Jarvis physical examination and health assessment pdf free download

A clear, conversational writing style makes learning easier. A two-column format distinguishes normal findings from abnormal findings, and uses color, step-by-step photos to clarify examination techniques and expected findings. Over 1, full-color illustrations present anatomy and physiology, examination techniques, and abnormal findings. Developmental considerations help in caring for patients across the lifespan with age-specific assessment techniques for infants, children, adolescents, pregnant females, and older adults.

Abnormal findings tables include over pathology photos to help in recognizing, sorting, and describing abnormalities. Promoting a Healthy Lifestyle boxes enable patient teaching and health promotion while performing the health assessment.

An emphasis on cultural competencies reflects today's care considerations for an increasingly diverse patient population. Documentation examples show how to record assessment findings in the patient's chart, using the SOAP format.

Summary checklists provide a quick review of examination steps. Spanish-language translations on the inside back cover highlight important phrases for better communication during the physical examination. A companion Evolve website helps you review key content offering case studies with critical thinking questions, printable health promotion handouts, a head-to-toe examination video, heart and lung sounds, audio chapter summaries, and more.

NEW evidence-based guidelines reflect a focus on conducting the most effective, qualitative exams. NEW Substance Use Assessment chapter addresses this increasingly critical aspect of holistic patient assessments. Expanded chapter on assessment of the hospitalized adult provides a focused assessment of the patient in the hospital setting. New content on obesity provides current information on this growing health problem.

Pocket Companion for Physical Examination and Health Assessment, Canadian 3rd Edition makes it fast and easy to look up essential assessment skills and techniques. This portable clinical guide helps you conduct more effective exams by referring to summaries of examination steps, normal versus abnormal findings, lifespan and multicultural considerations, and over full-colour photos and illustrations.

Two-column format for examination content makes it easier to access, learn, and understand key physical examination skills and findings. Abnormal findings tables help you to recognize, sort, and describe key abnormal findings. Colour-coded bars visually segment each body system chapter into major sections anatomy, subjective data, objective data, and abnormal findings to promote accessibility to content. More than full-colour illustrations demonstrate examination skills, underlying anatomy and physiology, and normal and abnormal findings to provide you with a complete picture for physical examination.

Content on the Electronic Health Record, charting, and narrative recording provides you with examples of how to document assessment findings. Normal and abnormal examination photos show the nose, mouth, throat, thorax, and pediatric assessment to give you a fresh perspective on key system examinations along with cultural diversity and developmental variations. It can be used as a study guide to reinforce the content of the text and as a clinical tool in the laboratory setting.

A variety of learning activities test your understanding with multiple-choice, short answer, fill-in-the-blank, matching, and review questions.

Clinical objectives for each chapter help you study more efficiently and effectively. Regional write-up sheets familiarize you with physical examination forms and offer practice in recording narrative accounts of patient history and examination findings. Anatomy labeling exercises offer additional practice with identifying key anatomy and physiology.

For example, clinicians should measure the ankle brachial index ABI , as described in Chapter 21 of this text. Evidence is clear about the value of ABI as a screening measure for peripheral artery disease. Despite the advantages to patients who receive care based on EBP, it often takes up to 17 years for research findings to be implemented into practice.

As individuals, nurses lack research skills in evaluating quality of research studies, are isolated from other colleagues knowledgeable in research, and lack confidence to implement change.

Other significant barriers are the organizational characteristics of health care settings. Nurses lack time to go to the library to read research; health care institutions have inadequate library research holdings; and organizational support for EBP is lacking when nurses wish to implement changes in patient care.

Students of medicine and nursing are taught how to filter through the wealth of scientific data and critique the findings. They are learning to discern which interventions would best serve their individual patients. Facilitating support for EBP at the organizational level includes time to go to the library; teaching staff to conduct electronic searches; journal club meetings; establishing nursing research committees; linking staff with university researchers; and ensuring that adequate research journals and preprocessed evidence resources are available in the library.

Collecting Four Types of Patient Data Every examiner needs to establish four different types of databases, depending on the clinical situation: complete, focused or problem-centered, follow-up, and emergency. It describes the current and past health state and forms a baseline against which all future changes can be measured. It yields the first diagnoses.

