Running head: TRANSCULTURAL NURSING 1

Transcultural Nursing

Kristyn Beaver

Ferris State University

TRANSCULTURAL NURSING 2

Abstract

Transcultural care affects every nurse; one of many challenges facing nurses today.

Madeleine Leininger (1991) brought her concepts for transcultural nursing to the profession;

knowledge of these concepts could help the nurse give the best possible care to the patient and

family. This paper addresses her concepts. Including patients and family in the planning of care

ensures that diet plans and medication directions are followed (Galanti, 2008). By including

minorities and other cultures to the planning and implementing of public policy will ensure that

all people’s needs are met. Nursing standards for cultural competence incorporates twelve key

areas that organizations, policy makers, community leaders and healthcare professionals should

follow to ensure that all people are represented and their needs addressed will be discussed.

Keywords: Madeleine Leininger, transcultural nursing, cultural competence, Roy’s theory

of adaptation.

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Transcultural Nursing

Nurses face many challenges in their careers. One challenge is cultural competence for

the nursing professional. Nurses in every part of the world encounter patients and families from

cultures different from their own. There are over three thousand cultures worldwide

(Narayanasamy and White, 2004). No nurse could possibly know everything about every culture.

To deliver culturally competent care the nurse must first reflect on his/her own beliefs,

attitudes regarding pain management, culture, and sexual relations. In our ever-changing political

environment and growing number of immigrants, nurses need to be able to put aside his or her

own biases to provide quality care to the patient. The competent nurse realizes that patients and

their families have different views, experiences, and beliefs than he or she has; being able to get

beyond these differences to provide quality, competent care is essential. Care and treatment

should reflect the patients’ needs, ability, desires and understanding. By including the patient and

family in care planning, then treatments, diets and medications are better adhered to; providing

better outcomes (Douglas et al., 2011 and Smith 2013). In an environment of escalating costs of

healthcare, maintaining optimal health is essential; when patients stick to their diets and

medications, then their health improves.

Theory

Madeleine Leininger, in 1991, developed a theory known as the transcultural theory. This

theory is also known as the culture care theory (Nursing Theories, 2012). Culture care theory

looks at how cultures are the same and how they are different; and how nurses can care for

patients of other cultures in a holistic way. To be culturally competent, the nurse must decide and

act on three things: 1. Cultural preservation or maintenance, 2. Cultural care accommodation or

negotiation, and 3. Cultural care repatterning or restructuring (Nursing Theories, 2012).

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Concepts

Leininger (1991) described the major concepts related to her theory. These concepts

include: “1. Illness and wellness are shaped by various factors including perception and coping

skills, as well as the social level of the patient 2. Cultural competence is an important component

of nursing. 3. Culture influences all spheres of human life. It defines health, illness and the

search for relief form disease or distress. 4. Religious and cultural knowledge is an important

ingredient in health care. 5. The health concepts held by many cultural groups may result in

people choosing not to seek modern medical treatment or procedures. 6. Health care providers

need to be flexible in the design of programs, policies and services to meet the needs and

concerns of the culturally diverse population, groups that are likely to be encountered. 7. For the

nurse to successfully provide care for the client of a different cultural or ethnic background,

effective intercultural communication must take place” (Nursing Theories, 2012, p. 3).

Application

Nurses who incorporate Leininger’s concepts into their practice will achieve a degree of

cultural competence in providing care to the patient. Every nurse is affected by cultural

diversity; whether it is admitted or not. Hospital organizations need to make cultural diversity a

priority as there are growing numbers of immigrants each year. Not only do staff need to be

aware of cultural differences and how to handle them, staff need to be of a diverse nature too;

more male nurses and more nurses of ethnicity. For instance, caring for a Hispanic patient, it

would be considered polite and proper to inquire about their family upon admission. A form of

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small talk puts the Hispanic patient at ease, making the nurse seem personable to the patient

(Galanti, 2008).

Collaborative Theory

Roy’s Adaptation Model

This model is chosen as it applies to the patient’s ability to adapt to changing conditions

and environments. Other professions discuss the need to be able to incorporate diversity in their

employee and management teams, however, finding a specific theory that has been tested and

used in the business world was elusive. There were many papers discussing transcultural

diversity, but none about a particular theory. Sister Callista Roy’s model fits for both the patient

and the nurse; as everyone needs to adapt and be flexible. Roy’s model makes some assumptions

about all people. A few of these assumptions are: 1. that each person copes with change based on

their environment, culture, experiences and biological makeup; 2. There are four modes of

adaptation (physiologic needs, self-concept, role function, and inter-dependence); and 3. Each

person is in constant interaction with his/her ever-changing environment (Nursing Theories,

2012). These assumptions apply to everyone; nurse and patient.

