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The Giger and Davidhizar Transcultural Assessment Model
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Journal of Transcultural Nursing
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The Giger and DavidhizarTranscultural Assessment Model JOYCE NEWMAN GIGER, EdD, RN, CS, FAANUniversity of Alabama at Birmingham RUTH DAVIDHIZAR, DNS, RN, CS, FAANBethel College The Giger and Davidhizar Transcultural Assessment Model Communication. Communication embraces the entire was developed in 1988 in response to the need for nursing stu- world of human interaction and behavior. Communication is dents in an undergraduate program to assess and provide the means by which culture is transmitted and preserved.
care for patients that were culturally diverse. The model Both verbal and nonverbal communication are learned in includes six cultural phenomena: communication, time, one’s culture. Communication often presents the most signif- space, social organization, environmental control, and bio- icant problem in working with clients from diverse cultural logical variations. These provide a framework for patient assessment and from which culturally sensitive care can bedesigned. Space. Space refers to the distance between individuals when they interact. All communication occurs in the context of space. According to Hall (1966), there are four distinct he Giger and Davidhizar Transcultural Assessment zones of interpersonal space: intimate, personal, social and Model was developed in 1988 in response to the need for consultative, and public. Rules concerning personal distance nursing students in an undergraduate program to assess and vary from culture to culture. Territoriality refers to feelings or provide care for patients that were culturally diverse. Today, an attitude toward one’s personal area. Each person has their the fourth edition of Transcultural Nursing: Assessment and own territorial behavior. Feelings of territoriality or violation Intervention (1999) is in process. In 1998, Mosby Yearbook of the client’s personal and intimate space can cause discom- published a companion book that addresses Canadian ethnic fort and may result in a client’s refusing treatment or not groups (Davidhizar & Giger, 1998). In addition, a pocket guide was also published by Mosby that provides a quickuser-friendly format to understand various cultural groups Social organization. Social organization refers to the man- (Geissler, 1998). These books provide chapters on six cultural ner in which a cultural group organizes itself around the fam- phenomena and chapters that address cultural groups which ily group. Family structure and organization, religious values have been authored by nurses who are experts in the culture or and beliefs, and role assignments may all relate to ethnicity who are members of the cultural group.
The Giger and Davidhizar Transcultural Model postulates that each individual is culturally unique and should be Time. Time is an important aspect of interpersonal com- assessed according to six cultural phenomena: (a) communi- munication. Cultural groups can be past, present, or future cation, (b) space, (c) social organization, (d) time, (e) envi- oriented. Preventive health care requires some future time ori- ronmental control, and (f) biological variations.
entation because preventive actions are motivated by a futurereward.
Environmental control. Environmental control refers to Journal of Transcultural Nursing, Vol. 13 No. 3, July 2002 185-188 the ability of the person to control nature and to plan and direct factors in the environment that affect them. Many JOURNAL OF TRANSCULTURAL NURSING / JULY 2002
Biological
Environmental
FIGURE 1.
Giger and Davidhizar’s Transcultural Assessment Model.
SOURCE: Giger, J., & Davidhizar, R. (1999). Transcultural Nursing: Assessment and Intervention. St. Louis, MO: Mosby.
Americans believe they control nature to meet their needs and internal control and more in external control, there may be a thus are more likely to seek health care when needed. If per- fatalistic view in which seeking health care is viewed as sons come from a cultural group in which there is less belief in Giger & Davidhizar / TRANSCULTURAL ASSESSMENT MODEL
Biological variations. Biological differences, especially METAPARADIGM FOR THE
genetic variations, exist between individuals in different GIGER AND DAVIDHIZAR MODEL
racial groups. It is a well-known fact that people differ cultur- The metaparadigm for the Giger and Davidhizar model ally. Less recognized and understood are the biological differ- ences that exist among people in various racial groups.
Although there is as much diversity within cultural and racial 1. Transcultural nursing: Aculturally competent practice field groups as there is across and among cultural and racial that is client centered and research focused.
groups, knowledge of general baseline data relative to the 2. Culturally competent care: Adynamic, fluid, continuous pro- specific cultural group is an excellent starting point to provide cess whereby an individual, system, or health care agency finds meaningful and useful care delivery strategies based on There is some evidence suggesting that different races knowledge of the cultural heritage, beliefs, attitudes, and be- metabolize drugs in different ways and at different rates haviors of those to whom they render care (Davidhizar & (Echizen, Horari, & Ishizaki, 1989). For example, Chinese Giger, 1998). Cultural competence connotes a higher, moresophisticated level of refinement of cognitive skills and people are more sensitive to the cardiovascular effects of psychomotor skills, attitudes, and personal beliefs. To de- Propranolol than are White people. Primaquine is metabo- velop cultural competency, it is essential for the health care lized by oxidation and is used in the treatment of malaria.
professional to use knowledge gained from conceptual and Although Primaquine is given to individuals who lack the theoretical models of culturally appropriate care. Attainment enzymes necessary for glucose metabolism or the red blood of cultural competence can assist the astute nurse in devising cells, hemolysis of the red blood cells occurs. Approximately meaningful interventions to promote optimal health among 100 million people in the world are affected by this particular individuals regardless of race, ethnicity, gender identity, sex- enzyme deficiency and thus are unable to ingest Primaquine.
