When asked to discuss her client's cultural background, the third year nursing student said, "Mrs. G. looks just like the rest of us. I can't see why her culture makes any difference when she is sick." Similar outward appearances belie the great cultural diversities among us. Unless a clients clothing, language, or appearance is different, many nursing students fail to consider their client's cultural background when assessing, planning, or implementing care. Nurses often label clients "noncompliant" when they do not follow through with health teaching. Could it be that health teaching or nursing care are culturally inappropriate? Students need to learn how to provide culturally congruent health teaching and care (Leininger, 1991).
Nursing educators can teach students to become culturally sensitive. An important strategy for teaching cultural awareness is for nursing students to conduct cultural assessments as part of their clinical or theory courses. This paper presents a cultural assessment (Figure) to assist holistic data collection.
The cultural assessment is framed within Leiningerfc Theory of Culture Care Diversity and Universality (1991). Leininger holds that all cultures express care, but have a variety of care meanings and practices. She emphasizes that health and care are influenced by social structure features such as technology, religion, cultural values, economics, and education. These social factors are addressed within environmental contexts and language expressions. The cultural assessment covers phenomena of interest to nurses such as health, illness, and care. Important aspects of living such as dietary practice, communication patterns, and childrearing practices are assessed.
To obtain cultural assessment data, the nurse offers broad statements and openended questions to encourage clients to express themselves fully (Leininger, 1984; Rosenbaum, 1991). The nurse needs to avoid interrogating clients; instead, the use of broad assessment statements will encourage descriptive responses. For example, to learn about the meanings and expressions of health, a client may be approached as follows:
I would like to learn what health means to you. Imagine yourself totally healthy. Tell me what it would be like for you. Tell me how you know when you are healthy. I am wondering how you believe people of your culture stay healthy.
The important principle to maintain when conducting a cultural assessment is that the client is the teacher and expert regarding his or her culture, and the nurse is the learner. The nurse introduces broad topics to allow the client to fully express cultural beliefs and practices. It must be emphasized to students that there is also great diversity among members of a culture and between generations of immigration within the culture (Rosenbaum, 1990). While there are patterns to be discovered, each client must be assessed individually to avoid stereotyping.
When nurses have obtained cultural assessments of their clients, they will be better able to provide culturally relevant care using Leiningers three modes of nursing actions (1991): (a) cultural care preservation/maintenance, which preserves cultural resources; (b) cultural care accommodation/negotiation, which adapts clients' or nurses' actions; and (c) cultural care repatterning/restructuring, which alters behavior of either the client or nurse.
The following specific examples demonstrate the three modes of nursing actions.
Cultural care preservation occurs with a Jewish client recovering from surgery when the nurse encourages use of the Jewish folk health care practice of giving chicken soup to someone ill. When a Greek older woman requires a diabetic diet, the nurse adapts the diabetic diet to accommodate her culture by planning meals using Greek cultural foods. When a client from a Third World country throws his garbage on the street, the community health nurse repatterns this behavior by teaching him that this practice is unacceptable in this society.
The process of teaching cultural assessment begins with nursing programs that include multiculturalism in their curricula and faculty who are committed to the importance of providing culturally relevant nursing care. Faculty can teach the use of the assessment format in the classroom or clinical setting by explaining the importance of cultural assessments and demonstrating an assessment with a volunteer student. Following this, students will conduct cultural assessments with their clients in clinical settings. These assessments become incorporated into client care plans.
The success of promoting cultural awareness among nursing students is borne out by their comments following their opportunity to perform cultural assessments. A few examples of their verbatim statements follow:
I used to think that people were people. Now I know that people of different cultural backgrounds have special needs.
I always thought that people of one culture are alike. I found out that we can't lump everyone together.
I'm more careful now about how I touch people because they may misunderstand my touching.
I learned that there are many attitudes toward childrearing that are culturally based.
I have new respect for folk health practices and try to accommodate them into my nursing care.
I can see that cultural groups may have different ways of defining health and illness.
I didn't know that there are so many ways to show care. I always thought about care in terms of my own culture.
I didn't know about the "evil eye." Now I understand about the importance of special precautions taken by new parents in some cultures.
In summary, nurses must be sensitive to clients' cultural patterns. They must also understand that there are diversities within and between cultural groups. Systematic cultural assessment of clients is an important first step for the provision of culturally relevant care. This article presents a cultural assessment to encourage nursing students to become culturally sensitive.
- Leininger, M. (1984). Transcultura] interviewing and health assessment. In P. Pedersen, N. Sartorius, & A. Marsella (Eds.), Mental health services: The cross cultural context (pp. 109-133). Beverly Hills, CA: Sage.
- Leininger, M. (1991). Culture care diversity and universality: A theory of nursing. New York: National League for Nursing Press.
- Rosenbaum, J. (1990). Cultural care of older Greek Canadian widows within Leiningers theory of culture care. Journal of Transcultural Nursing, 2(1), 33-47.
- Rosenbaum, J. (1991). A cultural assessment guide. Canadian Nurse, 87(4), 32-33.