Health Disparities, Cultural Analysis and Health Care Needs/Andrews/Boyle Transcultural Nursing
Thisis an example of an assessment guide that is intended to help the learner as he or
she strives toward cultural competency.
With what cultural group(s) does the client report affiliations (e.g., American, Hispanic,
Navajo, or combination)? To what degree does the client identify with the cultural group
(e.g., ?we? concept of solidarity or as a fringe member)?
Where was the client born?
Where has the client lived (country, city) and when (during what years)? Note: If a
recent relocation to the United States, knowledge of prevalent diseases in country of
origin may be helpful. Current residence? Occupation?
What are the client?s attitudes, values, and beliefs about developmental life events such
as birth and death, health, illness, and healthcare providers?
Does culture affect the manner in which the client relates to body image change resulting
from illness or surgery (e.g., importance of appearance, beauty, strength, and roles in
cultural group)? Is there a cultural stigma associated with the client?s illness (i.e., how is
the illness or client condition viewed by the larger culture)?
How does the client view work, leisure, education?
How does the client perceive change?
How does the client perceive changes in lifestyle relating to current illness or surgery?
How does the client value privacy, courtesy, touch and relationships with individuals of
different ages, social class (or caste), and gender?
How does the client view biomedical/scientific health care (e.g., suspiciously, fearfully,
acceptingly)? How does the client relate to persons outside of his or her cultural group
(e.g., withdrawal, verbally or nonverbally expressive, negatively or positively)?
Cultural Sanctions and Restrictions
How does the client?s cultural group regard expression of emotion and feelings,
spirituality, and religious beliefs? How are dying, death, and grieving expressed in a
culturally appropriate manner?
How is modesty expressed by men and women? Are there culturally defined expectations
about male-female relationships, including the nurse-client relationship?
Does the client have any restrictions related to sexuality, exposure of body parts, certain
types of surgery (e.g., amputation, vasectomy, hysterectomy)?
Are there any restrictions against discussion of dead relatives or fears related to the
What language does the client speak at home? What other languages does the client speak
or read? In what language would the client prefer to communicate with you?
What is the fluency level of the client in English?both written and spoken use of the
language? Remember that the stress of illness may cause clients to use a more familiar
language and to temporarily forget some English.
Does the client need an interpreter? If so, is there a relative or friend whom the client
would like to interpret? Is there anyone whom the client would prefer did not serve as an
interpreter (e.g., member of the opposite sex, a person younger/older than the client,
member of a rival tribe or nation)?
What are the rules (linguistics) and modes (style) of communication? How does the client
prefer to be addressed?
Is it necessary to vary the technique of communication during the interview and
examination to accommodate the client?s cultural background (e.g., tempo of conversation,
eye contact, sensitivity to topical taboos, norms of confidentiality, and style of
How does the client?s nonverbal communication compare with that of individuals from
other cultural backgrounds? How does it affect the client?s relationship with you and with
other members of the healthcare team?
How does the client feel about healthcare providers who are not of the same cultural
background (e.g., black, middle-class nurse and Hispanic of a different social class)?
Does the client prefer to receive care from a nurse of the same cultural background,
gender, and/or age?
What are the overall cultural characteristics of the client?s language and communication
Health-Related Beliefs and Practices
To what cause(s) does the client attribute illness and disease (e.g., divine wrath,
imbalance in hot/cold or yin/yang, punishment for moral transgressions, hex, soul loss,
What are the client?s cultural beliefs about ideal body size and shape? What is the client?s
self-image vis-?-vis the ideal?
What name does the client give to his or her health-related condition?
What does the client believe promotes health (eating certain foods, wearing amulets to
bring good luck, sleep, rest, good nutrition, reducing stress, exercise, prayer, rituals to
ancestors, saints, or intermediate deities)?
What is the client?s religious affiliation (e.g., Judaism, Islam, Pentacostalism, West
African voodooism, Seventh-Day Adventism, Catholicism, Mormonism)? How actively
involved in the practice of this religion is the client?
Does the client rely on cultural healers (e.g., curandero, shaman, spiritualist, priest,
minister, monk)? Who determines when the client is sick and when he or she is healthy?
Who influences the choice/type of healer and treatment that should be sought?
In what types of cultural healing practices does the client engage (use of herbal remedies,
potions, massage, wearing of talismans, copper bracelets or charms to discourage evil
spirits, healing rituals, incantations, prayers)?
How are biomedical/scientific healthcare providers perceived? How does the client and
his or her family perceive nurses? What are the expectations of nurses and nursing care?
