Environmental Control and Cultural Health Beliefs
Environmental Control
Definition: Environmental control is about an individual's or cultural group's ability to plan activities to control nature. It also covers what an individual thinks about their ability to influence environmental factors.
Scope of Environment: "Environment" isn't just a physical place; it includes all systems and processes that affect individuals.
Systems: Organized structures that both influence and are influenced by individuals.
Processes: Organized, goal-oriented patterns of operation, including dynamics and interactions among families, groups, and the community.
Reciprocal Relationship: People and their environment constantly exchange matter and energy.
Functional/Useful: When this exchange has a purpose and a goal.
Dyssynchronous: When the exchange lacks purpose or direction.
Health and Balance: Health, in a broad sense, is a balance between the individual and their environment.
Positive Effects: Things like eating healthy, using preventive health services, and setting up pollution-control devices positively affect individuals, who can then positively affect the environment.
Illness Perception: We can ask: Is illness caused by nature? Or is it a perception of human weakness?
Health Beliefs and Practices
Matching terms with descriptions:
Can be defined as an individual’s perception of being sick.
Illness
Is diagnosed when the condition is a deviation from clearly established norms based on Western biomedical science.
Disease
Is defined as the social and biological activities of an individual that are based on maintaining an acceptable health status or manipulating and altering an unacceptable condition.
Health care behavior
Is defined as the success with which an individual adapts to the internal and external environment.
Health
Refers to the ability of an individual or persons from a cultural group to plan activities that control nature and direct environmental factors.
Environmental control
A balance between the individual and the environment.
Health status
Biological concerns and the treatment of disease.
Biomedical model of health care
Folk beliefs, traditional practices, and popular beliefs that diverge from medical science.
Traditional model of health care
Cultural Variation: Health beliefs and practices differ a lot among and within cultural groups, varying due to ethnic background, social class, and even family.
Biomedical Model: This is the most common approach in modern Western society.
Emphasis: It focuses on biological issues, seeing them as more "real" or important than psychological or sociological problems.
Practitioner Focus: Doctors are mainly interested in body system abnormalities and disease treatment.
Characteristics: It's specific to Western culture, culture-bound, and value-laden.
Traditional Model: This is basically the opposite of the biomedical model.
Emphasis: It supports popular beliefs and practices different from medical science, shaped by culture.
Variety: Includes folk beliefs and other traditional beliefs.
Distinction Between Illness and Disease
Emerging Distinction: Recently, scientists and anthropologists started differentiating between "illness" and "disease."
Illness: This is an individual's personal feeling of being sick.
Cultural Shaping: How it's perceived and dealt with depends on an individual's cultural understanding of sickness (Kleinman et al., ).
Occurrence: Someone can feel ill even without having a disease; about of doctor visits are for complaints without a clear biomedical cause.
Disease: This is a condition diagnosed as different from standard norms based on Western biomedical science.
Description: It's described in medical-surgical nursing textbooks.
Nursing Implications: Nurses need to consider clients' personal and cultural reactions to illness, disease, and discomfort to provide appropriate care.
Cultural Influence: Culture deeply affects how we expect and perceive sickness, influencing how, when, and to whom health problems are discussed.
Health Care Behavior: These are social and biological activities done to maintain an acceptable health status or to change an unacceptable one.
Health Status: This refers to how well an individual adapts to their internal and external environment.
Interrelationship: Health care behavior affects health status, and health status, in turn, affects health care behavior (they influence each other).
Sociocultural Influences: Both health care behavior and health status are impacted by things like economics, politics, environmental factors, and the healthcare system.
Cultural Health Practices
Categorization: Cultural health practices are grouped based on how effective they're thought to be:
Efficacious: These are beneficial for health according to Western medical standards, even if they differ from modern science.
Nursing Role: Nurses should encourage these practices and combine them with scientific care, since treatment aligned with client beliefs is more likely to work.
Neutral: These practices have no effect on health status.
Nursing Role: Even if they don't impact physical health, nurses must understand their importance and respect a client's right to practice them, as they are often tied to deep-seated beliefs.
Dysfunctional: These practices are harmful to health.
Nursing Role: Nurses need to identify these harmful practices and work to create educational programs to help people replace them with beneficial ones.
Uncertain: These are practices with unknown effects (Williams, Baumslag, & Jelliffe, ).
Examples: Swaddling a newborn for warmth, using an abdominal binder for a mother and infant to prevent umbilical hernias.
Evaluation (Greene, ): Health practices are subjectively judged as more or less beneficial or harmful when compared to other options.
Values and Their Relationship to Health Care Practices
Values: These are personal rules people live by, forming the basis for beliefs, attitudes, and behaviors.
Cultural Values: Often learned without realizing it during development, making them hard to change because they're unconscious. They strongly influence individuals.
