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MODULE 1 Sex differences – can be observed at the level of chromosomes, gene

expression, hormones, immune system and anatomy (e.g. body size, and
Concepts in the Care of At Risk and sexual and reproductive anatomy).
Sick Adult Clients Gender – refers to the socially constructed norms, roles and relations of
and among women, men, boys and girls. Gender also refers to
HEALTH CARE SITUATIONS
expressions and identities of women, men, boys, girls and gender-
Global trend is a general development or change in a diverse people. Gender is inextricable from other social and structural
situation that affects many countries of the world. There are different determinants shaping health and equity and can vary across time and
areas being studied in the global trends, and one of which, and very place.
significant for those in the health care industry are health trends. Gender differences – and inequalities influence exposure to risk
“Health trends are constantly evolving, and so are health factors, health-seeking and risk-taking behaviors, access to and use of
systems. No health system is perfect, and all countries have people who health information; promotive, preventive, curative, rehabilitative and
are left behind. It is therefore important to accurately document the state palliative health services; and experience with health care, including in
of global health and how it is changing.”, says Dr Tedros Adhanom terms of access to and control over resources and power relations.
Ghebreyesus Director-General World Health Organization. It is in this Examples of gender-related factors resulting
light that the World Health Statistics started to document data annually in differential health outcomes:
since 2005. It has been publishing the World Health Organization’s
o Early pregnancy, including as a result of child marriage,
annual snapshot of the state of the world’s health. Since 2016, the World
increases girls’ risk of adverse health outcomes;
Health Statistics series has focused on monitoring progress toward the
o Due to the gender-based division of labor, men and women
Sustainable Development Goals (SDGs).
may be exposed to different risks for work-related injuries or
The 2019 edition contains the latest available data for the illnesses;
health-related SDG indicators. o Gender norms related to masculinity promote smoking and
The World health statistics 2019 summarizes recent trends alcohol use among men, while gender norms associating
and levels in life expectancy and causes of death, and reports on the smoking with women’s freedom and liberation are being
health and health-related Sustainable Development Goals (SDGs) and targeted to young women by the tobacco industry;
associated targets. Where possible, the 2019 report disaggregates data o Women’s access to health services may be limited by lack of
by WHO region, World Bank income group, and sex; it also discusses access to and control of household financial resources,
differences in health status and access to preventive and curative services, caregiving roles, and restrictions on their mobility; whereas
particularly in relation to differences between men and women. Where men’s use of health services may be influenced by masculinity
possible, it indicates the roles of sex as a biological determinant, and of norms in which seeking health care is not seen as manly; and
gender as a social construct, in accounting for the observed differences. o In addition to gender norms and roles, intersecting
The analyses presented are not exhaustive; nevertheless, it is hoped that discrimination based on gender identity contributes to
the report will raise awareness of some critical sex and gender differences transgender people experiencing high rates of stigma and
in health outcomes, highlight the importance of those differences in the discrimination including in health care settings, and a lack of
attainment of the SDGs, and encourage the roles of sex and gender appropriate services responding to their needs.
to be systematically taken into account when collecting data,
analyzing health situations, formulating policies and designing THE WORLD POPULATION TODAY
health programs. • The world population now stands at 7.8 billion inhabitants,

