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Nursing in Multicultural Society: Transcultural Assessment Model

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    Nursing in Multicultural Society: Transcultural Assessment Model


    Problem and its Background

                Culture is a simple word with complex meanings that encompass the entire domain of human activities. As variant areas in the world possess their own identity, culture is one of the defining factors that forms the pattern of shared meanings, beliefs, and behaviors that are acquired and learned by a group of individuals during the course of experience. In addition, culture provides a reflection of whole human behavior, values, attitudes, and ways of relating to and communicating with each other. In the field of health care delivery, culture plays a significant factor that contributes greatly in rendering the best possible client care. By knowing the cultural description of the patient, the breaking down of the initial gaps and cultural discrepancies are indeed possible. As cultural identities of the patient sometimes hinder the care delivery especially if the target plan is the optimum health, awareness expansion and rapport building, right cultural assessment is indeed essential in such case confronted.

                Nursing cultural assessment requires inclusion of client’s criterion of cultural characteristics as well as social indicatives of care. Differences in culture care values, beliefs, and practices between nurse and client may lead to cultural conflicts and less beneficial care for the client. If the nurse does not understand and accept the cultural characteristics of the client, the client may decide to reject the nursing care that is offered. Essentially, theoretical frameworks are necessary in the application of such assessment; hence, the need to apply the Multicultural Care conceptual framework is indeed essential to be able to provide the maximum care output for the patient.

    Scope and Limitations

                The course study aims to discuss and elaborate the theoretical framework of Multicultural Care model, and further relate it to cultural assessment application for the improvement of nursing-patient care assessments. Moreover, the study shall coincide on the importance of proper and appropriate cultural assessment for the beneficial client care improvement. Primarily speaking, the study shall utilize conceptual flow charts with supporting and evident data that shall illustrate the overall cultural assessment process.

    Emphasizing on the theoretical framework proposed, we shall cover as well its application in communication processes between nurse and patient. By discussing the right cultural-congruent patient assessment, we shall also cover the probable gaps, difficulties and barriers of communication that may progress in the course assessment. In addition, we shall also cover the resolutions for culture-related conflicts, and means of improving patient satisfaction and trust between health care providers through the utilization of Multicultural Care Model.

    The following shall be the prime objectives of study involved, which shall also pre-determine the course guideline of research.

    a.                  To be able to utilize the theoretical framework of Multicultural Care Model in application to patient care procedures guided by cultural considerations through rightful assessment

    b.                  To be able to provide appropriate and theoretically-inclined application of the said theory proposed, and identify the possible barriers of communication as well as the appropriate resolutions that may potentiate the improvement of client care

    Review of Related Literature

                All societal and community organizations possess their own cultural identity, which is dynamic in characteristics and composite of customs, beliefs, social norms, values, and physical traits that  are characteristic of a racial, religious, or social group. As nurses assess their own ethnocentric beliefs and stereotypes, they begin to grasp the effects of culture on human lives. As the nurse establish his or her own cultural awareness, assessment and appreciation of patient’s cultural backgrounds is easily comprehended. Eventually, the nurse learns to meet the patient requirements in culturally competent manner (Kaplow and Hardin, 2007 p.96).

                The Multicultural Care model is the prime theoretical model established by Giger and Davidhizar, which considers six interrelated contributors for assessing differences between people in cultural groups. The following serves as the six categories that govern the cultural assessment variables (Allender and Spradley, 2004 p.85):

    a.                   Ethnic or racial background – which involves the patient’s racial origination, influential attributes that influence their status, and cultural identity present.

    b.                   Language and Communication patterns – The pattern of language preferred to be spoke, which also involves the accent, ethnic-based communication pattern, and non-verbal communications as well

    c.                   Cultural values and norms – involves the behavioral attributes influenced by cultural patterns of lifestyle, values, beliefs, and standards regarding such things as family roles and functions, education, child rearing, work and leisure, aging, death and dying, and rites of passage.

    d.                   Biocultural factors – involves the physical and genetic traits unique to the patient’s cultural group that predispose them to certain conditions or illnesses

    e.                   Religious beliefs and practices – considers the patient’s religious background, and its influence on life events, roles, health and illness.

    f.                    Health beliefs and practices – involves the prevailing conceptual beliefs and practices of individuals regarding prevention, causes, and treatment of illnesses, as well as other health care management being utilized either through self-prescribed or consulted.

