nursing 216 final

definition of culture

definition of culture

a pattern of shared attitudes, beliefs, self-definitions, norms, roles, and values shared by a social grouP

attributes of culture

culture is learned

changes and adapts over time

shared beliefs and values about health and illness

health and illness expression

enculturation

learning culture (socialization)

acculturation

acquiring NEW culture

assimilation

giving up parts of culture for a new social group

cultural competence vs. humility vs. sensitivity

competence - ability to care

humility - attitude

sensitivity - awareness

steps of cultural humility

1. reflecting on your own culture

2. lifelong learning

3. addressing power imbalances

othering

making other groups external to us via categorization, identification, and comparison

bias

a tendency to prefer or favor one person or thing to another

bracketing

identify bps - acknowledge bps and consequences - separate and suspend bps from nurse-patient interaction - critically reflect

microaggression accountability

pause the action

assume good intent

explain why the action was paused

have patience but expect progress

systemic privilege

unfair advantage that some people have

systemic discrimination

unfair disadvantage that some people have

social determinants of health

economic stability

neighboorhood and physical environment

education

food

community, safety, and social context

health care system

social identity theory

people’s identity being tied to the social groups they belong to; leads to othering

social identity steps

categorization - identification - comparison

avowed identities

identities we apply to ourselves

sexuality

how we engage and express the interplay of pleasurable physical sensations, mental fantasy, and ways of connecting with other people

scope of sexuality

sexual wellbeing to sexual dysfunction

values

guide the manifestation of sexuality, influenced by culture, determines meaningfulness of sexuality

sensuality

our level of awareness, acceptance, and enjoyment of our own and another’s bodies

intimacy

our ability to express and have a need for closeness with another person

sexual identity

the sense of who one is as a sexual person including gender identity, gender expression, and to whom one is attracted

sexual health and reproduction

the sexual and reproductive biological systems, includes how one care for their body and health (reproductions and family planning, STI’s)

sexualization (power and agency)

the use of power within sexual relations, flirting, media messages, harmful abuses of power (harassment, incest, rape)

biological expression

sex refers to a person’s biological status and is typically categorized as male, female, or intersex. indicators include sex chromosomes, gonas, internal reproductive organs and external genitalia

childhood physical development

few months old babies find their fingers, toes, and genitals

spontaneous erections and vaginal lubrication

childhood common behaviors

curiosity about body and genitals, touching genitals in public and private, establish a sense of gender

childhood encouraging healthy development

masturbation occurs in private, educate on personal rights and responsibilities related to sexuality

preadolescence physical development

9-10 first signs of puberty including breast buds and pubic hair, production of estrogen and testosterone

preadolescence common behaviors

social division into groups based on gender identity, masturbation might begin

preadolescence encouraging healthy development

provide ongoing info on puberty, age-appropriate sexuality information, differentiate media fact and fiction, encourage healthy friendships and relationships

adolescence physical development

primary (reproductive organs) and secondary sex characteristics (pubic hair, widening hips, facial hair) begin to develop

adolescence common behaviors

desire to be independent, express identity, risk taking, decisions about sex and drugs, serious relationships, coming out

adolescence encouraging healthy development

educate on contraceptive and sexually transmitted infection

young adult physical development

complete the process of physical maturation

young adult common behaviors

intimate relationships with long term implications, adult roles and responsibilities, adult relationships with parent, understand abstract concepts and be aware of consequences

young adult encouraging healthy development

complete sexual health assessment, education on prevention of STI and screen for STIs, educate on contraception, sexual lifestyle (not orientation; celibacy, long-term monogamy, polyamory)

adulthood physical development

perimenopause, menopause, decreased hormone production in men

adult common behaviors

engage in sexual activity and sexual reproduction

adult encouraging healthy development

screen for prostate specific antigen (PSA) starting at 50 for males, screen for sexual dysfunction, normalize screenings

older adulthood physical development

changes in sexual response common, and phases of sexual response cycle may take longer in older adults

older adulthood common behaviors

many older adults enjoy sex well into their 80’s, no worry about pregnancy

older adulthood encouraging healthy development

educate about increased treatment options for sexual dysfunction

Problematic alterations

anything that prevents a person from engaging in sexual well-being

Desire disorders

low libido

Arousal disorders

erectile dysfunction

Orgasm disorders

premature orgasm, delayed orgasm, absent orgasm

Pain disorders

vaginal dryness, penetration pain disorder

Assessment: tips

Normalize your conversation, open-ended and nonjudgmental questions, no assumptions

risk factors for suboptimal sexuality

Medical illness, medications, mental health, hormones

Groups placed at risk for suboptimal sexuality

older adults, people with disabilities, sexual minorities

primary health promotion

stop smoking or don’t start

get regular exercise, including aerobic exercise

maintain a healthy weight

eat a well-balanced diet

limit alcohol intake to a max of two drinks per day

don’t use illegal drugs

controlling condition for those with chronic diseases to improve overall health

supporting sexual well-being in members of LGBTQ+ community

normalize conversations about sexual behavior

screen for STIs

provide LGBTQ+ inclusive sexual education

supporting sexual well-being of elders

initiate conversations about sexual well-being

sex is still a meaningful part of an elder’s life

provide education about screening and preventing STIs

make space for and normalize sex in elders

groups placed at risk of STIs

young age (15-24 years old)

