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HISTORICAL HISTORICAL PERSPECTIVESPERSPECTIVES

• Transcultural nursingTranscultural nursing is a body of knowledge tandem & practice for caring for persons from other cultures

• Cultural awarenessCultural awareness can they appreciate and are sensitive to the values, beliefs, Iifeways, practices, and problem-solving methods of a client s culture.

• Cultural blindnessCultural blindness occurs when the nurse does not recognize his or her own beliefs and practices, nor the beliefs and practices of others. EthnocentrismEthnocentrism refers to the idea that one's own ways are the only way or the best way to behave, believe, or do things.

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• Cultural KnowledgeCultural Knowledge encompasses the familiarity of the worldview, believes practices, & problem-solving strategies of groups that are ethnically or culturally diverse.

• Community-based nursingCommunity-based nursing practices require that the nurse have cultural knowledge of the community. This knowledge allows the nurse to use a preventive approach and facilitate self-care according to the client's particular culture. Collaboration and continuity in which he or she is working with the client.

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• Lack of cultural knowledgeLack of cultural knowledge stands in the cultural competence. Nurses can have wonderful intentions and be sensitive & caring, but if there is a lack of specific knowledge about the client's cultures, these mistakes are bound to be made.

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THE MEANING OF CULTURE

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• CultureCulture refers to the beliefs, values, and behavior that are shared by members of a society and provide a design or “map” for living. It is culture that tells people what is acceptable or unacceptable in a given situation. It is culture that dictates what to do, say, or believe. Culture is learned.

• Cultural diversityCultural diversity (also called cultural plurality) means that a variety of cultural patterns coexist within a designated geographic area.

• EthnocentrismEthnocentrism is the belief and feeling that one’s own culture is best. It reflects our tendency to judge other people’s beliefs and behavior using values of our own native culture”

• Discrimination; Differential treatment of an individual due to minority status; actual and perceived; e.g., "we just aren't equipped to serve people like that."

• Cultural imposition; Belief that everyone should conform to the majority; e.g., "we know what's best for you, if you don't like it you can go elsewhere."

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CHARACTERISTICS OF CULTURE

• Anthropologists & sociologists have made significant contributions to the field of community health.

• Their findings shed light on why and how culture influences behavior.

• Five characteristics shared by all cultures are especially pertinent to nursing efforts to improve community health: (1) culture is learned, (2) integrated, (3) it is shared, (4) it is tacit, (5) it is dynamic.

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Culture Is LearnedCulture Is Learned• Patterns of cultural behavior are acquired, not inherited. Rather

than being genetically determined, the way people dress, what they eat, and how they talk are all learned.

• At the moment of birth, we lack a culture. We don’t yet have a system of beliefs, knowledge, & patterns of customary behavior. But from that moment until we die, each of us participates in a kind of universal schooling that teaches us our native culture.

• Laughing and smiling are genetic responses, but as infants we soon learn when to smile, when to laugh, and even how to laugh. We also inherit the potential to cry, but we must learn our cultural rules for when crying is appropriate.

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Culture Is IntegratedCulture Is Integrated• Rather than being merely an assortment of various

customs and traits, a culture is a functional, integrated whole. As in any system, all parts of a culture are interrelated & interdependent.

• The various components of a culture, such as its social mores or religious beliefs, perform separate functions but come into relative harmony with each other to form an operating and cohesive whole. In other words, to understand culture, single traits should not be described independently.

• Each part must be viewed in terms of its relationship to other parts and to the whole. In some cultural groups (eg, Muslims), modesty for women may make it uncomfortable and perhaps traumatic to be examined by a person of the opposite sex.

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Culture Is SharedCulture Is Shared• Culture is the product of aggregate behavior, not

individual habit. Certainly, individuals practice a culture, but customs are phenomena shared by all members of the group.

• Culture does not depend on individuals. An ordinary habit dies with its possessor, but a group habit lives on in the survivors and is transmitted from generation to generation.