The complete database often is collected in a primary care setting such as a pediatric or family practice clinic, independent or group private practice, college health service, women's health care agency, visiting nurse agency, or community health agency. When you work in these settings, you are the first health professional to see the patient and have primary responsibility for monitoring the person's health care. Collecting the complete database is an opportunity to build and strengthen your relationship with the patient.

For the well person this database must describe the person's health state; perception of health; strengths or assets such as health maintenance behaviors, individual coping patterns, support systems, and current developmental tasks; and any risk factors or lifestyle changes. For the ill person the database also includes a description of the person's health problems, perception of illness, and response to the problems.

For well and ill people, the complete database must screen for pathology and determine the ways people respond to that pathology or to any health problem. You must screen for pathology because you are the first, and often the only, health professional to see the patient.

This screening is important to refer the patient to another professional, help the patient make decisions, and perform appropriate treatments. This database also notes the human responses to health problems. This factor is important because it provides additional information about the person that leads to nursing diagnoses. In acute hospital care the complete database is gathered on admission to the hospital.

In the hospital, data related specifically to pathology may be collected by the admitting physician. You collect additional information on the patient's perception of illness, functional ability or patterns of living, activities of daily living, health maintenance behaviors, response to health problems, coping patterns, interaction patterns, spiritual needs, and health goals.

Focused or Problem-Centered Database This is for a limited or short-term problem. It concerns mainly one problem, one cue complex, or one body system. It is used in all settings—hospital, primary care, or long-term care. For example, 2 days after surgery a hospitalized person suddenly has a congested cough, shortness of breath, and fatigue. The history and examination focus primarily on the respiratory and cardiovascular systems. Or in an outpatient clinic a person presents with a rash.

The history follows the direction of this presenting concern such as whether the rash had an acute or chronic onset; was associated with a fever, new food, pet, or medicine; and was localized or generalized. Physical examination must include a clear description of the rash. Follow-Up Database The status of any identified problems should be evaluated at regular and appropriate intervals.

What change has occurred? Is the problem getting better or worse? Which coping strategies are used? This type of database is used in all settings to follow up both short-term and chronic health problems. For example, a patient with heart failure may follow up with his or her primary care practitioner at regular intervals to reevaluate medications, identify changes in symptoms, and discuss coping strategies.

Emergency Database This is an urgent, rapid collection of crucial information and often is compiled concurrently with lifesaving measures.

Diagnosis must be swift and sure. For example, a person is brought into an ED with suspected substance overdose. Clearly the emergency database requires more rapid collection of data than the episodic database. Once the person has been stabilized, a complete database can be compiled. An emergency database may be compiled by questioning the patient, or if the patient is unresponsive, health care providers may need to rely on family and friends. A clear definition of health is important because this determines which assessment data should be collected.

In general the list of data that must be collected has lengthened as our concept of health has broadened. Consideration of the whole person is the essence of holistic health. Holistic health views the mind, body, and spirit as interdependent and functioning as a whole within the environment. Health depends on all these factors working together. The basis of disease is multifaceted, originating from both within the person and from the external environment. Thus the treatment of disease requires the services of numerous providers.

Nursing includes many aspects of the holistic model i. Both the individual human and the external environment are open systems, dynamic and continually changing and adapting to one another.

Each person is responsible for his or her own personal health state and is an active participant in health care. Health promotion and disease prevention form the core of nursing practice. In a holistic model, assessment factors are expanded to include such things as lifestyle behaviors, culture and values, family and social roles, self-care behaviors, job-related stress, developmental tasks, and failures and frustrations of life.

All are significant to health. Health promotion and disease prevention now round out our concept of health. Guidelines to prevention emphasize the link between health and personal behavior. The report of the U. Preventive Services Task Force23 asserts that the great majority of deaths among Americans younger than 65 years are preventable.

Prevention can be achieved through counseling from primary care providers designed to change people's unhealthy behaviors related to smoking, alcohol and other drug use, lack of exercise, poor nutrition, injuries, and sexually transmitted infections.

In this model the focus of the health professional is on teaching and helping the consumer choose a healthier lifestyle. The frequency interval of assessment varies with the person's illness and wellness needs. Most ill people seek care because of pain or some abnormal signs and symptoms they have noticed, which prompts an assessment i. In addition, risk assessment and preventive services can be delivered once the presenting concerns are addressed.

