1. Nursing Practice Discussion
Nursing Practice DiscussionORDER HERE FOR ORIGINAL, PLAGIARISM-FREE PAPERS ON
Nursing Practice DiscussionThe Cultural Assessment Model. Compare and contrast two
cultural models. Post response in discussion board for week 5.Module 3: Nurse as a Cultural
BrokerNurse as a Cultural
Brokerhttps://nccc.georgetown.edu/documents/Cultural_Broker_Guide_English.pdfAssign
ment: Discussion 7 CC3.aReview information provided for cultural brokerage. What is the
meaning of cultural brokerage? What is the benefit of cultural brokerage in healthcare? List
3 ways nurses can fulfill their role of cultural broker in healthcare? Summarize your
findings in the discussion board for week 5.Cultural Assessment Models Dr Mitchell-Levy
NUR 3045 Leininger’s Cultural Assessment Model • • • Biography and Career of Madeleine
Leininger Madeleine Leininger was born on July 13, 1925 in Sutton, Nebraska. She earned
several degrees, including a Doctor of Philosophy, a Doctor of Human Sciences, a Doctor of
Science, and is a Registered Nurse. She is a Certified Transcultural Nurse, a Fellow of the
Royal College of Nursing in Australia, and a Fellow of the American Academy of Nursing.
Leininger’s Cultural Assessment Model • Madeleine Leininger’s theory of Transcultural
Nursing, also known as Culture Care Theory, falls under both the category of a specialty, as
well as a general practice area. The theory has now developed into a discipline in nursing.
The Transcultural Nursing theory first appeared in Leininger’s Culture Care Diversity and
Universality, published in 1991, but it was developed in the 1950s.The theory was further
developed in her book Transcultural Nursing, which was published in 1995. In the third
edition of Transcultural Nursing, published in 2002, the theorybased research and the
application of the Transcultural theory are explained. Leininger’s Cultural Assessment
Model • Transcultural nursing is a study of cultures to understand both similarities and
differences in patient groups. Culture is a set of beliefs held by a certain group of people,
handed down from generation to generation. In transcultural nursing, nurses practice
according to the patient’s cultural considerations.It begins with a culturalogical assessment,
which takes the patient’s cultural background into consideration in assessing the patient
and his or her health. • Once the assessment is complete, the nurse should use the
culturalogical assessment to create a nursing care plan that also takes the patient’s cultural
background into consideration Leininger’s Cultural Assessment Model • Leininger’s model
has developed into a movement in nursing care called transcultural nursing. • In 1995,
Leininger defined transcultural nursing as “a substantive area of study and practice focused
on comparative cultural care (caring) values, beliefs, and practices of individuals or groups
2. of similar or different cultures with the goal of providing culture-specific •And universal
nursing care practices in promoting health or well-being or to help people to face
unfavorable human conditions, illness, or death in culturally meaningful ways.” . Leininger’s
Cultural Assessment Model • • • • • Leininger developed new terms for the basic concepts of
her theory. The concepts addressed in the model are: Care, which assists others with real or
anticipated needs in an effort to improve a human condition of concern, or to face death.
Caring is an action or activity directed towards providing care. Culture refers to learned,
shared, and transmitted values, beliefs, norms, and lifeways to a specific individual or group
that guide their thinking, decisions, actions, and patterned ways of living. Culture Care is the
multiple aspects of culture that influence and help a person or group to improve their
human condition or deal with illness or death. Culture Care Diversity refers to the
differences in meanings, values, or acceptable forms of care in or between groups of
people.Leininger’s Cultural Assessment Model • • • • • • • • Culture Care Universality refers
to common care or similar meanings that are evident among many cultures. Nursing is a
learned profession with a disciplined focus on care phenomena. Worldview is the way
people tend to look at the world or universe in creating a personal view of what life is about.
Cultural and Social Structure Dimensions include factors related to spirituality, social
structure, political concerns, economics, educational patterns, technology, cultural values,
and ethnohistory that influence cultural responses of people within a cultural context.
