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MODULE 1 Sex differences – can be observed at the level of chromosomes, gene
Concepts in the Care of At Risk and
Sick Adult Clients
HEALTH CARE SITUATIONS
Global trend is a general development or change in a
situation that affects many countries of the world. There are different
areas being studied in the global trends, and one of which, and very
significant for those in the health care industry are health trends.
“Health trends are constantly evolving, and so are health
systems. No health system is perfect, and all countries have people who
are left behind. It is therefore important to accurately document the state
of global health and how it is changing.”, says Dr Tedros Adhanom
Ghebreyesus Director-General World Health Organization. It is in this
light that the World Health Statistics started to document data annually
since 2005. It has been publishing the World Health Organization’s
annual snapshot of the state of the world’s health. Since 2016, the World
Health Statistics series has focused on monitoring progress toward the
Sustainable Development Goals (SDGs).
The 2019 edition contains the latest available data for the
health-related SDG indicators.
The World health statistics 2019 summarizes recent trends
and levels in life expectancy and causes of death, and reports on the
health and health-related Sustainable Development Goals (SDGs) and
associated targets. Where possible, the 2019 report disaggregates data
by WHO region, World Bank income group, and sex; it also discusses
differences in health status and access to preventive and curative services,
particularly in relation to differences between men and women. Where
possible, it indicates the roles of sex as a biological determinant, and of
gender as a social construct, in accounting for the observed differences.
The analyses presented are not exhaustive; nevertheless, it is hoped that
the report will raise awareness of some critical sex and gender differences
in health outcomes, highlight the importance of those differences in the
attainment of the SDGs, and encourage the roles of sex and gender
to be systematically taken into account when collecting data,
analyzing health situations, formulating policies and designing
health programs.
SEX GENDER
• Biological: XY or XX • Socially constructed and
• Male/Female/Intersex enacted roles and behaviors
• Chromosomes • Man/Woman/Other
• Sex organs • Masculine/Feminine
• Hormones • Gender non-conforming
SEX – refers to the biological characteristics that define humans as female
or male. These sets of biological characteristics are not mutually exclusive,
because there are individuals who are born with physical or biological sex
characteristics who do not fit the traditional definitions of female or male
(intersex).
expression, hormones, immune system and anatomy (e.g. body size, and
sexual and reproductive anatomy).
Gender – refers to the socially constructed norms, roles and relations of
and among women, men, boys and girls. Gender also refers to
expressions and identities of women, men, boys, girls and gender-
diverse people. Gender is inextricable from other social and structural
determinants shaping health and equity and can vary across time and
place.
Gender differences – and inequalities influence exposure to risk
factors, health-seeking and risk-taking behaviors, access to and use of
health information; promotive, preventive, curative, rehabilitative and
palliative health services; and experience with health care, including in
terms of access to and control over resources and power relations.
Examples of gender-related factors resulting
in differential health outcomes:
o Early pregnancy, including as a result of child marriage,
increases girls’ risk of adverse health outcomes;
o Due to the gender-based division of labor, men and women
may be exposed to different risks for work-related injuries or
illnesses;
o Gender norms related to masculinity promote smoking and
alcohol use among men, while gender norms associating
smoking with women’s freedom and liberation are being
targeted to young women by the tobacco industry;
o Women’s access to health services may be limited by lack of
access to and control of household financial resources,
caregiving roles, and restrictions on their mobility; whereas
men’s use of health services may be influenced by masculinity
norms in which seeking health care is not seen as manly; and
o In addition to gender norms and roles, intersecting
discrimination based on gender identity contributes to
transgender people experiencing high rates of stigma and
discrimination including in health care settings, and a lack of
appropriate services responding to their needs.
THE WORLD POPULATION TODAY
• The world population now stands at 7.8 billion inhabitants,
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having reached the 7 billion milestone in 2011. Demographers
expect the 8 billion milestone in 2023, with global population
projected to reach 9 billion by 2037 and 10 billion by 2056. This
growth is slightly faster than projections from just a few years ago.
• World population currently grows at 1 percent annually, having
peaked at 2.1 percent in 1968. That annual growth rate is expected
to continue declining, reaching 0.5 percent by midcentury. The
current annual increase of world population is 81 million, lower
than the peak level of 93 million in 1988. Annual additions are
projected to continue declining, reaching 48 million by 2050. Of the
nearly 2 billion increase in world population expected by
midcentury, most will take place in less developed regions. Africa
leads, expected to add more than 1 billion people over the coming

three decades, followed by Asia with about 650 million. Europe’s
population, in contrast, is projected to decrease by 37 million over
this period.
• Sex Composition
o The world population’s sex composition has been
relatively balanced and stable over the past 70 years, with
a ratio of around 100 to 102 males for every 100 females.
o Notable exceptions to that general pattern are China and
India, whose population sex ratios are above 105, largely
due to sex-selective abortions of female fetuses.
o Sex ratios at birth of most countries are around 105 males
per 100 females, yet the ratios have reached as high as
120 in China and 114 India in recent years.
LIFE EXPECTANCY
“Women live longer than men, but the additional
years are not always healthy.”
• Life Expectancy
o Refers to the number of years of a person can expect to
live.
o By definition, life expectancy is based on an estimate of
the average age that members of a particular population
group will be then when they die. (Ospina, 2017)
o In 2019, more than 141 million children will be born: 73
million boys and 68 million girls. Based on recent
mortality risks the boys will live, on average, 69.8 years
and the girls 74.2 years – a difference of 4.4 years.
o Life expectancy at age 60 years is also greater for women
than men: 21.9 versus 19.0 years. Between 2000 and
2016, global life expectancy at birth, for both sexes
combined, increased by 5.5 years, from 66.5 to 72.0
years.
• Health Life Expectancy
o The number of years lived in full health (HALE) – also
increased over that period, from 58.5 years in 2000 to
63.3 years in 2016.
o HALE is greater in women than men at birth (64.8 versus
62.0 years) and at age 60 years (16.8 versus 14.8 years).
However, the number of equivalent years of full
health lost through living in poor health from birth
is also greater in women than in men (9.5 versus 7.8
years).
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CAUSES OF DEATH
• There are several conditions that are related to the reduced life
expectancy in males than in females.
• The reduced life expectancy of males compared with that of females
is not due to a single or a small number of causes. Of the 40 leading
causes of death, 33 contribute more to reduced life expectancy in
males than in females.
• The top 3 conditions for men include (1) Ischemic Heart Disease,
(2) Road Injury and (3) Cancers in Respiratory. For women on
the other hand are (1) Breast Cancer, (2) Maternal Conditions
and (3) Cervical/Uterine Cancer.
LIFE EXPECTANCY AND AGE OF DEATH
• Life expectancy and age of death varies greatly by country income
group. Life expectancy at birth in low-income countries (62.7 years)
is 18.1 years lower than in high-income countries (80.8 years). In
high-income countries, most of the people who die are old;
however, in low-income countries almost one in three deaths are of
children aged under 5 years.
• The differences in life expectancy between females and males are
smaller in low-income countries than in high income countries.
Communicable diseases, injuries and maternal conditions
contribute most to differences in life expectancy between females
and males in low-income countries, whereas
noncommunicable diseases (NCDs) contribute most to life
expectancy differences in high-income countries.
• Maternal deaths contribute more than any other cause to
differences in life expectancy at birth between men and women.
Maternal deaths are concentrated in low-income countries, being
related primarily to lack of access to essential health services. The
life expectancy of men is lower than that of women due to higher
mortality rates from most causes, particularly in higher-income
countries; in low income countries, the net effect of maternal
conditions, breast and cervical cancer reduces the differences in life
expectancy between men and women compared with high income
countries.
HEALTH-RELATED SUSTAINABLE DEVELOPMENT GOALS
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(SGD) INDICATORS
I. Global Trends
• Globally, there have been improvements in most of the health-
related SDG indicators. However, progress has stalled or trends are
in the wrong direction for five of the 29 health-related SDG
indicators for which trends are reported:
o the proportion of children aged under 5 years who are
overweight
o malaria incidence
o harmful use of alcohol
o deaths from road traffic injuries
o water-sector official development assistance.
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II. Differences Among Countries • SDG indicators of exposure to risk factors