What comprises appropriate ?sick role? behavior? Who determines what symptoms
constitute disease/illness? Who decides when the client is no longer sick? Who cares for
the client at home?
How does the client?s cultural group view mental disorders? Are there differences in
acceptable behaviors for physical versus psychological illnesses?
What nutritional factors are influenced by the client?s cultural background? What is the
meaning of food and eating to the client?
With whom does the client usually eat? What types of food are eaten? What is the timing
and sequencing of meals?
What does the client define as food? What does the client believe comprises a ?healthy?
versus an ?unhealthy? diet?
Who shops for food? Where are groceries purchased (e.g., special markets or ethnic
grocery stores)? Who prepares the client?s meals?
How are foods prepared at home (types of food preparation, cooking oil(s) used, length of
time foods are cooked, especially vegetables, amount and type of seasoning added to
various foods during preparation)?
Has the client chosen a particular nutritional practice such as vegetarianism or abstinence
from alcoholic or fermented beverages?
Do religious beliefs and practices influence the client?s diet (e.g., amount, type,
preparation or delineation of acceptable food combinations, e.g. kosher diets)? Does the
client abstain from certain foods at regular intervals, on specific dates determined by the
religious calendar, or at other times?
If the client?s religion mandates or encourages fasting, what does the term fast mean (e.g.,
refraining from certain types or quantities of foods, eating only during certain times of
the day)? For what period of time is the client expected to fast?
During fasting, does the client refrain from liquids/beverages? Does the religion allow
exemption from fasting during illness? If so, does the client believe that an exemption
applies to him or her?
Who comprises the client?s social network (family, friends, peers, and cultural healers)?
How do they influence the client?s health or illness status?
How do members of the clients social support network define caring (e.g., being
continuously present, doing things for the client, providing material support, looking after
the client?s family)? What is the role of various family members during health and
How does the client?s family participate in the promotion of health (e.g., lifestyle changes
in diet, activity level, etc.) and nursing care (e.g., bathing, feeding, touching, being
present) of the client?
Does the cultural family structure influence the client?s response to health or illness (e.g.,
beliefs, strengths, weaknesses, and social class)? Is there a key family member whose
role is significant in health-related decisions (e.g., grandmother in many African
American families or oldest son in Asian families)?
Who is the principal wage earner in the client?s family? What is the total annual income?
(Note: Thisis a potentially sensitive question.) Is there more than one wage earner? Are
there other sources of financial support (extended family, investments)?
What insurance coverage (health, dental, vision, pregnancy) does the client have?
What impact does economic status have on lifestyle, place of residence, living conditions,
ability to obtain health care? How does the client?s home environment (e.g., presence of
indoor plumbing, handicap access) influence nursing care?
Organizations Providing Cultural Support
What influences do ethnic/cultural organizations have on the client?s receiving health
care (e.g., Organization of Migrant Workers, National Association for the Advancement
of Colored People, Black Political Caucus, churches such as African American, Muslim,
Jewish, and others, schools including those which are church-related, Urban League,
community-based healthcare programs and clinics)?
What is the client?s highest educational level obtained?
Does the client?s educational background affect his or her knowledge level concerning
the healthcare delivery system, how to obtain the needed care, teaching-learning, and any
written material that he or she is given in the healthcare setting (e.g., insurance forms,
educational literature, information about diagnostic procedures and laboratory tests,
Can the client read and write English, or is another language preferred? If English is the
client?s second language, are materials available in the client?s primary language?
What learning style is most comfortable/familiar? Does the client prefer to learn through
written materials, oral explanation, or demonstration?
How does the client?s religious affiliations affect health and illness (e.g., life events such
as death, chronic illness, body image alteration, cause and effect of illness)?
What is the role of religious beliefs and practices during health and illness? Are there
special rites or blessings for those with serious or terminal illnesses?
Are there healing rituals or practices that the client believes can promote well-being or
hasten recovery from illness? If so, who performs these?
What is the role of significant religious representatives during health and illness? Are
there recognized religious healers (e.g., Islamic Imams, Christian Scientists practitioners
or nurses, Catholic priests, Mormon elders, Buddhist monks)?
Cultural Aspects of Disease Incidence
Are there any specific genetic or acquired conditions that are more prevalent for a
specific cultural group (e.g., hypertension, sickle cell anemia, Tay Sachs, G6PD, lactose
Are there socioenvironmental diseases more prevalent among a specific cultural group
(e.g., lead poisoning, alcoholism, HIV/AIDS, drug abuse, ear infections, family
Are there any diseases against which the client has an increased resistance (e.g., skin
cancer in darkly pigmented individuals, malaria for those with sickle cell anemia)?