Assessment of the Healthcare Environment

With ever-changing arena of healthcare, there is a noticeable shift in patient

demographics in most regions. Immigration is rising; not only people coming to our country but

nurses going to other countries. Eventually, the minorities will be the majority here in the United

States. With this in mind, nurses need to be culturally sensitive and competent in the differences

in patient populations.

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The article by Douglas et al. (2011) regarding the standards of practice for the culturally

competent nurse has twelve standards. The standards are as follows: 1. Social Justice, 2. Critical

reflection, 3. Knowledge of culture, 4. Culturally competent practice, 5. Cultural competence in

health care system and organization, 6. Patient advocacy and empowerment, 7. Multicultural

workforce, 8. Education and training in culturally competent care, 9. Cross-cultural

communication, 10. Cross-cultural leadership, 11. Policy development and 12. Evidence-based

practice and research (p.318). This article’s purpose was to bring about a discussion regarding

adopting universally acceptable standards of care for cultural competence. Authors compiled

information from the World Health Organization, American Nurses Association, United Nations,

International Council of Nurses, the Nursing Council of New Zealand, Nation Association of

Social Workers, and the American Association of the Colleges of Nursing; information totaling

fifty documents in all to compile their paper on standards.

Using these standards to set policy, organizations and networks can establish a culturally

competent nursing staff. Challenges organizations will have will be staff compliance and

prejudices; patient bias’ regarding staff members; physician bias and compliance; social

acceptance of cultural diversity in their communities; and healthcare disparities. With the

establishment of health insurance exchanges in the coming year, it is the hope that health

disparities will decrease with more accessible health care to more people. Other challenges will

be having enough providers to get minority patients care in a timely manner.

Culture care theory was used in several studies to analyze quality of care to different

ethnic groups in the United States. One article by Wehbe-Alamah (2011), focused on the Syrian

Muslim population in the mid-western United States. Using this theory, the author found that by

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interviewing and learning about other cultures, the nurse then can gain general knowledge about

other cultures to better care for the patient and family.

Ultimately, each nurse needs to be aware of the various cultures in the community in

which he/she work and live. Different religions have different practices so it is also the nurse’s

responsibility to learn something of these practices to better care for the patient. Being culturally

competent is to have tolerance for those of different beliefs, practices, ideologies, and

preferences. Some examples of flexibility in caring for patients would be for the Jewish

community, providing Kosher diets and being aware of their Sabbath days and the restrictions

the Jewish people have at those times. Another example would be to allow Catholic patients to

have religious medals or medallions with them for surgery or statues in their rooms. These

religious articles provide comfort to the patient in times of stress.

Quality and Safety

Douglas et al. (2011) gave wonderful examples on incorporating strategies into practice

for individuals and organizations. Organizations, communities and individuals need to include

elements of social justice into the educational systems; both private and public sectors. Institute

policies that address social injustices in our communities to push for more equality and eliminate

disparities; like the affordable care act providing insurance to more people. Hospitals and other

community organizations can host or sponsor workshops that “expand understanding of different

cultures” (Douglas et al., 2011 p.22). Individually, nurses can reflect on personal beliefs and

values; realizing how these might affect their patient care. Like, how a nurse might feel taking

care of a lesbian couple during labor and delivery of a baby. Hospitals and departments within

them can offer cultural diversity workshops that focus on the various cultures in their

communities to allow nurses to understand the people they will come in contact with.

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Key with any patient care is ultimately communication! Be an active listener with each

patient and family that enter the health care system. Offer patients, and families, opportunities to

participate in care and planning of care allowing for differences in approach, to take into account

varying lifestyles, will improve compliance and outcomes. Organizations can teach interviewing

techniques to new nurses. Provide professional interpreters for the languages in the community.

With effective and open communication between the nurse and the client, then each can learn

from the other. Learning is mutually beneficial; nurses learn varying cultures and patients can

formulate a plan of care they can adhere to.

Organizations must be willing to hire people of varying cultures and ethnicities. By

having a diverse workforce, organizations become more reflective of their community

population. Communities can celebrate ethnicities and religions by allowing and encouraging

celebrations by those groups. Nurses can participate in continuing education, either through

formal classes or informal inquiry, on various cultures.

Challenges to these standards, as states earlier, would be staff and community resistant to

change. Incorporating some of these changes in a planned process that includes staff, physicians,

and hospital administration along with community members will make these changes more

successful. Without open-communication, mistakes happen and patient care suffers. Including

patients and families in care, treatments, and evaluation of what is working and what is not, then

outcomes can only improve.

