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Lecture 7 Cultural Care Assessments for Congruent Competency Practices

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Objectives After the completion of this lecture the student will be able to: 1-Define the cultural assessment. 2-Dscribe the purpose of cultural assessment. 3-Discuss the characteristics of cultural assessment. 4-Identify the principles of cultural assessment. 5- Describe The Giger and Davidhizar’s transcultural assessment model.  
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Lecture 7 Cultural Care Assessments for Congruent Competency Practices Objectives After the completion of this lecture the student will be
able to: 1-Define the cultural assessment. 2-Dscribe the purpose of cultural assessment. 3-Discuss the characteristics of cultural assessment. 4-Identify the principles of cultural assessment. 5- Describe The Giger and Davidhizars transcultural assessment model. INTRODUCTION One of the greatest challenges for nurses is to discover how culturally based care factors can make a difference in providing meaningful appropriate and satisfying health care to those served. To achieve this goal, nurses need knowledge and skill todo culturological health care assessments.The nurse keep in mind the central goal of assessment toprovide culturally congruentspecific and meaningful care to individuals families special groups or subculture being served. Definition of Cultural Care Assessment
Cultural care assessments refer to the systematic identification and documentation of culture care beliefs, meanings, values, symbols, and practices of individuals or groups within a holistic perspective, which includes the worldview, life experiences, environmental context, ethno- history. Culturally based care assessments are directed toward obtaining a holistic or comprehensive picture of informants with their particular factors that are meaningful and important to them. Purposes of a culture care assessment
1-To discover the client's culture care and health patterns and meanings in relationto the client's world view, lifeway's, cultural values, beliefs, practices, context, and social structure factors. 2-To obtain holistic culture care information as a sound basis for nursing caredecisions and actions. 3-To discover specific culture care patterns, meanings, and values that can be usedto make differential nursing decisions that fit the client's values and life ways. 4-To discover what professionalknowledge can be helpful to the client. 5-To identify potential areas of cultural conflicts, clashes, and neglected areas resulting from emic and etic value differences between clients and professionalhealth personnel PRINCIPLES FOR CULTURALOGICAL ASSESSMENT
1- To show a genuine and sincere interest the client as one listens to and learns from theclient. 2-To give attention to gender or class differences, communication modes (with special language terms), and interpersonal space. 3-To study the Sunrise model dimensions and Culture Care theory before doing theassessment. 5- To draw on and use different components of the Sunrise Model and theirinterrelationships. 4-For an effective culture care assessment is that the nurse needs to remain fully aware ofone's own cultural biases and prejudices. 5-To guide the nurse in doing a culturalogical assessment is to be aware that clients may belong to subcultures or special groups such as the homeless. GIGER AND DAVIDHIZERS TRANSCULTURAL ASSESSMENT MODEL
METAPARADIGM FOR THE GIGER AND DAVIDHIZAR MODEL includes: (1)Transcultural nursing / culturally diverse nursing. (2) Culturally unique individuals. (3) Culturally sensitive environments. (4) Health and health states based on culturally specific illness and wellness behaviors. The Giger and Davidhizars Transcultural Assessment Model
NURSING Assessment Cultural unique individual Communication Space Biological variations Environment Control Time Social organization FIG.1 Application of cultural phenomena to nursing care and nursing practice. The Giger and Davidhizars Transcultural Assessment Model
Communication language spoken Voice quality Pronunciation Use of silence Use of nonverbal Nursing Assessment Summarize date obtained Cultural unique individual Clients cultural and racial identification Place of birth Time in country Space Degree of comfort observed (conversation) Proximity to others Body movement Perception of space Biologic variations Body structure Skin color Hair color Other physical dimensions Enzymatic and genetic existence of disease specific to populations susceptibility to illness and disease Nutritional preferences and deficiencies Psychologic characteristics coping Environmental control Culture health practicesefficacious neutral dysfunction uncertain Values Definition of health and illness Time Use of Measures Definition Social time work time Time orientation Future Present Past Social organization Culture Race Ethnicity Family role function Work Leisure Church Friends FIG.2 GIGER AND DAVIDHIZARS TRANSCULTURAL ASSESSMENT MODEL Communication -Communication is the means by which culture is transmitted andpreserved. -Both verbal and nonverbal communications are learned in onesculture.-Verbal and nonverbal patterns of communication vary acrosscultures. -If nurses do not understand the clients cultural rules incommunication, the clients acceptance of a treatment regimen maybe jeopardized. -Accurate diagnosis and treatment is impossible if the health-careprofessional cannot understand the patient. Communication -When the provider is not understood, he or she often avoids verbalcommunication and does not realize the effect of nonverbalcommunication, which is all too often the painful isolation of patientswho do not speak the dominant language and who are in an unfamiliar environment. -Consequently, the patient experiences cultural shock and may reactby withdrawing, becoming hostile or argumentative, or beinguncooperative. Communication Culture not only determines the appropriateness of the message but also influences all the components of communication Thus, an assessment of communication should consider 1. Dialect. 2. Style. 3. Volume, including silence. 4. Touch. 5. Context of speech or emotional tone Kinesics (including gestures, posture, and eye behaviour) Communication -Communication is the means by which culture is transmitted andpreserved. -Both verbal and nonverbal communications are learned in onesculture.