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Diverse Culture in Nursing



Diverse Culture in Nursing


Culture plays a critical role in the health of an individual. The reason for this assertion

centers on the fact that cultures create beliefs and ideologies that support the growth and personal

development of a persons. In this regard, certain cultural perspectives control the health and

well-being of an individual. For instance, a given culture may revere a certain object, symbol,

item, or food as divine, hence capable of healing powers (Davidhizar & Giger, 2002). In fact,

some cultures believe more in traditional medicines as opposed to modern conventional

medicines. Therefore, it is appropriate for nurses to evaluate the diverse cultural perceptions of

their patients in order to guide them on how best to provide them with effective nursing care. The

following paper examines how nurses can make use of culture specific knowledge, skills, as well

as behavior in eliciting data, developing a nursing diagnosis, as well as planning nursing care.

Client assessment using Giger and Davidhizars Transcultural Assessment Model (Giger

and Davidhizar, PP 9-11)

The Transcultural assessment model enables nurses to assess and provide nursing care to

patients from diverse cultural settings. According to Giger and Davidhizar (2002), the

Transcultural model postulates that each individual has culturally unique personalities and as

such, should be assessed and nursed according to the six main cultural phenomena, which

include communication, space, social organization, time, environmental control, as well as

biological variations. Using these six phenomena to assess a patient will provide the nurse with

adequate knowledge on how best to address the needs of the patient thereby providing him or her

appropriate nursing care. The following is the results from an interview conducted by a nurse to a

female elderly patient named Dorothy Spears. Dorothy was 62 years old suffering from acute

arthritis, and as such, confined to a wheel chair.


Communication embraces the whole world of human behavior and interaction, as it

entails the means by which communities transmit and preserve culture. In this regard, an

individual learns both verbal as well as non-verbal communication through his/her culture. As

such, it is appropriate to note that communication usually presents the most significant problems

for nurses when working with clients from diverse cultural backgrounds. The reason for this

assertion is that for people to communicate effectively, they have to understand one another

properly, and for understanding to exist, they must speak the same language (Giger, 2016).

However, nurses face a problem when encountered with patients from diverse cultural

backgrounds who speak different languages. In the process, they face a breach in communication

created by the language barrier between them and the patients. The best way to overcome this

barrier is for a nurse to be multi-lingual, by learning many different languages, or demand the

hospital to provide the services of a good language interpreter to assist in such cases of


Communication with Dorothy was smooth as we both spoke the same English language;

therefore, we understood one another clearly. She was an eloquent English speaker having been a

schoolteacher during her youthful years before old age caught up with her. As such, she

understood both verbal as well as non-verbal communication. Our good communication

relationship enabled me to attend to her better, making her one of my favorite patients.


Space in the nursing perspective refers to the distance separating individuals when they

interact with one another. All communication between nurses and their patients occurs within the

context of space. In this regard, it is imperative for the nurses to understand and uphold the four

distinct zones of interpersonal space. These zones are public, personal, intimate, and social

consultative. Furthermore, it is imperative for nurses to note the fact that different cultures have

different rules pertaining their issue of personal distance (Cartwright & Shingles, 2011). For

instance, territoriality refers to an attitude or feelings towards ones personal space or area, in

which case, territorial behaviors differ from one person to another. Therefore, nurses should be

keen not to arouse feelings of territoriality of violation of the personal or intimate space of a

patient as this can cause them discomfort, which may scare away the patient, leading to his/her

refusal to continue with the treatment or never returning to the hospital for further care.

Understanding and upholding the personal space of patients should be a key priority for nurses.

Dorothy was very concerned about her space. Even though she liked to speak about her

personal life, she was conscious not to reveal so much about her history. She was a closed book.

Therefore, every time she realized I was prying her personal space to know more than I should

not, she shut me out. This made it slightly difficult for me as I felt some things in her history

were haunting her, denying her peace to respond effectively the medicine administered.

Social organization

Social organization refers the manner in which cultural group organizes itself around the

family group. It is imperative for nurses to note that religious values and beliefs, family structure

and organization, as well as role assignments usually relate to the ethnicity and culture of an

individual (Deyer-Berenson, 2011). Dorothy was socially organized. She valued the bonds of

family as well as her religious beliefs and practices. In fact, she used to get visitors from her

family everyday during her admission at the health facility. In addition, students, fellow teachers

and other acquaintances also visited her at the hospital. Dorothy was a Christian Roman

Catholic. She believed in the power of prayers to heal the sick, and as such, held high hopes that

one day God would heal her from her ailment and lift the burden of arthritis from her. She

always prayed every morning after she woke up and every evening before retiring to bed, and

during any other free time she had, reciting and praying with her rosary.


Time refers to a crucial aspect of interpersonal communication. In fact, cultural groups

can be past, present, or future oriented. As such, preventive health requires some future time

orientation considering the fact that a future reward usually motivates most preventive actions.

Dorothy was past oriented, in the sense that she found difficulties in trusting in the advancements

of modern medicine to treat and cure her complications. As such, despite her confinement to a

wheelchair and admission to a health facility, she still looked up to God, rather than conventional

medicine to heal her from arthritis (Sagar, 2011). As such, she was sometimes difficult when

taking medicine, and I had to coerce her that faith without action is dead. Therefore, she was

convinced that she had to take medicine to play her part so that God could heal her through her


Environmental control

Environmental control refers to the capability of a person in controlling the nature and in

the process, plan and direct factors within the environment that affect them. In fact, a majority of

Americans believe that they can control nature to meet their personal needs. As such, they are

more likely to seek healthcare when the need arises (Giger, 2016). For instance, if a person hails

from a cultural group whereby they believe less in internal control and more in external control,

there is a fatalistic view whereby seeking health care is perceived as useless. Unfortunately, for

my case, Dorothy hailed from a cultural background that believed more in external control. In

fact, she was convinced that her illness was her karma for all the bad things she had done in life.

