Giger and Davidhizer’s Transcultural Assessment Model
The culture of homelessness is often shunned by most people who are fortunate enough to have their own homes. Distinguishing between rooflessness and homelessness is another concept that is often misplaced. For instance, an individual may be roofless but not homeless when they stay in areas such as sheds, which are technically homes but have no roofs. The conditions that the homeless go through in the streets lead to the acquisition of a culture of homelessness. The homeless community, just like any other communities in the world, has a set of cultures that are associated with it. While it is believed that the homeless use alcohol and other drugs besides committing petty crimes, there are some of them who do not exhibit similar characteristics. Such are mainly victims of circumstances and are considered to be the exceptional cases in the culture of homelessness.
To determine how homeless individuals fit within their cultural characteristics, a mock interview was conducted on Troy. The objective of the mock interview was to determine the fit between a homeless individual and the associated cultures of homelessness. Giger and Davidhizer’s assessment model based on six cultural phenomena was used as the guiding factors for the mock interview. To further enhance the process, the questions asked did not contain any insinuations towards the expected responses. Moreover, the process was made to be as objective as possible, to avoid any implications that would arise from negative perceptions. The subject was made to feel as comfortable as possible to enhance their probability of giving accurate responses to the questions asked. In each of the activities the assessment model provided a general guideline of what questions would help to determine the cultural inclination of the subject.
Giger and Davidhizer’s Transcultural Assessment Model
Giger and Davidhizer (2004) proposed a trans- cultural assessment model in which the personal health and well being of an individual is considered to be a centre island surrounded by different concepts and factors. The individual’s well being takes the center stage and is surrounded on the first layer by factors such as religion, ethnicity and culture. Each of these factors is associated with other phenomena, which are described as the six cultural phenomena for assessment purposes. The first circle provides general descriptions in relation to various cultures. On the other hand, the six phenomena provide greater details for an objective cultural examination. The six phenomena include: communication, space, time, environmental control, social organization and biological variations. Biological variations and time are linked to the ethnicity concept of culture. The culture component comprises of the space and the communication phenomena while the environmental control and social organizations are associated with the religion component. Understanding each of these phenomena is considered to be the starting point of effective trans-cultural nursing practices.
The model is based on a meta-paradigm that is driven towards culturally diverse nursing. Attending to culturally unique individuals such as the homeless individuals requires culturally competent care, whose basis is provided by Giger and Davidhizer’s transcultural assessment model. The rationale is to acquire as much understanding of the culture perceived differently, as possible. It is only in this way that a nursing practitioner can be able to provide objective rather than subjective care. According to Giger and Davidhizer (2002), patients have to be understood as unique cultural individuals in unique cultural settings. There are culturally unique illnesses and the client expects to be treated within the confines of their past experiences, cultural norms and beliefs. The assessment model is intended to assist in identifying the degree of individual identification with the perceived community cultures, ethnicity and religion. Applying the model to a client thus helps to obtain depth and comprehension of the patient’s conditions.
The study subject
To effectively identify the subject, the interview revolved around the six key cultural phenomena described by Giger and Davidhizer (2004). Application of the six phenomena resulted in the realization of various cultural inclinations contrary to those expected of the conventional homeless persons. As a culturally unique individual, the subject reported that he was born in Jamaica and moved to the U.S.A with his parents at the age of four. As an only child, his parents had provided him with what he needed to get through life and he had done well to study and eventually secure a job. However, when his parents passed on together in a road accident, he became psychologically disturbed and could not perform effectively at work. He was thus fired from his job and after a few months, he was evicted from his house and now stays on the streets. He has not adapted to the conditions yet and hopes that he would eventually get out of the streets for good.
The subject interviewed was a middle aged, black American male individual, referred to as J.B (not real name). He was of medium built, with black kinky hair and black complexion. He appeared healthy as well as psychologically stable based on his responses to questions and general disposition during the entire process. Through the interview session, he reported that he had no genetically linked allergies or even diseases. Despite his reportedly homeless situation, his medical records, as issued verbally indicate that he has not been ill in the last 6 months. This dispels the perception that the homeless are susceptible to various kinds of culturally aligned illnesses. Furthermore, he reported that he has never been treated for illnesses such as pneumonia and food borne diseases which are also common among the homeless. Upon further examination, conducted verbally, he reported that he has never been diagnosed with any nutritionally aligned diseases, although he at times feels constipated. Based on the biological variation reports, it was difficult to clearly characterize the subject’s cultural inclinations with regards to perceived cultural tendencies associated with homelessness.