Health refers to a state of well-being that is culturally defined and valued by a designated
culture. Cultural Care Preservation or Maintenance refers to nursing care activities that help
people from particular cultures to retain and use core cultural care values related to
healthcare concerns or conditions. Cultural Care Accomodation or Negotiation refers to
creative nursing actions that help people of a particular culture adapt or negotiate with
others in the healthcare community in an effort to attain the shared goal of an optimal
health outcome for patients of a designated culture. Cultural Care Re-Patterning or
Restructuring refers to therapeutic actions taken by culturally competent nurses. These
actions help a patient to modify personal health behaviors towards beneficial outcomes
while respecting the patient’s cultural values Leininger’s Cultural Assessment Model •The
nurse’s assessment of the patient should include a selfassessment that addresses how the
nurse is affected by his or her own cultural background, especially in regards to working
with patients from culturally diverse backgrounds. • The nurse’s diagnosis of the patient
should include any problems that may come up that involve the healthcare environment
and the patient’s cultural background. In addition, the nurse’s care plan should involve
aspects of the patient’s cultural background when needed. • Finally, the nurse’s evaluation
should include a selfevaluation of attitudes toward caring for patients from differing
cultural backgrounds. Leininger’s Cultural Assessment Model • In today’s healthcare field, it
is required for nurses to be sensitive to their patients’ cultural backgrounds when creating a
nursing plan. • This is especially important since so many people’s culture is so integral in
who they are as individuals, and it is that culture that can greatly affect their health, as well
as their reactions to treatments and care. • Thanks to Madeleine Leininger’s Transcultural
Nursing theory, nurses can look at how a patient’s cultural background is involved in his or
her health, and use that knowledge to create a nursing plan that will help the patient get
3. healthy quickly while still being sensitive to his or her cultural background. Transcultural
Nursing Theory •The Culture Care Theory defines nursing as a learned scientific and
humanistic profession that focuses on human care phenomena and caring activities in order
to help, support, facilitate, • 0r enable patients to maintain or regain health in culturally
meaningful ways, or to help them face handicaps or death. The Sunrise Model is Leininger’s
visual aid to the Culture Care Theory. Information taken from (http://www.nursing-
theory.org/theories-and-models/leininger-culture-care-theory.php) Leininger’s Sunrise
Model Spector’s Cultural Assessment Model • • • Rachel E. Spector, PhD, RN, CTN-A, FAAN
retired as an associate professor at the William F. Connell Boston College School of Nursing,
Chestnut Hill, Massachusetts. Her work focused on developing and teaching models of
effective nursing care, “CULTURALCARE”, in multicultural populations. She has researched
taught, practiced and consulted in this specialty for over 35 years and is the author of the
books Cultural Diversity in Health and Illness, now in its 8th edition; CulturalCare: Guides to
Heritage Assessment and Health Traditions; and Las Culturas de , la SALUD, published in
Spain in 2003. Spector’s Cultural Assessment Model •The purpose of this book is to increase
one’s knowledge of the dimensions and complexities involved in caring for people from
diverse cultural backgrounds. It is an attempt to bring the reader into direct contact with
the interaction between providers of care within the North American health care system
and the consumers of health care. The staggering issues of health care delivery are explored
and contrasted with the choices that people may make in attempting to deal with their
personal health care issues. The major concepts applied to this text are holistic: HEALTH,
defined as the balance of the person, both within one’s being – physical, mental, and
spiritual and in the outside world – natural, communal, and metaphysical; ILLNESS, the
imbalance of the person, both within one’s being – physical, mental, and spiritual and in the
outside world – natural, communal, and metaphysical; and HEALING, the restoration of
balance, both within one’s being – physical, mental, and spiritual – and in the outside world
– natural, communal, and metaphysical. The capital letters are used to imply that these
terms and others are being used to convey a holistic meaning. Spector’s Cultural
Assessment Model •People who identify with a traditional ethnocultural heritage may tend
to define HEALTH and illness in a holistic way, and have health beliefs and practices that
differ from those of the Western, or modern, health-care delivery system. • Imagine holistic
HEALTH as a three-dimensional phenomenon that encompasses the following: body (the
physical self), mind (feelings, attitudes, and behavior), and spirit (the I who I am). •
HEALTH, in the traditional sense, is the state of balance within the body, mind, and spirit,
and with the family, community, and the forces of the natural world. Illness is the opposite. •
Many traditional HEALTH beliefs and practices exist today among people who know and
live by the traditions of their given ethnocultural heritage. HEALTH, in this traditional
context, has three dimensions each of which has three aspects, making a total of nine
interrelated facets.Spector’s Cultural Assessment Model Appendix E page 376 Spector’s
Cultural Assessment Model • • • • • It can be argued that the development of
CULTURALCOMPETENCY does not occur in a short encounter with cultural diversity but
that it takes time to develop the skills, knowledge, and attitudes to safely and satisfactorily
deliver CULTURALCARE – a concept that describes holistic HEALTH care that is culturally
4. sensitive, culturally appropriate, and culturally competent. CULTURALCARE is critical to
meeting the complex nursing care needs of a given person, family, and community. It is the
provision of health care across cultural boundaries and takes into account the context in
which the patient lives as well as the situations in which the patient’s health problems arise.
