Introduction to Transcultural Nursing

1. Introduction to Transcultural Nursing Why should we study it??

2. WELCOME to Cultural and Spiritual Dimensions in Healthcare N237!

3. Support for teaching this content Table 1. Guidelines for the Practice of Culturally Competent Nursing Care. Guideline Description 1. Knowledge of Cultures  Nurses shall gain an understanding of the perspectives, traditions, values, practices, and family systems of culturally diverse individuals, families, communities, and populations they care for, as well as knowledge of the complex variables that affect the achievement of health and well-being. 2. Education and Training in Culturally Competent Care  Nurses shall be educationally prepared to provide culturally congruent health care. Knowledge and skills necessary for assuring that nursing care is culturally congruent shall be included in global health care agendas that mandate formal education and clinical training, as well as required ongoing, continuing education for all practicing nurses. 3. Critical Reflection  Nurses shall engage in critical reflection of their own values, beliefs, and cultural heritage in order to have an awareness of how these qualities and issues can impact culturally congruent nursing care. 4. Cross-Cultural Communication  Nurses shall use culturally competent verbal and nonverbal communication skills to identify client’s values, beliefs, practices, perceptions, and unique health care needs.

4. Culturally Competent Practice  Nurses shall utilize cross-cultural knowledge and culturally sensitive skills in implementing culturally congruent nursing care. 6. Cultural Competence in Health Care Systems and Organizations  Health care organizations should provide the structure and resources necessary to evaluate and meet the cultural and language needs of their diverse clients. 7. Patient Advocacy and Empowerment  Nurses shall recognize the effect of health care policies, delivery systems, and resources on their patient populations, and shall empower and advocate for their patients as indicated.  Nurses shall advocate for the inclusion of their patient’s cultural beliefs and practices in all dimensions of their health care. 8. Multicultural Workforce  Nurses shall actively engage in the effort to ensure a multicultural workforce in health care settings. One measure to achieve a multicultural workforce is through strengthening of recruitment and retention efforts in the hospitals, clinics, and academic settings.

5. 9. Cross-Cultural Leadership  Nurses shall have the ability to influence individuals, groups, and systems to achieve outcomes of culturally competent care for diverse populations.  Nurses shall have the knowledge and skills to work with public and private organizations, professional associations, and communities to establish policies and guidelines for comprehensive implementation and evaluation of culturally competent care. 10. Evidence-Based Practice and Research  Nurses shall base their practice on interventions that have been systematically tested and shown to be the most effective for the culturally diverse populations that they serve. In areas where there is a lack of evidence of efficacy, nurse researchers shall investigate and test interventions that may be the most effective in reducing the disparities in health outcomes. Douglas MK1, Rosenkoetter M, Pacquiao DF, Callister LC, Hattar-Pollara M, Lauderdale J, Milstead J, Nardi D, Purnell L. . (2014). Guidelines for implementing culturally competent nursing care. Journal of Transcultural Nursing, 25(2):109-21. doi: 10.1177/1043659614520998. Epub 2014 Feb 18. Retrieved August 12, 2016.

6. Basic Concepts • Transcultural Nursing—the study of the lifeways and patterns of persons of various cultures including their healthcare practices and nursing’s role in that culture. • Cross Cultural Nursing—the study of the lifeways and patterns of persons of various cultures from an anthropological perspective that is being applied to nursing.

7. Concepts (Cont’d) • International Nursing—the exchange of nurses between 2 or more nations/cultures. • Culture—the patterns and lifeways that guide a group of people’s worldview and decision-making. • Cultural Imposition—a situation where one culture forces their values and beliefs on another culture or subculture.

8. Concepts (Cont’d) • Acculturation—the process of adapting or modifying the patterns and lifeways of an adopted culture as a result of contact with another group or individual. • Assimilation—the process of accepting some of the cultural practices or traits of the prevailing culture into one’s own daily activities. • Refugee—a person who flees from persecution, invasion, or political danger.

9. Concepts (cont’d) • Values—something regarded as desirable, worthy, or right, as a belief, standard, or moral precept. • Beliefs—a tenet or body of tenets; doctrine; creed. • Ethnocentrism—the universal tendency of human beings to think that their ways of thinking, acting, and believing are the only right, proper, and natural ways. It can be a major barrier to providing culturally conscious care.

10. Concepts (Cont’d) • Generalization—usually an oversimplification made about behaviors of an individual or large group. • Stereotyping—to make a person possess or believe to possess characteristics or qualities that typify a particular group.

11. Cultural Competence in Nursing • Developing an awareness of one’s own existence, sensations, thoughts, and environment without letting it have an undue influence on those from other backgrounds. • Demonstrating knowledge and understanding of the client’s culture. • Accepting and respecting cultural differences. • Adapting care to be congruent with the client’s culture.

12. 4 Levels of Cultural Competence • Unconscious incompetence—not being aware that one is lacking knowledge about another culture. • Conscious incompetence—being aware that one is lacking knowledge about another culture. • Conscious competence—learning about the client’s culture, verifying generalizations about the client’s culture, and providing culturally specific interventions. • Unconscious competence—automatically providing culturally congruent care to clients of a diverse culture.

