1535 Cultural Assessment Tool

Module 5
Table 7: Brief Cultural Assessment: The CONFHER Model
C= Communication
Does the client speak English?
Understand common health terms, such as pain or fever?
What nonverbal communication is used?
O= Orientation
What are the client’s ethnic identity, values, orientation and acculturation?
Do they identify with a specific group?
Where were they born?
How long have they lived here?
N= Nutrition
Food preferences and taboos. Food has meaning for most people and is a source of
comfort. There may be some foods the person must avoid eating because they are taboo
in their cultural group. Consider addressing issues of artificial nutrition and hydration
based on assessment findings.
F= Family Relationships
Family structure is important…
How is family defined and who is in the family?
Who is the head of the household?
Who makes decisions in the family?
What is the role of women and children?
Is it important to have family present when someone is sick?
H= Health and health beliefs

Not all cultural groups subscribe to the germ theory of disease. Illness may be the result
of evil spirits or something being out of balance.
What does the person do to stay healthy?
Who do they consult for health problems?
How do they explain illness?
E= Education
What is the person’s learning style and educational level?
How much formal education did the person complete?
What is their occupation?
R= Religion
What is that person’s preference?
Does the client have any religious beliefs or restrictions that have an impact on healthcare
and illness?
Reference:
Fong, C. M (1985). Ethnicity and nursing practice. Topics in Clinical Nursing, 7(3), 1-10.
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ELNEC- For Veterans Curriculum Module 5: Cultural Considerations Page M5-51
Revised: May 2010 Supplemental Teaching Materials
Module 5
Table 9: Key Cultural Assessment Questions
Key Cultural Assessment Questions

Remember that a checklist does not always instill trust. Below are some suggestions for
ascertaining key cultural preferences from both patient and family caregivers.
 Tell me a little bit about yourself (for families, e.g., your mother, father, sister, brother, etc.)
Where were you born and raised? (If an immigrant: How long have you lived in this country?)
 What language would you prefer to speak?
 Is it easier to write things down, or do you have difficulty with reading or writing?
 Whom do you go to for support (family, friends, community, religious or community leaders)?
 Is there anyone we should contact to come to be with you?
 I want to be sure I’m giving you all the information you need. What do you want to know
about your condition? Whom should I speak to about your care?
 Whom do you want to know about your condition?
 How are decisions about health care made in your family? Should I speak directly with you, or
is there someone else I should be discussing decisions with?
 (Address to patient or designated decision maker.) Tell me about your understand of what has
been happening up to this point? What does the illness mean to you?
 We want to work with you to be sure you are getting the best care possible, and that we are
meeting all your needs. Is there anything we should know about any customs or practices that
are important to include in your care?
 Many people have shared that it is very important to include spirituality or religion in their
care. Is this something that is important for you? Our chaplain can help contact anyone that
you would like to be involved in your care.
 We want to make sure we respect how you prefer to be addressed, including how we should
act. Is there anything we should avoid? Is it appropriate for you to have male and female
caregivers?
 Are there any foods you would like or that you should avoid?
 Do you have any concerns about how to pay for care, medications or other services?
Death Rituals and Practices

 Is there anything we should know about care of the body, about rituals, practices, or
ceremonies that should be performed?
 What is your belief about what happens after death?
 Is there a way for us to plan for anything you might need both at the time of death and
afterward?
 Is there anything we should know about whether or not a man or woman should be caring for
the body after death?
 Should the family be involved in care?
Source: Mazanec, P., & Panke, J.T. (2010). Cultural considerations in palliative care. In B.R. Ferrell & N. Coyle
(Eds.), Textbook of Palliative Nursing (3rd ed., Chapter 37). New York, NY: Oxford University Press.
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Module 5
Figure 1: Self-Cultural Assessment
1. Where were you born?

If an immigrant, how long have you lived in this country?
How old were you when you came to this country?
Where were your grandparents born?
2. What is your ethnic affiliation and how strong is your ethnic identity?
3. Who are your major support people: family members, friends?

Do you live in an ethnic community?
4. How does your culture affect decisions regarding their medical treatment?
Who makes decisions - you, your family, or a designated family member?
What are the gender issues in your culture and in your family structure?
5. What are your primary and secondary languages, speaking and reading ability?
6. How would you characterize your nonverbal communication style?
7. What is your religion, its importance in your daily life, and current practices?
Is religion an important source of support and comfort?
8. What are your food preferences and prohibitions?
9. What is your economic situation, and is the income adequate to meet the needs of you and
your family?
10. What are your health and illness beliefs and practices?
11. What are your customs and beliefs around such transitions as birth, illness, and death?
What are your past experiences regarding death and bereavement?
How much do you and your family wish to know about the disease and prognosis?
What are your beliefs about the afterlife and miracles?
What are your beliefs about hope?
Adapted from:
Zoucha, R. (2000). The keys to culturally sensitive care. American Journal of Nursing, 100(2),
24GG-24II. Reprinted with permission.
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Module 5
Figure 2: Questions for Self-Reflection
1. How do you identify yourself racially, ethnically, and culturally?
2. When were you first aware of your own culture?
3. What is the first memory you have of someone dying in your family?
4. What were the rituals, practices or behaviors that your family observed at that time?
5. What aspects of your cultural background do you feel strengthen your caring for dying
patients and their families?
Source:
ACCESS to End-of-Life-Care: A community initiative (2000). Trainer’s Guide (p.15).
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Module 5

Table 7: Brief Cultural Assessment: The CONFHER Model

H= Health and health beliefs

Key Cultural Assessment Questions

Death Rituals and Practices

1. Where were you born?

3. Who are your major support people: family members, friends?

6. How would you characterize your nonverbal communication style?

8. What are your food preferences and prohibitions?

1. How do you identify yourself racially, ethnically, and culturally?

2. When were you first aware of your own culture?

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