CHAPTER 7 CULTURAL AND PHARMACOGENETIC CONSIDERAIONS ETHNOPHARMACOLOGY study of drug responses that may be unique to an individual due to social,

, cultural, and biologic phenomena o integrates pharmacokinetics, pharmacodynamics and pharmacogenetics emergence of ethnopharmacology highlights the need for nurses to utilize knowledge from the social sciences as well as the biologic and physical sciences to provide holistic nursing care o nurse must intergrate knowledge of pharmacogenetics within clients and cultural contexts Culture = defined as sets of learned behavior and ideas that human beings acquire as members of a community Community = cluster of individuals who function as a group to attain cultural universals Designed to meet the communitys survival needs and common goals such as the obtainment of food and the continuance of practices that serve to maintain the group. o Term community implies that groups are connected to a particular place but many groups are mobilemigrant workers, etc. Community may be composed of an ethnic group o Difficult to accurately describe the term ethnic group o Ethnocentrism is defined as the widespread human tendency to perceive the ways of doing things in ones own culture as normal and natural and the ways of other cultures as strange, inferior or possibly even unnatural or inhuman

TRANSCULTURAL NURSING Leininger! (OH NO!) o Migration and global movement o Transcultural Nursing Society 1974 Numerous and large cultural groups engage in traditional health practices that may be considered to be medicine o Include use of teas, herbs, spices and special foods as well as homeopathic remedies o Use of these agents can have neutral, beneficial, or deleterious effects on a clients health status Thorough health history must be elicited from the client to determine all different types of remedies use Healers play a large role in the traditional health practices o May combine practical knowledge with rituals and chants that seek to control otherworldly things Cultural groups undergo varying degrees of assimilation o Occurs when less powerful group changes its ways to blend in with the dominant cultural group o Essential to not make generalizations about an individuals beliefs or behaviors based upon apparent ethnicity. o Well-assimilated individuals may be influenced by traditional beliefs and practices Stage for complementary health practices that combine traditional and mainstream health practices Alternative health practices = when a dominant group adopts the health practices of a nondominant group.

THE GIGER AND DAVIDHIZAR TRANSCULTURAL ASSESSMENT MODEL premise is that all cultures have six cultural phenomena: o communication o space

o o o o Communication -

social organization time environmental control biologic variations

necessary for sustaining human life

Language use of languages other than English poses a challenge to work environment nonverbal language has become pivotal in these instances translators should be readily available o miscommunications could be disastrous

Vernacular English adding to the challenge of communication is the pervasive use of words and terms that are popular in particular social or cultural groups o any style of English that varies from standard English o use by clients can lead to misunderstandings

Greetings Space amount of space that surrounds a persons body is an important psychological consideration major challenge in the care of clients is the use of touch and protection of modesty o many cultures have taboos regarding touch o considerations also when the client is of a different gender than the nurse all cultures have prescribed norms for greeting and addressing other persons o not all communication problems are related to language or word choice culturally, need to be aware of cues that may be missed indicating care is needed

Social Organization Time Perception of time is largely shaped by culture o Present-time oriented o Concerned with future Long-term health outcomes rather than immediate effects Movement of time can be perceived as quick or slow groups are organized according to a social order o families are basic social unitsdefinition of this unit varies among different cultures small nuclear families vs. large extended families nursing care can be enhanced by the inclusion of family members all depends on where you are

Environmental Control desire to control nature to facilitate the needs of human beings

o concept of nature is to include otherworldly forces or beings like deities and spirits roles of healers and spiritual advisors may be helpful and comforting IN ADDITION to mainstream health treatments and practices

Biological Variance variety of genetic markers study of pharmacogenetics can pave the way for pharmacotherapy that yields greater therapeutic benefits o approached with caution: certain people may appear a specific way but can have different genetic markers certain classifications of medications have different effects in individuals whose genetic markers are predominantly characteristic o white people are more likely than people of Asian or African people to have abnormally low levels of enzyme that metabolize drugs like antidepressants, antipsychotics and beta-blockers. Differences in structure and physiology may affect responses of certain drugs Intrinsic biological factors must be considered along with extrinsic factors such as: o Diet o Environment o Sociocultural issues