TransculturalTranscultural Nursing Nursing CareCareCareCare

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Objectives:Objectives:

►►To gain cultural knowledge, evidenced by To gain cultural knowledge, evidenced by correctly identifying examples of correctly identifying examples of culturally congruent nursing care culturally congruent nursing care

►►To utilize cultural knowledge by To utilize cultural knowledge by identifying at least one culturally identifying at least one culturally congruent nursing intervention for the congruent nursing intervention for the case studies presentedcase studies presented

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Why Is Cultural Knowledge Why Is Cultural Knowledge Important to Nurses?Important to Nurses?

►►Migration of people worldwide is increasingMigration of people worldwide is increasing

►►Communication and health technology bring Communication and health technology bring diverse cultures closerdiverse cultures closer

►► Increased cultural conflict, clashes, and lawsuits Increased cultural conflict, clashes, and lawsuits ►► Increased cultural conflict, clashes, and lawsuits Increased cultural conflict, clashes, and lawsuits

�� Health consumers expect their cultural beliefs, Health consumers expect their cultural beliefs, values, and rights to be respectedvalues, and rights to be respected

►►Use of complementary “alternative” medicines Use of complementary “alternative” medicines and folk practicesand folk practices

►► Promoting peace, harmony and healthy livingPromoting peace, harmony and healthy living3

Cultural Phenomena Cultural Phenomena (By Giger and Davidhizer, (By Giger and Davidhizer, 19951995))

►► Environmental ControlEnvironmental Control

�� Beliefs of health/illness/spiritualityBeliefs of health/illness/spirituality

�� Health traditions/folk medicineHealth traditions/folk medicine

►►Biological variationsBiological variationsBiological variationsBiological variations

�� Physical and genetic differencesPhysical and genetic differences

►► Social organizationSocial organization

�� Family and social groups (religious/ethnic)Family and social groups (religious/ethnic)

►►CommunicationCommunication

►► Space (personal space/distance)Space (personal space/distance)

►►Time orientationTime orientation4

Transcultural Nursing Research:Transcultural Nursing Research:

►► Promotes cultural knowledge for current practices Promotes cultural knowledge for current practices and future generations of nurses in a global and future generations of nurses in a global worldworld

►►Discovers folk beliefs, values, and healing Discovers folk beliefs, values, and healing practices influencing health and wellpractices influencing health and well--being being practices influencing health and wellpractices influencing health and well--being being

►►Assists people of various cultures through birth, Assists people of various cultures through birth, illness, death or disabilityillness, death or disability

►►Makes culturally congruent care possibleMakes culturally congruent care possible

�� If care values, expressions, or patterns are If care values, expressions, or patterns are known and used by the nurseknown and used by the nurse

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Example of Dominant Care Values: Example of Dominant Care Values: Mexican AmericanMexican American

►► Extended family/interdependence with kinExtended family/interdependence with kin

►► Patriarchal (malePatriarchal (male--dominant culture)dominant culture)

►► Exact time less valuedExact time less valued

Cultural Values (from research):

►► Exact time less valuedExact time less valued

►►High respect for authority and the elderlyHigh respect for authority and the elderly

►►Religion valued (many Roman Catholics)Religion valued (many Roman Catholics)

►►Native foods for wellNative foods for well--beingbeing

►►Traditional folkTraditional folk--care healers usedcare healers used

►►Belief in hotBelief in hot--cold theorycold theory6

Mexican Americans:Mexican Americans:

►► Family love, aid, and involvement with Family love, aid, and involvement with extended familyextended family

►►Respect for authorityRespect for authority

Culture Care Meanings and Action Modes

►►Respect for authorityRespect for authority►► Protective male careProtective male care►►Mother as care decision maker Mother as care decision maker ►►Use of folkUse of folk--care practicescare practices►►Healing with foodsHealing with foods►►TouchingTouching►►Acceptance of God’s willAcceptance of God’s will

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Conducting Assessment:Conducting Assessment:

