if nurses do not understand the client’s

cultural rules in communication, the

Lesson 2: TRANSCULTURAL NURSING
client’s acceptance of a treatment
regimen may be jeopardized.
CULTURAL ASSESSMENT
-​ Accurate diagnosis treatment is
●​ A cultural nursing assessment is a
impossible if the healthcare professional
systematic way to identify the beliefs,
cannot understand the patient.
values, meanings, and behaviors of people
while considering their history, life -​ Culture not only determines the
experiences, and social and physical appropriateness of the message but also
environments. influences all the components of
communication.
PRINCIPLE OF CULTURAL ASSESSMENT
1. Dominant characteristics -​ Thus, an assessment of communication
2. Organizational leadership should consider:
3. Management of employees/patients 1.​ Dialect
4. Sources of connection 2.​ Style
5. Strategies and tactics 3.​ Volume, including silence
6. Definition of success 4.​ Touch
5.​ Context of speech or emotional
GIGER AND DAVIDHIZAR’S TRANSCULTURAL
tone, and
ASSESSMENT MODEL
6.​ Kinesics, including gestures,
-​ Is viewed as a culturally competent
stances, and eye behaviour
practice field that is client centered and
research focused. 2. SPACE
-​ To deliver culturally sensitive care, the
nurse must remember that everyone is -​ Refers to the distance between individuals
unique and a product of past experiences, when they interact. All communication
beliefs, and values that have been learned occurs in the context of space.
and passed down from one generation to
-​ There are four distinct zones of
the next.
interpersonal space:
SIX CULTURAL PHENOMENA
1.​ Intimate zone (extends up to 1 ½ ft)
1. Communication
2.​ Personal distance (extends up to 1 ½ - 4 ft)
2. Space
3.​ Social distance (extends from to 4 - 12 ft)
3. Social Organization
4.​ Public distance (extends 12 ft or more)
4. Time
5. Environmental Control 3. ​ SOCIAL ORGANIZATIONS
6. Biological Variations
-​ Refers to the social group organizations
1.​ COMMUNICATION with which clients and families may
-​ means by which culture is transmitted and identify.
preserved. Both verbal and nonverbal
communications are learned in one’s 4. ​ TIME ORIENTATION
culture.
-​ An important aspect of interpersonal
-​ Verbal and nonverbal patterns of
communication. Some cultures are
communication vary actions cultures, and
 considered future oriented, others CULTURAL VALUES AND CARE MEANINGS AND
present oriented, and still others past ACTIONS
oriented.
ANGLO AMERICAN CULTURE (MAINLY US
-​ These differences in time orientation may MIDDLE AND UPPER CLASS)
become important in health-care
measures such as long-term planning and A. ​ CULTURE VALUES
explanations of medication schedules. -​ Individualism
-​ Independence and freedom
-​ Ex. Latin Americans, Native Americans, -​ Competition and achievement
and Middle Easterners are present -​ Materialism
oriented cultures and may neglect -​ Technology dependent
preventive health care measures. They -​ Instant time and actions
may show-up late or at all for -​ Youth and beauty
appointments. -​ Equal sex rights
-​ Leisure time highly valued possible
5. ENVIRONMENTAL CONTROL
-​ Reliance on scientific facts and numbers
-​ Refers to the ability of the person to -​ Less respect for authority and the elderly
control nature and to plan and direct -​ Generosity in time of crisis
factors in the environment.
B. CULTURE CARE MEANINGS AND ACTIONS
-​ Some groups perceive man as having MODES
mastery over nature; others perceive Self-reliance by:
humans to be dominated by nature, while -​ reliance on self
others see harmonious relationships -​ becoming as independent
between humans and nature. -​ reliance on technology

