Patient assessment in pharmacy practice free pdf download

This theory and its alternatives are discussed in more depth in the following section. In addition, each pharmacist has a culture that is defined by his or her own personal situation. When a pharmacist interacts with someone from a culture with differing beliefs, conflict can result. Because of this potential conflict, it is helpful to explore your own perception, beliefs, and understanding of health and illness that have developed from your cultural background.

Sometimes, this requires significant introspection. The goal of this reflection is to develop cultural competence. Cultural and linguistic competence, as defined by the Office of Minority Health, is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.

To assist with your cultural self-assessment, answer the questions in Box 2. Cause of most illnesses explained by germ theory, stress, or improper diet. Frequently seek healthcare. Use self-help products. Illness is caused by natural e. Mental illness should be able to be controlled by the patient. Health maintaining balance between yin and yang in body and environment. Most physical illness caused by imbalance between yin and yang.

Harmony important to maintain body, mind, and spirit. Good health related to taking care of yourself. Balance between self, society, and universe.

Strong nuclear family rather than extended family. English is dominant language. Frequent eye contact. Frequently use prescription, over-the-counter, and herbal products. Increasing use of self-help products.

Strong bonds with extended family. Strong sense of peoplehood, even if not related. Alert to discrimination. High level of caution and distrust of majority group. Nonverbal behavior is important. Use English or Arabic language. Touch inappropriate between men and women. Use home remedies before seeking healthcare. Frequent use of folk medicine and self-care.

Prayer is common means of prevention and treatment. Strong extended family bonds. Women take care of the sick. Family makes healthcare decisions. Cantonese and Mandarin most common languages. Eye contact avoided with authority figures as sign of respect.

Being on time not valued. Address formally. Keep respectful distance. Silence may be sign of respect.

Family-oriented Japanese is the preferred cultural group; self language but usually able to understand and speak subordinate to English.

Men usual spokesman, Quiet and polite. Little direct eye contact. Women considered subordinate in more Promptness important. Extended families common; two or three generations often live in same household. Patriarchal society— oldest male makes decisions. Commonly seek and use healthcare. May use home remedies, herbalists, and acupuncturists in conjunction with Western medicine or before seeking medical help. Diet major source of promoting health. Western beliefs in health promotion becoming more accepted.

Screening may be inhibited if issues are sensitive. Herbal remedies may be used. Prayer and offerings may be used in conjunction with Western medicine. Western medicine generally accepted. Highly family oriented; may be extended or nuclear family. Father or eldest son spokesman.

Women who are not wage earners more subordinate in decision making. Three major languages: Vietnamese, French, and Chinese. Head may be considered sacred and feet profane. Respect shown by avoiding eye contact.

More distant personal space. Open expression of emotions is in bad taste. Mexican Americans Health is feeling well and being able to maintain roles. Disease based on imbalance between individual and environment. Mostly nuclear families, with extended family and godparents. Puerto Ricans Health is viewed as the absence of mental, spiritual, or physical discomforts. Being underweight or thin is also seen as unhealthy.

Illness might be seen as hereditary, punishment, sin, or the result of evil. Realistic, serene view of life. Some believe destiny or spiritual forces are in control of life situations, health, and even death.

Traditional Cubans think of someone overweight and rosycheeked as being healthy. Nuclear and extended family structure. All decisions conceived around family. Women assume active role in caring for the sick.

May use English or Spanish. Differences in word usage depending on home region. Direct eye contact frequently avoided with authority figures. Silence may indicate lack of agreement. Touch by strangers generally unappreciated. High degree of modesty.

Women may not share information about contraceptive activities. Men disclose feelings less often. Express gratitude by providing goods. Speak and give instructions slowly.

Relativistic view of time; negotiate for time of appointment. Cubans Family Relationships Communication Family oriented. Use Castilian Spanish but speak quickly, shorten words, and incorporate English words. Healthcare and Medication Use Treated with herbal medicine, spiritual practices, and acupuncture.

Other health practices include cupping, coin rubbing, pinching skin, inhaling aromatic oils, herbal teas, or wearing strings. Believe in both Western medicine and folk medicine.

Will seek screening only if emphasized by doctor or nurse. Frequently use herbs, rituals, and religious objects. Multivitamins commonly used. Health screening procedures often avoided, except for children. Home and folk remedies used before or in combination with Western medicine.

