Transcultural Concepts in Nursing Care


Part Three Healthcare Systems

from language, economic difficulties, and cultural differences, often suffer from a variety of health disparities (Weech-Maldonado et al., 2018). The information in this chapter will assist nurses to become aware of cultural factors that affect health, illness, and the practice of nursing in com munity settings. Purnell and Fenkl (2021) as well as Andrews and Boyle (2016) have provided models or frame works to guide the nurse in the assessment of cul tural factors in patient care. The Andrews/Boyle Transcultural Nursing Assessment Guides (see Appendices A, B, and D) provide outlines for the nurse to collect and assess cultural data relevant to individuals, families, and communities. Most cultural assessment guides are oriented toward individual clients and occasionally toward fami lies. The Andrews/Boyle assessment guides have the comprehensive view necessary for assessing cultural factors for intervention at the individual, family, and community levels. Because individual clients and their families constitute larger com munities, nurses who work in community settings must understand cultural issues as they relate to individuals and families as well as the context in which they live. Cultural Influences on Individuals and Families Cultural influences—values, norms, beliefs, and behaviors—have a profound effect on health. When assessing individuals and families, the community health nurse should carefully exam ine the following: 1. Family structure and makeup (multigen erational, nuclear, extended family, sig nificant others, etc.), individual roles and responsibilities, and dynamics in the family, particularly communication patterns and decision-making. 2. Health beliefs and practices related to dis ease causation, treatment of illness, and the use of indigenous healers or folk practitio ners and other alternative/complementary therapies.

3. Patterns of daily living, including work, school, and leisure activities. 4. Social networks, including friends, neigh bors, kin, and significant others, and how they influence health and illness. 5. Ethnic, cultural, or national identity of cli ent and family, for example, identification with a particular group, including language. 6. Nutritional practices and how they relate to cultural factors and health. 7. Religious preferences and influences on well-being, health maintenance, and illness as well as the impact religion might have on daily living and taboos or restrictions aris ing from religious beliefs that might influ ence health status or care. 8. Culturally appropriate behavior styles, including what is manifested during anger, competition, and cooperation, as well as relationships with healthcare professionals, relationships between genders, and rela tions with other groups in the community. 9. Health professionals should always be aware of their own personal beliefs and biases and how those can impact the client’s health. A cultural assessment of individuals and fami lies includes all of the preceding factors. This list is a starting point for community nurses to use when assessing individuals and families in every day practice. Cultural values shape human health behaviors and determine what individuals and families will do to maintain their health status, how they will care for themselves and others who become ill, and where and from whom they will seek healthcare. Most importantly, family mem bers are often the ones who decide on the course of treatment. Families have an important role in the transmission of cultural values and learned behaviors that relate to both health and illness. It is within the family context that individuals learn basic ways to stay healthy and to ensure their own well-being and that of their family members. One commonality shared by members of healthy families is a concern for the health and wellness of each individual within the family. The nurse must not only assess the health of each

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