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Population Health for Nurses

22.3 Cultural Assessment

Population Health for Nurses22.3 Cultural Assessment

Learning Outcomes

By the end of this section, you should be able to:

  • 22.3.1 Assess how different cultures, customs, and social and health care practices impact nursing care to enhance cultural sensitivity and promote delivery of compassionate care.
  • 22.3.2 Perform a cultural assessment to promote cultural sensitivity and humility in practice.
  • 22.3.3 Describe strategies to incorporate traditions and personal views in the plan of care to demonstrate empathy for the individual’s life experience.

As discussed in Cultural Influences on Health Beliefs and Practices, diversity refers to the differences among clients in terms of their culture, race, ethnicity, religion, language, customs, beliefs, and other factors that shape their health care needs and preferences. Culturally competent care involves acknowledging diversity, respecting and valuing it, and providing care sensitive to each client’s needs and preferences.

Cultural impacts on nursing care include differences in health care outcomes for racial and ethnic groups, which can vary significantly from one region to another and may result from structural inequities or cultural preferences in care. Other factors influencing cultural competence in nursing care include race, socioeconomics, health literacy, and language barriers. Additionally, increasing the diversity of the nursing workforce can improve client care, as it helps ensure that clients receive care from health care providers who understand their cultural backgrounds.

Cultural Nursing Assessment

A cultural nursing assessment systematically identifies the beliefs, values, meanings, and behaviors of an individual client or population while considering their history, life experiences, and social and physical environments. In a brief cultural assessment, the nurse should ask about ethnic background, religious preference, family patterns, food preferences, eating patterns, and health practices (Narayan & Mallinson, 2022). A cultural assessment can provide the information needed for a nurse to engage in effective cultural bridging, in which the nurse recognizes the elements of care that may be different from what a client is accustomed to and respectfully explains what the client can expect and why. A respectful exchange of information benefits both the nurse and the client and leads to better health outcomes.

Community health nurses are crucial in delivering culturally appropriate care to diverse populations. It is essential for these nurses to actively engage in efforts to provide care that respects the unique needs of individuals from different backgrounds. By involving clients in their care and empowering them to participate in decisions regarding their health-related goals, plans, and interventions, nurses help to ensure improvement in both client compliance and outcomes. As a community health nurse, embracing a continuous learning mindset is vital. It is important to have a commitment to ongoing personal and professional growth while also seeking to deepen the understanding of others. By striving to provide the best possible care and continuously expanding knowledge, community health nurses can ensure they contribute effectively to the well-being of their diverse client populations.

Conversations About Culture

Cultural Competency for Providers

This video presents a case study about Najma, a young Somali woman who was resettled by the United Nations in Lewiston, Maine, and soon discovers she is pregnant. The case follows Najma as she navigates the unfamiliar U.S. health care system.

Watch the video, and then respond to the following questions.

  1. How can health care workers seek to understand cultural differences, especially in refugee populations?
  2. Explain the concept of cultural bridging and identify techniques that can help.

Culturally Sensitive Environment

Nurses perform cultural assessments by first establishing a culturally sensitive environment and then incorporating a cultural assessment when caring for all clients. A culturally sensitive environment is a health care setting that is respectful and responsive to clients’ and their families’ cultural backgrounds, beliefs, and values. It is an environment that recognizes and values the diversity of clients and strives to provide care free from cultural bias or discrimination.

A culturally sensitive physical environment in health care incorporates various characteristics to accommodate clients’ diverse cultural needs This includes displaying décor, symbols, and artwork that reflect the diversity of the client population, providing multilingual signage and communication to overcome language barriers, ensuring client privacy and modesty, and promoting a knowledgeable and diverse staff. This environment promotes open communication between health care providers and clients. It encourages clients to express their beliefs and concerns about their health and health care. It also involves providing health care services that are appropriate and effective for clients from different cultural backgrounds. This includes being aware of cultural differences in areas such as diet, lifestyle, and religious practices and adapting care to meet each client’s individual needs.

Nurses can create a culturally sensitive environment by actively promoting cultural competence, learning about and understanding the cultural backgrounds of their clients, and developing the skills necessary to provide respectful and responsive care to meet their needs. Nurses may attend cultural competence training programs, use interpreters when necessary, and create informational materials that are culturally appropriate for clients from different backgrounds. Overall, a culturally sensitive environment is essential for providing high-quality health care that is accessible and respectful to clients from diverse cultural backgrounds.

Once the nurse has established a culturally sensitive environment, they must learn about the meaning of the illness in terms of the client’s unique culture. This can be done by asking open-ended questions about the client’s background, beliefs, and values. For example, some questions to ask during a cultural assessment include “What do you think has caused your problem?” and “Why do you think it started when it did?” Effective verbal and nonverbal communication is also essential for building trust and promoting respect with the client.

