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."
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.
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.
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.
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