Pharmacist has significant role in care-seeking. Seek care first from Western medical facilities; prayer and religious assistance used concurrently. Native Americans Health is a state of harmony with nature and universe. Illness is caused by supernatural forces e. Family Relationships Communication Extended family important; often three family generations in household. Men expected to make decisions and protect family.

Women usually in submissive supportive role. Respect for elderly. Elderly have leadership roles. Did you accept these differences, or did you discount them in favor of your own? Develop a plan for how you will react in the future. Health screening acceptable to most. Herbal medicine often used. Many food prescriptions used as home remedies. Nonverbal communication important.

Seek help from medicine men. Frequently use herbs and rituals. May wear objects to protect against supernatural forces. Religion and medicine intertwined. When working with patients, cultural differences will undoubtedly exist.

You must be sensitive to these differences and be certain that you understand exactly what the patient means—and what the patient thinks you mean. This is an underlying necessity during all patient assessments, no matter 2. Identify and examine your own cultural beliefs. Demonstrate respect for people as unique individuals, with culture as only one factor that contributes to their uniqueness. Respect the unfamiliar. Recognize that some cultural groups have definitions of health and illness, as well as practices that attempt to promote health and to cure illness, that may differ from your own.

Do not expect all members of one cultural group to conduct themselves in exactly the same way. Adapted from Stulc P. The family as bearer of culture. In: Cookfair JN, ed. Nursing Process and Practice in the Community. Louis: Mosby—Year Book, Close contact and touching acceptable. Eye contact expected during conversation. Often follow Western business time. For the purposes of this chapter, however, only the variables that most closely affect the process of patient 2.

How do you define illness? How do you keep yourself healthy? Do you believe in preventive medical practices? If so, which ones e.

What would you consider as a minor, or nonserious, medical problem? Give examples. How do you know when a health problem needs medical attention? Do you diagnose your own health problems?

Do you use over-the-counter medications? If so, which ones, and when? Do you believe in the use of alternative or complementary medicines? Do you believe that others outside the medical professions have the power to heal? Do you consider certain therapies traditional or nontraditional to be unacceptable? If so, which, and why?

Do you make your own health decisions, or do you involve family members in your decision-making process? Adapted from Spector R. Cultural Diversity in Health and Illness. Norwalk: Prentice Hall, The cultural beliefs and behaviors that affect assessment of the patient as well as development of an appropriate and acceptable patient-centered care plan include those involving 1 health beliefs and practices, 2 family relationships, and 3 communication.

Differing Views of Health and Illness The term disease describes an abnormal structure and function of the body that is generally treatable by modern medicine. The term illness, however, describes something less objective. Illness is synonymous with changes in social function and a general state of well-being; in other words, it describes how a person might respond to a disease or to changes in his or her function or well-being.

Healthcare professionals have an exceptional understanding of disease, but the causes of illness are not as well understood. One of the fundamental components of illness is what the patient believes causes disease and illness. Disease causation may be viewed in three ways: 1 biomedical, 2 naturalistic, and 3 magico-religious. For example, bacteria and viruses are responsible for certain infectious diseases, and antibiotics cure the infection. The biomedical theory of disease is also based on the assumptions that the human body is a mechanically functioning machine, that all life can be reduced into smaller parts, and that all reality can be observed and measured.

This approach to health and medical care is commonly embraced by the Western world and is taught in most educational programs for pharmacists and other healthcare workers. Naturalistic Many cultures embrace a more naturalistic or holistic approach to describing the cause of illness. People whose beliefs are congruent with this theory hold that humans are only one part of nature and the general order of the cosmos. The forces of nature—some of which are good and some of which are bad—must be kept in balance or harmony for a person to remain well or healthy.

Yin or female energy represents forces such as darkness, cold, and emptiness, whereas yang or male energy represents forces such as light, warmth, and fullness. Many Asians believe that the balance between yang and yin energies is very important for maintaining good health. Balanced yang and yin ensures peaceful interaction of mind and body and, thus, good health. If this balance is disturbed, then illness or disease results. Yang represents the five visceral organs, or the liver, heart, spleen, lungs, and kidneys.

On the other hand, yin represents the gallbladder, stomach, intestine, bladder, and lymph system. In addition, foods are classified as hot and cold and are transformed into yin and yang energies as they are metabolized in the body.