• SGD indicators of health status o Populations in lower-income countries are less likely to
o The disparities in life expectancy among countries are use safely managed drinking-water, and clean fuels and
reflected in many of the health- related SDG indicators. technology; also, they have greater exposure to fine
Maternal mortality ratios are 29 times higher in low- particulate matter in cities. In contrast, tobacco use and
income countries than in high-income countries. In alcohol consumption are highest in high-income
resource-poor settings, fertility rates are higher and the countries.
risks of dying in labor greater, so the lifetime risk of
III. Differences between Females and Males
maternal death is greatly amplified; in low- income
• SGD indicators of health status
countries, one woman out of 41 dies from maternal
o Differences between females and males are seen in most
causes.
of the health-related SDG indicators for which sex
• SDG indicators of health service coverage and financing
disaggregation has been possible. In 2017, male
o Populations in low-income countries generally have less
children were 11% more likely to die than female children
access to essential health services; values of the universal
before the age of 5 years, compared with only 6% in
health coverage (UHC) service coverage index are lower,
2000, indicating that the decline in under-5 mortality rate
as are indicators such as skilled birth attendance, women
since 2000 has been faster in females than in males.
who have their need for family planning satisfied with
o Globally in 2017, the incidence rate of new HIV infections
modern methods of contraception, and immunization
was 1.09 times higher in men than in women. In sub-
coverage.
Saharan Africa, the incidence was 1.27 times higher in
o Low income countries also experience greater shortages
women than in men; however, in other parts of the world,
of health care professionals and domestic government
the incidence was 1.7 times higher in men than women.
health expenditure as a proportion of total general
o The incidence rate of TB was 1.7 higher in men than in
government expenditures is lower (despite lower
women globally in 2017. In 2016, the probability of a
absolute levels of general government expenditure and
man aged 30 years dying from an NCD before 70 years of
greater health needs). The proportion of the population
age was 1.44 times higher than for a woman aged 30
that suffer catastrophic health expenditures (>10% or
years. Globally in 2016, suicide mortality rates were 1.75
>25% of total household expenditures or income) is
times higher in men than in women.
higher in middle-income countries than in low- or high-
• SDG indicators of health service coverage and financing
income countries.
o Household surveys suggest that vaccination rates are
o However, at all income levels people can suffer
similar in boys and girls. The risk of not using a condom
catastrophic health expenditures, even in high-income
during sex with a non-regular partner appears to be
countries and in countries where most of the out-of-
higher in women than in men. However, in countries with
pocket health spending is due to medicines.
generalized HIV epidemics, men are less likely than
o In low-income countries, about a third of children are
women to take an HIV test and less likely to access
stunted (i.e. short for their age), reflecting long-term
antiretroviral therapy; also, men are more likely than
nutritional deprivation, and one child out of 14 will die
women to die of an AIDS-related illness.
before his or her fifth birthday.
o Male TB patients appear to be less likely to seek care than
o Adolescent birth rates are eight times higher in low-
female TB patients. Death rates for some Non-
income countries than in high- income countries. The

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Communicable Diseases may also be influenced by
burden of infectious diseases, including HIV, TB, malaria,
access to diagnosis and treatment; for example, cervical
hepatitis B and neglected tropical diseases (NTDs) is
cancer mortality rates are higher in low-income countries
higher in low-income countries than in high- income
that have poorer access to health services.
countries. Mortality rates attributed to unsafe water,
• SDG indicators of exposure to risk factors
unsafe sanitation and lack of hygiene are also highest in
o Age-standardized prevalence of tobacco smoking was five
low-income countries, as are mortality rates for road traffic
times higher in men than in women in 2016, with the
injuries and unintentional poisoning. Although NCDs are
largest M/F ratio observed in the WHO Eastern
often associated with a more prosperous lifestyle, the
Mediterranean Region. Globally, per capita alcohol
probability of dying prematurely from cardiovascular
consumption was almost 4 times higher in men than in
disease (CVD), cancer, diabetes and chronic respiratory
women in 2016.
disease is highest in low- and lower-middle income
countries.
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Monitoring of the health-related SDGs is based on
statistics of two types:
o Primary data – data compiled by international agencies from
routine reporting by countries or publicly available sources
such as demographic and health surveys; statistics are
presented as they are reported or with modest adjustment
o Comparable estimates – country data are adjusted or
modelled to allow comparisons among countries or over time.
ESSENTIAL FINDINGS in the 2019 WHO STATISTICS OVERVIEW
What has improved?
• Global life expectancy increased by 5.5 years to 72.0 years between
2000 and 2016, and healthy life expectancy increased by 4.8 years
to 63.3 years.
• Of 29 health-related SDG indicators for which global trends are
reported, 24 have shown improvements in recent years. More births
are attended by skilled health personnel, and women are less likely
to die in childbirth. Global targets to reduce neonatal deaths and
deaths in children aged under 5 years are on track, and childhood
stunting is in decline. Nonetheless, it is estimated that 303 000
maternal deaths occurred globally in 2015 and that 5.4 million
children aged under 5 years died in 2017.
• Vaccination coverage rates have increased while incidence rates for
several infectious diseases, prevalence of tobacco smoking,
exposure to environmental risks and premature NCD mortality have
decreased at global level.
What has not improved?
• Progress has stalled or trends are in the wrong direction for five of
the 29 health-related SDG indicators for which trends are reported:
the proportion of children aged under 5 years who are overweight,
malaria incidence, harmful use of alcohol, deaths from road traffic
injuries, and water-sector official development assistance.
prevalence of tobacco use and higher per capita consumption of
alcohol. In many settings, men use health services less than women,
even after taking into account reproductive- related consultations.
The health gap between men and women is widest in high-income
countries.
DATA AVAILABILITY
• The World health statistics 2019 report reviews, for the first time, the
availability of country data for global SDG reporting. This review
suggests that major improvements are needed to country data
systems:
o one in seven indicator country values included in the
report have had no underlying data since 2000; low and
lower-middle-income countries in particular lack
underlying data;
o for around one third of countries, over half of the
indicators have no recent underlying data;
o 11 health-related SDG indicators require cause-of-death
data, yet only around half of countries are able to register
more than 80% of adult deaths, and less than one third of
countries have high- quality data on cause of death; and
o sex disaggregation is currently available for less than half
(11/28) of relevant health-related SDG indicators at
global level where it would be of interest.