-​ Ex. Asians and Native Americans may Health Instructions

perceive that illness is a disharmony with -​ teach us not “to do” this care for self
other forces and that medicine is capable -​ give use the “medical” facts – ex.
of relieving the symptoms rather than medications – they ask the classifications
curing the disease. These groups are likely of the drug.
to look for naturalistic solutions, such as
herbs and hot and cold treatments to MEXICAN AMERICAN CULTURE
resolve or cure a cancerous condition. A. ​ CULTURE VALUES
-​ Extended family valued
6. BIOLOGICAL VARIATIONS
-​ Interdependence with kin and social
1.​ Body structure activities
2.​ Skin colour -​ Patriarchal (Machismo) – strong belief of
3.​ Other visible physical characteristics masculinity
4.​ Enzymatics and genetic variations -​ Exact time less valued
5.​ Electrocardiogram patterns -​ High aspect of authority at the elderly
6.​ Susceptibility to disease -​ Religion valued (many Roman Catholic)
7.​ Nutritional preferences and deficiencies -​ Native foods for well being
8.​ Psychological characteristics -​ Traditional folk care healers for folk
illnesses
 -​ Belief in hot – cold theory B. CULTURE CARE MEANINGS AND ACTIONS
MODES
B. ​ CULTURE CARE MEANINGS AND ACTIONS -​ Concern for my “brother and sisters”
MODES -​ Being involved
-​ Succorance (direct family aid) -​ Giving presence (physical)
-​ Involvement with extended family -​ Family support and “get together”
-​ Filial love/loving -​ Touching appropriately
-​ Respect for authority -​ Reliance on folk home remedies
-​ Mother as care decision maker -​ Rely on “Jesus to save us” with prayers
-​ Protective male care and songs
-​ Acceptance of God’s will – ex cancer
-​ Use folk care practices (they don’t NORTH AMERICAN INDIAN CULTURE
immediately seek on medical attentions)
-​ Healing with foods A. ​ CULTURE VALUES
-​ Touching -​ Harmony between land, people, and
environment
HAITIAN AMERICAN CULTURE -​ Reciprocity with “mother earth”
-​ Spiritual inspiration (spirit guidance)
A. ​ CULTURE VALUES -​ Folk healers (shamans)
-​ Extended family as support system -​ Practice culture rituals and taboos
-​ Religion – God’s will must prevail -​ Rhythmicity of the life with nature
-​ Reliance on folk foods and treatments -​ Authority of tribal elders
-​ Belief in hot - cold theory -​ Pride in cultural heritage and “nations”
-​ Male decision maker and direct caregivers -​ Respect and value for children
-​ Reliance on native language
HEALERS AND THEIR SCOPE OF PRACTICES
B. CULTURE CARE MEANING AND ACTION
MODES I.​ CULTURE/FOLK PRACTITIONER
A.​ HISPANIC
-​ Involve family for support -​ Family member
-​ Respect -​ Curandero
-​ Trust -​ Espiritualista or spiritualist
-​ Succorance -​ Yerbero
-​ Touching -​ Sabador
-​ Reassurance B.​ BLACK
-​ Old lady
AFRICAN AMERICAN CULTURE
-​ Spiritualist
A. CULTURE VALUES -​ Voodoo priest or
-​ Extended family networks C.​ CHINESE
-​ Religion valued (many are Baptists) -​ Herbalist
-​ Interdependence with “blacks” -​ Acupuncturist
-​ Daily survival D.​ AMISH
-​ Technology valued e.g. radio, car -​ Braucher or Baruch - doctor
-​ Folk foods -​ Lay midwives (no training)
-​ Folk healing modes E.​ GREEK
-​ Music and physical activities -​ Magissa, “magician”, bonesetters
 -​ Priest (Orthodox) -​ African American - browneyes
F.​ NATIVE AMERICANS -​ Scandinavian - blue eyes
-​ Shaman
-​ Crystal gazer hand trembler 6. MUSCULOSKELETAL SYSTEM
(Navajo)
-​ African American - long bones narrower
BIOCULTURAL DIFFERENCE IN THE PHYSICAL and denser than the whites
EXAMINATION -​ Asians - below than the white Americans

1.​ GENERAL APPEARANCE CLINICAL DECISION MAKING AND NURSING

-​ Client’s dress for the following ACTIONS
groups:
-​ According to Leininger suggest 3 major
Amish (solid colors, use of snaps or pins modalities to guide nursing judgement:
instead of buttons, bonnets cover the 1.​ Cultural Preservation
heads of the women) -​ refers to “assistive, supporting,
facilitative or enabling professional
India - wear saris
actions and decisions that help
Arab - Muslim men - wear kafias (cloth people of culture to retain or
headdress) preserve relevant care values.

Church of Jesus Christ of Latter - Day 2.​ Cultural care accommodation and/or
Saints (Mormons) wear special white negotiation
underwear called temple garments. -​ Refers to “those assistive,
supporting, facilitative or enabling
2. SKIN creative professional actions and
decisions that help people of a
-​ Mongolian spots designated culture to adapt to or
-​ Jaundice negotiate to, or satisfying health
-​ Pallor outcomes with professional care
-​ Erythema providers.
-​ Petechiae 3.​ Cultural care repatterning and/or
restructuring
3. SECRETIONS
-​ refers to those assistive,
-​ Most Asians and native Americans have supporting, facilitative enabling
mild to absent body odor creative professional actions and
-​ White and African Americans tend to decisions that help people of
have a strong body odor. designated culture to reorder,
change or greatly modify their
4. HAIR lifeways for new while respecting
the clients cultural values and
-​ African Americans - fragile and long and
beliefs.
straight, thick and kinky.
-​ Asians - straight and silky hair.

5. EYES