Cultural Assessment The population of the United States is continually rising. The birth rate continues to rise, but more importantly, the number of foreign-born immigrants that relocated to the United States in 2003 was a staggering 33. 5 million, and that number rises every year (Jarvis, 2008). With such a large immigrant population comes the need for medical professionals that are culturally competent.
Being culturally competent means that the caregivers, “understand and attend to the total context of the individual’s situation, including awareness of immigration status, stress factors, other social factors, and cultural similarities and differences” (Jarvis, 2008, p. 38). Because the United States is so diverse, it is a federal law that all caregivers must be culturally competent. It should be noted, however, that is not something that can be accomplished so easily. It is a process that can take a lifetime. To become culturally competent one must have knowledge in several areas.
These include, but are not limited to, knowing one’s own personal heritage, the heritage of the nursing profession, the heritage of the health care system, and the heritage of the patient (Jarvis, 2008). When performing a cultural assessment of an individual one must take into account five important aspects of the individual’s heritage. These aspects will give the nurse an idea of the patient’s heritage consistency. First, is the individual’s culture. Everyone has a culture. There are four basic characteristics of culture. First, it is learned; from birth one is learning the language and socialization of that culture.
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Second, it is shared. All the members of the same group share that culture. Third, it is adapted. Culture adapts to environmental and technical factors, as well as the groups availability to natural resources. Finally, it is dynamic. Meaning, it is always changing (Jarvis, 2008). The second aspect of one’s heritage is ethnicity. This is a group within the social system that have a common geographical origin, race, religion, values, traditions and food preferences. The term ethnic is tricky in the United States (US) because of how large the US is, and the large diversity of ethnic differences it has.
Religion is the third aspect of one’s heritage. Religion is extremely important because an individual’s religious beliefs play a huge part in one’s health-related behaviors and how someone perceives illness and death. There are roughly 1500 different religions in the United States which is why this aspect is so important when performing an individual’s cultural assessment (Jarvis, 2008). The fourth aspect of one’s heritage is socialization. When someone is raised in a specific culture, the person naturally acquires the characteristics of that group.
Many people in the United States are bicultural, acquiring certain customs and traditions of the United States while staying loyal to their traditional culture as best they can. Time orientation is the fifth and final aspect of one’s heritage. Every culture has a different understanding of each other’s perception of time. Depending on the individual’s heritage, that person may focus on the past, the present, the future, or a combination of the three. It is important for the nurse to recognize the individual’s perception of time to gain a better understanding of how to individualize a plan of care.
To gain a better understanding of cultural assessment and how it relates to health care and being culturally competent, a sit down interview was performed with an 84 year old female of German-American heritage, who believes that any belief or view differing greatly from hers are strange, and usually wrong (Riley, 2008). In order to preserve her right to privacy, she will be referred to as G. E. Heritage Assessment Cultural Group G. E. is 84 years old and was born and raised in the United States. She considers herself an American who is extremely proud of her German heritage. She is 100% of German decent.
She had one older sister who is deceased. Her immediate family was all born in rural Illinois. Her father built a house in Coal Valley, IL when she was very young, where she lived until she was married at the age of 18. Her paternal grandparents were both born in Germany. It is unknown what city or village in Germany they came from, other than the northern part of Germany. They immigrated to the United States shortly before her father was born. She remembers her grandparents speaking little to no English, then, eventually broken English. Her father spoke English as a first language and some German. Her mother, her sister and she ever learned the German language. English was the only language spoken in the home. Her father was a coal miner and her mother took care of the home. In her culture, each generation lived in separate homes, whereas in some cultures, multiple generations live in the same household. However, her grandparents and extended family members did live nearby, so she spent a lot of time playing with her cousins, and saw her grandparents, aunts and uncles on a regular basis. They would all get together on Sundays after church, and have lunch together. She lived at home until she married at the age of 18. G. E. ent to public schools, then to secretary school after graduation. Her husband was also 100% of German decent. They had two sons and a daughter. Both of her sons live close by, but her daughter lives in Nebraska. Her daughter and she talk on the phone every day. Her husband was in the US Navy during WWII and her husband and she were very patriotic. Like she has stated earlier, she is an American. Other than that, she did not know much about the war or Hitler or just did not remember. What she did remember when asked about this subject was the fact that a few of her husbands’ ancestors were drivers for Hitler during his reign.
