ISSUES OF MATERNAL AND CHILD HEALTH NURSING – AGE, GENDER, SEXUALITY AND SOCIO – CULTURAL FACTORS Introduction Irrespective

of the race, culture, Age, Gender the care of the ante – natal mother is to be given equally. In a multicultural, multi ethnic society valuing diversity is an important aspect. An understanding of some of the cultural differences between social groups is essential in ensuring that professional practice is closely matched to meet the needs of individual clients. Practitioners of health and social cure must understand the role culture plays in determining health, health behaviours and illness so that services are planned and delivered to meet the health needs of population they serve. Terminologies Ethinicity It refers to the cultural, group into which a person was born, although the term is sometimes used in a narrow context to mean only a race. Culture Culture is a view of the world and a set of traditions that a specific society groups users and transmits to the next generation. the

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Cultural values These are preferred ways of acting based on those traditions. The way people react to health care is a cultural value. Norms : The usually values of a group are termed more of norms. Expecting women to come for prenatal care and for parents to bring children for immunizations are examples of norms in the United States, but these are not beliefs world wide. Taboos : Action that are not acceptable to a culture are called taboos. (eg) Murder The primary goal of maternal and child health nursing care can be stated simply as the promotion and maintenance of optimal family health to ensure cycles of optimal child bearing and child rearing. The range of Practice includes  Preconceptual health care  Care of women during 3 trimesters of pregnancy and the puerperium  Care of children during the perinatal period (6 weeks before conception to 6 weeks after birth).  Care of children from infancy through adolescens.

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 Care in settings as treated as the birthing room, paediatric intensive care unit, and the home. Maternal and child health nursing is always family – centered, which means the family is considered the primary unit of care. The level of family functioning affects the health status of individuals. If the family’s level of functioning is low, the emotional, physical and social health and potential of individuals in the family can be adversely affected. A healthy family, on the other hand establishers an environment. Conducive to growth and health promoting behaviours that sustain family members during crises. Similarly, the health of individuals and the ability to strongly influences the health of the family members, and overall family functioning. Thus a family centered approach enables the nurse to better understand an individual and in turn, provide the holistic care standards of maternal and child health nursing practice. The importance a society places on caring can best be measured by the concern it places on its most vulnerable members or its elderly, disadvantaged, and young citizens. Speciality organizations develop standards of care to promote consistency and ensure quality nursing care in their areas of nursing practice.

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Socio – cultural aspects Cultural values influence the manner on which people plan for child bearing and child rearing and respond to health and illness. In a culture, in which men are the authority figures, for example, if might be expected that the father rather than mother ensures questions about an ill child. If you are from a culture in which women are expected to provide all childcare, you might find it annoying to hear a man taking over the responses at a health interview. A nurse who has been culturally influenced to believe that stoic behaviour is the proper response to pain may be inpatient with a women who has been influenced to believe that expressing discomfort during child birth is ‘proper’. Nurses need to include all cultural groups in nursing research samples so more can be learned about cultural preferences in relation to nursing interventions and care. Cultural differences occur not only different ethnic backgrounds but also different life styles. Adolescents, urban, youth, the hearing – challenged, and gays or lesbians have separate cultures from mainstream, for instance. A patient who has been deaf since birth, for example, expects her deaf culture

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to be respected by having health care professionals attempt to communicate with her in her language.

A lesbian mother could become hesitating of she is ahead, where is your husband ? Given the cultural mix, almost any behaviour can be considered appropriate for some individuals at some time and place. Nursing care that is guided by cultural aspects and respects individual difference is termed transcultural nursing. Stereotyping culture It means expecting a person to act in a characteristic way without regard to his or her individual characteristics. It is generally derogatory in nature. Statements such as, “men never diaper babies well” or Japanese women are never assertive” are examples of stereo – typing. Sterotyping occurs largely because of lack of understanding of the wide range of differences among people. In the above examples, the first speaker, having seen one man change diapers poorly, assumes that this represents the entire male population, using this sterotype, planning health may be improper and it should be avoided. On the other hand it is important not to ignore cultural characteristics, because most people are proud of their cultural heritage. It is possible to acknowledge and celebrate a client’s culture without stereotyping by

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assessing the way in which she express cultural characteristics. Culture influences health so much that several National Health goals have been established in reference to socio cultural aspects of care. Assessment based on socio cultural aspects of care It is important to be certain that care is planned not on predetermined assumptions but on the actual preference of the family, to do this, assess each client as an individual, not merely as one of a group. Learn as much as you can about different cultures by reading about or talking to members of as many different ethnic groups as possible. Assessing the culture of a community is important as assessing individual families because families are intrinsically joined to their community. An important area to assess is whether the family matches the dominant culture in the community. This is important because the type of foods stocked in the supermarket, the type of entertainment events that are planned, and the values and history that are stressed in schools and work settings are all influenced by the dominant culture.