Interdisciplinary collaboration is an integral part of patient care Fig. Providers, nurses, dietitians, therapists and other health professionals must work together to care for increasingly complex patients. For the well person opinions are inconsistent about assessment intervals.

The term annual checkup is vague. What does it constitute? Is it necessary or cost-effective? How can primary-care clinicians deliver services to people with no signs and symptoms of illness? Periodic health checkups are an excellent opportunity to deliver preventive services and update the complete database. It presents evidence- based recommendations on screening, counseling, and preventive topics and includes clinical considerations for each topic.

These services include screening factors to gather during the history, age-specific items for physical examination and laboratory procedures, counseling topics, and immunizations. This approach moves away from an annual physical ritual and toward varying periodicity based on factors specific to the patient. Health education and counseling are highlighted as the means to deliver health promotion and disease prevention.

For example, the guide to examination for C. Counseling for physical activity and risk prevention e. Depression screening 5. Healthy diet counseling, including lipid disorder screening and obesity screening 6. Chemoprophylaxis to include multivitamin with folic acid females capable of or planning pregnancy. Because she has diabetes, including periodic checks of hemoglobin A1c and a fasting glucose level are important. In addition, you should ask how her pump is functioning and whether she is having any difficulties with blood sugar control.

An introduction to cross- cultural concepts follows in Chapter 2. These concepts are developed throughout the text as they relate to specific chapters. Metaphors such as melting pot, mosaic, and salad bowl have been used to describe the cultural diversity that characterizes the United States. The United States is becoming a majority-minority nation.

Although non-Hispanic whites will remain the largest single group, they will no longer constitute a numeric majority. Emerging minority is a term that has been used to classify the populations, including African Americans, Latinos, and Asian Americans, that are rapidly becoming a combined numeric majority. The Latino and Asian populations are projected to nearly double by , and all other racial groups are expected to increase as well. In the U. Census Bureau anticipates that there will be more people over the age of 65 years than under the age of 18 years for the first time in history.

Medical and nursing teams volunteer to provide free medical and surgical care in developing countries Fig. International interchanges are increasing among health care providers, making attention to the cultural aspects of health and illness an even greater priority. During your professional career you may be expected to assess short-term foreign visitors who travel for treatments, international university faculty, students from abroad studying in U.

A serious conceptual problem exists in that nurses and physicians are expected to know, understand, and meet the health needs of people from culturally diverse backgrounds with minimal preparation in cultural competence. Culture has been included in each chapter of this book. Understanding the basics of a variety of cultures is important in health assessment. People from varying cultures may interpret symptoms differently; therefore, asking the right questions is imperative for you to gather data that are accurate and meaningful.

It is important to provide culturally relevant health care that incorporates cultural beliefs and practices. Given the multicultural composition of the United States and the projected increase in the. Alfaro-LeFevre R. Critical thinking, clinical reasoning and clinical judgment.

Elsevier: Philadelphia; American Association of Colleges of Nursing. Essentials of baccalaureate education for professional nursing practice. American Nurses Association. Nursing: Scope and standards of practice. Managing clinical knowledge for health care improvements. Yearbook of medical informatics Schattauer: Stuttgart, Germany; Expertise in nursing practice. Springer: New York; Becoming an expert nurse. Am J Nurs. Cochrane Collaboration. Projections of the size and composition of the US population: to Population Estimates and projections.

Croskerry P. From mindless to mindful practice—cognitive bias and clinical decision making. N Engl J Med. Ezzati M, Riboli E. Behavioral and dietary risk factors for noncommunicable diseases. Goroll AH. Toward trusting therapeutic relationships—in favor of the annual physical.

Hanneman SK. Advancing nursing practice with a unit-based clinical expert. Image IN. Harjai PK, Tiwari R. Model of critical diagnostic reasoning: Achieving expert clinician performance. Nurs Educ Perspect. Fostering clinical reasoning in nursing students. Lipscomb M. Exploring evidence-based practice: Debates and challenges in nursing. Routledge: New York; Mackey A, Bassendowski S.