DISPARITIES OF HEALTH OUTCOMES

• Life expectancy at birth in low-income countries is 18.1 years lower
than in high-income countries. Much of this difference is
attributable to preventable and treatable conditions.
• In low-income countries, one in 41 women die from maternal

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causes. Such deaths rarely occur in upper, middle and high-income
countries. Maternal deaths contribute more to differences in life
expectancy in low-income countries between men and women than
any other single cause.
• In low-income countries, more than a third of children are stunted
(short for their age), reflecting long- term nutritional deprivation,
and one child out of every 14 born will die before his or her fifth
birthday.
• In 2016, life expectancy in men was 4.4 years lower than for women,
with higher death rates for multiple causes, especially
cardiovascular diseases, road injuries, lung cancer, chronic
obstructive pulmonary disease and stroke. Men are generally
exposed to increased occupational risks, and have higher
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MORTALITY: TEN (10) LEADING CAUSES ACUTE AND CHRONIC ILLNESS

NUMBER AND RATE/100,000 POPULATION Definition of terms:
Philippines Acute illness: A disease with an abrupt onset and, usually, a short
course; appears suddenly and lasts for a short amount of time
5-Year Average (2005-2009) & 2010 Chronic disease: medical or health problem with associated symptoms
5-Year Average or disabilities that require long- term management; has also been
2010*
CAUSES (2005-2009) referred to as noncommunicable disease, chronic condition, or chronic
disorder
Number Rate Number Rate
Chronic illness: the experience of living with a chronic disease or
1. Diseases of the Heart 88,299 99.4 102,936 109.5 condition; the individual’s perception of the experience and the
individual’s and others’ responses to the chronic disease or condition
2. Diseases of the Vascular
58,761 66.2 68,553 72.9 Disability: restriction or lack of ability to perform an activity in a normal
System
manner; the consequences of impairment in terms of an individual’s
3. Malignant Neoplasms 44,627 50.3 49,820 53.0 functional performance and activity—disabilities represent disturbances
4. Pneumonia 37,865 42.6 45,591 48.5 at the level of the person (e.g., bathing, dressing, communication,
walking, grooming)
5. Accidents** 35,005 39.5 36,329 38.6 Impairment: loss or abnormality of psychological, physiologic, or
6. Tuberculosis, all forms 25,296 28.6 24,714 26.3 anatomic structure or function at the organ level (e.g., dysphagia,
hemiparesis); an abnormality of body structure, appearance, and organ
7. Chronic lower respiratory or system function resulting from any cause
21,586 24.4 22,877 24.3
diseases Multiple chronic conditions (MCC): presence of more than one
8. Diabetes Mellitus 20,964 23.6 21,512 22.9 chronic disease or condition, which increases the complexity of care as
well as morbidity and mortality rates
9.Nephritis, nephrotic Noncommunicable diseases: a group of conditions that are not
12,321 13.9 14,048 14.9
syndrome and nephrosis caused by an acute infection; many are considered chronic diseases and
10. Certain conditions are often due to unhealthy behaviors
originating in the perinatal 12,257 13.8 12,086 12.9 Secondary health conditions or disorders: any physical, mental, or
period social disorders resulting directly or indirectly from an initial disabling
condition; a condition to which a person with a disability is more
Note: Excludes ill-defined and unknown causes of mortality
susceptible because of having a primary disabling condition
* reference year
Determinants of health: are factors that influence a person’s health
** External causes of Mortality
ACUTE DISEASE
MORBIDITY: 10 Leading Causes, Number and Rate • A condition or a disorder that comes on or onsets rapidly and lasts
2010* for a shorter period of time.
Diseases • The period of time associated with acute diseases varies with the
Number Rate
type of illness and the context, but it is always quantitatively shorter
1. Acute Respiratory Infection ** 1,289,168 1371.3
in time when compared to chronic diseases.

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2. Acute Lower Respiratory Tract Infection • The term ‘acute’ is also associated with diseases where the onset is
586,186 623.5
and Pneumonia rather sudden and occurs rapidly.
3. Bronchitis/Bronchiolitis 351,126 373.5 • The severity of acute diseases is mostly fulminant, even though it is
4. Hypertension 345,412 367.4 not always accurate as in the case of acute rhinitis, which is
5. Acute Watery Diarrhea 326,551 347.3 synonymous with the common cold.
• However, diseases like acute respiratory diseases are mostly
6. Influenza 272,001 289.3
fulminant and result in severe consequences.
7. Urinary Tract Infection** 83,569 88.9 • Acute diseases are caused mostly by an infectious agent, and thus
8. TB Respiratory 72,516 77.1 acute conditions appear in many communicable diseases.
9. Injuries 51,201 54.5 • In addition to the sudden onset of the disease, acute diseases also
worsen more rapidly than chronic conditions.
10. Disease of the Heart 37,589 40.

• Acute diseases might affect or occur in all systems throughout the
body. But they only affect just one system at a time.
• The treatment associated with acute diseases also differs depending
on the nature of the disease.
• Acute diseases like appendicitis, strep throat, and influenza do not
require hospitalization or intensive medical treatment. In contrast,
diseases like pneumonia and acute myocardial infarction (heart
attack), although they are acute, do require immediate medical
attention and extended treatment.
• These diseases also do not commonly have long term health effects
and can be treated once and for all.
• Sometimes, the diseases might be caused by a simple change in
diet like typhoid is caused by drinking polluted water, which can
simply be avoided by opting for a cleaner water source.
CHRONIC DISEASE
• A condition or a disorder that persists for a longer period of time or
has long-lasting health effects.
• As in acute disease, chronic diseases cannot be defined by a
particular period of time and are mostly used while comparing them
to acute diseases.
• However, sometimes, a disease lasting for a period of 3 three
months is considered a chronic illness.
• The term ‘terminal’ disease is used for diseases that are chronic with
high chances of ending with death because there are no effective
medications available against them.
• Chronic diseases tend to be more severe as they progress, which
occurs over a period of months and most years.
• Chronic diseases also affect multiple systems in the body and are
not always fully responsive to treatments.
• Chronic conditions are often associated with non-communicable
diseases as the causes are mostly non-infectious.
• Most of these diseases are not caused by an infectious agent and are
often caused due to poor lifestyle or health choices.
• These are caused due to unhealthy behavioral and eating habits
persisting for an extended period of time.
• Some chronic diseases might have a period of remissions or relapse
during where the disease might be temporarily absent.
• The risk factors associated with chronic diseases are different for
different diseases, but some of the common risk factors include
dietary, lifestyle, and metabolic factors.
• The severity of most chronic diseases is not fulminant. However,
patients with chronic conditions become prone to acquiring fatal
acute diseases.
• Because treatment is mostly not effective against chronic disease,
prevention is considered to be more advantageous.
• This can be achieved by regular screening for the existence of
predisposing factors which helps in early detection, severely
reducing the harmful outcomes.
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DEFINITION OF CHRONIC DISEASES OR CONDITIONS
• Chronic diseases or conditions are often defined as medical
conditions or health problems with associated symptoms or
disabilities that require long-term management. No single
definition for chronic disease exists, but it is generally accepted that
chronic diseases are those that persist for months or years rather
than days or weeks (Goodman, Posner, Huang, et al., 2013). The
U.S. National Center for Health Statistics defines chronic disease as
a condition lasting 3 or more months (Adams, Kirzinger, & Martinez,
2013) and the WHO (2014a) defines it as a long-lasting condition
that can usually be controlled but not cured. Definitions of chronic
disease or chronic illness share the characteristics of being
irreversible, having a prolonged course, and unlikely to resolve
spontaneously (Larsen, 2016). The specific chronic condition may be
a result of illness, genetic factors, or injury; it may be a consequence
of conditions or unhealthy behaviors that began during childhood
and young adulthood.
• Chronic diseases or disorders are one of the major health and
development challenges of the 21st century because of their global
human, social, and financial consequences. Although chronic
diseases affect all countries, their impact is more severe in low- and
middle-income countries (i.e., South American, African, and Asian
countries), where the majority of premature deaths due to chronic
diseases occur. Their impact is particularly devastating to poor and
vulnerable populations. Chronic diseases, also referred to as
noncommunicable diseases, cause more deaths than all other
causes combined. Deaths due to chronic disease are expected to
increase globally from 38 million in 2012 to 52 million per year by
2030 (WHO, 2014a).
• Management of chronic conditions includes learning to live with
symptoms or disabilities and coming to terms with identity changes
resulting from having a chronic condition. It also consists of carrying
out the lifestyle changes and regimens designed to control
symptoms and prevent complications. Although some people
assume what might be called a “sick role” identity, most people with
chronic conditions do not consider themselves to be sick or ill and
try to live as normal a life as possible. Only when complications
develop or symptoms interfere with activities of daily living (ADLs)
do most people with chronic health conditions think of themselves
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as being sick or disabled.
PREVALENCE AND CAUSES OF CHRONIC CONDITIONS
• Chronic conditions occur in people of every age group,
socioeconomic level, race, and culture. Seven of the 10 leading
causes of death in the United States are chronic diseases, with heart
disease and cancer together accounting for nearly half of all deaths.
It is predicted that by the year 2030, about half the population will
have a chronic disease or disorder. One fifth of those with chronic
disease also have an activity limitation. As the incidence of chronic
diseases increases, the costs associated with these chronic
conditions (e.g., hospital costs, equipment, medications, supportive