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having reached the 7 billion milestone in 2011. Demographers
SEX GENDER expect the 8 billion milestone in 2023, with global population
• Biological: XY or XX • Socially constructed and projected to reach 9 billion by 2037 and 10 billion by 2056. This
• Male/Female/Intersex enacted roles and behaviors growth is slightly faster than projections from just a few years ago.
• Chromosomes • Man/Woman/Other • World population currently grows at 1 percent annually, having
• Sex organs • Masculine/Feminine peaked at 2.1 percent in 1968. That annual growth rate is expected
• Hormones • Gender non-conforming to continue declining, reaching 0.5 percent by midcentury. The
current annual increase of world population is 81 million, lower
SEX – refers to the biological characteristics that define humans as female
than the peak level of 93 million in 1988. Annual additions are
or male. These sets of biological characteristics are not mutually exclusive,
projected to continue declining, reaching 48 million by 2050. Of the
because there are individuals who are born with physical or biological sex
nearly 2 billion increase in world population expected by
characteristics who do not fit the traditional definitions of female or male
midcentury, most will take place in less developed regions. Africa
(intersex).
leads, expected to add more than 1 billion people over the coming
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three decades, followed by Asia with about 650 million. Europe’s CAUSES OF DEATH
population, in contrast, is projected to decrease by 37 million over • There are several conditions that are related to the reduced life
this period. expectancy in males than in females.
• Sex Composition • The reduced life expectancy of males compared with that of females
o The world population’s sex composition has been is not due to a single or a small number of causes. Of the 40 leading
relatively balanced and stable over the past 70 years, with causes of death, 33 contribute more to reduced life expectancy in
a ratio of around 100 to 102 males for every 100 females. males than in females.
o Notable exceptions to that general pattern are China and • The top 3 conditions for men include (1) Ischemic Heart Disease,
India, whose population sex ratios are above 105, largely (2) Road Injury and (3) Cancers in Respiratory. For women on
due to sex-selective abortions of female fetuses. the other hand are (1) Breast Cancer, (2) Maternal Conditions
o Sex ratios at birth of most countries are around 105 males and (3) Cervical/Uterine Cancer.
per 100 females, yet the ratios have reached as high as
120 in China and 114 India in recent years. LIFE EXPECTANCY AND AGE OF DEATH
• Life expectancy and age of death varies greatly by country income
LIFE EXPECTANCY group. Life expectancy at birth in low-income countries (62.7 years)
“Women live longer than men, but the additional is 18.1 years lower than in high-income countries (80.8 years). In
years are not always healthy.” high-income countries, most of the people who die are old;
• Life Expectancy however, in low-income countries almost one in three deaths are of
o Refers to the number of years of a person can expect to children aged under 5 years.
live. • The differences in life expectancy between females and males are
o By definition, life expectancy is based on an estimate of smaller in low-income countries than in high income countries.
the average age that members of a particular population Communicable diseases, injuries and maternal conditions
group will be then when they die. (Ospina, 2017) contribute most to differences in life expectancy between females
o In 2019, more than 141 million children will be born: 73 and males in low-income countries, whereas
million boys and 68 million girls. Based on recent noncommunicable diseases (NCDs) contribute most to life
mortality risks the boys will live, on average, 69.8 years expectancy differences in high-income countries.
and the girls 74.2 years – a difference of 4.4 years. • Maternal deaths contribute more than any other cause to
o Life expectancy at age 60 years is also greater for women differences in life expectancy at birth between men and women.
than men: 21.9 versus 19.0 years. Between 2000 and Maternal deaths are concentrated in low-income countries, being
2016, global life expectancy at birth, for both sexes related primarily to lack of access to essential health services. The
combined, increased by 5.5 years, from 66.5 to 72.0 life expectancy of men is lower than that of women due to higher
years. mortality rates from most causes, particularly in higher-income
• Health Life Expectancy countries; in low income countries, the net effect of maternal
o The number of years lived in full health (HALE) – also conditions, breast and cervical cancer reduces the differences in life
increased over that period, from 58.5 years in 2000 to expectancy between men and women compared with high income
63.3 years in 2016. countries.
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). HEALTH-RELATED SUSTAINABLE DEVELOPMENT GOALS
However, the number of equivalent years of full

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(SGD) INDICATORS
health lost through living in poor health from birth
I. Global Trends
is also greater in women than in men (9.5 versus 7.8
• Globally, there have been improvements in most of the health-
years).
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 prevalence of tobacco use and higher per capita consumption of
statistics of two types: alcohol. In many settings, men use health services less than women,
o Primary data – data compiled by international agencies from even after taking into account reproductive- related consultations.
routine reporting by countries or publicly available sources The health gap between men and women is widest in high-income
such as demographic and health surveys; statistics are countries.
presented as they are reported or with modest adjustment
o Comparable estimates – country data are adjusted or DATA AVAILABILITY
modelled to allow comparisons among countries or over time. • The World health statistics 2019 report reviews, for the first time, the
availability of country data for global SDG reporting. This review
ESSENTIAL FINDINGS in the 2019 WHO STATISTICS OVERVIEW suggests that major improvements are needed to country data
What has improved? systems:
• Global life expectancy increased by 5.5 years to 72.0 years between o one in seven indicator country values included in the
2000 and 2016, and healthy life expectancy increased by 4.8 years report have had no underlying data since 2000; low and
to 63.3 years. lower-middle-income countries in particular lack
• Of 29 health-related SDG indicators for which global trends are underlying data;
reported, 24 have shown improvements in recent years. More births o for around one third of countries, over half of the
are attended by skilled health personnel, and women are less likely indicators have no recent underlying data;
to die in childbirth. Global targets to reduce neonatal deaths and o 11 health-related SDG indicators require cause-of-death
deaths in children aged under 5 years are on track, and childhood data, yet only around half of countries are able to register
stunting is in decline. Nonetheless, it is estimated that 303 000 more than 80% of adult deaths, and less than one third of
maternal deaths occurred globally in 2015 and that 5.4 million countries have high- quality data on cause of death; and
children aged under 5 years died in 2017. o sex disaggregation is currently available for less than half
• Vaccination coverage rates have increased while incidence rates for (11/28) of relevant health-related SDG indicators at
several infectious diseases, prevalence of tobacco smoking, global level where it would be of interest.
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.