Before the assessment, the nurse should know the key topics to address, how to address them without offending the client and family, and whether an interpreter is necessary.

Performing Cultural Nursing Assessment

A culturally competent nursing assessment is a process of gathering information about a client’s cultural background, beliefs, and practices to provide culturally sensitive care. The assessment aims to identify cultural factors that may influence the client’s health care needs and decisions and to develop a care plan that is respectful and responsive to the client’s cultural beliefs and practices.

The following are key components of a culturally competent nursing assessment:

  1. Gathering cultural information: The nurse should collect information about the client’s cultural background, including their beliefs, values, and practices related to health and illness. This includes asking the client about their language preferences, religious practices, dietary restrictions, and other cultural practices.
  2. Awareness and knowledge: The nurse should have foundational knowledge about the community and diversity within the community. For example, nurses should be familiar with concepts related to sexual orientation and gender identities, including common terminology.
  3. Assessing health literacy: The nurse should assess the client’s health literacy, which is the ability to understand and use health information to make informed decisions. The nurse should use plain language and culturally appropriate materials to assess the client’s understanding of their health condition and treatment plan.
  4. Identifying cultural barriers: The nurse should identify any cultural barriers that may affect the client’s health care access or outcomes, such as language barriers, limited access to health care services, or cultural beliefs that conflict with Western medicine. Understanding why clients might delay care due to the barriers they encounter when accessing safe health care can help nurses plan for a client’s ongoing care.
  5. Assessing cultural competence: The nurse should assess their own cultural competence, including their knowledge, attitudes, and skills related to providing culturally sensitive care. This includes recognizing any biases or stereotypes they may hold and addressing them appropriately.
  6. Developing a culturally sensitive care plan: Based on the information gathered during the assessment, the nurse should develop a care plan that is respectful and responsive to the client’s cultural beliefs and practices. Additionally, the nurse should use inclusive and gender-neutral language and respect names and pronouns. Treatment plans may need to be adapted to accommodate cultural practices, using interpreters or culturally appropriate resources or involving family members in the care plan.

During the assessment, the nurse should be aware of the environment. They should look around and also assess verbal and nonverbal communications.

The brief cultural assessment helps determine the need for an in-depth cultural assessment, which can be conducted throughout the nurse-client relationship as trust builds. The longer Culturological Assessment, a term coined by Leininger (2002), also known as the Cultural Assessment, includes additional questions in major data categories covering a wide range of topics. The box below provides sample questions nurses may use to begin a brief cultural assessment.

Conversation Starters for a Brief Cultural Assessment

“Forgive me...I was wondering if I could ask a few questions...”

“At times like this, many people draw on their religious/spiritual beliefs to help them...”

  • Is there anything the nurses can do to help you find the spiritual strength you need at this time?
  • Are there spiritual practices that we can facilitate for you? Is there a religious leader/healer who you might find helpful?
  • The health care team caring for you wants to be polite and respectful to you and your family...
  • How would you like to be addressed by our staff?
  • What pronouns do you prefer?
  • Are there certain cultural courtesies we should practice when we come to visit you?
  • Are there things we might do that you would find offensive?
  • Could you please let us know if anything we do seems rude or offensive so we can fix it?

“Everyone has cultural beliefs and customs that they find help them to heal...”

  • Are there special beliefs or customs you would like to keep related to this health problem?
  • Are there special herbs/foods/treatments you have found helpful?
  • Are there healers from your community who might also be able to help you?
  • How does your family think this illness should be treated?
  • What do you think about this treatment?
  • What are the characteristics of a good health care provider (e.g., nurse, doctor, social worker, etc.)?

(Adapted from Narayan, 2003.)

Conversations About Culture

Using Inclusive Language When Taking a Patient History

This video explores the necessity of using inclusive language when taking a client history.

Watch the video, and then respond to the following questions.

  1. Why is it important to standardize language in assessments and use them with all clients; for example, asking all clients for their preferred pronouns?
  2. Explain the concept of identity versus biology and how you might use inclusive language to ask assessment questions.

Incorporating Culture into the Plan of Care

Incorporating traditions and personal views in the care plan is essential to demonstrate empathy and respect for the client’s life experience. Empathy, the ability to understand and share the feelings, perspectives, and experiences of others, is an important part of providing culturally responsive care. Nurses can establish trust and rapport by consistently demonstrating empathy and respect. Nurses should actively listen to clients, demonstrating genuine interest and using appropriate nonverbal cues such as nodding, eye contact, and facial expressions to show empathy (Figure 22.5). Nurses should acknowledge and validate clients’ emotions and experiences, ensuring they feel heard and understood.

