1. Chapter 10—Assessment of Social, Cultural, and Spiritual Health

2. Models of Health
Biomedical model: Health is the absence of disease; most prominent model.
Complementary and alternative medicine (CAM) model: uses alternative therapy instead of/in addition to conventional medicine to restore health
Roy’s adaptation model: patient’s ability to adapt, compensate, manage, and adjust to various “setbacks”
Gordon’s functional health model: People are considered healthy if they can fulfill social roles.
Eudaimonistic model of health: Individual’s wholeness is essential to maintain good health.

3. Social Assessment
Identifying social context influencing patterns of health and illness
Individuals; communities; societies
Basic variables
Gender; age; ethnicity; race; marital status; shelter
Occupational class; employment status; education level
Integral to quality nursing care at every level
Avoids making sweeping generalizations about
Individuals; communities: societies

4. Social Assessment of the Individual
Primarily: informs nurse regarding patient’s physical, mental health
Related to existing: resources; constraints; demands
Data obtained via personal interviews
Essential to planning
Long-term management of illness
Evidence-based health promotion activities
Consider potential effects of culturally based practices on health.

5. Social Assessment of the Community
Scope of social assessment at community level
Broader, more complex
Gather data to identify.
Community resources; constraints; high-priority health concerns
Assess various health indicators.
Social; economic; environmental; quality-of-life
Relationship with community’s health concerns
Ongoing assessments are essential.

6. Social Assessment of the Community—(cont.)
Techniques
Interviews via focus groups, mailed surveys; analyzing situations and concerns
Framework examples
Asset mapping: data organized into categories
Primary, secondary, potential building blocks
Participatory action research approach
Community as Partner Assessment Model: mandates
Community assessment, interventions include
Systematic evaluation to identify intervention effects

7. Social Assessment at the Societal Level
Generate information about societal trends, relationships among social variables, prevalent health concerns
Data collected
Inform healthy public policy, broad health promotion initiatives
Identify ecological risks, disaster preparedness, or posttraumatic stress
Diverse research methods
Data analyses: summary statistics; population stratification; variable associations; predictions

8. Cultural Assessment Cultural health assessments and related care
Promote health, healing
Conducting cultural assessment
Ethical, moral, professional nursing responsibility
Create safe, culturally congruent environments

9. Question
Leininger and McKnight’s asset mapping generates data described as building blocks. Primary building blocks are considered to be what? A. Programs and services designed by an individual B. Agencies designed to serve the community C. A federally funded participatory action research study D. Fire station

10. Answer
Rationale: Data generated from the assessment are grouped into three categories: primary, secondary, and potential building blocks. Formal institutions in the area, such as local businesses, schools, libraries, parks, police, and fire stations, constitute the primary building blocks.

11. Characteristics of Culture
Culture: a shared, learned, and symbolic system of values, beliefs, and attitudes that shape and influence how people see and behave in the world
Primary and secondary characteristics of culture
Primary: age; gender; nationality; ethnicity
Secondary: cultural values; religious beliefs; morals; occupation; socioeconomic status; immigration status; reasons for migration; health beliefs
People’s cultural beliefs about health are important.
Powerfully influence health practices

12. Aims of Cultural Assessment
Cultural assessment: systematic assessment of individuals, families, and communities regarding their health beliefs and values
People of different cultures have the right to receive cultural assessment.
Specific aim of cultural assessment
Provide an all-inclusive picture of patient’s culture- based health care needs
Gaining knowledge about the patient’s cultural beliefs and practices
Food, eating rituals; daily personal hygiene rituals; sleeping habits
Compare culture care needs of specific person with those of similar cultural background

13. Aims of Cultural Assessment—(cont.)
Specific aim of cultural assessment—(cont.)
Identify similarities/differences among cultural beliefs of patient, health care agency, nurse
Generate holistic picture of patient care needs
Develop, implement a culturally congruent nursing care plan
Madeleine Leininger theory/Sunrise Model
Proposed essential areas of assessment
Identifies relationship between cultural variables, health

14. Cultural Health Beliefs and Practices
Assessment of patient health beliefs and practices
Each culture practices traditional values/beliefs about health, illness
Food, nutrition practices
Pregnancy, childbirth
Expressions of illness, pain

15. Spiritual Assessment
Spirituality: pertains to matters of the human soul
State of mind; state of being in the world; journey of self-discovery; a place outside the five senses
Integral part of religion or self-directed path
Spiritual care within health care context: congruent with patient spiritual beliefs
In many cultures: Church, religion play important roles and must be treated as such.
Important to accommodate patient spiritual practices within care
Fosters physical, spiritual healing

16. Critical Thinking Nursing diagnoses, outcomes, and interventions
Outcomes (partial list)
Patient will express meaning, purpose in life.
Patient will initiate interactions with others.
Interventions (partial list)
Monitor, promote supportive social contact.
Offer visits with spiritual or religious advisors.
Use patient assessment to: implement new interventions; evaluate their efficacy; improve quality of patient care.

