TRANSCULTURAL NURSING

A humanistic and scientific area of formal study and practice in nursing which is focused upon differences and similarities among cultures with respect to human care, health, and illness based upon the people's cultural values, beliefs, and practices, and to use this knowledge to provide cultural specific or culturally congruent nursing care to people ... Leininger

Leininger (1991) notes the main goal of transcultural nursing is to provide culturally specific care. But before transcultural nursing can be adequately understood, there must be a basic knowledge of key terminology such as culture, cultural values, culturally diverse nursing care, ethnocentrism, " race " and ethnography.

Culture refers to 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, 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 may ultimately return. (Leininger, 1985)

Ethnocentrism the perception that one's own way is best when viewing the world (Geiger & Davidhizar, 1991). Our perspective is the standard by which all other perspectives are measured and held to scrutiny.

Ethnic relates to group identification, large groups of people classified according to common traits or customs.

Race Any of the different varieties of humans assumed by some people to exist, based on the discredited typological model of human variation.

Ethnography is the study of a culture. The methodological approach of ethnographic research central to the nurse's ability to develop a heightened awareness of culturally diverse needs of individuals, is to define a field for observation for study of the environment and its people, as well as the reciprocal relationship that exists between the two (Tripp-Reimer & Dougherty, 1985).

ORGANIZING PHENOMENA OF CULTURE

In a multicultural society such as ours, nurses are likely to encounter clients from diverse settings. As nurses we need to develop a cultural insight and a deeper appreciation and respect for the rights of culturally diverse individuals. When cultural beliefs and practices are not appropriately identified, the significance of behavior may confuse the nurse and result in the delivery of inappropriate care.

manifestations of "normal" that exist between people with respect to, body structure- skin color- other visible physical characteristics- enzymatic and genetic variations- electrocardiographic patterns- susceptibility to diseasenutritional preferences and deficiencies, and - psychological characteristics.

Biological Variations diverse Biological variations are those

Biological differences between human beings, that is the small gene variations that give people different hair colors, make individuals more prone to certain diseases and determine how people react to drugs, are in most cases, the result of both hereditary factors and the influence of natural and social environments.

ENVIRONMENTAL CONTROL

Abilities of members of a particular group to plan activities that control nature, such as factors causing illness. Health practices, values, definitions of health and illness.

SOCIAL ORGANIZATION
Refers

to the family unit, and the social group organizations with which the patients and families may identify. It refers to ways in which groups determine roles of individual members.

Culture is determined not only by ethnicity but by factors such as geography, age, religion, gender, sexual orientation, and socioeconomic status. Understand that age and life cycle factors must be considered in interactions with all individuals and families.

Patterns of cultural behavior learned through enculturation. Recognize and accept that individuals from culturally diverse backgrounds may desire varying degrees of acculturation into the dominant culture. Life cycle factors must be considered in interactions with individuals and families

COMMUNICATION
Communication

is the vehicle for transmitting and preserving culture. Communication differences present themselves in many ways, including language differences, verbal and non-verbal behaviors, and silence.

Miscommunication is a frequent problem in hospitals. The most obvious is when the patient and hospital staff do not speak the same language. But the more subtle problems are those that result from cultural differences in meanings of non verbal behavior. Knowing what is the norm within the culture will facilitate understanding and lessen miscommunication.

SPACE
Particularly the comfort level related to personal space. - comfort in conversation, proximity to others, body movement, perception of space. Eye contact, space, and touch practices may be very different than your sphere of reference.

SPACE ZONES
INTIMATE

ZONE extends up to 1

feet. PERSONAL DISTANCE extends from 1 to 4 feet. SOCIAL DISTANCE extends from 4 to 12 feet. PUBLIC DISTANCE extends 12 feet or more

TIME ORIENTATION Concept of the passage of time, duration of time, and points in time. Countries such as England and China seem to be past oriented. They value tradition, doing things the way they have always been done. Individuals from these countries might be reluctant to try new procedures.

People from present oriented cultures tend to focus on the here and now. They may be relatively unconcerned with the future, they will deal with it when it comes. 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.

 European

Americans are future oriented as evidenced by their development of plans, such as retirement and savings. People who are future-oriented are concerned with long-range goals and with health care measures in the present to prevent the occurrence of illness in the future.

CULTURAL COMPETENCE
Refers

to the process through which the nurse provides care that is appropriate to the client's cultural context Culturally competent nurses are those who demonstrate knowledge and understanding of the client's culture; accept and respect cultural differences; and adapt care to be congruent with the client's culture.

ELEMENTS OF CULTURAL COMPETENCE

CULTURAL

AWARENESS a cognitive process in which the nurse becomes aware of and sensitive to the client's cultural values, beliefs, and practices. CULTURAL KNOWLEDGE the nurse seeks a sound educational base about different cultures

 CULTURAL

SKILLS the nurse's ability to perform a culturally specific assessment CULTURAL ENCOUNTERS the nurse interacts with client's from diverse cultural backgrounds. CULTURAL DESIRE the nurse's motivation to become culturally competent

ASSESSMENT

History of the origins of the patients' culture. Value orientations, including view of the world, ethics, and norms and standards of behavior as well as attitudes about time, work, money, education, beauty, strength, and change. Interpersonal relationships, including family patterns, demeanor, and roles and relationships.

ASSESSMENT

Communication patterns and forms. Religion and magic. Social systems, including economic values, political systems, and educational patterns. Diet and food habits. Health and illness belief systems, including behaviors, decision making, and use of healthcare providers.