Download UNIT 3: TRANSCULTURAL NURSING

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UNIT THREE
THEORITICAL BASES FOR
TRANSCULTURAL NURSING CARE
GIGER & DAVIDHIZAR
TRANSCULTURAL ASSESSMENT
MODEL
DR MAHMOUD MUSLEH
INTRODUCTION
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
This model was developed in 1988 in response
to the need for nursing students in an
undergraduate program to assess and provide
care for patients that were culturally diverse.

According to Giger & Davidhizar, although all
cultures are not the same, all cultures have the
same basic organizational factors
The metaparadigm for the Giger &
Davidhizar model includes:
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1. Transcultural nursing
2. Culturally competent care
3. Culturally unique individuals
4. Culturally sensitive environments
5. Health and health status
CULTURAL PHENOMENA
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
Giger & Davidhizar have identified six cultural
phenomena that vary among cultural groups
and affect health care. These are:
1. Communication
2. Space
3. Social organization
4. Time orientation
5. Environmental control
6. Biological variations
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
These six phenomena serve to present the
diversity that exists between cultural groups
Communication
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
Communication is the means by which culture is
transmitted and preserved

Both verbal and nonverbal communications are
learned in one’s culture

Verbal and nonverbal patterns of communication
vary across cultures
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If nurses do not understand the client’s cultural rules
in communication, the client’s acceptance of a
treatment plan may be compromised.
Accurate diagnosis and treatment is impossible if
the health-care professional cannot understand the
patient
Not understanding the patient’s communication
patterns will put the patient in a state of isolation
from the health care team
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
Consequently, the patient experiences cultural
shock and may react by withdrawing, becoming
hostile or argumentative, or being uncooperative

Culture not only determines the appropriateness
of the message but also influences all the
components of communication
An assessment of communication should
consider the following:
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1. Dialect
2. Style
3. Volume, including silence
4. Touch
5. Context of speech or emotional tone
6. Kinetics (including gestures, posture, and
eye behaviour)
Examples
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A. Afghans
can
be
expressive,
warm,
orientated to others, shy and modest. Maleto-male
communication
is
permissive
whereas female-to-male communication is
contraindicated unless with the husband,
son, or father of the women involved
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B. Asians consider it disrespectful to look
someone directly in the eye, especially if that
person is a nurse, not because of disinterest
or dishonesty. An Asian patient may avoid
eye contact out of respect for the superior
status of the nurse
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C. Many Middle Easterners see direct eye
contact between a man and a woman as an
invitation for love or sex
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
Knowing what the norm within the culture will
facilitate
understanding
miscommunication
and
lessen
Space
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
Space refers to the distance between individuals
when they interact

All communication occurs in the context of
space
There are four distinct
interpersonal space:
zones
of
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1. Intimate distance (zone) (extends from 0 to 1
½ feet)
2. Personal distance (extends from 1 ½ to 4
feet)
3. Social distance (extends from 4 to 12 feet)
4. Public distance (extends 12 feet or more)
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
Rules concerning personal distance vary from
culture to culture

For instance, some Afghans prefer closeness in
space with others and particularly with the same
sex. When comfortable with others, these
individuals prefer to be in close proximity to
build trusting relationships
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
Particularly the comfort level is related to
personal space - comfort in conversation,
proximity to others, body movement, perception
of space

Eye contact, space, and touch practices may be
very different from one’s sphere of reference
Social organization
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
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
The social environment in which people grow up
and live plays an essential role in their cultural
development and identification
Children learn their culture’s responses to life
events from the family and its ethno-religious
group
This socialization process is an inherent part of
heritage-cultural,
religious,
and
ethnic
background
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
Social organization refers to the social group
organizations with which clients and families may
identify

Family structure and organization, religious values
and beliefs and role assignments may all relate to
ethnicity and culture

Many social barriers, such as unemployment,
underemployment, homelessness, lack of health
insurance, and poverty can also prevent people
from entering the health-care system
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
For example, in the African-American culture, family
may include individuals who are unrelated or
remotely related

Members of families depend on the extended family
and kinship networks for emotional and financial
support in times of crises

Mothers and grandmothers play significant roles in
African-American households and should be
included in health care decisions
Time Orientation
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
Time is an important aspect of interpersonal
communication

Some cultures are considered future oriented,
others present oriented, and still others past
oriented

People who are future-oriented are concerned with
long-range goals and with health-care measures in
the present to prevent the occurrence of illness in
the future
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
They prefer to plan in making schedules, setting
appointments, and organizing activities

Others are oriented more to the present than the
future and may be late for appointments because
they are less concerned about planning to be on
time

These differences in time orientation may become
important in health-care measures such as longterm planning and explanations of medication
schedules
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
For instance, most Afghans are more past and
present than future time oriented, but generally they
tend to follow two different time concepts

Another example is that Latin Americans, Native
Americans, and Middle Easterners are present
oriented cultures and may neglect preventive health
care measures hey may show-up late or not at all
for appointments

United States and Canada tend to be future
oriented
Environmental control
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
Environmental control refers to the ability of the
person to control nature and to plan and direct
factors in the environment

Some groups perceive man as having mastery
over nature; others perceive humans to be
dominated by nature, while others see
harmonious relationships between humans and
nature
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This particular cultural phenomenon plays an
extremely important role in the way patients
respond to health-related experiences, including the
ways in which they define an illness and seek and
use health-care resources and social supports

For example, Asians and Native Americans may
perceive that illness is a disharmony with other
forces and that medicine is only capable of relieving
the symptoms rather than curing the disease
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
These groups are likely to look for naturalistic
solutions, such as herbs and hot and cold
treatments to resolve or cure a cancerous
condition
Biological variations
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
Biological variations are:
1. Body structure
2. Skin colour
3. Other visible physical characteristics
4. Enzymatic and genetic variations
5. Elelectrocardiographic patterns
6. Susceptibility to disease
7. Nutritional preferences and deficiencies
8. Psychological characteristics
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
For instance, Western-born neonates are
slightly heavier at birth than those born in nonWestern cultures
APPLICATION OF THE MODEL
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
The Giger and Davidhizar Transcultural
Assessment Model provides a process for
assessing clients from differing cultures in order
to be aware of differences and to plan
appropriate strategies

It was used to identify cultural beliefs from the
six cultural phenomena previously described by
Giger and Davidhizar
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
This Model, which also included interview
questions and observational guidelines, was
used for structural interviews
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The model can enable the nurse in assessing
individuals who are culturally diverse in order to
provide culturally competent care
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
It is broad enough in scope to be applied by
other health-care professions such as medical
imaging (professions of radiography, nuclear
medicine, and ultrasonography), dentistry,
education and hospital administration