                Nurses who practice Transcultural nursing consider that it is important to know the history of a person to comprehend the actions, behavior and attitudes that governs patients’ own health care (Leininger and McFarland, 2002 p.313). Transcultural nursing is a specialty of nursing care that focuses mainly on the delivery of culturally competent care, incorporating the patient’s culture into the plan of care to achieve the best outcomes (Kaplow and Hardin, 2007 p.96).

    Culturally diverse health care can and should be rendered in a variety of clinical settings. During the initial assessment, the goal is to summarize the patient data obtained. To assist nurses in caring for culturally diverse patients, a Transcultural assessment model was developed that centers on evaluating cultural variables and their impact on health and illness behaviors. In this model, emphasis is placed on the six cultural phenomena evident in all cultural groups as communication, space, social organizations, time, environmental control, and biological variations (Harrion, 2001 p.96). Although a general knowledge base and skills are applicable transculturally, immersion in a given culture is necessary to understand fully the conceptual patterns that modify the behavior of individuals within the cultural background (Allender and Spradley, 2004 p.85).

    Source: Allender and Spradley, 2004 p.85

                The cultural framework of Giger and Davidhizar has provided an efficient means to assess the cultural characteristics of the patient; hence, facilitating ease in the health care management. Nursing care should primarily include the six mentioned pillars of Multicultural model in the overall nursing care process in order to ensure maximum acceptance of the interventions made. Moreover, the nurse needs to include such concepts in detailed assessment of client, noting specific, measurable, and objective data that describes the overall description of the patient’s cultural background.


                Asian countries vary in their own health care beliefs, particularly in Korean cultural denominations. By utilizing the six pillars of Multicultural theory in Korean cultures and Asian studies, we are going to integrate the theoretical framework in the practice of nursing care involved in the overall concept of cultural assessment. Since culture is diverse and dynamic in its very nature, it is therefore, necessary to include the subjective and objective cultural factors to implicate the condition.

                Delivery of health care is Korea depends predominantly on the private sector, and more than 90% of hospitals are private. Healthcare ideas of individualism and autonomy are unfamiliar in traditional Korean culture, which emphasizes the individual as a part of a family unit, and decisions are made collectively by family groups. Korean elders will often involve family members in decision making, and an important health decision will commonly involve their conferring with and relying on an eldest son, if ever one exists (Adler and Kamel, 2004 p.102).

    Influenced by the Confucian ethic, the Korean culture accepts inherent social inequality among family members as a condition for achieving collective harmony. Strong loyalty to the family is a traditional Asian value, which is the primal core of relationships. Harmony and honor are important concepts for relationships, which on the whole angle of social pattern, afflicts health care management. Many Asian practices of healing are finding their way into Western health care systems, which includes acupuncture, tai chi, and herbal therapy. Nurses need to inquire about remedies used at home and what seems to be helpful. Family members may be present to provide personal care at the hospital, and when possible and appropriate, opinions of family members are an essential part of the plan of care (Orshan, 2006 p.257).

    Ethnic Background: Health Care in Asian and Korean Culture

                Korean culture are rich with medical facilities as well as high-end health care facilities; however, even with the advancements of medical firm. Korea and other Asian countries based most of their form of ethnic variants of medications on the traditional Chinese medicine, which dates back from 200 B.C. According to the principle of this of this traditional medication, the body is a balance of two opposing forces, mainly yin and yang. Yin represents the cold, slow, darkness, or passive principle, usually considers the female aspect, while Yang stimulates fire, excitement, active principle, and usually considered in male aspect. Homeostasis of bodily function is the prime goal of care in the traditional concept of Korean health care management (Mauk, 2004 p.685).