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.
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• Acute diseases might affect or occur in all systems throughout the DEFINITION OF CHRONIC DISEASES OR CONDITIONS
body. But they only affect just one system at a time. • Chronic diseases or conditions are often defined as medical
• The treatment associated with acute diseases also differs depending conditions or health problems with associated symptoms or
on the nature of the disease. disabilities that require long-term management. No single
• Acute diseases like appendicitis, strep throat, and influenza do not definition for chronic disease exists, but it is generally accepted that
require hospitalization or intensive medical treatment. In contrast, chronic diseases are those that persist for months or years rather
diseases like pneumonia and acute myocardial infarction (heart than days or weeks (Goodman, Posner, Huang, et al., 2013). The
attack), although they are acute, do require immediate medical U.S. National Center for Health Statistics defines chronic disease as
attention and extended treatment. a condition lasting 3 or more months (Adams, Kirzinger, & Martinez,
• These diseases also do not commonly have long term health effects 2013) and the WHO (2014a) defines it as a long-lasting condition
and can be treated once and for all. that can usually be controlled but not cured. Definitions of chronic
• Sometimes, the diseases might be caused by a simple change in disease or chronic illness share the characteristics of being
diet like typhoid is caused by drinking polluted water, which can irreversible, having a prolonged course, and unlikely to resolve
simply be avoided by opting for a cleaner water source. spontaneously (Larsen, 2016). The specific chronic condition may be
a result of illness, genetic factors, or injury; it may be a consequence
CHRONIC DISEASE of conditions or unhealthy behaviors that began during childhood
• A condition or a disorder that persists for a longer period of time or and young adulthood.
has long-lasting health effects. • Chronic diseases or disorders are one of the major health and
• As in acute disease, chronic diseases cannot be defined by a development challenges of the 21st century because of their global
particular period of time and are mostly used while comparing them human, social, and financial consequences. Although chronic
to acute diseases. diseases affect all countries, their impact is more severe in low- and
• However, sometimes, a disease lasting for a period of 3 three middle-income countries (i.e., South American, African, and Asian
months is considered a chronic illness. countries), where the majority of premature deaths due to chronic
• The term ‘terminal’ disease is used for diseases that are chronic with diseases occur. Their impact is particularly devastating to poor and
high chances of ending with death because there are no effective vulnerable populations. Chronic diseases, also referred to as
medications available against them. noncommunicable diseases, cause more deaths than all other
• Chronic diseases tend to be more severe as they progress, which causes combined. Deaths due to chronic disease are expected to
occurs over a period of months and most years. increase globally from 38 million in 2012 to 52 million per year by
• Chronic diseases also affect multiple systems in the body and are 2030 (WHO, 2014a).
not always fully responsive to treatments. • Management of chronic conditions includes learning to live with
• Chronic conditions are often associated with non-communicable symptoms or disabilities and coming to terms with identity changes
diseases as the causes are mostly non-infectious. resulting from having a chronic condition. It also consists of carrying
• Most of these diseases are not caused by an infectious agent and are out the lifestyle changes and regimens designed to control
often caused due to poor lifestyle or health choices. symptoms and prevent complications. Although some people
• These are caused due to unhealthy behavioral and eating habits assume what might be called a “sick role” identity, most people with
persisting for an extended period of time. chronic conditions do not consider themselves to be sick or ill and
• Some chronic diseases might have a period of remissions or relapse try to live as normal a life as possible. Only when complications
during where the disease might be temporarily absent. develop or symptoms interfere with activities of daily living (ADLs)
• The risk factors associated with chronic diseases are different for do most people with chronic health conditions think of themselves

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different diseases, but some of the common risk factors include as being sick or disabled.
dietary, lifestyle, and metabolic factors.
• The severity of most chronic diseases is not fulminant. However, PREVALENCE AND CAUSES OF CHRONIC CONDITIONS
patients with chronic conditions become prone to acquiring fatal • Chronic conditions occur in people of every age group,
acute diseases. socioeconomic level, race, and culture. Seven of the 10 leading
• Because treatment is mostly not effective against chronic disease, causes of death in the United States are chronic diseases, with heart
prevention is considered to be more advantageous. disease and cancer together accounting for nearly half of all deaths.
• This can be achieved by regular screening for the existence of It is predicted that by the year 2030, about half the population will
predisposing factors which helps in early detection, severely have a chronic disease or disorder. One fifth of those with chronic
reducing the harmful outcomes. 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
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services) also increase. Expenditures for health care for people with 3. Solutions for chronic disease prevention and control are
one chronic condition account for 86% of the $2 trillion the United expensive and not feasible for low-and middle-income
States spends each year on health care (AHRQ, 2014). These costs countries.
represent four of every five health care dollars expended. The Þ A full range of chronic disease interventions are very cost-
worldwide economic burden associated with chronic disease is effective for all regions of the world, including the poorest.
estimated to be $47 trillion over the next two decades (Bloom, Many of these interventions are inexpensive to implement.
Cafiero, Jané-Llopis, et al., 2011). Chronic disease is increasing rapidly around the world,
• Although some chronic health conditions cause little or no including low-and middle-income countries.
inconvenience, others are severe enough to cause major activity
4. There is nothing that can be done and chronic diseases
limitations. When people with activity limitations are unable to
cannot be prevented.
meet their needs for health care and personal services, they may be
Þ The major cause of chronic diseases is known, and if the risk
unable to carry out their therapeutic regimens or have their
factors were eliminated, at least more than 80% of heart
prescriptions filled on time, may miss appointments and office visits
disease, stroke, and type 2 diabetes and more than 40% of
with their health care providers, and may be unable to carry out
cancers would be prevented.
ADLs.
• Chronic diseases are a global issue that affects both rich and poor 5. If individuals develop chronic disease as a result of
nations. Chronic conditions have become the major cause of unhealthy “lifestyles,” they have only themselves to
health- related problems in developed countries as well as blame.
in the developing countries, which are also trying to cope Þ Individual responsibility can have its full effect only if
with new and emerging infectious diseases. individuals have equal access to a healthy life and are
• In almost all countries, chronic diseases are the major cause of death supported to make healthy choices. Poor people often have
among adults. Four of every five deaths occur in countries limited choices about the food they eat, their living
characterized as low- or middle income, where people tend to conditions, and access to education and healthcare.
develop chronic diseases at younger ages, suffer longer, and die
6. Certain chronic diseases primarily affect men.
sooner than people in high-income countries. In contrast to
Þ Chronic diseases, including heart disease, affect women and
common belief, the total number of people dying from chronic
women almost equally. Almost half of all deaths attributed to
disease is twice that of patients dying from infectious (including
chronic illness occur in women.
human immunodeficiency virus infection), maternal, and perinatal
conditions, and nutritional deficiencies combined (WHO, 2014a; 7. Chronic diseases primarily affect old people.
2014b). The number of people worldwide who die because of Þ Almost half of chronic disease deaths occur prematurely in
chronic disease is higher than all other diseases combined. Most of people younger than 70 years.
these chronic diseases and complications of chronic illness are
8. Chronic diseases mainly affect rich (affluent) people.
preventable, emphasizing the importance of health promotion
Þ Poor people are much more likely that wealthy to develop
across the globe.
chronic diseases and as a result are more likely to die. Chronic
• Although chronic diseases or illnesses are common, people have
diseases cause substantial financial burden and result in
many myths or misunderstandings about them.
extreme poverty.