CULTURALCOMPETENCY embraces the premise that all things are connected. Each facet
discussed in this text – heritage, culture, ethnicity, religion, socialization, and identity – is
connected to diversity – demographic change – population, immigration, and poverty. These
facets are connected to health/HEALTH, illness/ILLNESS, and curing/HEALING, beliefs and
practices, modern and traditional. All of these facets are connected to the health care
delivery system – the culture, costs, and politics of health care, the internal and external
political issues, public health issues, and housing and other infrastructure issues. In order to
fully understand a person’s health/HEALTH beliefs and practices, each of these topics must
be in the background of a provider’s mind. Spector’s Cultural Assessment Model •The way
to CULTURALCOMPETENCY is complex; the book depicts five steps to climb to begin to
achieve this goal. They are knowing: Personal heritage – Who are you?? What is your
heritage? How deeply do you identify with your traditional heritage? What are your
health/HEALTH beliefs, those of your family, and your reference community? • Heritage of
others – demographics – Who is the patient, their family, and their reference community?
How deeply does a given person identify with their traditional heritage? • Health and
HEALTH beliefs and practices – competing philosophies such as allopathic and
homeopathic. • Modern health care culture and system – all the issues and problems –
including, but limited to the costs and other relevant issues related to modern health care
delivery. • • Traditional HEALTH Care Systems – The way HEALTH CARE was for most and
the way HEALTH CARE still is for many. Once you have reached the sixth step in the
development of CULTURALCOMPETENCY, you are ready to open the door to
CULTURALCARE. Information taken from (http://www.ojccnh.org/project/spector.shtml)
Giger and Davidhizar’s Cultural Assessment Model • • • •Dr. Joyce Newman Giger holds an
Associate Degree in Nursing from Kentucky State University, Frankfort; a Bachelor’s in
Science in Nursing from Goshen College, Goshen, Indiana; a Master’s of Science in Education
from Indiana University at South Bend; a Masters of Arts in Nursing and a Doctorate in
Educational Administration from Ball State University, Muncie, Indiana. She also served as
the first African American elected Chair of the Faculty Executive Committee, coming most
recently from the University of Alabama at Birmingham where she served as Professor of
Graduate Studies for eleven years. Dr. Giger, a fellow of the American Academy of Nursing,
has authored approximately 135 articles, 14 book chapters, and 6 books on strategies to
enhance the provision of culturally-appropriate care and has developed a model for
assessing cultural phenomena relevant to the delivery of culturally appropriate care (Giger
& Davidhizar, 1991; 1995; Giger, Davidhizar, & Wieczorek, 1993). Her textbook titled
Transcultural Nursing: Assessment and Intervention, 5th Edition (2008) Mosby Year Book,
Inc. has been adopted widely by schools of nursing and has been translated in French. In
February 2003, it was selected for the 13th year as a “Brandon-Hill Best New Book.” In
addition, her second international text on cultural assessment was released in July of 1998
on the care of Canadian clients. Giger and Davidhizar’s Cultural Assessment Model • • • • •
5. •The late Dr. Ruth E. Davidhizar earned her BSN from Goshen College and her MSN in
Psychiatric Nursing Education and DNS in Psychiatric Nursing Research from Indiana
University. She received an honorary doctorate in Humane Arts from Andrews University.
