Transcultural Nursing Perspective - PDF

Perspective in transcultural nursing  OBJECTIVES At the end of this unit, you should be able to: Define culture Identify characteristics of culture Discuss areas of cultural influences on healthcare Enumerate factors inhibiting sensitivity to diversity Explain guidelines for delive...

Perspective in transcultural nursing  OBJECTIVES At the end of this unit, you should be able to: Define culture Identify characteristics of culture Discuss areas of cultural influences on healthcare Enumerate factors inhibiting sensitivity to diversity Explain guidelines for delivering culturally competent nursing care INTRODUCTION/DEFINITION Culture refers to the socially transmitted behaviour patterns, beliefs, values, customs, arts, and all other characteristics of people that guide their view of the world (worldview). Cultural beliefs, values, customs, and traditions are primarily learned within the family on an unconscious level. They can also be learned from the community in which one lives, in religious organizations, and in schools.  INTRODUCTION Cont’d Culture has strong influences on a patient’s understanding of health and responses to nursing care. You must understand the impact diversity can have on health behaviours in order to better meet the needs of your patients. As you learn more about ethnic and cultural groups, you will be challenged to look at the differences and similarities across cultures.  Characteristics of Culture 1. Culture is learned. Learning occurs through life experiences shared with other members of the culture. 2. Culture is taught. Cultural values, beliefs, and traditions are passed down from generation to generation either formally (e.g., in schools) or informally (e.g., in families) 3.Culture is shared by its members. Cultural norms are shared through teachings and social interactions.  Characteristics of Culture Cont’d 4. Culture is dynamic and adaptive. Cultural customs, beliefs, and practices are not static, but change over time and at different rates. Cultural change occurs with adaptation in response to the environment. 5. Culture is complex. Cultural assumptions and habits are unconscious, which may make it difficult for members of the culture to explain to others.  Characteristics of Culture Cont’d 6. Culture is diverse. Culture demonstrates the variety that exists between groups and among members of a particular group. 7. Culture exists at many levels. Culture exists in material (e.g., art, dress, or artifacts) and nonmaterial (as language, traditions, customs, beliefs, and practices) levels  Characteristics of Culture Cont’d 8. Culture has common beliefs and practices. Members of the culture share the same beliefs, traditions, customs, and practices as long as they continue to be adaptive and satisfy their needs. Some members do not always follow all of these, but many do.  Characteristics of Culture Cont’d 9. Culture is all encompassing. Culture can affect everything its members think and do. 10. Culture provides identity. Cultural beliefs provide identity for its members as long as there is no conflict with the dominant culture or lack of gratification by its members.  Cultural Sensitivity While the terms cultural sensitivity, cultural awareness, and cultural competence are similar, they have different meanings. Cultural sensitivity is knowing politically correct language and not making statements that may offend another person’s cultural beliefs.  Cultural Awareness: Focuses on history and ancestry and emphasizes an appreciation for and attention to arts, music, crafts celebrations, foods and traditional clothing. Cultural competence: Includes the skills and knowledge required to provide effective nursing care. In order for you to be culturally competent, you need to:  Cultural competence: 1. Have an awareness of your own culture and not let it have an undue influence on your patient. 2. Have specific knowledge about your patient’s culture. 3. Accept and respect cultural differences. 4. Adapt your nursing care (when appropriate) to your patient’s culture. Note: you may have knowledge about another culture, there are barriers that can cause you not to appreciate cultural differences  Factors Inhibiting Sensitivity to Diversity 1. Ethnocentrism, 2. Stereotype, 3. cultural imposition, 4. cultural blindness 1. Ethnocentrism: It is the tendency for human beings to think that their ways of thinking, acting, and believing are the only right, proper, and natural ways. Ethnocentrism perpetrates an attitude that beliefs that differ greatly from your own are strange or bizarre and therefore wrong.  Stereotype A stereotype is an opinion or belief about a group of people that is ascribed to an individual. For example, the statement “All Chinese people prefer traditional Chinese medicine” is a stereotype. This stereotype is not true. Although many Chinese people may prefer traditional Chinese medicine, but, not all Chinese people prefer it  Generalizations However, you can still make generalizations about an ethnic individual without stereotyping. Whereas a generalization, or assumption, may be true for the group, it does not necessarily fit the individual. Therefore, you must seek additional information to determine whether the generalization fits the individual.The challenge is for you to understand the patient’s cultural perspective.  Factors Inhibiting Sensitivity to Diversity Also affecting cultural sensitivity are cultural imposition, which is the belief that everyone should conform to your own belief system, and cultural blindness, which occurs when one ignores differences and proceeds as though they do not exist. This has been true of the healthcare system, especially in regard to what are considered non traditional methods of care.  