• Moreover, the individual is not a free agent with respect to culture. He is born and reared in a certain cultural environment, which impinges on him at every moment of his life.

• From earliest childhood his behavior is conditioned by the habits of those around him. He has no choice but to conform to the folkways current in his group.

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Culture Is Mostly TacitCulture Is Mostly Tacit

•Culture provides a guide for human interaction that is tacit that is, mostly unexpressed & at the unconscious level. Members of a cultural group, without the need for discussion, know how to act & what to expect from one another.

•Culture provides an implicit set of cues for behavior, not a written set of rules. Because culture is mostly tacit, realizing which of one’s own behaviors may be offensive to people from other groups is difficult. It also is difficult to know the meaning and significance of other cultural practices.

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Culture Is Mostly TacitCulture Is Mostly Tacit•In some groups, such as Islamic women, silence is valued and expected but may make others uncomfortable. Offering food to a guest in many cultures is not merely a social gesture but an important symbol of hospitality and acceptance; to refuse it, for any reason, may be an insult and a rejection.

•Touching or calling someone by their first name may be viewed as a demonstration of caring by some groups but is seen as disrespectful & offensive by others.

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Culture Is DynamicCulture Is Dynamic• Every culture undergoes change; none is entirely

static. Within every cultural group, some individuals generate innovations. More important, some members see advantages in doing things differently and are willing to adopt new practices.

• Each culture, including our own, is an amalgamation of ideas, values, and practices from a variety of sources. This process depends on the extent of exposure to other groups.

• Nonetheless, every culture is in a dynamic state of adding or deleting components. Functional aspects are retained; less functional ones are eliminated.

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Transcultural Assessment Model

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The leininger Sunrise ModelThe leininger Sunrise Model•A culture is made up of educational, economic, political, legal, kinship, religious, philosophical, & technological systems. Each of this identified system affects health.

•Health needs are biological psychosocial and cultural and are met within a combination of two subsystems: a folk health system (primarily rented to religious beliefs and practices) and the professional health system.

•Leininger (1991) points out that the greater the differences between folk and professional care practices the greater the need for nursing care accommodations.

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The folk health systemThe folk health system•The traditional or indigenous health care

beliefs and practices These are per- formed by local practitioners, are well known to the culture, and have special meanings and uses to heal or assist people to regain well-being or health or to face unfavorable circumstances.

•Professional health system refers to those cognitively learned & practiced modes of assisting others that are obtained through formal professional schools of learning.

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•Folk medicine systems vary, but they often explain illness in terms of balances between the individual & the physical, social, & spiritual worlds & focus on personal relationships, perhaps involving many persons.

•Folk medicine classifies illness and disease as natural or unnatural. Natural illnesses are based on logical cause- &-effect relationships. Unnatural events are believed to occur when the harmony of nature is upset. They are unpredictable & may be considered a result of evil forces.

Cont

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Complementary Therapies and Self-

Care Practices

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• Complementary therapies (also called alternative medicine or alternative therapies) are practices that are used to complement contemporary Western medical and nursing care and are designed to promote comfort, health and well-being. The range of complementary therapies is broad and includes:

Diet therapies (cancer diets, juice diets, fasting)GI treatments (coffee enemas, high colonic

enemas)Balance and exercise activities (yoga)Sensory exposure (aromatherapy, music therapy,

light therapy)Therapeutic manipulation (acupuncture,

acupressure) client based on cultural group norms.

C u l t u r a l / i d e o l o g i c a l L e v e lC u l t u r a l / i d e o l o g i c a l L e v e l• Culture consists of a society’s framework of knowledge and beliefs, the content

of its books and mass media, its technology, the determination of how social roles are to be fulfilled, which behaviors are normal and which unacceptable and which are its morals and value systems. It is culture that ranks the importance of families versus individuals, of industriousness versus leisure.