The history of evidence-based practice in nursing education and practice. J Prof Nurs. Listening to bowel sounds: An evidence- based practice project. Massey RL. Return of bowel sounds indicating an end of postoperative ileus: Is it time to cease this long-standing nursing tradition? Medsurg Nurs.

Mehrotra A, Prochazka A. Improving value in health care—against the annual physical. National League for Nursing Accrediting Commission.

Accreditation manual and interpretive guidelines by program type for postsecondary and higher degree programs in nursing. Author: New York; Spector RE. Cultural diversity in health and illness. Pearson: Indianapolis, IN; Published recommendations.

Part of forming trust is listening to each patient's individual needs and establishing an awareness of his or her culture. You must be open to people who are different from you, have a curiosity about people, and work to become culturally competent Fig. A cultural assessment is an integral part of forming a full database of information about each patient.

Serious errors can occur due to lack of cultural competence. If you fail to ask about traditional, herbal, or folk remedies, you may unknowingly give or prescribe a medication that has a significant interaction. For example, ginseng raises the serum digoxin level and can lead to adverse, even fatal, consequences. A key to understanding cultural diversity is self-awareness and knowledge of one's own culture. Your cultural identification might include the subculture of nursing or health care professionals.

You might identify yourself as a Midwesterner, a college student, an athlete, a member of the Polish community, or a Buddhist. These multiple and often changing cultural and subcultural identifications help define you and influence your beliefs about health and illness, coping mechanisms, and wellness behaviors. Developing self-awareness will make you a better health care provider and ensure that you are prepared to care for diverse clients.

Recognizing your own culture, values, and beliefs is an interactive and ongoing process of self-discovery. To understand another person's culture, you must first understand your own culture. Over the course of your professional education, you will study physical examination and health promotion across the life span and learn to conduct numerous assessments such as a health history, a physical examination, a mental health assessment, a domestic violence assessment, a nutritional assessment, and a pain assessment.

However, depending on the cultural and racial background of the person, the data you gather in the assessments may vary. Therefore a cultural assessment must be an integral component of a complete physical and health assessment. Among this emerging majority, the largest ethnic group is Hispanic, who make up The largest racial minority group is African American or black These demographic differences include age, poverty level, and household composition.

The number of relatives living in the household is higher for all racial and ethnic minorities compared to non-Hispanic whites, as is the number of multigenerational families Fig. African Americans, American Indians, and Alaska natives are more likely to have grandparents who are responsible for the care of grandchildren compared with other groups. Asians and non-Hispanic whites have the highest median income, whereas African Americans have the lowest household income followed by Hispanics.

All ethnic and racial minority groups have poverty rates exceeding the national average of Immigration Immigrants are people who are not U. Some new immigrants have minimal understanding of health care resources and how to navigate the health care system.

They may not speak or understand English, and they may not be literate in the language of their country of origin. Therefore it is imperative that health care providers address the needs of this growing population. In the population of the United States included over The number of foreign-born individuals residing in the United States has quadrupled since the s and is expected to almost double by The United States health care system is complex and difficult to navigate for anyone.

Keep in mind, the health care system may be even more difficult for foreign-born individuals with limited English proficiency. Make sure that you identify interpreter needs early and ask the appropriate cultural. Determinants of Health and Health Disparities An individual's health status is influenced by a constellation of factors known as social determinants of health SDOH. The five social determinants of health are interconnected and affect a person's health from preconception to death.

However, evidenced-based research has consistently shown that poverty has the greatest influence on health status. For the past two decades the goals of Healthy People have been to eliminate health disparities. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.

Public health sectors must be encouraged to address the needs for safe and affordable housing; reliable transportation; nutritious food that is accessible to everyone; safe, well-integrated neighborhoods and schools; health care providers that are culturally and linguistically competent; and clean water and air. These people are vulnerable populations and include ethnic and racial minorities, people with disabilities, and the LGBT community.

Health care disparities are measured by comparing the percent of difference from one group to the best group rate for a disease. One study found a year age difference between the longest- and shortest-living groups in the United States.

An estimated Disparities in exposure to environmental contaminants, violence, and substance abuse among some racial and ethnic minorities suggest the need for a major transformation of the neighborhoods and social contexts of people's lives. Although overall quality of health care is improving in the United States, access to care and health disparities are not showing any improvement.

