Heritage Assessment
Dianna Freeman
Grand Canyon University
Family Centered Health Promotions
NSG-429V
December 20, 2014

Heritage Assessment
“Health is influenced by culture and beliefs” (NRS-429V, 2011, p. 1). In order for the nurse to properly care for the patient, she must know and understand the patient’s culture. “Cultural care is a comprehensive model that includes the assessment of a client’s cultural needs, beliefs, and health care practices” (NRS-429V, 2011, p. 1). It is not enough to just know where the patient lives or where he came from. The nurse must embrace the concept of cultural competence and cultural awareness. This requires not only the awareness of the cultural beliefs and values of their patients, but also their own. A heritage assessment, whether formal or informal, can provide a wealth of information that helps the health care team to better understand the patient, his attitudes, his feelings, and beliefs. One of the challenges in nursing is to apply health education to individuals and families from diverse cultural backgrounds. “Cultural beliefs and values influence health decisions and must be taken into consideration.” (NRS-429V, 2011, p. 1). It is easier to care for the patient when we understand him better.
The first family interviewed was a Black couple. They were not married, but had been living together for over 6 years. The woman’s daughter lived with the couple. The man had two daughters who were grown. The man was interviewed about his family’s history. The woman was not. The man’s mother was born and raised in Houston, TX, his father in New Orleans, LA. His maternal grandparents were from Mississippi. His paternal grandparents were from Louisiana. He was raised as an only child living with his mother and grandmother in an urban area. His father was not present in the home, nor did he ever see him. He did maintain contact with all his mother’s family on at least a weekly basis until they died. He attended the Baptist Church as a child, did not attend church regularly through his adult life until recently being diagnosed with cancer. The woman in the relationship is also Baptist. Her mother and grandmother also raised her along with 1 sister. She maintains a relationship with her family. Both people attended public school. They consider their friends to be from a mixed religious and ethnic background.
The second family interviewed is Hispanic. The husband was interviewed, and the questions answered about his family. Both he and his mother were born in Monterrey, Mexico. His father was born in the countryside out of Monterrey, Mexico. His mother’s parents were born near Monterrey, but he does not know where his father’ parents were born; somewhere in Mexico is all he knows. He has 2 brothers and 3 sisters. One brother and one sister now live in the U.S. The others are still in Mexico. He grew up in a suburban area in Mexico, as did his parents. They remained there until they died. He lived in a home with his two brothers and three sisters with his maternal grandparents next door. He had a lot of family near by that he saw very often. He came to the U.S. when he was 29 years old to work with his uncle in a restaurant. He now owns his own restaurant with his wife. Both he and his wife are devout Catholic and attend church on a regular basis. They practice religion in their home by praying and reading their Bibles. They have no children at home, but have two sons and one daughter. The wife is also Hispanic. Both attended public school in Mexico. They participate in ethnic activities by playing and listening to music, dancing and participating in holiday celebrations. Their friends are mostly Hispanic and Catholic and speak Spanish as a first language. The wife speaks little English and reads only Spanish.
The third family that participated in the interview were a White husband and wife with no children living at home. They have two grown sons. The wife was interviewed about her family. Both of her parents were born in East Texas, as was she. Her maternal grandmother was born in Irving, TX and her maternal grandfather was born in Southeast Oklahoma. Both paternal grandparents were born in Northeast Texas. She has two sisters who grew up in the home with her. She grew in in Houston, TX and went to public school and a public university. Aunts, uncles, cousins, and grandparents all lived in Texas and get together several times a year throughout the growing up years. Both she and her husband are protestant and attend church regularly. They practice their religion in their home by praying and reading their Bibles. Their friends are from varied backgrounds, but they say most are White, English-speaking Americans.
There are many factors that contribute to the current health status of Black Americans, but “Poverty may be the most profound and pervasive determinant of health status” (Edelman & Mandle, 2010, p. 39). Health care is expensive and can only be purchased by those who can afford to pay, so those below the poverty level are those who lack insurance. Without insurance their access to healthcare is limited, especially preventative care. No preventative care means more expensive care that comes with illness.
The incidence of cancer is higher in Black Americans, both men and women, than non-Hispanic Whites. Men are more likely to have lung, pancreatic and stomach cancer. They are more likely to die from prostate cancer. Black African American women are 36% more likely to die from breast cancer. Severe hypertension is more common for Black Americans in both sexes. In 2003 there were 46.8 deaths per 100,000 Blacks compared to 12.8 deaths among Whites. They are 30% more likely to have a stroke and 50% more likely to die from one (Edelman & Mandel, 2010, p. 40). Obesity is getting more attention in contribution to these disease processes.
