Therefore, a nurse must be fully aware of these sensitivities when providing care to a patient, especially when the patient is a member of cultural group from outside the U.S. The third criteria is social organization. For example, most African-American families tend to be based on a matriarchal system with either the mother or another female member of the family serving as its leader. This matriarch may also serve as the source for advice on certain

family matters; of course, the patriarch of the family (i.e., the father figure) also plays a role in family decision-making. Thus, most African-American families are composed of a support network made up of mothers, fathers and other close relatives, something which often creates tension and dissent. In this respect, a nurse must be aware of this matriarchal system and its network in such a way as to gain the trust of family members when it comes to health care (Transcultural Nursing, 2004, pg. #'s?)

The fourth criteria is time, especially in relation to providing directions as to when to take medications. For example, when a nurse tells a patient to take his/her medication three times a day or perhaps once in the morning, some individuals may wrongly interpret these directions, thus creating life or death situations. This can also be applied to telling a patient when to change the dressing on a wound frequently. Therefore, a nurse must realize how a patient understands these and other directions and must be able to provide directions in a competent manner in line with a patient's cultural background (Transcultural Nursing, 2004, pg. #'s?)

The fifth criteria is environmental control which deals with a patient's cultural beliefs concerning physical illness and prevention practices. According to some studies, Hispanics are more likely than Caucasians to complain that physical pain has "ruined their lives" and the Chinese appear to consider asking for help as a sign of a lack of self-respect. In addition, some individuals view a request for pain medication as being disrespectful of a nurse's time. In this case, a nurse must always ask a patient if he/she requires medication; otherwise, the patient may do without, thus creating serious complications and/or physical pain (Transcultural Nursing,

2004, pg. #'s?)

The last criteria is biological variation which includes the susceptibility to disease, nutrition and genetics, all of which may have a significant impact on a patient's sensitivity to pain. Many studies have concluded that sensitivity to pain varies between individuals and cultures, a fact which all nurses must take into account when providing treatment or procedures which involve a certain amount of pain (Glanze, 2002, 467). Also, some cultures consider admitting to pain as being self-deprecating. Therefore, as with all of the criteria found in the Giger-Davidhizer model, a nurse must be aware of a patient's tolerance and acceptance of pain, particularly if the patient is a member of a cultural group from outside of the U.S.

Developing a Plan of Care:

The application of this model to the health care needs of African-Americans could be accomplished by focusing on three of the criteria -- social organization, environmental control and biological variation. With the first criteria, the role of the matriarchal mother or authority figure could be expanded as the primary source of advice for young African-American males and females, due to this figure being held in high esteem. For instance, this figure could possibly influence younger blacks to adhere to a diet that helps prevent in most cases obesity, heart disease, diabetes and certain types of cancer, due to statistics that demonstrate that black males tend to smoke at younger ages ("Health and Health Care," 2009, Internet). Of course, the matriarchal figure would have to be informed by her physician or caregiver about the true dangers of obesity and smoking and be convinced to follow proven medical procedures instead of relying upon traditional African remedies.

The second criteria of environmental control which in this case deals with a patient's traditional cultural beliefs related to physical/mental illnesses and prevention, could be overcome by educating not only the patient but also his/her family members about the unscientific basis of many African healing practices and "voodoo" remedies. Some of the diseases which could be avoided and which often result in premature death in African-Americans include hypertension, coronary heart disease, stroke, kidney failure, diabetes and certain types of cancer, most notably lung, breast, colon and prostate cancer (in men). Certainly, these often fatal diseases with high morbidity rates in African-Americans have been shown to be closely linked to a lack of education and the inability to access professional health care providers and clinics ("Health and Health Care," 2009, Internet).

Since this disease tends to run in families, nurses and other caregivers could advise their black patients to undergo genetic testing in order to determine their risk of acquiring sickle-cell anemia. However, for many African-Americans, this may not be possible, due to the often prohibitive cost of the test and genetic counseling.
Interdisciplinary Approaches:

Since the African-American population in the U.S. is one of the most affected groups when it comes to accessing and utilizing health care delivery systems, it would be advisable that the current American health care industry adopt a number of interdisciplinary approaches for culturally-sensitive care delivery. As Karen Williams and Veronica W. Johnson points out, patients and all health care providers must adopt "patient-empowered skills, learn to be more culturally sensitive" and support efforts to create health policies and agendas in order to improve the health status of African-Americans (2008, Internet). For example, state governments and local community organizations should support health conferences aimed at black Americans, along with creating some type of health institute for the medical needs of African-Americans living in each state.

At the federal level, there currently exists what is known as the Strategic Plan on health Disparities, run by the National Institutes of Health (NIH), the Healthy People 2010 Initiative and the 100% Access -- 0% Disparities Initiative of 2010 (Williams & Johnson, 2008, Internet). As to other health care professionals who could participate in newly-established programs or initiatives, this could include physicians and nurses with hands-on experience related to treating diseases in Africa and with specialization in specific illnesses and disorders afflicting mostly African-Americans, such as hypertension, diabetes, heart disease and obesity.

IMPLEMENTATION:

As to implementing changes in a culturally-sensitive area, one strategy related to the continuing prevalence of a belief in traditional African cures and remedies would be some type of extensive educational program aimed at reducing, if not eliminating, the beliefs regarding curing and treating certain illnesses with herbs and other concoctions, most of which are based on pseudo-scientific principles. One specific area is folk medicine which has been practiced in Africa for generations and continues to be used in modern America by a large number of African-Americans. As suspected, even blacks that live in large urban areas and have access to nearby health clinics continue to rely upon folk medicine to cure their ailments. Thus, many African-Americans tend to avoid visiting a local hospital or clinic when such pseudo-cures are readily available, particularly from faith healers and even family matriarchs with close connections to their African roots (Spector, 2008, 267).

Cultural Barriers Strategies:

In relation to strategies that could be utilized to overcome some of the identified barriers to African-American health care, the key factor is education in the form of a rigid adherence to proven scientific methods as compared to pseudo-scientific cures and remedies, and through providing the proper knowledge to nursing professionals when it comes to understanding the cultural sensitivities of many black Americans, such as knowing beforehand that certain comments and/or observations may be taken as insulting or inferences on the part of the nurse that an African-American patient is viewed as unimportant as compared to a white patient.

EVALUATION:

If all of the suggestions and observations so far discussed are to be made effective, one possible tool would be to create some kind of survey that could be handed out by physicians and nurses in either a hospital or clinical setting. This survey might include questions on the professionalism of the caregiver/nurse as it relates to understanding the cultural sensitivities and traits of African-Americans and any ideas to improve upon such understanding. Of course, this type of survey would have to be written in such a way as to avoid any misunderstandings on the part of the patient regarding the questions and in very simple language. When these surveys are finished by the patient, they could be mailed back to the hospital/clinic or dropped off on the patient's next visit. Clearly, the results of these surveys would be quite invaluable, for they would assist all health care professionals to see and appreciate cultural differences which in the long run would make their…