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Kee: Pharmacology, 8th Edition

Chapter 3: Cultural and Pharmacogenetic Considerations
Downloadable Key Points
• Ethnopharmacology is the study of drug responses that may be unique to an individual
owing to social, cultural, and biologic phenomena.
• Pharmacogenetics integrates the study of pharmacokinetics, pharmacodynamics, and
variations of the predicted response to a drug due to genetic factors.
• Culture is defined as sets of learned behavior and ideas that human beings acquire as
members of a community. A community is a cluster of individuals who function as a
group to attain cultural universals.
• Cultural universals are designed to meet the community’s survival needs and common
goals, such as the obtainment of food and other practices that maintain the group.
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• he concept of transcultural nursing was formali!ed by "adeleine #eininger, a nurse
anthropologist$ she founded the ranscultural %ursing &ociety in '()*. A challenge for
nurses worldwide is the degree of cultural diversity owing to migration and global
• %umerous cultural groups engage in the use of traditional health practices, which may
include use of teas, herbs, spices, and special foods as well as homeopathic remedies,
poultices, and ointments. hese practices can have neutral, beneficial, or deleterious
effects on a patient’s health.
• +ealers play a role in traditional health practices in about ,-. of the population
worldwide. raditional healers usually have some practical knowledge of human anatomy
and physiology, pharmacology, and pharmaceutical substances.
• Assimilation occurs when a less powerful group changes its ways to blend in with the
dominant cultural group.
• Acculturation is the process by which a group ad/usts to living within a dominant culture
while at the same time maintaining its original identity.
• Complementary health practices combine traditional beliefs and mainstream health
• 0hen a dominant group adopts health practices from a nondominant group, they are
called alternative health practices.
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• he ranscultural Assessment "odel, developed by 1iger and 2avidhi!ar in '((,,
suggests that all cultures have si3 cultural phenomena4 communication, space, social
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2ownloadable ;ey Points 9<6
organi!ation, time, environmental control, and biological variations. hese cultural
phenomena flow from a culturally unique individual.
• Communication occurs verbally and nonverbally. %urses must be alert to different types
of communication styles among patients to provide culturally competent care.
• he amount of space around a person’s body is an important psychological consideration.
• =amilies are basic social units. he definition of family and the criteria for inclusion
varies among individuals and among cultures.
• %urses and their patients may have different perceptions of time. ime moves slowly for
a patient who is an3ious or in pain but moves quickly for a nurse who has a demanding
workload. he use of vague terms to denote time may also cause a disparity between
nurses’ and patients’ perceptions of time.
• A ma/or aspect of culture is the desire to control nature to facilitate the needs of human
beings. he concept of >nature? may include otherworldly forces or beings, such as
deities and spirits. :llness may be attributed to cosmic forces and believed to be cured or
ameliorated by persons who possess special abilities.
• hrough the work of the +uman 1enome Pro/ect, an international, collaborative research
program, the field of pharmacogenomics is rapidly e3panding. Pharmacogenomics refers
to the general study of all the different genes that determine drug behavior.
• he 1enographic Pro/ect has performed 2%A testing on populations all over the world.
=indings reveal that human beings are ((.(. genetically identical$ this implies that there
are not multiple races but multiple genotypes.
• :ntrinsic biologic factors must be considered along with e3trinsic factors such as diet and
environmental and sociocultural issues to prescribe effective therapies and provide
holistic health care.
)#(*& P#!CE((
• Assess patient’s ability to communicate using standard English.
• 2etermine if the patient participates in traditional health practices and@or complementary
or alternative medical practices.
• #ist patient’s use of pharmacotherapeutic agents, including prescription medications,
over<the<counter medications, herbs, and teas.
• Ascertain if including a traditional healer would facilitate compliance with prescriptive
• :nquire about patient’s preferences regarding touch, modesty, and personal space. 1auge
patient’s perception of time.
• Ase appropriate persons as translators when patient’s use of standard English is limited.
Anticipate that therapeutic communication with patient and significant others who use
limited standard English will require additional time with each encounter.
• Provide appropriate spatial configurations for individual patients and members of their
social groups when delivering nursing care.
• :nclude significant members of the social group in planning and implementation of
patient care.
• Becogni!e the need for patients to e3ercise control in their environment.
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2ownloadable ;ey Points 9<9
• Anticipate unique responses to drugs based on social, cultural, and biologic influences.
• Consult with persons knowledgeable about the patient’s culture and mainstream culture.
• :ncorporate nonharmful traditional health practices with mainstream prescriptive
therapies when appropriate.
• =acilitate adherence to mainstream prescriptive therapies within patient’s social and
cultural conte3ts.
• Ase illustrations to e3plain prescriptive therapies.
• "onitor for patient adherence to prescriptive therapies.
• Evaluate physical, social, and psychological outcomes of prescriptive therapies.
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