Does the client have distinctive physical features characteristic of a particular ethnic or
cultural group (e.g., skin color, hair texture)? Does the client have any variations in
anatomy characteristics of a particular ethnic or cultural group (e.g., body structure,
height, weight, facial shape and structure [nose, eye shape, facial contour], upper and
How do anatomic, racial, and ethnic variations affect the physical examination?
Are there any distinct growth and development characteristics that vary with the client?s
cultural background (e.g., bone density, psychomotor patterns of development, fat-folds)?
What factors are significant in assessing children of various ages from the newborn
period through adolescence (e.g., expected growth on standard grid, culturally acceptable
age for toilet training, introducing various types of foods, gender differences, discipline,
socialization to adult roles)?
What is the cultural perception of aging (e.g., is youthfulness or the wisdom of old age
more highly valued)?
How are elderly persons handled culturally (e.g., cared for in the home of adult children,
placed in institutions for care)? What are culturally acceptable roles for the elderly?
Does the elderly person expect family members to provide care, including nurturance and
other humanistic aspects of care?
Is the elderly person isolated from culturally relevant supportive persons or enmeshed in
a caring network of relatives and friends?
Has a culturally appropriate network replaced family members in performing some caring
functions for the elderly person?
Note. From Transcultural Concepts in Nursing Care (3rd ed.) by M.M. Andrews and J.S. Boyle, 1999, Philadelphia:
Williams and Wilkins. Copyright 1999 by Williams and Wilkins. Reprinted by permission.
Students select a population that is of a different race, ethnicity, religion, or sexual orientation, or experiencing healthcare disparities and treat the population as their patient following the assignment guidelines. South Africa is race/ethnicity being used
For Part I: Client Interview Data /?APA Paper Part 1, Client Interview Data: 3- 5 pages using the assessment tool
Using the attached questionnaire, the student will explore the client?s health beliefs as they relate to his/her cultural diversity by completing the Cultural Assessment Guide. ?Complete the Cultural Assessment by doing research instead of an interview. Also include, how you anticipate changing this person?s health behavior if appropriate, and, what are the risk factors presented?
For Part II: Cultural Analysis and Health Care Needs Identification/ ?APA Paper Part 2, Cultural Analysis and Health Care Needs Identification: 3-4 pages with analysis of the client’s diversity supported with in-text reference citations
The student needs to analyze their client?s diversity using interview data and reference sources. At a minimum you should include the following:
? Using the client interview data and current literature, describe the traditional cultural health care beliefs and practices, which includes illness beliefs and customs, interpersonal relationships, spiritual/religious beliefs and practices, worldview beliefs, and social structures. ? Discuss any differences between what you?ve read in the literature regarding the culture?s traditional health and what your client told you. Include possible explanations for these differences. ? Identify actual or potential health care problems/concerns (for example cultural, physical, psychological, social, financial, or developmental) for the client and their cultural /diversity group. ? Discuss potential therapeutic interventions for the client and/or their cultural group that promote wellness, which demonstrate respect for the client?s culture/diversity, rights, beliefs, values, and life experiences and that incorporate professional values and practice standards. ? Record your observations from the interview regarding nonverbal and verbal communication (such as eye contact, rate of speech, personal space, and touch) demonstrated by yourself and the client. ? Discuss the health policy regulations that might affect this person?s care. ? Analyze the ethical considerations of this patient and their cultural and its alignment with the ANA Code of Ethics
For Part III: Personal Reflections / ?APA Paper Part 3, Personal Reflections: Minimum 2 pages of personal reflection of how this knowledge might influence your nursing care
The student needs to reflect upon how their own culture and beliefs influences their nursing care and how knowledge gained from this assignment will influence future nursing care with clients from diverse cultures. At a minimum you should include the following: analyze how your culture (beliefs, values, religion, orientation, etc.) influences your nursing care.
? To what extent do your beliefs, prejudices, or bias influence your thinking and nursing care? Give several examples.
? Discuss how you will ameliorate your biases ? Discuss specifically how the knowledge from this assignment will influence your future nursing care of clients from different cultures/orientations. Discuss several examples.
For Part IV: Nurses Role / ?APA Paper Part 4, Nurses Role: Minimum of 3 pages of analysis of the key nursing role you would assume to meet this population?s healthcare needs and how to assess the opportunities and challenges. Include ancillary healthcare people that will be part of the opportunities.
The student must submit an analysis of the key nursing role they would assume to meet this patient?s healthcare needs and how they would assess the opportunities and challenges of that role (minimum of 3 pages)