►► Incorporate cultural assessment into admission Incorporate cultural assessment into admission process and as neededprocess and as needed

►►Use your knowledge about the culture (cultural Use your knowledge about the culture (cultural awareness)awareness)

►►Remember that a patient may be traditional or Remember that a patient may be traditional or ►►Remember that a patient may be traditional or Remember that a patient may be traditional or nonnon--traditionaltraditional

►►Conduct a holistic assessment, including Conduct a holistic assessment, including discovery of folk practicesdiscovery of folk practices

►►Utilize an interpreter when neededUtilize an interpreter when needed

�� Avoid using children to interpretAvoid using children to interpret

►►Refer to Leininger’s Sunrise Model “Enabler”Refer to Leininger’s Sunrise Model “Enabler”8

Leininger’s Sunrise Model:Leininger’s Sunrise Model:

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Culturally Congruent Care:Culturally Congruent Care:

►►Culture care preservation and/or Culture care preservation and/or maintenancemaintenance

Three modes of nursing care actions and decisions:

maintenancemaintenance

►►Culture care accommodation and/or Culture care accommodation and/or negotiationnegotiation

►►Culture care restructuring and/or Culture care restructuring and/or repatterningrepatterning

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Culturally Congruent Care Culturally Congruent Care Planning:Planning:

►►Nurses try to Nurses try to mediate between mediate between the client’s cultural the client’s cultural beliefs and the beliefs and the

►► Include patient and Include patient and extended familyextended family

►►Work within the Work within the patient’s culture as it ispatient’s culture as it isbeliefs and the beliefs and the

nurse’s professional nurse’s professional goals.goals.

►►Use mutually Use mutually agreed upon agreed upon interventionsinterventions

patient’s culture as it ispatient’s culture as it is

►►Uphold cultural rituals Uphold cultural rituals whenever possiblewhenever possible

►►Avoid cultural Avoid cultural imposition to avoid imposition to avoid ethical problems, and ethical problems, and lawsuitslawsuits

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How to Avoid Cultural Imposition:How to Avoid Cultural Imposition:

►►Understand that nursing and Understand that nursing and medicine are typically Anglomedicine are typically Anglo--American cultures American cultures

►►Don’t use Nursing Diagnoses Don’t use Nursing Diagnoses that “don’t fit” nonthat “don’t fit” non--Western Western that “don’t fit” nonthat “don’t fit” non--Western Western cultures or undercultures or under--represented represented cultures cultures

►►Other cultures should not be Other cultures should not be treated the same as Anglotreated the same as Anglo--AmericansAmericans

►► Learn and reflect on cultural Learn and reflect on cultural differencesdifferences

Cultural pain Cultural pain is a very real is a very real consequence consequence

of cultural of cultural impositionimposition

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Case Study: What Would Your Case Study: What Would Your Intervention Be?Intervention Be?

►►A Mexican American mother brings her infant to A Mexican American mother brings her infant to the hospitalthe hospital

►► She believes that a “fallen fontanel” occurs by She believes that a “fallen fontanel” occurs by pulling the nipple out of an infant’s mouth too pulling the nipple out of an infant’s mouth too rapidly, or by a fall rapidly, or by a fall rapidly, or by a fall rapidly, or by a fall

►►The baby has not fallen, but the mother says he The baby has not fallen, but the mother says he is restless, cries weakly and has poor appetite is restless, cries weakly and has poor appetite

►►You see the baby’s dry mouth/poor skin turgorYou see the baby’s dry mouth/poor skin turgor

►►The folk cure is to restore the fontanel through The folk cure is to restore the fontanel through gravity or pressure on the palategravity or pressure on the palate

►►What will you do? What will you do? 13

Case Study Two: What Would Case Study Two: What Would Your Intervention Be?Your Intervention Be?

