Accessibility StatementFor more information contact us atinfo@libretexts.orgor check out our status page at https://status.libretexts.org. This finding was corroborated by the qualitative finding as a 25-year-old female participant said, my confidence in delivering care to patients of different cultures is increased as I stay longer in caring practice (Participant 4). Department of Nursing, College of Health Sciences, Mettu University, Mettu, Oromia Region, Ethiopia, Affiliation: The program you have selected is not available in your ZIP code. While this outcome might sound far-fetched on the surface, there have been a number of malpractice cases of this kind that arose from issues involving cultural incompetence. A nursing theory turns out to be a group of significant related concepts and relationships the purpose of which is to guide practice and promote the delivery of care. It has outpatient and inpatient services, maternal and child health services, referral and follow-up services, physiotherapy and rehabilitative services, intensive care, and recovery services. Backward elimination was used for selecting variables in the final model. Wells M; Beyond cultural competence: a model for individual and institutional cultural development [, Giger JN. Andrews MM; History of health and cultural competence in physical examination. These findings are supported by the study of Asurakkody (2019), in which cultural sensitivity, interpersonal communication, and cultural motivation positively and significantly predicted TSE [29]. 11.07.2022, Jordan Jantz | (2019) in which male nurses demonstrated a higher transcultural self-efficacy score than females [25]. This page titled 4.10: Criticisms of Transcultural Nursing is shared under a CC BY 3.0 license and was authored, remixed, and/or curated by Vasfiye Bayram De?er (IntechOpen) via source content that was edited to the style and standards of the LibreTexts platform; a detailed edit history is available upon request. Leininger, Campinha-Bacote, Giger and Davidhizar, Orque, Purnell and Paulanka, Spector, Andrews and Boyle are regarded as the pioneers contributing to the accumulation of the relevant data. The finding of this study highlights that it is advantageous if nurses struggle to improve their cultural understanding and knowledge of transcultural nursing theories. The finding indicates the mean score of transcultural self-efficacy perceptions to be 2.89. Assuming a holistic approach to care instead of biophysical approach, Showing efforts to reach rapidly increasing cultural beliefs and activities that are unique to distinct groups and individuals. Boyle JS & Andrews MM; Andrews/Boyle assessment guide. Background Transcultural self-efficacy is a nurse's perception of his or her own ability to accomplish activities effectively for culturally diverse clients. The Cronbachs alpha was 0.97 when it was developed [28] and Herrero Hahn et al. 10.24.2022. As a comprehensive text for master's and bachelor's level nursing students, it features case studies, care plans, initial role playing exercises, and implications of TCN concepts when planning, implementing and evaluating client care.T CN Theory, Models, and Assessment Guide Discussed: Leininger's Expand lghttp.48653.nexcesscdn.net Developing communicative and scientific language skills. The LibreTexts libraries arePowered by NICE CXone Expertand are supported by the Department of Education Open Textbook Pilot Project, the UC Davis Office of the Provost, the UC Davis Library, the California State University Affordable Learning Solutions Program, and Merlot. Jess is a Content Specialist at Collegis Education. Talk with an admissions advisor today. External links provided on rasmussen.edu are for reference only. However, researchers identified that working with culturally diverse patients can be challenging due to differences in ideas, beliefs, thoughts, norms, customs, and traditions. School of Nursing and Midwifery, Institute of Health Sciences, Jimma University, Jimma, Oromia Region, Ethiopia, Affiliation: Standard error;TNT, This is supported by the findings from studies of Chan and Sy (2016) and Quine et al. A Good Think About Ink, Connect with Rasmussen University on Facebook, Connect with Rasmussen University on Instagram, Connect with Rasmussen University on LinkedIn, Connect with Rasmussen University on Pinterest, Connect with Rasmussen University on Twitter, Connect with Rasmussen University on Youtube, Human Resources and Organizational Leadership, Information Technology Project Management, Transfer Credit & Other Knowledge Credit, American Association of Colleges of Nursing, the benefits of earning a BSN on an accelerated educational track, making the jump from RN to BSN to enhance your healthcare repertoire, A Crash Course in Patient Safety: 6 Things New Nurses Need to Know, 7 Expert Tips to Survive Stress and Get Through Nursing School, The Nursing Debate: 8-Hour Shifts vs. 12-Hours Shifts, Letter from the Senior Vice President and Provost, Financial Aid and FAFSA (for those who qualify). Cultural diversity: the intention of nursing. It is again consistent with the finding from the study of Li et al. Thus if you do not accept this, later it would influence your confidence(Participant 5). Being able to deal with cultural differences in real terms and make interpretations, Being able to use appropriate cultural teaching techniques. Ratings on all items are made on a 1 to 5 scale standing for the words very little confidence for a score of 1, little confidence for a