Week 3 and 4

In the context of Giger and Davidhizar’s Transcultural
Assessment Model (1990, 2002), transcultural nursing

is viewed as a culturally competent practice field that is
client centered and research focused.
Every individual is culturally unique, and nurses are

no exception to this premise. Nonetheless, nurses must
use caution to avoid projecting on the client their own
cultural uniqueness and worldviews if culturally
Appropriate care is to be provided.
What is Communication?
Considerations:
w Vocabulary
w Grammatical structure
w Voice qualities
w Intonation
w Rhythm
w Speed
w Silence
Vocabulary
For an Orthodox Jew, the word pig is

synonymous with the word unclean or
unholy and thus should be avoided. On
the other hand, for a pig farmer the word
pig implies a clean, wholesome means of
making a living.
b. language barrier also arise
when the sender uses technical
terms that are unfamiliar to the
receiver.
ex. Nurses use medical terms
when explaining a procedure to
a normal person or patient.
• Use of an interpreter
•Before locating an interpreter, first

know the language the client speaks at
home
•Avoid interpreter from a rival tribe,
state and region
•Be aware of gender differences
»
•Be aware of age differences
•Ask the interpreter to translate as

closely to verbatim as possible
•Expect compensation for services

rendered
Nonverbal - conveyed through facial
expressions and body language, eye
contact, also includes touch and proxemics
• 1. Silence – lack of audible sound
Consider this...
Many American Indians have this latter view of silence, as do
some traditional Chinese and Japanese persons. Therefore, when
one of these persons is speaking and suddenly stops, what may be
implied is that the person wants the nurse to consider the content
of what has been said before continuing. Other cultures may use
silence in yet other ways. For example, English and Arabic persons
use silence for privacy, whereas Russian, French, and Spanish
persons may use silence to indicate agreement between parties.
Some persons in Asian cultures may view silence as a sign of
respect, particularly toward an elder. Mexicans may use silence
when instructions are given by a person in authority rather than
showing the disrespect of disagreement (Quarnero, 2005). Nurses
need to be aware of possible meanings of silence so that personal
anxiety does not promote the silence to be interrupted prematurely
or to be nontherapeutic. A nurse who understands the therapeutic
value of silence can use this understanding to enhance care of
clients from other cultures.
Silence across the world…
vNative North American
= consider silence essential to

Silence across the world…
understanding and respecting other
person
vFrench, Spanish & Eastern
European
= interpret silence as a sign
of agreement
• African American
• = used in response to a
question perceived as
inappropriate
2. Facial expressions
v used as a guide to a person’s

feelings
v vary from culture to culture
Facial expressions across the world…
ØAFRICAN AMERICANS
AND SPANISH
Use many facial expressions along
with gestures to communicate
feelings of happiness, pain or
displeasure
• NORTHERN EUROPEANS
ØTend to use less facial

expression and are generally
less responsive
ASIANS
Ø Uses facial expression to
convey opposite meaning
from the one that is felt.
Ø Conceal negative emotions
with a smile
3. Eye contact
Ø important tool Eye contact is also a

culturally determined
in TCN
behavior.
assessment
“the eyes are the

windows of the
soul’’
• Eye contact is an important tool in
transcultural nursing assessment
and is used both for observation and
to initiate interaction. In the United
States, those of the dominant culture
(predominately Whites) value eye
contact as symbolic of a positive
self-concept, openness, interest in
others, attentiveness, and honesty
• McKenzie and Chrisman (1977)
reported that, for some Filipinos, eye
contact that turns away is associated
with the possibility of being a witch.
Other groups who find eye contact
difficult include some Asian people and
some American Indians, who relate eye
contact to impoliteness and an invasion
of privacy.
• Many American Indians regard
eye contact as disrespectful
because it is believed that
“looking in an individual’s eyes” is
“looking into an individual’s soul”
(Galanti, 2003; Giger &
Davidhizar, 2001; Henderson &
Primeaux, 1981; Poole,
Davidhizar, & Giger, 2003).
A strong gaze may be interpreted as a sign
of disrespect among Asian, American
Indian, Indo-Chinese, Arab patients who
feel that direct eye contact is impolite or
aggressive.
Eye contact across the world…
• An American Indian patient may

