The stranger friend enabler, self awareness and interpersonal and intercultural

factors can become known to the nurse. Considerable personal and professional growth has
occured with nurses and other health professionals who use this enabler consistently and
regularly. Indeed, one can also asses ones own progress of becoming a friend with other
strangers with the enabler that has been used for five decades in transcultural nursing with
many reliable and scientific truths and benefits.

Acculturation Health Care Assesment Guide

This guide was developed and tested in several cultures since the early 1960s. It is
shown in appendix 4-B (at the end of this chapter). It has been one of the oldest and the
most continuous guides for assessing whether cultural clients are more traditionally or
nontraditionally oriented to their cultures in diverse areas. Acculturation is a critical factor
in assesments to determine whether a client takes on or adopts the lifeways of another
culture. This dimension of assesment is important to obtain the dominant patterns of caring
and health practices, whether one is dealing with a traditional or new lifeway. This
influences nursing decisions and plans. This acculturation enabler was developed to obtain
data with the ethnonursing method and theory of culture care and has been used by several
disciplines and health care providers to get credible, reliable, and meaningful assesment
data about informants.
The strength of this enabler is that one can obtain holistic assesment, especially
when using it with the culture care theory and sunrise model. It offers a systematic
assesment of the client (or family) of a particular culture with respect to worldview, social
structure factors, language use, environmental context, appearence, generic and
professional care practices, and other areas. The nurse assesor makes notations drectly on
part I and uses this information in part II to make a qualitative summary profile of the
client regarding whether the person (or family) is more traditionally or nontraditionally
oriented in cultural values, beliefs, and lifeways. These data are then used to develop
guidelines or plans for nursing actions and decisions with clients using the three modes of
the theory, namely : 1) culture care maintenance/preservation; 2) culture care
accommodation negotiation; and 3) culture care repatterning/restructuring. It is very
important to document and describe the place where the assesment was done such as the
home, hospital, or another setting because the context can greatly influence the responses
and meanings. The enabler is not intended to be used by the client, but rather by the nurse

who is responsible for the assesment and who uses the culture care theory with the sunrise
model. This enabler is also used as a research guide for information to substantiate or refute
theories related to the extent of acculturation, showing documentation of past or present
lifeways. It provides more qualitative data indicators than quantitative data, but has been
used with both data goals. Again, this enabler provides a holistic picture or profile of a
cultural informant(s) as related to care, health, and special needs of clients of designated
culture. The nurse jots down general observations of the home, setting, person, and
environment, as well as narrative infoemation shared by the client. A more detailed
summary account is generally prepared after the profile (B) is obtained.

Important Summary Points For Effective Culture Care Assesments

In this chapter several principles, guidelines, models, and enablers have been presented to
achieve culturally competent care assesments for quality care outcomes. The following
summary points are important to keep in mind :
1. The culture care theory with the sunrise model serves as one of the best and most
reliable guides to obtain a holistic view of an individual, family, or group and for
institutional assesments of cultures. The worldview, social structure factors,
ethnohistory, language uses, and environmental context are all essential areas to
obtain a holistic and comprehensive picture with culture-specific information. Some
areas will be of more interest than others in specific cultures and with teh assessor.
For example, mexicans, africans, italians, and arabs generally emphasize the
importance of extended family care. In contrast, anglo-americans emphasize
individuals and tehir specific needs with a focus on costs, technologies, and legal
and political factors of health care. The nurse actively listens to and observes the
informants to enter their world and learn from them. Rather than a narrow mindbody pathophysiological or emotional symptom or disease focus, a broad and open
view is maintained.
2. Throughout the assesment teh nurse remains an active listener, learner, and reflector
rather than a teacher or as a know it all medical specialists. The nurse refrains
from using a lot of professional jargon or medical terms as this tends to suppress
cultural data and prevents informants from sharing their ideas. If the informant
inquires about professional knowledge, the nurse is obligated to share ideas but is
careful not to practice cultural imposition or rigid ethnocentrism.

3. The nurse always keeps the assesment focused on the clients world of knowing
(the emic focus) rather than on the nurses views or professional (the etic focus)
ideas about care, health, and lifeways. If the nurse is prone and eager to sell ideas or
products to the client, this often leads to cultural conflicts and clashes and thwarts
and the clients participationand shared ideas.
4. The nurse always encourages the client or family to share their cultural care
practices, including health values, beliefs, and lifeways and how they use them in
daily life. Clients usually like to share their values and lifeways through stories,
special life experiences, photographs, letter, or material cultural symbols such as
talking about a blue stone or the medicine bag ( of native americans) that
promote or hinder healing and well-being in their culture. Clients like to share
material items and nonmaterial ideas that have the mos meaning for them in their
life. Focusing on the meaning of clients ideas to themselves during the assesment
is extremely important. Some family members have diaries and videotapes to share
their special life experiences, especially during a home assesment with the nurse. In
the hospital such video and home artifacts are seldom used.
5. Throughout the assesment, the nurse asks very few direct questions, but instead
uses indirect probing that focuses on areas of inquiry. Open-ended frames are used
such as tell me about _____ or i would like to have you to talk about yourself
and your family or i need to learn more about the ways you care for children and
elders. Encouraging the client to talk about ther experiences is a good strategy.
Also, it is important to clarify terms used as comfort care . Elicting ideas to help
the nurse tries to always use the clients words and frame of reference rather that
those of the nurse. This preserves the clients world of knowing and understanding.
This is a major approach today in developing culturally competent skills.
6. The nurse explores not only present- life experiences and values but also past
historical events and future views related to the general assesment. These are
discovered in relation to culture, care/caring, health, well-being, environmental
context, and social structure domain factors influencing health or illness patterns.
7. The nurse identifies and appreciates that most clients are capable of explaining and
interpreting their experiences related to care, health, illnes, and maintaining
wellness in their culture. Narratives, poems, cultural taboos, songs, pictures, and
symbols have cultural meanings that the clients often may use to explan their ideas.
The nurse should assume that she or he is not expert interpreter and analyzer, but
that the client is the knower. The nurses etic (outsiders) views usually differ from

the clients emic interpretations, so it is the responsibility of the nurse to hold back
her or his ideas and interpretations. Knowledge of the language and being able to
speak certain phrases or questions is critical to accurate assesments and
interpretations. At the end of each assesment period (and there may be several), the
nurse rechecksfor accurate client interpretations and explanations.
8. Tapping the clients cultural secrets is done gently and sensitively. They are

generally not shared unless the client believes that the nurse can be trusted, is
genuinely interested in him or her and the culture, and can protect cultural secrets
and viewpoints from being misinterpreted or used inappropriately. Some clients fear
that their cultural ideas and experiences might be demeaned or devalued by
outsiders. Respect as caring is practices when doing assesments. Spiritual,