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ASSESSING FOR CULTURAL VALUES Areas of assessment • Ethnicity • Communication • Touch • Occupation • Pain Questions to ask or observations to make What country or race is the family from ? What is the main language used in the home ? Does the family typically touch each other ? Do they use intimate or conversational space Is work important to the family ? Do they plan leisure time or leave it instructed > Does the family express pain or remain stoic in the face of it ? • Family structure What do they believe relieves pain best ? Is the family nuclear ? Extended ? Single parent ? Are family roles clear ? Can an individual name a family member he/she would call on for support in a crisis ? • Male and female Is the family male or female dominant ? roles • Religion • Health beliefs What is the family religion ? Do they actually practice their religion ? What does the family believe about health ? What do they believe causes illness ? Makes illness better ? Do they use alternative • Nutrition therapies or established practices ? Does the family eat in ethnic diet ? Are the foods they enjoy available in their

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community ? Nursing diagnosis • Powerlessness related to expectations of care not being respected • Powerlessness related to socio – cultural isolation • Impaired verbal communication related to English not being primary language. • Nutrition, less than body requirements, related to cultural preferences. • Anxiety related to a cultural preference for not bathing while ill. • Fear related to inability to buy food due to poor economic status. Outcome identification and planning Planning needs to be very specific for the family and circumstance involved because socio – cultural preferences tend to be very personal. Care may begin with in service education for health care providers who are unfamiliar with particular cultural practice and its importance to the specific family involved. It may include arranging for variations in policy, such as the length of the family visiting. Lower types of food served, or kind of child care. It can make health care more acceptable. Implementation Appreciate that cultural values are ingrained and usually very difficult to change. An example of implementing care might be making arrangement

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for a new Native American mother to take home the placenta of that is important to her, or planning home care for a Chinese – American child whose family believer in herbal medicine. It must be establishing a network of health care agency personnel or personnel from a nearby university or importing firm to serve as interpreters. It might be educating a child, family or community about the reason for a hospital practice. A particular situation may call for both sides to adjust (cultural negotiation). Outcome Evaluation by assessing whether outcomes have been met should reveal that a family’s socio – cultural preferences were considered and respected during care.

Examples • Parents lost three ways they are attempting to presence cultural traditions in their children. • Child states she no longer feels socially isolated because of cultural differences.

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Family members state they have learned to substitute easily purchased foods for traditional foods unavailable in local stores in order to obtain adequate nutrition cultural competence continuum.

Cultural destructiveness Making every one fit the same cultural pattern and exclusion of those who don’t fit forced assimilation. Emphasis on difference and using difference as barriers. Cultural blindness Don’t see or believe there are cultural differences among people. Everyone is same Cultural awareness Being aware that we all live and function within a culture of our own and that our identity is shaped by it.

Cultural sensitivity Making every one fit the same cultural pattern, and exclusion of those who don’t fit forced assimilation. Emphasis on differences and using differences as barriers.

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Cultural blindness Don’t see or believe there are cultural difference among people. Everyone is same. Cultural awareness Being aware that we all live and function with in a culture of our own and that our identity is shaped by it. Cultural sensitivity Understanding and accepting different cultural values, attitudes and behaviour. Cultural competence The capacity to work, effectively and with people integrating elements of their culture, values, attitudes rule and norms. Translation of knowledge into action.

Conclusion To provide maternal and child health nursing effectively the socio cultural factors to be considered in mind so that the wholistic care can be

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achieved fully, people also seek the health service if it is satisfied as per their custom, culture etc. Health education can be given to modify their behaviour if they need to get change regarding the prevention of health problems. We can’t force the public to follow the methods to attain the goal. Creating the awareness in such a way and to accept them to follow the healthy aspects to maintain their health is most important.

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