Cultural Competence in the

Health History and

Physical Examination
NCM 120 – Decent Works and Transcultural Nursing

BSN 4B – Group 3
Cultural Competence in the
Health History and
Physical Examination
NCM 120 – Decent Work Employment and Transcultural Nursing

BSN 4B – Group 3
Overview
Cultural Competencies in the Health History and Physical Examination
1. Transcultural Perspective on the Health History
2. Transcultural Perspective on the Physical Examination
3. Clinical Decision-Making and Nursing Practice
4. Modes to Guide Nursing Judgments, Decisions, and Actions
 Objectives
1. Emphasize the importance of culturally competent nurse
2. Understand the Transcultural Perspective on Health History and
Physical Examination
3. Learn the Clinical Decision-Making and Nursing Practices applied
in transcultural nursing
4. Determine the modes to guide nursing judgments, actions and
decisions
 Cultural Competence
It is considered a vital skill for nurses to deliver quality nursing care across
culturally diverse groups, where each patient is seen as a unique individual
from the other patients.
 Cultural Competence
“Nurses must be able to understand and appreciate cultural backgrounds to do
their job effectively and with the highest degree of care.”
Culturally Competent
Care
Cultural Competence
Awareness
Is consciousness of one’s personal
reactions to people who are
culturally different

Nurses can pay close attention to

their own biases and how they react
to those people who have a different
culture from theirs.
Cultural Competence
Attitude
More than becoming aware of our
reactions to those who are different
from us

Once nurses tap into awareness, they

can actively analyze their increased
awareness and internal belief
systems
Cultural Competence
Knowledge
Indicates that values and beliefs about
culture may be inconsistent with our
behaviors and we might be unaware of
it

Nurses can work to acknowledge that

this disconnection exists and view
knowledge as an important element of
developing cultural competence.
Cultural Competence
Skills
Focuses on practicing cultural
competence, where awareness, attitude,
and knowledge are applied into practice
until the nurses become integrated into
their daily interactions.

Includes effective and respectful

communication and body language.
Benefits of Culturally
Competent Care
 Benefits of Culturally
Competent Care
1. Fosters mutual respect, understanding, and trust
2. Promotes the inclusion of patient and family’s responsibilities for their
health
3. Increases community participation and involvement in health issues.
4. Improved data collection, preventative care, cost savings, and patient
outcomes
5. Reduce healthcare disparities
6. Access to different ideas, perspectives, and strategies in decision making.
Examples of culturally
competent care
 Examples of culturally
competent care
1. Using language and terms the patients understand
2. Make sure a medical interpreter is present if the patient speaks another
language
3. Respecting patient’s cultural and religious beliefs that conflict with
treatment plans
4. Recruiting health professionals from underserved, diverse, and LGBTQ+
communities
5. Analyzing the ethnic composition demographics of the patient
6. Identifying patients in underserved populations and communities
Tips to improve Cultural
Competence
 Tips to improve cultural competence

1. Change your practitioner/patient perspective

• Work from a place of humble partnership instead of from an
imbalanced hierarchical notion of caregiver/care-recipient
2. Share something about your own culture that may be similar to your
patient’s culture
• Establishing a common ground by sharing experiences is a great
way to build rapport with patients and break down preconceived
barriers.
Tips to improve cultural competence

