Cultural Competence in the Health History

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.

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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 exam for both well and ill clients.

Question #1

Is the following statement true or false?

Subjective data refers to things that people say or relate about themselves, whereas objective data result from the physical examination and the laboratory findings.

Answer to Question #1

True

Rationale: Subjective data come from the client and is information only they can give and confirm; objective data are observable and confirmed through sources other than the client.

Health History #2

Major data categories to be considered when conducting a culturally competent health history:

1. Biographic data and history

2. Genetic data

3. Review of medications and allergies

4. Reason for seeking care

Health History #3

Major data categories to be considered when conducting a culturally competent health history (cont.):

5. Present health and history of present illness

(culture-bound syndromes)

6. Past health

7. Family and social history

8. Review of systems

Question #2

Is the following statement true or false?

Most cultures recognize the difference between prescribed medications and over-the-counter medications including herbs.

Answer to Question #2

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.

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

Physical Examination #2

Biocultural variations in:

Measurements

Height, body proportions, weight (see Table 3-5)

Vital signs, including pain

General appearance

Physical Examination #3

Skin

Mongolian spots

Vitiligo

Hyperpigmentation

Cyanosis

Jaundice

Pallor

Erythema, petechial, ecchymoses

Addison’s disease, uremia, albinism

Physical Examination #4

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)

Physical Examination #5

Musculoskeletal system

Bone composition

Bone density

Bone curvature

Body composition

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