TRANSCULTURAL NURSING CARE

Tim transkulturalDKKD FIK UI

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TRANSCULTURAL NURSING CARE (1) All nursing care are transcultural because

each person (nurse as well as client) is a cultural being

Nurses need cultural competencies in order to provide transcultural nursing care

Cultural competence refer to “the complex integration of knowledge, attitudes, and skills that enhance cross-cultural communication and effective interactions with others”

Experienced transcultural nurses synthesize culturally relevant data about clients and apply their knowledge and skills when caring for people from various culture

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TRANSCULTURAL NURSING CARE (2) In this context, we will examine:

- cultural assessment- cultural values- specific areas in which knowledge about

one’s own & others’ cultural values, belief, attitudes & practices affect health, illness, & health-seeking behaviors

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CULTURAL ASSESSMENT Refers to “a systematic appraisal or

examination of individuals, groups, and communities as to their beliefs, values, and practices to determine explicit nursing needs and intervention practices within the cultural context of the people being evaluated”

Tend to be broad and comprehensive since they deal with cultural values, belief system and life ways

Consist of both process and content

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PURPOSES OF A CULTURE CARE ASSESSMENT

To discover the clients culture care and health patterns and meanings in relation to client worldviews, life ways, cultural values, beliefs, practices, context and social structure factors

To obtain holistic, culture care information as a sound basis for nursing care decisions and actions

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To discover specific culture care patterns that can be used to make differential nursing decisions that fit the clients values and life ways and to discover what professional knowledge can be helpful to the client.

To identify potential areas of cultural conflicts, clashes, and neglected areas resulting from emic and etic value differences between clients and professional health personnel.

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To identify general and specific dominant themes and patterns that need to be known in context for culturally congruent care practices

To identify comparative cultural care information among clients of different or similar cultures, which can be shared and used in clinical, teaching and research practices

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To identify both similarities and differences among clients in providing quality care

To use theoretical ideas and research approaches to interpret and explain practices for congruent care and new areas of transcultural nursing knowledge for discipline users

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THE SUNRISE MODEL SERVES AS A GUIDE TO CULTURAL ASSESSMENT...\..\..\..\SEMINAR DISERTASI 1\TEORI LEININGER SUNRISE.PPTX The major areas for assessment are

the following (Leininger, 2001): 1. Cultural values, beliefs, and

practices2. Religious and philosophical beliefs3. Kinship & social factors4. Technological factors5. Political and legal factors6. Economic factors7. Educational factors

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SIX ESSENTIAL CULTURAL FENOMENA (GIGER & DAVIDHIZAR, 1991)

1. Communication2. Space3. Social organization4. Time 5. Environmental control6. Biological variations

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CULTURAL FACTORS & NURSING PROCESS (BY GIGER & DAVIDHIZAR)

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PROCESS1. ASSESSMENT Environmental

control

ACTION

- Ask client’s belief of the nature of the health problem and actions being taken at home or in the community to treat & resolve it

- Ask about other health care resources being used

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Biological variations

Social organization

Communication skills

Observe body structure, skin tone and color

Be aware of health problems that may be more common in client’s background

Conduct community activities

Determine the needs of the client who does not speak the nurse’s language and provide competent interpreters

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Space

Time

NURSING DX Development of

problem list

Be aware of territoriality; seek permission before intruding in the client’s territory

Understand the differences in time orientation

Ask about the client’s interpretation of the problem and possible effective interventions

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PLANNING

IMPLEMENTATION

EVALUATION

Involve client, family and community in plans as needed

After usual ways of interacting to adjust to client’s social interaction and etiquette

Incorporate interventions agreeing with client’s cultural heritage, educational level, & language skills

With client, determine whether nursing care has met expectations and needs

ENVIRONMENTAL CONTROL

Locus of control: internal or externalValue orientation: believes in supra

natural focus, relies on magic, prayer to affect change

Definition of health and illnessCultural health practices

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BIOLOGICAL VARIATIONS

Conduct a complete physical assessment noting: body structure, skin color, unusual skin discolorations, hair color & distributions, other visible characteristics, weight, height, etc

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SOCIAL ORGANIZATION

Sistem kekerabatan Status perkawinan Jumlah anak dalam keluarga Peran di dalam keluraga Fungsi di dalam keluarga Siapa yang paling berpengaruh dalam

keluarga Bagaimana hubungan dengan saudara

kandung, orang tua dan kerabat Makna “bekerja”

