Heritage Assessment Tool: Cultural Health Beliefs Across Families

Introduction: Culture and Health Beliefs in Nursing

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, leading to poorer, less effectual care. One of the reasons instruments such as the Heritage Assessment Tool can be so useful is that they offer a clear and efficient way to establish the culturally contextual health beliefs of a patient whose experiences and values differ from those of the physician, nurse, or other healthcare provider treating them.

Chinese-American Family: Traditional Medicine and Dietary Practices

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. who 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 practiced in their immediate family, were common among many Chinese communities.

For example, many Chinese families believe in the value of traditional Chinese medicine. Although some Chinese health practices may be compatible with Western medicine — such as acupuncture and yoga — many of the herbs used in traditional medicine may be unfamiliar to Western practitioners, including Western doctors. Conventional Western medicine generally views traditional Chinese medicine as a "complement" to its own practices; however, some Chinese individuals will first try traditional home remedies before consulting a physician. If those remedies prove ineffectual, the doctor may criticize the individual for coming so late. Rather than dismiss such behaviors as superstitious, it is important to treat the individual patient with sensitivity and awareness of the different tradition influencing his or her health-related behaviors.

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

In Chinese culture, dietary beliefs may also differ from what Western norms suggest for a healthy lifestyle. In general, the family I interviewed ate relatively unprocessed foods — meat, rice, and vegetables — with very little sugar. Although not common among the younger members of the family, older members would often use a specific diet to address illnesses 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 and walked frequently.

Collective Decision-Making in Chinese-American Families

The family I interviewed had strong multigenerational ties. Even in relatively modern Chinese families, health-related decision-making may be approached collectively rather than individually. Patients may believe it is better that an elderly parent not be told the full nature of an illness, or parents might not wish a child to be told he or she has cancer. Decision-making authority regarding health matters may be invested in the head of the household rather than in the individual patient.

Conclusion: Cultural Sensitivity in Nursing Practice

Cultural sensitivity and awareness does not necessarily mean that the nurse must validate all of a family's belief practices, but she must still communicate with the patient in a manner that acknowledges the patient's worldview. All three families I interviewed were willing, to varying degrees, to accept Western medicine, though they also maintained traditional and cultural practices that could conflict with standard medical advice. Promoting wellness is best accomplished in conjunction with these cultural assumptions rather than by attempting to override them.