Presentation on Giger and Davidhizar’s Transcultural Assessment Model and its use in assessing care of clients from multicultural populations for medical professions.

1. Giger and Davidhizar’s
Transcultural Assessment Model
and its use in assessing care of clients from
multicultural populations
Presented by
Gerri Virgil, M.S.N., R.N.

2. Objectives
• Describe Giger and Davidhizar’s Transcultural Assessment Model and
its use in assessing care of clients from multicultural populations.
• Identify nursing diagnoses and interventions specific to Mai’s Vietnam
culture using the Transcultural Assessment Model.
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3. Giger and Davidhizar’s
Transcultural Assessment Model
• The goal of transcultural nursing is to be cognizant of
culturally relevant facts about the client in order to provide
culturally competent care.
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4. Giger and Davidhizar’s
Transcultural Assessment Model
Nursing
Culturally
assessment
unique
individual
Communication
Space
Biological Environmental Social
Time Organization
variations control
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5. Giger and Davidhizar’s
Transcultural Assessment Model
The Transcultural Model has components of social structure and
world view factors that influence health through language and
environment.
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6. Giger and Davidhizar’s
Transcultural Assessment Model
It is important to remember that this model does not
presuppose that all individuals of a specific cultural group think
or behave in a similar manner.
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7. Giger and Davidhizar’s
Transcultural Assessment Model
The U.S. Census Bureau has projected that by the year 2020 only 53%
of the U.S. population will be of White European descent.
By the year 2020 only 53%
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8. Giger and Davidhizar’s
Transcultural Assessment Model
Further projections indicate that the number of Asian Americans will
triple and African Americans will double. An understanding of cultures
differing from the so-called “norm” is crucial to providing relevant care
for our clients.
Asian Americans will triple African Americans will double
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in population in population

9. Giger and Davidhizar’s
Transcultural Assessment Model
We will began our discussion by:
1. Assessing our client’s Vietnamese culture using Giger and
Davidihizar’s Trancultural Assessment Model
2. Identifying nursing diagnoses followed by nursing interventions
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10. Nursing Assessment
Component 1
Culturally unique individuals (includes place of birth and “time” in
country)
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11. Nursing Assessment
Component 1
Mai was born in Vietnam
and left with her family at
age 7. She is now 25 years
old.
Vietnam is bordered by
Cambodia and Laos on the
west, Gulf of Thailand on
the south and on the east
by the China Sea.
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12. Nursing Assessment
Component 1
Vietnam was initially divided into 2 spheres of influence with North
Vietnam communist and South Vietnam U.S. supported. It is now the
Socialist Republic of Vietnam.
There were 3 waves of migration to the U.S. after the Vietnam War:
First Wave – 1978 included professionals and ranking South Vietnam
military officials
Second Wave – Chinese & Vietnamese business people
Third Wave – I980 boat people left for economic and political reasons. A
majority in poor physical condition and unable to write/read English or
Vietnamese well. (Mai’s family was in this “wave”.
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13. Nursing Assessment
Component 2
Space (Proximity to others -
degree of closeness when talking
or standing near others)
• In Vietnam culture, individuals are
“comfortable” when others stand 18
inches to 3 feet away
• Touch is not welcomed from
“strangers” or non-family members
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14. Nursing Assessment
Component 3
Communication (Language spoken – includes non-verbal)
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15. Nursing Assessment
Component 3
Respect is evident in
communication and
“cornerstone” of Vietnam
society notably with use of
“titles (i.e., Aunt, Uncle in
front of “names” for family
members). Last name
comes before first name
(i.e., Nyguen Mai). Great
respect for the family and
“elders”.
This Soviet or Communist style statue presents Ho Chi Minh as a kindly older male relative, with his arm protecting the girl
beside him. The statue’s form suggests not only that Ho Chi Minh was, and is, like a father, educating the Vietnam nation
and people, but also that the nation and its citizens are vulnerable, precious, and uneducated like young children. 15

16. Nursing Assessment
Component 3
• Children are taught to think before
speaking
• Eye contact is avoided out of “respect”
• Bowing of head to show respect (i.e., to
nurse, teacher, elder)
– “Beckoning” is done with palm and
waving of fingers (upward palm is for
“beckoning of an animal and is
considered an insult)
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17. Nursing Assessment
Component 3
Communication Style – Expression of emotion
Asian American
Non-verbal Verbal
Subtle, indirect Open, direct
Serene, stoic, suppression of Expressive, spontaneous
negative emotions
Indirect expression of Direct, verbal and physical
affection by fulfilling expression of affection 17
obligations, needs

