TRANSCULTURAL
NURSING
Last updated on
30-10-2008
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Outline
INTRODUCTION
Transcultural nursing with established clinical
approached to clients with varying cultures are
relatively new. According to Madeleine Leininger
(1987) founder of the filed of transcultural
nursing in the mid 1960s. The education of nursing
students in this field is only now beginning to
yield significant results.
Today nurses with a deeper appreciation of human
life and values are developing cultural
sensitivity for appropriate individualized
clinical approaches.
Religious and Cultural knowledge is an important
ingredient in health care. If the client do not
respond as nurse expects the nurse may interpret
it as unconcern or resistance the nurse then can
be anxious and frustrated in order to incorporate
cultural knowledge in care cultural knowledge in
care.
It is important to understand some definition and
cultural components that are important in health
care.
For a nurse to successfully provide care for a
client of a different cultural or ethnic to
background, effective intercultural communication
must take place. Intercultural communication
occurs when each person attempts to understand the
other’s point of view from his or her own
cultural frame of reference. Effective
intercultural communication is facilitated by the
nurse identification of areas of commonalities.
After reaching a cultural. understanding, the
nurse must consider cultural factor throughout the
nursing process.
Major Nursing organizations have emphasized in the
last decade the importance of considering culture
factors when delivering nursing care.
According to the American Nurses’ s Association
(1976)”Consideration of individual value systems
and lifestyles should be included in the planning
and health care for each client Nursing curriculum
recognize the contribution nursing to the health
care needs of a diverse and multi cultural society
life-style may ret1ect cultural heritage.
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Culture-Broadly defines set of values,
beliefs and traditions, that are held by a
specific group of people and handed down from
generation to generation. Culture is also
beliefs, habits, likes, dislikes, customs and
rituals learn from one’s family. (Specter 1991)
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Culture is the learned, shared and
transmitted values, beliefs, norms and life way
practices of a particular group that guide
thinking, decisions, and actions in patterned
ways.
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Religion:
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Is a set of belief in a divine or super human
power (or powers) to be obeyed and worshipped as
the creator and ruler of the universe? Ethical
values and religion system of beliefs and
practices, difference within the culture and
across culture are found
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Ethnic: refers to a group of people who
share a common and distinctive culture and who
are members of a specific group.
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Ethnicity :a consciousness of belonging
to a group.
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Cultural Identify: the sense of being
part of an ethnic group or culture
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Culture-universals: commonalities of
values, norms of behavior, and life patterns
that are similar among different cultures.
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Culture-specifies ; values, beliefs, and
patterns of behavior that tend to be unique to a
designate culture.
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Material culture; refers to objects
(dress, art, religious arti1acts)
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Non-material culture; refers to beliefs
customs, languages, social institutions.
Subculture: -composed of people who have a
distinct identity but are related to a larger
cultural group.
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Bicultural : a person who crosses two
cultures, lifestyles, and sets of values.
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Diversity: refers to the fact or state of
being different. Diversity can occur between
cultures and within a cultural group.
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Acculturation; individuals who have taken
on, usually observable, features of another
culture. People of a minority group tend to
assume the attitudes, values, beliefs, find
practices of the dominant society resulting in a
blended cultural pattern.
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Cultural shock:-the state of being
disoriented or unable to respond to a different
cultural environment because of its sudden
strangeness, unfamiliarity, and incompatibility
to the stranger's perceptions and expectations
at is differentiated from others by symbolic
markers (cultures, biology, territory,
religion).
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Ethnic groups; share a common social and
cultural heritage that is passed on to
successive generations.,
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Ethnic identity;- refers to a subjective
perspective of the person's heritage and to a
sense of belonging to a group that is
distinguishable from other groups.
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Race: the classification of people
according to shared biologic characteristics,
genetic markers, or features. Not all people of
the same race have the same culture.
TRADITIONAL CONCEPTS OF HEALTH AND DISEASE
When viewed across a variety of multicultural
groups, explanations for health and disease that
characterized, many traditional beliefs about
disease causation, treatment, and general health
practices can be seen as highly complex, dynamic,
and interactive. These explanations often involve
family, community, and/or supernatural agents in
cause and effect, placation, and treatment rituals
to prevent, control, or cure illness. A failure to
understand and appreciate these "differences" can
have serious implications for the success of any
Health Promotion and Disease Prevention (HPDP)
effort.
Be aware that in many
Eastern cultures and other cultures in the
developing world, the locus of control for
disease causality often is centered outside the
individual, whereas in Western cultures, the
locus of control tends to be more internally
oriented (Dim-out, 1995).
Remember that if the more
traditional person does seek Western medical
treatment, then that person might not be able to
provide or describe his or her symptoms in
precise terms that the Western medical
practitioner can readily treat (Landline &
Logoff, 1992).