services) also increase. Expenditures for health care for people with
one chronic condition account for 86% of the $2 trillion the United
States spends each year on health care (AHRQ, 2014). These costs
represent four of every five health care dollars expended. The
worldwide economic burden associated with chronic disease is
estimated to be $47 trillion over the next two decades (Bloom,
Cafiero, Jané-Llopis, et al., 2011).
• Although some chronic health conditions cause little or no
inconvenience, others are severe enough to cause major activity
limitations. When people with activity limitations are unable to
meet their needs for health care and personal services, they may be
unable to carry out their therapeutic regimens or have their
prescriptions filled on time, may miss appointments and office visits
with their health care providers, and may be unable to carry out
ADLs.
• Chronic diseases are a global issue that affects both rich and poor
nations. Chronic conditions have become the major cause of
health- related problems in developed countries as well as
in the developing countries, which are also trying to cope
with new and emerging infectious diseases.
• In almost all countries, chronic diseases are the major cause of death
among adults. Four of every five deaths occur in countries
characterized as low- or middle income, where people tend to
develop chronic diseases at younger ages, suffer longer, and die
sooner than people in high-income countries. In contrast to
common belief, the total number of people dying from chronic
disease is twice that of patients dying from infectious (including
human immunodeficiency virus infection), maternal, and perinatal
conditions, and nutritional deficiencies combined (WHO, 2014a;
2014b). The number of people worldwide who die because of
chronic disease is higher than all other diseases combined. Most of
these chronic diseases and complications of chronic illness are
preventable, emphasizing the importance of health promotion
across the globe.
• Although chronic diseases or illnesses are common, people have
many myths or misunderstandings about them.
COMMON MISCONCEPTIONS AND REALITY
1. Everyone dies of something.
Þ Chronic illnesses typically do not result in sudden death but
often result in progressive illness and disability. People with
chronic disease often die slowly, painfully, and prematurely.
2. People can live to old age even if they lead unhealthy lives
(smoke, are obese).
Þ While there are exceptions (some people who live unhealthy
lives live to old age, and some people who live healthy lives
develop chronic illnesses), most chronic illnesses can be
traced to modifiable risk factors and can be prevented by
eliminating these risks.
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3. Solutions for chronic disease prevention and control are
expensive and not feasible for low-and middle-income
countries.
Þ A full range of chronic disease interventions are very cost-
effective for all regions of the world, including the poorest.
Many of these interventions are inexpensive to implement.
Chronic disease is increasing rapidly around the world,
including low-and middle-income countries.
4. There is nothing that can be done and chronic diseases
cannot be prevented.
Þ The major cause of chronic diseases is known, and if the risk
factors were eliminated, at least more than 80% of heart
disease, stroke, and type 2 diabetes and more than 40% of
cancers would be prevented.
5. If individuals develop chronic disease as a result of
unhealthy “lifestyles,” they have only themselves to
blame.
Þ Individual responsibility can have its full effect only if
individuals have equal access to a healthy life and are
supported to make healthy choices. Poor people often have
limited choices about the food they eat, their living
conditions, and access to education and healthcare.
6. Certain chronic diseases primarily affect men.
Þ Chronic diseases, including heart disease, affect women and
women almost equally. Almost half of all deaths attributed to
chronic illness occur in women.
7. Chronic diseases primarily affect old people.
Þ Almost half of chronic disease deaths occur prematurely in
people younger than 70 years.
8. Chronic diseases mainly affect rich (affluent) people.
Þ Poor people are much more likely that wealthy to develop
chronic diseases and as a result are more likely to die. Chronic
diseases cause substantial financial burden and result in
extreme poverty.
9. The priority of low and middle-income countries should be
on control of infectious diseases.
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Þ Although infectious diseases are an issue, low and middle-
income countries are experiencing a dramatic increase in
chronic disease risk factors and deaths, especially in urban
settings.
10. Chronic diseases affect mostly high-income countries.
Þ Eighty percent of deaths attributed to chronic disease are in
low and middle-income countries. The prevalence of chronic
diseases in low and middle-income countries is rapidly
growing.

