Introduction to Transcultural Nursing PDF

WELCOME to Cultural and Spiritual Dimensions in Healthcare! Ben Bienvenu Willkom Venuti a a tout le tutti!! monde!! men!! Mabuhay! BIenvenidos a todos! Welcome! Why should we study it?? It’s very Important Madeleine Lein...

WELCOME to Cultural and Spiritual Dimensions in Healthcare! Ben Bienvenu Willkom Venuti a a tout le tutti!! monde!! men!! Mabuhay! BIenvenidos a todos! Welcome! Why should we study it?? It’s very Important Madeleine Leininger (1925 -2012) “ Care” heart of nursing power healing curing central and dominant focus of nursing  Support for teaching this content Table 1. Guidelines for the Practice of Culturally Competent Nursing Care. Guideline Description 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. 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. Douglas MK1, Rosenkoetter M, Pacquiao DF, Callister LC, Hattar-Pollara M, Lauderdale J, Milstead J, Nardi D, Purnell L.. (2014). Guidelines for implementing culturally competent nursing care. Journal of Transcultural Nursing, 25(2):109-21. doi: 10.1177/1043659614520998. Epub 2014 Feb 18. Retrieved August 12, 2016.  TRANSCULTURAL NURSING  a major area of nursing focused on the comparative study and analysis of diverse cultures and subcultures in the world with respect to their caring values, expressions, health illness beliefs, and patterns of behavior (Leininger, 1991)  Basic Concepts  Transcultural Nursing—the study of the lifeways and patterns of persons of various cultures including their healthcare practices and nursing’s role in that culture.  Cross Cultural Nursing—the study of the lifeways and patterns of persons of various cultures from an anthropological perspective that is being applied to nursing.  Concepts (Cont’d)  International Nursing— the exchange of nurses between 2 or more nations/cultures.  Culture—the patterns and lifeways that guide a group of people’s worldview and decision-making.  Cultural Imposition—a situation where one culture forces their values and beliefs on another culture or subculture.  Concepts (Cont’d)  Acculturation—the process of adapting or modifying the patterns and lifeways of an adopted culture as a result of contact with another group or individual.  Assimilation—the process of accepting some of the cultural practices or traits of the prevailing culture into one’s own daily activities.  Refugee—a person who flees from persecution, invasion, or political danger.  Concepts (cont’d)  Values—something regarded as desirable, worthy, or right, as a belief, standard, or moral precept.  Beliefs—a tenet or body of tenets; doctrine; creed.  Ethnocentrism—the universal tendency of human beings to think that their ways of thinking, acting, and believing are the only right, proper, and natural ways. It can be a major barrier to providing culturally conscious care.  Prejudice—Negative attitudes toward a specific group of people (e.g., race, religion) (Pincus, 2006).  Discrimination—Actions that deny equal treatment to persons perceived to be members of some social category or group (Pincus, 2006).  Concepts (Cont’d)  Generalization—usually an oversimplification made about behaviors of an individual or large group.  Stereotyping—An oversimplified conception, opinion, or belief about some aspect of an individual or group of people (Purnell, 2005).  Bias—A preference or an inclination, especially one that inhibits impartial judgment; or an unfair act or policy stemming from prejudice (IOM, 2003).  Assumption—A basic underlying assumption is an unconscious, taken-for-granted belief and value that helps determine behavior, perception, thought, and feeling (Schein, 2010). Cultural Competence in Nursing  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.  4 Levels of Cultural Competence  Unconscious incompetence—not being aware that one is lacking knowledge about another culture.  Conscious incompetence—being aware that one is lacking knowledge about another culture.  Conscious competence—learning about the client’s culture, verifying generalizations about the client’s culture, and providing culturally specific interventions.  Unconscious competence— automatically providing culturally congruent care to clients of a diverse culture.  W hat is Y OUR goal re: Cultural Competence??  Through this course we hope that you will desire to strive for CONSCIOUS COMPETENCE regarding your client’s culture when you practice. Nursing Theorists in Transcultural Nursing  Madeleine Leininger— the founder of Transcultural Nursing. Dr. Leininger studied anthropology in the 1950’s and early 60’s. She earned her PhD in Cultural Anthropology. She then decided that nursing was constantly dealing with the lifeways and patterns of peoples of many backgrounds and that in caring for these persons, nurses needed to be sensitive to the unique needs of all peoples. She felt strongly that we should NOT impose our views on others whenever possible. Date Contribution 1954 Leininger noticed and studied the cultural differences in the perception of care 1965 Leininger earned a doctorate in cultural anthropology [Univ. of Washington] Date Contribution 1965- Leininger offered first courses and telelectures offered in 1969 Transcultural Nursing [Univ. of Colorado School of Nsg] Est. 1st PhD nurse-scientist program combining anthro- pology and nursing[Univ. of Colorado School of Nsg] 1973 1st Academic Dept. in Transcultural Nursing est’d [Univ. of Washington, School of Nsg] 1974 Transcultural Nursing Society(TNS) est’d as the official organization of transcultural nursing. 