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 the

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.

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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 Questions to ask or observations to make

use intimate or conversational space

Do they plan leisure time or leave it instructed >

face of it ?

What do they believe relieves pain best ?

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 What is the family religion ? Do they actually

practice their religion ?

What do they believe causes illness ?

Makes illness better ? Do they use alternative

therapies or established practices ?

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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