INTRODUCTION -
Madeleine Leininger is considered as the founder of the filed of transcultural nursing. -
Leininger has defined transcultural nursing as a comparative study of cultures to understand similarities (culture universal) and difference (culture-specific) across human groups. -
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. With increased mobilization of people across geographical and national borders, multicultural trends are emerging in many countries. (Ayonrinde O, 2003) -
Religious and Cultural knowledge is an important ingredient in health care. -
For a nurse to successfully provide care for a client of a different cultural or ethnic to background, effective intercultural communication must take place. -
Intercultural communication occurs when each person attempts to understand the other’s point of view from his or her own cultural frame of reference. -
Effective intercultural communication is facilitated by identification of areas of commonalities by the nurse. -
After reaching a cultural. understanding, the nurse must consider cultural factor throughout the nursing process.
DEFINITIONS Culture -
Set of values, beliefs and traditions, that are held by a specific group of people and handed down from generation to generation. Culture is also beliefs, habits, likes, dislikes, customs and rituals learn from one’s family. -
Culture is the learned, shared and transmitted values, beliefs, norms and life way practices of a particular group that guide thinking, decisions, and actions in patterned ways.
Religion -
Is a set of belief in a divine or super human power (or powers) to be obeyed and worshipped as the creator and ruler of the universe. -
Ethical values and religion system of beliefs and practices differ within the culture and across culture.
Ethnic Ethnicity Cultural Identify Culture-universals Culture-specifies Material culture Non-material culture - refers to beliefs customs, languages, social institutions.
Subculture - -composed of people who have a distinct identity but are related to a larger cultural group.
Bicultural Diversity Acculturation -
People of a minority group tend to assume the attitudes, values, beliefs, find practices of the dominant society resulting in a blended cultural pattern.
Cultural shock -
the state of being disoriented or unable to respond to a different cultural environment because of its sudden strangeness, unfamiliarity, and incompatibility to the stranger's perceptions and expectations at is differentiated from others by symbolic markers (cultures, biology, territory, religion).
Ethnic groups Ethnic identity Race TRADITIONAL CONCEPTS OF HEALTH AND DISEASE -
The health concepts held by many cultural, groups may result in people choosing not to seek mordern medical treatment procedures because they do not view the illness or disease as coming from within themselves -
In many Eastern cultures and other cultures in the developing world, the locus of control for disease causality often is centered outside the individual, whereas in Western cultures, the locus of control tends to be more internally oriented (Dim-out, 1995). -
The individuals from other cultures might not follow thorough with health-promoting or treatment recommendations because they perceive the medical or other health- promoting encounter as a negative or perhaps even hostile experience. -
Individual patients and health care practitioners have specific notions about health and disease causality and treatment which come from the respective cultural and social training, beliefs, and values; the personal beliefs, values, and behaviors-, and the understanding of biomedical concepts that each group holds.. -
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.
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Folk illnesses are generally learned syndromes that individuals from particular cultural groups claim to have and from which their culture defines the etiology, behaviors, diagnostic procedures, prevention methods, and traditional healing or curing practices. -
Most cases of lay illness have multiple causalities and may require several different approaches to diagnosis, treatment, and cure including folk and Western medical interventions -
Folk illnesses, which are perceived to arise from a variety of causes, often require the services of a folk healer who may be a local corianders, shaman, native healer, spiritualist, root doctor, or other specialized healer. -
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.
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Understanding these differences may help us to be more sensitive to the special beliefs and practices of multicultural target groups when planning a program. -
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.
CONCEPT OF CULTURE -
Culture is learned by each generation through both formal and informal life experiences. -
Language is primary through means of transmitting culture. -
The practices of particular culture often arise because of the group's social and physical environment. -
Culture practice and beliefs are adapted over time but they mainly remain constant as long as they satisfy needs.
Cultural awareness It is an in-depth self-examination of one's own background, recognizing biases and prejudices and assumptions about other people 
PURPOSES OF KNOWING THE PATIENTS CULTURE AND RELIGION FOR HEALTH CARE PERSONNEL Cultural background affect a person's health in all dimensions, so the nurse should consider the client's cultural background when planning care. -
To heighten awareness of ways in which their own faith system. Provides resources for encounters with illness, suffering and death. -
To foster understanding, respect and appreciation for the individuality and diversity of patients beliefs, values, spirituality and culture regarding illness, its meaning, cause, treatment, and outcome. -
To strengthen in their commitment to relationship-centered medicine that emphasizes care of the suffering person rather than attention simply more to the pathophysiology of disease, and recognizes the physician as a dynamic component of that relationship. -
To facilitate in recognizing the role of the hospital chaplain and the patient's clergy as partners in the health care team in providing care for the patient. -
To encourage in developing and maintaining a program of physical, emotional and spiritual self-care introduce therapies from the East, such as ayurveda and pancha karma
Culturally congruent care Culturally competent care -
is the ability of the practitioner to bridge cultural gaps in caring, work with cultural differences and enable clients and families to achieve meaningful and supportive caring. -
Culturally competent care requires specific knowledge, skills, and attitudes in the delivery of culturally congruent care and awareness.