She was board certified as a psychiatric nursing practitioner and was inducted as a fellow in
the Academy of Nursing in 1995. In 2006, she was elected as Transcultural Nursing Scholar
by the Transcultural Nursing Society. In 1987, Ruth joined the faculty at Bethel College as an
adjunct professor. In this role, along with that current Chair of that Division and that sitting
faculty, she assisted in the creation of new innovative nursing program that included at that
time a BSN, BSN-RN, and ADN program. During that time, she served with that founding
Chair and faculty to develop and write the first NLN accreditation report which under the
founding Chair became the first nursing program in history to receive NLN accreditation
without having graduated its first generic nursing students. In 1990, she assumed the leader
of the Division of Nursing.From 1990 until June of 2008, she served faithfully as a Professor
and Dean of the School of Nursing and Dean of Faculty in the MSN program. Dr. Davidhizar
has authored more than 850 articles, book chapters, and books on strategies to enhance the
provision of culturally-appropriate care and has developed a model for assessing cultural
phenomena relevant to the delivery of culturally appropriate care Giger and Davidhizar’s
Cultural Assessment Model • • • • Giger and Davidhizar’s Transculural Assessment Model
The Giger and Davidhizar Transcultural Assessment Model was developed and field tested
in 1988 (2008) by Joyce Newman Giger and the late Ruth Elaine Davidhizar. The Model
focuses on assessment and intervention from a transcultural nursing perspective. I n this
model, the person is seen as a unique cultural being influenced by culture, ethnicity, and
religion. In response to the need for a practical assessment tool for evaluating cultural
variables and their effects on health and illness behaviors, a transcultural assessment model
is offered that greatly minimizes the time needed to conduct a comprehensive assessment
in an effort to provide culturally competent care. The metaparadigm for the Giger and
Davidhizar Transcultural Assessment Model includes: Transcultural nursing: A culturally
competent practice field that is client centered and research focused. Culturally competent
care: A dynamic, fluid, continuous process whereby an individual, system, or health care
agency finds meaningful and useful care delivery strategies based on knowledge of the
cultural heritage, beliefs, attitudes, and behaviors of those to whom they render care.
Cultural competence connotes a higher, more sophisticated level of refinement of cognitive
skills and psychomotor skills, attitudes, and personal beliefs. Giger and Davidhizar’s
Cultural Assessment Model •To develop cultural competency, it is essential for the health
care professional to use knowledge gained from conceptual and theoretical models of
culturally appropriate care. Attainment of cultural competence can assist the astute nurse in
devising meaningful interventions to promote optimal health among individuals regardless
of race, ethnicity, gender identity, sexual identity, or cultural heritage. • Culturally unique
individuals: An individual is culturally unique and as such is a product of past experiences,
cultural beliefs, and cultural norms. • Culturally sensitive environments: Culturally diverse
health care can and should be rendered in a variety of clinical settings. Regardless of the
level of care, primary, secondary, or tertiary knowledge of culturally relevant information
will assist in planning and implementing a culturally competent treatment regime. • Health
6. and health status: Health and health status is based on culturally specific illness and
wellness behaviors. An individual’s cultural beliefs, values, and attitudes all contribute to
the overarching meaning of health for each individual Giger and Davidhizar’s Cultural
Assessment Model • Giger and Davidhizar* have identified six cultural phenomena that vary
among cultural groups. These are •Environmental control—The ability of members of a
particular cultural group to plan activities that control nature or direct environmental
factors. Included are the complex systems of traditional health and illness beliefs, the
practice of folk medicine, and the use of traditional healers. These play an extremely
important role in the way clients respond to healthrelated experiences, including the ways
in which they define health and illness and seek and use health-care resources and social
supports. • Biological variations—People from one cultural group differ biologically
(physically and genetically) from members of other cultural groups: – Body build and
structure – Skin color – Enzymatic and genetic variations – Susceptibility to disease –
Nutritional variations Giger and Davidhizar’s Cultural Assessment Model • Social
organization—The family unit, (nuclear, single-parent, or extended family) and the social
group organizations (religious or ethnic) with which clients and families may identify. •
Communication—Communication differences are presented in many ways, including
language differences, verbal and nonverbal behaviors, and silence. • Space—Personal space
and territoriality involves people’s behaviors and attitudes toward the space around
themselves and are influenced by culture. The following terms indicate different types of
space and relate to acceptable behaviors within these zones: • • – Intimate zone: extends up
to 1 1/2 feet. – Personal distance: extends from 1 1/2 to 4 feet. – Social distance: extends
from 4 to 12 feet. – Public distance: extends 12 feet or more. Time orientation—The viewing
of the time in the present, past, or future varies among different cultural gr …Purchase
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