men who have sex with men (MSM)

history of a prior STI

HIV-positive status

pregnant females

admission to correctional facility or juvenile detention center

illicit drug use

Risky sexual behaviors

new sex partner in past 60 days

multiple sex partners or sex partner with multiple concurrent sex partners

sex with sex partners recently treated for an STI

no or inconsistent condom use outside a mutually monogamous sexual partnership

trading sex for money or drugs

sexual contact (oral, anal, penile, or vaginal) with sex workers

meeting anonymous partners on the internet

Assessment should include

normalize and “opt-out” screening saying that it is a part of our routine regardless of sexual activity, testing should include all “sites” of sexual activity

5 P’s approach

partners, practices, protection from STIs, past history of STI, pregnancy intention

safer sex / lower risk of STI’s

avoid using alcohol and drugs before and during sexual intercourse, learn the common STI/STD symptoms and performs monthly genital self-exams, have regular medical checkups, stay healthy, get tested, limit your number of sexual partners, know yourself and what you want in a relationship, learn how to communicate with your partner about safer sex issues, use barrier methods to protect against unwanted pregnancy

family planning

the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births, including the option to not have children

Types of contraceptives

the pill: oral contraceptives; birth control pills

the shot: Depo-Provera

the implant: Nexplanon, formerly Implanon

the IUD: Mirena, Skyla, Liletta

the patch: Xulane / twirla, formerly ortho Evra

the Ring: nuva ring

emergency contraception: EC

combined hormonal contraception

estrogen and progestin

mechanism of action: prevents pregnancy mainly by stopping ovulation by regulating hormones

primary symptom target: prevents pregnancy, may make periods more regular, lighter, and shorter, and reduce menstrual cramps

monitor blood clots, STI’s, nausea, breast tenderness, mood changes, abnormal vaginal bleeding

med class: Progesterone (only) hormonal contraception

used for post-partum women who are breastfeeding

progestin

mechanism of action: prevent pregnancy mainly by stopping ovulation by regulating hormones

primary symptom target: prevent pregnancy, may make periods more regular, lighter, and shorter, reduce menstrual cramps

blood clots, STI’s, compliance ineffectiveness, abnormal vaginal bleeding

puberty

the period in which adolescents start to develop secondary sexual characteristics, triggered by sex hormones (testosterone and estrogen)

menstrual cycle

4 stages, average length 28 days but varies

Stage 1

menstruation, lasts 4 day, breakdown of uterine lining

Stage 2

lasts around 10 days, prepare uterine lining for fertilized egg, building up of lining, increase in estrogen

Stage 3

ovulation, lasts one day

Stage 4

lasts around 14 days, maintaining of the uterine lining, if not fertilized egg back to stage 1, decrease in estrogen, increase in progesterone (drop restarts the cycle)

Follicle stimulating hormone (FSH)

stimulates egg to mature in the ovaries by stimulating ovaries to produce estrogen, as estrogen levels increase, they inhibit FSH (negative feedback)

Luteinizing hormone (LH)

stimulates egg to release on day 14 (ovulation) by increase in estrogen levels

Progesterone

inhibits both LH and FSH

Contraceptives

any artificial method people use to prevent pregnancy

How pregnancy starts

ovulation = release of egg, travels fallopian tube, meets sperm and fertilizes, implants into the uterine wall

contraception has to interrupt this process in order to prevent pregnancy

Hormonal methods of contraception

rely on producing estrogen, progesterone, or some combo of the two

estrogen

inhibits FSH production which stimulates egg production and release

progesterone

stimulates the production of thick mucus in the cervix, which prevents the sperm from ever reaching the egg

combined oral contraceptive pill

most common and over 99% effective with correct usage

side effects include headaches and nauses

progesterone only pill

just as effective as combined pill, tends to have fewer side effects

contraceptive patch

slowly releases estrogen and progesterone, each patch lasts one week

Contraceptive injection

injection of progesterone into the upper arm, each dose lasts 2-3 months

Contraceptive implant

small device placed under the skin of the arm, slowly releases progesterone for up to 3 years

Intrauterine device (IUD)

placed inside the uterus, can last over 3 years

plastic version releases progesterone

copper version (no hormones) prevents sperm from surviving in the uterus by killing them

Non-hormonal methods

prevent the sperm from meeting the egg

Diaphragm

plastic cup that fits over the cervix and blocks sperm from entering the uterus, not very reliable and has to be used with spermicide

Spermicide

only reliable 7/10 times when used alone

Sterilization

tying tubes (permanent), vasectomy (reversible

Natural methods

calendar method, pull out method, both unreliable

Abstinence

most effective