score of 2, neutral or noncommittal confidence for a score of 3, moderate confidence for a score of 4 and high confidence for a score of 5. A major limitation of transcultural nursing models is their lack of consideration of the relationship between power and knowledge, and the analysis of prejudice and discrimination (Mulholland, 1995). Papadopoulos I. It is considered a cognitive specialty within nursing, which first originated by combining the "culture" construct of anthropology with the "care" construct of nursing. Fill out the form to receive information about: There are some errors in the form. This finding is supported by the study of Herrero-Hahn et al. But this means much more than hiring qualified interpreters. An historical overview of Leininger's Theory of Culture Care Diversity and Universality also known as the Culture Care Theory (CCT) and evolution of the Sunrise Enabler are presented along with descriptions of the theory purpose, goal, tenets, basic assumptions, major core constructs, and orientatio I personally have use and will continue to use Madeleine Leininger theory. Participants who were genuinely willing to take part and prepared to offer data freely were involved in the study. Orque is a leading figure in developing a cultural model for nursing with the conceptual framework of the ethnic system. nurses. Ethiopian birr;ICS, A constructivist grounded theory lens was applied to better appreciate how participants discussed their lived experiences and perspectives (Charmaz, Citation 2017a, Citation 2017b). A key theme is preparing current and future nurses at all levels to understand and address health . It is considered a cognitive specialty within nursing, which first originated by combining the culture construct of anthropology with the care construct of nursing. You could be on your way to contributing to the new faces of nursing in no time. The discrepancy might be because they selected study participants using convenience sampling and the vast majority of their sample were females. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Then TSE level was divided into low, moderate, and high based on this score. Legal. The mean TSE scores for the knowledge of cultural concepts and specific nursing skills were 3.35 (SD = 0.78) and 3.14 (SD = 0.88) respectively. For new nursing graduates looking to enter the field, it can be helpful to be proactive in learning more about cultural competence in healthcare, whether by signing up for a relevant class or volunteering in culturally diverse healthcare settings. Nurses communication effectiveness when caring for patients from different cultural backgrounds measured using 5 items on a 5-point Likert scale with the value ranging from 525. Culture develops over generations and is therefore difficult to fully penetrate as an outsider, which is why it is important for nurses to learn about cultural care. 2022 Jul 22;10:904158. doi: 10.3389/fpubh.2022.904158. Disclaimer. This website uses cookies to ensure you get the best experience. The internal consistency was tested using a reliability scale. nurses, and M.Sc. It was administered in English. Simple random sampling technique was used to recruit participants in the quantitative part of the study. More than three fourth 190(80.5%) of them had B.Sc. 2020 Nov 30;9(11):e17324. Nurse researchers are encouraged to conduct further study including nurses working at public health centers. The scale consists of Likert-type questions with responses ranging from strongly disagree to strongly agree. Therefore, nurses must be prepared to recognize clients desires that are derived from their culture and to develop skills that will help facilitate their achievement [10]. The total scale score is between 5 and 25. This finding was corroborated by the finding from the qualitative study as one 28-year-old male participant said, I am willing and motivated to serve these people. Nurs Forum. Diversity awareness, according to the National Student Nurses Association (NSNA), refers to a conscious and ongoing process in which we identify similarities and differences within and between varying cultural groups. In Turkey internationally developed models and classification systems in nursing care are translated into Turkish, or new guidelines specific to clinics are developed and used. Kirsten Slyter | nurses were recruited from Agaro General Hospital for facilitating quantitative data collection. Nurses who had at least 6-month work experience at JMC were included in the quantitative strand of the study. Cultural competence models developed by nurse researchers can be transferred not only to nursing but also to other disciplines. The study used both quantitative and qualitative methods of data collection and this maximizes the reliability of the data. Accordingly, being male increases transcultural self-efficacy by 2.034 times than female ( = 2.034, p = .045). Culture Set of values, beliefs and traditions, that are held by a specific group of people and handed down from generation to