Mr.

Bernard Wolfgang, a 56-year-old German immigrant who works as an Engineer, is

admitted with chest pain and shortness of breath. He is admitted to the Coronary Care Unit to
rule out Myocardial Infarction. Immediately after admission, his wife comes to the Coronary
Care Unit with personal items such as family portraits, some roses from the client's garden, and
some personal clothing. However, since the Coronary Care Unit is restricted in space, personal
items are not allowed and the wife is instructed to take the items home. On admission, Mr.
Reyes vital signs are stable and his color is good. He reports that the chest pain is not debilitating
and is more or less an occasional dull ache. After 2 days, the diagnosis of MI is confirmed and
Mr. Reyes remains restricted to bed but is transferred to a semi-private room in the Coronary
care Step-down unit. After admission to the coronary care step-down unit, the nurse observes
that Mr. Reyes is anxious, somewhat withdrawn, and unable to express his needs and feelings.

CLINICAL DECISION MAKING

1. When assessing Mr. Reyes, the nurse should realize some German people have specific needs
that are related to territoriality and space. Name at least two factors that affect some Germans
and their spatial behavior. (20%)

2. List ways the nurse could enable Mr. Reyes to meet his needs for privacy and autonomy while
in a semiprivate room. (20%)

3. Identify markers that would indicate Mr. Reyes's need for the establishment of a temporary
territorial space. (20%)
In nature, people can be territorial. Territoriality refers to a state of characterized by
possessiveness, control and authority over an area of physical space. It serves as diverse
functions to individuals by meeting needs for security, privacy, autonomy and self-identity.
Markers that would indicate Mr. Reyes’ need for establishment of a temporary territorial space
are his cultural background, spatial behavior of the client, age and implications of nursing care to
personal space.
Cultural Implications
Cultural implication or background of the client is one of the markers because individuals in the
same cultural group tend to act similarly even though there are variations in spatial requirements
from person to person. For our case the client is a German immigrant, and Germans have certain
practices regarding their territory or space.
- In the case of Mr. Reyes when he was admitted to the Coronary Care Unit, his wife
bought personal items and clothing but since Coronary Care Unit is restricted, personal items are
not allowed. Territoriality influences relationships between people. Some German people tend to
need a larger space and are less flexible in their spatial behavior. Differences in spatial patterns
also include behavior towards as changing geographic location. For example, Germans often live
in the same house their entire lives.
- After 2 days of admission, Mr. Reyes was transferred to a semi-private room. Semi-
private rooms in a hospital are a type of room that usually accommodates at least two patients at
any given time. According to Hall (1966, 1969) German and Dutch people depend on double
doors and thick walls to screen out sound and may have difficulty if they must rely on their own
powers of concentration to do so. A sensitive German or Dutch person who is trying to
concentrate will feel less intruded on in the former and thus less crowded. (Cultural patterning of
space)
Spatial Behavior
Spatial behavior is often described as relation to the universal need for territoriality.
- Based on the client’s health situation his chief complaint were chest pain and shortness of
breath. In cultures where priority is given to the individual rather than the group (United States,
Canada, cultures of North and West Europe, Australia, and New Zealand) privacy is more likely
to be valued. (Goldman & Schmalz, 2005). According to Davidhizar & Hart (2005) when feeling
ill or in pain the person may choose to be alone if the priority is given to the individual.
Age
Mr. Reyes is a 65 year old male patient, and he is considered as part of the elderly group.
- Spatial needs and the desire for a certain proximity to certain people continue through life
and have been studied in the elderly. Since elderly are more likely to experience separation from
other through the death of a spouse and the moving away of offspring, their spatial needs may
appear to change, it may result to them be more withdrawn. (Ittelson, Proshansky, Rivlin &
Winkel, 1974)
Implications for Nursing Care in Personal Space
- The nurse must remember that is a client is in a place where a feeling of control is
experienced, the client will feel safer, less threatened and less anxious (Sheeshka, Potter, Norrie,
et al., 2001). Nurses must remember that the anxiety level of a client is increased when
hospitalized.
- The nurse should remember that the client may experience increased anxiety when a
client is transferred from one room to another because of the loss of security and privacy of the
room which the client has become accustomed to.
- Rapidly moving toward an anxious client may dramatically increase the client’s anxiety.

4. Identify ways in which illness and hospitalization could threaten Mr. Reyes personal sense of
territorial space. (20%)
5. Identify factors present in Coronary Care Unit that could negatively affect spatial behavior.
(20%)

Reference:
Giger, JN. (n.d.). Transcultural Nursing: Assessment and Intervention. Retrieved from
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