Why is there an increasing number of chronic diseases?
o A decrease in mortality from infectious diseases (e.g.,
smallpox, diphtheria, acquired immune deficiency syndrome
[AIDS]–related infections) and from acute conditions because
of prompt and aggressive management of acute conditions
(e.g., myocardial infarction, trauma).
o Lifestyle factors such as smoking, chronic stress, poor nutrition,
and sedentary lifestyle that increase the risk of chronic health
problems such as respiratory disease, hypertension,
cardiovascular disease, and obesity. Although signs and
symptoms of chronic illness often first appear during older
age, risks typically begin earlier in life, even during fetal
development.
o Obesity, often due to lifestyle issues, has become a major
health issue across the lifespan and across the globe with
about 2 billion people overweight and one third of them
obese. Obesity is no longer limited to high-income countries
but increasingly occurs in low- and middle-income countries.
The proportion of adults with a body mass index (BMI) of 25 or
greater increased between 1980 and 2013 from about 29% to
37% in men and about 30% to 38% in women (Seidell &
Halberstadt, 2015).
o The increasing prevalence of obesity has increased the
incidence of heart disease, strokes, diabetes, and
hypertension. Obesity also affects one’s self-esteem,
achievement, and emotional state.
o Longer lifespans because of advances in technology and
pharmacology, improved nutrition, safer working conditions,
and greater access (for some people) to health care.
o Improved screening and diagnostic procedures enabled early
detection and treatment of diseases, resulting in improved
outcomes of management of cancer and other disorders.
Physiologic changes in the body often occur before the appearance of
symptoms of chronic disease. Therefore, the goal of emphasizing healthy
lifestyles early in life is to improve overall health status and slow the
development of such disorders. Major risk factors for chronic disease,
which represent a growing challenge to public health, include
unhealthy eating habits, decreased energy expenditure
associated with a sedentary lifestyle, increasing age, and tobacco
use and alcohol consumption (WHO, 2014a). In addition, serious
psychiatric or mental illness puts people at greater risk for chronic
illness than the general population and leads to higher morbidity and
mortality rates of chronic diseases (National Prevention Council, 2014).
CHARACTERISTICS OF CHRONIC CONDITION
Sometimes it is difficult for people who are disease free to understand
the profound effect that chronic illness often has on the lives of patients
and their families. It is easy for health professionals to focus on the illness
or disability itself while overlooking the person who has the disorder. In
all illnesses, but even more so with chronic conditions, the illness cannot
be separated from the person. People with chronic illness must contend
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with it daily (Lorig et al., 2012). To properly manage their chronic
condition, individuals often have to find the time, and the social and
financial resources, to participate in physically and psychologically
beneficial activities, work with health care professionals to follow
treatment guidelines, monitor their health and make decisions about
their health and lifestyle and that of their family, and manage the effects
of the illness on their physical, psychological, and social well-being. To
relate to what people must cope with or to plan effective interventions,
nurses must understand the multiple characteristics of a chronic illness.
• Psychological and social issues: Managing chronic illness
involves more than treating medical problems. Associated
psychological and social issues must also be addressed, because
living for long periods with illness symptoms and disability can
threaten identity, bring about role changes, alter body image, and
disrupt lifestyles. These changes require continuous adaptation and
accommodation, depending on age and situation in life. Each
decline in functional ability requires physical, emotional, and social
adaptation for patients and their families (Corbin, 2003).
• Phases of illness: Chronic conditions usually involve many
different phases over the course of a person’s lifetime. There can be
acute periods, stable and unstable periods, flare-ups, and
remissions. Each phase brings its own set of physical, psychological,
and social problems, and each requires its own regimens and types
of management.
• Therapeutic regimens: Keeping chronic conditions under control
requires persistent adherence to therapeutic regimens. Failing to
adhere to a treatment plan or to do so consistently increases the
risks of developing complications and accelerating the disease
process. However, the realities of daily life, including the impact of
culture, values, and socioeconomic factors, affect the degree to
which people adhere to a treatment regimen. Managing a chronic
illness takes time, requires knowledge and planning, and can be
uncomfortable and inconvenient. It is not unusual for patients to
stop taking medications or alter dosages because of side effects that
are more disturbing or disruptive than symptoms of the illness, or
to cut back on regimens they consider overly time-consuming,
fatiguing, or costly (Corbin, 2003).
• Development of other chronic conditions: One chronic
disease can lead to the development of other chronic conditions.
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Diabetes, for example, can lead to neurologic and vascular changes
that may result in visual, cardiac, and kidney diseases and erectile
dysfunction. The presence of a chronic illness also contributes to a
higher risk of morbidity and mortality in patients admitted to the
intensive care unit with acute health conditions as well as greater
utilization of clinical services during hospitalization.
• Family life: Chronic illness affects the entire family. Family life can
be dramatically altered as a result of role reversals, unfilled roles,
loss of income, time required to manage the illness, decreases in
family socialization activities, and the costs of treatment. Family
members often become caregivers for the person with chronic
illness while trying to continue to work and keep the family intact.

Stress and caretaker fatigue are common with severe chronic
conditions, and the entire family may need care (Golics, Basra,
Salek, et al., 2013). However, some families are able to master the
treatment regimen and changes that accompany chronic illness as
well as make the treatment regimen a routine part of life.
Furthermore, they are able to keep the chronic illness from
becoming the focal point of family life.
• Home life: The day-to-day management of illness is largely the
responsibility of people with chronic disorders and their families
(Lorig et al., 2012). As a result, the home, rather than the hospital,
is the center of care in chronic conditions. Hospitals, clinics,
physicians’ offices, nursing homes, nursing centers, and community
agencies (home care services, social services, and disease-specific
associations and societies) are considered adjuncts or backup
services to daily home management.
• Self-management: The management of chronic conditions is a
process of discovery. People can be taught how to manage their
conditions. However, each patient must discover how their own
body reacts under varying circumstances—for example, what it is like
to be hypoglycemic, what activities are likely to bring on angina, and
how these or other conditions can best be prevented and managed.
• Collaborative process: Managing chronic conditions must be a
collaborative process that involves many different health care
professionals working together with patients and their families to
provide the full range of services that are often needed for
management at home. The medical, social, and psychological
aspects of chronic health problems are often complex, especially in
severe conditions.
• Health care costs: The management of chronic conditions is
expensive. Many of the expenses incurred by an individual patient
(e.g., costs for hospital stays, diagnostic tests, equipment,
medications, and supportive services) may be covered by health
insurance and by federal and state agencies. The Patient Protection
and Affordable Care Act (ACA), passed in 2010, the most significant
change to health care policy in the United States since the
establishment of Medicare and Medicaid, has made available
health insurance for many previously uninsured individuals who
were unable to obtain health insurance. The ACA has ended lifetime
and most annual limits on health care, provided patients with access
to recommended preventive services, and banned the practice of
denying coverage because of the presence of a preexisting health
condition (Krahn, Walker, & Correa-De-Araujo, 2015). Despite the
positive effects of the ACA, it has not changed the health care
delivery system and how health care is delivered.
• Lost income: Direct out-of-pocket expenses represent a significant
percent of income, especially in low- and middle-income families.
These expenses include high copays and deductibles that must be
paid out of pocket. Those with serious chronic disorders may have
difficulty paying for care, resulting in bankruptcy or having to rely
on family or friends to pay for health insurance or health care.
People from low-income groups who do not receive adequate
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health care get sicker and die sooner from chronic diseases than
those from groups with higher levels of education, greater financial
resources, and access to care (WHO, 2014a). If a family’s primary
income earner becomes ill, chronic diseases can result in drastic loss
in income with inadequate funds for food, education, and health
care. Furthermore, affected families may become unstable and
impoverished (WHO, 2014a).
• Ethical issues: Chronic conditions raise difficult ethical issues for
patients, families, health care professionals, and society.
Problematic questions include how to establish cost controls, how
to allocate scarce resources (e.g., organs for transplantation), and
what constitutes quality of life and when life support should be
withdrawn.
• Living with uncertainty: Having a chronic illness means living
with uncertainty. Although health care providers may be aware of
the usual progression of a chronic disease such as Parkinson disease
or multiple sclerosis, no one can predict with certainty a person’s
illness course because of individual variation. Even when a patient
is in remission or symptom free, he or she often fears that the illness
will reappear.
To understand what nursing care is needed for clients with chronic
disease, it is important to recognize and appreciate the issues that people
with chronic illness and their families contend with and manage, often
on a daily basis (Larsen, 2016). The challenges of living with chronic
conditions include the need to accomplish the following:
o Alleviate and manage symptoms
o Psychologically adjust to and physically accommodate
resulting disability
o Prevent and manage crises and complications
o Carry out regimens as prescribed
o Validate individual self-worth and family functioning
o Manage threats to identity
o Normalize personal and family life as much as possible
o Live with altered time, social isolation, and loneliness
o Establish networks of support and resources that can enhance
quality of life
o Return to a satisfactory way of life after an acute debilitating
episode (e.g., another myocardial infarction or stroke) or
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reactivation of a chronic condition
o Die with dignity and comfort
PHASES OF CHRONIC CONDITIONS
The Trajectory Model of Chronic Illness (Corbin and Strauss Model,
1991), a nursing model based on many years of interdisciplinary research
on chronic illness, is used to describe the (9) phases and the role of nurses
in the trajectory of chronic illness.
1. Pretrajectory
¾ Genetic factors or lifestyle behaviors that place a person or
community at risk for a chronic condition.

