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So the nurse has to understand, when giving directions as to medications or other therapies, what that culture's definition of "three times a day" or "first thing in the morning," etc. means to them. And explanations of which directions are flexible and which are not are critical -- and might be life or death. They may nod their heads but have their own ideas about what change the dressing "frequently" means.
Time also has to do with tradition. Many countries are oriented to the past and value the "old" ways. China and England come to mind. A nurse may find that these cultures may not be so acceptable of "new" technologies or "cutting-edge" procedures.
Environmental Control deals with an individual's beliefs about illness and disease and their health prevention practices and ideas. It also has to do with their values and whether or not they feel at the mercy of "nature." For instance, according to studies, Hispanics are more likely than Caucasians to say that pain had "ruined their life." And in these same cultures, like the Chinese, asking another for help may be considered a lack of respect. That applies to nursing in the fact that requesting pain medication from a clinician (nurse) is believed to be disrespectful of the nurse's time, so they may go without unless asked about the need for the medication by the nurse or doctor (Hart, Davidhizar, & Davidhizar, 2005).
Biological Variations include susceptibility to disease, nutrition, and inherited genes. These, and others, may have a significant impact on the individual's level of pain sensitivity.
There is a gene that has been discovered that can make a person more or less sensitive to pain.
There is no doubt that this would be important information for the nurse to be aware of as she and the doctor apply treatments, medications, etc. To a patient who could think an injection is extremely painful because to her or him -- it is. And, on the other hand, it is important to know that, in some cultures, admitting to pain is abhorrent. So, "does that hurt?" could cause a health practitioner to apply unnecessary force or even injury to one from those cultures who may be sitting there smiling at them while experiencing severe pain but not admitting it.
Assessment of a person's health is a very important part of being a nurse. The doctor may perform the exam, but it is usually the nurse who spends more time with the patient and may sit with them to interview or do an evaluation of the past and present health.
There is nothing more crucial than understanding who is sitting there across the table or lying in that hospital bed, and why she or he has the beliefs that might seem so strange to some.
It is only when both patient and caretaker cooperate to discuss, explain, ask questions, and listen that this transcultural assessment model can be utilized to provide optimum care for each patient in every culture.
Why I Chose This Model
I chose the model because it was first developed in response to the need for nursing students in an undergraduate program and to assess and provide care for patients that were culturally diverse. It is now widely used because it is an effective tool in assessing cultural differences in health values, beliefs and disease behaviors and their effects. It allows nurses to focus on the six areas of transcultural phenomena that will help them gain an understanding of the patient's perspective and the impact it has on health. It also helps us to understand that all patients suffering from the same affliction cannot be treated in the same way. In many cases there are racial, ethnic and other cultural factors that must be considered and addressed in prescribing and providing treatment. It is a transcultural assessment model that greatly minimizes time when conducting a comprehensive assessment.
AAN. (n.d.). Giger & Davidhizar transcultural assessment model. Retrieved June 13, 2009, from American academy of nursing (AAN): http://www.aannet.org/files/public/Giger_template.pdf
Giger, J.N., & Davidhizar, R.E. (2004). Transcultural nursing: assessment & intervention. Philadelphia: Elsevier Health Sciences.
Hart, A.N., Davidhizar, R., & Davidhizar, R. (2005, June 1). Pain management: Delivering culturally appropriate care. Retrieved June 13, 2009, from Mediwire.com: Mom m.d. (from healthcare traveller): http://mommd.mediwire.com/main/Default.aspx?P=Content&ArticleID=165063[continue]
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