• It is culture that determines the relative value of competitiveness, equity among people, benevolence, valuation of health, and ultimate goals. A community’s infrastructure— its roads, bridges, water, electricity, buildings, and medical technology— might be viewed as part of the physical environment, but it all has been created or borrowed by the culture.

• Culture is the way of life of a people. Like health and disease, culture is transmitted from group to group, from generation to generation. Witness the power of television to transmit the culture of high-technology nations—both the useful and the destructive aspects—to every corner of the world. Raising the hopes for a healthier, happier life has been useful, but marketing materialism, consumerism, aggression, & violence has been harmful.

C u l t u r a l / i d e o l o g i c a l L e v e lC u l t u r a l / i d e o l o g i c a l L e v e l• A community’s ideology is part of its overall culture, and is often

inferred, rather than seen. Ideology is the world of ideas, beliefs, and values in which the members of a society live.

• What people say is important to them is not always reflected in their behavior, however, and the written plan for many institutions is often not the “real” way they operate. In health planning, it is critical to understand this paradox.

• Culture tells its possessor what is important. It may value fame, sports skills, or conforming to friends. Or, it may tell who is important and who can be left out—perhaps women, ethnic minorities, the poor, and the powerless, who are often neglected.

C u l t u r a l / i d e o l o g i c a l L e v e lC u l t u r a l / i d e o l o g i c a l L e v e l• The stream of illness generated in these subgroups by lack of

resources, lack of knowledge and skills, and lack of “a way out,” is forced under the surface in many communities. But illness filters upwards to and through the roots of the upper and powerful classes, and the garden at the top soon ceases to flourish.

• Culture also tells us what is possible and what is not. For example, villagers in Suriname’s interior had known malaria as far back as their spoken history could trace. And, they used the statistically powerful “persistency forecast”—the best predictor of the future is what has always happened in the past—to accept that malaria would always be a part of their lives.

• By developing trust in health workers, however, who themselves had seen malaria eradicated in their own communities, Surinamese villagers were able to change their perception of what “is possible,” and so release hope and energy to eradicate the malaria scourge in their own communities

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Generic & Professional Knowledge•EmicEmic refers to the local or insider's views

and values about a phenomenon.

•EticEtic is the professional or outsider s views and values about a phenomenon.

•The community-based nurse uses both these types of care knowledge and verified with the client and family those areas that are meaningful and acceptable to them. Discovering how generic (Emic) and professional (Etic) systems are alike or different assists the nurse in providing culturally congruent care to individuals or groups

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Component of Cultural Assessment

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Six phenomena of cultural assessment

1)1) CommunicationCommunication. A continuous process by which one person may affect another through written or oral language, gestures, facial expressions

2)2) SpaceSpace- The area around a person's body that includes the individual, surrounding environment and object within that environment.

3)3) Social organizationSocial organization. The family and other groups within a society that dictate culturally accepted role behaviors of different member of the society

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4)4) TimeTime.. The meaning & influence of time from a cultural perspective. Time orientation refers to an individual's focus on the past, the present or the future.

5)5) Environmental controlEnvironmental control The ability or perceived ability of an individual or persons from a particular cultural group to plan activities that control nature such as illness causation & treatment

6)6) Biologic variationBiologic variation. The biologic differences among racial and ethnic groups. It can include physical characteristics, such as skill color; physiology

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Communication Because the community-based nurse

spends much of his or her time teaching, communicating roles, knowledge of communication styles and meanings is essential.

Verbal and nonverbal behavior, space between persons talking, family number roles, eye contact salutations & integrate communication patterns

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Space and Physical Contact

The concept of space is another important dimension of cultural knowledge.

How close people stand by each other in conversation, overt expressions of affection or caring with touch, and rules relating to personal space and privacy vary greatly among cultures

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Time Time Because the concept of time has

such different meanings in various cultures it is important

for the nurse to know of this dimension within the cultural group receding care

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Social Organization

•A The community-based nurse must understand the family patterns of the groups within the community being served the family is the basic unit of society

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Biologic Variations• To perform a thorough assessment

and provide culturally congruent care, the community-based nurse who bows biologic variations specific to his or her clients will be most effective.

