The nursing culture class utilized the heritage assessment tool by Spector for all culture related interviews for this nursing class.

This tool may be copied and pasted into a word document for your use during the nursing class but please be sure to reference the source by Spector and if you wish my site where you accessed the tool.

Heritage Assessment Tool for nursing culture class

1. Where was your mother born?
2. Where was your father born?
3. Where were your grandparents born?
a. Your mother’s mother?
b. Your mother’s father?
c. Your father’s mother?
d. Your father’s father?
4. How many brother’s _____ and sister’s ____ do you have?
5. What setting did you grow up in? Urban ____ Rural____
6. What country did your parents grow up in?
a. Father
b. Mother
7. How old were you when you came to the United States?
8. How old were your parents when they came to the United States?
a. Father
b. Mother
9. When you were growing up, who lived with you?
10. Have you maintained contact with
a. Aunts, uncles, cousins?
b. Brothers and sisters?
c. Parents?
d. Your own children?
11. Did most of your aunts, uncles, cousins live near your home?
Yes or No
12. Approximately how often did you visit family members who lived outside of your home?
Daily Weekly Monthly Once a year or less Never
13. Was your original family name changed?
14. What is your religious preference?
15. Is your spouse the same religion as you?
Yes or No
16. Is your spouse the same ethnic background as you?
Yes or No
17. What kind of school did you go to?
Public Private Parochial
18. As an adult, do you live in a neighborhood where the neighbors are the same religion and ethnic background as yourself?
Yes or No
19. Do you belong to a religious institution?
Yes or No
20. Would you describe yourself as an active member?
Yes or No
21. How often do you attend your religious institution?
More than once per week Weekly Monthly Special Holidays only Never
22. Do you practice your religion in your home?
Yes or No
If yes praying, bible reading, diet, celebrate religious holidays?
23. Do you prepare foods special to your ethnic background?
Yes or No
24. Do you participate in ethnic activities?
Yes or No
If Yes.. singing, dancing, holiday celebrations, festivals, costumes?
25. Are your friends from the same religious background as you?
Yes or No
26. Are your friends from the same ethnic background as you?
Yes or No
27. What is your native language?
28. Do you speak this language?
29. Do you read your native language?

References for this nursing culture page:

Spector, R. E. (2004). Cultural diversity in health and illness (6th ed.). Upper Saddle River, NJ: Pearson Education, Inc.

This reference is in APA format for your use in correctly citing your source when utilizing this template.

Home » Student Resources » nursing culture