COMMON MISCONCEPTIONS AND REALITY 9. The priority of low and middle-income countries should be
1. Everyone dies of something. on control of infectious diseases.

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Þ Chronic illnesses typically do not result in sudden death but Þ Although infectious diseases are an issue, low and middle-
often result in progressive illness and disability. People with income countries are experiencing a dramatic increase in
chronic disease often die slowly, painfully, and prematurely. chronic disease risk factors and deaths, especially in urban
settings.
2. People can live to old age even if they lead unhealthy lives
(smoke, are obese). 10. Chronic diseases affect mostly high-income countries.
Þ While there are exceptions (some people who live unhealthy Þ Eighty percent of deaths attributed to chronic disease are in
lives live to old age, and some people who live healthy lives low and middle-income countries. The prevalence of chronic
develop chronic illnesses), most chronic illnesses can be diseases in low and middle-income countries is rapidly
traced to modifiable risk factors and can be prevented by growing.
eliminating these risks.
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Why is there an increasing number of chronic diseases? with it daily (Lorig et al., 2012). To properly manage their chronic
o A decrease in mortality from infectious diseases (e.g., condition, individuals often have to find the time, and the social and
smallpox, diphtheria, acquired immune deficiency syndrome financial resources, to participate in physically and psychologically
[AIDS]–related infections) and from acute conditions because beneficial activities, work with health care professionals to follow
of prompt and aggressive management of acute conditions treatment guidelines, monitor their health and make decisions about
(e.g., myocardial infarction, trauma). their health and lifestyle and that of their family, and manage the effects
o Lifestyle factors such as smoking, chronic stress, poor nutrition, of the illness on their physical, psychological, and social well-being. To
and sedentary lifestyle that increase the risk of chronic health relate to what people must cope with or to plan effective interventions,
problems such as respiratory disease, hypertension, nurses must understand the multiple characteristics of a chronic illness.
cardiovascular disease, and obesity. Although signs and • Psychological and social issues: Managing chronic illness
symptoms of chronic illness often first appear during older involves more than treating medical problems. Associated
age, risks typically begin earlier in life, even during fetal psychological and social issues must also be addressed, because
development. living for long periods with illness symptoms and disability can
o Obesity, often due to lifestyle issues, has become a major threaten identity, bring about role changes, alter body image, and
health issue across the lifespan and across the globe with disrupt lifestyles. These changes require continuous adaptation and
about 2 billion people overweight and one third of them accommodation, depending on age and situation in life. Each
obese. Obesity is no longer limited to high-income countries decline in functional ability requires physical, emotional, and social
but increasingly occurs in low- and middle-income countries. adaptation for patients and their families (Corbin, 2003).
The proportion of adults with a body mass index (BMI) of 25 or • Phases of illness: Chronic conditions usually involve many
greater increased between 1980 and 2013 from about 29% to different phases over the course of a person’s lifetime. There can be
37% in men and about 30% to 38% in women (Seidell & acute periods, stable and unstable periods, flare-ups, and
Halberstadt, 2015). remissions. Each phase brings its own set of physical, psychological,
o The increasing prevalence of obesity has increased the and social problems, and each requires its own regimens and types
incidence of heart disease, strokes, diabetes, and of management.
hypertension. Obesity also affects one’s self-esteem, • Therapeutic regimens: Keeping chronic conditions under control
achievement, and emotional state. requires persistent adherence to therapeutic regimens. Failing to
o Longer lifespans because of advances in technology and adhere to a treatment plan or to do so consistently increases the
pharmacology, improved nutrition, safer working conditions, risks of developing complications and accelerating the disease
and greater access (for some people) to health care. process. However, the realities of daily life, including the impact of
o Improved screening and diagnostic procedures enabled early culture, values, and socioeconomic factors, affect the degree to
detection and treatment of diseases, resulting in improved which people adhere to a treatment regimen. Managing a chronic
outcomes of management of cancer and other disorders. illness takes time, requires knowledge and planning, and can be
uncomfortable and inconvenient. It is not unusual for patients to
Physiologic changes in the body often occur before the appearance of
stop taking medications or alter dosages because of side effects that
symptoms of chronic disease. Therefore, the goal of emphasizing healthy
are more disturbing or disruptive than symptoms of the illness, or
lifestyles early in life is to improve overall health status and slow the
to cut back on regimens they consider overly time-consuming,
development of such disorders. Major risk factors for chronic disease,
fatiguing, or costly (Corbin, 2003).
which represent a growing challenge to public health, include
• Development of other chronic conditions: One chronic
unhealthy eating habits, decreased energy expenditure
disease can lead to the development of other chronic conditions.

