Chapter 10: Gastrointestinal System
Eunice Abudu
Background
Human anatomy is the same across the globe, despite the cultural variation in skin pigmentations, religions, dietary considerations, and socioeconomic status, which affects food access and security. Gastrointestinal/abdominal assessment correlates with dietary intake. Because diet is essentially a part of ethnicity, a patient’s culture must be considered in gathering subjective data in addition to the objective assessments.
The Social Determinants of Health in Relation to Gastrointestinal Health
- The research by Tarraf et al. (2017) stated that many Canadian immigrants arrive in a healthy state, then slowly decline within their first several years in Canada. One of the causes of this decline is diet and food insecurity (Terraf et al., 2017). Food insecurity, along with poor nutrition, can lead to obesity. Obesity, in turn, is a risk factor in developing heart disease, stroke, hypertension, diabetes, and various types of cancer (Tarraf et al., 2017). The physical and social determinants of health are therefore strongly related to food. The quality and quantity of food individuals consume greatly affects their health status, which is key to productivity and prosperity (Tarraf et al., 2017).
- Murphy (2017) asserted that food is medicine. It should be a part of health care and calls for action to leaders in health care to build healthy food and nutrition culture within institutions and across systems.
- In parts of the world where there is no free access to health care, individuals cannot visit the doctor’s office without a hefty cost involved. This deters low-income individuals from seeking medical attention. It also limits their access to teaching about health promotion and prevention, which leads to further discrimination against them.
Culturally Responsive Practice Points for Health Care Providers
- Health care providers (HCPs) should pay attention to the distinct cultural considerations in the relationship between abdominal assessment and dietary intake. Gbareen et al. (2021) stated that during a subjective nutritional assessment, HCPs should be aware of the influence of culture on the dietary intake of each patient.
- During hospitalization, nutrition plays a vital role in recuperation. Hospital food can appear unpalatable to racialized patients who are not familiar with (or don’t enjoy) Western foods. HCPs can encourage families and loved ones to bring nutritious, familiar foods for the patients to eat. This should be a collaborative process between the family and HCPs to ensure that any dietary restrictions related to the disease process are adhered to. The advantages and disadvantages of encouraging families to provide familiar foods are as follows:
- Advantage: Patients can enjoy their familiar, ethnic food while in hospital and maintain a nutritionally balanced diet. Patients may recover quicker due to balanced nutrition.
- Disadvantages: Ethnic foods can pose a challenge for patients with chronic diseases that require dietary restrictions. It can be difficult to determine the nutritional values and quantity of restricted elements like sodium, glucose, potassium, and vitamins in these foods. It is important to maintain strict dietary restrictions in cases of coronary artery diseases, kidney failure, and diabetes, to name a few. Most ethnic foods are not well known in the Western part of the world. Therefore, the nutritional values of these foods are not quantified. Neither are the sugars, sodium, and many other elements they contain. Most immigrants do not cook using recipes and measurements, and unfamiliar foods cannot be accurately approved for dietary restrictions or benefits.
- It is important for HCPs to connect with patients and discuss their cultural preferences in regards to diet while they are in the hospital setting. There are many cultural dietary preferences (such as halal, kosher, vegetarian, and vegan) and periods of fasting to consider. If a patient is from a culture that practices fasting, it is important to understand how the fasting may impact the patient. Many cultures do exempt those with chronic or acute illnesses from fasting periods (Abolaban & Al Moujahed, 2017). It is essential for HCPs to discuss dietary preferences with the patients/families they encounter in an open and non-judgmental way. It is also essential for them to try to accommodate these needs to the best of the hospital’s ability.
- Acculturation poses challenges for immigrants and contributes to concerns about eating disorders such as anorexia and bulimia. These disorders may be taboo topics among immigrants and may not be openly discussed because of the mental health aspects involved.
References
Abolaban, H., & Al Moujahed, A. (2017). Muslim patients in Ramadan: a review for primary care physicians. Avicenna Journal of Medicine, 7(03), 81–87.
Gbareen, M., Barnoy, S., & Theilla, M. (2021). Subjective and objective nutritional assessment: nurses’ role and the effect of cultural differences. BMC Nursing, 20(1), 1–10.
Murphy, T. (2017). The role of food in hospitals. HealthCareCAN. https://www.healthcarecan.ca/wp-content/themes/camyno/assets/document/Reports/2017/HCC/EN/RoleofFood_FinalEN.pdf
Tarraf, D., Sanou, D., & Giroux, I. (2017). Immigration and food insecurity: The Canadian experience—a literature review. In I. Muenstermann (Ed.), People’s movements in the 21st century: Risks, challenges and benefits (pp. 37–53). InTech.