Chapter 1: Theoretical Foundations of Transcultural Nursing PDF

INTRODUCTION TO TRANSCULTURAL NURSING ===================================== - **Madeliene Leininger:** Nursing and Anthropology: Two Worlds To Blend (1970) - Leininger used the term transcultural nursing (TCN) to describe the blending of nursing and anthropology into an area of special...

INTRODUCTION TO TRANSCULTURAL NURSING ===================================== - **Madeliene Leininger:** Nursing and Anthropology: Two Worlds To Blend (1970) - Leininger used the term transcultural nursing (TCN) to describe the blending of nursing and anthropology into an area of specialization within the discipline of nursing. - Using the concepts of culture and care, Leininger established as a theory-and-evidenced based formal area of study and practice within nursing that focuses on people's culturally based beliefs, attitudes, values, behaviors, and practices related to health, illness, healing and human caring. TRANSCULTURAL NURSING ===================== - Sometimes used interchangeably with cross-cultural, intercultural, and multicultural nursing. - the **goal** of TCN is to develop a scientific and humanistic body of knowledge in order to provide culture-specific and culture-universal nursing care practices for individuals, families, groups, communities and institutions of similar and dividers cultures. - **[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 lifestyle. ANTHROPOLOGY AND CULTURE ======================== - **Anthropology** is an academic discipline that is concerned with the scientific study of humans, past, and present. Anthropology builds on knowledge from the physical, biological, and social sciences as well as the humanities. - In nursing, Leininger defines culture as the "learned, shared, and transmitted values, beliefs, norms, and lifeways of a particular group of people that guide thinking, decisions and actions in a patterned way". - A central concern of anthropologists is the application of knowledge to the solution of human problems. One of the central concepts that anthropologist's study is culture. - Culture influences a person's definition of health and illness, including when its appropriate to self-treat and when the illness sufficiently serious to seek assistance from one or more healers outside of the immediate family. Although the term culture sometimes connotes a person's racial or ethnic background, there are also many other examples of non-ethnic cultures. 1. Socioeconomics status, for example, the culture of poverty or the culture of the homeless; 2. Ability or disability, such as the culture of the deaf or hearing impaired, or the culture of the blind or visually impaired; 3. Sexual orientation, such as the lesbian, gay, bisexual, and transgender (LGBT). 4. Age, such as the culture of adolescence and the culture of the elderly; and 5. Occupational or professional cultures, such as nursing, medicine, and other professions in healthcare, the military, business, education, and other related field. In a classic study of culture by the anthropologists Edward Hall (1984) three levels of culture are identified: 1. **Primary Level**: refers to the implicit rules known and followed by the members of the group, but seldom stated or made implicit to outsiders. 2. **Secondary Level**: refers to underlying rules and assumptions that are known to members of the group buy rarely shared with outsiders. 3. **Tertiary Level**: refers to the explicit or public face that is visible to outsiders, including dress, rituals, cuisine and festivals. \*The primary and secondary levels are the most deeply noted and most difficult to change. THE CULTURAL ICEBERG ==================== - **Surface Culture** - observable; you have background. - **Deep Culture** - not observable; dig deeper into their culture and it explains the story of their culture. 1. Food 2. Flags 3. Festivals 4. Fashion 5. Holidays 6. Music 7. Performances 8. Dances 9. Games 10. Arts & Crafts 11. Literature 12. Language **COMMUNICATIONS STYLES AND RULES:** 1. Facial Expressions 2. Gestures 3. Eye Contact 4. Personal Space 5. Touching 6. Body Language 7. Conversational Patterns in Different Social Situations 8. Handling and Displaying of Emotion 9. Tone of Voice **Notions of:** 1. Courtesy and Manners 2. Frendship Leadership 3. Cleanliness Modesty 4. Beauty **Concepts of:** 1. Self Time Past and Future 2. Fairness and Justice 3. Roles related to Age, Sex, Class, Family, etc. **Attitudes toward:** 1. Elders 2. Adolescent 3. Dependents 4. Rule 5. Expectations 6. Work 7. Authority 8. Cooperation vs. Competition 9. Relationships with Animals 10. Age 11. Sin 12. Death **Approaches to:** 1. Religion 2. Courtship 3. Marriage 4. Raising Children 5. Decision-Making 6. Problem Solving SUBCULTURE ========== 1. The term subculture refers to groups that have values and norms that are distinct from those held by the majority within a wider society. 2. Members of subcultures have their own unique shared of customs, attitudes, and values, often accompanied by group-specific language, jargon or slang that sets them apart from others. 3. A subculture can be organized around a common activity, occupation, age, ethnic background, race, religion, or any other unifying social condition. 4. For example, in the United States, Hispanic is a panethnic designation that includes many subcultures consisting of people who subidentify with Mexican, Cuban, Puerto Rican and other groups that often share Spanish language and culture (Morris, 2015). ETHNICITY VS. RACE ================== 1. **Ethnicity** refers to the cultural expression and identification of people of different geographic regions, including their customs, history, language, and religion. 2. **Race** refers to a group of people who share genetically transmitted traits such as skin color, hair texture, and eye/shape color. LEININGER\'S CONTRIBUTIONS TO TCN ================================= 1. **Culture Care:** aspects of culture that influences or enable a person to deal with illness or death. 