Review of Literature regarding Culture Care Theory

Studies that have shown that improved outcomes have occurred when cultural

competency is practiced include the previously mentioned study done by Wehbe-Alamah (2011)

with Syrian Muslims in the mid-western United States. This study looked at the way Syrian

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Muslims care for each other in times of health and illness. Another study done by Swanson

(2012) reviewed immigrant Hispanic culture. With this study, it revealed that more work needs

to be done with regards to decreasing disparities among this group; one of the fastest growing

population in our country. Better access to preventive medicine of some of the major chronic

illness; hypertension and diabetes among them. The federal government with its institution of

Consumer Assessment of Healthcare Providers and Systems (CAPHS) is looking for patient

perceptions of five areas that look at cultural competencies. The five area are “language access,

patient provider communication and alternative medicine, shared decision-making, experiences

of discrimination, and trust” (Swanson, 2011, p.2-3). In the last study reviewed, homelessness

was the topic. In using culture care theory to address homelessness as a culture in itself, then

nurses and physicians can address this population’s unique needs and desires (Law and John,

2012). This study expanded on the theory’s ethnicity focus to a much broader scope. In doing so,

it opens the doors for studying other subcultures in our varying cultures (Law and John, 2012).

Conclusion

With the ever changing dynamics of our communities and healthcare settings, nurses and

the organizations they work for need to strive to understand and care for persons of varying and

differing beliefs. Social justice and awareness are parts of acceptance of others. Nurses need to

understand their patient population, the do not necessarily need to agree with them. Everyone

deserves respect and quality care with outcomes aimed at achieving optimal health and living for

every person. Through cultural awareness and respect, nurses can deliver care for the individual

patient and family. In individualizing care, taking the patients’ needs, desires, and beliefs into

account, this will give the best outcomes for our patients.

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References

Douglas, M.K., Pierce, J.U., Rosenkoetter, M., Pacquiano, D., Callister, L.C., Hattar-Pollara, M.,

Lauderdale, J., Milstead, J., Nardi, D., Purnell, L. (2011). “Standards of practice for

culturally competent nursing care: 2011 update.” Transcultural Nursing, 22; 317. Doi

10.1177/1043659611412965.

Galanti, G.A. (2008). Caring for patients from different cultures. Philadelphia, Pennsylvania,

University of Pennsylvania.

Law, K., & John, W. (2012). “Homelessness as culture: how transcultural nursing theory can

assist caring for the homeless.” Nurse Education in Practice. DOI:

10.1016/j.nepr.2012.04.010.

Narayanasamy, A., & White, E. (2004). “A review of transcultural nursing” Nurse Education

Today. Doi: 10.1016/j.nedt.2004.09.011.

Nursing Theories (2012). “Transcultural nursing theory” As retrieved from

http://currentnursing.com/nursing_theory/transcultural_nursing.html. On June 11, 2013

Nursing theories (2012). “Roy’s Adaptation Model” As retrieved from

http://currentnursing.com/nursing_theory/Roy_adaptation_model.html. On June 11, 2013

Smith, L.S. (2013). “Reaching for cultural competence” Nursing 2013, June, 2013. Lippincott

Williams & Willkins. As retrieved from Nursing2013.com.

Swanson, C.R. (2012). “The case for studying cultural competence from the perspective of the

Hispanic immigrant patient: a state of science” Online journal of Cultural Competence

in Nursing and Healthcare 2(1); 1. As retrieved from www.ojccnh.org.

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Wehbe-Alamah, H. (2011). “The use of cultural care theory with Syrian Muslims in the Mid-

western United States” Online Journal of Cultural Competence in Nursing and

Healthcare 1(3) 1-12. As retrieved from www.ojccnh.org.

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CHECKLIST FOR SUBMITTING PAPERS

CHECKDATE, TIME, & INITIAL

PROOFREAD FOR: APA ISSUES

x 1. Page Numbers: Did you number your pages using the automatic functions of your Word program? [p. 230 and example on p. 40)]

x 2. Running head: Does the Running head: have a small “h”? Is it on every page? Is it less than 50 spaces total? Is the title of the Running head in all caps? Is it 1/2” from the top of your title page? (Should be a few words from the title of your paper). [p. 229 and example on p. 40]

You said in abstract that there is going to be a review of prominent cultures and religions but you only talked about 2 (Syrian Muslims & Hispanics) not sure if you want more cultures in your paper

3. Abstract: Make sure your abstract begins on a new page. Is there a label of Abstract and it is centered at the top of the page? Is it a single paragraph? Is the paragraph flush with the margin without an indentation? Is your abstract a summary of your entire paper? Remember it is not an introduction to your paper. Someone should be able to read the abstract and know what to find in your paper. [p. 25 and example on p. 41]

x 4. Introduction: Did you repeat the title of your paper on your first page of content? Do not use ‘Introduction’ as a heading following the title. The first paragraph clearly implies the introduction and no heading is needed. [p. 27 and example on p. 42]

x 5. Margins: Did you leave 1” on all sides? [p. 229]x 6. Double-spacing: Did you double-space throughout? No triple or extra spaces between

sections or paragraphs except in special circumstances. This includes the reference page. [p. 229 and example on p. 40-59]

x 7. Line Length and Alignment: Did you use the flush-left style, and leave the right margin uneven, or ragged? [p. 229]

x 8. Paragraphs and Indentation: Did you indent the first line of every paragraph? See P. 229 for exceptions.