Yin foods e. The individual as a whole, rather than just a particular disease, is significant. Many Hispanic, African, Asian, and Middle Eastern Americans embrace this theory and believe that health encompasses a state of total wellbeing, including physical, psychological, spiritual, and social aspects of the person.

In this theory, basic bodily functions are described in terms of temperature, dryness, and moisture, and they are regulated by the four humors of the body i. For example, earaches, chest cramps, and gastrointestinal discomfort are believed to be caused by cold entering the body, whereas sore throats and rashes are believed to be caused by the body overheating. According to this theory, treatment of illness includes adding or subtracting cold, heat, dryness, or moisture to restore the balance of the four humors.

Magico-Religious The third major view of health and illness is the magicoreligious perspective. This model is based on the belief that supernatural forces, both good and evil, dominate the world.

These supernatural forces, which cannot be controlled by people, cause certain types of illness, and the fate of the person depends on the action of these forces.

Alternatively, a wicked person can cast an evil spell over a good person, thereby causing illness, injury, or bad luck. Because evil spirits are believed to have stronger powers than good spirits, a great deal of energy and time is spent to rid the evil spirits from the body by offering gifts or performing rituals.

Some African Americans believe in magical causes of illness, such as voodoo or witchcraft, whereas certain Christian religions e. Family Relationships Despite the high divorce rate in the United States, the family remains the basic social unit for most people. A family is defined as a group of individuals living together as one unit. Communication and culture are closely intertwined, especially in the way that feelings are expressed, both verbally and nonverbally.

If you are unaware of cultural differences in communication, you may misinterpret patient information and assess the patient inaccurately.

First, determine how well the patient understands written and spoken English. When the patient does not speak English, a translator or interpreter can be very helpful. Many times, a family member will be expected to serve as an interpreter; however, in some cultures, this may be very challenging and uncomfortable for the family member because of family role conflicts or lack of medical terminology. In addition, the family member may relay messages to both the patient and the pharmacist based on his or her own perception of the situation—or even withhold important information because it may embarrass the patient or the family member.

Because of these possible problems, use of a professionally trained interpreter is recommended. Tips to assist you when working with an interpreter are listed in Box 2. When working with an interpreter, remember to look at and speak directly to the patient, not the interpreter. This is a common error when first working with an interpreter. Even if you and the patient speak the same language, differences in culturally based values and beliefs can still make communication difficult.

Culture-based variations can occur in both verbal e. A hundred years ago, the extended family was a crucial part of traditional American life. Parents, grandparents, and other family members lived together under one roof. In contrast, the contemporary European American family most commonly consists of a parent s — child ren unit such as the nuclear or single-parent families. European American families teach the values of individual freedom and personal independence to children, who are then expected to make their own life decisions in areas such as education and careers.

Most children from European American families are taught to be self-reliant; encouraged to sleep in their own rooms; and expected to learn—and to perform— independent self-care skills, such as eating and dressing, at an early age. In addition, these children are expected to leave home on completion of their education. In contrast, many individuals from other cultural groups not only live with extended families but also base their personal decisions on what is considered to be good for the entire family.

In other words, they value the common good of the family. In fact, the common good of the family often is so important that praise of personal accomplishments may cause embarrassment to some members of these cultural groups. These cultural values are also seen during healthcare decision making.

Whereas European American culture values individual autonomy in making health decisions, family consensus is prevalent in other cultures. Typically, the individual consults with the extended family before seeking healthcare. Additionally, it is not unusual in some cultural groups for family members to accompany the sick person to his or her medical appointments and the pharmacy.

Consequently, any healthcare decisions need to be approved by other family members, especially older members of the immediate family.

Because family roles, relationships, and responsibilities vary from culture to culture, pharmacists must be able to identify key decision makers and caregivers. These may—or may not—be the biological parents, as is typical in European American culture.

Some cultures expect the sick person to be cared for by other family members, whereas European American culture emphasizes self-reliance and self-care even when a person is sick. How will they help the patient? Because some cultures include family members in making healthcare decisions, you should also include other family members in the discussions when interviewing a patient or developing patient-centered care plans. Such acknowledgement and acceptance of diverse family relationships will strengthen the quality of healthcare for members of certain cultures.

For example, bad may have a negative implication in one culture and a positive meaning in another. Some groups also may have common lay terms for specific types of medical problems. These various lay terms will differ between ethnic and cultural groups, so clarify your understanding of the term with the patient. This can be accomplished by asking the patient to describe what they mean by low blood or stating your own understanding of low blood and then asking the patient if that is correct.