Recognize that individuals from
other cultures might not follow through with
health-promoting or treatment recommendations
because they perceive the medical or other
health- promoting encounter as a negative or
perhaps even hostile experience.
Acknowledge that many individual
patients and health care practitioners have
specific notions about health and disease
causality and treatment called explanatory
models. These models are generally a
conglomeration of the respective cultural and
social training, beliefs, and values; the
personal beliefs, values, and behaviors-, and
the understanding of biomedical concepts that
each group holds (Klein man, 1980).
Recognize that the more disparate
the differences are between the biomedical model
and the lay/popular explanatory models, the
greater the potential for, on to encounter
resistance to Western HPDP programs.
Be aware of the need to be
flexible in the design of programs, policies,
and services to meet the needs and concerns of
the culturally diverse population, groups that
are likely to be encountered.
Traditional Concepts of Illness
Causality
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Be aware that folk illnesses are
generally learned syndromes that individuals
from particular cultural groups claim to have
and from which their culture defines the
etiology, behaviors, diagnostic procedures,
prevention methods, and traditional healing or
curing practices.
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Remember that most cases of lay
illness have multiple causalities and may
require several different approaches to
diagnosis, treatment, and cure including folk
and Western medical interventions
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Recognize that folk illnesses,
which are perceived to arise from a variety of
causes, often require the services of a folk
healer who may be a local corianders, shaman,
native healer, spiritualist, root doctor, or
other specialized healer.
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Recognize that the use of
traditional or alternate models of health care
delivery is widely varied and may come into
conflict with Western models of health care
practice.
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Understanding these differences may help us to
be more sensitive to the special beliefs and
practices of multicultural target groups when
planning a program. Culture guides behavior into
acceptable ways for the people in a specific
group as such culture originates and develops
within the social structure through inter
personal interactions.
CONCEPT OF CULTURE
Cultural awareness
It is an in-depth self-examination of one's own
background, recognizing biases and prejudices and
assumptions about other people
PURPOSES OF KNOWING THE PATIENTS CULTURE AND
RELIGION FOR HEALTH CARE PERSONNEL
Cultural background
affect a person's health in all dimensions, so the
nurse should consider the client's cultural
background when planning care
Although
basic human needs are the same for all people, the
way a person seeks to meet those needs is
influenced by culture.
To foster
understanding, respect and appreciation for the
individuality and diversity of patients beliefs,
values, spirituality and culture regarding
illness, its meaning, cause, treatment, and
outcome.
To strengthen in
their commitment to relationship-centered
medicine that emphasizes care of the suffering
person rather than attention simply more to the
pathophysiology of disease, and recognizes the
physician as a dynamic component of that
relationship.
To facilitate in
recognizing the role of the hospital chaplain
and the patient's clergy as partners in the
health care team in providing care for the
patient.
To encourage in
developing and maintaining a program of
physical, emotional and spiritual self-care
introduce therapies from the East, such as
ayurveda and pancha karma
Leininger (1991,2002a) has defined transcultural
nursing as a comparative study of cultures to
understand similarities (culture universal) and
difference (culture-specific) across human groups
Culturally congruent care;
Care that fits the people's valued life patterns
and set of meanings -which is generated from the
people themselves, rather than based on
predetermined criteria. Discovering
client's culture care values, meanings, beliefs
and practices as they relate to nursing and health
care requires nurses to assumes the roles of
learners of client’s culture and copartners with
client's and families in defining the
characteristics of meaningful and beneficial
care.(Leininger,2002
Culturally competent care is the ability of
the practitioner to bridge cultural gaps in
caring, work with cultural differences and enable
clients and families to achieve meaningful and
supportive caring. Culturally competent care
requires specific knowledge, skills, and attitudes
in the delivery of culturally congruent care and
awareness.
Pacquiato (2003) identifies three distinct
levels of cultural competence at the practitioner,
organizational and social levels.
Nursing Decisions
Leininger (1991) identified three nursing decision
and action modes to achieve culturally congruent
care. All three modes of professional decisions
and actions are aimed to assist, support,
facilitate, or enable people of particular
cultures
The three modes for congruent care, decisions, and
actions proposed in the theory are predicted to
lead to health and well being, or to face illness
and death.
1. Cultural preservation or maintenance:
Retain and or preserve relevant care values so
that clients can maintain their well-being,
recover from illness, or face handicaps and/or
death .
2.Cultural care accommodation or negotiation-
Adapt or negotiate with the others for a
beneficial or satisfying health outcome
3. Cultural care repatterning or restructuring
: Records, change, or greatly modify client’s
life ways for a new, different and beneficial
health care pattern
PURPOSE
AND GOAL OF THE THEORY
The central
purpose of the theory is to discover and
explain diverse and universal culturally based
care factors influencing the health, well-being,
illness, or death of individuals or groups.