Value Orientations: These are patterned principles that give structure and direction to human actions and thoughts regarding common human problems.
Temporal Orientation: How cultural groups view and divide time.
Activity Orientation: Whether a culture focuses on "doing" (accomplishment) or "being" (who one is).
Relational Orientation: How people in a culture set goals for individuals.
Modes: Lineal (hierarchical, continuity), Individualistic (personal goals), Collateral (group goals).
People-To-Nature Orientation: How people relate to nature: dominating it, living in harmony with it, or being controlled by it.
Innate Human Nature Orientation: Classifies human nature as good, evil, or neutral.
Locus-of-Control Construct as a Health Care Value
Origin: From social learning theory.
Definition: Describes what an individual believes causes events in their life.
External Control: People think that outcomes don't fully depend on their actions, attributing them to luck, chance, fate, control by powerful others, or unpredictable forces.
Characteristic: Individuals see the future as a result of external factors and are less likely to act to change it.
Health Implications: Often linked to a fatalistic view of nature, health, illness, death, and disease.
Internal Control: Events are believed to depend on one's own behavior or lasting personal traits.
Characteristic: Individuals believe their actions and outcomes are connected, leading to feelings of control and actions to influence future situations.
Applicability: This applies to various things like weather, preventive health, curative health actions, and feelings of well-being.
Malleability (Rotter, ): Locus of control isn't a fixed trait; it can be changed through interactions with others.
Nursing Implications (Giger, Davidhizar, & Turner, ): This concept is helpful for understanding people from different cultural backgrounds.
Nurses can help clients with an external locus of control change behaviors by showing how actions affect health, encouraging them to develop an internal locus of control.
People to Nature Orientation: Modes of Interaction
Domination over Nature: This is typical of Western medicine, where humans try to control natural and environmental processes.
Harmony with Nature: Often found in folk medicine, this suggests living in balance with natural forces.
Controlled by Nature: A fatalistic belief that individuals are powerless against natural events and forces.
Folk Medicine
Description: Often called "Third World beliefs and practices," these can seem "strange" or "weird" to healthcare professionals who aren't familiar with them.
Familiarity: They seem less strange or weird once you become familiar with them.
Nurse's Role: It's important for nurses to tell the difference between familiar practices and desirable ones; familiarity doesn't mean acceptance.
Worldview: A person's worldview largely determines their beliefs about disease and the right way to treat it.
Folk Medicine Belief System: This system categorizes illnesses as either natural or unnatural.
Natural Events: These relate to the world as God created it and intended it to be.
Natural Illnesses: Occur due to dangerous agents like cold air, or impurities in air, food, or water. This is based on the idea that everything in nature is connected, and events can be understood and directed through these relationships.
Unnatural Events: These are seen as divine punishment.
Unnatural Illnesses: Believed to happen because someone has sinned badly, causing God to withdraw favor, or as punishment for not following God's rules.
Comparison of the Folk Medicine System and Other Medical Systems
Universal Goal: Every medical system aims for human survival.
Social Systems (Weaver): Both folk and Western medical practices are social systems with interconnected parts (beliefs, attitudes, practices, roles related to health/disease, diagnostic/treatment patterns).
Adaptive Nature: All medical systems adapt over time.
Medical System Definition: A medical system is a pattern of cultural tradition and social institutions that develops from intentional behavior to improve health status, no matter the outcome.
Components of a Medical System: This includes a philosophy of disease, defined health roles, specific practitioners (like medical societies or people who deal with supernatural forces), using body parts or waste for diagnosis, and prescribed medicine applications.
Systems for Comparison:
Ecological Model: This is closely related to folk medicine.
Foci: Biological (relationship between organism and environment), Social (relationship between people and institutions), Cultural (relationship between culture and environment, including societies).
Nursing Utility: Helps explain how individuals get and prevent diseases.
Western Medical System: This contrasts with folk medicine by focusing on scientific explanations for illness and using preventive/curative medicine.
Alternative Therapies: These address the whole patient, seeing symptoms as signs of deeper issues needing change. The mind and body are viewed as one.
Examples: Acupuncture, holistic healing, therapeutic touch, aromatic therapy, meditation, guided imagery.
Religious Systems: These dictate healthcare behaviors, including giving/receiving care, and social, moral, and dietary practices for maintaining health balance and preventing illness.
Healing Power: Can come from spiritual leaders, visions, miracle cures, and animate/inanimate objects.
Shaman vs. Priest: A shaman gets power from the supernatural; a priest learns established rituals from other priests and biblical laws.
Rituals: Important religious rituals in traditional folk medicine act as a bridge between the earthly and the spiritual/otherworld.
Death and Dying and End-of-Life Decision-Making Across Cultures
Grieving and Death Rituals: These vary greatly among cultures and are heavily influenced by religion.
