What should be included in a cultural assessment in the healthcare setting?
In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of cultural awareness and influences on health in order to: Show
Assessing the Importance of Client Culture and Ethnicity When Planning, Providing and Evaluating CareMadeleine Leininger was a nursing professor, theorist and anthropologist who is now considered to be the leader in terms of transcultural nursing. Madeleine Leininger's work relating to cultural care began in the 1950s, and she published her book "Culture Care Diversity and Universality: A Theory of Nursing" in 1991. Madeleine Leininger, herself, states that her theory is the only existing theory that "searches for comprehensive and holistic care data relying on social structure, worldview, and multiple factors in a culture in order to get a holistic knowledge base about care" (Leininger, 2006, p. 219) The purpose of transcultural nursing research is to study cultures in order to better understand both the similarities and the differences among patient groups and cultures. Culture is a set of established beliefs that are held by a certain group of people that has been handed down from generation to generation and not held and shared by other groups or the members of other groups. These beliefs, values and perceptions are unique to the particular culture. Nurses' practice must incorporate cultural needs and beliefs into their nursing practice to provide care that is individualized for the client and appropriate to the client's needs. During the assessment phase of the nursing process, the nurse assesses the client's and family member's cultural background, preferences and needs, after which the nurse modifies the plan of care accordingly. This cultural assessment and culturally oriented care enables the nurse to:
In the Transcultural Nursing Theory, nurses have a responsibility to understand the role of culture in the health of the patient. Not only can a cultural background influence a patient’s health, but the patient may be taking culturally driven home remedies that can affect his or her health, as well. Leininger proposes that care is the dominant, unifying and distinctive essence of nursing. Caring, a universal phenomenon is primarily culturally driven as based on the variations among cultures in reference to their process, patterns and expressions. Madeleine Leininger's theoretical thoughts also support three nursing modes of intervention that are necessary in order for nurses to care for, and assist, people of diverse cultures. These three nursing modes are:
In today’s health care field, nurses and other health care providers have the professional responsibility to be sensitive to their clients’ cultural backgrounds. This sensitivity is particular important and vital to the quality of care because culture is so integral and intrinsic to who the client is as a unique individual. Culture can greatly affect client health, as well as their reactions to treatments and care. Madeleine Leininger’s Transcultural Nursing Theory facilitates the nurses' understanding of why and how the patient’s cultural background is important to health. Recognizing Cultural Issues That May Impact on the Client's Understanding of and Acceptance of a Psychiatric DiagnosisCultural issues that may impact on the client's understanding and acceptance of a psychiatric mental health disorder and diagnosis are numerous and varied. For example, these cultural beliefs, values and practices can impact on the client's understanding and acceptance of a psychiatric mental health disorder and diagnosis among various cultures:
It must also be noted that psychiatric mental health professionals, including nurses, are affected and impacted by their own cultural beliefs, values and practices. It is, therefore, necessary that all health care providers eliminate their cultural biases towards clients with mental disorders and all other disorders and diseases; therefore, the nurse must recognize their own cultural biases and then overcome them with a full understanding, acceptance and respect for all clients regardless of their own integral cultural practices, values, beliefs and perceptions. Incorporating the Client's Cultural Practices and Beliefs When Planning and Providing CareIn addition to the cultural practices and beliefs that were discussed immediately above this section, culture also impacts on other areas of the client-nurse relationships. Some of these cultural influences include:
Culture is integral to the person as a unique individual. It impacts greatly on the client's health, and their reactions to treatments and care. Cultural beliefs, perspectives, values and practices are determined and assessed by the nurse, after which they are then integrated into the planning, implementation and evaluation of client care. All aspects of the direct and indirect care of the client is modified and changed according to the client's culture and cultural background. Additionally, all these cultural modifications must be documented as all other aspects of nursing care are. Respecting the Cultural Background and Practices of the ClientLike religious and spiritual beliefs, nurses remain respectful and accepting of all cultural beliefs, practices and perspectives, regardless of those that the nurse possesses. They must, additionally, overcome their own cultural biases by recognizing that they have them and then detaching from them as they plan and render client care to clients from diverse cultures. Using Appropriate Interpreters to Assist in Achieving Client UnderstandingAs previously mentioned in the "Integrated Process: Communication and Documentation" and the "Integrated Process: Teaching and Learning", interpreters and other aids such as large print and Braille reading materials, are used to facilitate the client's understanding of their health care status, their care and their treatments. Although at first glance a nurse may think of only a foreign language interpreter for those who do not have English as their primary language, it should not be forgotten that American Sign Language interpreters should, and can, be used among those clients who cannot gain their understanding of their health care status, their care and their treatments when the client is adversely affected with an auditory impairment. Evaluating and Documenting How the Client Language Needs Were MetInterpreters and the use of instructional materials in multiple languages often have to be used in order to accommodate for the clients' language barriers. These accommodations, like all other accommodations and modifications of care, are thoroughly documented. The most effective way to decide whether or not the client language needs were met is to assess whether or not the client has gained an understanding and insight into their health care status, their care and their treatments. Documentation in the medical record should include the client's level of comprehension, or lack thereof, and the modifications that were used to facilitate this comprehension using an interpreter and/or appropriate reading materials. What is a cultural assessment in healthcare?The Cultural Assessment
identifies patient beliefs, values, and practices that could assist or interfere with nursing interventions; helps the nurse better understand the patient and his/her frame of reference.
What are the 4 C's of cultural assessment?The 4 C's: Creativity, Culture, Contemplation, Community.
What is an example of cultural assessment?Here are some sample questions you might consider for a culture assessment: Does this company have a personal feeling where you can share personal details with others? Do management teams adapt well to changes in the organization? Do employees and management teams take risks to achieve better results?
Which four 4 components are included in the culturally competent model of care?This process began in 1991 when I conceptualized and named the model, “Culturally Competent Model Of Care.” In this first version, I identified four constructs of cultural competence: cultural awareness, cultural knowledge, cultural skill, and cultural encounters (figure 1, below).
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