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associated with a sedentary lifestyle, increasing age, and tobacco
Diabetes, for example, can lead to neurologic and vascular changes
use and alcohol consumption (WHO, 2014a). In addition, serious
that may result in visual, cardiac, and kidney diseases and erectile
psychiatric or mental illness puts people at greater risk for chronic
dysfunction. The presence of a chronic illness also contributes to a
illness than the general population and leads to higher morbidity and
higher risk of morbidity and mortality in patients admitted to the
mortality rates of chronic diseases (National Prevention Council, 2014).
intensive care unit with acute health conditions as well as greater
utilization of clinical services during hospitalization.
CHARACTERISTICS OF CHRONIC CONDITION
• Family life: Chronic illness affects the entire family. Family life can
Sometimes it is difficult for people who are disease free to understand
be dramatically altered as a result of role reversals, unfilled roles,
the profound effect that chronic illness often has on the lives of patients
loss of income, time required to manage the illness, decreases in
and their families. It is easy for health professionals to focus on the illness
family socialization activities, and the costs of treatment. Family
or disability itself while overlooking the person who has the disorder. In
members often become caregivers for the person with chronic
all illnesses, but even more so with chronic conditions, the illness cannot
illness while trying to continue to work and keep the family intact.
be separated from the person. People with chronic illness must contend
 Medical-Surgical Nursing | NCM 0112

Stress and caretaker fatigue are common with severe chronic health care get sicker and die sooner from chronic diseases than
conditions, and the entire family may need care (Golics, Basra, those from groups with higher levels of education, greater financial
Salek, et al., 2013). However, some families are able to master the resources, and access to care (WHO, 2014a). If a family’s primary
treatment regimen and changes that accompany chronic illness as income earner becomes ill, chronic diseases can result in drastic loss
well as make the treatment regimen a routine part of life. in income with inadequate funds for food, education, and health
Furthermore, they are able to keep the chronic illness from care. Furthermore, affected families may become unstable and
becoming the focal point of family life. impoverished (WHO, 2014a).
• Home life: The day-to-day management of illness is largely the • Ethical issues: Chronic conditions raise difficult ethical issues for
responsibility of people with chronic disorders and their families patients, families, health care professionals, and society.
(Lorig et al., 2012). As a result, the home, rather than the hospital, Problematic questions include how to establish cost controls, how
is the center of care in chronic conditions. Hospitals, clinics, to allocate scarce resources (e.g., organs for transplantation), and
physicians’ offices, nursing homes, nursing centers, and community what constitutes quality of life and when life support should be
agencies (home care services, social services, and disease-specific withdrawn.
associations and societies) are considered adjuncts or backup • Living with uncertainty: Having a chronic illness means living
services to daily home management. with uncertainty. Although health care providers may be aware of
• Self-management: The management of chronic conditions is a the usual progression of a chronic disease such as Parkinson disease
process of discovery. People can be taught how to manage their or multiple sclerosis, no one can predict with certainty a person’s
conditions. However, each patient must discover how their own illness course because of individual variation. Even when a patient
body reacts under varying circumstances—for example, what it is like is in remission or symptom free, he or she often fears that the illness
to be hypoglycemic, what activities are likely to bring on angina, and will reappear.
how these or other conditions can best be prevented and managed.
• Collaborative process: Managing chronic conditions must be a To understand what nursing care is needed for clients with chronic
collaborative process that involves many different health care disease, it is important to recognize and appreciate the issues that people
professionals working together with patients and their families to with chronic illness and their families contend with and manage, often
provide the full range of services that are often needed for on a daily basis (Larsen, 2016). The challenges of living with chronic
management at home. The medical, social, and psychological conditions include the need to accomplish the following:
aspects of chronic health problems are often complex, especially in o Alleviate and manage symptoms
severe conditions. o Psychologically adjust to and physically accommodate
• Health care costs: The management of chronic conditions is resulting disability
expensive. Many of the expenses incurred by an individual patient o Prevent and manage crises and complications
(e.g., costs for hospital stays, diagnostic tests, equipment, o Carry out regimens as prescribed
medications, and supportive services) may be covered by health o Validate individual self-worth and family functioning
insurance and by federal and state agencies. The Patient Protection o Manage threats to identity
and Affordable Care Act (ACA), passed in 2010, the most significant o Normalize personal and family life as much as possible
change to health care policy in the United States since the o Live with altered time, social isolation, and loneliness
establishment of Medicare and Medicaid, has made available o Establish networks of support and resources that can enhance
health insurance for many previously uninsured individuals who quality of life
were unable to obtain health insurance. The ACA has ended lifetime o Return to a satisfactory way of life after an acute debilitating
and most annual limits on health care, provided patients with access episode (e.g., another myocardial infarction or stroke) or