A nurse and a client sit across from one another in folding chairs. The nurse smiles and looks the client in the eye.
Figure 22.5 A nurse shows empathy by actively listening and using nonverbal cues, such as eye contact, to build trust and rapport with the client. (credit: “University of California, Irvine” by Paul R. Kennedy/Flickr, Public Domain)

Here are some strategies that nurses can use to incorporate these elements in their care plan:

  1. Ask the client about their cultural traditions and preferences: By doing this, the nurse can gain insight into the client’s values and beliefs and incorporate these elements into the plan of care in a way that is respectful and meaningful to the client.
  2. Use interpreters: If the client and the nurse do not speak the same language, using an interpreter can help the nurse understand the client’s beliefs and preferences. This can help the nurse incorporate these elements into the plan of care.
  3. Involve family members (when culturally appropriate): Family members can play an essential role in incorporating traditions and personal views into the care plan. Involving family members in discussions about the plan of care can help the nurse understand the client’s cultural beliefs and preferences.
  4. Be flexible: Being willing to adapt the plan of care to meet the client’s needs and preferences is essential. This can involve adjusting the timing of treatments or medications to accommodate the client’s religious practices or dietary restrictions.
  5. Use culturally appropriate resources: Educational materials and videos can help the nurse provide respectful and culturally sensitive care.

Incorporating traditions and personal views into the care plan requires nurses to be open-minded, flexible, and willing to learn about the client’s cultural background and beliefs. By doing so, they can provide care that is respectful, empathetic, and meaningful to the client.

Case Reflection

Incorporating Culture in a Refugee Vaccination Program

Read the scenario, and then respond to the questions that follow.

A public health nurse working with a community of refugees is tasked with implementing a vaccination program to prevent the spread of a highly contagious disease in the community. The nurse is aware that many community members come from cultures where vaccinations are not widely accepted or are met with suspicion and wants to ensure that the program is culturally sensitive and effectively reaches and educates the community about the importance and safety of vaccines.

Public health nurses must consider the community’s cultural beliefs and values surrounding vaccination to effectively reach and educate them. By conducting comprehensive cultural assessments and implementing appropriate strategies, the nurse can ensure that the program is culturally sensitive and meets the unique needs of the refugees.

  1. Conducting Cultural Assessments
    • Gather community information: Research and gather information about the cultural backgrounds of, languages spoken by, and beliefs of the members of the refugee community.
    • Engage cultural brokers: Collaborate with cultural brokers or community leaders who can provide insights into the community’s beliefs and assist in designing the vaccination program.
    • Conduct interviews and focus groups: Conduct interviews and focus groups with community members to understand their perceptions, concerns, and experiences related to vaccination.
  2. Developing Culturally Sensitive Strategies
    • Understand cultural beliefs: Research and understand the cultural beliefs and values surrounding vaccination within the refugee community.
    • Tailor educational materials: Develop culturally appropriate educational materials that acknowledge and address the specific concerns and beliefs of the community.
    • Collaborate in decision making: Engage community members in the decision-making process, ensuring their opinions and preferences are considered in the development of the vaccination program.
    • Ensure language accessibility: Provide interpreters and translated materials to overcome language barriers during the education and vaccination process.
    • Provide culturally competent health care providers: Ensure that health care providers involved in the program are trained in cultural competence and demonstrate sensitivity and respect toward different cultural beliefs.
  3. Promoting Community Engagement
    • Establish trust and rapport: Build trust and rapport within the community by establishing relationships, respecting cultural practices, and showing empathy and understanding.
    • Utilize community influencers: Collaborate with community influencers and leaders to raise awareness, address concerns, and promote vaccination within the refugee community.
    • Conduct culturally tailored health-education sessions: Host culturally tailored health-education sessions that address the community’s cultural beliefs and values surrounding vaccination, providing accurate and evidence-based information.
    • Utilize culturally sensitive messaging: Develop messaging that resonates with the community, acknowledging their concerns and highlighting the importance of vaccination in the context of their cultural beliefs and values.

Implementing a culturally sensitive vaccination program for a community of refugees involves conducting cultural assessments, developing appropriate strategies, and promoting community engagement. By understanding and respecting the cultural beliefs and values of the community, public health nurses can effectively reach and educate the refugees, ultimately preventing the spread of a highly contagious disease. This approach exemplifies how transcultural nursing can play a vital role in providing culturally sensitive and inclusive health care to diverse communities.

  1. How should the nurse approach addressing and overcoming vaccine hesitancy among refugees, considering their cultural beliefs and experiences?
  2. Describe how the nurse should assess the effectiveness and impact of the culturally sensitive vaccination program for refugees.

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