2. **Ethnohistory**: refers to past events and experiences of individuals or groups, which explain human life ways within particular cultural contexts over short or long periods of time. 3. **Culturally Congruent Care:** it is the culturally based care knowledge, acts, and decisions used in sensitive, creative, and meaningful ways to appropriately fit the cultural values, beliefs, and lifeways of clients for their health and well-being, or to prevent or face illness, disabilities, or death. 4. **Culture Care Diversity:** the variabilities or differences in culture care beliefs, meanings, patterns, values, symbols, lifeways, and other features among human beings related to providing beneficial care for clients from a designated culture. 5. **Culture Care Universality**: it is the common, similar, or dominant uniform care meanings, pattern, values, lifeways or symbols that are manifest among many cultures and reflect assistive, supportive, facilitative, or enabling ways to help people. 6. **Worldview**: it is the way in which people look at the world, or at the universe, and form a \"picture or value stance\" about the world and their lives. PRIMARY THEMES OF THE SUNRISE MODEL =================================== 1. Nursing must be based on knowledge by examining social structure, world view, cultural values, language, and environmental contexts. 2. Health and care behaviors vary among cultures, therefore nursing care cannot be determined through superficial knowledge and limited contact with a cultural group. 3. If one fully discovers care meanings, patterns, and process, one can explain and predict health or well-being. 4. The ultimate goal of the theory is to provide cultural congruent nursing care practices. THREE CARE MODALITIES ===================== Nursing is humanistic and scientific mode of helping through culture-specific process. There are 3 care modalities that emphasizes human caring vanes among cultures 1. Culture Care Preservation and Maintenance ============================================ Refers to professional actions and decisions that help people of a particular culture to retain, preserve, or maintain meaningful care beliefs and values for their well-being or to recover from illness, or to deal with handicaps or dying. 2. Culture Care Accommodation and Negotiation ============================================= Refers to professional actions and decisions that help people of a designated culture to adapt or renegotiate with others for culturally congruent, safe, effective care meaningful and beneficial health outcomes. 3. Culture Care Restructuring and Repatterning ============================================== Refers to professional actions and decisions that help client\'s reorder, change or modify their lifeways for beneficial heath care patterns, practices or outcomes. ASSUMPTIONS OF LEININGER\'S THEORY ================================== 1. Care is the essence and central focus of nursing 2. Caring is essential for health and well-being. healing, growth, survival, and also for facing illness or death. 3. Culture care is the broadest holistic perspective to guide nursing care practices. 4. Nursing\'s central purpose is to serve human beings in health, illness and if dying. 5. There can be no curing without the giving and receiving of care. 6. Every human culture has folk remedies, professional knowledge and professional care practices that vary. 7. Beneficial healthy, satisfying culturally based nursing care enhances the well-being of clients. INTERPROFESSIONAL HEALTH CARE TEAM ================================== - The World Health Organization defines interprofessional collaboration as **multiple health workers from different professional backgrounds working together with patients, families, caregivers, and communities to deliver the highest quality of care** (WHO, 2013). To be successful in interprofessional collaboration, the following core competencies are required: 1. Values and ethics related to interprofessional practice. 2. Knowledge of the roles of team members. 3. Team approach to health care. The transcultural interprofessional health care team has its core the client, who is the teams raison d\'être (reason for being). In addition to the client, the team may have one or more of the following members. 1. Client\'s family, significant others, or legally appointed guardian who might not be genetically related. 2. Credentialed health professionals such as nurses, physicians, nutritionists, physical therapist, respiratory therapists and other related professionals with formal academic preparation, licensure, and/or certification. 3. Folk, indigenous, or traditional healers: unlicensed individuals who learn healing arts and practices through study, observation, apprenticeship, and imitation and sometimes by inheriting healing powers, for example herbalists, curanderos, medicine men/women, Amish brauchers, bonesetters, and lay midwives. 4. Religious or spiritual healers: clergy or lay members of religious groups who heal through prayer, religious or spiritual rituals, and faith healing practices such as priests, elders, rabbis, imams, monks, and others believed to have healing powers derived from faith, spiritual powers or religion. 5. Others identified by the client as significant to his or health, well-being, or healing such as companion animals or pets as culturally appropriate. COMMUNICATION ============= 1. Language =========== 1. Language is one of the primary ways that culture is transmitted from one generation to the next. 2. More than 7,000 languages are spoken throughout the world. 3. 382 languages are spoken in the U.S. alone, where nearly 62 million people, aged 5 years or older, speak a language other than English at home. 4. Spanish is the second most commonly spoken language, and Chinese ranks third. 