ü Refer for genetic testing and counseling if indicated; provide
education about prevention of modifiable risk factors and
behaviors
2. Trajectory onset
¾ Appearance or onset of noticeable symptoms associated with
a chronic disorder; includes period of diagnostic workup and
announcement of diagnosis; may be accompanied by
uncertainty as a patient awaits a diagnosis and begins to
discover and cope with implications of diagnosis.
ü Provide explanation of diagnostic tests and procedures and
reinforce information and explanations given by primary
provider; provide emotional support to patient and family.
3. Stable
¾ Illness course and symptoms are under control as symptoms,
resulting disability, and everyday life activities are being
managed within limitations of illness; illness management
centered in the home.
ü Reinforce positive behaviors and offer ongoing monitoring,
provide education about health promotion, and encourage
participation in health-promoting activities and health
screening
4. Unstable
¾ Characterized by an exacerbation of illness symptoms,
development of complications, or reactivation of an illness in
remission.
¾ Period of inability to keep symptoms under control or
reactivation of illness; difficulty in carrying out everyday life
activities.
¾ May require more diagnostic testing and trial of new
treatment regimens or adjustment of current regimen, with
care usually taking place at home.
ü Provide guidance and support; reinforce previous patient
education.
5. Acute
¾ Severe and unrelieved symptoms of the development of
illness complications necessitating hospitalization, bed rest,
or interruption of the person’s usual activities to bring illness
course under control.
ü Provide direct care and emotional support to the patient and
the family members.
6. Crisis
¾ Critical or life-threatening situation requiring emergency
treatment or care and suspension of everyday life activities
until the crisis has passed.
ü Provide direct care, collaborate with other health care team
members to stabilize patient’s condition.
7. Comeback
¾ Gradual recovery after an acute period and learning to live
with or overcome disabilities and return to an acceptable way
of life within the limitations imposed by the chronic condition
or disability; involves physical healing, limitations stretching
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through rehabilitative procedures, psychosocial coming-to-
terms, and biographical reengagement with adjustments in
everyday life activities.
ü Assist in coordination of care; rehabilitative focus may require
care from other health care providers; provide positive
reinforcement for goals identified and accomplished
8. Downward
¾ Illness course characterized by rapid or gradual worsening of
a condition; physical decline accompanied by increasing
disability or difficulty in controlling symptoms; requires
biographical adjustment and alterations in everyday life
activities with each major downward step.
ü Provide home care and other community-based care to help
patient and family adjust to changes and come to terms with
these changes; assist patient and family to integrate new
treatment and management strategies; encourage
identification of end-of-life preferences and planning.
9. Dying
¾ Final days or weeks before death; characterized by gradual or
rapid shutting down of body processes, biographical
disengagement and closure, and relinquishment of everyday
life interests and activities.
ü Provide direct and supportive care to patients and their
families through palliative care or hospice programs.
APPLYING THE NURSING PROCESS USING THE PHASES OF THE
CHRONIC ILLNESS SYSTEM
The focus of care for patients with chronic conditions is determined
largely by the phase of the illness and is directed by the nursing process,
which includes assessment, diagnosis, planning, implementation, and
evaluation.
Step 1: Identifying Specific Problems and the Trajectory Phase
• The first step is assessment of the patient to determine the specific
problems identified by the patient, family, nurse, and other health
care providers. Assessment is necessary to identify the specific
medical, social, and psychological problems likely to be
encountered by the patient and the family. For example, a patient
with early onset Parkinson disease or emphysema is likely to have
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very different issues compared to a patient with advanced Parkinson
disease or end-stage chronic obstructive pulmonary disease. The
types of direct care, referrals, education, and emotional support
needed in each situation are different as well. In addition, because
complementary and alternative therapies are often used by people
with chronic illness across the age spectrum (Ho, Rowland-Seymour,
Frankel, et al., 2014), the assessment should address the patient’s
use of these therapies or regimens.
Step 2: Establishing and Prioritizing Goals
• Once a patient’s specific medical problems and related social and
psychological problems are identified, the nurse helps prioritize
these and establish the goals of care. Goals must be a collaborative
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effort, with the patient, family, and nurse working together, and KEY DIFFERENCES (Acute disease vs Chronic disease):
they must be consistent with the abilities, desires, motivations, and Basis for
Acute diseases
resources of those involved. comparison
Definition Acute disease is a
Step 3: Defining the Plan of Action to Achieve Desired Outcomes
condition or a disorder condition or a disorder that
• Next, a realistic and mutually agreed-on plan for achieving the
that comes on or
patient’s goals is identified, along with specific criteria that will be
onsets rapidly and
used to assess the patient’s progress. Identifying the
lasts for a shorter
environmental, social, and psychological factors that might interfere
period of time.
with or facilitate achieving the desired outcome is important to
Appearance Acute diseases mostly The onset of chronic
guide planning.
appear suddenly.
Step 4: Implementing the Plan and Interventions Timespan Acute diseases last for Chronic diseases last for a
• Implementation of the plan might include nursing interventions a shorter time as
such as providing direct care, serving as an advocate for the patient, compared to chronic
educating, counseling, making referrals, and case management diseases.
(e.g., arranging for resources). These interventions should focus on Causes Infections by foreign
enabling the patient to live with the symptoms and therapies agents cause most
associated with chronic conditions, while gaining or maintaining acute conditions.
independence. Some diseases might
• The nurse works with the patient and the family to identify strategies even appear due to
to integrate treatment regimens into ADLs to promote (1) adherence accidents and misuse
to regimens to control symptoms and keep the illness stable and (2) of medication.
healthy responses to the psychosocial issues that can hinder illness Nature Most acute diseases
management and affect quality of life. Helping patients and their are communicable
families to implement regimens and to carry out ADLs within the and are caused by an
limits of the chronic condition is an important nursing role when infectious agent.
caring for patients with chronic disorders and their families.
Step 5: Following Up and Evaluating Outcomes Effects Acute diseases do not
• The final step involves following up to determine if the problem is have harmful health
resolving or being managed and if the patient and the family are effects.
able to adhere to the treatment plan. Follow-up may uncover new
problems resulting from the intervention, problems that interfere Relapse There are no periods
with the ability of the patient and the family to carry out the plan, or of relapse during the
previously unexpected problems. A primary goal is to maintain the disease as the time
stability of the chronic condition while preserving the patient’s span is shorter.
sense of control, identity, independence, and accomplishment. Onset of Symptoms associated
Alternative strategies or revisions to the initial plan may be Symptoms with acute diseases
warranted based on evaluation and follow-up. appear suddenly and
Chronic diseases
Chronic disease is a
persists for a longer period
of time or has long-lasting
health effects.
diseases is more gradual.
longer period of time.
Some might even be life-
long.
Causes of chronic diseases
are not always certain but
an unhealthy lifestyle and
diet often cause these
diseases.
Most chronic diseases are
non-communicable as no
infectious agent is
associated with the
disease.
Because chronic diseases
last for a longer time, it
causes long-term effects on
the health of the patient.
There might be multiple
periods of relapse during
the disease.
Symptoms of chronic
diseases might not appear
for a very long period of