National Cultural and Linguistic Standards Many forms of discrimination based on race or national origin limit the opportunities for people to gain equal access to health care services. Many health and social service programs provide information about their services in English only. Language barriers have a negative impact on the quality of care provided, and those patients with language barriers also have increased risk of noncompliance to treatment regimens.

This set of 15 standards provides a blueprint to improve quality of care and eliminate health disparities for culturally diverse populations. Health disparities affect the health of individuals and communities, making this a major public health concern in the United States.

Linguistic Competence Under the provisions of Title VI of the Civil Rights Act of , when people with LEP seek health care in settings such as hospitals, nursing homes, clinics, daycare centers, and mental health centers, services cannot be denied to them.

English is the predominant language of the United States. Additional time and resources are necessary to adequately care for patients with LEP. The language barrier may lead to a decreased quality of care due to limited understanding of patient needs.

To prevent serious adverse health outcomes for LEP persons, it is imperative that health care professionals communicate effectively and utilize resources such as interpreter services. Chapter 3 describes in more detail how to communicate with people who do not understand English, how to interact with interpreters, and which services are available when no interpreter is available. It is vital that interpreters be present who not only serve to verbally translate the conversation but who can also describe to you the cultural aspects and meanings of the person's situation.

Culture-Related Concepts Culture is a complex phenomenon that includes attitudes, beliefs, self-definitions, norms, roles, and values. It is also a web of communication, and much of culture is transmitted nonverbally through socialization or enculturation Fig. According to the Department of Health and Human Services Office of Minority Health, a person's culture defines health and illness, identifies when treatment is needed and which treatments are acceptable, and informs a person of how symptoms are expressed and which symptoms are important.

Culture has four basic characteristics: 1 learned from birth through the processes of language acquisition and socialization; 2 shared by all members of the same cultural group; 3 adapted to specific conditions related to environmental and technical factors and to the availability of natural resources; and 4 dynamic and ever changing.

Culture is a universal phenomenon, yet the culture that develops in any given society is unique, encompassing all the knowledge, beliefs, customs, and skills acquired by members of that society. However, within cultures some groups of people share different beliefs, values, and attitudes.

Differences occur because of ethnicity, religion, education, occupation, age, and gender. When such groups function within a large culture, they are referred to as subcultural groups. Many people think about race and ethnicity as a part of the concept of culture. Race reflects self- identification and is typically a social construct referring to a group of people who share similar physical characteristics.

The U. A growing number of respondents are identifying as more than one race, especially those in younger generations. An additional question asks respondents to identify whether they are of Hispanic origin. People who self-identify as Hispanic can be of any racial category. For example, Dominicans typically identify as black Hispanics, whereas people from Argentina identify as white Hispanics.

Because the terms race and origin cause confusion, the U. Census Bureau is considering changing the race and origin questions so that people can select all that apply, with racial categories and Hispanic origin combined in the same question.

Throughout the text, information on disease prevalence related to race is presented in the culture and genetics section of each chapter. As we learn more about the human genome, we may find that genetic variations become more important than overarching racial classifications. Ethnicity refers to a social group that may possess shared traits, such as a common geographic origin, migratory status, religion, language, values, traditions or symbols, and food preferences.

The ethnic group may have a loose group identity with few or no cultural traditions in common or a coherent subculture with a shared language and body of tradition.

Similarly ethnic identity is one's self-identification with a particular ethnic group. This identity may be strongly adherent to one's country of origin or background or weakly identified. Acculturation is the process of adopting the culture and behavior of the majority culture. During the late s and early part of the s when the United States experienced its greatest period of immigration, the expectation was that immigrants would take on the characteristics of the dominant culture, known as assimilation.

Immigrants were discouraged from having a unique ethnic identity in favor of the nationalist identity. The recent wave of immigrants in the latter part of the 20th century has developed different strategies of acculturation. Rather than solely relying on assimilation, new immigrants developed new means of forging identities between the countries of origin and their host country, such as.

However, biculturalism and integration are bidirectional and bidimensional, inducing reciprocal changes in both cultures and maintaining aspects of the original culture in one's ethnic identity Fig. Those who emigrate to the United States from non-Western countries may find the process of acculturation, whether in schools or society, to be an extremely difficult and painful process.

