Cultural Factors
Biological Factors
Provider Culture
Healer Within

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Suggested Readings
(click on selection for reviews and more information)


Culture, Health and Illness
Cecil G. Helman;

Illness and Culture in the Postmodern Age David B. Morris


Healing Logics: Culture and Medicine in Modern Health Belief Systems


Pocket Guide to Cultural Assessment

Transcultural Health Care: A Culturally Competent Approach (Book with Diskette)

A Hospital Handbook on Multiculturalism and Religion by Neville A. Kirkwood



Assessment Measures

The assessment step of the nursing process is extremely important in inter ethnic relationships between patients and nurses. To gather data about a patient of a culture different from the nurse's, the nurse needs to view the patient in the contexts within which he exists. 
Giger and Davidhizer (1991) proposed six cultural phenomena that the nurse must understand to provide effective care for all patients: Communication , Space,  Social Organizations,  Time,  Environmental Control , Biological Variation. A Basic Cultural Assessment Model containing these six primary elements is presented here to help you gather the necessary data.

TransCultural Nursing Assessment Tool  -

Communication-  Miscommunication is a frequent problem in hospitals. The most obvious is when the patient and hospital staff do not speak the same language. Language problems can also occur among English speaking patients. In England, Australia and South Africa, the word "fanny" is a derogatory term referring to a woman's vagina. Imagine the reaction of a British woman when asked to prepare for a shot in the fanny.  But the more subtle problems are those that result from cultural differences in meanings of non verbal behavior. Many Asians consider it disrespectful to look someone directly in the eye, especially if that person is a nurse, not because of disinterest or dishonesty. An Asian patient may avoid eye contact out of respect for the superior status of the nurse. Many Middle Easterners see direct eye contact between a man and a woman as a sexual invitation. Knowing what is the norm within the culture will facilitate understanding and lessen miscommunication.
Space-  Particularly the comfort level related to personal space. - comfort in conversation, proximity to others, body movement, perception of space. Eye contact, space, and touch practices may be very different than your sphere of reference.

Social Organizations-  Patterns of cultural behavior learned through enculturation. Recognize and accept that individuals from culturally diverse backgrounds may desire varying degrees of acculturation into the dominant culture. Life cycle factors must be considered in interactions with individuals and families ( e.g. high value placed on the decision of elders, the role of eldest male or female in families, or roles and expectation of children within the family). Culture is determined not only by ethnicity but by factors such as geography, age, religion, gender, sexual orientation, and socioeconomic status. Understand that age and life cycle factors must be considered in interactions with all individuals and families.

Time-  Concept of the passage of time, duration of time, and points in time. Countries such as England and China seem to be past oriented. They value tradition, doing things the way they have always been done. Individuals from these countries might be reluctant to try new procedures. 
People from present oriented cultures tend to focus on the here and now. They may be relatively unconcerned with the future, they will deal with it when it comes. Latin Americans, Native Americans, and Middle Easterners are present oriented cultures and may neglect preventive health care measures. They may show-up late or not at all for appointments. 

Environmental Control-  Abilities of persons to control nature.  Health practices, values, definitions of health and illness. 

Biological Variation-  Racially (see article on race) related body structure, skin color, hair texture, and other physical characteristics; enzymatic and genetic variations; electrocardiographic patterns; susceptibility to disease; nutritional preferences and deficiencies, and psychological characteristics. 

Consistent with the above mentioned cultural phenomena, Boyle and Andrews (1989) propose that nurses need to assess eight areas reflecting cultural variation, and encourage the nurse to gather the following data: 

  • History of the origins of the patients' culture. 

  • Value orientations, including view of the world, ethics, and norms and standards of behavior as well as attitudes about time, work, money, education, beauty, strength, and change. 
  • Interpersonal relationships, including family patterns, demeanor, and roles and relationships. 
  • Communication patterns and forms.
  • Religion and magic.
  • Social systems, including economic values, political systems, and educational patterns.
  • Diet and food habits.
  • Health and illness belief systems, including behaviors, decision making, and use of healthcare providers. 



Boyle JS, Andrews MM: Transcultural Concepts in Nursing Care. Glenview, IL, Scott, Foresman/Little, Brown College Division, 1989
Giger JN, Davidhizar RE: Transcultural Nursing: Assessment and Intervention. St. Louis, CV Mosby, 1991

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