Variations: Depend on the country of origin and how much someone has adopted a new culture.
Process Duration/Intensity (Clements et al., ): Based on how the death occurred and the family's cultural beliefs.
US Health Care System Values:
Life is sacred and should be preserved at all costs.
People should be able to make their own decisions.
No one should suffer unnecessarily.
Cultural Variations in Attitudes: Studies show cultural differences in telling the truth, using life-prolonging techniques, and making decisions at the end of life.
Advance Directives: Some cultural groups slowly adopt the idea of autonomy and decision-making in healthcare.
Nursing Role: Nurses must be aware of cultural differences in beliefs about death, dying, advance directives, truth-telling, and autonomy in decision-making.
Homeopathic Care
Holistic View: Views the entire body's impact on the wellness-illness cycle.
Wellness Continuum: Aims to help patients improve their wellness using holistic care principles.
Tradition: Has ancient traditions, and many cultures still hold these beliefs, even in modern societies.
Implications for Nursing Care
Harmony and Balance: No matter the locus of control or chosen medical system, nurses should recognize the safety in harmony and balance and the danger in extremes.
Individual Strengths and Weaknesses: Differences in gender and age are linked to strengths (ability to resist illness) and weaknesses (higher susceptibility).
Natural Phenomena: For cultural groups that believe in a direct body-nature connection, recognizing the importance of perceived natural phenomena (moon phases, planetary positions, seasons) is crucial.
Zodiacal Manipulation: Many use zodiac signs for health regimens but might not mention it due to fear of being judged.
Dreams: Dreams might play a role in health beliefs.
Involving Spiritual Healers: It might be necessary to include spiritual healers and priests in crisis intervention therapy.
Conflicting Medical Systems: The presence of alternative/folk medical systems that clash with Western medicine makes care more complicated.
Deeply Ingrained Beliefs: Clients have strong beliefs about health, possibly linked to natural and supernatural worlds, which affect relationships with doctors and nurses, and how well they follow treatment plans.
Relevance: Standard Western medical approaches might not always seem relevant to diverse populations.
Assessing Home Remedies: Find out what clients are doing to fight illness.
Harmless Remedies: Keep these in the treatment plan and add professional suggestions.
Harmful Practices: Eliminate these by asking if they've worked; if not, suggest alternatives. If they are seen as helpful, educate clients about the dangers.
Nursing Research: Research explores how people and their environments interact.
Gould ( ) Study: Examined elderly nursing home residents, finding that life satisfaction indicated well-being and quality of care. The bond between institutionalized elderly and caregivers seemed to be more important than self-determination, explaining high life satisfaction among lower-income elderly despite feeling they had little influence over their environment.
Health Belief Model
Purpose: This model helps explain and predict health behaviors.
Key Concepts (and how they're applied):
Perceived Susceptibility: A person's opinion about their chances of getting a condition.
Application: Identify populations and risk levels; personalize risk; increase perceived susceptibility if it's too low.
Perceived Severity: A person's opinion of how serious a condition and its outcomes are.
Application: Clearly state the consequences of the risk and the condition.
Perceived Benefits: Belief that the recommended action will effectively reduce risk or seriousness.
Application: Define the action (how, where, when); explain the positive effects.
Perceived Barriers: Opinion of the practical and psychological costs of the recommended action.
Application: Identify and reduce barriers through reassurance, incentives, and assistance.
Cues to Action: Strategies to trigger "readiness."
Application: Provide how-to information, raise awareness, use reminders.
Schematic Diagram for Health Belief Model:
Individual Perceptions: Perceived Susceptibility to Disease "X" and Perceived Severity of Disease "X" combine to form a Perceived Threat of Disease "X."
Modifying Factors: Demographic variables (age, sex, race, ethnicity) and socio-psychological variables influence the perceived threat and the likelihood of action.
Likelihood of Action: Determined by the Perceived benefits of preventative action minus the Perceived barriers to preventative action.
Cues to Action: External stimuli such as mass media campaigns, advice from others, reminder postcards, a family/friend's illness, or newspaper articles, all affect the likelihood of taking the recommended preventative health action.
Barriers to Health Care
The A's Review:
Availability: Whether services are accessible.
Affordability: The cost of services.
Appropriateness: If services are suitable for the need.
Accessibility: How easy it is to reach and use services.
Accountability: The responsibility and transparency of providers.
Adaptability: How well services can adjust to changing needs.
Acceptability: If services are culturally and personally acceptable.
Awareness: Knowledge about available services.
Attitudes: Perceptions of healthcare providers and the system.
Approachability: How easy it is to initiate contact with services.
Alternative Practices: Acknowledging and integrating non-Western medicine.
Additional Services: A full range of support services.