3.7 Cultural Assessment

Open Resources for Nursing (Open RN)

After establishing a culturally sensitive environment, nurses should incorporate a cultural assessment when caring for all patients. There are many assessment guides used for patient interviews that are adaptable to a variety of health care settings and are designed to facilitate understanding and communication. The Four Cs of Culture model[1] is an example of a quick cultural assessment tool that asks questions about what the patient Considers to be a problem, the Cause of the problem, how they are Coping with the problem, and how Concerned they are about the problem. See the following box for examples of sample answers to the four Cs assessment.

Four Cs of Culture[2]

1. What do you think is wrong? What is worrying you? (In other words, discover what the patient Considers to be the problem and what they Call it.)

  • A patient with a diagnosis of pneumonia believes his body is “unbalanced.”

2. What do you think Caused this problem? How did this happen?

  • The patient believes this illness is a punishment for a misdeed.
  • The patient avoids eating certain foods to treat the illness while also using home remedies such as herbal tea.

3. How serious is this problem for you? How Concerned are you?

  • A patient views the illness as being “God’s will” and states, “It’s in God’s hands.”

A more comprehensive cultural assessment tool, inspired by R. E. Spector’s Heritage Assessment interview,[3] is described in the following box.

Sample Cultural Assessment Interview (Adapted from Spector’s Heritage Assessment Tool)[4]

  • Where were you born? Where were your parents born?
  • What pronoun do you use (he, she, they)?
  • In what language are you most comfortable speaking and reading?
  • Did you grow up in a city or a town or a rural setting?
  • When you were growing up, who lived with you and your family?
  • Are your friends from the same cultural background as you?
  • What is your religious preference?
  • Do you have any dietary preferences related to your religious or cultural beliefs?
  • In your culture, how do you celebrate the birth of a baby? A wedding?
  • When a woman is pregnant, are there any special customs she needs to follow? Any special foods?
  • When someone in your family is ill, who cares for them? What foods are prepared? Is there anything the ill person should avoid or refrain from doing?
  • What home remedies might be used if someone is ill?
  • As a family member is approaching death, what actions do you find comforting?
  • After a loved one dies, what rituals are performed?
  • What do you think a nurse should know about your culture if a family member is hospitalized?
  • Who makes the decisions in your family?
  • How are elders viewed in your culture?
  • Are there any special beliefs regarding organ donation or blood transfusions that are held in your culture?
  • Is your culture known for any special customs (e.g., rites of passage, foods, holidays, etc.)?

  1. Galanti, G. A. (2014). Caring for patients from different cultures (5th ed.). University of Pennsylvania Press.
  2. Galanti, G. A. (2014). Caring for patients from different cultures (5th ed.). University of Pennsylvania Press.
  3. Spector, R. E. (2017). Cultural diversity in health and illness (9th ed.). Pearson Education.
  4. Spector, R. E. (2017). Cultural diversity in health and illness (9th ed.). Pearson Education.

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Nursing Fundamentals by Open Resources for Nursing (Open RN) is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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