    Korea, still, has utilized the natural means of health care through the utilization of medicinal herbal treatments. In fact, the profit margin of herbal medicines is variously estimated to be 100-500% compared to their basic cost, and the population utilizes herbal medicines on a large scale. The amount of reimbursement for herbal medicine under the National Medicine Insurance scheme was approximately 50 billion Korean won in 1993, which estimated to be only a small portion of total expenditures on herbal medicines. The herbal form of treatment has played a tremendous contribution in the role of patient care management (Packer et al., 2004 p.12).

                Another ethnical attributes of the Korean culture is the belief of Shamanism, which is the traditional personnel that administers traditional medical aid to the ethnic minorities in Korea. These individuals are regarded as the traditional curers that utilizes most primitive, indigenous and folk methods of curing such as herbals, chants, and spells. To some point of view, these ethnomedical personalities are comparable to the western’s witch doctors (Kim, 2003 p.16).

                Nurses are required to consider such treatments utilized in these procedurals in order to assess possible maltreatments, or otherwise, that may have been afflicted by the herbal treatment. The ethnic considerations of these treatments are required in order to provide maximal care for the patient. If in case the patient prefers to utilize herbals or other traditional means of treatments, the nurse’s knowledge on herbal medicines may provide appropriate and rightful advise that renders maximal care management of the patient’s needs.

    Ethnic Background: Health Care in Asian and Korean Culture

                Language patterns of Korean are distinct and most likely exclusive in the health care facility primarily of their own country. As for Koreans, Japanese, Filipinos and other Asian health care delivery system, the primary language being utilized is their own national linguistics; however, to some internationally oriented hospital settings, English are also part of the training curriculum in order for health care providers to render the best possible care management for every ethnicities involved. In addition, high standardized medical facilities provide care measures that are friendly in other cultural diversities. Such hospital intervention protocols provides international friendly instructions in the form of two or three-language (English, native tongue, and optional secondary language) setups (Packer et al., 2004 p.12).

                Koreans located in other cultural settings, such as United States or other western countries, may have difficulty of achieving maximum health care needs due to language gaps that are presented. Cultural distinctions of Korean practices and non-verbal means of communication are sometimes the best way for Korean in such scenario to communicate their healthcare needs. Such scenario usually ends with outcomes of health care impairments, which may compromise the totality of health care needs (Mauk, p.685).

                Language gaps are usually prevented through organized hospital features of translator personnel that should be present in the hospital setting. Moreover, nursing care should be aware of the possible non-verbal means of communications, such as eye contact, hand signals, etc, that may facilitate the most probable and accurate instructions of health care, which is most critical especially during cases of emergency (Orshan, 2006 p.257). If nurses are not aware of such cultural characteristics, the total health care management of the client may be compromised; hence, efficient and most available translators, and trained health care staffs with culturally-inclined training considerations are essential to part in the health care team (Kim, 2003 p.16).

    Cultural Values and Norms: Health Care in Asian and Korean Culture

                Koreans are very much inclined to their family as inclusive personnel of every decision making that needs to be done. Independence and self-management are not part of their traditional perspectives; although, the western influence has modified such presented concept. The family ties from different lineage of familial ancestry are very much attached to the point that decisions, such as medical care, are disseminated and decided by the family members themselves. Consultations of medical care usually come from the eldest personnel in the family, mainly in the grandparents especially in the patriarchal aspect (Adler and Kamel, p.102).

                The nurse needs to be aware of the core decision making procedures of these cultural diversions, most especially when consulting health related conditions. The awareness of patriarchal and hierarchy of mainstream personnel of the family should be addressed properly in order to avoid conflicts, which usually arises when decisions of elders are disregarded or maternal decisions are consulted first instead of patriarchal decision makers.

    Biocultural Factors: Health Care in Asian and Korean Culture

                The cultural diversity of Koreans in terms of their biological stature possesses partial similarities with Japanese and Chinese appearance, but still has variations of physical statures. For cultural anthropologists, humankind is primarily divided into natural occurring classifications on the bases of physical characteristics such as height, hair color, the shape of the head, and facial features such as eyes, nose, and mouth. Based on their physical characteristics, Korean males tends to be a little taller than the compared feature of Japanese, but their facial features are almost the same, particularly the “Chinese-like” eyes, oblong facial frame, and tan to lighter skin complexion (Duus, 1995 p.416).