The
purpose and goal of the theory is to
use research findings to provide culturally
congruent, safe, and meaningful care to clients of
diverse or similar cultures.
Status of Traditional Practices
Many traditional practices are used to prevent and
a redemptive practice used to prevent illness and
harm treat illness, including objects and
substances and religious practices. (Morgenstern,
1966)
USE OF PROTECTIVE OBJECTS
Protective objects can be worn or carried or hung
in the home. Amulets are objects with magical
powers, for all walks of life and cultural and
ethnic backgrounds is example, charms worn on a
string or chain around the neck, wrist, or waist
to protect the wearer from the evil eye or evil
spirits. Amulets exist in societies all over the
world and are associated with protection from
trouble (Budge, 1978)
USE OF SUBSTANCES
Substances are ingested in certain ways or amounts
regimen, an effort must be made to determine if
they are worn or hung in the home. This practice
uses diet and consists of many different
observances. It is believed that the body is kept
in balance or harmony by the type of food eaten so
many food taboos and combinations exist in
traditional belief systems. For example, it is
believed that some food substances can be ingested
to prevent illness. People from many ethnic
backgrounds eat raw garlic or onion In an effort
to prevent illness or wear them on' the body or
hang them in the home.
Jews also believe that milk and meat must never be
mixed or eaten at the same meal (Steinberg, 1947)
mind, and spirit, or the restoration of holistic
health
RELIGIOUS PRACTICES Another traditional
approach to illness prevention female centers
around religion and includes practices such as
from a divine source the burning of candles,
rituals of redemption, and In many instances a
heritage consistent person may prayer. Religion
strongly affects the way people attempt to prevent
illness, and it plays a strong role in rituals
associated with health protection. Religion
dictates social, moral, and dietary practices
designed to keep a traditional healer (Kaptchuk
and Croucherl987)
Traditional Remedies The admitted use of
folk or traditional medicine increasing, and the
practice is seen among people from all walks of
life and cultural ethnic back ground Use of folk
medicine is not a new practice among heritage
consistent people, so many of the remedies have
been used and passed on for generations. The
pharmaceutical, must be made to determine
properties of vegetation-plants, roots, tested
stems, flowers, seeds, and herbs-have been studied
tested, cataloged, and used for countless
centuries. Many of these plants are used by
specific communities. Others cross ethnic and
community lines and are used in certain Geographic
areas in the person's country of origin.
When patients -do not adhere to a pharmacological
regimen an effort must be made to determine the
remedy if they are taking traditional remedies.
Frequently, the active ingredients of traditional
remedies are unknown. If a client is believed to
be, taking them an effort must be made to
determine the remedy as well as its active in
gradients Often, these ingredients can be
antagonistic or synergistic to prescribed
medications. Over dose may occur.
Healer's
In the traditional context, healing is the
restoration of the person to a state of harmony
between the body, Within a given community,
specific people are known to have the power to
heal. The healer may be male or and is thought to
have received the gift of healing In many
instances a heritage consistent person may consult
a traditional healer before, instead of, or in
conjunction with a modern health care provider.
Many differences exist between the Western
physician and the Eastern A broad range of health
and illness beliefs exist many of these beliefs
have roots in the culture, ethnic, religious, or
social back ground .of a person family, or
community. 'When people anticipate fear or
experience an illness or crisis, they may use a
modern or traditional approach
toward prevention and healing.
These approach may originate in culture, ethnicity
or religion. These beliefs and practices may be
internal or personal and person may be able to
define or describe them. However, they may be due
to external social forces not within the person's
control Examples of external social forces include
communication barriers, such as language
differences, or economic barriers causing limited
access or lack of access to modem, health care
facilities.
IMMIGRATION
Every immigrant group has its own cultural
attitudes ranging beliefs and practices regarding
these areas Health and illness can be interpreted
in terms of personal experience and expectations.
There are countless ways to explain health and
illness, and people base their responses on
cultural, religious, and ethnic back ground. The
responses are culture specific, based on a
client's experience and perception.
Gender Roles
In many cultures, the male is dominant figure. In
cultures where this is time, males make decisions
for other family members well as for themselves.
For example, no matter which family member is
involved cultures where the male dominate. The
female usually is passive. In African -American
families, however as well as in many Caucasian
families, the female often is dominant Knowledge
of the dominant member of the family is important
consideration in planning Nursing care folk
illnesses, which are perceived to arise from a
variety of causes, often require the services of a
folk healer who may be a local curandero, shaman,
native healer, spiritualist, root doctor, or other
specialized healer. Recognize that the use of
traditional or alternate models of health care
deliveries widely varied and may come into
conflict with Western models of health care
practice. Understanding these differences may help
you to be more sensitive to the special beliefs
and practices of multicultural target groups when
planning a program.
