Question

Create a 1 to 2 page questionnaire for your patients/clients to identify their cultural needs that might affect their healthcare.

The questions should address each of these cultural components:

religion

cultural traditions

family involvement with health

traditional foods

spoken and written language

and any traditional healthcare practices they participate in.

Answer 1

Health care is a complex issue. Cultural and language barriers complicate the situation. Western medicine has developed into a subculture with its own history, language, codes of conduct, expectations, methods, technologies, and concerns about the science which supports it. Science teaches us that human populations are governed by biologic universals that transcend cultural boundaries. The methods and language of biologically based and somatically focused health care have created an extraordinary gulf between practitioners and the public they serve.

There is a disparity between the biomedical categorization of human disruptions as disease and the patient's personal and social experience of illness. The dichotomy between disease and the illness experience has provoked extensive commentary. It has been proposed that the inability to deal with illness is a major failing of biomedicine. Cross-cultural circumstances often magnify the discrepancy between the views held by patients and health care providers. The inability to recognize and deal with perspectives of illness that deviate from those of the biomedically trained practitioner can paralyze attempts at identifying problems and developing plans for solving them.

The following techniques help to obtain information in circumstances in which the patient seems reluctant to provide explanations or historical data:

1. Use an indirect approach, externalize questions by referencing problems in others. Traditional patients who are unwilling to answer questions regarding feelings and fears directly often provide illustrations of their own concerns by discussing illness in others.
2. Acknowledge traditional beliefs, and illustrate them. Reference folk terms in conversation, or discuss what others have said in similar circumstances. For example:

Patients who are}	as ill as you have been
	ill the way you are
	they can"t sleep
tell me}	they have had trouble with dreams (or reference an actual dream)
	friends say they were … (use a relevant folk term, eg, embruhado)

1. Change direct "questions" into narrative statements (as in the examples given in 2). Information exchanged in this fashion gives patients and families a broadened sense of the practitioner's focus, permits discussion of issues often left undisclosed, and avoids direct inquiry.
2. Inquire about special terminology that may apply to the problem ("What is this called in your own language?"). If the patient doesn"t know, ask what a grandmother or an elder would say about the difficulty. This indirect approach sidesteps the unwillingness of some traditional patients to discuss their problems openly and directly appeals to family knowledge and beliefs.
3. Inquire about dreams and difficulties with sleep. Discussion of sleep and dreaming patterns often leads to the revelation of key information regarding the illness's impact and the nature of the patient's concerns. Dreams have increased significance in settings where magical–religious beliefs have played a role in healing and problem solving. They are often critical markers in the assessment of mental status.