Chapter 3: Cultural and Pharmacogenetic Considerations
Downloadable Key Points ETH!PH"#$"C!%!&' Ethnopharmacology is the study of drug responses that may be unique to an individual owing to social, cultural, and biologic phenomena. Pharmacogenetics integrates the study of pharmacokinetics, pharmacodynamics, and variations of the predicted response to a drug due to genetic factors. Culture is defined as sets of learned behavior and ideas that human beings acquire as members of a community. A community is a cluster of individuals who function as a group to attain cultural universals. Cultural universals are designed to meet the communitys survival needs and common goals, such as the obtainment of food and other practices that maintain the group. T#"(C)%T)#"% )#(*& he concept of transcultural nursing was formali!ed by "adeleine #eininger, a nurse anthropologist$ she founded the ranscultural %ursing &ociety in '()*. A challenge for nurses worldwide is the degree of cultural diversity owing to migration and global movement. %umerous cultural groups engage in the use of traditional health practices, which may include use of teas, herbs, spices, and special foods as well as homeopathic remedies, poultices, and ointments. hese practices can have neutral, beneficial, or deleterious effects on a patients health. +ealers play a role in traditional health practices in about ,-. of the population worldwide. raditional healers usually have some practical knowledge of human anatomy and physiology, pharmacology, and pharmaceutical substances. Assimilation occurs when a less powerful group changes its ways to blend in with the dominant cultural group. Acculturation is the process by which a group ad/usts to living within a dominant culture while at the same time maintaining its original identity. Complementary health practices combine traditional beliefs and mainstream health practices. 0hen a dominant group adopts health practices from a nondominant group, they are called alternative health practices. THE &*&E# "D D"+*DH*,"# T#"(C)%T)#"% "((E(($ET $!DE% he ranscultural Assessment "odel, developed by 1iger and 2avidhi!ar in '((,, suggests that all cultures have si3 cultural phenomena4 communication, space, social Copyright 5 6-'7, 6-'6, 6--(, 6--8, 6--9, 6---, '((), '((9 by &aunders, an imprint of Elsevier :nc. 2ownloadable ;ey Points 9<6 organi!ation, time, environmental control, and biological variations. hese cultural phenomena flow from a culturally unique individual. Communication occurs verbally and nonverbally. %urses must be alert to different types of communication styles among patients to provide culturally competent care. he amount of space around a persons body is an important psychological consideration. =amilies are basic social units. he definition of family and the criteria for inclusion varies among individuals and among cultures. %urses and their patients may have different perceptions of time. ime moves slowly for a patient who is an3ious or in pain but moves quickly for a nurse who has a demanding workload. he use of vague terms to denote time may also cause a disparity between nurses and patients perceptions of time. A ma/or aspect of culture is the desire to control nature to facilitate the needs of human beings. he concept of >nature? may include otherworldly forces or beings, such as deities and spirits. :llness may be attributed to cosmic forces and believed to be cured or ameliorated by persons who possess special abilities. hrough the work of the +uman 1enome Pro/ect, an international, collaborative research program, the field of pharmacogenomics is rapidly e3panding. Pharmacogenomics refers to the general study of all the different genes that determine drug behavior. he 1enographic Pro/ect has performed 2%A testing on populations all over the world. =indings reveal that human beings are ((.(. genetically identical$ this implies that there are not multiple races but multiple genotypes. :ntrinsic biologic factors must be considered along with e3trinsic factors such as diet and environmental and sociocultural issues to prescribe effective therapies and provide holistic health care. )#(*& P#!CE(( Assess patients ability to communicate using standard English. 2etermine if the patient participates in traditional health practices and@or complementary or alternative medical practices. #ist patients use of pharmacotherapeutic agents, including prescription medications, over<the<counter medications, herbs, and teas. Ascertain if including a traditional healer would facilitate compliance with prescriptive therapies. :nquire about patients preferences regarding touch, modesty, and personal space. 1auge patients perception of time. Ase appropriate persons as translators when patients use of standard English is limited. Anticipate that therapeutic communication with patient and significant others who use limited standard English will require additional time with each encounter. Provide appropriate spatial configurations for individual patients and members of their social groups when delivering nursing care. :nclude significant members of the social group in planning and implementation of patient care. Becogni!e the need for patients to e3ercise control in their environment. Copyright 5 6-'7, 6-'6, 6--(, 6--8, 6--9, 6---, '((), '((9 by &aunders, an imprint of Elsevier :nc. 2ownloadable ;ey Points 9<9 Anticipate unique responses to drugs based on social, cultural, and biologic influences. Consult with persons knowledgeable about the patients culture and mainstream culture. :ncorporate nonharmful traditional health practices with mainstream prescriptive therapies when appropriate. =acilitate adherence to mainstream prescriptive therapies within patients social and cultural conte3ts. Ase illustrations to e3plain prescriptive therapies. "onitor for patient adherence to prescriptive therapies. Evaluate physical, social, and psychological outcomes of prescriptive therapies. Copyright 5 6-'7, 6-'6, 6--(, 6--8, 6--9, 6---, '((), '((9 by &aunders, an imprint of Elsevier :nc.