Madeline Leininger is the nurse and anthropologist who first developed the theory of addressing the needs of the whole person within their culture, heritage and traditions. Her book, Transcultural Nursing: Concepts, Theories, and Practice (1978), gave rise to an area of nursing practice that has become known as transcultural care. Nurses continue to develop tools to assess the nature of an individual’s culture, traditions and heritage. The Heritage Assessment Tool, developed by Rachel Spector (2000, figure 6-1), identifies language preference, family dynamic, religious practices, educational background, and social standing. The information gathered from the heritage assessment combined with further dialog will allow the nurse to implement an indivualized, culturally competent plan of care. The heritage assessment tool was utilized as part of a series of interviews comparing the health traditions of subjects from three different cultures.
The focus of the interview was health maintenance, health protection, and health restoration. Subject one is a 46 year old Hispanic female. Her paternal great-grandmother was born in a small village in Spain. Her maternal great-grand father’s was born in Mexico. It is interesting to note that while she has both Mexican and Spanish lineage, she most strongly identified with the Spanish side of her heritage. She clearly indicated she and her family spoke Castilian Spanish, not Mexican Spanish. Both sets of her grandparents and parents were born in the United States of America (U.S.A.). Her father and grandparents are bilingual, and come from a large family of 16 children. Her grandparents had very little formal education; her father attended school. Her mother was from a family of 4 children and speaks Spanish as a second language. She received formal education and was a college graduate. Twenty years ago, both sides of this family lived in rural areas and in close proximity but have since dispersed across the country for employment opportunities. This subject’s family has a strong tradition of beliefs and non-traditional methods for health protection.
They did not routinely seek out a physician but rather relied on herbalists and folk remedies. There was a strong spiritual component to this family’s traditions. Prayers, lighting candles during church services and saying novenas or the rosary were all considered to be important to health protection .With regards to health restoration; the subject’s paternal grandmother had a firm belief in “mal ojo” or the evil eye. When sickness occurred, it was due to “mal ojo” transmitting sickness through jealousy either consciously or unconsciously. Her grandmother believed many illnesses were the result of “mal ojo” and could be reversed through prayer and placing a bowl of hard boiled eggs near the sick person to “pull out the mal ojo”. In addition to prayer, teas were consumed for nausea or upset stomach; eucalyptus salve was applied to the chest for colds or respiratory infections, and mercurochrome was applied to any scrapes, bruises, insect bites or reddened areas on the skin.
Food was an important part of health maintenance for this family. The subject’s mother and grandmother both provided all the family meals which consisted primarily of fish, wild game and steamed vegetables. Food was never fried, and wheat germ was added to most foods, including desserts. The subject relayed that in recent years her family has moved into a suburban setting. Her grandparents now seek regular care from a physician. They also have mostly abandoned the folk remedies previously preferred and now use pharmaceuticals for health restoration. Prayer remains a large part of this family culture (P. Sanchez, personal communication, January 28, 2012). Subject two is a 46 year old Asian-American female of Chinese heritage. She has no knowledge of her grandparents who are deceased. The entire family migrated to the USA when the subject was three years of age. She is the youngest of three siblings, all of whom live within the same city. It is of interest that all the girls in this family have traded their Chinese names for western names and have married outside their race to men of Caucasian, non-Hispanic origin. In spite of this, the family maintains a strong culture of family unity and respect for their ancestors.
Neither her mother nor father read or write English; therefore, Chinese is the language spoken when communicating at home. All the children and grandchildren are bilingual. The subject shares caretaking responsibility for her parents with her sisters. To protect health, they practice healthy eating habits and engage in regular exercise. The subject’s parents walk daily, and practice tai chi. They drink warm water after each meal to ensure good digestion. In the event of illness, several cures are used to restore health. To reduce a fever, drinking cool water is believed to be effective. To alleviate a sore throat or cough, a vinegar and warm water gargle; for headache, cold compresses on the forehead and back of neck with massage; for body aches or pain, rest with meditation is the preferred remedy. To maintain health, this family again relies on exercise, meditation, and the use of herbal supplements and teas. Mint is used for digestion, ginger is used for energy. The subject shares that her parents are now receiving Medicare benefits and they engage in primary health prevention by receiving the influenza vaccine and yearly physical examinations (C. C. Lu, personal communication, January 31, 2012).
This student was the third subject. She is a 55 year old Caucasian of Scottish heritage. Her mother’s side of the family is of German Descent and her father’s side is of Scottish descent. She is strongly identified with her heritage and culture as all of her family on both sides were born and lived in West Virginia. Her mother was one of six siblings; her father an only child. This subject was the oldest of three siblings. The extended family unit was active in the same church and participated in many of the same social activities. They took family vacations and were together for most holidays and birthdays. Her father and grandfather were both professionals; her grandfather worked as a teacher, her father as an engineer. Both her grandmother and mother were homemakers. English is the only language spoken in this family. To protect health, this family used a combination of folk remedies and primary physician care. Both she and her siblings were immunized as babies and received yearly physical and dental exams.
However, prior to seeking medical care for health restoration, her grandmother and mother would utilize herbal and folk remedies to include warm salt water gargle for sore throat, cool compresses to reduce fever, or eucalyptus salve combined with inhaling steam for upper respiratory infections. Mineral oil was used to relieve ear aches and baking soda was dissolved mixed with warm water and then drank to cure indigestion. Hot chicken soup was a cure all for any type of sickness. Food was also an important part of health maintenance for this family. Her grandmother maintained a large garden and several fruit trees. She preserved every variety of vegetable and fruit and taught this skill to the subject. The family also would join together to purchase a whole cow and have it butchered. Meals were simple and wholesome.
Exercise in this family was not structured but every member participated in some type of physical activity through school, work or church. In conclusion, all three families interviewed have similar health traditions. Two of the three have strong religious traditions. All three use herbal and folk remedies in much the same way. The interviews revealed a pattern of change in tradition that appears to be based on education, and access to western based medicine. As the family units evolved through marriage, immigration, or education, their reliance on western medicine increased. However, the use of folk remedies were not completely abandoned and continued to be viewed as an important component in achieving and maintaining wellness. By including the health traditions in the nursing plan of care and teaching, the needs of the whole person can be addressed: Culturally competent nursing is achieved.
Leininger, M. (1978). Transcultural nursing: Concepts, theories and practice. New York: Wiley. Spector, R. E. (2000). CultureCare: Guide to heritage assessment and health traditions (5th ed.). Upper Saddle River, N.J.: Pearson Education/PH College.