1978 First advanced degree programs [Master’s & Doctoral] est’d [Univ. of Utah School of Nursing] 1988 Transcultural Nursing Society(TNS)—initiated certification examinations: Certified Transcultural Nurse 1989 Journal of Transcultural Nursing (JTN)—1st published as official publication of the TNS; Leininger is founding editor. The goal of the JTN is to disseminate transcultural ideas, theories, research findings, and/or practice experiences. 1991 Dr. Leininger published Culture Care Diversity and Universality: A theory of Nursing in which she outlines her theory [Culture Care Diversity and Universality and the Sunrise Model] and its research implications. 1995 Dr. Leininger published Transcultural Nursing— Concepts, Theories, Research & Practices as a text for undergraduate and graduate nursing students. 2001+ Dr. Leininger continued to teach a graduate level Transcultural Course at the Univ. of Northern Colorado. She guest lectured internationally at age 77!!  MAJOR CONCEPTS & DEFINITIONS  Human care and caring refers to the abstract and manifest phenomena with expressions of assistive, supportive, enabling, and facilitating ways to help self or others with evident or antici_x0002_pated needs to improve health, a human condition, or lifeways, or to face disabilities or dying.  MAJOR CONCEPTS & DEFINITIONS  Culture refers to patterned lifeways, values, beliefs, norms, symbols, and practices of individuals, groups, or institutions that are learned, shared, and usually transmitted from one generation to another  MAJOR CONCEPTS & DEFINITIONS  Culture Care refers to the synthesized and culturally constituted assistive, supportive, enabling, or facilitative caring acts toward self or others focused on evident or anticipated needs for the client’s health or well-being, or to face disabilities, death, or other human conditions.  MAJOR CONCEPTS & DEFINITIONS  Culture Care diversity refers to cultural variability or differences in care beliefs, meanings, patterns, values, symbols, and lifeways within and between cultures and human beings.  MAJOR CONCEPTS & DEFINITIONS  Culture Care universality refers to commonalities or similar culturally based care meanings (“truths”), patterns, values, symbols, and lifeways reflecting care as a universal humanity  MAJOR CONCEPTS & DEFINITIONS  Worldview refers to the way an individual or a group looks out on and understands the world about them as a value, stance, picture, or perspective about life and the world  MAJOR CONCEPTS & DEFINITIONS  Cultural and social structure dimensions refer to the dynamic, holistic, and interrelated patterns of structured features of a culture (or subculture), including religion (or spirituality), kinship (social), political characteristics (legal), economics, education, technology, cultural values, philosophy, history, and language.  MAJOR CONCEPTS & DEFINITIONS  Environmental context refers to the totality of an environment (physical, geographic, and sociocultural), situation, or event with related experiences that give interpretative meanings to guide human expressions and decisions with reference to a particular environ_x0002_ment or situation.  MAJOR CONCEPTS & DEFINITIONS  Ethnohistory refers to the sequence of facts, events, or developments over time as known, witnessed, or documented about a designated people of a culture.  MAJOR CONCEPTS & DEFINITIONS  Emic refers to local, indigenous, or the insider’s views and values about a phenomenon.  Etic refers to the outsider’s or more universal views and values about a phenomenon.  MAJOR CONCEPTS & DEFINITIONS  Health refers to a state of well-being or a restorative state that is culturally constituted, defined, valued, and practiced by individuals or groups and that enables them to function in their daily lives.  MAJOR CONCEPTS & DEFINITIONS  Culturally competent nursing care refers to the explicit use of culturally based care and health knowledge in sensitive, creative, and meaningful ways to fit the general lifeways and needs of individuals or groups for beneficial and meaningful health and well being, or to face illness, disabilities, or death.  Leininger’s Theory  She developed the “SUNRISE MODEL” as a basis for assessment and research in nursing. This model remains as a standard in Transcultural Nursing Theory.  Dr. Leininger also developed the ETHNONURSING Method for conducting Transcultural Research. While it is considered by Dr. Leininger to be Qualitative, it has certain attributes that make it somewhat Quantitative as well. Resource: http://www.madeleine-leininger.com/cc/overview.pdf Retrieved on 3/14/2017 from http://www.tcns.org/The ories.html  Leininger’s Theory (cont’d)  Note that the model looks like a Sunrise and the Worldview encompasses everything that makes people who they are.  The7 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.  