Approximately 35% of African Americans have this particu- 3. Culturally unique individuals: An individual is culturally lar enzyme deficiency. Antihypertensives are another cate- unique and as such is a product of past experiences, cultural gory of drugs that are metabolized differently depending on 4. Culturally sensitive environments: Culturally diverse health race. For example, African Americans tend to need higher care can and should be rendered in a variety of clinical set- doses of beta-adrenergic blocking agents such as Inderal.
tings. Regardless of the level of care, primary, secondary, or Chinese men tend to need only about half as much Inderal as tertiary knowledge of culturally relevant information will as- sist in planning and implementing a culturally competent One category of differences between racial groups is sus- ceptibility to disease. The increased or decreased incidence 5. Health and health status: Health and health status is based on may be genetically, environmentally, or gene-environmen- culturally specific illness and wellness behaviors. An individ- tally induced. American Indians have a tuberculosis inci- ual’s cultural beliefs, values, and attitudes all contribute to the dence that is 7 to 15 times that of non-Indians. African Ameri- overarching meaning of health for each individual.
cans have a tuberculosis incidence three times that of White Internal Structure, Linkages, and Concepts
Americans. Urban American Jews have been the most resis-tant to tuberculosis. Ethnic minorities now account for more The Giger and Davidhizar Transcultural Assessment than two thirds of all the reported cases of tuberculosis in the Model is based on a number of premises. Culture is a pat- United States, partly as a result of the increased incidence of terned behavioral response that develops over time as a result tuberculosis among ethnic minorities affected with HIV of imprinting the mind through social and religious structures (Centers for Disease Control, 1998). Diabetes is quite rare and intellectual and artistic manifestations. Culture is also the among American Eskimos. Diabetes has a high incidence result of acquired mechanisms that may have innate influ- within certain American Indian tribes, including the Semi- ences but are primarily affected by internal and external stim- nole, Pima, and Papago. NIDDM, or Type 2 diabetes, is a uli. Culture is shaped by values, beliefs, norms, and practices major health problem for Native American Indians, occurring that are shared by members of the same cultural group. Cul- as early as the teens or early twenties. Age-specific death ture guides our thinking, doing, and being and becomes pat- rates for diabetes appear to be 2.6 higher for Native Ameri- terned expressions of who we are. These patterned expres- cans between 25 and 54 years of age, compared with the rest sions are passed down from one generation to the next.
of the general population. The incidence of hypertension is Culture implies a dynamic, ever-changing, active, or passive higher in African Americans than Whites. The onset by age is process. Cultural values guide actions and decision-making earlier in African Americans, and the hypertension is more and facilitate self-worth and self-esteem.
severe and associated with the higher mortality in African Knowledge Antecedents
Americans. It is important to remember that susceptibility todisease may also be environmental or a combination of both The Giger and Davidhizar Transcultural Assessment Model builds on the seminal work of the founder of trans- JOURNAL OF TRANSCULTURAL NURSING / JULY 2002
cultural nursing, Dr. Madeleine Leininger (1985); the work of REFERENCES
Dr. Rachel Spector (1996); the classic work of Orque, Bloch, Bernal, H., & Froman, R. (1987). The confidence of community health and Monrroy (1983); and the classic work of Hall (1966) and nurses in caring for ethnically diverse populations. Image: Journal of others in space phenomena, communication, and Nursing Scholarship, 19(4), 201-203.
Bonaparte, B. (1977). An investigation of the relation between ego defensive- ness and open-closed mindedness of female registered public nurses andtheir attitude toward culturally different patients. Unpublished doctoral APPLICATION TO THEORY,
dissertation, New York University, New York, NY.
Bonaparte, B. (1979). Ego defensiveness, open-closed mindedness, and RESEARCH, AND PRACTICE
nurses’ attitude toward culturally different patients. Nursing Research,28(3), 166-172.
