Cultural Assessment

The Population in the US:

• Emerging majority groups tend to be younger,
with lower median ages and higher
proportions of the population under the age of
18 years.

• The non-Hispanic, single-race, white

population has an older median age and a
smaller proportion of the population under the
age of 18 years.
Linguistic Competence
• Title VI of the Civil Rights Act of 1964: Services
cannot be denied to people of limited English
proficiency.
• Over 47 million Americans > 5 years of age
speak a language other than English in their
homes.
• This represented an increase of 15 million
people over the numbers documented in the
1990’s.
• Certain states require that providers offer
language assistance in health care settings:
California, Massachusetts, and New York.
 Health:
• “The balance of the person, both within
one’s being—physical, mental and/or
spiritual—and in the outside world—
natural, communal, and/or metaphysical,
is a complex, interrelated phenomenon
(Spector, 2004)
 Culture
• Totality of socially transmitted behavioral
patterns, arts, beliefs, values customs, life
ways, and all other products of human
work and thought characteristics of a
population of people that guide their
worldview and decision making.
(Purnell, 2013)
 Illness:
• The loss of the person’s balance, within
one’s being—physical, mental and/or
spiritual—and in the outside world—
natural, communal, and/or metaphysical.
 Culturally Competency
• Integration of knowledge, attitudes and skills
– Promote meaningful interactions
• Communications
• Applying underlying background knowledge
necessary to provide the best possible health care
• Understanding and attending to total context of patient’s
situation including
– Immigration status
– Stress factors
– Social factors
– Cultural similarities and differences
Cultural Competent Assessment
Purposes and Scope of Assessment
•To learn about the client’s beliefs and usual behaviors associated with
health and illness, including beliefs about disease causes, caregiving,
expected treatments (both Western medicine and folk practices), daily
hygiene, food preferences and rituals, religious beliefs relative to health
care
•To compare and contrast the client’s beliefs and practices to standard
Western health care
•To compare the client’s beliefs and practices with those of other
persons from a similar cultural background (to avoid stereotyping)
•To assess the client’s health relative to diseases prevalent in the
specific cultural group
 Characteristics of Culture
• Learned from birth
• Shared by group members
• Adapted to conditions
• Dynamic and ever-changing
 Subculture
• Ethnicity
• Religion
• Occupation
• Health-related characteristics
• Gender
• Sexual preference
 Ethnicity
• Describes a group united by
– Common geographic origin
– Migratory status
– Religion
– Race
– Language
– Shared values, traditions, or symbols
– Food preferences
 Assessment
• Communication
– Dominant language and dialects
– Cultural communication patterns
– Temporal (time) relationships
– Format and names
 Assessment
• Family Roles and Organization
– Head of household and gender roles
– Prescriptive, restrictive, and taboo behaviors
– Family roles and priorities
– Alternative lifestyles
 Cultural Diversity: Best Practices
• Overcoming Cultural Awareness Obstacles
– Increase confidence
– Be open to information
– Expect time needs when working with non-English
speaking clients
– Seek out organizational support
– Be alert to statements that devalue people from other
groups
– Raise questions about care provided to culturally
diverse clients

Killian, P. & Waite, R. (2007) Cultural diversity: Best

practices, Advance for Nurses, 29- 32.
 Cultural Diversity: Best Practices

• Tips Developing Your Cultural Sensitivity

– Increase awareness of your cultural values, beliefs
and practices.
– Explore the influence of your culture on health, health
behaviors and culture in general.
– Develop easy access to materials on cultural groups,
utilize materials.
– Increase awareness about assessment tools, and
questions that can be used to shape interventions.
Killian, P. & Waite, R. (2007) Cultural diversity: Best
practices, Advance for Nurses, 29- 32.
Steps to Cultural Competence
• Understanding one’s own heritage-based cultural
values, beliefs, attitudes, and practices
• Identifying meaning of “health” to the patient
• Understanding how the health care system works
• Acquiring knowledge about the social backgrounds of
one’s patients
• Becoming familiar with the languages, interpretive
services, and community resources used by (and
available to) your patients and yourself
 R.E.S.P.E.C.T.
• R = Realize that you • P = Pace questioning
must know the throughout the exam.
• E = Encourage patient to
heritage of yourself discuss meaning of health
and your patient. and illness with you.
• E = Examine the • C = Check patient’s
patient within the understanding and
cultural context. acceptance of
recommendations.
• S = Select questions • T = Touch the patient
that are simple and within the boundaries of
speak them slowly. his or her heritage.