Heritage Assessment and Cultural Competency: A Community Nursing Approach

In this report, the Heritage Assessment Tool will be used to evaluate the needs of three families from the community that the nurse interviewed, and then the families will be evaluated to facilitate greater quality nursing care by increasing cultural sensitivity and competency through the development of unique plans for health maintenance, protection, and restoration.

Heritage and culture play a tremendous role in accurately assessing a patient’s health history, current harmful or health-promoting activities, presence or absence of family support, and other facets of fully understanding a patient’s unique care context. Most importantly, this tool can be used to “determine how deeply a given person identifies with a particular tradition,” based on how many positive answers the patient gives (Pearson Education, 2014). Different cultures have their own set of practices used to maintain, protect, and restore health (Pearson Education, 2014). When the nurse is able to identify cultural traditions which double as health traditions, such as dietary restrictions, she can use the nursing process to negotiate a patient’s treatment in a culturally sensitive manner while exploiting the usefulness of the Heritage Assessment Tool to its fullest potential.

In order to maintain health, proper dietary recommendations must be followed, especially in the case of medical necessity as ascertained by a doctor or nurse. For example, some cultures view foods in categories of “cold” and “hot” which do not correspond directly to temperature but rather perceived values of the food’s innate category and health-related properties. (Seidel, 2003) When providing dietary education to a patient who has a “hot” and “cold” interpretation of food, the nurse should try to explain foods in ways the patient can relate to, while providing evidence-based rationales for any dietary changes that need to be made. Instead of telling this patient to avoid hot foods, which may be misinterpreted by the patient as a cultural category of foods, the nurse should explain which foods the patient currently eats that she needs to remove from her diet; and use high temperature, scalding, boiling, or other terms for hot in order to keep the patient education effective, clear and consistent.

This cultural awareness applies directly to one of the three families interviewed using the Heritage Assessment Tool. The “Kumar” family follows relatively strict dietary guidelines for religious reasons that include abstaining from pork, some other meats, and alcohol, and the purchase of approved meat from specific markets who use the proper butchering process (Akhtar, 2002). When the head of the household was asked about eating preferences, she stated that she would appreciate a nurse who understood that certain products that contain pork may not be acceptable for her, including gelatin (in Jell-O). This could make implementing the intervention that a hospitalized member of the Kumar family eats a soft diet more difficult if cultural considerations are not considered. Ms. Kumar suggested that rice porridge could be a good substitute for gelatin, although there are some important differences regarding aspiration risk and nutritional content. This is an example of the positive, back-and-forth dialogue which occurs between a community health nurse and her clients, increasing understanding and improving patient outcomes through the fulfillment of specific needs. This modification of the nursing intervention of providing patient dietary information reflects the care that is culturally aware and engages Ms. Kumar’s physical, mental, and spiritual health.

For health protection, many cultures use preventative rituals, foods, or medicines to ward off sickness before it requires treatment ranging from “keeping warm and dry,” to “wearing…holy medals” (Giger, 2013, pp. 305,326). A nurse can assess a patient’s likelihood of using these folk methods of health protection using metrics such as the Heritage Assessment Tool. If a patient is very interested in their family history, has close ties to relatives near and distant, and shows commitment to cultural traditions, it is very likely that they may be using culturally instilled methods of health protection which a nurse needs to be aware of. For example, the “Smith” family considered prayer and bible reading to be integral to protecting their family’s health. Prayer has a powerful influence on families’ and patient’s feelings, but there is conflicting evidence as to whether it produces increased positive medical outcomes. More important than the evidence of a prayer’s effect, however, is the idea that a nurse should support the faith diversity families and patients and accommodate their cultural needs in whatever ways possible, including allowing a reasonable time for prayer and consultation with a higher power as part of an overall care plan (Akhtar, 2002). Cultural practices such as praying can be an important component of a family’s sense of control over health decisions and outcomes and nurses should encourage the exercise of these cultural remedies when they do not interfere with any nursing assessments or interventions being provided.

Every culture seems to have its own set of cures that can be synergistic to scientific evidence-based practice, or sometimes, in opposition or conflict with accepted nursing assessments, treatments, and outcomes. The three families interviewed all had different ideas about curing disease which were based mostly on knowledge and ideas passed on from older family members who lived with them or guided them through health events. (Giger, 2013, pp. 55-57) The “Fernandez” family and the “Kumar” family both had high scores for traditional identification, and are therefore more likely to try a culture-based cure before and after seeing a medical professional such as a nurse to be evaluated. Some cultures, such as the Hispanic and the Indian culture, choose to use spices to treat specific ailments that medical professionals understand the call for evidence-based interventions. (Pearson Education, 2014) If a cultural coping mechanism such as taking spices will not interfere with treatment (some foods cause dangerous drug interactions), then a nurse should assess a patient’s cultural actions and try to provide patient education on how to incorporate these habits safely into a nursing plan of care. (Seidel, 2003)

In order to maintain, protect, and restore health in a holistic manner, which accounts for physical, mental and spiritual dimensions, culturally competent nurses should empower themselves with the knowledge of a client’s racial, ethnic, religious, and cultural background through tools such as the Heritage Assessment Tool. These three families can each benefit from specially tailored plans of care that emphasize nurse, patient, and family communication and address their respective patients’ needs in the context of their unique cultures.

References

Akhtar, S. (2002, April 16). Nursing with dignity. Part 8: Islam. Nursing Times. Retrieved March 16, 2014, from http://www.nursingtimes.net/nursing-with-dignity-part-8- islam/206284.article

Giger, J. N. (2013). Transcultural nursing: Assessment & intervention (6th ed.). St. Louis, Mo.: Elsevier/Mosby. pp. 55-57, 305-326

Pearson Education. (2014). Cultural care guide. Retrieved March 16, 2014, from http://wps.prenhall.com/chet_spector_cultural_7/94/24265/6211875.cw/index.html

Seidel, H. M. (2003). Mosby's guide to physical examination (5th ed.). St. Louis, MO: Mosby. pp. 33-38.