Nursing Decisions Leininger (1991) identified three nursing decision and action modes to achieve culturally congruent care. All three modes of professional decisions and actions are aimed to assist, support, facilitate, or enable people of particular cultures. 1. Cultural preservation or maintenance: Retain and or preserve relevant care values so that clients can maintain their well-being, recover from illness, or face handicaps and/or death . 2.Cultural care accommodation or negotiation- Adapt or negotiate with the others for a beneficial or satisfying health outcome 3. Cultural care repatterning or restructuring : Records, change, or greatly modify client’s life ways for a new, different and beneficial health care pattern PURPOSE AND GOAL OF THE THEORY -
The central purpose of the theory is to discover and explain diverse and universal culturally based care factors influencing the health, well-being, illness, or death of individuals or groups. -
The purpose and goal of the theory is to use research findings to provide culturally congruent, safe, and meaningful care to clients of diverse or similar cultures.
USE OF PROTECTIVE OBJECTS -
Protective objects can be worn or carried or hung in the home. -
Amulets are objects with magical powers, for all walks of life and cultural and ethnic backgrounds is example, charms worn on a string or chain around the neck, wrist, or waist to protect the wearer from the evil eye or evil spirits. -
Amulets exist in societies all over the world and are associated with protection from trouble (Budge, 1978)
USE OF SUBSTANCES Substances are ingested in certain ways or amounts regimen, an effort must be made to determine if they are worn or hung in the home. This practice uses diet and consists of many different observances. It is believed that the body is kept in balance or harmony by the type of food eaten so many food taboos and combinations exist in traditional belief systems. For example, it is believed that some food substances can be ingested to prevent illness. People from many ethnic backgrounds eat raw garlic or onion In an effort to prevent illness or wear them on' the body or hang them in the home. Jews also believe that milk and meat must never be mixed or eaten at the same meal (Steinberg, 1947) mind, and spirit, or the restoration of holistic health RELIGIOUS PRACTICES -
practices such as from a divine source the burning of candles, rituals of redemption, and In many instances a heritage consistent person may prayer. -
Religion dictates social, moral, and dietary practices designed to keep a traditional healer.
Traditional Remedies -
The use of folk or traditional medicine is seen among people from all walks of life and cultural ethnic back ground -
Use of folk medicine is not a new practice among heritage consistent people, so many of the remedies have been used and passed on for generations. -
The pharmaceutical, must be made to determine properties of vegetation-plants, roots, tested stems, flowers, seeds, and herbs-have been studied tested, cataloged, and used for countless centuries. -
Many of these plants are used by specific communities. Others cross ethnic and community lines and are used in certain Geographic areas in the person's country of origin. -
When patients -do not adhere to a pharmacological regimen an effort must be made to determine the remedy if they are taking traditional remedies.
Healers -
Within a given community, specific people are known to have the power to heal. -
The healer may be male or female, and is thought to have received the gift of healing In many instances a heritage consistent person may consult a traditional healer before, instead of, or in conjunction with a modern health care provider. -
A broad range of health and illness beliefs exist many of these beliefs have roots in the culture, ethnic, religious, or social back ground .of a person family, or community -
These approach may originate in culture, ethnicity or religion. These beliefs and practices may be internal or personal and person may be able to define or describe them.
IMMIGRATION Gender Roles -
In many cultures, the male is dominant figure and often they take decisions.The female usually is passive. -
In African -American families, however as well as in many Caucasian families, the female often is dominant. -
Knowledge of the dominant member of the family is important consideration in planning Nursing care folk illnesses, which are perceived to arise from a variety of causes, often require the services of a folk healer who may be a local curandero, shaman, native healer, spiritualist, root doctor, or other specialized healer. -
Recognize that the use of traditional or alternate models of health care deliveries widely varied and may come into conflict with Western models of health care practice. -
Understanding these differences may help you to be more sensitive to the special beliefs and practices of multicultural target groups when planning a program.
ILLNESS CAUSE AND PREVENTION RELATED TO FOOD - Several factors cause illness.
- A hot-cold imbalance, or a different time taking of food.