Leininger’s Theory (cont’d)  Generic or Folk Systems are the everyday remedies an individual, family or group may use to promote wellness and healing. Some examples might include:  Chicken Soup  Chamomile Tea or other Herbal teas  Voodoo  Sacrifices of birds or animals to the spirits  Prayer  Curandero Nurses need to assess in all these areas to plan safe, effective care.  Leininger’s Theory (cont’d) 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.  How to Provide Culturally Congruent Care:  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.  How to Provide Culturally Congruent Care: (cont’d)  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.  How to Provide Culturally Congruent Care: (Cont’d)  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 Effect of the Nursing Care Model Based on Culture to Improve the Care of Malnourished Madurese Children in Indonesia (Hidayat and Uliyah, 2019)  Cultural care from Leininger’s perspective on the health of children (aged 0-2 years): a. Cultural care maintenance or preservation - action plan for including the habit of breastfeeding, formula milk, and prohibition on taking infants outside for 40 days after birth. b. Cultural care accommodation or negotiation - Breastfeeding for less than 2 years c. Cultural care re-patterning or restructuring - feeding NB with honey, formula and bananas and discarding the first milk  Josepha Campinha-Bacote  In 1991, Campinha-Bacote developed her own Transcultural Theory entitled “Culturally Competent Model of Care”.  She has continued to evolve in her model development through her research. Her newest 2010 model emphasizes the importance of ‘cultural encounters’ to increase cultural awareness, knowledge, skill, and desire.  She did much research in the African-American population. “Culturally Competent Model of Care” http://www.transculturalcare.net/  Geiger and Davidhizer Model  Joyce Newman Geiger and Ruth Davidhizer were inspired to develop a culturally competent assessment tool by their nursing students at Bethel College in Mishawaka, IN. Dr. Davidhizer just passed away in 2007.  The Transcultural Assessment Model was developed and researched in 1990.  Geiger and Davidhizer Model Communication Culturally Unique Individual Space Social Organization Biological Variations Time Environmental Control Giger, J. N., & Davidhizar, R. (2002). Culturally competent care: emphasis on understanding the people of Afghanistan, Afghanistan Americans, and Islamic culture and religion. International Nursing Review, 49(2), 79-86. doi:10.1046/j.1466-7657.2002.00118.x  Cultural competence in nursing  implies the ability of health care workers to give the best medical care to patients while demonstrating cultural awareness for their beliefs, race, and values. It entails having knowledge of patients’ cultural diversity and treating them with this in mind.  prepares nurses to empathize, relate more to patients, and attend more deeply to their needs.  Cultural competence goal:  Understanding the relationship between nurses and patients  Acquiring knowledge of various cultural practices and views of the world  Developing communication skills to promote and achieve interaction among cultures  Ensuring a positive attitude is displayed toward differences and various cultures  Components of cultural competence in nursing  Cultural awareness involves examining yourself, dropping prejudices that you have previously formed against foreign cultures, and developing the right attitude toward giving the best health service to all patients and clients.  Cultural knowledge involves searching for information about the culture and beliefs of your patients to better understand and interact with them.  Components of cultural competence in nursing  Cultural skills - involves your ability to collect relevant data and process it to help engage a patient in meaningful cross-cultural interaction.  Cultural encounter - encourages nurses to venture out of the environment they are conversant with and try new cultures and places. They improve their competence by interacting with people from different backgrounds, cultures, and ethnicities.  Cultural desire - requires a strong motivation to learn more about other cultures. It is a strong force that involves the ability to be open to new people, to accept and understand cultures that are different from yours, and be willing to learn.  A nurse who exhibits cultural competence:  Speaking in terms that are easy for the patient to follow and understand.  Not judging or disregarding a patient’s belief and religious background, but encouraging them to do what works best for them.  Empathizing with the patient at all times.  Valuing the individual and applauding strengths and individuality.  In Summary  You have been introduced to several theorists in Transcultural Nursing other than the author of your text. Next, we will explore the Purnell and Paulanka Model in greater depth as it will be the basis for your Cultural Presentations.  I hope you have been inspired to learn more about cultures in order to be a CULTURALLY CONSCIOUS COMPETENT NURSE   References  https://www.thechicagoschool.edu/insight/ health-care/the-importance-of-cultural- competence-in-nursing/