3. Cultural assessment:
   1. Knowledge of ethnic beliefs and cultural practices can assist the nurse in the planning and implementation of holistic care.
   2. Consider the following:
      1. Demographic data: is this an “ethnic neighborhood”?
      2. Socioeconomic status: occupation, education (formal and informal), income level; who is employed?
      3. Ethnic/racial orientation: ethnic identity, value orientation.
      4. Country of immigration: date of immigration; where were the family members born? Where has the family lived?
      5. Languages spoken: does family speak English? Language and dialect preferences.
      6. Family relationships: what are the formal roles? Who makes the decisions within the family? What is the family lifestyle and living arrangements?
      7. Degree of acculturation of family members: how are the family customs and beliefs similar to or different from the dominant culture?
      8. Communication patterns: social customs, nonverbal behaviors.
      9. Religious preferences: what role do beliefs, rituals, and taboos play in health and illness? Is there a significant religious person? Are there any dietary symbolisms or preferences or restrictions due to religious beliefs?
      10. Cultural practices related to health and illness: does the family use folk medicine practices or a folk healer? Are there specific dietary practices related to health and illness?
      11. Support systems: do extended family members provide support?
      12. Health beliefs: response to pain and hospitalization; disease predisposition and resistance.
      13. Other significant factors related to ethnic identity: what health care facilities does the family use?
      14. Communication barriers:
          1. Differences in language.
          2. Technical languages.
          3. Inappropriate place for discussion.
          4. Personality or gender of the nurse.
          5. Distrust of the nurse.
          6. Time-orientation differences.
          7. Differences in pain perception and expression.
          8. Variable attitudes toward death and dying.

Interviewing

1. Definition: a goal-directed method of communicating facts, feelings, and meanings. For interviewing to be successful, interaction between two persons involved must be effective.


2. Nine principles of verbal interaction
   1. Client’s initiative begins the discussion.
   2. Indirect approach, moving from the periphery to the core.
   3. Open-ended statements, using incomplete forms of statements such as “You were saying...” to prompt rather than close off an exchange.
   4. Minimal verbal activity in order not to obstruct thought process and client’s responses.
   5. Spontaneity, rather than fixed interview topics, may bring out much more relevant data.
   6. Facilitate expression of feelings to help assess events and reactions by asking, for example, “What was that like for you?”
   7. Focus on emotional areas about which client may be in conflict, as noted by repetitive themes.
   8. Pick up cues, clues, and signals from client, such as facial expressions and gestures, behavior, emphatic tones, and flushed face.
   9. Introduce material related to content already brought up by client; do not bring in a tangential focus from “left field.”
   
   
3. Purpose and goals of interviewing
   1. Initiate and maintain a positive nurse-client relationship, which can decrease symptoms, lessen demands, and move client toward optimum health when nurse demonstrates understanding and sharing of client’s concerns.
   2. Determine client’s view of nurse’s role in order to utilize it or change it.
   3. Collect information on emotional crisis to plan goals and approaches in order to increase effectiveness of nursing interventions.
   4. Identify and resolve crisis; the act of eliciting cause or antecedent event may in itself be therapeutic.
   5. Channel feelings directly by exploring interrelated events, feelings, and behaviors in order to discourage displacement of feelings onto somatic and behavioral symptoms.
   6. Channel communication and transfer significant information to the physician and other team members.
   7. Prepare for health teaching in order to help the client function as effectively as possible.