Understanding the biological variations would provide sufficient information about the patient’s past and so use the information as the baseline for the treatment process. This is a prerequisite in establishing a positive rapport with the patient as it builds the knowledge base upon which to plan actions. For the case of this patient, the nursing implication for the information given is that the present attendance would involve a new diagnosis and would be specifically aimed at treating emergent problems. In a case where other problems have been identified in the past, it would have been prudent to conduct other analyses. For instance, culturally inclined diseases would warrant an examination, not only in relation to the present issue but also inclusive of other potential issues.
Environmental Control Phenomenon
Besides the biological variation, the patient was also interviewed on the environmental control perspective. The main objective of this interview session was to determine the cultural practices held by the individual with regards to health. From the responses, it was determined that the patient has an efficacious health practice. For instance, he reported that he often engages in physical activities such as jogging to ensure that h stays healthy. Moreover, unlike some other homeless people, J.B reported that he does not eat food picked or obtained from dirty places. Lack of experience in diseases associated with homelessness. He also reported that although he engages in hard labor to obtain his daily meals, he consumes only low cost foods but also ensures that his diet is healthy. The main constraint faced in his health, is lack of finances for a better or even more satisfying diet. The subject was also questioned concerning his values and beliefs. On this, he responded that he believed in God and is a Christian. The most important values according to the subject include honesty and integrity. He thus keeps away from street gangs and strives to make his own life better through work instead of theft.
While personal convictions have no impacts on the service intensity and quality, the health perspectives held by the patient are an important clue as to how much the he would do sustainably to maintain a positive health outcome. The nurse practitioner has to understand the potential sources of illness in the individual and knowing whether a patient engages in physical activity can help to dispel thoughts about lifestyle diseases. It can also bring to mind the potential of the patient’s issues being a result of activity related injury. In this way, methods of sustainably helping the patient to manage their condition can be established.
O n the time phenomenon, the main objective of the mock interview was to determine whether the respondent had distinguished time spent with family, friends as well as time for work and leisure activities. From the session, it was established that the most valuable time for respondent was the time spent with his friends and the time he spent at work and doing physical activities. The time spent at work was valuable as it indicated that the respondent would earn a living from his services. Based on his description, being at work gave him satisfaction as it meant he could not be destitute eternally. He saw it as a promise of better days to come. At the same time, he valued the time he engaged in physical activity and made it an early morning routing to go jogging in spite of his poor sleeping conditions. He took the time to refresh his mind and to boost his belief in a better future. While he had valued time spent with friends, he did not have many friends as most of those he had been used to, had broken off from him due to his homeless status. On the other hand, he did not want to align with the hardened homeless people as they possessed some negative habits. From the value on time, it can be deduced that the most therapeutic activities for the patient would include outdoor physical activities and a more or less permanent employment. For the nurse practitioner, any issue requiring therapy can be directed to the physical activity component and the patient advised on the same.
Being the only surviving member of his family after the death of both parents, J.B has no family obligations in the country. He is not married yet, thus his only obligation is to take care of his own needs. Similarly, he has no active friends but has acquaintances. Although he goes to church occasionally, he has no special ties with any church or anyone in a church he frequents. His main leisure activities are the morning workouts and afternoon naps on street benches. The social orientation has an implication to nursing, especially among the chronically or acutely ill patients. Conducted as part of the mock interview, the information collected can be essential where there is need to find out the most suitable person to take care of the patient when providing home-based care. In such a case, the nurse confirms with the mentioned person if they would be in a position to care for the patient and also to communicate effectively to the health facility in case of any issues. For the interviewee, this would not have been necessary due to the perceived limited need. However, he would still need someone to look out for him even though he can self medicate.
The space dimension in transcultural assessment tells a lot about a patient’s perception. Although the interviewee responded that he does not normally find comfort where there are other homeless people, he seemed to be comfortable in the interview space. He spoke with a body language that showed great confidence and openness to health. The conversation was easy and progressed effectively as he let out more about himself, his challenges and the difficulties he faced in his efforts towards better life. The space concept is essential to the transcultural assessment model due to various reasons. The first is that by ensuring the patient is comfortable in the provided space, he can be made to feel free and open up. In this way, greater help can be provided as opposed to where the patient experiences discomfort at the interface of interaction with the healthcare personnel in charge of the case. Furthermore, a closed environment provides greater freedom of expression to the patient compared to an open environment where the patient may feel infringed by the presence of others.