3. Learn from your coworkers and colleagues

• Working in a place that has people with different cultures, beliefs,
genders, races, and ethnicity can foster an environment of
belonging
4. Learn a new language
• can help to address many of the language gaps in healthcare as
language barriers have a negative impact on healthcare outcomes
and satisfaction.
Transcultural Perspective on the Health
History
 Cultural Assessment
Is a systematic, comprehensive examination of individuals, families, groups
and communities regarding their health-related cultural beliefs, values and
practices
 Cultural Assessment
Goals:
To determine the nursing and health needs of people from diverse cultures
and intervene in ways that are culturally acceptable congruent, competent,
safe and affordable, high quality, and based on evidence and best practices.
 Components of Cultural
Assessment
1. Process
• Refers to how to approach the client, consideration of verbal and
nonverbal communication, and the sequence and order in which
data are gathered.
2. Content
• Consists of the actual data categories in which information about
clients is gathered
 Transcultural Assessment Model: Six
Dimensions
Was developed in response to student nurses’ need to assess and design care
for culturally diverse patients as this provides a framework that can be
incorporated into the nursing education curriculum
 Transcultural Assessment Model: Six
Dimensions
1. Communication
• Mutual understanding of the patient’s cultural needs is achieved
through communication, including verbal and non-verbal cues
2. Time
• To understand individualistic views of culture, student nurses must
assess patient views about the passage of time, points in time, and
duration of time
 Transcultural Assessment Model: Six
Dimensions
3. Space
• Focuses on spatial concerns such as the personal preferences of the
patients to achieve their comfort related to their personal space.
4. Social Organization
• Nurses must have a knowledge of geography, socioeconomic status,
religious affiliation, gender and sexual orientation, and life cycle
organization by adopting and learning it through the social
organization.
 Transcultural Assessment Model: Six
Dimensions
5. Environmental Control
• Refers to patient’s ability within their cultural system to plan
activities and their perception of personal control over
environmental factors that control their environment,
6. Biological Variation
• This is evaluated carefully to avoid stereotypes and discrimination,
including factors such as race, body structure, genetic variations,
nutritional preferences, and psychological characteristics.
Transcultural Perspective on the Health
History
Purpose of Health History
• Enables the nurse to assess health strengths including cultural beliefs,
and practices that might influence the nurse’s ability to provide
culturally competent nursing care
• History is combined with the objective data to form a nursing diagnosis
Transcultural Perspective on the Health
History
Health History
A. Biographic Data
• Cultural affiliation
• Ancestry or ethnohistory
B. Genetic Data
C. Genetic Screening
Transcultural Perspective on the Health
History
Health History
D. Review of Systems
• To evaluate the past and present health state of the body system
• To provide an opportunity for the client to report symptoms not
previously stated
• Evaluate health promotion practices
Transcultural Perspective on the Physical
Examination
Transcultural Perspective on the Physical
Examination
A. Biocultural Variations
• Height
• Body proportions – blacks have longer arms and legs and shorter
trunks than Whites, Native Americans, or Asians.
• Weight – black men weigh less than their white counterparts
• Vital signs – black men have lower SBP than their white counterparts
from ages 18 – 34 but reverses at 35-64
 Incidence of hypertension is 2x as high in African American
 Transcultural Perspective on the Physical
Examination
B. Biocultural Variations in General Appearance
• Physical Appearance – includes age, gender, LOC, facial features and
skin color
• Body Structure – includes stature, nutrition, symmetry, posture,
position, and overall body build or contour
• Mobility – includes gait and ROM
• Behavior – includes variables such as facial expression, mood, and
affect, fluency of speech, ability to communicate ideas, appropriateness
of word choice, and grooming.
 Transcultural Perspective on the Physical
Examination
C. Biocultural Variations in Skin
• Melanin – protects the skin against harmful UV rays which is a genetic
advantage accounting for the lower incidence of skin cancer among
darkly pigmented black and Native American Clients
• Mongolian Spots – normal variation in children of African, Asian, or
Latin descent, where irregular areas of deep blue pigmentation usually
located in the sacral and gluteal areas are seen
 Transcultural Perspective on the Physical
Examination
C. Biocultural Variations in Skin
• Vitiligo – a nonfunctional melanocyte condition characterized by
unpigmented, patchy, milky white skin that may cause greater
psychosocial stress among dark-skinned individuals.
• Hyperpigmentation – darker skin areas such as nipples, areola,
scrotum, and labia majora especially seen among African American
and Asian clients
- when assessing the skin surface on dark-skinned clients, observe
carefully for erythema, rashes, and other abnormalities, as having a
darker color might mask this presence
 Transcultural Perspective on the Physical
Examination
C. Biocultural Variations in Skin
• Cyanosis – lack of oxygen in the blood characterized by bluish
discoloration of the skin
- May be difficult to observe in darkly pigmented people
• Jaundice – yellowish pigmentation of the skin and can be best
observed in the sclera in both light and dark-skinned clients
- increase caution to avoid confusing other forms of pigmentation
with jaundice
 Transcultural Perspective on the Physical
Examination
C. Biocultural Variations in Skin
• Erythema – frequently associated with inflammation and characterized
by increased in skin temperature
- difficult to assess in darkly pigmented clients because of the
contrast between white and red
• Petechiae – best visualize in the areas of lighter melanization, such as
the abdomen, buttocks, and volar spaces of the forearm
- cannot be seen in black or very dark brown skin
 Transcultural Perspective on the Physical
Examination
C. Biocultural Variations in Skin
• Albinism – is an inherited condition, where people with this have no or
little pigment in their eyes, skin, or hair
• Ecchymosis – caused by a systemic disorder found in the same
location as petechiae and more apparent in dark-skinned individuals
 Transcultural Perspective on the Physical
Examination
D. Biocultural Variations in Sweat glands
• African American have lower salt concentration in their sweat than
Whites do
 Transcultural Perspective on the Physical
Examination
E. Biocultural Variations in the Head
• Eyes – persons of Asian background are often identified with their
characteristic epicanthic eye folds, whereas the presence of narrowed
palpebral fissures in Non-Asian individuals might be diagnostic of a
serious congenital anomaly
• Mouth – oral hyperpigmentation also shows variation by race
- leukodema, a grayish-white benign lesion occurring on buccal
mucosa is present in 68% to 90% of blacks and 43% of whites
 Transcultural Perspective on the Physical
Examination
F. Biocultural Variations in the Musculoskeletal
• long bones of blacks are significantly longer, narrower, and denser than
whites
• Black males have densest bones, accounting for the relatively lower
incidence of osteoporosis and hip fractures
• Blacks have more skeletal muscle than white, Hispanic, and Asian
counterparts across the entire age range, even when adjusting for
weight and height
Clinical Decision-Making and Nursing Actions
Clinical Decision Making and Nursing Actions

