Heritage Assessment Tool Benchmark assessment

Heritage Assessment Tool: Cultural values and health beliefs

Cultural sensitivity is an integral part of effective nursing. Although the definitions of concepts such as 'health' and 'wellness' might seem on their surface to be self-evident, these notions are, in fact, highly mutable and particular to the individual and his or her culture. Cultural insensitivity can result in patients becoming alienated from the medical system and this results in poorer, ineffectual care. One of the reasons instruments such as the Heritage Assessment Tool can be so useful is that it can be a clear and efficient way to establish the culturally-contextual health beliefs of a patient whose experiences and values that are different those of the physician, nurse, or other healthcare provider treating the patient.

The first family I interviewed was a Chinese-American household. Although the family was relatively assimilated and the children were second-generation residents of the U.S. that did not speak fluent Chinese, the grandparents at least understood and remembered many Chinese customs from their native homeland. They were also able to explain many common Chinese medical folk beliefs which, while not necessarily common in their immediate family, were common amongst many Chinese. For example, many Chinese families believe in the value of traditional Chinese medicine. Although some Chinese health beliefs may be compatible with Western medicine such as acupuncture and yoga, many of the herbs used in traditional medicine may be unfamiliar to Westerners, even Western doctors. Conventional Western medicine views traditional Chinese medicine generally as a 'complement' to its practices; however some Chinese people will first see if traditional home remedies work first. If they are not effectual, the doctor may berate the individual for coming to him or her so late but rather than dismiss such behaviors as superstitious, it is important to treat the individual patient with sensitivity and awareness of the different tradition which is affecting the patient's health-related behaviors.

A hostile attitude towards traditional medicine may also mean that the physician or nurse will not obtain all the information he or she needs. According to the Chinese-American family I interviewed, physicians who were aware of the fact that they practiced TCM (traditional Chinese medicine) would ask them what herbs they were using, given that some could be dangerous to use in combination with standard pharmaceuticals. Although much of traditional Chinese medicine is complementary, this cannot be universally assumed: some herbs may be contraindicated because of their negative effects with Western medicine. This is another reason why inquiring in a nonjudgmental fashion what previous treatments the patient has used is essential.

In Chinese culture, dietary beliefs may also be somewhat different from...

In general, the family I interviewed ate relatively unprocessed foods with meat, rice, and vegetables and not very much sugar. But although not common amongst the younger members of the family, older family members would often use a specific diet to address illnesses, again before consulting a physician. Certain foods may be regarded as necessary to restore the body to its natural state of balance. The family also exercised regularly, including the oldest members who practiced yoga as well as walked frequently.
The family I interviewed had strong multigenerational ties. Even in relatively modern Chinese families, health-related decision-making may be entered into in a collective rather than an individualistic manner. Patients may believe it is better that an elderly parent not know what is making him so sick or parents might not wish a child to be told he or she has cancer. Decision-making authority may be invested in the head of household regarding health, versus individuals.

This emphasis on the collective, versus the individual, and the idea that decisions are made in harmony rather than in a unilateral fashion was also typical of the Latino family I interviewed. They noted that on many occasions it was common to have several generations in the consulting room during an appointment, particularly when decisions were made about an elderly or very young family member. Or, sometimes a grandmother would take a child to a doctor's appointment if the mother had to work. The physician or nurse in attendance must be sensitive to this fact: it might be surprising to see grandparents equally involved in decisions about children's health as parents or a competent elderly patient relying so much on their children to make decisions, but these practices are not atypical for Hispanic families.

The Hispanic family I interviewed was relatively well-assimilated for many generations to America but it is also important to remember that language can be a barrier for individuals who have recently arrived to the U.S. (as is the case with Chinese-Americans as well). Even if someone speaks near-fluent English, medical terminology can be confusing in a second language. (Also, although this was not the case with this family, bad experiences with authority figures due to immigration issues -- or finances -- could also act as an impediment to seeking out healthcare, as is the case for all recent immigrants to the U.S.). Folk medicine and basing health-related behaviors more upon custom than science may also be common amongst elderly members of the family, although in the family I interviewed this did not seem to be the case. Religion, however, was very important to the family and prayers (as well as conventional medicine and home remedies) were used to deal with illnesses. Prayer was a very important component of dealing with serious illnesses even though family only considered itself…