Giger and Strickland (1995) received $750,000 to test the Centers for Disease Control and Prevention. (1998). HIV/AIDS surveillance usefulness of the model to identify behavioral risk reduction report, 1997. Atlanta, GA: U.S. Department of Health and Human strategies and chronic genetic indicators for premenopausal, African American women with high-risk indices of coronary Davidhizar, R., & Giger, J. (1998). Canadian transcultural nursing: Assess- ment and intervention. St. Louis, MO: C. V. Mosby.
heart disease. In 1998, Linda Smith, DSN, completed a pilot Echizen, H., Horari, Y., & Ishizaki, T. (1989). Letter to the editor. New Eng- study using the model. The primary purpose of the study was land Journal of Medicine, 32(4), 258.
to describe the relationship among the scores and subscores Geissler, E. (1998). Pocket guide to cultural assessment. St. Louis, MO: C. V.
on scales measuring concepts of cultural competency. Three Giger, J., & Davidhizar, R. (1990). Transcultural nursing: Assessment and scales were used: the cultural attitude scale originally devel- intervention (1st ed.). St. Louis, MO: C. V. Mosby.
oped by Bonaparte (1977, 1979) and modified by Rooda Giger, J., & Davidhizar, R. (1995). Transcultural nursing: Assessment and (1990, 1992), the cultural self-efficacy scale developed by intervention (2nd ed.). St. Louis, MO: C. V. Mosby.
Bernal and Froman (1987), and the knowledge-based ques- Giger, J., & Davidhizar, R. (1999). Transcultural nursing: Assessment and intervention (3rd ed.). St. Louis, MO: C. V. Mosby.
tions on cultural competencies developed by Rooda (1990).
Giger, J., & Strickland, O. (1995). Behavioral risk reduction strategies for In this study, the model served as the theoretical foundation, chronic indicators and high-risk factors for premenopausal African and the three scales served as the instruments. In 1998, Dr.
American women (25-45) with coronary heart disease. Grant No. N95- Sharon Mullen and Dr. Carla G. Phillips at Ohio University’s 019, Department of Defense, Uniformed Health Services, University of School of Nursing also used the model as the overarching the- Health Sciences. Bethesda, MD: Tri-Service Nursing Research.
Hall, E. T. (1966). The silent language. Westport, CT: Greenwood.
oretical framework to explore the cultural beliefs of south- Leininger, M. (1985). Transcultural care, diversity, and universality: Athe- eastern Ohio Appalachians. The primary purpose of the qual- ory of nursing. Nursing and Health Care, 6(4), 209-212.
itative ethnographic study was to identify cultural beliefs of Orque, M. S., Bloch, B., & Monrroy, L.S.A. (Eds.). (1983). Ethnic nursing southeastern Ohio Appalachians as a means of providing cul- care: A multicultural approach (pp. 5-48). St. Louis, MO: C. V. Mosby Rooda, L. (1990). Attitudes of nurses toward culturally diverse patients.
turally competent care. Giger and Davidhizar’s model was Unpublished doctoral dissertation, Purdue University, West Lafayette, used to identify cultural beliefs from the six cultural phenom- ena previously described by Giger and Davidhizar (1990, Rooda, L. (1992). Knowledge and attitudes of nurses toward culturally 1995, 1998, 1999). Subjects were 14 adults who had resided diverse patients: An examination of the social contact theory. Journal ofthe National Black Nurses Association, 6(1), 48-56.
in the area their entire lives. The Giger and Davidhizar Spector, R. (1996). Cultural diversity in health and illness (3rd ed.).
Transcultural Assessment Model, which also included inter- view questions and observational guidelines, was used for Joyce Newman Giger is a professor in the School of Nursing at structural interviews. Findings from this study suggested that University of Alabama at Birmingham. She received her EdD in these individuals were more socially inclined, communicated nursing education from Ball State University. Areas of interest in- more openly, had more of an internal locus of control, had clude cultural diversity, psychiatric nursing, genetic research, and fewer personal space needs, were more future oriented, used nursing administration. She is a fellow in the American Academy ofNursing; has published more than 100 manuscripts, book chapters, no significant home remedies, tended to be conscientious and books on topics related to cultural diversity; and has done exten- about getting to appointments on time, and were more likely sive research on topics related to cultural phenomena. to follow medical protocols than Appalachians in general.
Ruth Davidhizar is dean of nursing in the Division of Nursing at Bethel College. She received her DNS in nursing from Indiana Uni- AREAS OF FUTURE DEVELOPMENT
versity. Areas of interest include transcultural nursing, psychiatricnursing, and nursing education. She is the author of more than 700 Work relative to biological variation specifically regarding articles, book chapters, and books on cultural competency and other genetic variations continues to undergo refinement with addi- tional research by various researchers, including Giger andStrickland.

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