ILLNESS CAUSE AND PREVENTION RELATED TO FOOD
Several factors cause illness. A hot-cold
imbalance, for example, is primarily caused by
improper diet. Food substances are classified as
hot or cold with and without regard to their
actual temperature. This classification can vary
from person to person, but essentially, certain
foods are known to be hot, and others are known to
be cold. Examples of cold food are, honey,
avocados, bananas, and lima beans. Examples of hot
foods-are chocolate, coffee, com meal, garlic,
kidney beans, onions, and peas. Illness can
occur if these foods are eaten in improper
combinations or amounts. .
Traditional beliefs about mental health In
the traditional belief system, mental illnesses
are caused by a lack of harmony of emotions or,
sometimes, by evil spirits. Mental wellness occurs
when psychological and physiologic functions are
integrated. Some elderly Asian Americans share the
Buddhist belief that problems in this life are
most likely related to transgressions committed in
a past life. In addition our previous life and our
future life are as much a part of the life cycle.
ECONOMIC BARRIERS
Several economic barriers, such as unemployment,
underemployment, homelessness, lack of health
insurance poverty prevent people from entering the
health care system. Poverty is by far the most
critical factor. Poverty a relative term and
changes from time and place. In the United States,
poverty is pervasive and found extensively among
people in certain norms geographical areas, such
as rural populations, the elderly migrant workers,
and illegal aliens. Poor health, crippling
diseases, drug and alcohol abuse, poor education;
and inferior are contributing social causes of
poverty.
Several programs, both governmental and private,
aid people with short- and long-tem problems. It
is important for the nurse to be aware clients
needs and financial resources available in the
local community.
Time orientation
It is varies for different cultures groups. A
client may be late for an appointment not because
of reluctance or lack of respect for the nurse but
because he is less concerned about planning ahead
to be on time than with the activity in which he
is currently engaged.
PERSONAL SPACE AND TERRITORIALITY;
Personal space involves a person's set of
behaviors and attitudes toward the space around
himself. Staff members and other clients
frequently encroach on a client's territory in the
hospital, which includes his room, bed, closet,
and belongings. The nurse should try, to respect
the client's territory as much as possible,
especially when performing nursing procedures. The
nurse should also welcome visiting members of the
family and extended family. This can remind the
client of home, lessening the effects of isolation
and shock from hospitalization.
SOCIOCULTURAL FACTORS AND THE NURSING PROCESS
Religious belief that effect the care Nursing;
Belief about birth
&death.
Belief about diet
and food practices.
Belief regarding
medical care
Comments (cremation is preferred)
ROLE OF NURSE
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The nurse should begin the assessment by
attempting to determine the client's cultural
heritage and language skills. The client should
be asked if any of his health beliefs relate to
the cause of the illness or to the problem. The
nurse should then determine what, if any, home
remedies the person is taking to treat the
symptoms
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Nurses should evaluate their attitudes toward
ethnic nursing care. Some nurses may believe
they should treat all clients the same and
simply act naturally, but this attitude fails to
acknowledge that cultural differences do exist
and that there is no one "natural" human
behavior The nurse cannot act the same with all
clients and still hope to deliver effective,
individualized ,holistic care.
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Sometimes, inexperienced nurses are so
self-conscious about cultural differences and so
afraid of making a mistake that they impede the
nursing process by not asking questions about
areas of difference or by asking so many
questions that they seem to try into the client'
personal life.
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The process of self-evaluation can help the
nurse become more comfortable when providing
care to clients from diverse backgrounds
Culture is the sum
total of mores traditions & beliefs about how
people function encompasses others products of
human works & thoughts. Specific to member of an
intergenerational group, community or
population.
Nurses have a
responsibility to understand the influence of
culture, race ðnicity on the development of
social emotional relationship child rearing
practices &attitude toward health.
A child's self
concepts evolves from ideas about his or her
social roles
Primary groups are
characterized by intimate contact mutual support
and pressure for conformity.
Important sub
culture influences on children include ethnicity
social class, occupation school peers and mass
culture
Socioeconomic
influences play major role in ability to seek
opportunity for health promotion for wellness
Religious
practices greatly influences health promotion
belief in families.
Many ethnic and
cultural groups in country retain the cultural
heritage of their original culture.
How culture
influences behaviors, attitudes, and values
depends on many factors and thus is not the same
for different members of a cultural group.
Ethnocentrism can
impede the delivery of care to ethnic minority
clients and, when pervasive, can become
cultural racism.
Stereotyping
ethnic group members can lead to mistaken
assumptions about a client.
The nurse should
have an understanding of the general
characteristics of the major ethnic groups, but
should always individualize care rather than
generalize about all clients in these groups.
