Summary Physical examination and health assessment 7th edition

18 UNIT 1 Assessment of the Whole Person balance.26 Rooted in the ancient Chinese philosophy of Tao, the yin/yang theory states that all organisms and objects in the universe consist of yin and yang energy forces. 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 yin/yang theory is the basis for Eastern or Chinese medicine and is commonly embraced by many Asian Americans. The naturalistic perspective holds that the laws of nature create imbalances, chaos, and disease. People embracing this view use metaphors such as the healing power of nature, and they call the earth “Mother.” For example, from the perspec- tive of the Chinese, illness is not seen as an intruding agent but as a part of the rhythmic course of life and an outward sign of disharmony within. Many Hispanic, Arab, Black, and Asian groups embrace the hot/cold theory of health and illness, an explanatory model with origins in the ancient Greek humoral theory. 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 treat- ment 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 clas- sified as hot or cold according to their perceived effects on the body, not on their physical characteristics. Illnesses believed to be caused by cold entering the body include earache, chest cramps, paralysis, gastrointestinal discomfort, rheumatism, and tuberculosis. Among illnesses believed to be caused by overheating are abscessed teeth, sore throats, rashes, and kidney disorders. According to the hot/cold theory, the person is whole, not just a particular ailment. Those who embrace the hot/cold theory maintain that health consists of a positive state of total well-being, including physical, psychological, spiritual, and social aspects of the person. Paradoxically the language used to describe this artificial dissection of the body into parts is itself a reflection of the biomedical/scientific perspective, not a naturalistic or holistic one. Magicoreligious The third major way that people explain the causation of Illness is from a magicoreligious perspective. The basic premise is that the world is an arena in which supernatural forces dominate.14 The fate of the world and those in it depends on the action of supernatural forces for good or evil. Examples of magical causes of illness include belief in voodoo or witchcraft among some Blacks and others from circum- Caribbean countries. Faith healing is based on religious beliefs and is most prevalent among certain Christian groups, symptoms or convert mental experiences or states into bodily symptoms (e.g., complain of cardiac symptoms because the center of emotion in the Chinese culture is the heart). For example, you may collect in-depth data about the cardiovas- cular system only to learn later that all diagnostic tests are negative. On further assessment you find that the person has experienced a loss and is grieving (e.g., has experienced the death of a close relative or friend or has been divorced or separated). This is a culturally acceptable somatic expression of emotional disharmony. For patients, symptom labeling and diagnosis depend on the degree of difference between the person’s behaviors and those that the group has defined as normal (e.g., beliefs about the causation of illness, level of stigma attached to a particular set of symptoms, prevalence of the pathologic condition, and the meaning of the illness to the person and his or her family). 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 knowl- edge.22 Many people who maintain traditional beliefs would define Health in terms of balance and a loss of this balance. This understanding includes the balance of mind, body, and spirit in the overall definitions of Health and Illness. Disease causation may be viewed in three major ways: from a biomedical or scientific, a naturalistic or holistic, or a magicoreligious perspective.21 Biomedical The first, called the biomedical or scientific theory of illness causation, assumes that all events in life have a cause and effect, that the human body functions more or less mechani- cally (i.e., the functioning of the human body is analogous to the functioning of an automobile), that all life can be reduced or divided into smaller parts (e.g., the reduction of the human person into body, mind, and spirit), and that all of reality can be observed and measured (e.g., intelligence tests and psycho- metric measures of behavior). Among the biomedical expla- nations for disease is the germ theory, which holds that microorganisms such as bacteria and viruses cause specific disease conditions. Most educational programs for physi- cians, nurses, and other health care providers embrace the biomedical or scientific theories that explain the causes of both physical and psychological illnesses.20 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. Some Asians believe in the yin/yang theory, in which health exists when all aspects of the person are in