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Biological Variations   Biological variations are those diverse manifestations of "normal" that exist between people with respect to, body structure- skin color- other visible physical characteristics- enzymatic and genetic variations- electrocardiographic patterns- susceptibility to disease- nutritional preferences and deficiencies, and - psychological characteristics. While it is accepted that people differ culturally, the biological differences evident among people in various ethnic groups are rarely considered when administering nursing care.  The 'faulty genes' for example; Sickle cell anemia is an inherited disease in which the red blood cells, normally disc-shaped, become crescent shaped. As a result, they function abnormally and cause small blood clots. These clots give rise to recurrent painful episodes called "sickle cell pain crises." The disease is much more common in certain ethnic groups, a health risk associated with black or African-descended populations.  affecting approximately one out of every 500 African Americans. Because people with sickle trait were more likely to survive malaria outbreaks in Africa than those with normal hemoglobin, it is believed that this genetically aberrant hemoglobin evolved as a protection against malaria.  Phenylketonuria (PKU) is a genetic disorder that is characterized by an inability of the body to utilize the essential amino acid, phenylalanine. PKU is a health risk commonly associated with white or Northern European-descent populations. Classic PKU affect about one of every 10,000 to 20,000 Caucasian or Oriental births.  The incidence in African Americans is far less. Tay-Sachs  is a progressive, neurodegenerative disorder caused by an enzymatic deficiency (hexosaminidase A). The classic infantile form is characterized by developmental retardation followed by paralysis, dementia, seizures, and blindness. Death usually occurs by age 4. A heritable metabolic disorder commonly associated with Ashkenazi Jews,Tay-Sachs in Jewish populations (1 in 250 of general population but 1 in 25 Jews). Adults may be healthy carriers but two carriers have 1 in 4 chance of passing to children who then have 3-4 year life span.   The genetic test for cystic fibrosis(CF) accurately predicts the gene for those of European ancestry, but not for Asians or Hispanics. Testing for the CF gene can be done from a small blood sample or from a "cheek swab," which is a brush rubbed against the inside of your cheek to obtain cells for testing. Laboratories generally test for the most common mutations, and most labs test for anywhere from 30 to 100 total mutations. The detection rate depends on the person's ethnic background. In general, the detection rate for the White population is around 90 percent, 97 percent or more for the Ashkenazi population, 57 percent for Hispanics, 75 percent for African-Americans, and 30 percent for Asians. The detection rate differs because CF is more common in certain geographical areas and certain populations of the world. Whites are most often affected, at a rate of about 1 per 3500 births. Incidence is also high for Hispanics, at a rate of 1 per 9500 live births. CF is quite rare in native Asians and Africans (<1 per 15,000 births), but it occurs somewhat more frequently in Asian American or African American populations, reflecting white admixture (National Institutes of Health [NIH] Consensus Statement, 1999). In the US CF occurs in Whites  in 1 per 3500 live births. In blacks, CF occurs in 1 per 17,000 live births. Worldwide incidence varies from 1 per 377 live births in parts of England to 1 per 90,000 Asian live births in Hawaii.   Biological differences between human beings, that is the small gene variations that give people different hair colors, make individuals more prone to certain diseases and determine how people react to drugs, are in most cases, the result of both hereditary factors and the influence of natural and social environments. The degree to which environment or heredity affects any particular trait varies greatly. There is great genetic diversity within all human populations. Unfortunately, biological explanations often underpin racist links between ' race ', biology and illness. It is critical that nurses begin to move away from biological models that use normative data based on Caucasians that may not hold true for members of other ethnic groups. As an example, the Portland Fetal Growth Curves were developed after obtaining fetal growth data from 40,000 singleton, white, middle-class infants born at sea level. Therefore the likelihood of inaccurate assessments of fetal growth, based on these norms, is increased and might possibly lead to a faulty nursing diagnosis. References to and information about biocultural differences are emerging in the literature and have resulted in a new field of study known as biocultural ecology. The field of biocultural ecology is attempting to transcend the fragmentation inherent in the separation of culture, human biology, and ecology/environment. In spite of its obvious relevance for nursing, this field of study has only recently begun to emerge in the nursing literature. According to Geissler(1991), a study was done to determine the applicability of the North American Nursing Diagnosis Association (NANDA) as a culturally appropriate assessment tool for use with culturally diverse populations. The study focused primarily on three selected NANDA nursing diagnoses in an effort to validate their cultural appropriateness. These included (1) impaired verbal communication, (2) social isolation, and (3) noncompliance in culturally diverse situations.  The NANDA nursing diagnosis "impaired verbal communication, related to cultural differences", is defined by NANDA as being relevant when " an individual experiences a decreased or absent ability to use or understand language in human interaction" (NANDA, 1989, p.49). This diagnosis implies that the patient's verbal communication and ability to understand and utilize language is impaired in some way regardless of the cause. An individual who speaks a different language than that used by the health care provider, may be capable of both use and comprehension of a familiar language when interacting with persons fluent in the language. In this situation if the patient is verbally impaired, then the nurse is equally impaired. It is clear this NANDA diagnosis does not adequately address the issue of nonverbal communication, an essential assessment factor in transcultural nursing.  The NANDA nursing diagnoses relating to social isolation and noncompliance also need further defining characteristics for use with culturally diverse populations. The current NANDA diagnoses are extremely ethnocentric and fail to recognize that every human being is culturally unique. Recognizing this essential fact is fundamental in understanding the importance of transcultural nursing. Knowledge about biocultural variations is essential because many of the clinical standards and norms applied to the care and management of our patients are based on "white normed" standards.     References: Geissler, E.M. (1991). Transcultural nursing and nursing diagnosis. Nursing and Health Care, 12(4), 190-203]   Copyright and Acceptable Use Policy Culturediversity.org  Home Copyright © 1997-2008 culturediversity.org.  All Rights Reserved. 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