OTHER TERMS IN CULTURE Acculturation: As people immigrate to a new country they learn to accept their own beliefs and those of their new country. This is known as Acculturation. This occurs because the new member must learn enough of the new culture to survive. Cultural Assimilation: This happens when new member takes on the dominant culture’s values, beliefs, and practices.  OTHER TERMS IN CULTURE Culture conflict: occurs when people become aware of cultural differences, feel threatened, and respond by ridiculing the beliefs and traditions of others to make themselves feel more secure about their own values Worse than that is cultural shock: this happens when values, beliefs, and practices sanctioned by the new culture are very different from the ones of the native culture.  CULTURAL INFLUENCES ON HEALTHCARE Physiologic Variations: Various studies have shown that certain racial and ethnic groups are more prone to developing specific diseases. For example, a hereditary disorder  CULTURAL INFLUENCES Cont’d Reactions to Pain: Studies have shown that many of the expressions and behaviours exhibited by people in pain are culturally prescribed. Some cultures allow and even encourage the open expression of emotions experienced by a person in pain, whereas other cultures frown on the open and free expression of emotions.  Reactions to Pain Cont’d Nursing care for patient in pain is individualized, but important culture-sensitive considerations are 1. Recognize that culture is an important component of individuality and that each person holds (and has the right to hold) various beliefs about pain. 2. Respect the patient’s right to respond to pain in whatever manner is culturally and individually appropriate. 3. Never stereotype a patient’s perceptions or responses to pain based on the person’s culture.  Mental Health Many ethnic groups have their norms or acceptable patterns of behaviour for psychological well-being and normal psychological reactions to certain situations. E.g. Hispanic people deal with problems within the family and would view it as inappropriate to tell problems to a stranger. Traditional Chinese people often consider mental illness a stigma; therefore, seeking psychiatric help would be a disgrace to the family.  Gender Roles In many cultures, men are dominant figures and generally makes decisions for all family members. E.g. if approval for medical care is needed, the man gives it regardless of which family member is involved. On the other hand, in many African American and Caucasian families, the woman is often dominant. Knowing who is the dominant member of the family is important when planning nursing care.  Language and Communication Nurses who work in a geographic area with a high number of residents who speak a language other than English should learn pertinent words and phrases in that language. Consider how difficult it must be to describe symptoms or give a personal health history when you do not understand the questions being asked.  Orientation to Space and Time Personal space is the area around a person regarded as part of the person. This area, individualized to each person and to different cultures and ethnic groups, is the area into which others should not intrude during personal interactions. If others do not consider a person’s personal space, that person may become uncomfortable or even angry. When giving care that involves physical contact, patient’s cultural personal space is considered.  Food and Nutrition Food preferences and how foods are prepared often are related culturally. Patients in a hospital or long-term care setting often do not have much choice of foods. This means that people with cultural food preferences may not be able to select appealing foods and thus may be at risk for inadequate nutrition. When assessing the cause of decreased appetite in patients, try to determine whether the problem may be related to culture.  Family Support In many cultural and ethnic groups, people have large, extended families and consider the needs of any family member to be equal to or greater than their own. They may be unwilling to share private information about family members with those outside the family (including healthcare providers). Other cultural groups have great respect for the elders in the family and would never consider institutional care for them.  Socioeconomic Factors Poverty cultures have characteristics like 1. Feelings of despair, resignation, and fatalism 2. Day-to-day attitude toward life, with no hope for the future 3. Unemployment and need for financial or government aid 4. Unstable family structure, characterized by abusiveness and abandonment 5. Decline in self-respect and retreat from community involvement  CULTURAL INFLUENCES ON HEALTH & ILLNESS People’s values and beliefs about health, illness, and care for an illness develop as a direct result of cultural and ethnic influence. For example, in some groups, illnesses are classified as natural or unnatural. “Natural illnesses” are caused by dangerous agents, such as cold air or impurities in the air, water, or food. “Unnatural illnesses” are punishments for failing to follow God’s rules, resulting in evil forces causing physical or mental health problems.  CULTURALLY COMPETENT NURSING CARE Providing culturally competent nursing care means that care is planned and implemented in a way that is sensitive to the needs of individuals, families, and groups from diverse populations within society. The nurse who recognizes and respects cultural diversity will be better equipped to exhibit cultural sensitivity and provide nursing care that accepts the significance of cultural factors in health and illness.  CULTURALLY COMPETENT NURSING CARE The healthcare system is itself a culture with customs, rules, values, and a language of its own, with nursing as its largest subculture. As you progress through your education, you will be acculturated into the culture of the healthcare system and will develop values related to health and healthcare.  