Nursing Heritage Assessment
The Heritage Assessment Tool is a useful way of examining how strongly a person identifies with his or her heritage. It asks questions that can give a healthcare provider information about how long the family has been in the United States, how many generations of the family have been in the United States, how close the family is with other family members, whether the person lives in an ethnically-identified community, and whether the person married someone from the same cultural background (Spector, 2000). Furthermore, the questions in the assessment tool also seem aimed at helping determine whether the person is from a minority ethnic community. While it is not always the case, people who belong to minority groups may be more likely to identify with ethnic sub-communities. This can have a tremendous impact on the healthcare choices made by the individual patient, so that understanding a patient’s heritage can be important.
My own heritage assessment did not reveal me as highly identifying with my cultural heritage. This makes sense to me because I come from a diverse ethnic background, so that my family’s personal cultural traditions draw from a variety of different backgrounds. Personally, I have found that this makes my family more accepting of outside traditions. In the context of a medical approach, I believe that this would make me more likely to accept novel medical treatments than a person whose cultural traditions might make them wary of certain medical approaches.
In fact, the Heritage Assessment Tool can be a way of helping ensure cultural competency. “Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations” (The Office of Minority Health, 2012). Cultural competency is important because cultural norms can dictate not only what treatments a patient will accept, but also the manner of treatment. For example, cultural norms may prohibit certain female patients from accepting treatment from male doctors, or help describe which family or community members would be involved in an individual’s healthcare decisions. “Cultural competency is one the main ingredients in closing the disparities gap in health care. It’s the way patients and doctors can come together and talk about health concerns without cultural differences hindering the conversation, but enhancing it” (The Office of Minority Health, 2012).
These differences become clear when looking at families from different cultural backgrounds. Because of the diversity of my own cultural background, I chose not to examine my family, but focused, instead, on three families with . The first family was a family of zero-generation and from Pakistan. The second family was a family of zero-generation and from India. The third family was a family of zero-generation, first-generation, second-generation, third-generation, and fourth generation Ashkenazi Jewish immigrants from Eastern Europe. While all of the families came from the same apparent comfortably middle-class family backgrounds, their approaches to healthcare were sufficiently different to indicate some strong cultural differences.
The Jewish family placed a tremendous emphasis on health, with regular doctor visits and a proactive approach to eliminating potential health difficulties. Judaism puts a historical and religious emphasis on health maintenance, so much so that medical treatment might be seen as an obligation for observant Jews (My Jewish Learning, Unk.). This approach was certainly visible in the family interviewed, which stressed the importance of routine medical care, regular exercise, and maintenance of good health habits. In addition, while the family drank alcohol, it was very discouraging of negative health habits, such as smoking. They did not identify any cultural traditions that would impact medical treatment. While they acknowledged that more orthodox Jews might have to observe gender-rules and norms, the family did not observe these gender rules. Likewise, none of the family members kept kosher, so that their dietary healthcare concerns were not based upon religious traditions. In fact, their approach to healthcare seemed very similar to my own cultural healthcare traditions, though they placed a much higher emphasis on preventative healthcare than my own family does.
The Muslim family initially seemed as if it would present the greatest differences from the to healthcare. However, they actually illuminated the fallacy in thinking that there is a “typical” American approach to healthcare. For example, the Muslim family did adhere to many gender-based behaviors that led to an impression that the women were not respected in the same way as women in other communities. However, one of the issues that the family discussed was routine healthcare for women, and one of the women in the family made a distinction between traditional Muslims and fundamentalist Christians and their rules about abortion; I was surprised to learn that abortion is not prohibited in Islam prior to about 120 days of gestation (Sachedina, 2013). However, they also informed me that for medical decisions concerning the family, the male spouses are considered part of the decision-making process, and may even want to sign consent forms (Sachedina, 2013). In addition, there were cultural norms regarding females disrobing for male doctors. In fact, the family indicated that male family members, particularly the older members, might find it uncomfortable to disrobe for female doctors, though they stressed this was more of a cultural norm than a religious norm. One issue that they discussed had to do with life support; life saving measures are permissible under the religious traditions. However, removing a patient from life support can be a very difficult religious issue, so that the consideration to utilize life support becomes critical. That would suggest that patients from these backgrounds be instructed to leave detailed descriptions of their wishes. Muslims do experience some dietary restrictions, such as an absolute prohibition on pork and pork products. This not only impacts what they can eat, but may also impact their ability to utilize certain vaccines; the family said that a vaccine that is necessary for travel to Mecca on pilgrimage actually uses some type of pig product in production, and indicated that it was a substantial healthcare barrier for many Muslims.
The Indian family described a healthcare tradition that was very different from a Western medical approach. They believed in health maintenance, but had a belief about “hot” and “cold” foods and when they could be eaten, which differed from Western understanding of which foods are healthy and unhealthy. They also believed that illnesses and maladies could have non-scientific causes, and in the efficacy of folk medical treatments, even if those treatments have no proven record of success (Sharma, 2002). I was actually surprised to hear about the role of faith healers in their lives, and concerned that such an approach might delay seeking out healthcare. They also described a number of practices that could negatively impact health. For example, one woman in the family was diabetic and had been instructed by her doctors to maintain a consistent blood sugar level, but still engaged in fasting for religious purposes, which made it very difficult to control her blood sugar during those times. Moreover, the family was vegetarian. Rather than promote a healthier diet, the family had otherwise very American eating habits, and they described a diet that was very heavy in simple carbohydrates. The family indicated that, for their family that still resides in India, mental health issues, particularly depression, are viewed as stigmatizing. However, several of the family members discussed having used anti-depressants, suggesting that they did not agree with this cultural approach to depression.
References
My Jewish Learning. (Unk.). Jewish health & healing practices. Retrieved September 28, 2013
from http://www.myjewishlearning.com/practices/Ethics/Our_Bodies/Health_and_Healing.shtml?p=1
The Office of Minority Health. (2013, May 9). What is cultural competency? Retrieved
September 28, 2013 from U.S. Department of Health and Human Services website: http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=11
Sachedina, A. (2013). Muslim beliefs and practices affecting health care. Retrieved September
28, 2013 from The University of Virginia website:
http://people.virginia.edu/~aas/issues/care.htm
Sharma, A. (2002). The Hindu tradition: Religious beliefs and healthcare decisions. Retrieved September 28, 2013 from Catholic Health East website: http://www.che.org/members/ethics/docs/1264/Hindu.pdf
Spector, R.E. (2000). Heritage assessment tool. Retrieved September 28, 2013 from Prentice
Hall website: http://wps.prenhall.com/wps/media/objects/663/679611/box_6_1.pdf