generation. { "4.01:_Introduction" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "4.02:_Cultural_Factors_Affecting_Health_and_Disease" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "4.03:_Health_Culture" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "4.04:_Transcultural_Healthcare" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "4.05:_Understanding_Transcultural_Nursing" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "4.06:_The_Significance_of_Cultural_Competence" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "4.07:_The_History_of_Transcultural_Nursing" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "4.08:_Transcultural_Nursing_Care_Models" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "4.09:_Transcultural_Nursing_Education" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "4.10:_Criticisms_of_Transcultural_Nursing" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()" }, { "00:_Front_Matter" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "01:_Introductory_Chapter-_Nursing" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "02:_Choosing_Your_Philosophical_Slat" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "03:_Effective_Communication_in_Nursing" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "04:_Transcultural_Nursing" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "05:_How_to_Solve_Conflicts_between_Nurses_and_Patients-_Examination_from_Japanese_Culture" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "zz:_Back_Matter" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()" }, 4.10: Criticisms of Transcultural Nursing, [ "article:topic", "license:ccby", "showtoc:no", "autonumheader:yes2", "authorname:nulutasdemir", "licenseversion:30", "author@Vasfiye Bayram De?er", "source@https://www.intechopen.com/chapters/61494" ], https://med.libretexts.org/@app/auth/3/login?returnto=https%3A%2F%2Fmed.libretexts.org%2FBookshelves%2FNursing%2FNursing_(Ulutasdemir)%2F04%253A_Transcultural_Nursing%2F4.10%253A_Criticisms_of_Transcultural_Nursing, \( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}}}\) \( \newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash{#1}}} \)\(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\) \(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\)\(\newcommand{\AA}{\unicode[.8,0]{x212B}}\), 5: How to Solve Conflicts between Nurses and Patients - Examination from Japanese Culture, source@https://www.intechopen.com/chapters/61494, status page at https://status.libretexts.org. 2 MULTICULTURAL AND TRANSCULTURAL NURSING THEORY Introduction Patient-centered care is an evidence-based approach that focuses on the needs, preferences, and values of patients, which guarantees quality, safe and optimal healthcare to patients (Engle et al., 2019). One unit increase in cultural sensitivity leads to 2.075 units increase in transcultural self-efficacy ( = 2.075, p < .001). as the communication ability of nurses increases amidst different cultures, their transcultural self-efficacy perception increase. Pacquiao DF; Cultural competence in ethical decision making. The other finding of this study was the identification of factors that are significantly associated with the transcultural self-efficacy perceptions of nurses. This difference might be due to differences in socio-cultural characteristics and study settings. Normality assumption was checked by Kolmogorov-Smirnov test, which was insignificant. In late 2000, the Joint Commission, the accrediting agency from more than 21,000 healthcare organizations nationwide, said low healthcare literacy, cultural barriers and low English proficiency were the triple threat to communication in healthcare. Descriptive statistics for each subscale of transcultural self-efficacy and the total TSE scale score of nurses working at JMC, Oromia Region, Ethiopia, May to June 2020 (n = 236). The records of the research path were kept throughout the study. For additional information about Licensing and State Authorization, and State Contact Information for Student Complaints, please see those sections of our catalog. 7.5.16 for coding and analyzed thematically. Translating and Evaluating a Physical Activity Program for Aboriginal Elders on Noongar Boodjar (Country) - A Longitudinal Study. Gidgup MJR, Kickett M, Jacques A, Weselman T, Hill KD, Coombes J, Ivers R, Bowser N, Palacios V, Hill AM. This model is a tool developed to assess cultural values and their effects on health and disease behavior [33] (Figure 4.8.2). Bivariate and multivariable linear regression analyses were used to identify factors associated with transcultural self-efficacy. Accordingly, nurses should possess the cultural knowledge required to deliver effective and satisfactory care that is congruent with the culture of the patient [1114]. Conversely, a lack of diversity awareness can result in providing culturally incongruent nursing care, which adversely impacts patient outcomes and can even jeopardize patient safety in certain cases. Please enable it to take advantage of the complete set of features! Cultural motivation was measured by the cultural motivation scale (CMS) adapted from 5 items subscale of the cultural intelligence scale. While there has been an increased awareness of the importance of cultural care and collecting cultural data in recent years in Turkey, no models or guides have been developed in Turkey [55]. The LibreTexts libraries arePowered by NICE CXone Expertand are supported by the Department of Education Open Textbook Pilot Project, the UC Davis Office of the Provost, the UC Davis Library, the California State University Affordable Learning Solutions Program, and Merlot. She researches and writes articles on behalf of Rasmussen University to help empower students to achieve their career dreams through higher education. Diversity has increased in many countries due to wars, discrimination, political strife, and worldwide socioeconomic conditions. 