CULTURAL CARE ASSESSMENT FOR CONGRUENT COMPETENCY PRACTICE

The major focus : is to identify culture care beliefs ,values, patterns, expressions, and meanings related to the clients needs for obtaining or maintaining health or to face acute or chronic illness, disabilities, or death.

In cultural care assessment the nurse goes beyond assessment of physical, psycho . ,social, and mental aspects to include or tap the holistic or totality living and functioning dimensions. Nurses are taught in Trans- cultural nursing to use liberal arts and other broad areas of knowledge to get a realistic and accurate picture of people and their health needs or concerns

Purposes of a culture care assessment: To discover the clients culture care and

health patterns and meanings in relation to the clients worldview, life ways, cultural values, beliefs, practices, context, and social structure factors.

To obtain holistic culture care information as a sound basis for nursing care decisions and actions.

To discover specific culture care patterns,……, that can be used to make differential nursing decisions that fit the clients values and life ways and to discover what professional knowledge can be helpful to the client.

To identify potential areas of cultural conflicts, clashes, and neglected areas resulting from emic and etic value differences between clients and professional health personnel

To identify general and specific dominant themes and patterns that need to be known in context for culturally congruent care practices.

To identify comparative cultural care information among clients of different or similar cultures, which can be shared and used in clinical, teaching, and research practices.

To identify both similarities and differences among clients in providing quality care.

To use theoretical ideas and research approaches to interpret and explain practices for congruent care and new areas of Trans- cultural nursing knowledge for discipline users.

The sunrise model serves as a guide to cultural assessment .

The major areas for assessment are the following:

Cultural values, beliefs, and practices. Religious, philosophical, and spiritual

beliefs. Economic factors. Educational factors. Technological views. Kinship and social ties. Political and legal factors.

Caring rituals important to assess

Eating rituals Daily and nightly ritual care activities Sleep and rest ritual patterns Life cycle rituals are especially

crucial because they demonstrate patterns of caring for health, as well as illnesses and generic folk life ways

Nurse and hospital rituals

Leininger short culturalogical assessment guide

Phase 1 : Record observation of what you see, hear or experience with clients (includes dress and appearance, body condition features, language, mannerisms and general behavior, attitudes, and cultural features).

Phase 2 : Listen to learn from the client about cultural values, beliefs, and daily (nightly) practices related to care and health in the clients environmental context. Give attention to generic (home or folk) practices and professional nursing practices.

Phase 3 : identify and document recurrent client patterns and narratives (stories) with client meanings of what has been seen, heard or experienced.

Phase 4 : Synthesize themes and patterns of care derived from the information obtained in phase 1, 2, 3.

Phase5: Develop a culturally-based client-nurse care plan as co-participants for decisions and actions for culturally congruent care.

Principles for culturalogical assessment

TO show a genuine and sincere interest in the client as one listens to and learns to and learns from the client.

To give attention to gender or class differences, communication modes (with special language terms), and interpersonal space.

The nurse need to remain fully aware of ones own cultural biases and prejudices. If not aware about she will fall in a( cultural blindness)

To remain an active listener to fit client expectations and create a climate that is trusting so that the client feels it is safe and

beneficial to share ones beliefs and life ways.

Issues and behaviors should be considered in Trans- cultural assessment

1 .Transcultural Food behaviors Universal functions and uses of foods Food for biophysical needs: to provide essential

nutritional needs to help people maintain body functions and energy and survive. If infants and adults do not get sufficient basic food nutrients, signs of nutritional deficiencies, illnesses, inability to function, and even death occur. E.g. kwashiorkor ,caused by a protein-scarce diet.

every culture over time has developed what they believe are essential and preferred foods in their diet and also have patterned ways to prepare foods for children and adults.

foods for human relationships: in establishing and maintaining social and cultural relationships with friends, kinfolk, strangers, and others . food is a symbol to indicate special social and cultural patterns and to test or maintain relation ships. E.g. a ritual beverage break often serve as more than a nourishment or rest break.

Food has, a universal functions in all ceremonies and cultures for prestige, to exchange wealth, and to renew bonds of friendship, solidarity, and religious functions.

Food to assess interpersonal distance: to assess social relationships or interpersonal closeness or distance between people. Trans culturally and universally food use often reflects the social stratification of society and indicates which persons are to be respected or held in positions of higher authority or status.

Food to cope with stress and conflict; using food for coping with emotional stress conflicts, and traumatic life events.

Canadians, and Australians often rely on eating to relieve their stresses and in ways they may not be fully aware of until weight gain occur.

Food for rewards and punishment: rewarding children for good behavior are often by some kind of sweet.

Food to influence status: universal function of food is to influence the political and economic status of an individual or group. Serving food before, during, and after political meetings often leads to friendly and congenital outcome. Foods tends to soften political group behavior and ease questionable relationships.

Foods to treat and prevent illness: in many cultures food remains important to prevent and cure certain illnesses such as hypertension, D/M, peptic ulcers, coronary diseases, aging, and other conditions or disorders.

8. Generic food theories and uses: the hot and cold theory in non western countries and in ancient Greece with the desire to balance body fluids or humors between perceived hot and cold substances .

9. Cultural preferences: eating culturally desired foods can lead to a quicker recovery from illness and greater client satisfaction than when these clients are expected to eat strange or taboo food. Today , hospital staff need to be educated about cultural food likes and dislikes through in-service education and academic courses on Transcultural nutrition and health care.

10.Environmental influences: nurse knowledge about the peoples environment with an understanding of what foods are raised or available is important as one counsels clients about food resources and uses.

11 .Trans cultural communication modes

The nurse should understand the many verbal and nonverbal modes of many diverse cultures. This is an imperative today in this multicultural world. Nurses should speak at least two languages today. Body language expressions are forms of communication and are culturally patterned.

Kinesics is the term that refers to body movements communication modes, which include posture, facial expressions (smile or anger), gestures, eye contact, and other body features.

Proxemics: it refers to the use and perception of interpersonal or personal space in socio cultural interactions.

Finally, within the many areas of Tran cultural communication, a few pointers need to be given about the use of interpreters to get accurate assessments. The interpreter should knows the clients cultural language and knows the culture.

111 .Other determined culture behaviors

Space and distance; The amount of space they prefer between

themselves and others to feel comfortable is a culturally determined phenomenon.

Eye contact; Although most nurses are taught to maintain

eye contact when speaking with patients, people from some cultural backgrounds may prefer you don’t.

* Time and punctuality; Attitudes about time vary widely among cultures and

can be a barrier to effective communication between nurses and patients. Concepts of time and punctuality are culturally determined, as is the concept of waiting.

Touch; the meaning people associate with touching is culturally determined to a great degree. Some culture may prohibited from touching or examining certain parts of the female body; similarly, females may be prohibited from caring for males.

Holidays; people from all cultures celebrate civil and religious holidays. Expect to scheduled routine health appointments, diagnostic tests, surgery, and other major procedures to avoid such holidays. If their holiday rituals aren’t contraindicated in the health care setting, try to accommodate them.

Biologic variations; Along with psychosocial adaptations, you also need to consider cultures physiologic impact on how patients respond to treatment, particularly medications.

Environmental variations; various cultural groups have wide-ranging beliefs about mans relationship with the environment.