- Illness can occur ifsome of the foods are eaten in improper combinations or amounts or at improper time.
Traditional beliefs about mental health -
In the traditional belief system, mental illnesses are caused by a lack of harmony of emotions or, sometimes, by evil spirits. -
Some Asian and Buddhist believe that problems in this life are most likely related to transgressions committed in a past life and our previous life and our future life are as much a part of the life cycle.
ECONOMIC BARRIERS -
Several economic barriers, such as unemployment, underemployment, homelessness, lack of health insurance poverty prevent people from entering the health care system. -
Poverty is the most critical factor. Poor health, crippling diseases, drug and alcohol abuse, poor education; and inferior are contributing social causes of poverty. -
It is important for the nurse to be aware clients needs and financial resources available in the local community.
Time orientation -
It is varies for different cultures groups. -
A client may be late for an appointment not because of reluctance or lack of respect for the nurse but because he is less concerned about planning ahead to be on time than with the activity in which he is currently engaged.
PERSONAL SPACE AND TERRITORIALITY -
Personal space involves a person's set of behaviors and attitudes toward the space around himself. -
The nurse should try, to respect the client's personal space as much as possible, especially when performing nursing procedures. -
The nurse should also welcome visiting members of the family and extended family. -
This can remind the client of home, lessening the effects of isolation and shock from hospitalization.
SOCIOCULTURAL FACTORS AND THE NURSING PROCESS Religious belief that effect the care Nursing -
Belief about birth &death. -
Belief about diet and food practices. -
Belief regarding medical care
ROLE OF NURSE -
The nurse should begin the assessment by attempting to determine the client's cultural heritage and language skills. -
The client should be asked if any of his health beliefs relate to the cause of the illness or to the problem. -
The nurse should then determine what, if any, home remedies the person is taking to treat the symptoms. -
Nurses should evaluate their attitudes toward ethnic nursing care. -
The process of self-evaluation can help the nurse become more comfortable when providing care to clients from diverse backgrounds
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Nurses have a responsibility to understand the influence of culture, race ðnicity on the development of social emotional relationship child rearing practices &attitude toward health. -
A child's self concepts evolves from ideas about his or her social roles -
Important sub culture influences on children include ethnicity social class, occupation school peers and mass culture -
Socioeconomic influences play major role in ability to seek opportunity for health promotion for wellness -
Religious practices greatly influences health promotion belief in families. -
Many ethnic and cultural groups in country retain the cultural heritage of their original culture.
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How culture influences behaviors, attitudes, and values depends on many factors and thus is not the same for different members of a cultural group. -
The nurse should have an understanding of the general characteristics of the major ethnic groups, but should always individualize care rather than generalize about all clients in these groups. -
Before assessing the cultural background of a client, nurses should assess how they are influenced by their own culture. -
The nursing diagnosis for clients should include potential problems in their interaction with the health care system and problems involving the effects of culture. -
The planning and implementation of nursing interventions should be adapted as much as possible to the client's cultural background. -
Evaluation should include the nurse's self-evaluation of attitudes and emotions toward providing nursing care to clients from diverse sociocultural backgrounds.
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The client’s educational level and language skills should be considered when planning teaching activities. -
Discussing cultural questions related to care with the client and family during the planning stage helps the nurse understand how cultural variables are related to the client's health beliefs and practices, so that interventions can be individualized for the client. -
Evaluation continues throughout the nursing process and should include feedback from the client and family. -
Self-evaluation by the nurse is crucial as he or she increases skills for interaction. .
CONCLUSION REFERENCES -
Kleinman AL, Eisenberg L, Good B. Culture and illness and care: clinical lessons from anthropologic cross cultural research. Ann Intem Med. 1978;88:251-258. -
Ayonrinde O. "Importance of Cultural Sensitivity in Therapeutic Transactions: Considerations for Healthcare Providers," Disease Management and Health Outcomes, Wolters Kluwer Health | Adis, 2003. vol. 11(4), pages 233-248. -
Boyle, JS: The practice of trans cultural nursing, Transcultural Nursing Morgenstern, J: Rites of birth, marriage, death, and kindred occasions -
George Julia B. Nursing theories: The base of professional nursing practice 3rd edition. Norwalk, CN: Appleton and Lange; 1990. -
Kozier B, Erb G, Barman A, Synder AJ. Fundamentals of nursing; concepts, process and practice, Edn 7th, 2001. -
Leninger M, McFarland M. Transcultural Nursing: Concepts, Theory, Research, and Practice; Edn 3rd, McGraw-Hill Professional; New York, 2002. -
Potter A, Perry G .Basic Nursing-Theory and Practice, Edn 3rd Mosby Company.
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