Just like the concept of space, communication is another important phenomenon in cultural assessment. In terms of communication, the respondent managed to use various features of communication to describe his situation. His understanding of the English language and its application was good. Furthermore, he used both verbal and non-verbal communication strategies effectively, leading to greater understanding of his condition. The combination of verbal and silent language in his communication was essential as it made it possible not only to listen to what he said but also to empathize with him. Through silence, he reinforced his thoughts and perceptions about various issues. This can be crucial in the healthcare setting as a nurse needs as much information as possible from a patient. This fosters holistic treatment processes. By understanding the feelings of a patient based on their non- verbal and verbal communication strategies, a nurse can be able to assign a patient to the right medical practitioner. For instance, poor communication may result in focus on the physical aspect of health when the problem is emotional or psychological instead.
Based on the information given by the patient on various aspects of his health, it was established that the patient would only need a proper diagnosis to determine what they are suffering from at the time of hospital visit. While the patient seemed healthy and potentially capable of taking care of himself, he was to be advised on the need to have closer relations with people who could be in a position to offer support and help where need be. In particular, he would be advised to keep closer ties with those who could stand up for him in times of need and were close by.
Variance from Conventional Cultures
According to Philipps (2012), the homeless people are commonly characterized by a variety of negative values. For instance, the causes of homelessness are usually associated with factors such as unstable upbringing and violence in families. As such, they have the tendency to engage in alcohol and drug abuse among other vices. The older individuals among the homeless are more likely to abuse alcohol while the younger ones are more likely to abuse heavy drugs. The rates of alcoholism and drug abuse among the homeless are 38% and 26% respectively, relative to the rates among the mainstream society which are 15% alcohol abuse and 8% other drugs abuse (Philipps, 2012). They are also most likely to suffer from depressive conditions such as post traumatic stress disorder. Besides these behavioral practices, the homeless are also associated with the establishment of strong social bonds for the purpose of achieving ontological security. They also establish social orders characterized by inverted hierarchies whereby those who have stayed longer on the streets and have undergone the most traumas are considered the heroes. Among the homeless, violence is a norm due to their anger and resentment of the general population. Such characteristics enforce unhealthy behaviors and also result in negative strategies for coping with homelessness.
J.B portrays a culture that deviates significantly from the expected homeless culture described by Philipps (2012). The culture portrayed based on the interview conducted exhibits characteristics of a respectable homeless man as described by Ravenhill (2016). According to Ravenhill, the respectable homeless men use neither drugs nor alcohol, and are not violent to the entire public. Such people were also used to being employed, as J.B was, but were rendered homeless due circumstances somewhat beyond their control. Through their experiences, they suffer greatly on the streets as victims of circumstances. While the position is regarded to be temporary, such victim characters have great potential of using their status as the bait in getting what they desire (Ravenhill, 2016).
Homelessness is a culture that results from various factors, often considered negative. Giger and Davidhizer’s transcultural assessment model provides a perfect description of the homeless culture based on the six phenomena of consideration. From the perspective of the model, the subject, J.B provides a vivid description of himself, his past and the expected future outcomes. The model provides an objective view of the respondents culture contrary to what could have been established based on the stereotypical perceptions of the homeless. Through the model, it has been possible to determine that the subject exhibits characteristics associated only with the respectable homeless men and not the general homeless culture.
Giger, J.N., Davidhizer, R.E. (2002). The Giger and Davidhizer transcultural assessment model. Journal of Transcultural Nursing, 13(3): 185 -188. Retrieved from www.ncbi.nlm.nih.gov/pubmed/12113147
Giger, J.N., Davidhizer, R.E. (2004). Transcultural nursing: Assessment and intervention. Mosby Publishers.
Philipps, K. (2012). Homelessness: Causes, culture and community development as a solution. Pell Scholars and Senior Theses, paper 88. Retrieved from www.digitalcommons.salve.edu/cgi/viewcontent.cgi?article=1088&context=pell_theses
Ravenhill, M. (2016). The culture of homelessness. Routledge. Retrieved from https://books.google.co.ke/books?id=-gXACwAAQBAJ&dq=Cultural+characteristics+of+homeless+individuals&source=gbs_navlinks_s