Therefore, she dismissed most of the medicine offered to her arguing that only her spiritual

redemption and salvation would heal her from her ailment.

Biological variations

Individuals in different racial groups display biological differences and genetic variations.

Due to such differences, it is appropriate for nurses to seek knowledge concerning the general

baseline data, which is relative to the specific cultural group in order to be in a position to

provide culturally appropriate care for the patient (Cartwright & Shingles, 2011). Dorothy hailed

from a biological background whereby most of the elderly persons in her family suffered from

arthritis. As such, there was high likelihood that her ailment was more genetically engineered as

opposed to karma as she always claimed.

Care Plan

The care plan identifies the actual or potential nursing diagnosis, the expected client

outcomes, as well as possible therapeutic interventions. The following section diagnoses the

cultural perspective of nursing care with regard to the health of our study patient, Dorothy.

Nursing Diagnosis

As mentioned above, the study patient receiving nursing care was Dorothy Spears, a 62

years old woman suffering from acute arthritis and confined to a wheelchair. The first diagnosis

of Dorothys condition indicated that she had developed arthritis because of her old age.

However, her athletics activities during her heydays also contributed significantly to her ailing

bones. In the same regard, the arthritis gene present in her family could be presumed as well as a

significant cause of her deteriorating health condition. Most of the elderly people in her lineage

suffered from arthritis during their old age, and as such, when the same case applied to her, it

was more of genetics at work than karma at work. However, the patient insisted that her karma

that had confined her to the wheelchair (Deyer-Berenson, 2011). Therefore, I consider that three

of her risk diagnoses had a cultural implication; these are time, environmental control, and

biological variations.

Client Outcomes

The client expected client outcomes for each diagnosis are as follows. The outcome for

communication was positive, as there was no language barrier. This would improve immediately.

The outcome for space was negative, as the patient held back some of her deepest secrets that

deterred her beliefs and trust in modern medicine. This was expected to change over some

weeks, 3 weeks at most. The outcome for social organization was positive, as the client was very

attached to her social life, such as family and religion. This would improve immediately. The

outcome for time was negative, as the client was stuck in the past orientation of time, thereby

had little or no belief in the power of conventional medicine. This was expected to change

immediately, latest in a weeks time (Sagar, 2011). The outcome for environmental control was

negative, as the patient believed that external factors had more control over her life as opposed to

internal factors. This was to change gradually, in a months time. In this regard, she considered

modern medicine as useless in combating her present predicament. The outcome for biological

variations was positive, whereby I realized that the genetic implications contributed significantly

to her present illness, there being a gene of arthritis in her family lineage. This was to be effected


Nursing interventions

The following are the proposed nursing interventions to apply to Dorothy following the

analysis of her cultural orientation and background.

1. Use good communication platforms to reach out to her, make her feel comfortable and cared

for at the health facility.

2. Observe and uphold her personal space, avoiding unnecessary invasion of her privacy as

required. This will help in gaining the trust and confidence of the patient, and as such, give

her free time to open up on her own.

3. Promote her visitations from social circles as this assists in getting control of her, by using

her closest people to speak to her and convince her to take medicine in order to cure her


4. Change her perception to time from past oriented to future oriented, as this would equally

transform her belief in modern medicine, thereby making it easier and more effective to treat


5. Eliminate her fears regarding the control of external factors on her personal life, in which

case it returns her belief in the power of modern medicine.

Personal Reflection

After concluding this assignment, I have learnt a very important lesson regarding the

critical role of culture in the provision of appropriate nursing care to an individual. In this regard,

I believe that cultural perspectives largely control the well-being of an individual, as well as their

uptake of medicine leading to their quick recovery. In most cases, negative cultural perspectives

impede the quick healing and fast recovery of a patient as opposed to positive cultural

perspectives of time, communication, space, environmental control, biological variations and

social organization. My cultural analysis somewhat differs from that of Dorothy. For one, I am

future oriented as opposed to past oriented. Secondly, I believe I have internal control of the

environment as opposed to external control, and as such, believe in the power of modern

medicine. However, we also have some cultural perspectives in common, such as good command

of the English language, thereby communicating easily, upholding our personal space and

privacy, belief in impact of biological variations on our present lives, as well as surviving in a

socially enclosed setting with a lot of family members, friends and relatives.


Cartwright, L. & Shingles, R. (2011). Cultural Competence in Sports Medicine. Champaign, IL:

Human Kinetics.
Davidhizar, R. & Giger, J. (2002). The Giger and Davidhizer transcultural assessment model.

Journal of Transcultural Nursing, Vol. 13, No. 3, July 2002, pp.185-188.

Deyer-Berenson, L. (2011). Cultural Competencies for Nurses: Impact on Health and Illness.

Boston, MA: Jones & Bartlett Learning.

Giger, J. (2016). Transcultural Nursing: Assessment and Intervention. Amsterdam, NE: Elsevier

Health Sciences.
Sagar, P. (2011). Transcultural Nursing Theory and Models: Application in Nursing Education,

Practice, and Administration. New York, NY: Springer Publishing Company.