nursing cultural assesment
University of Rhode Island
College Of Nursing
Heritage Assessment: Karla Gabriel
I. Demographic Data
1) Location: Lebanon
2) a)age: 40
b) Date of Birth: October 22, 1974
c) Place of Birth
3) Sex: Female
4) What is the highest grade completed in school? Second year of college
5) Are you: Married II. Heritage Assessment: your Ethnic, Cultural, and Religious Background
1) Where was your mother born? Syria
2) Where was your father born? Lebanon
3) Where were your grandparents born?
a) Your mother’s father? Syria
b) Your mother’s mother? Syria
c) Your father’s father? Lebanon
d) Your father’s mother? Lebanon
4) How many brothers do you have? 0 Sisters? 2
5) In what setting do you grow up? Suburban/rural
6) In what country did your parents grow up? Mother: Lebanon Father: Lebanon
7) How old were you when you came to the United States? 21
8) How old were your parents when they came to the U.S? Mother: n/a Father: 58
9) When you were growing up who lived with you? Mom, Dad, and two sisters
10) Have you remained in contact with:
a) Aunts, uncles, and cousins? some
b) Brothers and sisters? yes
c) Parents? yes
d) Your own children? yes
11) Did most of your aunts, uncles, cousins, live near to your home? yes
12) Approximately how often did you visit your family members who lives outside your home? Pretty often
13) Was your original family name changed? yes
14) What is your religious preference? Christian
15) Is your spouse the same religion as you? yes
16) Is your spouse the same ethnic background as you? yes
17) What kind of school did you go to? catholic
18) As an adult, do you live in a neighborhood where the neighbors are the same religion and ethnic background as yourself? no
19) Do you belong to a religious institution? no
20) Would you describe yourself as an active
College Of Nursing
Heritage Assessment: Karla Gabriel
I. Demographic Data
1) Location: Lebanon
2) a)age: 40
b) Date of Birth: October 22, 1974
c) Place of Birth
3) Sex: Female
4) What is the highest grade completed in school? Second year of college
5) Are you: Married II. Heritage Assessment: your Ethnic, Cultural, and Religious Background
1) Where was your mother born? Syria
2) Where was your father born? Lebanon
3) Where were your grandparents born?
a) Your mother’s father? Syria
b) Your mother’s mother? Syria
c) Your father’s father? Lebanon
d) Your father’s mother? Lebanon
4) How many brothers do you have? 0 Sisters? 2
5) In what setting do you grow up? Suburban/rural
6) In what country did your parents grow up? Mother: Lebanon Father: Lebanon
7) How old were you when you came to the United States? 21
8) How old were your parents when they came to the U.S? Mother: n/a Father: 58
9) When you were growing up who lived with you? Mom, Dad, and two sisters
10) Have you remained in contact with:
a) Aunts, uncles, and cousins? some
b) Brothers and sisters? yes
c) Parents? yes
d) Your own children? yes
11) Did most of your aunts, uncles, cousins, live near to your home? yes
12) Approximately how often did you visit your family members who lives outside your home? Pretty often
13) Was your original family name changed? yes
14) What is your religious preference? Christian
15) Is your spouse the same religion as you? yes
16) Is your spouse the same ethnic background as you? yes
17) What kind of school did you go to? catholic
18) As an adult, do you live in a neighborhood where the neighbors are the same religion and ethnic background as yourself? no
19) Do you belong to a religious institution? no
20) Would you describe yourself as an active