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COMMUNICATIONLanguage spokenVoice qualityPronunciation Use of silentUse of non verbalTouchPola komunikasi dalam keluarga,

teman dan orang-orang sekitar

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SPACE

Degree of comfortDistance in conversationsDefinitions of space: degree of

comfort with closeness when talking with or standing near others; how does objects in the environment affect your sense of space

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TIME Orientation to time: past, present or

future Definition of time View of time: social time or clock-oriented Physiochemical reaction to time: sleeps at

least 8 hrs at night, sleep at a consistent schedule; understand the importance of taking medication and other treatments on schedule

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NURSING ASSESSMENT Note whether the client has become

culturally assimilated or observes own cultural practices

Incorporate data into plan of nursing care:a. Encourage the client to discuss cultural

differencesb. Make efforts to accept & understand

methods of communicationc. Respect the individual’s personal need for

spaced. Respect the rights of client to honor and

worship the Supreme Being of their choice

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e. Identify a clerical or spiritual person to contact

f. Determine whether spiritual practices have implications for health, life and well being

g. Identifies hobbies, especially devising interventions for rehabilitation

h. Honor time and value orientation and differences in these areas

i. Provide privacy according to personal need and health status of the client (note: the perception and reaction to pain may be culturally related)

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j. Note cultural health practices:1) identify & encourage efficacious practices2) identify & discourage dysfunctional practice3) identify & determine whether neutral practices will have a long-term ill effect

k. Note food preferences:1) make any adjustment in diet2) note dietary practice that may have serious implications for the client

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LEININGERS SHORT CULTURALOGICAL ASSESSMENT GUIDE Phase 1: record observation of what

you see, hear or experience with clients

Phase 2: listen to learn from the client about cultural values, beliefs, and daily practices related to care and health in the clients environmental context

Phase 3: identify and document recurrent client patterns and narratives (stories) with client meanings of what has been seen, heard or experiences

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Phase 4: Synthesize themes and patterns of care derived from the information obtained

in phase 1,2, 3 Phase 5: develop a culturally-based-client-

nurse care plan as co-participants for decisions and actions for culturally

congruent care

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STANDARDS FOR CULTURALLY COMPETENT AND CONGRUENT CARE

Consumers of diverse cultures have a right to have Transcultural care standards used to protect and respect their generic (folk) values, beliefs and practices and to have health personnel incorporate

Nurses assessing and providing care to diverse culture have a moral obligation to be prepared in Transcultural nursing to provide knowledgeable, sensitive, and research-based care to the culturally different

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Cultural assessment and practices need to demonstrate the use of Transcultural nursing concepts, principles, theories, and research findings and competencies to ensure safe, congruent, and competent practices

Nurses as caregivers have an ethical, morale, professional obligation and responsibility to study, understand, and use relevant research-based trans cultural care for safe, beneficial, and satisfying client or family outcome

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Providing culturally competent and congruent care should reflect the caregivers ability to assess and use culture-specific data without biases, prejudices, discrimination, or related negative outcome

Nurses caring for clients of diverse cultures should seek to provide holistic care that is comprehensive and takes into account the clients worldview and include ethno history, religion, morale/ethical values, specific cultural care beliefs and values, kinship ties

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Nurses demonstrating cultural competence and congruent care maintain an open learning, flexible attitude and desire to expand their knowledge of diverse cultures and caring life ways

Nurses with Transcultural competencies show evidence of being able to use local, regional, and national resources for beneficial care outcomes

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Nurses with transcultural competencies demonstrate leadership skills to work with other nurses and interdisciplinary colleagues who need help to provide culturally safe & congruent client practices, thus preventing cultural imposition, cultural pain offenses, cultural conflicts and many other negative and destructive outcomes

Nurses with Trans cultural competencies active to defend, uphold, & improve care to clients of diverse cultures and to share their research findings and competency experiences in public and professional arenas.

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References:1. Giger & Davidhizar (1995). Transcultural

Nursing: Assessment & Intervention. St Louis: Mosby

2. Leininger, M & Mcfarland, MR (2002). Transcultural Nursing: Concepts, Theories, Research, and Practice. New York: Mc.Graw-Hill Companies

3. Potter & Perry (1997). Fundamentals of Nursing: Concepts, Process & Practice. St. Louis; Mosby-year Book.

4. Kozier et al (1995).Fundamentals of Nursing: Concepts, Process & Practice. California: Addison-Wesley

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