CULTURALLY COMPETENT NURSING CARE When a nurse with a particular set of cultural values about health, interacts with a patient who has his own set of cultural values about health, some factors affect this interaction: 1. The cultural background of each participant 2. The expectations and beliefs of each about healthcare 3. The cultural context of the encounter (e.g., hospital, clinic, home) 4. The degree of agreement between the two persons’ sets of beliefs and values  CULTURALLY COMPETENT CARE Cont’d Nursing care can become complicated when the patient and the nurse have distinctly different cultural norms. Cultural imposition in healthcare is the tendency for health personnel to impose their beliefs, practices, and values on people of other cultures. Closely related to cultural imposition is ethnocentrism  CULTURALLY COMPETENT CARE Cont’d Unless the nurse is willing to examine carefully and clarify his or her own attitudes and values and to be sensitive to others who are “different,” the use of cultural concepts to provide care will be unsuccessful. The nurse’s role is to understand the patient’s needs and to adapt care to meet those needs. A careful merging of modern and traditional cultural beliefs is a necessary prerequisite for safe, considerate, and successful nursing care of all patients.  CULTURAL NORMS OF THE HEALTHCARE SYSTEM Beliefs 1. Standardized definitions of health and illness 2. Omnipotence of technology Practices 1. Maintenance of health and prevention of illness 2. Annual physical examinations and diagnostic procedures  CULTURAL NORMS OF HEALTHCARE SYSTEM Cont’d Habits 1. Documentation 2. Frequent use of jargon 3. Use of a systematic approach and problem-solving methodology Likes 1. Promptness 2. Neatness and organization 3. Compliance CULTURAL NORMS OF HEALTHCARE SYSTEM Cont’d Dislikes 1. Tardiness 2. Disorderliness and disorganization Customs 1. Professional reverence and adherence to the pecking order found in autocratic and bureaucratic systems 2. Use of certain procedures attending birth and death  Cultural Assessment When caring for patients with a different culture, it is important to first ask a patient how they want to be treated based on their values and beliefs. An effective way to identify specific factors that influence a patient’s behaviour is to perform a cultural assessment. The primary informant should be the patient, if possible. If the patient is not able to respond to the questions, a family member or a friend can be consulted.  Guidelines for Nursing Care Transcultural nursing care has been both developed as a specialty and established as a formal area of practice as the result of theory development by Dr. Madeleine M. Leininger, a nurse–anthropologist. Her Theory of Cultural Care Diversity and Universality (1991) provides the foundation for providing culturally competent care for patients of all ages, as well as to families, groups, and communities. Guidelines for Nursing Care Cont’d A nurse who is culturally competent has the knowledge and skills to adapt nursing care to cultural similarities and differences. Cultural competence takes time. It involves developing awareness, acquiring knowledge, and practicing skills. It is important to remember that these are only general guidelines and that each patient must be considered a unique individual.  Develop Cultural Self- Awareness Before you can provide culturally competent care to patients from diverse backgrounds, it is important to become aware of the role of cultural influences in your own life. Objectively examine your own beliefs, values, practices, and family experiences. As you become more sensitive to the importance of these factors, you will also become more sensitive to cultural influences in others’ lives.  Develop Cultural Knowledge Learn as much as possible about the belief system and practices of people in your community and of patients in the area in which you work. Practice techniques of observation and listening to acquire knowledge of the beliefs and values of patients for whom you are caring. Some people, especially those of minority cultures, may have been belittled and subjected to ridicule and may be hesitant to discuss their beliefs and practices.  Accommodate Cultural Practices in Healthcare Incorporate factors from the patient’s cultural background into healthcare whenever possible and when the practices are not considered harmful to health. To ignore or contradict the patient’s background may result in the patient refusing care or failing to follow prescribed therapy. Modify care to include traditional practices and practitioners as much as possible and be an advocate for patients from diverse cultural groups.  Respect Culturally Based Family Roles Take into consideration the cultural role of the family member who makes most of the important decisions. In some cultures, it is the husband or father, whereas in others, it is the grandmother or another respected elder. To disregard this fact or to proceed with nursing care that is not approved by this person can result in conflict or in disregard for what has been taught. Be careful to involve this person in the nursing care planning.  Avoid Mandating Change Keep in mind that health practices are part of the overall culture and that changing them may have widespread implications for the person. You need to provide the necessary support and reinforcement for the patient if a change in a health practice with a cultural basis is considered necessary. Do not force the patient to participate in care that conflicts with his or her values.  Seek Cultural Assistance Seek assistance of a respected family member, member of the clergy, or traditional healer, as indicated, so that the patient is more likely to accept healthcare services. Acknowledging the role of the person’s traditional healer can be an important way of building trust. If invited, folk medicine practitioners can work closely with professional health practitioners in the interest of the patient and family.