►►A pregnant Mexican American woman has A pregnant Mexican American woman has gained gained 30 30 pounds before the third trimester pounds before the third trimester

►► She believes that “You have to eat everything She believes that “You have to eat everything for your baby. You can’t watch your weight”for your baby. You can’t watch your weight”for your baby. You can’t watch your weight”for your baby. You can’t watch your weight”

►► Families demonstrate care by preparing Families demonstrate care by preparing traditional food, and satisfying any cravings of traditional food, and satisfying any cravings of the motherthe mother

►►They believe the mother’s eating habits are They believe the mother’s eating habits are healthy for the fetus healthy for the fetus

►►What patient teaching is needed?What patient teaching is needed?

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Culturally Congruent Care? Culturally Congruent Care? Compare Cultures:Compare Cultures:

Limit visitors to a postpartum woman to immediate family only (because she is tired)

Teach mother of newborn how to change

placement of charms, beads, or knotted strings placement of charms, beads, or knotted strings when doing umbilical cord care

Use translated handouts for all patient

education

A patient who refuses to sign consent forms

should be assessed for illiteracy, or whether an interpreter is needed 15

Examples: (Continued)Examples: (Continued)

Use NANDA Diagnosis for Alterations in Parenting or Dysfunctional Coping because she dramatically expresses her negative emotions, and speaks sharply to her children

Allow food preferences/foods from homeAllow food preferences/foods from home

Discuss modifications to fit prescribed diet

Use direct eye contact to increase trust

Use first name when speaking to patient

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Examples: (Continued)Examples: (Continued)Request that a female patient sign consent forms without her husband being present

Research interactions folk remedies (herbs, liniments or oils) with prescribed medications

Discuss with patient and physician if a Discuss with patient and physician if a different medication would be safer with their folk remedies

Allow flexibility, if possible, for treatment or medication schedule

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Evaluate Your Nursing Care:Evaluate Your Nursing Care:

►►Was there open communication Was there open communication between patient and nurse?between patient and nurse?

►►Was the patient able and willing to Was the patient able and willing to follow through with the planned follow through with the planned interventions?interventions?interventions?interventions?

►►Were the patient’s health goals met?Were the patient’s health goals met?

►►Were the nurse’s goals met?Were the nurse’s goals met?

►►Were the patient and family satisfied Were the patient and family satisfied with health care?with health care?

If “yes”, it was culturally congruent care!18

Excellence in Nursing Care:Excellence in Nursing Care:

You reap the benefits of culturally congruent care when you use yourTranscultural Nursing

knowledge!

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References:References:

►► Bastable, S. (Bastable, S. (20032003). Nurse as educator: Principles of ). Nurse as educator: Principles of teaching and learning for nursing practice (teaching and learning for nursing practice (22ndnd Ed.). Ed.). Sudbury, MA: Jones and Bartlett.Sudbury, MA: Jones and Bartlett.

►► Giger, J.N. & Davidhizar, R.E. (Giger, J.N. & Davidhizar, R.E. (19951995). Transcultural nursing ). Transcultural nursing assessment and intervention (assessment and intervention (22ndnd ed.). St. Louis: Mosby.ed.). St. Louis: Mosby.

►► Leininger, M. (Leininger, M. (20022002). ). Transcultural Nursing: Concepts, Transcultural Nursing: Concepts, ►► Leininger, M. (Leininger, M. (20022002). ). Transcultural Nursing: Concepts, Transcultural Nursing: Concepts, theories, research, and practicetheories, research, and practice ((33rdrd Ed.). New York: McGraw Ed.). New York: McGraw Hill. Hill.

►► Leininger, M. (Ed.).(Leininger, M. (Ed.).(19911991). ). Culture care diversity and Culture care diversity and universality: A theory of nursinguniversality: A theory of nursing. New York, NY: NLN Press.. New York, NY: NLN Press.

►► Leininger, M. (Leininger, M. (19991999). What is Transcultural Nursing and ). What is Transcultural Nursing and culturally competent care? culturally competent care? Journal of Transcultural Nursing, Journal of Transcultural Nursing, 1010, , 99

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