The losses and changes that occur when adjusting to or integrating a new system of beliefs, routines, and social roles are known as acculturative stress, which has important implications for health and illness. Latinos, acculturation, and acculturative stress: a dimensional concept analysis. Policy Politics Nurs Pract, 8 2 , Religion and Spirituality Other major aspects of culture are religion and spirituality.

Spirituality is a broader term focused on a connection to something larger than oneself and a belief in transcendence. On the other hand, religion refers to an organized system of beliefs concerning the cause, nature, and purpose of the universe, as well as the attendance of regular services. Some people define their spirituality in terms of religion, whereas others identify spirituality outside a formal religion. B, Saint Basil's Cathedral.

C, Thai spirit house. D, Buddhist shrine. C and D, Spector, The Landscape Survey detailed statistics on religion in America. The number of people who say they are not affiliated with any particular faith increased from The number of people affiliated with Christian denominations fell from The percentage of people who affiliate with a Christian faith has dropped, but American Christians are becoming increasingly diverse. In times of crisis such as serious illness and impending death, spirituality may be a source of consolation for the person and his or her family.

Religious dogma and spiritual leaders may exert considerable influence on the person's decision making concerning acceptable medical and surgical treatment such as vaccinations, choice of healer s , and other aspects of the illness. Completion of a spiritual assessment is one component of a holistic patient assessment. Understanding a patient's spirituality can improve understanding of coping mechanisms, identify referral needs such as visits by a chaplain, identify social support after discharge, and open discussions about medical care e.

Failure to assess spiritual needs has. Health-Related Beliefs and Practices Healing and Culture HEALTH is defined as the balance of the person, both within one's being physical, mental, or spiritual and in the outside world natural, communal, or metaphysical. It is a complex, interrelated phenomenon. Before determining whether cultural practices are helpful, harmful, or neutral, you must first understand the logic of the traditional belief systems coming from a person's culture and then grasp the nature and meaning of the health practice from the person's cultural perspective.

Wide cultural variation exists in the manner in which certain symptoms and disease conditions are perceived, diagnosed, labeled, and treated. Beliefs About Causes of Illness Throughout history people have tried to understand the cause of illness and disease. Theories of causation have been formulated on the basis of ethnic identity, religious beliefs, social class, philosophic perspectives, and level of knowledge.

Disease causation may be viewed in three major ways: from a biomedical or scientific perspective, a naturalistic or holistic perspective, or a magicoreligious perspective. Biomedical The biomedical or scientific theory of illness causation assumes that all events in life have a cause and effect.

Among the biomedical explanations for disease is the germ theory, which holds that microorganisms such as bacteria and viruses cause specific disease conditions.

Most educational programs for physicians, nurses, and other health care providers embrace the biomedical or scientific theories that explain the causes of both physical and psychological illnesses. Naturalistic The second way in which people explain the cause of illness is from the naturalistic or holistic perspective, found most frequently among American Indians, Asians, and others who believe that human life is only one aspect of nature and a part of the general order of the cosmos.

These people believe that the forces of nature must be kept in natural balance or harmony. The seat of the energy forces is within the autonomic nervous system, where balance between the opposing forces is maintained during health. Yin energy represents the female and negative forces such as emptiness, darkness, and cold, whereas yang forces are male and positive, emitting warmth and fullness.

Foods are classified as hot and cold in this theory and are transformed into yin and yang energy when metabolized by the body.

Yin foods are cold, and yang foods are hot. Cold foods are eaten with a hot illness, and hot foods are eaten with a cold illness. The four humors of the body —blood, phlegm, black bile, and yellow bile—regulate basic bodily functions and are described in terms of temperature, dryness, and moisture.

The treatment of disease consists of adding or subtracting cold, heat, dryness, or wetness to restore the balance of the humors. Beverages, foods, herbs, medicines, and diseases are classified as hot or cold according to their perceived effects on the body, not on their physical characteristics.

Clinical case study: Y. You notice that she has not been drinking, refused her shower, and that her family has been providing much of the baby's care. In an effort to promote healing, you encourage her to go for a walk, provide fresh ice water, and talk to her about the importance of bonding. You are concerned for Y. You: I'm worried about Y. She isn't caring for her baby or herself, won't drink her water, and barely gets out of bed.

