Mia's presentation revised

Giger and Davidhizar’s Transcultural Assessment Model

and its use in assessing care of clients from multicultural populations

Presented byGerri Virgil, M.S.N., R.N.

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Objectives• Describe Giger and Davidhizar’s Transcultural Assessment Model and

its use in assessing care of clients from multicultural populations.

• Identify nursing diagnoses and interventions specific to Mai’s Vietnam culture using the Transcultural Assessment Model.

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• The goal of transcultural nursing is to be cognizant of culturally relevant facts about the client in order to provide culturally competent care.


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Culturally unique

individual

Biological variations

Environmental control Time

Social Organization

Space

Nursing assessment

Communication

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The Transcultural Model has components of social structure and world view factors that influence health through language and

environment.


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It is important to remember that this model does not presuppose that all individuals of a specific cultural group think

or behave in a similar manner.


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The U.S. Census Bureau has projected that by the year 2020 only 53% of the U.S. population will be of White European descent.


By the year 2020 only 53%

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Further projections indicate that the number of Asian Americans will triple and African Americans will double. An understanding of cultures differing from the so-called “norm” is crucial to providing relevant care

for our clients.


African Americans will doublein population

Asian Americans will triplein population

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We will began our discussion by:

1. Assessing our client’s Vietnamese culture using Giger and Davidihizar’s Trancultural Assessment Model

2. Identifying nursing diagnoses followed by nursing interventions


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Culturally unique individuals (includes place of birth and “time” in country)

Nursing AssessmentComponent 1

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Mai was born in Vietnam and left with her family at age 7. She is now 25 years old.

Vietnam is bordered by Cambodia and Laos on the west, Gulf of Thailand on the south and on the east by the China Sea.

Nursing Assessment Component 1

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Vietnam was initially divided into 2 spheres of influence with North Vietnam communist and South Vietnam U.S. supported. It is now the Socialist Republic of Vietnam.

There were 3 waves of migration to the U.S. after the Vietnam War:

First Wave – 1978 included professionals and ranking South Vietnam military officials

Second Wave – Chinese & Vietnamese business people

Third Wave – I980 boat people left for economic and political reasons. A majority in poor physical condition and unable to write/read English or Vietnamese well. (Mai’s family was in this “wave”.

Nursing Assessment Component 1

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Space (Proximity to others - degree of closeness when talking or standing near others)


• In Vietnam culture, individuals are “comfortable” when others stand 18 inches to 3 feet away

• Touch is not welcomed from “strangers” or non-family members

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Communication (Language spoken – includes non-verbal)


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Respect is evident in communication and “cornerstone” of Vietnam society notably with use of “titles (i.e., Aunt, Uncle in front of “names” for family members). Last name comes before first name (i.e., Nyguen Mai). Great respect for the family and “elders”.


This Soviet or Communist style statue presents Ho Chi Minh as a kindly older male relative, with his arm protecting the girl beside him. The statue’s form suggests not only that Ho Chi Minh was, and is, like a father, educating the Vietnam nation and people, but also that the nation and its citizens are vulnerable, precious, and uneducated like young children.

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• Children are taught to think before speaking

• Eye contact is avoided out of “respect”

• Bowing of head to show respect (i.e., to nurse, teacher, elder)– “Beckoning” is done with palm and

waving of fingers (upward palm is for “beckoning of an animal and is considered an insult)


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Communication Style – Expression of emotion


Asian

Non-verbalSubtle, indirectSerene, stoic, suppression of negative emotionsIndirect expression of affection by fulfilling obligations, needs

American

VerbalOpen, directExpressive, spontaneous

Direct, verbal and physical expression of affection

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For interviewing purposes:– Use short and direct sentences– Plan questions carefully, focus on

one item for yes and no questions– Avoid technical jargon– Avoid “jokes” – humor difficult to

translate

Use an interpreter for language of origin (same sex, if possible)


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Biological variations (body structure, diseases specific to population and nutrition)


Body size of Vietnamese

• Averages 80 to 130lbs with a small frame

• Blood type B (present in only 8% of White race)

• Lactose intolerant (congenital)

• Anemia

• Prone to fungal infections and parasites (i.e., hookworm and amebiasis)

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Environmental Health

Cultural health practices (definition of health and illness)

Emphasis on :– Naturalistic (Folk medicines)– Supernaturalistic (Demons,

Gods)– Metaphysical (“Balance”

harmony)


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Environmental Health

• Laboratory tests (drawing of blood) - to Vietnamese means losing body fluids may lead to “suffering” and “loss”

• Consider tablets as “strong” - may take 1/2 of tablet. Prefer liquid medicines. Studies show Vietnamese required dose for psychotropic is significantly lower than for American counterparts

• Nutrition - staple is rice diet, up to 3 bowls of rice daily, osteoporosis common with low calcium intake. Children drink milk (evaporated milk) with ice and fruit


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Mental Health

• Emphasis on “saving of face” for family - family member not brought in for “mental assistance” until the situation is “critical”


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Mental Health

• Cultural adjustment and PTSD common with immigration. Emotional and behavioral problems often related to:

– Underemployment– Loss of extended family– Stresses of adaptation– Symptoms of hopelessness– Acute distress– Fatigue– Mood instability seen


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Mental Health

Denial as a defense mechanism is seen and congruent with Vietnamese values of harmony and submission to the common good. The culture is Chinese influenced, with overt expression of anxiety, disappointment, anger and negative feelings are considered “weaknesses.” Studies show mental illness expressed as physical illness is “preferred.”


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Time

Emphasis is on ancestors and the past. Orientation is in terms of events, such as births, deaths and marriage, not specific dates on a calendar. This is important for nurses obtaining a chronological “history of illness.” Also, being “late or early” is not considered “important.” (factor with medication compliance and medical appointments.)


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Social Orientation

The family is the backbone of tradition and heritage, family, loyalty with “filial loyalty” commanding children to obey parents. Mental illness, juvenile delinquency, academic failure, etc. are consider a disgrace to family.


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Nursing Diagnosis Communication, impaired verbal, related to foreign-language barrier

Treatment Plan

Client Outcome

1. Client will be able to communicate more effectively customs and beliefs used in treating illnesses and nurse will better understand these customs.

Nursing Interventions

1. Determine client’s understanding and ability to communicate in English.

2. Talk slowly, enunciating words.3. Face client and speak in a slow, clear

voice.4. Use gestures to convey meanings, but

do not use excessive “touching.”5. Attempt to locate a translator for

assistance (if needed).6. Provide client adequate space to

communicate without “crowding.”7. Keep language simple.

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Nursing Diagnosis - Noncompliance (risk for) related to misunderstanding of the prescribed treatment secondary to the belief that medications in the Western world are much stronger than those found in the Far East.

Treatment Plan

Client Outcome

1. Client will demonstrate an understanding of prescribed medical regimen.

Nursing Interventions

1. Assess client fear of prescribed treatment2. Promote health teaching to educate client on

the effects of prescribed medicine.3. Warn client that some medications may

make the client sleepy and that this is an expected occurrence.

4. Teach client about importance of adhering to prescribed medical treatment.

5. Reassure client that prescribed medication is appropriate and safe for client.

6. Review medication, dosage, and proper administration technique to help client feel more comfortable with the treatment.

Mia's presentation revised

Health & Medicine

Transcript of Mia's presentation revised