Transcultural nursing is an area of study and practice focused on

comparative holistic cultural care, health and illness patterns of people with
respect to the differences and similarities in their cultural values, beliefs and
lifeways with the goal to provide culturally congruent, competent and
compassionate care
Clinical Decision Making and Nursing Actions

Cultural Needs
 Equal access to treatment and care
o Racial discrimination
o Racial harassment
o Oppression
o Stress
o Psychological trauma
Clinical Decision Making and Nursing Actions

 Respect for cultural beliefs and practices

 Religious beliefs, taboos, customs
 Dietary, personal care needs, daily routines
 Dying needs
 Communication needs
o Language
o Non-verbal communication
o Interpreters
Clinical Decision Making and Nursing Actions

 Cultural safety needs

o Engage patients as partners
o Respect and rapport
o Cultural negotiation and compromise
Clinical Decision Making and Nursing Actions

Negotiation process
 Listen to the client’s perspective
 Teach the patient from your knowledge in language appropriate for the
client and family
 Compare similarities and differences, disagree but do not devalue the
client’s view
 Compromise
o If treatment is not harmful, promote
o If harmful, explain harm and suggest alternatives
Modes to guide nursing
Judgment
 Modes to Guide Nursing Judgment
Modes to guide nursing judgments, decisions and actions in order to provide
culturally congruent care that is beneficial, satisfying and meaningful to the
people served by nurses. These modes are care centered and based on the use
of the client’s care knowledge.
 Modes to Guide Nursing Judgment