Family and religion are the center of the Black culture. They provide the bond between generations and are the source of support in times of health crisis. As a general rule, family members are consulted before medical personnel. “Religion and religious behavior are an integral part of the Black community. Black African Americans are said to be ‘the most religious group in the world’. The church, as the second most important institution for Blacks, has many purposes beyond worship and formation” (Edelman & Mandel, 2010, p. 40). The church is where people socialize, access welfare services, find a stabilizing source in the community, obtain citizenship training and community social action, learn about cultural history, and look for a means of coping in the world.
The definition of health to Black Americans is “a feeling of well-being and the ability to fulfill role expectations” (Edelman & Mandel, 2010, p. 40). They believe that natural or spiritual forces can cause illness. Blacks will use their traditional health system when they lack access to professional care providers. If professional health care is not available, family members are often consulted for traditional home remedies. Because Blacks find such great comfort in their religious leaders and the folk healing beliefs, these remedies can be beneficial to them and can augment care provided by professional providers. It is important to find a way to incorporate them into plans of care.
The Black family interviewed considers family to be of great importance to them. They consider themselves to be very close to all living members of their family, and see them often. The are both Christians and have always attended church, but are attending much more regularly since the husband has been diagnosed with cancer. While they have choses to traditional medical care for the husband’s illness, they still believe in the power of prayer for healing also. Their church family and pastor pray with them weekly and they pray in their home daily. They consider their friends to be from mixed religious and ethnic backgrounds. Both husband and wife, as well as their parents were born in the U.S. Their language is English, which they both read and write.

Hispanic Americans “have many health issues complicated by multiple, economic, political, and social factors” (Edelman & Mandel, 2010, p. 37). They are the highest uninsured racial/ethnic group in the U.S. “In addition to lack of insurance, language and cultural barriers to preventative care have implications for their health” (Edelman & Mandel, 2010, p. 37). Both sexes of Hispanic adults have higher incidences of stomach cancer and are twice as likely than non-Hispanic Whites to have diabetes and 1.5 times as likely to die from the disease. HIV is ranked as the leading cause of death among Hispanic adults 25-44. Most are reluctant to participate in vaccine programs.
A major barrier in obtaining health care is the lack of racial and ethnic diversity in the leadership and workforce of the healthcare system. Interpreter services and culturally appropriate health care resources serve as barriers to care. Lack of culturally appropriate personal interaction with health care providers serves as a deterrent in seeking and obtaining care. Hispanics may also not seek care because they trust their folk system of healing. Without insurance, money to pay for care, and difficulty navigating the health care system, it is easier to continue to rely on what is comfortable for them.
Like the Blacks, family and religion are the most important aspects of the Hispanic culture. Family is the most important component of good health for the older generation of Hispanics. The needs of the family are greater than the need of an individual since the family is so important (Edelman & Mandel, 2010, p. 38). Hispanics have profound belief on prayer and spiritual strength to aid them in illness and dying. “They have ‘profound reverence for God and for other powerful forces they believe exist….Furthermore, health and disease are believed to be consequences of God’s approval or disapproval of a person’s behavior’. Hispanics attribute the origins of disease and illness to spiritual or natural punishments, hot and cold imbalances, magic, dislocation of internal organs, natural diseases, and emotional and mental issues” (Edelman & Mandel, 2010, p. 39). Like Blacks, Hispanics will resort to home remedies and folk healers and use a variety of folk remedies, prayers, rituals, herbs, and laying of hands. They may use these in combination with professional health care services and the trust in them can have positive effects on the patient’s care. Professional care plans can benefit by including these folk remedies. “According to The Commonwealth Fund, White Americans seemingly have the advantage over minorities when it comes to the quality health care they receive” (The Commonwealth Fund, n.d., p. 1). But there are many reasons that White Americans experience barriers in obtaining healthcare also. As with the other groups, lack of insurance due to poverty is the greatest reason. The uninsured are all ages, but young white adults are the most likely to lack insurance. Most uninsured live in a family with at least one full-time worker. The largest share of the uninsured is by far White Americans, although Hispanics are the highest percentage of uninsured ("The uninsured," 2010, para. 3). Consequences of not having health insurance can be serious in that those without insurance are less likely to use health care professional services and therefore are more likely to suffer episodes of poor health. Of those with insurance, many have prohibitively high deductibles. Their policies are intended for major medical use, so while they can get preventative care, the still do not get care for minor illnesses. Many will not seek preventative care in fear of finding an illness.