13. What is YOUR goal re: Cultural Competence?? • Through this course we hope that you will desire to strive for CONSCIOUS COMPETENCE regarding your client’s culture when you practice.

15. Nursing Theorists in Transcultural Nursing • Madeleine Leininger—the founder of Transcultural Nursing.Dr. Leininger studied anthropology in the 1950’s and early 60’s. She earned her PhD in Cultural Anthropology. She then decided that nursing was constantly dealing with the lifeways and patterns of peoples of many backgrounds and that in caring for these persons, nurses needed to be sensitive to the unique needs of all peoples. She felt strongly that we should NOT impose our views on others whenever possible.

16. Contributions of Madeleine Leininger(July 13, 1925-August 10, 2012) to the Development of Transcultural Nursing from the TCNS website: www.tcns.org

18. Leininger’s Theory • She developed the “SUNRISE MODEL”as a basis for assessment and research in nursing. This model remains as a standard in Transcultural Nursing Theory. • Dr. Leininger also developed the ETHNONURSING Method for conducting Transcultural Research. While it is considered by Dr. Leininger to be Qualitative, it has certain attributes that make it somewhat Quantitative as well. Resource: http://www.madeleine-leininger.com/cc/overview.pdf

19. Retrieved on 3/14/2017 from http://www.tcns.org/Theories.html

20. Leininger’s Theory (cont’d) • Note that the model looks like a Sunrise and the Worldviewencompasses everything that makes people who they are. • The7 Cultural and Social Structure Dimensionsare the large areas that nurses need to learn about through interview and living among the people of different cultures. • Below the Individuals, Families, Groups, Communities, & Institutions are theDiverse Health Systems that all persons deal with in various ways.

21. Leininger’s Theory (cont’d) • Generic or Folk Systemsare the everyday remedies an individual, family or group may use to promote wellness and healing. Some examples might include: • Chicken Soup • Chamomile Tea or other Herbal teas • Voodoo • Sacrifices of birds or animals to the spirits • Prayer • Curandero • Nurses need to assess in all these areas to plan safe, effective care.

22. Leininger’s Theory (cont’d) • Professional Systemsare different depending upon the Health Care Delivery System of that culture. Whether there is socialized medicine, private insurance, communal healthcare, poor economic support vs. great wealth, all contribute to the influence of the utilization of Professionals to prevent illness, heal illness, and promote health and wellness. • Nursing must collaborate within the healthcare delivery system to plan and implement safe, effective, culturally competent care.

23. How to Provide Culturally Congruent Care: • Leininger suggests 3 approaches to plan and implement Culturally Congruent Care. • The first is Cultural Care Preservation/Maintenance where we look at what we as nurses can do to preserve and maintain the cultural practices of an individual or family while receiving safe, holistic care somewhere in the Healthcare Delivery System.

24. How to Provide Culturally Congruent Care: (cont’d) • The second approach is Cultural Care Accommodation/Negotiation where we look at what we as nurses can do to accommodate the patient and negotiate with the patient within the healthcare environment in order to provide culturally congruent care while he/she is in the Healthcare Delivery System.

25. How to Provide Culturally Congruent Care: (Cont’d) • The third approach is Cultural Care Repatterning/Restructuringwhere we look at what we as nurses need to do with the patient and family to repattern or restructure their lifeways in order to promote healing and wellness, always being cognizant of the cultural influences that affect why they do what they do in their life experience.

26. Josepha Campinha-Bacote • In 1991, Campinha-Bacote developed her own Transcultural Theory entitled “Culturally Competent Model of Care”. • She has continued to evolve in her model development through her research. Her newest 2010 model emphasizes the importance of ‘cultural encounters’ to increase cultural awareness, knowledge, skill, and desire. • She did much research in the African-American population. • Her 2002 model is visually inspirational

27. “Culturally Competent Model of Care”http://www.transculturalcare.net/

28. Geiger and Davidhizer Model • Joyce Newman Geiger and Ruth Davidhizer were inspired to develop a culturally competent assessment tool by their nursing students at Bethel College in Mishawaka, IN. Dr. Davidhizer just passed away in 2007. • The Transcultural Assessment Model was developed and researched in 1990.

29. Geiger and Davidhizer Model Communication Culturally Unique Individual Space Social Organization Biological Variations Time Environmental Control Giger, J. N., & Davidhizar, R. (2002). Culturally competent care: emphasis on understanding the people of Afghanistan, Afghanistan Americans, and Islamic culture and religion. International Nursing Review, 49(2), 79-86. doi:10.1046/j.1466-7657.2002.00118.x

30. In Summary • You have been introduced to several theorists in Transcultural Nursing other than the author of your text. Next, we will explore the Purnell and Paulanka Model in greater depth as it will be the basis for your Cultural Presentations. • I hope you have been inspired to learn more about cultures in order to be a CULTURALLY CONSCIOUS COMPETENT NURSE