-Verbal and nonverbal patterns of communication vary acrosscultures. -If nurses do not understand the clients cultural rules incommunication, the clients acceptance of a treatment regimen maybe jeopardized. -Accurate diagnosis and treatment is impossible if the health-careprofessional cannot understand the patient. Communication Examples -Afghans can be expressive, warm, orientated to others, shy andmodest. Male-to-male communication is permissive whereas female- to-male communication is contraindicated unless with the husband,son, or father of the women involved.-Asians consider it disrespectful to look someone directly in the eye,especially if that person is a nurse, not because of disinterest ordishonesty. An Asian patient may avoid eye contact out of respect forthe superior status of the nurse. Communication Examples Many Middle Easterners see direct eye contact between a man and a woman as an invitation for love or emotional involvement - Knowing what the norm within the culture is will facilitate understanding and lessen miscommunication Space - Space refers to the distance between individuals when they interact - All communication occurs in the context of space There are four distinct zones of interpersonal space: 1. Inmate zone (extends up to 1 feet) 2. Personal distance (extends from 1 to 4 feet) 3. Social distance (extends from 4 to 12 feet) 4. Public distance (extends 12 feet or more) Space - Rules concerning personal distance vary from culture to culture - The extreme modesty practiced by members of some cultural groups may prevent members from seeking preventive health care - For instance, some Afghans prefer closeness in space with others and particularlywith the same sex. When comfortable with others, these individuals prefer to be inclose proximity to build trusting relationships - Particularly the comfort level is 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 from ones sphere of reference Social organization - The social environment in which people grow up and live plays an essential role in their cultural development and identification. - Children learn their cultures responses to life events from the family and its ethno-religious group. -This socialization process is an inherent part of heritage-cultural, religious, and ethnic background. - Social organization refers to the social group organizations with which clients and families may identify. - Family structure and organization, religious values and beliefs and role assignments may all relate to ethnicity and culture Social organization -Many social barriers, such as unemployment, underemployment,homelessness, lack of health insurance, and poverty can alsoprevent people from entering the health-care system For example, in the African-American culture, family may includeindividuals who are unrelated or remotely related -Members of families depend on the extended family and kinship networks for emotional and financial support in times of crises -Mothers and grandmothers play significant roles in African- American households and should be included in health caredecisions. Time Orientation -Time is an important aspect of interpersonal communication-Some cultures are considered future oriented, others presentoriented, and still others past oriented -People who are future-oriented are concerned with long-range goalsand with health-care measures in the present to prevent theoccurrence of illness in the future -They prefer to plan in making schedules, setting appointments, andorganizing activities -Others are oriented more to the present than the future and may be latefor appointments because they are less concerned about planning to beon time. Time Orientation -These differences in time orientation may become important inhealth-care measures such as long-term planning and explanations ofmedication schedules -For instance, most Afghans are more past and present than futuretime oriented, but generally they tend to follow two different timeconcepts -Another example is that Latin Americans, Native Americans, and Middle Easterners are present oriented cultures and may neglectpreventive health care measures hey may show-up late or not at all forappointments-United States and Canada tend to be future oriented Environmental control
-Environmental control refers to the ability of the person to controlnature and to plan and direct factors in the environment. -Some groups perceive man as having mastery over nature; othersperceive humans to be dominated by nature, while others seeharmonious relationships between humans and nature -This particular cultural phenomenon plays an extremely importantrole in the way patients respond to health-related experiences,including the ways in which they define an illness and seek and usehealth-care resources and social supports Environmental control
-For example, Asians and Native Americans may perceivethat illness is a disharmony with other forces and thatmedicine is only capable of relieving the symptoms ratherthan curing the disease -These groups are likely to look for naturalistic solutions,such as herbs and hot and cold treatments to resolve orcure a cancerous condition Biological variations
Biological variations are: 1. Body structure. 2. Skin colour. 3. Other visible physical characteristics. 4. Enzymatic and genetic variations. 5. Electrocardiographic patterns. 6. Susceptibility to disease. 7. Nutritional preferences and deficiencies. 8. Psychological characteristics. For instance, Western-born neonates are slightly heavier at birth than those born in non-Western cultures Application of the Model
-The Giger and Davidhizar Transcultural Assessment Model provides a process forassessing clients from differing cultures in order to be aware of differences and toplan appropriate strategies. -It was used to identify cultural beliefs from the six cultural phenomena previouslydescribed by Giger and Davidhizar. -This Model, which also included interview questions and observational guidelines,was used for structural interviews. -The model can enable the nurse in assessing individuals who are culturally diverse inorder to provide culturally competent care.-It is broad enough in scope to be applied by other health-care professions such asmedical imaging (professions of radiography, nuclear medicine, andultrasonography), dentistry, education and hospital administration. THANK YOU

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