Trans-cultural nursing concepts and assessment

UNIT# VII TRANS-CULTURAL NURSING CONCEPTS AND ASSESSMENT

OBJECTIVES:At the end of this session learners will be able to:1- Describe concept of transcultural nursing.a. Explain key concepts related to transcultural nursing.b. Identify the components of cultural assessment.2- Integrate concepts of transcultural nursing care throughout life span.3- Identify nursing frameworks & theories applicable to transcultural nursing.a. Examine culturally related issues across the life span.b. Explore the role of family & cultural practices related to the developmental stages.TRANSCULTURAL NURSING: Transcultural nursing a humanistic and scientific area of nursing study and practice that focuses on how patterns of behavior in health, illness, and caring are influenced by the values and beliefs of specific cultural groups.

According to Madeleine

HYPERLINK "http://en.wikipedia.org/wiki/Madeleine_Leininger" Leininger, the pioneer of transcultural nursing, transcultural nursing is a substantive area of study and practice that focuses on the comparative cultural values of caring, the beliefs and practices of individuals or groups of similar or different cultures.

KEY CONCEPTS RELATED TO TRANSCULTRAL NURSING:

1- Culturally competent care

2- Second concept that is important to Nurses are:

a. Emic View-is insiders perception.

b. Ethic View-is external or outsiders perception

OBJECTIVES OF TRANSCULTRAL NURSING: To highlight transcultural nursing framework to guide nursing practice in diverse health care setting To analyze major concerns and issues in providing transcultural nursing To expand the theoretical basis for using this concept in providing culturally competent and culturally congruent nursing care.

CULTURAL ASSESSMENT: The main goal of the cultural assessment is to gather sufficient information from the client that will enable the nurse to implement culturally congruent care

COMPONENTS OF CULTURAL ASSESSMENT:

Giger and Davidhizer (1991) proposed six cultural phenomena that the nurse must understand to provide effective care for all patients: Communication, Space,Social Organizations,Time,Environmental Control, and Biological Variation.A Basic Cultural Assessment Model containing these six primary elements is presented here to help you gather the necessary data. 1. COMMUNICATION:

Miscommunication is a frequent problem in hospitals. The most obvious is when the patient and hospital staff do not speak the same language. So there must be good communication skills in a nurse.

2. SPACE:

Particularly the comfort level related to personal space- comfort in conversation, proximity to others, body movement, perception of space. Eye contact, space, and touch practices may be very different than your sphere of reference.

3. SOCIAL ORGANIZATION:

Patterns of cultural behavior learned through enculturation. Recognize and accept that individuals from culturally diverse backgrounds may desire varying degrees of acculturation into the dominant culture.

4. TIME:

Concept of the passage of time, duration of time, and points in time. Countries such as England and China seem to be past oriented. They value tradition, doing things the way they have always been done. Individuals from these countries might be reluctant to try new procedures.

5. ENVIRONMENTAL CONTROL:

Abilities of persons to control nature. Health practices, values, definitions of health and illness.

6. BIOLOGICAL VARIATION:

Racially related body structure, skin color, hair texture, and other physical characteristics; enzymatic and genetic variations; electrocardiographic patterns; susceptibility to disease; nutritional preferences and deficiencies, and psychological characteristics.

Consistent with the above mentioned cultural phenomena, Boyle and Andrews (1989) propose that nurses need to assess eight areas reflecting cultural variation, and encourage the nurse to gather the following data:

History of the origins of the patients' culture.

Value orientations, including view of the world, ethics, and norms and standards of behavior as well as attitudes about time, work, money, education, beauty, strength, and change.

Interpersonal relationships, including family patterns, demeanor, and roles and relationships.

Communication patterns and forms.

Religion and magic.

Social systems, including economic values, political systems, and educational patterns.

Diet and food habits.

Health and illness belief systems, including behaviors, decision making, and use of healthcare providers.