x 9. Spacing After Punctuation Marks: Did you space once at the end of separate parts of a reference and initials in a person’s name? Do not space after periods in abbreviations. Space twice after punctuation marks at the end of a sentence. [p. 87-88]

x 10. Typeface: Did you use Times Roman 12-point font? [p. 228]x 11. Abbreviation: Did you explain each abbreviation the first time you used it? [p. 106-

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111]x 12. Plagiarism: Cite all sources! If you say something that is not your original idea, it must

be cited. You may be citing many times…this is what you are supposed to be doing! [p. 170]

x 13. Direct Quote: A direct quote is exact words taken from another. An example with citation would look like this:“The variables that impact the etiology and the human response to various disease states will be explored” (Bell-Scriber, 2007, p. 1).Please note where the quotation marks are placed, where the final period is placed, no first name of author, and inclusion of page number, etc. Do all direct quotes look like this? [p. 170-172]

I’m not sure if your Leininger quote on page 4 is in block quotes or not so just double check

14. Quotes Over 40 Words: Did you make block quotes out of any direct quotes that are 40 words or longer? [p. 170-172]

x 15. Paraphrase: A paraphrase citation would look like this:Patients respond to illnesses in various ways depending on a number of factors that will be explored (Bell-Scriber, 2007).It may also look like this: Bell-Scriber (2007) found that…… [p. 171 and multiple examples in text on p. 40-59]For multiple references within the same paragraph see page 174.

x 16. Headings: Did you check your headings for proper levels? [p. 62-63].Pretty sure you know how to do this

17. General Guidelines for References:A. Did you start the References on a new page? [p. 37]B. Did you cut and paste references on your reference page? If so, check to make sure they are in correct APA format. Often they are not and must be adapted. Make sure all fonts are the same.C. Is your reference list double spaced with hanging indents? [p. 37]

PROOFREAD FOR GRAMMAR, SPELLING, PUNCTUATION, & STRUCTUREx 18. Did you follow the assignment rubric? Did you make headings that address each major

section? (Required to point out where you addressed each section.)x 19. Watch for run-on or long, cumbersome sentences. Read it out loud without pausing

unless punctuation is present. If you become breathless or it doesn’t make sense, you need to rephrase or break the sentence into 2 or more smaller sentences. Did you do this?

x 20. Wordiness: check for the words “that”, and “the”. If not necessary, did you omit?x 21. Conversational tone: Don’t write as if you are talking to someone in a casual way. For

example, “Well so I couldn’t believe nurses did such things!” or “I was in total shock over that.” Did you stay in a formal/professional tone?

x 22. Avoid contractions. i.e. don’t, can’t, won’t, etc. Did you spell these out?x 23. Did you check to make sure there are no hyphens and broken words in the right margin?x 24. Do not use “etc.” or "i.e." in formal writing unless in parenthesis. Did you check for

improper use of etc. & i.e.?

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x 25. Stay in subject agreement. When referring to 1 nurse, don’t refer to the nurse as “they” or “them”. Also, in referring to a human, don’t refer to the person as “that”, but rather “who”. For example: The nurse that gave the injection….” Should be “The nurse who gave the injection…” Did you check for subject agreement?

x 26. Don’t refer to “us”, “we”, “our”, within the paper…this is not about you and me. Be clear in identifying. For example don’t say “Our profession uses empirical data to support ….” . Instead say “The nursing profession uses empirical data…..

x 27. Did you check your sentences to make sure you did not end them with a preposition? For example, “I witnessed activities that I was not happy with.” Instead, “I witnessed activities with which I was not happy.”

x 28. Did you run a Spellcheck? Did you proofread in addition to running the Spellcheck?x 29. Did you have other people read your paper? Did they find any areas confusing?x 30. Did you include a summary or conclusion heading and section to wrap up your paper?x 31. Does your paper have sentence fragments? Do you have complete sentences?x 32. Did you check apostrophes for correct possessive use. Don’t use apostrophes unless it is

showing possession and then be sure it is in the correct location. The exception is with the word it. It’s = it is. Its is possessive.

Signing below indicates you have proofread your paper for the errors in the checklist:

___________________K.Beaver____________________DATE:_________7-17-2013_______

A peer needs to proofread your paper checking for errors in the listed areas and sign below:

_______Cassie K._________________________DATE:______7-15-13_________

Revised Spring 2010/slc

For the record I am not awesome at grammar so you may not want to take my word for it. The paper is good and I think you are on track with everything. I would love to talk to you about some suggestions on things to add but it is completely up to you. Sorry it took so long