Cultural Competence in Health history Assessment of Individuals. Cultural Competence in the Health History. This week, we will delve into cultural competence in the health history and physical examination of individuals. Although this course concentrates on a cultural assessment, you will need to know transcultural perspectives on the physical examination for your day-to-day nursing practice. Your text is a valuable resource that can help as you work in diverse settings and with diverse populations.
What are the transcultural implications of asking a patient to fill in a health history form? What are the advantages and disadvantages to such an approach to obtaining information?
Various experts offer transcultural assessment models, but the elements are similar among all of them. The elements include, but are not limited to,
- communication (our focus this week);
- space (how close is too close?);
- religion (nurses of all faiths have a responsibility to respect religious diversity);
- perceptions of the world (is this ethnocentricity?);
- health beliefs (they vary widely);
- kinship and social networks (the value of family and friends); and
- traditions (these vary widely) (Andrews & Boyle, 2016).
A culturally competent history taker will ask questions about these elements in a way that elicits meaningful responses from the patient. This means questions should be open-ended wherein one elicits maximum information in a short period of time. Please see Appendix A in your text by Andrews and Boyle (2016) for a transcultural nursing assessment guide for individuals and families. You will have an opportunity to develop open-ended questions in Milestone 2 of your Course Project, Transcultural Assessment Guide and Questions. It is not too early to review those guidelines.
Patients who have limited skills reading and speaking English may need a medical or healthcare interpreter or translator. Both the interpreter and translator can serve as a communication bridge between the patient and the healthcare provider. Both need to understand English and the patient’s own language, including medical terms and ways to explain this so that a nonhealthcare professional may understand. Being sensitive to culture is an important attribute.
An interpreter is similar to, but not the same as, a translator. A translator converts information into the desired language but does not attempt to embellish or explain it. An interpreter may go further than simple translation to give cultural meaning to what is being communicated. As nurses, we may be tempted to embellish and explain.
What is the difference between an interpreter and a translator?
Can you think of an example of where the difference between translating and interpreting may impact your communication with a patient?
To learn more about interpreters and the use of language access services, connect to www.ThinkCulturalHealth.hhs.gov (Links to an external site.), and review the short videos units entitled “Working with an interpreter” and “Using language access services.” These will be valuable videos for your review.
Assessment Questions: Q & A
In Milestone 2, you will be asked to develop primary and follow-up questions for the individual you choose for your Course Project. While we are talking about communication, let’s think about some quality questions. Asking the correct questions during any health history/assessment is a skill. Review the following and see how you do.
Assessment Questions: Q & A
Please indicate if the following are high quality assessment questions.
- “Can you tell me about a disease that is prevalent in your culture?” This is a high quality assessment question.
- “What would you say are the similarities and/or differences between your two generations regarding cultural values?” This is a high quality assessment question.
- “You spoke about missing your family. How do you handle the occasions such as weddings, funerals, and other important family events?” This is a high quality assessment question.
- “What religious beliefs do you have?” This is a high quality assessment question.
- “In the United States, we have Medicaid and Medicare. Can you tell me how healthcare is funded in your country?” This is a high quality assessment question.
- “Are your health beliefs different in the United States than the country where you were born?” This is a high quality assessment question.
Cultural Differences and Response to Drugs
Part of the health history includes obtaining an accurate review of drugs that the patient is taking. This occurs in a variety of healthcare settings. Medication reconciliation is important regardless of our practice settings. Included in the list of medications should be over-the-counter as well as prescribed medications. In addition, herbal remedies may be utilized, and many people do not consider these to be medications, so asking them specifically about herbs is necessary.
According to Andrews and Boyle (2016), there is a growing body of evidence-based data indicating that modifications in dosages of some drugs is necessary for members of selected racial and ethnic groups.
For example, Chinese patients may be less sensitive to the respiratory depressant and hypotensive effects of morphine. Hispanic patients may require lower dosages and experience a higher incidence of side effects with tricyclic antidepressants. Native American patients may experience prolonged muscle paralysis and an inability to breathe without postoperative assistance after administration of some muscle relaxants.
Even the liquids in which medications are administered can have cultural implications. We routinely offer patients water to swallow medications. Some cultures believe that hot liquids promote healing, so offering tea or coffee might be an alternative. Some Mexican Americans believe grapefruit juice has healing properties, and having this readily available would be important.
As mentioned, an important aspect to consider when dealing with culture and drugs is medication reconciliation. Let’s hear from Chana about her experiences working in a new setting.
The Story Continues . . .
“I knew that medication reconciliation was a big deal at the hospital and that it takes extensive nursing time, but I didn’t consider how important it is at the family practice clinic, as well. I found some really good articles while searching the Chamberlain library about medication reconciliation and the ethnic and cultural differences with drugs. For example, one article in Psychiatry discussed a study on antidepressant medications in the Latino culture. According to Lewis-Fernandez et al. (2013), compared to non-Latino White patients, U.S. racial and ethnic minority groups show higher nonadherence with outpatient antidepressant therapy. I want to let my classmates know that there is evidence that medications are not metabolized the same way by everyone, and this includes not just prescription but over-the-counter drugs, too.”
It’s Week 2 already and Chana and Eric continue their interactions.
Please click on the link.
Play media comment.
This week, we examined cultural competence in health assessment of individuals. The importance of considering culture when taking a health history was stressed. Outstanding communication skills are very important when working with culturally diverse patients and their families, especially when using interpreters and translators.
The influence of culture on responses to drugs was explored. The need for medication reconciliation was highlighted.
- Which assessment question shows an understanding of the impact of cultural beliefs and behaviors on a client’s demonstration of pain?
- “Can you describe the pain you are experiencing for me?”
B. “Can you describe the pain you are experiencing for me?”
C. “Have you ever taken medication to help control your pain?”
D. “How can I help you deal with the pain you are experiencing?”
- Which nursing activity shows an understanding of the process of culturally competent nursing practice?
- Attending two in-service programs yearly on attaining cultural competency
B. Including cultural assessment questions in an admission interview
C. Providing a non–English-speaking client with information written in his or her native language
D. Encouraging the facility to provide access to language translators
- Which consideration is the basis for the selection of an interpreter for an older client who has a limited ability to speak and understand English?
- Younger adults are generally more understanding of American jargon and so can translate it better.
B. Family members are generally considered good interpreters because they share the same dialect.
C. The interpreter should ideally be of similar age and of the same gender as the client.
D. The client should be allowed to select the interpreter as a means of maintaining autonomy.
- Which nursing activity has priority when providing culturally congruent care?
- Identifying the client’s healthcare expectations
B. Assessing the client’s ability to communicate effectively with staff
C. Self-reflection concerning beliefs associated with the client’s culture
D. Evaluating the facility’s ability to meet the client’s cultural needs