Ethnic Group G. E. ’s ethnicity focuses around her family and church. Even though her father’s parents were born in Germany, there is no indication that they were passing down many values, traditions, or food preferences to the new generations. By all accounts, they wanted to completely immerse themselves into the American way of life. The only German recipes that were passed down to her were for sauerkraut, German pigs-in-a-blanket, which included sauerkraut, and German potato salad. Her family also eats a lot of beef, pork, and chicken. Potatoes are also a staple of her diet.
For many years, G. E. and her husband would grow a big garden and produced enough vegetables for the entire winter months. Traditions are very important to G. E. For many years her family would come to her house after church for Sunday lunch and also for Thanksgiving. The day after Thanksgiving the grandchildren would come over to decorate the Christmas tree. She still has her family over every Christmas Eve. She says she does not cook a meal anymore, she orders a meat and cheese tray, and makes some side dishes. The other family members bring over the desserts.
She also used to have a birthday party for her children and grandchildren. She baked a cake and the family would come over and eat dinner. The birthday person got to pick the dinner, and would then open presents. Her grandchildren bring her great-grandchildren to see her at least once a month. She says she enjoys it when they come to visit. She really enjoys seeing the great-grandchildren. She says that it makes her feel proud. Religious Group Religion is the most important aspect of G. E. ’s life besides her family, and always has been. G. E. and her family are Protestants.
Knowing that most of her ancestors came from the northern part of Germany, this is interesting because in Germany, Protestantism is practiced predominantly in northern Germany (Fuller & Vossmeyer, 2004), which is where her ancestors lived. This is proof that their religion has been passed down through the generations and still continues to be practiced. Her husband and his family, who are all deceased now, shared the same ethnic and religious background as her family. She regularly attends a Presbyterian church at least once a week and is a very active member of the church.
Her husband would fill in as pastor when the regular pastor could not. She practices her religion in her home every day by praying and reading the Bible. G. E. celebrates all of the holidays of her religion which are Easter, Thanksgiving, and Christmas with her family. She states that her religion has no influence on her diet or health practices. G. E. believes in heaven and hell, which is common to many German religions (Fuller & Vossmeyer, 2004). She insists that younger family members who do not go to church attend church with her at least once a year. She does not like the fact that her other family members do not attend church.
She feels in order to get into heaven one has to attend church occasionally. Social Group Most, but not all, of her friends share the same ethnic and religious background. She also has a few Hipic friends whom she enjoys spending time. She still lives in her home in the same neighborhood in which she has lived for over 50 years. The neighborhood is located close to the church and most of her neighbors are close in age. Most of them attend the same church and are of the same ethnic background. She has always had a very active social life which can contribute to her excellent health.
She goes to a senior activities hall twice a week to play bingo and has a swimming class twice a week to exercise and socialize with friends. She goes to have her hair done every Saturday which she has done for many years. She regularly goes out to lunch and to watch a movie with friends once or twice a month and is on the phone a lot with family and friends. She made sure to mention is that she absolutely does not like to travel and has never been outside of the United States. When her children were young they would take camping trips to Wisconsin and Minnesota. That was pretty much the extent of her travels.
As a result, her sons do not like to travel much either but her daughter enjoys traveling. Her daughter has been to many countries and G. E. does not understand why she enjoys it so much. Time Orientation G. E. ’s time orientation focuses on the present and the future with little to no focus on the past. She feels at her age, focusing on the past is a waste of time. She says, “I just move on” (G. E. 2011). She does not like to dwell on the past. She says, “what’s done is done”. Although she misses her husband very much she believes she will meet up with him in heaven one day. She enjoys the thought of that.
She does not think of health care in terms of the past either. She follows her doctor’s advice and is open to new treatments and medications. This is another reason she is in excellent health for an 84 year old woman. She does not like the thought of a doctor not knowing the latest in medical technology and treatments. She also is not bothered if health care personnel are not culturally sensitive to her heritage since she sees herself as an American who is proud of her German heritage. G. E. is uncomfortable with doctors who are not Caucasian. She also does not like to be cared for by male nurses or other male caregivers who are not doctors.