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• Helping the patient and the family to integrate changes into their worsen over a short time.
lifestyle is an important part of the process. Change takes time, period.
patience, and creativity and often requires encouragement from the Symptoms Symptoms of acute Symptoms of chronic
nurse. Validation of the patient’s progress is important for diseases differ diseases might overlap,
enhancing self-esteem and reinforcing behaviors. If no progress is according to the and the common
made, or if progress toward goals seems too slow, it may be nature of the disease. symptoms like weight loss
necessary to redefine the goals, the intervention, or the time frame. and shortness of breath
The nurse must realize and accept that some people will not change. might be seen in most
Patients share responsibility for management of their conditions, chronic diseases.
and outcomes are as much related to their ability to accommodate Diagnosis Accurate diagnostic Accurate diagnosis tests
the illness and carry out regimens as they are to nursing tests are available for are not available for many
intervention (Lorig et al., 2012). many acute diseases. chronic diseases.
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Treatment Acute diseases can be Chronic diseases are rarely DETERMINANTS OF HEALTH
cured completely with cured with medicines.
the administration of Most medications available The DETERMINANTS of HEALTH are factors that influences a
appropriate dosages for chronic diseases only person’s health.
of drugs. functions to keep the o Income and social status
disease from getting o Social support networks
worse. Early detection of o Employment and working conditions
the disease might help o Physical environments
reduce severe outcomes. o Education
o Healthy child development
Prevention Different prevention Developing better
o Biology and genetic endowment
steps can be followed behavioral, lifestyle, and
for acute diseases. The dietary habits can be o Health services
prevention might employed to prevent o Personal health practice and coping skills
defer with the nature chronic diseases. Some The term ‘determinants of health’ was introduced in the 1970s and
of the disease. acute conditions might it refers to those factors that have a significant influence, whether positive
progress to become or negative, on health. The term should not imply a cause– effect
chronic, so proper relationship between a risk factor and a health status. Health is the result
treatment of acute diseases of multiple factors including those genetic, biological, and lifestyle
is also a method of factors relating to the individual and those factors relating to the structure
prevention. of society and its policies
Examples Typhoid, Jaundice, Diabetes, Cancer,
Individual Sociocultural Socioeconomic Environmental
Bone fracture, Burns, Tuberculosis, Arthritis, etc.
factors factors factors factors
Heart attack, Cholera, Knowledge Family Employment Access to
etc. Genetics Peers Education healthcare
Attitudes Media Income services and
Skills Religion technology
Personal Culture Geographical
characteristics location

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CULTURAL DIVERSITY AND
COMPETENCE
CULTURE
• Is the characteristics and knowledge of a particular group of
people, encompassing language, religion, cuisine, social
habits, music and arts.
• Shared patterns of behaviors and interactions, cognitive
constructs and understanding that are learned by socialization.
Thus, it can be seen as the growth of a group identity fostered
by social patterns unique to the group.
• Encompasses religion, food, what we wear, how we wear it, our
language marriage, music, what we believe is right or wrong,
how we sit at the table, how we greet visitors, how we behave
with loved ones, and a million other things.
• The arts and other manifestations of human intellectual
achievement regarded collectively; pattern of human activity
and the symbols that give significance to them
• The customs, arts, social institutions, and achievements of a
particular nation, people, or other social group.
• Varies across the different parts of the world but may have
similar characteristics
7 Major Characteristics of Culture:
1. Culture is shared
2. Culture is learned
3. Culture changes
4. Culture takes years to form
5. Culture cannot be isolated
6. Culture is essential
7. Culture is transmitted across generation
TAKE NOTE: CULTURE is a crucial determinant of health.
• Culturally based health beliefs explain what causes illness,
how illness can be cured or treated, who will be involved in care
and treatment, and when they will be involved.
• “The systematic neglect of culture in health is the single
biggest barrier to advancing the highest attainable standard of
health” (The Lancet Commission on Culture and Health)
Race is understood by most people as a mixture of physical, behavioral
and cultural attributes. Ethnicity recognizes differences between people
mostly on the basis of language and shared culture." (Bryce, E. 2020)
Race refers to physical differences that groups and cultures consider
socially significant, while ethnicity refers to shared culture, such as
language, ancestry, practices, and beliefs. (American Sociological
Association)
CULTURAL DIVERSITY
• Is about appreciating that society is made up of many different
groups with different interests, skills, talents and needs. It also
means recognizing that people in society can have differing
religious beliefs and sexual orientations.
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CULTURAL EQUALITY
• Is about people being treated fairly, equally and specifically to
their needs. It’s about inclusion regardless of race, gender,
disability, religion or belief, sexual orientation and age. It
encourages an environment that allows people from different
backgrounds to reach their full potential.
CULTURAL DISPARITY
• The variation across cultural traits such as knowledge, skill, and
belief
o Cultural disparities in healthcare can create a pattern
of inequality in maintaining or restoring the health
of a sector of the population.
o Cultural disparities in healthcare happen within a
mix of influences, including cultural incompetency,
social inequality, the structure and function of
communities of care, and the social conditions that
undermine or enhance well-being.
HEALTH DISPARITY
• Generally, refers to differences in the burden of illness, injury,
disability, or mortality experienced by one population group
relative to another group.
HEALTHCARE DISPARITY
• Refers to differences among groups in health coverage, access
to care, use of care, and quality of care.
• Factors that contribute to healthcare disparities worldwide
include culture, race, ethnicity, sex, gender identity, age,
disability, socioeconomic status, and geographic location.
HEALTH EQUITY
• means providing all people what they need to be healthy and
to optimize their quality of life.
Nurses as a healthcare worker must understand:
o That they must be aware of “multiculturalism” (recognize and
acknowledge the existence of multiple cultures.
o That they will be serving clients of diverse culture therefore
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must be culturally sensitive.
o Cultural sensitivity- being open to learning and accepting
cultural differences and similarities
o That cultural disparities in healthcare affect not only health but
also quality of life.
o That they have an obligation to be respectful and sensitive to
another’s belief system.
o That they should understand how their personal biases and
values influence communication with patients, families and
coworkers.
o That they must be culturally competent and comfortable with
those they serve.

CULTURAL INFLUENCES ON HEALTHCARE
Psychological Characteristics
Reactions to Pain
Gender roles
Language and communication
Orientation to space and time
Food and nutrition
Socioeconomic Factors
Spirituality and Religious Beliefs
Physiologic Characteristics
• Certain racial groups are more prone to specific diseases and
conditions.
o Keloids (Africans, Asians)
o Lactase deficiency and lactose intolerance (East
Asian Decent)
o Sickle cell anemia (African-American)
Psychological Characteristics
• In most situations, a person interprets the behaviors of another
person in terms of her or his own familiar culture.
Reactions to Pain
• Healthcare researchers have discovered that many of the
expressions and behaviors exhibited by people in pain are
culturally prescribed.
• Nursing care for patients in pain should be individualized, but
important culture- sensitive considerations include the
following:
o Recognize that culture is an important component of
individuality and that each person holds various
beliefs about pain
o Respect the patient’s right to respond to pain in
whatever manner is culturally and individually
appropriate
o Never stereotype a patient’s perceptions or
responses to pain based on the persons culture
Gender roles
• In many cultures either the man or woman is the dominant
figure and generally makes decisions for the family.
• Knowing who is the dominant member of the family is an
important consideration when planning nursing care.
o Because they mostly make decisions
Language and Communication
• To avoid misinterpretation of questions and answers, it is
important to use an interpreter who understands the
healthcare system.
• When caring for culturally and ethnically diverse patients, it is
important to perform a transcultural assessment of
communication.
Orientation to Space and Time
• Personal space is the area around a person regarded as part of
the person. This area, individualized to each person and to
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different cultures and ethnic groups, is the area others should
not intrude during personal interactions.
• Different cultures vary in being future, present, or past
oriented.
Food and Nutrition
• Food preferences and how foods are prepared are often related
to culture.
• Patients in a hospital or long-term care often do not have a
choice in foods. This can be a cause for weight and health
changes in a patient.
Socioeconomic Factors
• Research suggests that both physical and mental health are
associated with Socioeconomic status (SES).
• In particular, studies suggest that lower SES is linked to poorer
health outcomes. Poor health may in turn decrease an
individual’s capacity to work, thus reducing their ability to
improve their SES.
o Treat the patient the way you will treat a paying
client
o Refer them to the services that may assist them
Spirituality and Religious Beliefs
• Religious convictions may affect health care decision making.
• Spirituality may be a patient need and may be important in
patient coping.
CULTURALLY COMPETENT NURSING CARE
• Providing culturally competent care means that care is planned
and implemented in a way that is sensitive to the needs of
individuals, families, and groups from a diverse population
within society.
CULTURAL COMPETENCE
• The understanding of diverse attitudes, beliefs, behaviors,
practices, and communication patterns attributable to a variety
of factors (such as race, ethnicity, religion, SES, historical and
social context, physical or mental ability, age, gender, sexual
orientation, or generational and acculturation status).
• A health care provider is culturally competent when he/she is
able to deliver culturally appropriate and specifically tailored
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care to patients with diverse values, beliefs, and behaviors.
• Providing culturally competent care is an advocated strategy
for reducing heath disparities.
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COMPONENTS OF CULTURALLY COMPETENT CARE GUIDELINES FOR CARE

