NCM 110: Transcultural Nursing Ethics

History and Theoretical Foundation of Transcultural Nursing

• Culture serves as a pattern on how each person thinks and acts.
• Key components of culture: ethnicity, race, and minority status.
• Dr. Madeleine Leininger is the foundress of Transcultural Nursing.
• Transcultural Nursing is a research-focused practice that deals with patient-centered, culturally competent nursing care.

Factors that Influenced the Creation of Transcultural Nursing

• Migration of people within and between countries increased worldwide.
• Growth in multicultural identities respected by nurses.
• Usage of healthcare technology gave rise to disputes with the client's cultural values.
• Conflicts in culture created clashes and violence in healthcare worldwide.
• Huge count of travelers and overseas workers in different parts of the world.
• Cultural conflicts, negligence, and illiteracy led to an increase in legal suits.
• Demand for community and culturally based healthcare services increased.

Theoretical Foundation of Transcultural Nursing

• The foundation of Transcultural Nursing is based on cultural concepts and their relation to health beliefs, values, and practices.
• Culture is termed as the knowledge, norms, beliefs, morals, laws, customs, habits, traditions, and other capabilities acquired and developed by humans as members of society.

Culturally Competent Nursing Care

• Cultural competency is defined by the National Institute of Health (2015) as services delivered by healthcare providers that are respectful and responsive to the health beliefs, practices, cultural, and linguistic needs of diverse clients.
• Cultural competency does not occur overnight, but rather it takes time to flourish the needed knowledge, skill, and attitude to become culturally competent and deliver safe and quality care.

Cultural Assessment

• Cultural assessment is a systematic, comprehensive examination of the cultural beliefs, values, and practices of individuals, families, and communities.
• Cultural assessment identifies the healthcare needs of people, so that proper nursing diagnosis will be formulated, for proper planning and execution of culturally congruent and meaningful actions.
• The goal of the health history is to collect subjective and objective data, including present and past history, family history, social history, lifestyle, health strength, and cultural beliefs and practices.

Psychomotor Skills in Transcultural Nursing

• Some of the psychomotor skills useful in Transcultural Nursing are:
  • Assessment
  • Communication
  • Hygiene
  • Activities of daily living
  • Religion

Cultural Beliefs and Practices

• Examples of cultural beliefs and practices during pregnancy:
  • Prescriptive beliefs: remain active during pregnancy to aid the baby's circulation (Crow Indian), keep active during pregnancy to ensure a small baby and easy delivery (Mexican and Cambodian).
  • Restrictive beliefs: avoid cold air during pregnancy to prevent physical harm to the fetus (Mexican, Haitian, Asian), do not reach over your head or the cord will wrap around the baby's neck (African American, Hispanic, White, Asian).
  • Taboos: avoid lunar eclipse and moonlight or the baby might be born with a deformity (Mexican), do not walk on the streets at noon or 5 o'clock because this might make the spirits angry (Vietnamese).

Transcultural Nursing Across the Lifespan

• Cultural care on childbearing and childrearing:

  • Childbearing is a period of change, in which many cultures have beliefs, norms that govern the activity and behavior during pregnancy and can influence pregnancy outcomes.
  • Examples of cultural beliefs and practices during childbearing and childrearing: Hispanic taboo involves the traditional belief that an early baby shower will invite bad luck, or mal ojo, the evil eye (Spector, 2008).### Pregnancy and Childbirth

• 130 million babies are born every year worldwide.

• Cultural beliefs and practices regarding pregnancy, childbirth, and postpartum care vary across cultures.

• Food taboos and cravings are common in many cultures, with some believing that certain foods can cause harm or affect the baby's development.

• Some cultures believe that a pregnant woman must be given the food she smells to eat; otherwise, the fetus will move inside her, and a miscarriage may result.

• Spicy, cold, and sour foods are often avoided during pregnancy in some cultures.

• Pica, or the craving for non-food substances, is a common phenomenon in some cultures.

Birth Positions

• Various birth positions are used across cultures, including squatting, kneeling, standing, and reclining.
• Squatting is a common position, with the mother's knees closer together or farther apart.
• Supported squatting, where the mother holds onto attendants or furniture, is also used.
• Counter-force, where the mother pushes against a device or a person, is used to help with birthing.

Cultural Expression of Labor Pain

• Coping strategies for labor pain vary across cultures, including moaning, breathing rhythmically, and massaging the thighs and abdomen.
• In some cultures, screaming or crying out during labor is seen as shameful.

Feeding and Culture

• Feeding practices vary across cultures, with some using bottles filled with milk, juice, or carbonated beverages to quiet or lull a child to sleep.
• Premastication, or chewing food for young children, is practiced in some cultures to facilitate digestion.
• In some cultures, fasting is viewed as a means of penance for evil.

Elimination and Culture

• Potty training practices vary across cultures, with some starting as early as birth and others starting at around 2 years old.
• Elimination Communication, a method of recognizing signs that a baby is about to go, is used in some cultures.

Culture and Postpartum Care

• Traditional birth attendants, such as Dais in India or Mae Jang in Thailand, play a significant role in postpartum care.
• Placental burial rituals are part of the traditional Hmong culture.
• Yu Duan, a drying of the uterus, and Yu Fai, a period of observation and rest, are practiced in Thailand after birth.

