This document discusses key concepts in transcultural nursing. It defines culture and related terms like cultural competence, diversity, safety, ethnicity, and more. It outlines Leininger's theory and SUNRISE model for assessing culture. The theory aims to provide culturally congruent care by understanding peoples' values, beliefs, and lifeways. The document also discusses Campinha-Bacote's model of culturally competent care through cultural awareness, knowledge, skills, encounters, and desire. Finally, it provides guidelines for culturally competent nursing practice focusing on gaining cultural understanding, education and training, and critical self-reflection.
This document discusses key concepts in transcultural nursing. It defines culture and related terms like cultural competence, diversity, safety, ethnicity, and more. It outlines Leininger's theory and SUNRISE model for assessing culture. The theory aims to provide culturally congruent care by understanding peoples' values, beliefs, and lifeways. The document also discusses Campinha-Bacote's model of culturally competent care through cultural awareness, knowledge, skills, encounters, and desire. Finally, it provides guidelines for culturally competent nursing practice focusing on gaining cultural understanding, education and training, and critical self-reflection.
This document discusses key concepts in transcultural nursing. It defines culture and related terms like cultural competence, diversity, safety, ethnicity, and more. It outlines Leininger's theory and SUNRISE model for assessing culture. The theory aims to provide culturally congruent care by understanding peoples' values, beliefs, and lifeways. The document also discusses Campinha-Bacote's model of culturally competent care through cultural awareness, knowledge, skills, encounters, and desire. Finally, it provides guidelines for culturally competent nursing practice focusing on gaining cultural understanding, education and training, and critical self-reflection.
This document discusses key concepts in transcultural nursing. It defines culture and related terms like cultural competence, diversity, safety, ethnicity, and more. It outlines Leininger's theory and SUNRISE model for assessing culture. The theory aims to provide culturally congruent care by understanding peoples' values, beliefs, and lifeways. The document also discusses Campinha-Bacote's model of culturally competent care through cultural awareness, knowledge, skills, encounters, and desire. Finally, it provides guidelines for culturally competent nursing practice focusing on gaining cultural understanding, education and training, and critical self-reflection.
• 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!