Surgery and Healing in the Developing World - Dartmouth-Hitchcock

CHAPTER 1
CHAPTER 11
Tropical Nursing
Diana Downing
When locating to a new geographcal site and seeking to be an effective nurse
among a new ethnic group, I have found it most helpful to conduct a cultural assessment
in a systematic approach. As I become more familiar with the individuals, this
knowledge base will be modified, but it gives me a framework for better communication
and understanding. Culture refers to values, beliefs, customs, attitudes and
behaviors that are shared by a large group of people and are passed from generation
to generation. These deeply rooted characteristics are difficult to change, and affect
the person’s view of health and illness. The Andrews/Boyle Transcultural Nursing
Assessment Guide is useful. The tool assesses the following:
• Cultural affiliations: birth site, tribe, cultural group.
• Values orientation: beliefs concerning lifestyle, work and leisure ethic,
death and life, stigma associated with current illness, education, privacy,
how is change perceived.
• Cultural sanctions and restrictions: how are emotions expressed, modesty,
clothing, restrictions to surgery, fertility and deliveries, naming the
baby, gender issues between the patient and healthcare provider, promiscuity
and polygamy, male and female circumcision, taboos of subjects
discussed, spitting, left-handedness.
• Communication: language spoken and written, verbal and nonverbal expression,
eye contact permitted, is an interpreter needed for the healthcare
provider, how does the patient prefer to be addressed; when counting—
does one begin with the index finger or pinky or thumb, is the mother
tongue used for the educational language, what are acceptable hand signals
(for “come here”, height of a person or animal).
• Health-related beliefs and practices: causes of disease (punishment, hex,
pathogenic organism, yin/yang), concept of body size, shape and color,
name and description of diseases, what promotes health, cultural healers
involved, perception of Western medicine, what is the appropriate “sick
role”, family planning.
• Nutrition: significance of food and eating, social or solitary activity, timing
and frequency of meals; how foods are procured, prepared and by
whom; fasting, religious mandates, identify foods which are supportive
or ruinous to good health.
• Socioeconomic considerations: social support and network, family participation,
wage earner, insurance, ability to obtain healthcare and transportation
for same, measures of success, child labor isssues.
• Organizations providing cultural support: (when in a multicultural setting):
churches, schools, NAACP, clinics, government.
Surgery and Healing in the Developing World, edited by Glenn Geelhoed.