person with darkly pigmented skin?
Palms of the hands
Soles of the feet
Lining of the mouth
Upper chest and shoulders
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C. Lining of the mouth
Rationale: In dark-skinned clients, petechiae are best visualized
in the areas of lighter melanization, such as the abdomen,
buttocks, and volar surface of the forearm. When the skin is
black or very dark brown, petechiae cannot be seen in the skin.
Petechiae are most easily seen in the mouth, particularly the
buccal mucosa, and in the conjunctiva of the eye.

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Laboratory Tests
Biocultural variations occur with some lab test results, such as:
Hemoglobin
Hematocrit
Cholesterol
Serum transferrin
Blood glucose
Renal (creatinine, GFR)
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Clinical Decision-Making and Actions
The three major modalities to guide nursing judgments,
decisions, and actions are:
Cultural care preservation or maintenance
Cultural care accommodation or negotiation
Cultural care repatterning or restructuring
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Question #4
Which is an example of cultural care accommodatio n?
Arranging the client’s dressing changes to avoid scheduled
prayer times

Providing the client with foods that are aligned with his or her
religious dietary concerns
Explaining to the client the need to reduce fat content from his
or her ethnic high-fat diet
Arranging for an interpreter to facilitate communication
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A. Arranging the client’s dressing changes to avoid scheduled
prayer times
Rationale: Cultural care accommoda tion or negotiation refers to
professional actions and decisions that help people of a
designated culture to adapt to or to negotiate with others for
beneficial or satisfying health outcomes with professional care
providers.
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Chapter 4:
Influence of Cultural and Health Belief Systems on Health Care
Practices

Copyright © 2016 Wolters Kluwer Health | Lippincott Williams
& Wilkins
1
Cultural Belief Systems #1
Cultural meanings and cultural belief systems develop from the
shared social group experiences and are expressed symbolically.
2
Worldview
The set of metaphoric explanations used by a group of people to
explain life’s events and to offer solutions to life’s mysteries
Permeates every lifeway within a group culture
3
Worldview (paradigm) includes the assumptions, premises, and
linkages that bind together a prevailing interpretation of reality;
typically slow to change.

4
Question #1
All clients refer to illness and disease in the same context.
False
Rationale: Not all clients relate to health and illness in the same
context. A client’s worldview influences his or her cultural
belief system.
These are often the reasons why nurses may encounter
challenges when communicating with those who have a different
worldview than theirs.
6
Health Belief Systems #1
Health and illness worldviews are influenced by a person’s
values, beliefs, and practices.
This concept is his or her health belief system.

7
The three major health belief systems are:
Magico-religious
Scientific/biomedical
Holistic
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In the magico-religious paradigm:
The world is an arena in which supernatural forces dominate.
The fate of the world and those in it depends on the actions of
God, or the Gods, or other supernatural forces of good or evil.
The cause of health or illness is mystical.
Examples: Voodoo, Christian Scientists
9
In the scientific paradigm (biomedical model):
Life is controlled by a series of physical and biochemical
processes, which can be studied and manipulated by humans.
Determinism (cause and effect for natural phenomena).

Mechanism (control life processes through mechanical, genetic,
and engineered processes).
Reductionism (all life reduced to smaller parts).
Objective materialism (what is real can be observed/measured).
Example: most Western cultures
10
In the holistic paradigm:
The forces of nature itself must be kept in natural balance or
harmony.
Everything in the universe has a place and a role to perform.
Disturbing natural laws create imbalance, chaos, and disease.
Examples: yin/yang, hot/cold
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Question #2
Asians and Native American Indians should be assessed for
holistic health beliefs.

12
True
Rationale: The holistic paradigm has existed for centuries in
many parts of the world, particularly in Native American Indian
cultures and Asian cultures.
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Health and Illness Behaviors #1
Health behavior (prevention/early detection)
Illness behavior (illness/remedy)
Sick role behavior (illness/coping)
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Health and Illness Behaviors #2
Influencing factors:
One’s beliefs
Personal factors
Cues to action

15
Types of Healing Systems #1
The term healing system refers to the sciences, arts, and
techniques of restoring and preserving health that are used by
any cultural group.
Example: utilizing health care practitioners along with healers,
religious figures, etc.
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Self-care
Professional care systems
Folk healing system
Complementary, integrative, and alternative health systems
(CIH)
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Complementary Health Approaches/CIH:
Traditional alternative medicine beliefs
Natural products and senses
Mind and body practices

Manipulative and body-based methods
Energy therapies
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Question #3
What is the focus of allopathic or biomedicine?
Replacing conventional medicine
Adding to conventional medicine
Killing bacteria and suppressing symptoms
Healing with naturally occurring substances
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C. Killing bacteria and suppressing symptoms
Rationale: Allopathic medicine is the practice most physicians
and nurses are educated in. Life is controlled by a series of
physical and biochemical processes that can be studied and
manipulated by humans through allopathic medicine or
professional care systems.
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Cultural Competence in Health History and Physical Exam

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