stare at the floor during
conversations. That's a cultural
behavior conveying respect, and it
shows that he's paying close
attention to you.
vLikewise, a Hispanic patient may maintain
downcast eyes in deference to someone's
age, sex, social position, economic status, or
position of authority.
vHispanic clients
= eye contact is expected of you but will
not be reciprocated by patients
vAmericans
= assumes that it is a negative sign
when a person avoids eye contact; it means
shyness, lack of interest and dishonesty
v value eye contact as symbolic of a

positive self - concept, openness and
honesty
vMuslim Arab women
= avoid eye contact with males (except
for one’s husband)
vIndia
= amount of eye contact depends on
one’s social position
vAfrican-American; Mexican-Americans
= comfortable with eye contact
4. TOUCH
Ø The meaning people associate with
touching is culturally determined to a
great degree.
In Hispanic and Arab
cultures, male health
care providers may be
prohibited from
touching or examining
certain parts of the
female body; similarly,
females may be
prohibited from caring
for males.
Among many Asian
Americans, touching a
person's head may be
impolite because that's
where they believe the Before assessing an
spirit resides. Asian American
patient's head or
evaluating a head
injury, you may need
to clearly explain what
you're doing and why.
For example, some
Jewish and Islamic
Always consider a women believe that
patient's culturally modesty requires
defined sense of covering their head,
modesty when giving arms, and legs with
nursing care. clothing. Respect their
tradition and help
them remain covered
while in your care.
Touch across the world…
ASIANS
touching the head is a sign of

disrespect because it is believe
that the head is the source of
person's strength
• Vietnamese Americans may find touching
shoulders with another to be anxiety producing,
since they believe that the soul can leave the
body on physical contact and that health
problems may result (Rocereto, 1981). The
Vietnamese regard the human head as the
seat of life and therefore highly personal.
Procedures that invade the surface or any
orifice of the head can frighten the Vietnamese,
who fear that these procedures could provide
an escape for the essence of life (Stauffer,
2005).
üNative Americans
view a firm handshake as

aggressive and offensive
WESTERNERS
Think nothing of kissing or hugging

a friend as a form of greeting when
meeting in public places
TRADITIONAL ASIAN CULTURES
kissing and hugging is reserved

for intimate relationships in
private settings
Proxemics
w the term for the study of human use and

perception of social and personal space
(Hall, 1974).
w Individuals tend to divide surrounding
space into regions of front, back, right, and
left (Franklin, Henkel, & Zangas, 1995).
Territoriality
w Refers to the behavior and attitude people

exhibit about an area they have claimed
and defend or react emotionally when
others invade it.
SPACE across the world…
Middle Class Americans, Canadians,
British
when forced to stand or sit close to
people they do not know well
they feel that their space is being
violated
Types of Family structure
w Traditional nuclear family
w Nuclear dyad family
w Extended family
w Skip-generation family
w Alternative family
w Single-parent family
w Reconstituted or Blended family
w Special form of families: communal and gay
family
RELIGION
Religion is a social phenomenon (Carroll,

Johnson, & Marty, 1979). Religious practices,
therefore, are usually rooted in culture, and
each culture typically has a set of beliefs that
define health and the behaviors that prevent
or treat illness (Davidhizar, Bechtel, & Cosey,
2000).
w Jehovah’s Witness
w Seventh-Day Adventist
w Islam
w Christianity
SELECTED CULTURE-BOUND
SYNDROME
example
w 1. Amok, a mental or emotional affliction

known in the Philippines that causes one to
become a killer
w 2. Susto, an ailment widely associated with
Spanish-speaking groups in which the soul
is believed to leave the body as a result of a
frightening event (Bonder, Martin, &
Miracle, 2002).
HISPANIC
Ø Empacho
Ø Mal ojo
Ø Pasmo
Ø Susto / fright sickness

