culture and addiction

"I hate to advocate drugs, alcohol, violence, or insanity

to anyone, but they've always worked for me”

--- Hunter S Thompson

Culture vs Ethnicity vs Racevs subculture

• The dynamic network of knowledge, beliefs, patterns of behavior, ideas, attitudes, values, and norms that are unique to a particular group of people

• An individual’s identification of self as a part of an ethnic group

• A group of people based on biological similarities (hair, skin, eyes, etc).

• A group with characteristic patterns of behavior that distinguish the group from the larger culture or society

Cultural _________

… assimilation… competence… diversity… imposition

And then there’s acculturation

assimilation vs acculturation

• Process in which individuals from a minority group are absorbed by the dominant culture and take on the characteristics of the dominant culture

• Process of learning norms, beliefs, and behavioral expectations of a group other than one’s own group

competence vs diversity

• Acquisition of knowledge, understanding, and appreciation of a culture that facilitates the provision of culturally appropriate health care

• Differences among a group of people that result from ethnic, racial and cultural variables

imposition

• Tendency to assert one’s own beliefs, values, and patterns of behavior on individuals from another culture

Belief vs value

• Something accepted as true by a culture• Priniciples and standards that have meaning

and worth to an individual, family, group, community or culture

practice questions

1.) a nurse in an ambulatory care clinic is performing an admission assessment for an AA pt scheduled for a cataract removal w/ an intraocular lens impact. Which question would be innapropriate for the RN to ask on an initial assessment?a.) do you ever experience CP?b.) do you have any difficulty breathing?c.) do you have a close family relationship?d.) do you frequently have HA’s?

Question 2

2.) RN is preparing a POC for a pt who is a Jehovah’s Witness. The pt has been told that surgery is necessary. The RN considers the client’s religious preferences in developing the plan of care and documents that: a.) faith healing is practiced primarilyb.) med administration is not allowedc.) surgery is prohibitedd.) administration of blood and blood products is forbidden

Question 3

An anti HTN med has been prescribed for a pt. The client tells the RN that she would like to take an herbal substance to help lower her BP. The RN should …

a.) tell the client that herbal substances are not safe and should never be used

b.) advise the client to discuss the use of an herbal substance with the MD

c.) teach the client how to take her BP so that it can be monitored closely

d.) tell the client that if she takes the herbal substance she will need to have her BP checked freqently

question 4

a nurse educator is providing in-service education to the nursing staff regarding transcultural nursing care when a staff member asks the nurse educator to describe the concept of acculturation. The appropriate response is…

a.) it is a subjective perspective of the person’s heritage and a sense of belonging to a group

b.) it is a group of individuals in a society who are culturally distinct and have a unique identity

c.) it is a process of learning a different culture to adapt to a new or changing environment

d.) it is a group that shares some of the characteristics of the larger population group of which it is a part

Question 5

Which of the following are low-risk therapies? (select all that apply)

HerbsPrayerTouchMassageRelaxationAcupuncture

Question 6

A nursing student is discussing cultural diversity issues in a clinical conference when a nursing instructor asks the student indicates a lack of understanding of the issue of enthnocentrism?

a.) it is a tendency to view one’s own ways as bestb.) it is acting in a manner that is superior to other culturesc.) it is imposing one’s beliefs on individuals from another

cultured.) it is believing that one’s own way is the only acceptable

way

Case Studies

• Report from the previous shift: Ms R is an 84 y/o AA pt admitted for advanced ALS. She is trached but can communicate through writing. She has a DNR/DNI, so there’s no IV acess. She also has a boyfriend who visits every evening, and often during the day. She is suctioned about 4x per shift and frequently requests RT. She is seen by the chaplain every day. Otherwise, aside from a foley, systems are normal, regular diet. She isn’t to be attended by any male nurses.

Case Studies

30 y/o male patient admitted s/p motorcycle accident. He has only recently regained baseline mental status. Upon entering his room you notice he has multiple facial piercings, a shaved head, and tattoos on his extremities. His face sheet shows his address as Salt Lake City Utah. He has TPN hanging, IV access is an 18g LFA. He has multiple abrasions and a R femur fracture. VSS, RA, A&O x 4, GCS 15, no resp. distress, CMSTP, CR<2.