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to recommended preventive services, and banned the practice of reactivation of a chronic condition
denying coverage because of the presence of a preexisting health o Die with dignity and comfort
condition (Krahn, Walker, & Correa-De-Araujo, 2015). Despite the
positive effects of the ACA, it has not changed the health care PHASES OF CHRONIC CONDITIONS
delivery system and how health care is delivered. The Trajectory Model of Chronic Illness (Corbin and Strauss Model,
• Lost income: Direct out-of-pocket expenses represent a significant 1991), a nursing model based on many years of interdisciplinary research
percent of income, especially in low- and middle-income families. on chronic illness, is used to describe the (9) phases and the role of nurses
These expenses include high copays and deductibles that must be in the trajectory of chronic illness.
paid out of pocket. Those with serious chronic disorders may have 1. Pretrajectory
difficulty paying for care, resulting in bankruptcy or having to rely ¾ Genetic factors or lifestyle behaviors that place a person or
on family or friends to pay for health insurance or health care. community at risk for a chronic condition.
People from low-income groups who do not receive adequate
 Medical-Surgical Nursing | NCM 0112

ü Refer for genetic testing and counseling if indicated; provide through rehabilitative procedures, psychosocial coming-to-
education about prevention of modifiable risk factors and terms, and biographical reengagement with adjustments in
behaviors everyday life activities.
2. Trajectory onset ü Assist in coordination of care; rehabilitative focus may require
¾ Appearance or onset of noticeable symptoms associated with care from other health care providers; provide positive
a chronic disorder; includes period of diagnostic workup and reinforcement for goals identified and accomplished
announcement of diagnosis; may be accompanied by 8. Downward
uncertainty as a patient awaits a diagnosis and begins to ¾ Illness course characterized by rapid or gradual worsening of
discover and cope with implications of diagnosis. a condition; physical decline accompanied by increasing
ü Provide explanation of diagnostic tests and procedures and disability or difficulty in controlling symptoms; requires
reinforce information and explanations given by primary biographical adjustment and alterations in everyday life
provider; provide emotional support to patient and family. activities with each major downward step.
3. Stable ü Provide home care and other community-based care to help
¾ Illness course and symptoms are under control as symptoms, patient and family adjust to changes and come to terms with
resulting disability, and everyday life activities are being these changes; assist patient and family to integrate new
managed within limitations of illness; illness management treatment and management strategies; encourage
centered in the home. identification of end-of-life preferences and planning.
ü Reinforce positive behaviors and offer ongoing monitoring, 9. Dying
provide education about health promotion, and encourage ¾ Final days or weeks before death; characterized by gradual or
participation in health-promoting activities and health rapid shutting down of body processes, biographical
screening disengagement and closure, and relinquishment of everyday
4. Unstable life interests and activities.
¾ Characterized by an exacerbation of illness symptoms, ü Provide direct and supportive care to patients and their
development of complications, or reactivation of an illness in families through palliative care or hospice programs.
remission.
¾ Period of inability to keep symptoms under control or APPLYING THE NURSING PROCESS USING THE PHASES OF THE
reactivation of illness; difficulty in carrying out everyday life CHRONIC ILLNESS SYSTEM
activities. The focus of care for patients with chronic conditions is determined
¾ May require more diagnostic testing and trial of new largely by the phase of the illness and is directed by the nursing process,
treatment regimens or adjustment of current regimen, with which includes assessment, diagnosis, planning, implementation, and
care usually taking place at home. evaluation.
ü Provide guidance and support; reinforce previous patient
Step 1: Identifying Specific Problems and the Trajectory Phase
education.
• The first step is assessment of the patient to determine the specific
5. Acute
problems identified by the patient, family, nurse, and other health
¾ Severe and unrelieved symptoms of the development of
care providers. Assessment is necessary to identify the specific
illness complications necessitating hospitalization, bed rest,
medical, social, and psychological problems likely to be
or interruption of the person’s usual activities to bring illness
encountered by the patient and the family. For example, a patient
course under control.
with early onset Parkinson disease or emphysema is likely to have
ü Provide direct care and emotional support to the patient and