Symptoms include
nervousness, anorexia,
insomnia, listlessness,
despondency,
involuntary muscle tics,
and diarrhea
Thought to be caused by
fright that results in loss
of soul from the body;
causes can be natural or
"supernatural"
natural susto may occur
Those most likely to
after a near accident
suffer from susto are
culturally stressed
supernatural susto may adults--women more
occur after witnessing a than men
supernatural
phenomena such as a
ghost; and might be
sent by sorcerers
Whites
Anorexia nervosa – ● Bulimia – gross
excessive overeating and
preoccupation with then vomiting or
thinness; self- fasting
imposed starvation
Blacks
q Blackout q Collapse,
dizziness, inability
to move
Ø Low blood q Weakness or not
enough blood
v High blood v Blood that is too
rich in certain
things
Campinha-Bacote (1997)
w compared time orientation among certain groups
in relation to future-time and present-time
orientation:
• Dominant American: future over present
• African Black: present over future
• Puerto Rican American: present over future
• Mexican American: present
• Chinese American: past over present
• American Indian: present
A.MEASUREMENTS
Height and weight vary among cultural group
• B. VITAL SIGN
Black men have lower BP than their White

counterparts from ages 18 to 34
Black women have a higher average
systolic BP than White counterparts at
every age
C. SKIN
Normal skin color ranges widely
Observation is labeled with the following
adjectives:
>copper
>olive
>tan
>brown
SKIN CONDITION
Mongolian spots
Vitiligo
Cyanosis
Jaundice
Pallor
Petechiae
Mongolian spots
Irregular areas of deep blue pigmentation
usually located in the sacral & gluteal areas
Present in 90% of Blacks, 80% of Asians and 9%
of Whites
Vitiligo
Characterized by unpigmented skin patches
Affects an estimated 2-4 million Americans,
primarily dark-skinned individuals
Cyanosis
The most difficult clinical sign to observe in
darkly pigmented persons
Exercise caution when assessing person from
Mediterranean descent, because their
circumoral region is normally dark blue
Jaundice
Exercise caution to EXAMPLE
avoid confusing other African Americans,
forms of pigmentation Filipinos have heavy
with jaundice deposits of
subconjunctival fat
that contains high
levels of carotene in
sufficient quantities to
mimic jaundice
Pallor
When assessing for Brown-skinned
pallor in darkly individual will manifest
pigmented patients, pallor with a more
you might experience yellowish brown color
difficulty because the Black-skinned person
underlying red tone will appear ashen or
are absent gray
Petechiae
In dark-skinned Black or very dark
patients: brown patients:
Are best visualized in Petechiae are most
the area of lighter easily seen in the
melanization, such as mouth; buccal mucosa
the abdomen and and conjunctiva
buttocks
D. Variations in Illness
Aland Islanders – Ocular
Albinism
Amish – Hemophilia B
Blacks – sickle cell disease
Chinese – thalassemia
The Amish are a group of traditionalist

Christian church fellowships with Swiss
Anabaptist origins.
Costa Ricans –
Malignant
Osteopetrosis
Eskimos – congenital
Adrenal Hyperplasia
Jews – Tay-Sachs
disease
Bio cultural Aspects of Disease
Anemia – high incidence among

Vietnamese
Asthma – six times greater for Native

North American
Lactose intolerance –
present among 66%
of Hispanic women
Sickle cell anemia –

increased incidence
among Blacks
cancer
Nasopharyngeal – high among Chinese North
American
Esophageal – no.2 cause of death for Black men
Cervical – 120% higher in Black women
E. LABORATORY TESTS
Biocultural variations occur with some

laboratory test results such as measurement
of hemoglobin, hematocrit, cholesterol, and
blood glucose

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In the context of Giger and Davidhizar’s Transcultural

Assessment Model (1990, 2002), transcultural nursing

Every individual is culturally unique, and nurses are

For an Orthodox Jew, the word pig is

•Before locating an interpreter, first

•Ask the interpreter to translate as

•Expect compensation for services

vNative North American

= consider silence essential to

v used as a guide to a person’s

ØTend to use less facial

Ø important tool Eye contact is also a

“the eyes are the

• An American Indian patient may

v value eye contact as symbolic of a

touching the head is a sign of

view a firm handshake as

Think nothing of kissing or hugging

kissing and hugging is reserved

w the term for the study of human use and

w Refers to the behavior and attitude people

Religion is a social phenomenon (Carroll,

w 1. Amok, a mental or emotional affliction

Ø Susto / fright sickness

Black men have lower BP than their White

The Amish are a group of traditionalist

Anemia – high incidence among

Asthma – six times greater for Native

Sickle cell anemia –

Biocultural variations occur with some

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