2009 Jan-Mar;44(1):11-8. doi: 10.1111/j.1744-6198.2009.00122.x. Orque M.; Orques ethnic/cultural system: Conceptual framework for ethnic nursing care. Therefore, having good communication ability is crucial to give care with confidence (Participant 5). Careers. Thus, this study aimed to assess perceived transcultural self-efficacy and its associated factors among nurses working at Jimma Medical Center. Nurses confidence when providing care for patients from different cultural backgrounds measured using 25 items on a 5-point Likert scale with the value ranging from 25125. doi:10.1371/journal.pone.0254643, Editor: Paola Gremigni, University of Bologna, ITALY, Received: November 13, 2020; Accepted: June 30, 2021; Published: July 22, 2021. Quantitative results were integrated with qualitative results. Qualitative data were coded and analyzed thematically. Ones self-efficacy perceptions can have an important role in how one deals with challenging situations [1]. Operating on the belief that quality healthcare can only occur within the patients cultural context and that embracing diversity among healthcare professionals will promote multicultural workplace harmony and minimize workplace conflict, it has been posed that the nursing workforce should renew its focus on diversity awareness. Accordingly, each text was read again and again carefully and then codes were generated by two data coders. This article discusses changes that are important to transcultural nursing. Quality care can be improved significantly when nurses provide patient-centered care that considers cultural background of the patients. This finding is also consistent with the study of Herrero-Hahn et al. Sarah probes the potential and the limitations of care robots - and looks at historical ideas from earlier eras about emotional qualities, including fortitude and . The CSES-Cultural Concepts scale consists of three items and assesses knowledge of cultural concepts (i.e., ability to distinguish inter- from intracultural diversity, ability to distinguish ethnocentrism from discrimination, ability to distinguish between ethnicity and culture). If poorly managed, this can result in miscommunication, maladaptive behaviors, and interpersonal conflicts [15,2022]. The conceptualization of the cultural competence model in nursing has emerged after 1989. Please visit www.rasmussen.edu/degrees for a list of programs offered. (2016), in which nurses who have worked for 15 years or longer had significantly greater TSE scores when compared with other nurses [31]. Jimma medical center;M, This theory, unlike other theories which focus on people, health, nursing and environment, (2012), in which intercultural communication was positively associated with cultural self-efficacy [33,34]. The finding of the present study indicates that being male increases transcultural self-efficacy. Interviews were transcribed verbatim into plain text, translated into English, and then imported directly into ATLAS.ti. { "4.01:_Introduction" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "4.02:_Cultural_Factors_Affecting_Health_and_Disease" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "4.03:_Health_Culture" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "4.04:_Transcultural_Healthcare" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "4.05:_Understanding_Transcultural_Nursing" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "4.06:_The_Significance_of_Cultural_Competence" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "4.07:_The_History_of_Transcultural_Nursing" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "4.08:_Transcultural_Nursing_Care_Models" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "4.09:_Transcultural_Nursing_Education" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "4.10:_Criticisms_of_Transcultural_Nursing" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()" }, { "00:_Front_Matter" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "01:_Introductory_Chapter-_Nursing" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "02:_Choosing_Your_Philosophical_Slat" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "03:_Effective_Communication_in_Nursing" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "04:_Transcultural_Nursing" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "05:_How_to_Solve_Conflicts_between_Nurses_and_Patients-_Examination_from_Japanese_Culture" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "zz:_Back_Matter" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()" }, [ "article:topic", "license:ccby", "showtoc:no", "autonumheader:yes2", "authorname:nulutasdemir", "licenseversion:30", "author@Vasfiye Bayram De?er", "source@https://www.intechopen.com/chapters/61494" ], https://med.libretexts.org/@app/auth/3/login?returnto=https%3A%2F%2Fmed.libretexts.org%2FBookshelves%2FNursing%2FNursing_(Ulutasdemir)%2F04%253A_Transcultural_Nursing%2F4.08%253A_Transcultural_Nursing_Care_Models, \( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}}}\) \( \newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash{#1}}} \)\(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\) \(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\)\(\newcommand{\AA}{\unicode[.8,0]{x212B}}\), 4.7: The History of Transcultural Nursing, Giger and Davidhizars Trans-cultural Assessment Model, Nurses Competence to Provide Trans-cultural Care, source@https://www.intechopen.com/chapters/61494, status page at https://status.libretexts.org, Culturally focusing on the patients life style, beliefs and practices related to health, Awareness of the variety of verbal and nonverbal reactions.