White Americans leading cause of death is heart disease caused from hypertension, increased cholesterol, or smoking. Cancer, chronic lower respiratory disease, and stroke all follow. Unintentional injuries, Alzheimer’s disease, diabetes, influenza/pneumonia, kidney disease, and suicide round out the list of the top ten causes of death. Of these ten, the third family interviewed has a family history of heart disease, increased cholesterol, cancer, stroke, Alzheimer’s disease, and diabetes.
There are reasons that White Americans do not seek care besides just not having insurance or funds to do so. Many people don’t feel that they have a doctor they can trust or who will listen to them. And the doctor’s office is where you hear bad news and bad things happen to you (Richard, 2008, p. 2). People can continue to live in denial of what they don’t have to acknowledge. Embarrassment plays a role in not seeking treatment. Either patients haven’t followed a prescribed treatment plan, not made lifestyle adjustments as directed by the doctor, or feel that they will be judged, and do not seek or return for follow-up care (Epstein, 2000, p. 2).
While the percentage of White Americans is rapidly decreasing and the percentage of Hispanics is increasing, especially in the Southwest part of the U.S., the “health status of White Americans is often used as the ‘baseline’ against which other racial and ethnic groups are measured. However, Whites experience many of the same health problems a other groups. Factors that contribute to poor health outcomes among Whites include lack of access to health car and lack of health insurance” ("White populations," 2010, p. 1).
White Americans may also rely on alternative forms of treatment, depending on religion, local culture or their attitudes on holistic health, but as a group are the most likely to seek traditional professional medical help.
The third family interviewed, a White family, has a primary care doctor that they visit regularly for preventative care and have had all recommended screenings. They could make lifestyle changes to be more active and eat healthier, but in general, they are at the top of the health care system, as far as quality and access to care are concerned. Both husband and wife consider themselves to be healthy, although the husband takes daily medication for hypertension that is under control. They also consider family very important and maintain close ties both with their siblings and children, whom they see as often as possible since they live several hours away. They consider themselves to be of the same ethnic and religious background, Christian, as most of their friends. They attend church regularly and practice their religion in their home. Because they were both born and raised in the U.S., they speak, read and write English.
The cultural heritage “assessment of the nursing process is extremely important in inter- ethic relationships between patients and nurses. To gather data about a patient of a culture different from the nurse’s, the nurse needs to view the patient in the context within which he exists” (“Assessment measures”, p. 1). “ Incongruent beliefs and attitudes about health and health care services among ethnic groups versus the rest of the population, particularly health care providers, are major barriers in improving the health status of ethnic group members” (Edelman & Mandel, 2010, p. 32). The rate with which our world is changing makes it especially important for nurses to understand the different cultures and to deal with others who have different beliefs, values, and ideas about health care, illness, wellness, and death. Each person has the right to make decisions about their own health care. Nurses who are better informed about a patient’s background and culture are more able to guide that patient to make better decisions and to accept the decisions that the patient makes.

References
Edelman, C., & Mandle, C. (2010). Health promotions throughout the life span (7th ed.). [evolve]. Retrieved from http://www.elsevier.com
Epstein, R. H. (2000, October 31). Major medical mystery: Why people avoid doctors. The New York Times. Retrieved from http://www.nytimes.com/2000/10/31/health/major-medical-mystery-why-people-avoid-doctors.html
Health policy center, The uninsured. (2010). Retrieved from http://www.urban.org/health_policy/uninsured/index.cfm
NRS-429V Lecture 3. (2011). Retrieved from https://lc-ugrad1.gcu.edu/learningPlatform/user/users.html?operation=loggedIn#/learningPlatform/loudBooks/loudbooks.html?viewPage=past&operation=innerPage&topicMaterialId=9d0c4da5-75b2-44c5-93d9-fc842b1fc1eb&contentId=4defd497-161d-4932-8820-388849402941&
Richard, S. (2008). Beyond ’white coat syndrome’. Retrieved from http://www.webmd.com/anxiety-panic/features/beyond-white-coat-syndrome
The Commonwealth Fund. (n.d., ). Minority Americans lag behind whites on nearly every measure of health care quality [Press release]. Retrieved from http://www.commonwealthfund.org/publications/press-releases/2002/mar/minority-americans-lag-behind-whites-on-nearly-every-measure-of-health-care-quality
Transcultural nursing: Assessment measures. (2012). Retrieved from http://www.culturediversity.org/assesmnt.htm
White populations. (2010). Retrieved from http://www.cdc.gov/omhd/populations/White.htm#Disparities