Health Related Beliefs and Practices G. E. has health insurance and Medicare, so she is able to see the doctor on a regular basis. Lack of insurance coverage is not a factor for her. She never goes without her medication because of lack of prescription coverage. Also, with the money she and her husband saved over the years, plus both of their retirement packages and social security benefits, she lives comfortably and does not have to worry about not having enough money to live out the rest of her life in the lifestyle she leads. Developmental Situation G. E. remembers things her mother did when G.
E. was a child to maintain and protect her health. She had to wash her hands regularly, especially before and after meals and after using the bathroom. She always had three meals a day which consisted of foods from all of the food groups. In the winter she could not go outside until she was bundled up. When she did get sick, she had to stay home in bed until her mother thought she was feeling better. This was solely the job of her mother since her father worked long hours in the coal mines. She states that her mother was the stereotypical strict, but loving, German mother.
When she started her own family, she ran her home in the same manner. She was raised during the Great Depression and was raised to be hard working and to appreciate what one has, which G. E. has instilled in her children. G. E. is accomplishing all the developmental tasks of her age group and has successfully resolved Erickson’s last ego stage, which is the psychological conflict of ego integrity versus despair. In this stage, “resolution to this final conflict occurs when the adult accepts one’s one and only life cycle as something that had to be and that, by necessity, permitted of no substitutions” (Jarvis, 2008, p. 8). Causes of Illness G. E. describes illness as not being able to do the things she normally does and she defines health as having no aches or pains. She rates her health as good to excellent for a woman of her age. She has never smoked, however, her husband smoked a pipe for years. She does not use any devices to help her get around and she still goes up and down the stairs to do laundry. She states she has fallen a few times but has never broken a bone as a result, and was able to get back up on her own. She has never been hospitalized as a result of an illness, only for an occasional elective surgery.
What she believe causes illness are environmental change, God’s punishment, grief and loss, stress and anxiety, incorrect food combinations, poor eating habits, smoking, inactivity, and viruses and bacteria. Cultural Practices in Healing and Health She maintains and protects her health by washing her hands regularly, taking her prescribed medications, staying active, eating a well-balanced diet based on the food pyramid, taking vitamin supplements, seeing her doctors regularly, staying inside when it is too hot or too cold, avoids people who are sick, and does not take on more than she thinks she can handle.
When she does get sick she does not make a big deal out of it and does not feel the need to worry family members. She stays at home because she fears getting others sick as well, especially her great-grandchildren. She takes care of herself by getting enough rest, keeping herself hydrated, not eating certain foods she knows will make her feel worse, taking needed medications, and calling her doctor when she feels she needs to be seen. When G. E. feels she needs some lab work done, other tests, or has any concerns, she immediately calls her doctor. She trusts in her doctor’s advice and always follows his or her orders.
It is because of all of this, she believes she is still living an active and healthy life. G. E. is also extremely concerned with the health and well-being of her family. When her children, grandchildren and great-grandchildren are sick, she worries about them and calls them regularly to check on them. She also prays for them to get well. Cultural Expressions of Illness G. E. does whatever her doctor suggests and does not believe he would do anything to jeopardize her health. However, as far as family and friends go, she will not outwardly express indications of pain.
She states that it is because she does not want people to worry about her. G. E. believes this is due to her strict German up-bringing and growing up during the Great Depression. She believes one can never work too hard, so pain is seen as a weakness to her. The more she expresses pain or illness, the weaker she is seen, and possibly unable to effectively take good care of herself. Alternative assisted living is not an option G. E. needs at this point. G. E. feels she does not need it, and she absolutely will not burden her children with having to care for her.
Cultural use of Alternative Therapies G. E. sometimes uses home remedies when she is ill. When she was a child her mother would use some vapor rub then put a sock around G. E. ’s neck. G. E. ’s mother would feed her chicken soup and give her juice or hot tea to drink, and keep her in bed. G. E. believes that healing and curing are the same and believes that praying, following the doctors orders, getting recommended treatments and taking prescribed medications brings healing. In the past few years G. E. has used alternative therapies to help with pain and arthritis.