Have you asked her about her beliefs? Colleague: We have pretty rigid standards of treatment in Western medicine, but we need to respect the beliefs of our patients. You should talk to her about her beliefs and any postpartum rituals we can support. The basic premise is that the world is an arena in which supernatural forces dominate.

Examples of magical causes of illness include beliefs in voodoo or witchcraft, whereas faith healing is based on religious beliefs. Traditional Treatments and Folk Healers All cultures have their own preferred lay or popular healers, recognized symptoms of ill health, acceptable sick role behavior, and treatments. In some religions, spiritual healers may be found among the ranks of the ordained and official religious hierarchy.

Spirituality is included in the perceptions of health and illness. US DoD, Hispanics may rely on curandero ra , espiritualista spiritualist , yerbo ba herbalist , or partera lay midwife. American Indians may seek assistance from a shaman or a medicine man or woman. Asians may mention that they have visited herbalists, acupuncturists, or bonesetters. Among the Amish the term braucher refers to folk healers who use herbs and tonics in the home or community context.

Brauche, a folk healing art, refers to sympathy curing, which is sometimes called powwowing in English. Many cultures believe that the cure is incomplete unless healing of body, mind, and spirit is carried out. The division of the person into parts is itself a Western concept. If your patient refers to a lay healer that you are unfamiliar with or a practice you do not understand, ask for clarification.

Be careful not to ask in a judgmental way that makes the person feel attacked for seeking help outside the medical community e. Instead ask in a way that communicates acceptance of their beliefs and allows for open communication e.

The variety of healing beliefs and practices used by the many ethnocultural populations found in the United States far exceeds the limitations of this chapter.

In addition to folk practices, many other complementary healing practices exist. A, The glass blue eye from Turkey seen here is an example of an amulet that may be hung in the home. B, A seed with a red string may be placed on the crib of a baby of Mexican heritage. C, These bangles may be worn for protection by a person of Caribbean heritage. D, This small packet is placed on a crib or in the room of a baby of Japanese heritage. The availability of over-the-counter medications, the relatively high literacy level of Americans, the growing availability of herbal remedies, and the influence of the Internet and mass media in communicating health-related information to the general population have contributed to the high percentage of cases of self-treatment.

Home treatments are attractive for their accessibility,. Furthermore, home treatment may mobilize the person's social support network and provide the sick person with a caring environment in which to convalesce. Acupuncture, acupressure, therapeutic touch, massage, therapeutic use of music, biofeedback, relaxation techniques, meditation, hypnosis, distraction, imagery, iridology, reflexology, and herbal remedies are examples of interventions that people may use either alone or in combination with other treatments.

Many pharmacies and grocery stores routinely carry herbal treatments for a wide variety of common illnesses. The effectiveness of complementary and alternative interventions for specific health problems has been studied see National Center for Complementary and Integrative Health at www. Children and adults have spiritual needs that vary according to the child's developmental level and the religious climate that exists in the family.

Parental perceptions about the illness of the child may be partially influenced by religious beliefs. For example, some parents may believe that a transgression against a religious law is responsible for a congenital anomaly in their offspring. Other parents may delay seeking medical care because they believe that prayer should be tried first.

Certain types of treatment e. Values held by the dominant U. Some cultures have attitudes and specific behaviors for older adults that include humanistic care and identification of family members as care providers. Older immigrants who have made major lifestyle adjustments in their move from their homelands to the United States or from a rural to an urban area or vice versa may not be aware of health care alternatives, preventive programs, health care benefits, and screening programs for which they are eligible.

These people also may be in various stages of culture shock i. Transcultural Expression of Pain To illustrate how symptom expression may reflect the person's cultural background, let us use an extensively studied symptom—pain. Pain is a universally recognized phenomenon, and it is an important aspect of assessment. It is a private, subjective experience that is greatly influenced by cultural heritage. Expectations, manifestations, and management of pain are all embedded in a cultural context.

The definition of pain, like that of health or illness, is culturally determined. The meaning of painful stimuli, the way people define their situations, and the impact of personal experience all help determine the experience of pain. In addition to expecting variations in pain perception and tolerance, you also should expect variations in the expression of pain. User icon An illustration of a person's head and chest. Sign up Log in.

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