• Although some biologic variations are obvious e.g., skin color, hair texture, facial features, stature, and body markings), others require knowledge based on medical information and research.

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Environmental ControlEnvironmental Control• There are three predominant views on

the relationship between the environment & health: magic religious, biomedical, & humeral.

• The magic religious view sees illness as a having a supernatural force that is, malevolent or evil spirits cause disease, or illness is a punishment from God.

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Acculturation and Assimilation

• AcculturationAcculturation may occur as they learn the ways to exist in a new culture. This may include learning to drive going to schools negotiating public transportation getting a job and interacting in an environmental unlike that of the home country

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• AssimilationAssimilation, takes place when individuals or groups identify more strongly with the dominant culture in values activities and daily living.

• Cultural Cultural SkillsSkills;; asas the ability to collect relevant cultural data regarding the client's health history.

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• A culturologic assessmentA culturologic assessment as a systematic identification & documentation of culture care, beliefs, meaning, values, symbols & practices of individuals or groups with a holistic perspective.

• It gives the nurse good information with cultural implications to use as a basis for planning teaching and treatment plans.

• All clients have a right to have their values beliefs & practices considered, respected & incorporated into the plan of care

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Cultural Care Preservation

•The first of the modalities is cultural care preservation &/or maintenance. After careful assessment & observation, the nurse identifies those cultural care practices that are helpful to the client.

•The nurse then assists, supports, facilitates, or enables the client & family to preserve those actions or behaviors.

•The nurse working in this community encourages & supports ways to enlist the help of the extended community & facilitates ways to let the care needs be known

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Cultural Care Accommodation

• The second mode of cultural care accommodation or negotiation refers to those nursing actions & decisions that assist or enable the client arid family to continuity with practices that are meaningful to them but may be altered due to circumstances.

• For example the nurse in the community may be setting up a referral for a client to be seen in a clinic for follow-up care. The client is Muslim and must adhere to the practice of praying five times a day.

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• The nurse will negotiate with the client as to times of day that would provide enough time between prayers for an appointment or assist in helping the client find a place within or near the clinics where these prayers may be said.

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Cultural Care Repatterning

The third way in which nurses make decisions or intervene is cultural care Repatterning or restructuring.

When the nurse assesses the client, family, and communities and finds practices that may be detrimental to health and well-being, he or she will work with the client to change behaviors that are harmful. .

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Develop Cultural Self-Awareness

• The first transcultural nursing principle focuses on the nurse’s own culture. Self-awareness is crucial for the nurse working with people from other cultures.

• Nurses must remember that their culture often is sharply different from the culture of their clients.

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•Cultural self-awarenessCultural self-awareness means recognizing the values, beliefs, and practices that make up one’s own culture.

•It also means becoming sensitive to the impact of one’s culturally based responses. In terms of her own culture, this nurse’s behavior was intended to reassure clients and meet their needs.

•Unaware of the negative consequences of her behavior, the nurse caused damage rather than meeting needs

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Cultural self-assessmentCultural self-assessment

1. Ethnic and racial background influences

2. Typical verbal & nonverbal communication patterns

3. Cultural values and norms, or expected cultural practices or behaviors

4. Religious beliefs and practices5. Health beliefs and practices

Concepts Related to Bridging Concepts Related to Bridging Cultural Differences (ETHNIC)Cultural Differences (ETHNIC)

E Everyone has a culture.

T Take time to collect relevant cultural information.

H Hold all judgments; ie. be careful about interpreting the culturally different student's behavior, especially if unfamiliar with the culture.

N Notice and negotiate differences in understanding of teaching and learning

I

Involve cultural resources as appropriate.

C Collaborate to develop objectives and educational strategies.

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