She gets acupuncture once a week, and sees a massage therapist occasionally. She admits, ten years ago she would have never done these types of alternative therapies, but her daughter is a nurse, and recommended it as an alternative to pain medication. She also admits that it does help, or she would not pay to go, but she feels it does not cure anything. She still has to supplement the pain with medications from time to time. Summary G. E. ’s interview was conducted at her home, and it took about an hour and a half. She would often change the subject, so having to restate questions happened often.
She felt comfortable being in her home answering these questions, but often asked why an assessment of this type was so important. She has no issues with cultural sensitivity, or nurses being culturally competent, and has had little experience with other cultures. G. E. does not understand the need for such learning. Her views are ethnocentric, and at 84 years old, that will probably not change. During the interview, both open-ended and close-ended questions were used to gain the most information. She was very open to doing the interview, but stated she did not think she had much to contribute.
She states she has lived a wonderful, privileged life with a loving husband, and a great family. She has never been disappointed by her family and is extremely proud of them. The only regret she has, has to do with her sister. They lived about five properties apart from each other, and some land next to her sister that G. E. owned, her sister planted a garden there for years. Well, G. E. gave the property to her daughter and son in-law to build a home. Her sister got extremely upset, which ended up with their families not talking for years. Then she received word that her sister was diagnosed with breast cancer, and G.
E. called her up, and they reconciled. Unfortunately, she died shortly after that. G. E. has never gotten over that. Because of that, she is continually telling her family not to bicker over the small stuff, and that one’s family is all one has, and the people who love them the most in this world. Even though G. E. will not openly express pain to anyone except her doctor, the rest of her family will openly talk about any illness they have or pain they are experiencing. This is something she practically requires of them. She says it is like “do as I say, not as I do”.
This goes back to her not wanting to be a burden on anyone, yet she has to know that her family is alright. It is perfectly fine for her family to be a burden on her, because to her it is not a burden. She sees it as her responsibility. She states that her family always tells her she will never be a burden, but she is too stubborn to listen to them. She is the mother and she knows best. She says her family jokes to her that they are 50 something year old adults, yet they still feel like children when they are around her and have to do what their mother says or there will be trouble. She finds this very amusing.
She does not believe in cremation and plans to be buried alongside her husband. She has all of her final arrangements already planned and paid for, again, as not to burden her family. Many members of her family plan to be cremated and she cannot understand why. She believes one’s soul will not go to heaven if the body is cremated. There were no communication barriers while interviewing G. E. It was a very easy and pleasant interview. G. E. enjoyed talking about her heritage and family. G. E. is a very active and healthy woman for her 84 years, and she cannot wait until she can reunite with her husband in Heaven.
She prays to her husband every night. Personal Reflection Writing a cultural assessment about someone from a different generation was very interesting for me. While some of the information I received during the interview was similar to my own personal beliefs, most were not. Being two generations younger than G. E. makes a huge difference in certain beliefs. My mother is 100% Swedish and my father was a Vietnam veteran who is 50% German, with some English, French and more German. Growing up, my family did not follow any ethnic traditions and had no heritage related beliefs other than being American.
We were a middle class family and as a child I thoroughly enjoyed life. I have one younger sister, and we, for the most part, were spoiled. I think that has to do with having baby boomers for parents. We took dance classes and I was a gymnast through junior high school. We had a whole neighborhood of other children our age. We were outside from morning until evening, especially in the summer. Both of my parents worked and provided us with whatever we needed. My parents made me attend Sunday school every week until I was about 12. After that, I attended church only a few times a year. Religion does not play a big role in my culture.
Even at Sunday school, it did not make much sense to me, but I was too young really understand. My parents and grandparents always had a strong work ethic and I also do as a result. My parents wanted me to be my own person and choose my own path as long as it was an honest path. I live within a mile from my parents and from my sister so we see each other frequently. My parents help out my husband and me with our children. I have two sons and a daughter who are ages three, four, and six. One thing that differs from G. E. and me is that I like to know about the past as well as the present and future.