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very different issues compared to a patient with advanced Parkinson
the family members.
disease or end-stage chronic obstructive pulmonary disease. The
6. Crisis
types of direct care, referrals, education, and emotional support
¾ Critical or life-threatening situation requiring emergency
needed in each situation are different as well. In addition, because
treatment or care and suspension of everyday life activities
complementary and alternative therapies are often used by people
until the crisis has passed.
with chronic illness across the age spectrum (Ho, Rowland-Seymour,
ü Provide direct care, collaborate with other health care team
Frankel, et al., 2014), the assessment should address the patient’s
members to stabilize patient’s condition.
use of these therapies or regimens.
7. Comeback
¾ Gradual recovery after an acute period and learning to live Step 2: Establishing and Prioritizing Goals
with or overcome disabilities and return to an acceptable way • Once a patient’s specific medical problems and related social and
of life within the limitations imposed by the chronic condition psychological problems are identified, the nurse helps prioritize
or disability; involves physical healing, limitations stretching these and establish the goals of care. Goals must be a collaborative
 Medical-Surgical Nursing | NCM 0112

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 Chronic diseases
resources of those involved. comparison
Definition Acute disease is a Chronic 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 persists for a longer period
patient’s goals is identified, along with specific criteria that will be
onsets rapidly and of time or has long-lasting
used to assess the patient’s progress. Identifying the
lasts for a shorter health effects.
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. diseases is more gradual.
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 longer period of time.
such as providing direct care, serving as an advocate for the patient, compared to chronic Some might even be life-
educating, counseling, making referrals, and case management diseases. long.
(e.g., arranging for resources). These interventions should focus on Causes Infections by foreign Causes of chronic diseases
enabling the patient to live with the symptoms and therapies agents cause most are not always certain but
associated with chronic conditions, while gaining or maintaining acute conditions. an unhealthy lifestyle and
independence. Some diseases might diet often cause these
• The nurse works with the patient and the family to identify strategies even appear due to diseases.
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 Most chronic diseases are
management and affect quality of life. Helping patients and their are communicable non-communicable as no
families to implement regimens and to carry out ADLs within the and are caused by an infectious agent is
limits of the chronic condition is an important nursing role when infectious agent. associated with the
caring for patients with chronic disorders and their families. disease.
Step 5: Following Up and Evaluating Outcomes Effects Acute diseases do not Because chronic diseases
• The final step involves following up to determine if the problem is have harmful health last for a longer time, it
resolving or being managed and if the patient and the family are effects. causes long-term effects on
able to adhere to the treatment plan. Follow-up may uncover new the health of the patient.
problems resulting from the intervention, problems that interfere Relapse There are no periods There might be multiple
with the ability of the patient and the family to carry out the plan, or of relapse during the periods of relapse during
previously unexpected problems. A primary goal is to maintain the disease as the time the disease.
stability of the chronic condition while preserving the patient’s span is shorter.
sense of control, identity, independence, and accomplishment. Onset of Symptoms associated Symptoms of chronic
Alternative strategies or revisions to the initial plan may be Symptoms with acute diseases diseases might not appear
warranted based on evaluation and follow-up. appear suddenly and for a very long period of

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

• 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.
 Medical-Surgical Nursing | NCM 0112

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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 Medical-Surgical Nursing | NCM 0112

CULTURAL DIVERSITY AND

COMPETENCE
CULTURAL EQUALITY
• Is about people being treated fairly, equally and specifically to
CULTURE
their needs. It’s about inclusion regardless of race, gender,
• Is the characteristics and knowledge of a particular group of
disability, religion or belief, sexual orientation and age. It
people, encompassing language, religion, cuisine, social
encourages an environment that allows people from different
habits, music and arts.
backgrounds to reach their full potential.
• Shared patterns of behaviors and interactions, cognitive
constructs and understanding that are learned by socialization. CULTURAL DISPARITY
Thus, it can be seen as the growth of a group identity fostered • The variation across cultural traits such as knowledge, skill, and
by social patterns unique to the group. belief
• Encompasses religion, food, what we wear, how we wear it, our o Cultural disparities in healthcare can create a pattern
language marriage, music, what we believe is right or wrong, of inequality in maintaining or restoring the health
how we sit at the table, how we greet visitors, how we behave of a sector of the population.
with loved ones, and a million other things. o Cultural disparities in healthcare happen within a
• The arts and other manifestations of human intellectual mix of influences, including cultural incompetency,
achievement regarded collectively; pattern of human activity social inequality, the structure and function of
and the symbols that give significance to them communities of care, and the social conditions that
• The customs, arts, social institutions, and achievements of a undermine or enhance well-being.
particular nation, people, or other social group.
HEALTH DISPARITY
• Varies across the different parts of the world but may have
• Generally, refers to differences in the burden of illness, injury,
similar characteristics
disability, or mortality experienced by one population group
7 Major Characteristics of Culture: relative to another group.
1. Culture is shared
HEALTHCARE DISPARITY
2. Culture is learned
• Refers to differences among groups in health coverage, access
3. Culture changes
to care, use of care, and quality of care.
4. Culture takes years to form
• Factors that contribute to healthcare disparities worldwide
5. Culture cannot be isolated
include culture, race, ethnicity, sex, gender identity, age,
6. Culture is essential
disability, socioeconomic status, and geographic location.
7. Culture is transmitted across generation
HEALTH EQUITY
TAKE NOTE: CULTURE is a crucial determinant of health.
• means providing all people what they need to be healthy and
• Culturally based health beliefs explain what causes illness,
to optimize their quality of life.
how illness can be cured or treated, who will be involved in care
and treatment, and when they will be involved. Nurses as a healthcare worker must understand:
• “The systematic neglect of culture in health is the single o That they must be aware of “multiculturalism” (recognize and
biggest barrier to advancing the highest attainable standard of acknowledge the existence of multiple cultures.
health” (The Lancet Commission on Culture and Health) o That they will be serving clients of diverse culture therefore