                The usual manifestations of diseases or illnesses progress more commonly on the physical stature of the body; hence, with the variations of the physical nature of every culture, the health care provider needs to consider such characteristics in order to provide rightful assessments that are patterned on the social norms and standards of the patient’s cultural character. In addition, biocultural factors of multicultural approach should be considered in the nursing care plan of action, as well in the criteria of evaluations (Adler and Kamel, p.102).

    Religious Beliefs and Practices: Health Care in Asian and Korean Culture

                Religion in Korea has been heavily influenced by Chinese traditions, particularly with Buddhism and Confucian concepts. Values and attitudes relating to family life and society are deeply from the Confucian, and the perspective on the natural world and the human life process is related to the traditional Daoist ideas. The Chinese traditional medical system likewise has exerted much influence over Korean ideas of health and healing. Spiritual health in these groups is evidently manifested through their routine and religious practices that involve their ancestral rituals, spiritual activity and meditations. As for these individuals, the cultural trademarks of spiritual practices that may directly affect the conditions of health care are present in every religious sect.

                As for Roman Catholics, the religion inhibits the utilization of artificial family planning methods, such as condom usage, pills, etc, which implicates a probable increase of the population count in their area. In other Christian sects, organ donation and blood transfusion are strictly prohibited due to their belief man possesses their own God-given parts, which are solely for themselves and not to be transmitted. On the other hand, other Christian sects, which predominantly prevails in South Korea, prohibits the intake of pork, blood, and other believed to be unholy, which are usually outsourced from the biblical scriptures (Packer et al., 2004 p.12).

                The nurse needs to instill such cultural inhibitions of their cultural religious background in order to avoid cultural conflicts especially during intervention acceptance. However, if the status of the patient exceeds to the point of a life threatening conditions, such practices are needed to be reconsidered. Nevertheless, consultations from the family prior to any interventions that may be contrary to their belief are still necessary.

    Health Beliefs and Practices: Health Care in Asian and Korean Culture

                Korean health practices are based on a complex mix of traditional and modern beliefs including the concept of the body possessing a life energy (called ki or in Chinese, chi), religious beliefs, and biomedical beliefs (Kemp and Rasbridge, 2004 p.223). Many Koreans believe in holistic concept of health and perceive health and illness as an integration of biological, social, psychological, and emotional attributes of the human. Such holistic concept also instills the inseparable components of mind and body. Homeostasis is the primary belief that serves as the goal of care, which is usually influenced by the concept of Yin and Yang (Lassiter, 1998 p.99).

                In terms of their health practices, Korean folks still follow the traditional mundang or shamans, herbalists, and acupuncturists, which are primarily derived from the Chinese cultural background. Other traditions include their ancestral worship for the purpose of advice consultations, which often requires the aid of the shaman (Lassiter, 1998 p.99).

    Summary and Conclusion

    In the overall study concept, the Multicultural theoretical framework of Giger and Davidhizar is primarily composed of six components. The following criteria have been applied on the case concept of cultural diversity in Korean individuals. The nurse needs to understand the cultural considerations of these individuals through cultural assessment utilizing the model as the fundamental tool. Such procedure prevents cultural conflict and enhances patient care management through broadened patient care approach and patient’s acceptability of care. Culture is a very distinct characteristic yet dynamic and unique; hence, awareness to such is essential for nursing care.


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    Kaplow, R., & Hardin, S. R. (2007). Critical Care Nursing: Synergy for Optimal Outcomes. Jones and Bartlett Publishing.

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    What are the six points in the Transcultural Assessment Model?
    The model includes six cultural phenomena: communication, time, space, social organization, environmental control, and biological variations. These provide a framework for patient assessment and from which culturally sensitive care can be designed.
    What is transcultural nursing model?
    Transcultural nursing models provide nurses with the foundation required for gaining knowledge about different cultures during healthcare delivery. The models are under continual development and they guide nursing practice all over the world.

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