18. Nursing Assessment
Component 3
For interviewing purposes:
– Use short and direct sentences
– Plan questions carefully, focus on
one item for yes and no questions
– Avoid technical jargon
– Avoid “jokes” – humor difficult to
translate
Use an interpreter for language of origin
(same sex, if possible)
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19. Nursing Assessment
Component 4
Biological variations (body structure, diseases specific to
population and nutrition)
Body size of Vietnamese
• Averages 80 to 130lbs with a small frame
• Blood type B (present in only 8% of White race)
• Lactose intolerant (congenital)
• Anemia
• Prone to fungal infections and parasites (i.e.,
hookworm and amebiasis)
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20. Nursing Assessment
Component 5
Environmental Health
Cultural health practices (definition
of health and illness)
Emphasis on :
– Naturalistic (Folk medicines)
– Supernaturalistic (Demons,
Gods)
– Metaphysical (“Balance”
harmony)
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21. Nursing Assessment
Component 5
Environmental Health
• Laboratory tests (drawing of blood) - to
Vietnamese means losing body fluids may lead
to “suffering” and “loss”
• Consider tablets as “strong” - may take 1/2 of
tablet. Prefer liquid medicines. Studies show
Vietnamese required dose for psychotropic is
significantly lower than for American
counterparts
• Nutrition - staple is rice diet, up to 3 bowls of
rice daily, osteoporosis common with low
calcium intake. Children drink milk (evaporated
milk) with ice and fruit
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22. Nursing Assessment
Component 5
Mental Health
• Emphasis on “saving of face” for family - family member not brought
in for “mental assistance” until the situation is “critical”
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23. Nursing Assessment
Component 5
Mental Health
• Cultural adjustment and PTSD common with
immigration. Emotional and behavioral
problems often related to:
– Underemployment
– Loss of extended family
– Stresses of adaptation
– Symptoms of hopelessness
– Acute distress
– Fatigue
– Mood instability seen
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24. Nursing Assessment
Component 5
Mental Health
Denial as a defense mechanism is seen and
congruent with Vietnamese values of
harmony and submission to the common
good. The culture is Chinese influenced,
with overt expression of anxiety,
disappointment, anger and negative
feelings are considered “weaknesses.”
Studies show mental illness expressed as
physical illness is “preferred.”
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25. Nursing Assessment
Component 6
Time
Emphasis is on ancestors and the
past. Orientation is in terms of
events, such as births, deaths and
marriage, not specific dates on a
calendar. This is important for
nurses obtaining a chronological
“history of illness.” Also, being “late
or early” is not considered
“important.” (factor with medication
compliance and medical
appointments.)
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26. Nursing Assessment
Component 7
Social Orientation
The family is the backbone of
tradition and heritage, family,
loyalty with “filial loyalty”
commanding children to obey
parents. Mental illness, juvenile
delinquency, academic failure, etc.
are consider a disgrace to family.
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27. Treatment Plan
Nursing Diagnosis Communication, impaired verbal, related to foreign-
language barrier
Client Outcome Nursing Interventions
1. Client will be able to 1. Determine client’s understanding and
communicate more ability to communicate in English.
effectively customs and 2. Talk slowly, enunciating words.
beliefs used in treating 3. Face client and speak in a slow, clear
illnesses and nurse will voice.
better understand these 4. Use gestures to convey meanings, but
customs. do not use excessive “touching.”
5. Attempt to locate a translator for
assistance (if needed).
6. Provide client adequate space to
communicate without “crowding.”
7. Keep language simple.
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28. Treatment Plan
Nursing Diagnosis - Noncompliance (risk for) related to misunderstanding of the
prescribed treatment secondary to the belief that medications in the Western world
are much stronger than those found in the Far East.
Client Outcome Nursing Interventions
1. Client will demonstrate an 1. Assess client fear of prescribed treatment
understanding of prescribed 2. Promote health teaching to educate client on
medical regimen. the effects of prescribed medicine.
3. Warn client that some medications may
make the client sleepy and that this is an
expected occurrence.
4. Teach client about importance of adhering to
prescribed medical treatment.
5. Reassure client that prescribed medication
is appropriate and safe for client.
6. Review medication, dosage, and proper
administration technique to help client feel
more comfortable with the treatment.
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