TRANSCULTURAL NURSING

Ferry Efendi, PhD

BASIC CONCEPT

• Culture: “Culture refers to integrated patterns of

human behavior that include the language, thoughts,
communications, actions, customs, beliefs, values, and
institutions of racial, ethnic, religious, or social groups”
(Office of Minority Health, 2005).
• “The totality of socially-transmitted behavior patterns,
arts, beliefs, values, customs, lifeways, and all other
products of human work and thought characteristics of
a population of people that guides their worldview and
decision making. These patterns may be explicit or
implicit, are primarily learned and transmitted within
the family, and are shared by the majority of the
culture” (Giger et al., 2007; Purnell, 2008).
• Cultural patterns can also be transmitted from outside
the family by means of pressures exerted by society
• Cross-Cultural: Any form of activity between members of
different cultural groups; or, a comparative perspective on how
cultural differences and similarities shape human behaviors and
events (Harris, 1983; Trimmer & Warnock, 1992; Verburg,
2000).
• Cultural Brokering: Cultural brokering is bridging, linking, or
mediating between groups or persons of different cultural
backgrounds to effect change (Jezewski, 1990).
• Cultural Competence: The “ongoing capacity of health care
systems, organizations, and professionals to provide for diverse
patient populations high quality care that is safe, patient-
centered and family-centered, evidence-based, and equitable”
(Ngo-Metzger et al., 2006)
• Cultural Diversity: “Cultural diversity refers to the differences
between peoples based on a shared ideology and valued set of
beliefs, norms, customs, and meanings evidenced in a way of life”
(American Nurses Association, 1991).
• Cultural Safety: Health care that recognizes and respects the
cultural characteristics of the patient, the patient’s family, the
environment, and the patient’s community. This occurs through
ongoing self-reflective practices by the nurse. Culturally safe
practices by the nurse protect patients against devaluation or
obliteration of their cultural histories, cultural expressions, and
cultural experiences (Nursing Council of New Zealand, 2011).
• Ethnicity: The identification with population groups characterized
by common ancestry, language, and customs (American
Anthropological Association, 1997).
• Ethnocentrism: A universal tendency to believe that one’s own
culture and worldview are superior to another’s (Purnell, 2013).
• Stereotype: A simplified standardized conception, image,
opinion, or belief about a person or group. Stereotypes are
qualities assigned to an individual or group of people related to
their nationality, ethnicity, sexuality, socioeconomic status, and
gender, among others. Most often they are negative
generalizations. A health care provider who fails to recognize
individuality within a group is stereotyping (Purnell, 2008).
• Transcultural: A descriptive term implies that concepts transcend
cultural boundaries or are universal to all cultures, such as caring,
health, and birthing. In contrast cross-cultural refers to a
comparative perspective on cultures to generate knowledge of
differences and similarities (Harris, 1983; Trimmer & Warnock,
1992; Verburg, 2000).
• Acculturation is the process of adapting to and adopting a new
culture.
• Assimilation results when an individual gives up his or her ethnic
identity in favor of the dominant culture.
Characteristics of Culture
• Culture is learned and taught
Transmitted from one generation to another a person is not
born with cultural concepts but learn through socialization
• Culture is shared
The sharing of common practices provides a group with part
of its cultural identity
• Culture is social in nature
Culture develops in and is communicated by group of
people
• Culture is dynamic, adaptive and ever-changing
Adaption allows cultural group to adjust to meet
environmental changes. Cultural change occurs slowly and
in response to the needs of the group
Leininger’s Theory