Conversational style also varies from culture to culture, from a direct and to-the-point style to a more indirect style, during which the patient may provide information through an abundant amount of words or, possibly, with stories.

A loud voice may mean anger, simple emphasis, or passionate feelings concerning a subject. For example, European Americans tend to talk more directly and loudly, whereas the English speak in more accentuated tones and with a softer voice. The use of silence also may have different meanings.

Explain the purpose of the interaction. Agree on interpretation techniques how to signal pause or when they need to explain something the patient said. When working with nonstaff interpreters, outline importance of accuracy, completeness, impartiality, and confidentiality.

Instruct the interpreter not to insert his or her own interpretations or ideas or to omit any information. Encourage them to ask questions when uncertain. Encourage them to make pertinent comments when they notice a conceptual, cultural, or linguistic misunderstanding. Request interpreter of same gender, if possible, especially when physical examination is involved. Be patient. An interpreted interview may take twice as long as an ordinary interchange.

Place the interpreter slightly to one side and behind the patient, so that it is easy to look directly at the patient when the interpreter is speaking. During the interview, look at and speak directly to the patient rather than the interpreter.

Use the first person when speaking to the patient. Express one concept at a time. Speak in short sentences. Avoid long, involved sentences or discussion involving more than one topic. Use simple language. Avoid technical terminology and professional jargon.

Listen to the patient and watch for nonverbal communication. Periodically, ask the interpreter to restate exactly what he or she told the patient. Be open for comments related to cultural and emotional differences. Culturally competent nursing care. Pharmacists should tailor their conversational style to that of the patient, ask questions to clarify their understanding, and observe for consistency in the conversational style of the patient.

Inconsistent patterns in conversational style may be a symptom of an underlying pathological condition. For example, rapid speech accompanied by restlessness may be displayed in patients suffering from anxiety. Nonverbal Nonverbal messages are considered to be a very critical and complex part of human communication.

Nonverbal communication can range from facial expressions, head movements, hand and arm gestures, physical space, touching, eye contact, and physical postures.

Understanding nonverbal communication is very challenging; however, because of the variations with which human beings express themselves. Understanding the features of nonverbal communication can be a useful tool in cross-cultural communication. Culturally appropriate eye contact will vary from direct to fleeting.

In the European American culture, direct eye contact while you are speaking to a person is considered to be appropriate. In other cultures e. Gestures such as the thumbs-up sign or a shrug can be interpreted as a vulgar gesture in countries such as Iran and Latin America. For example, if you are too close to the patient while talking, he or she may perceive you as being aggressive and be very uncomfortable and untrusting.

On the other hand, the opposite may also be true: If you back away when the patient approaches, you may be perceived as being rude and distant. Keep in mind that the comfortable amount of personal space varies from patient to patient, and adjust the distance between you and the patient accordingly. Different cultural groups also have different norms concerning how and when people should touch each other. Some groups use touch to communicate feelings; others view touch as an invasion of privacy.

In addition, certain parts of the body are considered to be sacred in some cultural groups e. Throughout most of the Middle East and some African culture, the left hand is reserved for bodily hygiene and so the left hand should never be offered to shake hands or accept a gift. In other groups, touch e.

Some other cultures e. As with all specific examples that describe a particular cultural group in this chapter, these should not be considered as rigid characteristics of all individuals in that group.

They are meant to be basic generalizations to provide insight during a particular situation and, thus, to help avoid a misunderstanding. You should recognize, accept, and adapt to differences in verbal and nonverbal communication styles to accurately assess the patient and to maximize the potential for a positive healthcare experience.

Do not assume that a patient will express symptoms or complaints in a way that has the same meaning as that in the dominant American culture. Symptoms are reported and perceived in a variety of ways. For example, Chinese patients somaticize emotional symptoms and may describe complaints associated with the heart because it is the center of emotion rather than tell you they are sad due to the recent death of a family member.

To illustrate the cross-cultural variability of a common and universal symptom, this section describes variations in the expression of pain Table 2. The expression, expectation, and treatment of pain are all shaped through a cultural context and personal history. In addition, cross-cultural research has found that pain is a highly individual experience depending on cultural learning and on the meaning of the situation.