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must be culturally sensitive.
Race is understood by most people as a mixture of physical, behavioral
o Cultural sensitivity- being open to learning and accepting
and cultural attributes. Ethnicity recognizes differences between people
cultural differences and similarities
mostly on the basis of language and shared culture." (Bryce, E. 2020)
o That cultural disparities in healthcare affect not only health but
Race refers to physical differences that groups and cultures consider also quality of life.
socially significant, while ethnicity refers to shared culture, such as o That they have an obligation to be respectful and sensitive to
language, ancestry, practices, and beliefs. (American Sociological another’s belief system.
Association) o That they should understand how their personal biases and
values influence communication with patients, families and
CULTURAL DIVERSITY
coworkers.
• Is about appreciating that society is made up of many different
o That they must be culturally competent and comfortable with
groups with different interests, skills, talents and needs. It also
those they serve.
means recognizing that people in society can have differing
religious beliefs and sexual orientations.
 Medical-Surgical Nursing | NCM 0112

CULTURAL INFLUENCES ON HEALTHCARE different cultures and ethnic groups, is the area others should
Psychological Characteristics not intrude during personal interactions.
Reactions to Pain • Different cultures vary in being future, present, or past
Gender roles oriented.
Language and communication Food and Nutrition
Orientation to space and time • Food preferences and how foods are prepared are often related
Food and nutrition to culture.
Socioeconomic Factors • Patients in a hospital or long-term care often do not have a
Spirituality and Religious Beliefs choice in foods. This can be a cause for weight and health
Physiologic Characteristics changes in a patient.
• Certain racial groups are more prone to specific diseases and Socioeconomic Factors
conditions. • Research suggests that both physical and mental health are
o Keloids (Africans, Asians) associated with Socioeconomic status (SES).
o Lactase deficiency and lactose intolerance (East • In particular, studies suggest that lower SES is linked to poorer
Asian Decent) health outcomes. Poor health may in turn decrease an
o Sickle cell anemia (African-American) individual’s capacity to work, thus reducing their ability to
improve their SES.
Psychological Characteristics
o Treat the patient the way you will treat a paying
• In most situations, a person interprets the behaviors of another
client
person in terms of her or his own familiar culture.
o Refer them to the services that may assist them
Reactions to Pain
Spirituality and Religious Beliefs
• Healthcare researchers have discovered that many of the
• Religious convictions may affect health care decision making.
expressions and behaviors exhibited by people in pain are
• Spirituality may be a patient need and may be important in
culturally prescribed.
patient coping.
• Nursing care for patients in pain should be individualized, but
important culture- sensitive considerations include the CULTURALLY COMPETENT NURSING CARE
following: • Providing culturally competent care means that care is planned
o Recognize that culture is an important component of and implemented in a way that is sensitive to the needs of
individuality and that each person holds various individuals, families, and groups from a diverse population
beliefs about pain within society.
o Respect the patient’s right to respond to pain in CULTURAL COMPETENCE
whatever manner is culturally and individually • The understanding of diverse attitudes, beliefs, behaviors,
appropriate practices, and communication patterns attributable to a variety
o Never stereotype a patient’s perceptions or of factors (such as race, ethnicity, religion, SES, historical and
responses to pain based on the persons culture social context, physical or mental ability, age, gender, sexual
Gender roles orientation, or generational and acculturation status).
• In many cultures either the man or woman is the dominant • A health care provider is culturally competent when he/she is
figure and generally makes decisions for the family. able to deliver culturally appropriate and specifically tailored

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• Knowing who is the dominant member of the family is an care to patients with diverse values, beliefs, and behaviors.
important consideration when planning nursing care. • Providing culturally competent care is an advocated strategy
o Because they mostly make decisions for reducing heath disparities.
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
 Medical-Surgical Nursing | NCM 0112

COMPONENTS OF CULTURALLY COMPETENT CARE GUIDELINES FOR CARE

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

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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