17. Question Nurses use assessment data for what purpose?
A. To identify patient outcomes
B. To develop nursing theories
C. To provide socially correct care
D. To identify family support systems

18. Answer
Rationale: Nurses use assessment information to identify patient outcomes and determine appropriate nursing diagnoses.

19. NCLEX-Style Review Questions
The National Standards for Culturally and Linguistically ­ Appropriate Services in Health Care mandate that the standards
should be applied in private offices.
may be used in public settings.
should be used in hospitals.
be upheld in every health care setting.

20. NCLEX-Style Review Questions
Rationale: The ­national standards should be used in all health care settings, public and private, and acute and outpatient.

21. NCLEX-Style Review Questions
CAM therapies used instead of conventional treatments to restore health are often termed
alternative.
advantaged.
complementary.
conventional.

22. NCLEX-Style Review Questions
Rationale: Therapies used with conventional ­medicine are often labeled complementary, whereas those used ­instead of conventional treatments are called alternative.

23. NCLEX-Style Review Questions
The social context influences the patterns of health and illness for individuals, communities, and societies. An example is assessment of
the patient's health beliefs and practices.
focus groups in multiple locations.
culturally based postpartum practices.
the religious practices of the patient.

24. NCLEX-Style Review Questions
Rationale: Assessment of the patient's health beliefs and practices, postpartum practices, and religious practices are individually based assessments. Focus groups are social assessments at the societal level.

25. NCLEX-Style Review Questions
The purpose of comparing culture care needs of the ­specific individual to the general themes of people from similar cultural background is to
identify the dietary needs of a specific religious ­ preference.
determine if the patient needs a spiritual ­consultation.
provide a picture of the individual's culture-based health care needs.
consider how closely the patient follows his or her ­ religion.

26. NCLEX-Style Review Questions
Rationale: Although the other answers may be ­important, they relate to the spiritual assessment more closely than to the cultural assessment.

27. NCLEX-Style Review Questions
With transcultural assessment, the nurse must
ask all the questions for completeness.
determine which questions to ask.
include all the questions as part of an admitting ­ assessment.
wait until the relationship is established to ask ­ questions.

28. NCLEX-Style Review Questions
Rationale: Because the list of suggested transcultural assessment questions is extensive, nurses are not able for every patient to conduct a complete assessment on admission to inpatient or outpatient care. Instead, the nurse must determine which questions to ask based on the patient's symptoms, learning needs, and potential health effects of culturally based practices.

29. NCLEX-Style Review Questions
A shared, learned, and symbolic system of values, ­beliefs, and attitudes that shapes and influences the way people see and behave in the world is defined as
society.
community.
culture.
spirituality.

30. NCLEX-Style Review Questions
Rationale: This is the common definition of culture.

31. NCLEX-Style Review Questions
Even when daily prayers or other religious practices are not a part of a patient's life routine, they often take a central position during life transitions, such as loss of a loved one, accident, or serious illness. A related nursing diagnosis might be
spiritual distress.
impaired social interaction.
readiness for enhanced spiritual well-being.
social isolation

32. NCLEX-Style Review Questions
ationale: Spiritual distress indicates a disruption in concepts by which the patient integrates the meaning of life into his or her world view. Impaired social interaction is related to an insufficient quantity or quality of social exchange. Readiness for enhanced spiritual well-being is appropriate when a patient is developing inner strengths to understand life's purpose and harmony with all. Social isolation is used when the patient is experiencing loneliness.

33. NCLEX-Style Review Questions
It is important to identify similarities and differences among the cultural beliefs of the patient, health care agency, and the nurse to
get the proper diet.
perform a spiritual consult.
communicate with family.
avoid making assumptions.

34. NCLEX-Style Review Questions
Rationale: Making assumptions or generalizations about the patient's spiritual needs based on ethnic or religious affiliation is almost certain to be an oversimplification.

35. NCLEX-Style Review Questions
Seeking understanding of patients’ culturally based health care practices is essential to nursing because each culture has its own traditional values and beliefs about health and illness that
has things that need to be avoided.
affect the body image and habits that may lead to becoming overweight.
may affect patients’ adherence to treatments.
use various health methods that might be harmful

36. NCLEX-Style Review Questions
Rationale: For some patients, health care services may not be affordable or culturally relevant, especially when dietary habits and preferences are not considered when treatments are ordered. Other patients, because of the unequal distribution and underrepresentation of ethnic minori­ties in health care, may reluctantly decide, after traditional healing ­remedies prove unsuccessful, to seek conventional care from a health care provider who does not represent the patients’ own culture.

37. NCLEX-Style Review Questions
What is the nurse's best response when a Muslim ­patient has a basin of water on his bedside stand that he does not want emptied?
Tell him that the water is a health hazard.
Empty it because it could spill and get the bed wet.
Talk with him about why he should not have it there.
Support and accommodate his preference

38. NCLEX-Style Review Questions
Rationale: A devout Muslim patient may request to turn his bed to face Mecca, change his hospital gown, and place a basin of water near his bed for ritualistic handwashing before praying. The health risks are minimal compared with the benefit of supporting his spiritual needs.