TRANSCULTURAL NURSING

Transcultural Nursing is a specialty with in Nursing focused on the comparative study and analysis of different cultures and sub-cultures.

Various groups are examined with respect to their caring behaviour, nursing care, health and illness values, beliefs and patterns of behaviour.

INTRODUCTION:

Culture: Norms and practices of a

particular group that are learned and shared and guide thinking, decisions, and actions.

Cultural values: The individual's desirable or

preferred way of acting or knowing something that is sustained over a period of time and which governs actions or decisions.

Culturally diverse nursing care: An optimal mode of health care

delivery; it refers to the variability of nursing approaches needed to provide culturally appropriate care that incorporates an individual’s cultural values, beliefs, and practices including sensitivity to the environment from which the individual comes and to which the individual may ultimately return..

Leininger defined transcultural nursing as: “A legitimate and formal area of

study, research, and practice focused on culturally based care, values, and practices to help cultures and sub-cultures maintain or regain their health and face difficulties or death in a culturally congruent and beneficial caring ways”

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DEFINITION:

“Transcultural Nursing is a comparitive study of cultures to understand similarities(cuture universal) and differences(culture-specific) across human group.”

In 1950’s Medeleine M. Leininger, known as the foundress of Transcultural Nursing, noted cultural differences between patients and nurses while working with emotionally disturbed children.

This experience led to study clinical difference in perception of the care.

She recognized that health and illness states are strongly influenced by culture and formulated the theory of Transcultural Nursing.

History of Transcultural Nursing

In 1991, she published ‘Culture Care Diversity And Universality: A Theory Of Nursing’

Her theory has now developed into a discipline in nursing.

In 1988 Transcultural Nursing Society initiated certification examinations: certified Transcultural Nurse (CTN)

1) There is a marked increase in the migration of people within and between countries world wide.

2) There has been a rise in multicultural identifies, with people expecting their cultural belief, values, and lifeways to be understood and respected by nurses and other health care providers.

3) The increased use of health care technology sometimes conflicts with cultural values of clients.

Importance of Transcultural Nursing

4)World wide there are cultural conflicts, clashes, and violence that have an impact health care as more cultures interact with one another.

5) There was an increase in legal suits resulting from cultural conflict, negligence, ignorance, and imposition of health care practices.

6) There is an increase in the number of people travelling and working in many different parts of the world.

7) There has been a rise in feminism and gender issues, with new demands on health care systems to meet the needs of woman and children

8) There has been an increased demand for community and culture based health care services in diverse environmental contexts.

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To help develop, test and organize the emerging body of knowledge in Transcultural Nursing, it is necessary to have a conceptual framework from which various theoritical statements can emerge.

There are two popular models widely used in the field Leininger’s Sunrise ModelThe Giger and Davidhizar: ‘Transcultural

Assessment Model’

Models of Transcultural Nursing:

The model is based on the concept of culture care and shows 3 major nursing modalities that guide nursing judgments and activities to provide ‘Culturally Congruent Care’

3 major modalities are 1) Cultural care preservation/

Maintainance2) Cultural care

Accommodation/Negotiation3) Cultural care Repatterning

/Reconstructing.

Leininger's Sunrise Model

Culturally Congruent Care:The care that is beneficial

and meaningful to the people being served.

Culturally Diverse Nursing Care:An optimal mode of

health care delivery; It refers to the variability of nursing approaches needed to provide culturally appropriate care that incorporates an individuals cultural values, beliefs and practices including sensitivity to the environment from which the individual comes and to which the individual ultimately return.

This model was developed in 1988 in response to the need for nursing students in an undergraduate program to assess and provide care for patients that were culturally diverse.

Giger and Davidhizar have identified six cultural phenomena that vary among cultural groups and affect health care.

The Giger and Davidhizar- Transcultural Assessment

Model

Communication is the means by which culture is transmitted and preserved. Both verbal and nonverbal communications are learned in one’s culture.

Verbal and nonverbal patterns of communication vary across cultures, and if nurses do not understand the client’s cultural rules in communication, the client’s acceptance of a treatment regimen may be jeopardized.

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1.Communication:

Accurate diagnosis and treatment is impossible if the health-care professional cannot understand the patient.

Culture not only determines the appropriateness of the message but also influences all the components of communication.

Thus, an assessment of communication should consider: 1) dialect,

2) style, 3) volume, including silence, 4) touch, 5) context of speech or emotional

tone, and 6) kinesics, including gestures, stances, and eye behaviour

Space refers to the distance between individuals when they interact. All communication occurs in the context of space.

There are four distinct zones of interpersonal space: 1)inmate zone (extends up to 1 ½ feet),

2)personal distance (extends from 1 ½ to 4 feet), 3)social distance (extends from 4 to 12 feet) and 4)public distance (extends 12 feet or more)

2. Space:

3) Social organization:Social organization refers to the

social group organizations with which clients and families may identify.

4) Time OrientationTime is an important aspect of

interpersonal communication. Some cultures are considered future oriented, others present oriented, and still others past oriented

These differences in time orientation may become important in health-care measures such as long-term planning and explanations of medication schedules.

eg:Latin Americans, Native Americans, and Middle Easterners are present oriented cultures and may neglect preventive health care measures. They may show-up late or not at all for appointments

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Environmental control refers to the ability of the person to control nature and to plan and direct factors in the environment.

Some groups perceive man as having mastery over nature; others perceive humans to be dominated by nature, while others see harmonious relationships between humans and nature

5)Environmental control:

For example, Asians and Native Americans may perceive that illness is a disharmony with other forces and that medicine is only capable of relieving the symptoms rather than curing the disease. These groups are likely to look for naturalistic solutions, such as herbs and hot and cold treatments to resolve or cure a cancerous condition

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Biological variations are: (1) body structure, (2) skin colour, (3) other visible physical characteristics, (4) enzymatic and genetic variations, (5) electrocardiographic patterns, (6) susceptibility to disease, (7) nutritional preferences and deficiencies,

and (8) psychological characteristics

6)Biological variations:

1) Theoritical foundations of Transcultural Nursing.2) Cultural information gathering.3) Caring and healing systems.4) Cultural health patterns and caring patterns.5) Health care planning.6) Evaluation.7) Research.8) Professional development.

Standards of Transcultural Nursing

Research studiesConclusion.