Trans Cultural Nursing Assessment

TransCultural Nursing Assessment

Date ____________ Time ____________ Pt Initials ________ Age ______  M

F

Medical dx __________________________________________________________________

Communication - language, voice quality, pronunciation, use of silence and nonverbals. SubjectiveCan you speak English?  YES  NO Can you read English?  YES  NO Are you able to read lips?  YES  NO Native Language? ____________________ Do you speak or read any other language? _______________________________ How do you want to be addressed?  Mr.  Mrs.  Ms  First Name  Nick Name__________________ ObjectiveHow would you characterize the nonverbal communication style? ______________________________________ _______________________________________________________________________________________ Eye contact -  Direct

 Peripheral gaze or no eye contact preferred during interactions.

Use of interpreter  Family  Friend  Professional  Other  None  Verbally loud and expressive.  Quiet, reserved  use of silence Meaning of common signs - O.K., got ya nose, index finger summons, V sign, thumbs up _______________________________________________________________________________________ Determine any familial colloquialisms used by individuals or families that may impact on assessment, treatment or other interventions. _______________________________________________________________________________________ _______________________________________________________________________________________

Social Orientation - cultural, ethnicity, family role function, work leisure, church, and friends. SubjectiveCountry of birth? ______________________ Years in this country ___________ (If an immigrant or a refugee, how long has the patient lived in this country? -You are not questioning legal status.) What setting did you grow up in --  urban  suburban  rural What is your ethnic identity? _________________________________________ Who are the major support people: 0family members 0friends 0other _________________________________ Who are the dominant family members? _________________________________________________________ Who makes major decisions for the family? ______________________________________________________ Occupation in native country_________________ Present Occupation____________________

Education? ______________________________________________________________________________ Is religion important to you? _________________________________________________________________ What is your religion affiliation? __________ would you like a Chaplain visit?  Y  N Any cultural/religious practices/restrictions? If yes describe __________________________________________ ObjectiveInteraction with family\significant other - describe __________________________________________________ _______________________________________________________________________________________ Age and life cycle factors must be considered in interactions with individuals and families ( e.g. high value placed on the decision of elders, the role of eldest male or female in families, or roles and expectation of children within the family). _______________________________________________________ ______________________________________________________________________________________ Religious icons on person or in room?__________________________________________________________

Space - comfort in conversation, proximity to others, body movement, perception of space. SubjectiveDo you have any plans for the future? _________________________________________________________ What do you consider a proper greeting? ______________________________________________________ Objective Tactile relationships, affectionate & embracing.  Non-contact Personal space? _________________________________________________________________________

Biological Variations - skin color, body structure, genetic and enzymatic patterns, nutritional preferences and deficiencies. SubjectiveWhat type of food do you prefer? ____________________________________________________________ What type of food to you dislike?_____________________________________________________________ what do you believe promotes health?__________________________________________________________ Family hx of disease? ______________________________________________________________________ ObjectiveSkin color ______________________ Hair type _______________________

Environmental Control - health practices, values, definitions of health and illness. SubjectiveWhat do you think caused your problem? ______________________________________________________

Do you have an explanation for why it started when it did?__________________________________________ What does your sickness do to you; how does it work?____________________________________________ How severe is your sickness? How long do you expect it to last? ____________________________________ What problems has your sickness caused you?__________________________________________________ What do you fear about your sickness?________________________________________________________ What kind of treatment do you think you should receive?___________________________________________ What are the most important results you hope to receive from this treatment?____________________________ ______________________________________________________________________________________ What are the health and illness beliefs and practices of the family? ____________________________________ ______________________________________________________________________________________ What are the most important things you do to keep healthy?_________________________________________ ______________________________________________________________________________________ Any concerns about health and illness? ________________________________________________________ What types of healing practices do you engage in (hot tea and lemon for cold, copper bracelet for arthritis, magnets) ? ______________________________________________________________________________________ OjectiveDescribed patients appearance and surroundings _________________________________________________ What diseases/disorders are endemic to the culture or country of origin? _______________________________ What are the customs and beliefs concerning major life events? ______________________________________

Time - use of measures, definitions, social and work time, time orientation -- past, present, and future. SubjectivePreventive health measures ?  Y  N _________________________________________ ObjectiveTime orientation  Present  Past Hx of noncompliance, missed appointments?__________________________________________________