2. Interpreters =============== 1. Even a person from another culture or country who has a basic command of the language spoken by the majority of nurses and other health professionals may need an interpreter when faced with the anxiety-provoking situation of entering a hospital, encountering an unfamiliar symptom, or discussing a sensitive topic such as birth control or gynecological or urological concerns. 2. A trained medical interpreter knows interpreting techniques, has the knowledge of medical terminology, and understands patient\'s rights. 3. The trained interpreter is also knowledgeable about cultural beliefs and health practices. 4. This person can help bridge the cultural gap and can give advice concerning the cultural appropriateness of nursing and medical recommendations. 3. Greetings ============ 1. Most cultures value formal greetings at the start of the day or whenever the first encounter of the day occurs. 2. When communicating with people from cultures that tend to be more formal, it is important to call a person by their title such as Mr., Ms., Mrs., Dr., Reverend, and related greeting as a sign of respect until such time as the individual gives permission to address them less formally. 4. Silence ========== 1. Native Americans: consider silence essential to understanding and respecting the other person. A pause following a question signifies that what has been asked is important enough to be given thoughtful consideration. 2. Chinese and Japanese: silence may mean that the speaker wishes the listener to consider the content of what has been said before continuing. 3. Arabs: may use silence out of respect for another\'s privacy. 4. French, Spanish and Russian: may interpret silence as a sign of agreement. 5. Asians: often use silence to demonstrate respect for elders. 6. African Americans: silence is used in response to a question perceived as inappropriate. 5. Eye Contact and Facial Expression ==================================== 1. U.S., Canada, Western Europe and most parts of Australia: eye contact is interpreted similarly: conveying interest, active engagement with the other person, forthrightness and honesty. People who avoid eye contact when speaking are viewed negatively and may perceived as withholding information or lacking in confidence. 2. Asia, Africa, Middle East: direct eye contact may be seen as disrespectful, a sign of aggression, or a sign that the other person\'s authority is being challenged. 3. Native American: a person that looks down the floor while someone in authority is speaking is a sign of respect and interest. 4. In some cultures, staring at someone for a prolonged period of time means that person has sexual interest in the other person. People who make eye contact, but only briefly are viewed as respectful and courteous. Eyerolling in most cultures are considered inappropriate. 6. Gestures =========== 1. Emblems: gestures that serve the same function as words. For example, thumbs up means okay, the come here hand movement, or the hand gesture used when hitchhiking. 2. Illustrators: gestures that accompany words to illustrate a verbal message. For example, pointing to the right or left, while verbally saying right or left. 3. Regulators: gestures such as raising one\'s hand before verbally asking a question. Head nodding and short sounds such as \"uh huh\" or \"hmmm\" are also included in regulators. 4. Adaptors: are nonverbal behaviors that either satisfy some physical need such as scratching or adjusting eyeglasses or represent a psychological need such as biting fingernails when nervous, yawning when bored or clenching your fist when angry. 7. Posture ========== 1. Open posture is characterized by hands apart or often leaning forward showing interest in someone and a readiness to listen. 2. Closed posture is often characterized with having arms folded or legs crossed usually conveying disinterest or discomfort. \*Crossed arms: defensive, self-protective, or closed-off \*Hands on the hips: ready and in control, or a sign of aggressiveness **8.** **Proxemics**: the study of space and how differences in that space can make people feel more relaxed or more anxious. Distances have been identified based on the relationship between or among the people involved. 1. Intimate space (touching to one foot) is typically reserved for whispering and embracing. Nurses sometimes need to enter this intimate space when providing care for clients. 2. Personal space (2-4 feet) is used among family and friends or to separate people waiting in line at the drug store or ATM. 3. Social space (4-10 feet) used for communication among business or work associates and to separate strangers, such as those taking a course on natural childbirth. 4. Public space (12-25 feet) is the distance maintained between a speaker and the audience. **9.** **Modesty**: a form of mixed non-verbal and verbal communication that refers to reserve or propriety in speech, dress, or behavior. It conveys a message that is intended to avoid encouraging sexual attention or attraction in others. 1. Hijab-traditional Muslim women beyond the age of puberty wear a headscarf to cover their head and hair as a sign of modesty and religious faith. 2. Burka-is the most concealing of all Islamic coverings, it is a one-piece veil that conceals the face and body, often leaving just a mesh screen to see through. 3. Amish, Orthodox, Judaism, Catholics- women cover their heads, arms, and or legs. Men often cover their heads and/or wear clothing that conveys modesty. 4. The Church of Jesus Christ of Latter-day Saints often discourage clothing such as \"short shorts\" and short skirts (usually needs to reach the knees), shirts that do not cover the stomach, and clothing that does not cover the shoulders (or sleeveless shirts) or is low cut in the front or the back is discouraged.