Alcohol

“Here’s to alcohol: the cause of…and answer to all of life’s little problems.” – H.Simpson

Regardless of the logic or validity of this statement, it might be true and factual.

Alcoholism

• This is a drinking pattern that interferes with physical, social, familial, vocational, and emotional functioning.

• Like the moon and stars, the sea and life itself, there are patterns indicative of alcoholism.

• These patterns are:

Patterns:

• Episodic drinking, continuous drinking, morning drinking, increase in family fighting about drinking, blackouts, legal problems, health problems, hiding drinking problems.

The Little Prince

“What are you doing there?” he asked the drunkard, whom he found sunk in silence before a collection of empty bottles and a collection of full ones.

“Drinking,” replied the drunkard, with a gloomy expression.

“Why are you drinking?” the little prince asked.

“To forget,” replied the drunkard.“To forget what?” inquired the little prince

who was already feeling sorry for him.“To forget that I am ashamed,” confessed

the drunkard.“What are you ashamed of?” inquired the

little prince, who wanted to help.“Of drinking!” concluded the drunkard,

withdrawing into silence for good.

Questions:

1. What medications can the nurse expect to administer to a pt withdrawing from etoh?

a. warm maple syrupb. pineapple schnappsc. antabused. librium or ativan

2. Using aversion therapy, what can be used in the treatment of alcoholism?

a. Radiation therapyb. Ketamine (Special-K)c. Gasoline (petrol)d. Disulfiram (Atabuse)

3. In rehabilitation of an alcoholic patient, what methods should not be used?

a. Scornb. Use of nonjudgmental, matter-of-fact

attitude.c. Setting realistic goals.d. Help increase self-esteem.

4. Chronic alcohol-related illnesses include (pick those that apply):

a. Chronic gastritis.b. Hepatitisc. Peripheral neuropathyd. Malnutrition and dehydratione. Pancreatitis

5. Patterns or behaviors indicative of alcoholism include all the following except:

a. Morning drinkingb. Nursing schoolc. Binge drinkingd. Worry free mornings and a life time

without regret.

6. Delirium tremens may appear 12 to 36 hours after the last drink and symptoms may include the following except:

a. Paranoiab. Hallucinationsc. Market tremorsd. A positive outlook and a totally normal

take on the world and all that exists

Drugs!

• Marijuana leads to homosexuality ... and therefore to AIDS.White House Drug Czar Carlton Turner, 1986

• "Woe to you my Princess, when I come, I will kiss you quite red and feed you till you are plump. And if you are forward, you shall see who is the stronger, a gentle little girl who doesn't eat enough or a big wild man who has cocaine in his body."Sigmund Freud addressing his wife, from 'On Coca'

Drug Abuse:

State of dependency produced by repeated use of substance that causes altered perception or mood,

or both.

1. Patients suffering from cocaine and amphetamine withdrawal may exhibit all of the following symptoms except

a. Depressionb. Fatiguec. Priapismd. Disturbed sleep

2. The following physical signs may indicate intravenous drug abuse in a client:

a. Sudden and unexpected competency in the German language

b. Priapismc. Needle track marks, cellulitis at puncture

site, poor nutritional statusd. Rhinorrhea

3. Frequent reassessment of vital signs and level of consciousness is especially important in people undergoing valium withdrawal because

a. Priapismb. Valium raises heart rate.c. Rapid withdrawal from barbiturates,

antianxiety medications, and hypnotics may be fatal.

d. The patient is depressed and lonely

4. When recommending therapy for chemically dependent clients, the following therapy works best

a. Hypnotherapyb. Priapismc. Group therapy such as Narcotics Anonymousd. Chemotherapye. Hydrotherapy

5. All of the following questions are part of assessment for clients suffering from drug abuse excepta. What drugs have you used and what is your

drug of choice?b. How much have you taken and how long

have you been using this drug?c. Priapism?d. How often do you use this drug?

6. A client suffering from a cocaine overdose may present with

a. Priapismb. Jaundicec. Pupillary dilation d. Respiratory depression

• - LSD is known to induce psychosis, in people who have never used it. Timothy Leary