What is a cultural nursing assessment?

Cultural Assessment

Cultural nursing assessment refers to a systematic appraisal or ex-amination of individuals, families, groups, and communities in terms of their cultural beliefs, values, and practices. The purpose of such an assessment is to provide culturally competent care (Giger & Davidhizar, 1999). In an effort to establish a database for determining a patient’s cultural background, nurses have de-veloped cultural assessment tools or modified existing assessment tools (Spector, 2000; Leininger, 2001) to ensure that transcul-tural considerations are included in the plan of care. Giger and Davidhizar’s (1999) model has been used to design nursing care from health promotion to nursing skills activities (Giger & Davidhizar, 1999; Smith-Temple & Johnson, 2002). The infor-mation presented in this and the following general guide-lines can be used to direct the nurse’s assessment of culture and its influence on a patient’s health beliefs and practices.

•          What is the patient’s country of origin? How long has the patient lived in this country? What is the primary language and literacy level?

•          What is the patient’s ethnic background? Does he or she identify strongly with others from the same cultural back-ground?

·      What is the patient’s religion, and how important is it to his or her daily life?

·      Does the patient participate in cultural activities such as dressing in traditional clothing and observing traditional holidays and festivals?

·      Are there any food preferences or restrictions?

·       What are the patient’s communication styles? Is eye contact avoided? How much physical distance is maintained? Is the patient open and verbal about symptoms?

·      Who is the head of the family, and is he or she involved in decision making about the patient?

·      What does the patient do to maintain his or her health?

·       What does the patient think caused the current problem?

·       Has the advice of traditional healers been sought?

·       Have complementary therapies been utilized?

·      What kind of treatment does the patient think will help? What are the most important results he or she hopes to get from this treatment?

·      Are there religious rituals related to health, sickness, or death that the patient observes?

Additional Cultural Considerations: Know Thyself

Because the nurse–patient interaction is the focal point of nurs-ing, nurses should consider their own cultural orientation when conducting assessment of the patient and the patient’s family and friends.

•          Know your own cultural attitudes, values, beliefs, and practices.

•          Regardless of “good intention,” everyone has cultural “bag-gage” that ultimately results in ethnocentrism.

•          In general, it is easier to understand those whose cultural heritage is similar to our own, while viewing those who are unlike us as strange and different.

•          Maintain a broad, open attitude. Expect the unexpected. Enjoy surprises.

•          Avoid seeing all people as alike; that is, avoid cultural stereo-types, such as “all Chinese like rice” or “all Italians eat spaghetti.”

•          Try to understand the reasons for any behavior by discussing commonalities and differences.

•          If a patient has said or done something that you do not un-derstand, ask for clarification. Be a good listener. Most pa-tients will respond positively to questions that arise from a genuine concern for and interest in them.

•          If at all possible, speak the patient’s language (even simple greetings and social courtesies will be appreciated). Avoid feigning an accent or using words that are ordinarily not part of your vocabulary.

•          Be yourself. There are no right or wrong ways to learn about cultural diversity.

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Genetics Perspectives in Nursing

Human genome discoveries have ushered in a new era of medicine, genomic medicine, which recognizes that multiple genes work in concert with environmental influences to cause disease. Genomic medicine aims to improve predictions about individuals’ susceptibility to diseases, the time of onset for those diseases, their extent and eventual severity, and which treatments or medications are likely to be most effective or harmful (Billings, 2000). Already, new gene-based strategies for disease detection, management, and treatment have been created, allowing health professionals to tailor care to an individual’s particular genetic make-up.To meet the challenges of genomic medicine, nurses need to understand the new technologies and treatments of gene-based health care. Nurses also must recognize that they are a vital link between patients and health care services; patients often turn to nurses first with questions about family history of risk factors, genetics information, and genetic tests and interpretations. Incorporating genetics into nursing means bringing a genetics framework to health assessments, planning, and interventions that supports identification of and response to individuals’ changing genetics-related health needs (Lea, Williams, Jenkins, et al., 2000).

Nurses must learn to recognize patterns of inheritance when obtaining family and medical histories and understand when it is appropriate to consider new gene-based testing and treatment options.

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A Framework for Integrating Genetics Into Nursing Practice

Nursing’s unique contribution to genomic medicine is its philosophy of holism. Nurses are ideally positioned to incorporate genetics into their assessments, planning, and interventions for patients at different ages and stages across the lifespan and in all settings. The holistic view that characterizes nursing takes into account each person’s intellectual, physical, spiritual, social, cultural, biopsychologic, ethical, and esthetic experiences while addressing genetics information, gene-based testing, diagnosis, and treatments. Thus, knowledge about genetics is basic to nursing practice (Lea, Anderson & Monsen, 1998).

A framework for integrating genetics into nursing practice in-cludes a philosophy of care that recognizes when genetics factors are playing a role or could play a role in an individual’s health. This means using family history and the results of genetics tests effectively, informing patients about genetics concepts, under-standing the personal and societal impact of genetics informa-tion, and valuing the privacy and confidentiality of genetics information.

A person’s response to genetics information, genetic testing, or conditions may be either disabling or empowering. Genetics in-formation may stigmatize individuals if it affects how they view themselves or how others view them. Nurses can help individu-als and families understand the genetic aspect of themselves and learn how genetic traits and conditions are passed on within fam-ilies and how genetic and environmental factors influence health and disease (Lea, Anderson & Monsen, 1998; Peters et al., 1999).

Nurses facilitate communication among family members, the health care system, and community resources; they offer valuable support by virtue of their continuity of care with patients and families. All nurses should be able to recognize when a client is asking a question related to genetics information and should know how to obtain genetics information by gathering family and health histories and conducting physical and developmental assessments. Being able to recognize a genetics concern allows the nurse to provide appropriate genetics resources and support to individuals and families (Lea, Jenkins & Francomano, 1998).

Key to nurses’ genetics framework is the awareness of one’s at-titudes, experience, and assumptions about genetics concepts and how these are manifested in one’s own practice. Chart 9-1 offers insights on how nurses can conduct periodic self-assessments.