• Leininger developed the

“SUNRISE MODEL” as a basis
for assessment and research in
nursing.
• This model remains as a
standard in Transcultural
Nursing Theory.
“ If human beings are to survive and live in a healthy,
peaceful and meaningful world, then nurses and other
health care providers need to understand the cultural
care beliefs, values and lifeways of people in order to
provide culturally congruent and beneficial health care
”
- Madeleine Leininger’s, 1978 -
Definition
A formal area of study and practice focused on comparative
holistic culture care, health and illness patters of people with
respect to differences and similarities in their cultural values,
beliefs, and lifeways with the goal to provide culturally
congruent, competent and compassionate care.
• The 7 Cultural and Social Structure Dimensions are
the large areas that nurses need to learn about through
interview and living among the people of different cultures.
• Below the Individuals, Families, Groups, Communities, &
Institutions are the Diverse Health Systems that all persons
deal with in various ways.
• Generic or Folk Systems are the everyday
remedies an individual, family or group may
use to promote wellness and healing.
• Nurses need to assess in all these areas to plan
safe, effective care.
• Professional Systems are different depending upon
the Health Care Delivery System of that culture.
Whether there is socialized medicine, private
insurance, communal healthcare, poor economic
support vs. great wealth, all contribute to the
influence of the utilization of Professionals to prevent
illness, heal illness, and promote health and wellness.
• Nursing must collaborate within the healthcare
delivery system to plan and implement safe,
effective, culturally competent care.
• Leininger’s theory helps to better define the
expectations of the nurse-patient relationship because
ultimately the nurse is the one who implements care
and is at the patient’s side for the majority of his or her
time receiving care.
• Transcultural Theory of Nursing has transformed
caregivers previously less aware of patient diversity and
enhanced perceptions that could potentially be the
difference between a patient’s convalescence and
decline.
• Transcultural nursing is a nursing specialty
focused on the comparative study and analysis
of cultures and subcultures.
• It examines these groups with respect to their:
• caring behavior
• nursing care
• health–illness values and beliefs
• patterns of behavior
• Transcultural nursing’s goal is to develop a scientific and
humanistic body of knowledge in order to provide nursing
care that is both
• culture-specific
• culture-universal
• Culture-specific refers to: particular values, beliefs, and
patterns of behavior that tend to be special or unique to a
group and that do not tend to be shared with members of
other cultures
• Culture-universal refers to: the commonly shared values,
norms of behavior, and life patterns that are similarly held
among cultures about human behavior and lifestyles
Eight factors that affect
transcultural nursing:
• Marked increase in the migration of people
• A rise in multicultural identities
• The increased use of health care technology
• Cultural conflicts, clashes, and violence
• An increase in the number of people traveling and
migrating for work
• An increase in legal suits resulting from cultural conflict,
negligence, ignorance, and imposition of health care
practices
• A rise in feminism and gender issues
• An increased demand for community and culturally based
health care services
Transcultural nursing enables
nurses to:
• Communicate more effectively with clients from
diverse cultural and linguistic backgrounds
• Assist those of various cultures with mental health
problems
• Accurately assess the cultural expression of pain
• Provide culturally appropriate interventions to prevent
or alleviate discomfort
• Assess the for parent–child relationship that promote
the health and well-being of children
Culturally Competent Model of Care
Josepha Campinha-Bacote, 1991