One thing that we agree on is that we see our doctor regularly and rely on the latest in medical technology and medications. When we are both ill, we tend to use the same methods to take care of ourselves. However, I am not one to hide any pain or illness I have from my family; when I am sick or in pain, everyone knows about it. Also, the way we in which we raise our children is different. G. E. raised her children in a loving, but more strict, manner. I do not raise my children in such a strict manner. I raise them like my parents raised me. They are very different styles, but I do not know that one is better than the other.
They both have positive and negative parts to them. In G. E. ’s generation the woman usually stayed home to take care of the family. In my generation I feel many women enjoy getting an education and usually find it a necessity to work outside of the home. I know I would enjoy the best of both worlds, to contribute to the family income, yet limiting my work outside the home to part time until the children are older. One thing about religion I also learned was how important it was to G. E. Other than her family, her religion was most important to her life, which is very different from me.
As I stated earlier, religion has virtually no importance in my life. Also, I do not consider myself to be ethnocentric. I have yet to meet a person whose religion, culture, ethnicity, or heritage shocked or bothered me. As long as I do not feel that I am being pushed into one belief or another, I am fine. Everyone needs to find the path that makes one happy, healthy, and whole. I want to be a nurse because I like people. I feel I can make a difference in this career by letting my patients know that I genuinely care for their well-being and want them to lead the best possible life they can.
I have been a Certified Nursing Assistant for the last 6 years and I enjoy it. I think by becoming a nurse I can do even more to help them. It is an awful experience to go to see the doctor, and feel like cattle being shipped in and out of the office at record speed. I like the thought of, as nurses, we take a holistic approach to healing that I feel doctor’s lack. Patients need to feel they can openly discuss their problems and that someone is actually listening to them and taking time to talk about it with them without judgment or prejudice; to come up with a plan of care that suits everyone involved, as much as possible.
I realize since I do work in a hospital that there will not always be a happy ending. Some patients can be difficult to care for, but as a nurse, I need to understand that they are there because they are ill, which has an effect on their personality and mental status. I must have empathy for them, as difficult as that may be sometimes. I know that when I am not feeling well, my personality changes, as does everyone’s. I feel the issues I need to work on most is the language barriers when they arise, and patient’s family dynamics. The diverse and often complex dynamics of a patient’s family is extremely difficult to understand.
It will take time to develop a way to handle these often difficult situations. No family has the same relationship, so as a nurse I must go in prepared for anything, and keep an open, non-judgmental frame of mind while performing a cultural assessment on the patient. Writing this paper has made me even more sensitive to people’s cultural differences. No matter what background one comes from, most people essentially want similar things when it comes to healthcare. One wants to be seen as an individual, rather than a number. We want compassionate care. We want to be listened to. We want to get well. We do not want to be judged or belittled.
We want to be understood and we do not want to be dismissed as just another “crazy patient”. Nobody reacts well to negativity especially when there is no need to be. These are the things I must keep in mind while doing cultural assessments in the future. References Alexopoulos Y. (2007). Illness, Culture, and Caring: Impact on Patients, Families, and Nurses. In Chitty, K. K. & Black, B. P. (Ed. ), Professional nursing concepts & challenges (5th ed. , pp. 237-269). St. Louis, Missouri: Saunders. Baxter, A. (2001). In search of your German roots, A complete guide to tracing your ancestors in the Germanic areas of Europe (4th ed. . A. Baxter (Ed. ), Baltimore, Maryland: Genealogical Publishing. Carter R. (2008). Cultural competence: Cultural care. In Jarvis, C. (Ed. ), Physical examination & health assessment (5th ed. , pp. 35-53). St. Louis, Missouri: Saunders. Downing J. (2008). Understanding each other: Communication and culture. In Riley, J. B. (Ed. ), Communication in nursing (6th ed. , pp. 46-62). St. Louis, Missouri: Mosby. Santos S. (2004). In Fuller, B. & Vossmeyer G. (Ed. ) Cultures of the world, Germany (2nd ed. ). Tarrytown, New York: Marshall Cavendish.
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