In addition, patients will compare and validate the expression of pain with their social environment i. In addition, nurses who infer greater patient pain tended to report their own experiences as being more painful. This is a critical first step in accurately assessing the patient and in providing patient-centered care. Culturally competent care of patients with acute chest pain. J Am Acad Nurse Pract ;17 9 — This chapter does not include a detailed exploration of all health-related beliefs and characteristics of all cultures, but this section does describe generalizations about the most common cultural groups.

It is important to note that not all members of a culture will share all the preferences, values, beliefs, or traits that are described. Each person within the group has his or her own personal traits and characteristics.

In other words, it is inappropriate to stereotype individuals from a particular cultural group. Before outlining some cultural generalizations see Table 2. Two of these factors are the degree of heritage consistency and generation.

The degree of heritage consistency refers to how closely an individual relates to his or her original heritage.

This factor is closely intertwined with the issue of generation. For example, an individual who immigrated from Cuba to the United States within the last year may closely identify with generalizations about the Cuban culture. In contrast, an individual whose grandparents immigrated to the United States from Cuba may identify more closely with the Anglo American culture. Then again, that same individual may live in a very cloistered environment in South Florida that closely holds to the culture of their native country; in this case, the generation factor would be overshadowed by the high degree of heritage consistency.

In addition, care must be taken in how broadly cultural generalizations are made. This same error can also be made by classifying all individuals from Japan, Vietnam, China, and India as Asian Americans. What do you call it? When did it start?

Why do you think it started when it did? What does your sickness do to you? How does it work? How bad is your sickness? How long do you think it will last? What should be done to get rid of it? How have you treated the illness?

Have you used nonmedical remedies or treatments for your problem? What benefit will you get from the treatment? What are the most important problems your sickness has caused for you? What worries you and frightens you the most about your sickness? How can I be most helpful to you? What is most important for you? Have you seen anyone else about this problem besides a physician? Who advises you about your health? Adapted from Narayan MC. Cultural assessment in home healthcare.

Cross-cultural primary care: a patient-based approach. Ann Intern Med ;— Are you ever short of food or clothing? How do you keep track of appointments? Are you more concerned about how your health affects you right now or how it might affect you in the future? What made you decide to come to this country city, town? When did you come? How have you found life here as compared in your country city, town? What was medical care like there compared to here?

How do you deal with this? Do you have friends or relatives you can call on for help? Who are they? Do they live close to you? Are you very involved in a religious or social group? Do you feel that God or a higher power provides a strong source of support in your life? What language do you speak at home?

Do you ever feel you have difficulty communicating everything you want to say to your doctors or their staff? European Americans Europeans have been immigrating to the United States for more than years and have diverse origins.

Because European i. Thus, some of the basic beliefs regarding health and illness that dominate the American culture are described. Most European Americans view health as something more than just not being ill; they view health as a state of physical and mental well-being.

Special boxes highlight signs and symptoms of diseases, causes of diseases, and drug-induced symptoms of diseases. Tables summarize important information. Online patient assessment video clips use a "head to toe" approach and demonstrate a range of pharmacist-patient encounters. The book covers basic anatomy and physiology, pathology, and system assessment through interview, communication, and some physical exams, to help pharmacists and pharmacy students correlate signs and symptoms of possible diseases.

Part 1 discusses global assessment issues and health-related problems that span many body systems. Part 2 covers head-to-toe assessment of body systems and assessment of special populations.

Each chapter explores pharmacy practice applications, including ambulatory care and special community settings. Case studies in each chapter include interview questions, patient assessment algorithms, sample pharmaceutical care plans, and critical thinking questions.

A companion Website will offer the fully searchable text and head-to-toe patient assessment video clips. To perform their day-to-day duties, pharmacists are best-served using a framework called the patient care process. This framework involves three steps: patient assessment; care plan development and implementation; and monitoring and follow up.

Organized in four parts, this practical book begins with introductory chapters regarding the basics of patient assessment and the patient care process. Part II includes a detailed assessment of common symptoms encountered by pharmacists. Part III discusses assessment of patients with various chronic illnesses. Part IV addresses select specialized topics and assessment considerations.

An invaluable contribution to the literature, Patient Assessment in Clinical Pharmacy: A Comprehensive Guide will be of great benefit to pharmacists, regardless of their practice setting, and to pharmacy students as well. Plus, to meet the needs of today's pharmacist, each chapter explores pharmacy practice applications for ambulatory care and special communities such as pediatric and geriatric settings. We also use third-party cookies that help us analyze and understand how you use this website.

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