Health Belief Systems

• Evil eye, or mal ojo, is a feared affliction in many cultures, caused by an individual's gaze or admiration.
• Caida de la mollera, or sunken fontanel, is attributed to various causes, including failure to press on the palate after delivery.
• Acculturation and assimilation are important processes in adapting to a dominant culture.

Child Rearing

• Family is the primary health care provider of infants, children, and adolescents, influencing their physical and psychosocial growth and development.
• Cultural background is crucial in the delivery of culturally competent care.

Care of Adults and Older Adults

• Sociocultural factors affect adult lives, leading to crisis and transformation.
• Middle adulthood is a time for reflection and reassessment, often triggered by serious illness or mortality.
• Healthcare professionals should be aware of the influence of families on health behavior and respect cultural history, beliefs, and practices in managing illness.

Guidelines in Communicating with Older Adults

• Elicit the client's views on their symptoms and treatment expectations.

• Create a positive environment, using formal terms and addressing the client's needs.

• Negotiate with the client about their biomedical healthcare model and compliance.

• Use nonverbal methods of communication and provide printed instructions in the client's native language, if possible.### Culturally Competent Care for Older Adults

• The majority of older adults prefer to "age in place" (stay in their homes and neighborhoods) as long as possible.

• Culturally and ethnically diverse older adults' life experiences will shape their health behavior.

• Older adults may have strong recollections of traditional beliefs and related remedies from their childhood.

• Activity theory describes that older adults may substitute recreational and meaningful opportunities to take the place of previous occupations and careers.

• Continuity theory focuses on supporting adults to remain engaged by adapting patterns of behavior from their younger adulthood.

Transcultural Healthcare Setting

• Health disparity is a particular type of health variation with disadvantages on social, economic, and environmental factors.
• Health equity is the attainment of the highest level of health for all people.

Cultural Perspective of Older Adults

• Understanding the culture of an individual is important since it has a great influence on access to care and health-seeking behavior.
• Programs to implement for the improvement of organizational cultural competence include:
  • Training to control and value cultural diversity in promoting the corporate culture.
  • Nursing administrators recognizing the effort of staff with respect to cultural variations and delivering appropriate culturally competent care.
  • Choosing a culturally competent nurse.
  • Recruiting and hiring culturally diverse staff to analyze the country's demographics.

Common Beliefs and Health Practices

• Hmong patients: believe that an illness can be caused by evil spirits if one's own spirit has left the body.
• Chinese adults: may follow traditional practices including herbal medicine, massage, acupuncture, or dietary therapy for chronic pain, musculoskeletal problems, and headaches.
• Asian Indian immigrants: may follow Ayurveda, which includes the use of spices and herbs for cold, congestion, diabetes, and heart problems.
• Hindu and Sikh patients: may believe that illness is due to karma.

Factors That Affect Adults' Health and Illness Behaviors

• Regional and religious identity.
• Homeland situation causing them to migrate.
• Length of stay in one place, including the degree of acculturation.
• Proximity to immediate family.
• Network of friends and social support group.
• Link with ethnic, social, health-related institutions.

Culturally Competent Care

• Nurses should be sensitive to the life experiences and previous health care experiences of older clients.
• Approaches to older adults include:
  • Being sensitive to the life experiences and previous health care experiences of the older clients.
  • Listening attentively to the older client's complaints, recollections, and strengths.
  • Eliciting information about the older client's preferences for care, including diet and use of self-care remedies.
  • Identifying available sources of informal support and confirming availability.

Challenges in Transcultural Nursing

• Religious beliefs influence the health beliefs and practices of many people.
• Examples of the influences of religion on health practices include:
  • Meditating.
  • Being vaccinated.
  • Being willing to have the body examined.
  • Maintaining family viability.
  • Hoping for recovery.
  • Coping with stress.
  • Caring for children.

Nursing Responsibilities

• Asks the patient if they want a priest to hear confession and to give communion.
• Comforts both the patient and the family members.
• Provides as much privacy as possible.
• If a patient is unconscious or in a serious condition and found to have a rosary, Catholic medal, or identification card indicating that the patient is Catholic, a priest should be called.

Buddhism

• Utilizes beads and images of Sakyamuni Buddha for meditation.
• Holly day is Saga Dawa, the observance of the birth of Buddha on the month of May or June.
• Vegetarian: alcohol and drugs are discouraged.
• No restriction for medication, vaccines, and therapeutic treatments.
• Do not tolerate taking one's life.
• DIET: many are vegetarians because of their respect for all life.
• HYGIENE: strict rules of hygiene, and need to wash before meditation, as well as after urination and defecation.
• PAIN RELIEF: may be reluctant to take pain-relieving drugs.
• FASTING: many Buddhists would not wish to eat after 12 noon on festival days.
• SLEEPING: some Buddhists may prefer to sleep on the floor.
• PRAYER: patients who are mobile could use a room adjacent to the hospital chapel.
• DEATH: many Buddhist patients will have already given a "who to contact" name.

Catholic Patients and Health Care

• Sacraments and blessings by a Catholic priest are highly important, especially before surgery or whenever there is a perceived risk of death.
• The sacramental requests "Sacrament of the Sick" (what some Catholics may think of as "Last Rites").
• Confession, and Holy Communion (Eucharist).
• Baptism: in the case of an infant who is likely to die before a priest can arrive, such an infant may be baptized by a nurse with proper intent.
• Holy Communion (Eucharist) prior to surgery: patients who are NPO should have this request approved by the care team as medically safe.
• Religious objects: such as a rosary, a scapula, or a religious medal.