1. Cultural Preservation or Maintenance

• Professional actions and decisions that help people of a particular
culture to retain or preserve relevant care values so that they can
maintain their well-being, recover from illness, or face handicaps
and/or death
 Modes to Guide Nursing Judgment
2. Cultural Care Restructuring or Repatterning
• Professional actions and decisions that help clients reorder, change
or greatly modify their lifeways for new, different and beneficial
healthcare patterns while respecting the client’s cultural values and
beliefs and still proving more beneficial or healthier lifeways than
before the changer were co-established with the clients
 Modes to Guide Nursing Judgment

3. Cultural Care Accommodation or Negotiation

• Professional actions and decisions that help people of a designed
culture to adapt to or to negotiate with others for beneficial or
satisfying health outcomes with professional care providers
 References
https://www.slideshare.net/FGabrielOliveros/ncm120lecnotesdocx
https://www.slideshare.net/tonefeleo/madeliene-leiningerssunrise-model-ppt
https://www.studocu.com/ph/document/university-of-st-la-salle/nursing/ncm-120-transcultural-nursing-module
-3/39112748

https://www.studocu.com/ph/document/university-of-st-la-salle/nursing/ncm-120-transcultural-nursing-module
-3/39112748

https://www.studocu.com/ph/document/notre-dame-of-marbel-university/medical-technology/transcultural-hea
lth-care-delivery-perspectives/27391387

https://www.healthecareers.com/nurse-resources/nursing-news-updates/how-student-nurses-utilize-the-transcul
tural-assessment-model

https://www.slideshare.net/DelightsonRufus/transcultural-care-practice07
 Quiz
NCM 120 – Decent Work Employment and Transcultural Nursing

BSN 4B – Group 3
 Quiz
1. ___________ includes ages, gender, level of consciousness, facial
features, and skin color.
 Quiz
2. ___________ is professional actions and decisions that help clients
reorder, change or greatly modify their lifeways for new, different,
and beneficial healthcare patterns while respecting the client’s
cultural values and beliefs.
 Quiz
3. It is considered a vital skill for nurses to deliver quality nursing
care across culturally diverse groups, where patients are seen as
unique individuals from others.
 Quiz
4. What are the 4 components of culturally competent care?
 Quiz
5-6. Give two components of cultural assessment
 Quiz
7. This is one of the tips you can apply to be culturally competent,
where you should work from a place of humble partnership, instead of
an imbalanced hierarchical notion of caregiver/care recipient.
 Quiz
8. It is defined as a systematic, comprehensive examination of
individuals, families, groups, and communities regarding their health-
related cultural beliefs, values, and practices.
 Quiz
9. This model was developed in response to student nurses’ needs to
assess and design care for culturally diverse patients.
 Quiz
10-11. Give two dimensions of transcultural assessment model: Six
Dimension
 Quiz
12. To negotiate with your patient in making clinical decisions and
nursing actions, you must not devalue the client’s perspective about
certain aspects they believe in. True or False.
 Quiz
13. This mode to guide nursing judgment helps people of a particular
culture to maintain and preserve their relevant values while recovering
from an illness or disease.
 Quiz
14. This is the professional actions and decisions that help people of a
particular culture to adapt to or negotiate with others for satisfying
health outcomes.
 Quiz
15. This condition refers to a lack of oxygen in the blood characterized
by bluish discoloration of the skin and may be difficult to observe in
darkly pigmented people.
 Answers
1. Physical appearance
2. Cultural care reconstruction/repatterning
3. Cultural competence
4. Awareness, attitude, knowledge, and skills
5. Process
6. Content
7. Change your practitioner/patient perspective
 Answers
8. Cultural assessment
9. Transcultural assessment model: Six Dimensions
10 -11. Communication/ time/ space/ social organization/
environmental control/ biological variation
12. True
13. Cultural preservation or maintenance
14. Cultural accommodation or negotiation
15. Cyanosis
 Group Members
Caballero, Missy Kaye M.
Coprade, Jesel C.
Coronado, Ruther M.
Dineros, Angelica R.
Madraga, Rigor L.
Maglalang, Joan Richelle D.
Sison, Mary Ann N.
Vergara, Ma. Crystelle A.
Villamin, Gene Keann O.