perfect CHAPTER 2 Cultural Competence 19 come to the United States from every corner of the world, the East and the West. They may be purchased in pharmacies, markets, and natural food stores. Fig. 2-5 illustrates the inte- rior of a botanica, a store in which a person can purchase amulets and remedies used by people from many Latino ethnicities. Others may be objects or substances used exter- nally. Fig. 2-6 presents samples of traditional amulets. The variety of healing beliefs and practices used by the many ethnocultural populations found in this country far exceeds the limitations of this chapter. Fig. 2-7 presents samples of traditional remedies used for recovery. In addition to folk practices, many other complementary healing prac- tices exist. In the United States an estimated 38% of adults use some form of complementary therapy to treat an illness, including acupuncture, Ayurveda, biofeedback, chiropractic or osteopathic manipulation, deep-breathing exercises and guided imagery, diet-based therapies, homeopathy, hypnosis, meditation, Tai-Chi and Yoga, and traditional folk healers.28 Furthermore, U.S. adults spent $33.9 billion out-of-pocket on visits to complementary and alternative medicine practitio- ners, to traditional healers, and for the purchase of related products.2 The availability of over-the-counter medications, the rela- tively 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, especially compared with the inconve- nience associated with traveling to a physician, nurse practi- tioner, or pharmacist, particularly for people from rural or sparsely populated areas. Furthermore, home treatment may mobilize the person’s social support network and provide the sick person with a caring environment in which to convalesce. However, not all home remedies are inexpensive. including Christian Scientists, whereas various healing rituals may be found in other religions such as Roman Catholicism and Mormonism. Traditional Treatments and Folk Healers All cultures have their own preferred lay or popular healers, recognized symptoms of ill health, acceptable sick role behav- ior, and treatments. In addition to seeking help from you as a biomedical/scientific health care provider, patients may also seek help from folk or religious healers. Each culture has its own healers, most of whom speak the person’s native tongue, make house calls, understand the person’s cultural health beliefs, and cost significantly less than practitioners in the biomedical/scientific health care system. Table 2-3 lists exam- ples of traditional Health and Illness beliefs and practices, causes of illness, and examples of traditional healers. In some religions spiritual healers may be found among the ranks of the ordained and official religious hierarchy and may be known by a variety of names such as priest, bishop, elder, deacon, rabbi, brother, and sister. In other religions a separate category of healer may be found (e.g., Christian Science “nurses” [not licensed by states] or practitioners). Spirituality is included in the perceptions of health and illness. Hispanics may rely on curandero(ra), espiritualista (spiritualist), yerbo(ba) (herbalist), partera (lay midwife), or sabedor (healer who manipulates bones and muscles). Blacks may mention having received assistance from a hougan (a voodoo priest or priestess), spiritualist, or “old lady” (an older woman who has successfully raised a family and who special- izes in child care and folk remedies). American Indians may seek assistance from a shaman or medicine (wo)man. Asians may mention that they have visited herbalists, acupuncturists, or bone setters. Among the Amish the term braucher refers to folk healers who use herbs and tonics in the home or com- munity 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 are all carried out. The divi- sion of the person into parts is itself a Western concept. For example, a Hispanic person with a respiratory infection may take the antibiotics prescribed by a physician or nurse prac- titioner and herbal teas recommended by a curandero and may say prayers for healing suggested by a Catholic priest.5 American Indians may frequent sweat lodges or use talking circles and other healing ceremonies such as smudging or ritual purifying with the smoke of sacred herbs.17 Many people from different faith traditions practice prayer or visit healing shrines, as discussed earlier. Amulets are objects such as charms that may be worn on a string or chain around the neck, wrist, or waist to protect the wearer from the “evil eye” or the “evil spirits” that could be transmitted from one person to another or that could have supernatural origins. They may also be hung in the home, car, or workplace. Natural folk medicine uses remedies from the natural environment (i.e., herbs, plants, minerals, and animal substances) to treat illnesses. Amulets and remedies have 2-5 The interior of a botanica. (Spector, 2006.) 20 UNIT 1 Assessment of the Whole Person