CONCEPTS OF TRANSCULTURAL NURSING CARE THROUGHOUT LIFE SPAN:

Illness and wellness are shaped by a various factors including perception and coping skills, as well as the social level of the patient.

Cultural competence is an important component of nursing.

Culture influences all spheres of human life. It defines health, illness, and the search for relief from disease or distress.

Religious and Cultural knowledge is an important ingredient in health care.

The health concepts held by many cultural groups may result in people choosing not to seek modern medical treatment procedures.

Health care provider 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.

The use of traditional or alternate models of health care delivery is widely varied and may come into conflict with Western models of health care practice.

Culture guides behavior into acceptable ways for the people in a specific group as such culture originates and develops within the social structure through inter personal interactions.

For a nurse to successfully provide care for a client of a different cultural or ethnic to background, effective intercultural communication must take place.

NURSING FRAMEWORKS & THEORIES APPLICABLE TO TRANSCULTURAL NURSING:

1. LEININGERS SUNRISE MODEL:

This model demonstrates the inclusiveness of culture in everyday life and helps to explain why cultural assessment needs to be comprehensive.

The central purpose of the theory is to discover and explain diversed and universal culturally based care factors influencing the health, well-being, illness or death of individuals or groups & to use research findings to provide culturally congruent, safe and meaningful care to clients of diverse or similar cultures

2. GIGER & DAVIDHIZARS TRANSCULTURAL ASSESSMENT MODEL:1- Communication

2- Space

3- Social organization

4- Time

5- Environmental controls

6- Biological variations

3. NARAYANASAMYS ACCESS MODEL:ACCESS

a. A= Assessment

b. C=Communication

c. C=Cultural Negotiation & Compromise

d. E=Establishing Respect & Rapport

e. S=Sensitivity

f. S=Safety

4. CAMPINHA-BACOTES CULTURAL COMPETENCE MODEL:

Cultural awareness

Cultural skill

Cultural knowledge

Cultural encounters

Cultural desireCULTURALLY RELATED ISSUES:

Beliefs about illness, causes and cures

Nutrition and dietary practices

Disorders specific to a particular ethnic group

Religious beliefs about illness and death

ROLE OF FAMILY &CULTURAL PRACTICES RELATED TO DEVELOPMENTAL STAGES:Early Childhood:From the moment of birth, children are absorbed into culture. The ways that they are handled, fed and clothed are all influenced by their birth culture and their caregivers' approach to child rearing. Different cultures have different beliefs with regard to infants' sleeping arrangements and whether or not they should be left to cry or play alone. These different approaches to early childhood care can affect cognitive and emotional development, as well as contribute to the growth of the child's self-confidence, risk taking behaviors and feelings of security.Middle Childhood: Middle childhood, generally defined as the period from ages 6 to 11, is a time when children are actively socialized into their culture through family, school and play. During this time, children begin to learn the values most upheld by their culture and are exposed to social differences, such as categories of age, ethnicity, and importantly, gender. Young children start to identify themselves in terms of being a boy or girl, and this self-concept affects their dress, their manner of play and also the way that adults will interact with them. Additionally, during middle childhood, different cultures place different emphasis on learning and skill set development. Adolescence: Adolescence is a period when sexual maturation takes place and young people undergo significant physiological and social changes. In some cultures, such as mainstream American society and Western Europe, adolescence is regarded as a time of preparation for adulthood, where development is assessed according to building skills in logic and problem solving, and demonstrating greater levels of responsibility. However, in many other cultures, adolescence is not viewed as separate from adulthood, but rather as the time for beginning formal labor activities and commencing childbearing.Adulthood: Stages of development suggest that during each part of the lifespan, people achieve physical and social milestones. Culture plays a large role in determining development in adulthood, by helping structure ideas about personal meaning and achievement, as well as expected social roles. In a culture that values material success, development in adulthood is measured according to one's ability to participate in the market economy. Additionally, while many cultures emphasize the role of women as mothers and caretakers, others lay stress on women's educational advancement and economic self-sufficiency.

CULTURE HEALTH AND SOCIETY