• Five interdependent constructs of the cultural

competence model are:
• cultural awareness
• cultural knowledge
• cultural skill
• cultural encounter
• cultural desire.
• Developing an awareness of one’s own existence,
sensations, thoughts, and environment without letting
it have an undue influence on those from other
backgrounds.
• Demonstrating knowledge and understanding of the
client’s culture.
• Accepting and respecting cultural differences.
• Adapting care to be congruent with the client’s
culture.
Guidelines for the Practice of
Culturally Competent Nursing Care
1. Knowledge of Cultures
• Nurses shall gain an understanding of the perspectives, traditions, values, practices, and
family systems of culturally diverse individuals, families, communities, and populations
they care for, as well as knowledge of the complex variables that affect the achievement
of health and well-being.
2. Education and Training in Culturally Competent Care
• Nurses shall be educationally prepared to provide culturally congruent health care.
• Knowledge and skills necessary for assuring that nursing care is culturally congruent shall
be included in global health care agendas that mandate formal education and clinical
training, as well as required ongoing, continuing education for all practicing nurses.
3. Critical Reflection
• Nurses shall engage in critical reflection of their own values, beliefs, and cultural heritage
in order to have an awareness of how these qualities and issues can impact culturally
congruent nursing care.
4. Cross-Cultural Communication
• Nurses shall use culturally competent verbal and nonverbal communication skills to
identify client’s values, beliefs, practices, perceptions, and unique health care needs.
5. Culturally Competent Practice
• Nurses shall utilize cross-cultural knowledge and culturally sensitive skills
in implementing culturally congruent nursing care.
6. Cultural Competence in Health Care Systems and Organizations
• Health care organizations should provide the structure and resources
necessary to evaluate and meet the cultural and language needs of their
diverse clients.
7. Patient Advocacy and Empowerment
• Nurses shall recognize the effect of health care policies, delivery systems,
and resources on their patient populations, and shall empower and
advocate for their patients as indicated.
• Nurses shall advocate for the inclusion of their patient’s cultural beliefs
and practices in all dimensions of their health care.
8. Multicultural Workforce
• Nurses shall actively engage in the effort to ensure a multicultural
workforce in health care settings. One measure to achieve a multicultural
workforce is through strengthening of recruitment and retention efforts
in the hospitals, clinics, and academic settings.
9. Cross-Cultural Leadership
• Nurses shall have the ability to influence individuals, groups, and
systems to achieve outcomes of culturally competent care for diverse
populations.
• Nurses shall have the knowledge and skills to work with public and
private organizations, professional associations, and communities to
establish policies and guidelines for comprehensive implementation
and evaluation of culturally competent care.
10. Evidence-Based Practice and Research
• Nurses shall base their practice on interventions that have been
systematically tested and shown to be the most effective for the
culturally diverse populations that they serve. In areas where there is a
lack of evidence of efficacy, nurse researchers shall investigate and test
interventions that may be the most effective in reducing the disparities
in health outcomes.
The three modes of nursing
decisions and actions
• Leininger suggests 3 approaches to plan and
implement Culturally Congruent Care.
• The first is Cultural Care Preservation/Maintenance
where we look at what we as nurses can do to
preserve and maintain the cultural practices of an
individual or family while receiving safe, holistic care
somewhere in the Healthcare Delivery System.
• The second approach is Cultural Care
Accommodation/Negotiation where we look at
what we as nurses can do to accommodate the
patient and negotiate with the patient within the
healthcare environment in order to provide
culturally congruent care while he/she is in the
Healthcare Delivery System.
• The third approach is Cultural Care Repatterning/
Restructuring where we look at what we as nurses
need to do with the patient and family to repattern or
restructure their lifeways in order to promote healing
and wellness, always being cognizant of the cultural
influences that affect why they do what they do in
their life experience.
The Benefits of Transculturalism
• The nurse is a beneficiary of this approach to treating
patients. On a global scale, nurses remain the largest
proportion of caregivers, and by learning about cultural
strangers and helping patients with their particular
lifeways and in their environmental contexts, nurses have
the opportunity to stand out as the most culturally-
understanding and demographically-sensitive group of
healthcare providers.
• When patient’s quality of care is in question, the nurse’s
role as a caregiver is jeopardized, for his profession is
“essential to curing and healing, for there can be no curing
without caring”
• Leininger provides insight into identifying and executing
excellent care that can be assumed by nurses, who do not
necessarily need to travel to foreign countries in order gain
an adequate grasp on care across cultures (“Nursing,”
1996).
• Initially, the nurse must listen to the patient, assess his or
her beliefs and values, and implement care decisions that
make a point of avoiding offensive practices (“Nursing,”
1996). The patient may require special requests outside
the expected spectrum of nursing care, and therefore,
communication and accommodation are key to becoming
a nurse characterized by transculturalism.
Instances of Cultural Impacts in
Nursing Care
• nursing technique of “palpation,” or touch. While
considered ordinary in Western cultures, this may not
be the case for members of non-Western cultures.
Some religions do not permit cross-gender contact
while others do not allow certain areas of the body to
be touched altogether, such as below the waist in the
case of gypsies. As a result, nurses must take steps to
communicate with their patients to determine what is
expected and maintain a high level of professionalism
throughout the interaction.
The Future of Transcultural Nursing
• In the coming years, the demographics of several
countries and regions will continue to change with the
continuous influx of diverse cultures.
• Transcultural nursing remains and will continue to be a
topic not simply discussed but also one that will
become an area of much-needed expertise for those
who seek professional success in nursing. Every hospital
provides care to people of diverse values and beliefs, so
education on transcultural nursing and maintenance of
unbiased attitudes as a nurse are crucial.
REFERENCES
• Leininger, M. (2002). Culture care theory: A major contribution to
advance transcultural nursing knowledge and practices. Journal of
transcultural nursing, 13(3), 189-192.
• Leininger, M. M., & McFarland, M. R. (2006). Culture care diversity
and universality: A worldwide nursing theory. Jones & Bartlett
Learning.
THANK YOU!