CULTURAL AWARENESS
• Involves self-examination of in-depth exploration of one's
cultural and professional background.
• This component begins with insight into one's cultural
healthcare beliefs and values.
• A cultural awareness assessment tool can be used to assess a
person's level of cultural awareness.
• Ex. Suicide
CULTURAL KNOWLEDGE
• Involves seeking and obtaining an information base on
different cultural and ethnic groups.
• This component is expanded by accessing information offered
through sources such as journal articles, seminars. Textbooks,
Internet resources, workshop presentations and university
courses.
CULTURAL SKILL
• Involves the nurse's ability to collect relevant cultural data
regarding the patients presenting problem and accurately
perform a culturally specific assessment.
• The Giger and Davidhizar model offer a framework for
assessing cultural, racial and ethnic differences in patients.
CULTURAL ENCOUNTER
• As the process that encourages nurses to directly engage in
cross-cultural interactions with patients from culturally diverse
backgrounds.
• Nurses increase cultural competence by directly interacting
with patients from different cultural backgrounds.
• This is an ongoing process: developing cultural competence
cannot be mastered.
CULTURAL DESIRE
• Refers to the motivation to become culturally aware and to seek
cultural encounters.
• This component involves the willingness to be open to others,
to accept and respect cultural differences and to be willing to
learn from others.
Cultural competency is a process and takes time. It involves
developing awareness, acquiring knowledge, and practicing skills. As
defined by Campinha-Bacote, the nurses should answer the following
questions when caring for culturally diverse patients:
§ Am I aware of my personal biases and prejudices toward
cultural groups different from mine?
§ Do I have the skill to conduct a cultural assessment in a
sensitive manner?
§ Do I have knowledge of the patient’s worldview?
§ How many encounters have I had with patients from diverse
cultural backgrounds?
§ What is my genuine desire to be culturally competent?
ACQUIRING CULTURAL COMPETENCE REDUCES THE
CHANCE OF STEREOTYPING
§ Starts with Awareness
§ Grows with Knowledge
§ Enhanced with Specific Skills
§ Polished through Cross-Cultural Encounters
ASK YOURSELF THESE QUESTIONS
§ Who are my patients, families and co-workers?
§ How can I learn about them?
§ What are my beliefs about this group?
ACQUIRE KNOWLEDGE OF THE CULTURAL VALUES, BELIEFS AND
PRACTICES OF YOUR CLIENTS
§ Ask questions
§ Listen
§ Account for language issues
§ Be aware of communication styles
BE SENSITIVE TO PERSONAL HEALTH BELIEFS AND PRACTICES
§ Special foods, drinks, objects or clothes
§ Avoidance of certain foods, people or places
§ Customary rituals or people used to treat the illness
§ Will the patient take medicine even when he/she doesn't feel

G.M.M.E. | A.J.E.F. | T.A.M.M. – MARILAG

Cultural Cultural Cultural Cultural sick?
Awareness Knowledge Sensitivity Competence § Is the patient taking other medicines or anything else to help
“Me-Centered” Knowledge Sensitivity Competence
Analysis Analysis Analysis Analysis him feel well?
What are my How are my values, Am I open to What adjustments § Who in the family makes decisions about health care?
values, beliefs, beliefs, norms, accepting and both in the way I
norms, customs, customs, traditions, respecting think and behave § Are illnesses treated at home or by a community member?
traditions, styles, styles, biases, differences? Why or do I need to make
biases, stereotypes, stereotypes, and why not? What are in order to
and behaviors? behaviors the same the challenges for BE SENSITIVE TO LANGUAGE BARRIERS
effectively operate
(Who am I?) or different from me?
in a different
“Other- others? Can I avoid cultural context? § Does the patient understand any English?
Centered” What additional assigning
Analysis cultural knowledge, judgments, be § Consider literacy level
What are other’s awareness, and/ better or worse, § Use visual aids and demonstrate procedures
values, beliefs, understanding do I right or wrong, to
norms, customs, need? cultural § Check understanding
traditions, styles, differences? Why or
biases, stereotypes, why not? § Is an interpreter necessary?
and behaviors?
 Medical-Surgical Nursing | NCM 0112

CONSIDER BODY LANGUAGE

§ Eye contact
§ T ouching
§ Personal space
§ Privacy/modesty

OTHER CULTURAL FACTORS TO CONSIDER

§ Gender
§ Wealth or social status
§ Presence of a disability
§ Sexual orientation

CONSIDER RELIGIOUS/SPIRITUAL FACTORS

Are there sensitivities/beliefs associated with:
§ Birth, death
§ Certain treatments, blood products
§ Prayer, medication and worship
§ Food preparation, clothing, special objects, and gender
practices

WAYS TO FACILITATE COMMUNICATION ACROSS

CULTURAL BOUNDARIES
1. Recognize differences
2. Build your self-awareness
3. Describe and identify, then interpret
4. Don’t assume your interpretation is correct
5. Verbalize your own non-verbal signs
6. Share your experience honestly
7. Acknowledge any discomfort, hesitation, or concern
8. Practice politically correct communication
9. Give your time and attention when communicating
10. Don’t evaluate or judge

It is because we are different that each of us is special.

G.M.M.E. | A.J.E.F. | T.A.M.M. – MARILAG

 ANGELES UNIVERSITY FOUNDATION
McArthur Highway, Angeles City, 2009
A.Y. 2020 – 2021
College of Nursing

Name: Gerick Maica M. Española Section: BSN III – A

Top 10 Leading Causes of Deaths in the World (2016)

Retrieved from: https://www.who.int/gho/mortality_burden_disease/causes_death/top_10/en/

Both Sexes Males Females Both Sexes Both Sexes

TOP
ALL Ages ALL Ages ALL Ages Ages 30 - 49 Ages 50-59
1 Ischemic heart disease Ischemic heart disease Ischemic heart disease HIV/AIDS Ischemic heart disease
2 Stroke Stroke Stroke Ischemic heart disease Stroke
Chronic obstructive Chronic obstructive Lower respiratory Trachea, bronchus, lung
3 Road injury
pulmonary disease pulmonary disease infections cancers
Lower respiratory Lower respiratory Chronic obstructive
4 Tuberculosis Cirrhosis of the liver
infections infections pulmonary disease
Alzheimer disease and Trachea, bronchus, lung Alzheimer disease and
5 Stroke Tuberculosis
other dementias cancers other dementias
Trachea, bronchus, lung
6 Road injury Diabetes mellitus Cirrhosis of the liver Diabetes mellitus
cancers
7 Diabetes mellitus Cirrhosis of the liver Diarrheal diseases Self-harm Road injury
Chronic obstructive
8 Road injury Tuberculosis Breast Cancer Interpersonal violence
pulmonary disease
9 Diarrheal diseases Diabetes mellitus Kidney diseases Maternal conditions Liver cancer
Alzheimer disease and Trachea, bronchus, lung Lower respiratory Lower respiratory
10 Tuberculosis
other dementias cancers infections infections