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Transcultural Nursing theory
Transcript of Transcultural Nursing theory
NURSING THEORY, NURS 500
Fall Semester 2011-2012
American University of Beirut, HSON Case Study 1 N. M. an 18 year female
Known to have history of Seizure disorder
Diagnosed with Autistic disorder (4 years)
She is Russian.
Currently she lives in Saudi Arabia.
Referred to American University of Beirut Medical Center (AUBMC) for reevaluation and further management.
Challenges for a teenager with Autism: Poor communication
Nursing diagnosis: Impaired social interaction related to inability to comprehend Arabic language manifested by emotional distress. Apply in the practice Theory in the scope of nursing practice Nursing contribution of the theory to the patient Madeleine Leininger Founder of transcultural nursing
1950- Benedictine College, in Kansas
1954- Masters degree in psychiatry, Catholic university, in Washington
First graduate nursing program in psychiatry at the Univ.Cincinnati
Observation: lack of understanding of cultural values
Doctoral student: concentrated on many cultures: Anthropology Development of Cultural Care Theory of Diversity and Universality 1959-1969 she published two books:
“Nursing and Anthropology: Two Wolds to Blend ” – foundation of the theory
“Transcultural Nursing: Concepts, Theories, and Practices”
main concepts, theoretical ideas, and practices in transcultural nursing
Director of the first nurse science program (PhD) in the US 1989
Foundation: Journal of Transcultural Nursing as editor
Two disciplines: nursing and anthropology.
M. Leininger passed away on the 10th of August 2012. cont' Transcultural nursing as “a comparative study and analysis of diverse culture and subcultures in the world with respect to their caring values, expressions, and believes.” Purpose: to discover human care diversities and compare them to general care practices.
Goal: to improve and provide culturally congruent care.
Core functions of nursing education and practice: culture and care knowledge Unique features of the theory Focuses explicitly on comprehensive cultural care
Culturally diverse nursing
Ethnography Empirical Evidence The Transcultural theory is a generalizable assumption because of it’s qualitative broad orientation which leads to its comprehensible scope. The central thesis of the theory: "health care of the individual can be predicted and culturally congruent care can be provided" As one of the most powerful constructs in nursing So Why Cultural knowledge important to nurses? patients' satisfaction 1)To develop understanding, respect and appreciation for the individuality and diversity of patients beliefs, values and culture regarding illness, its meaning, cause, treatment, and outcome.
2)To encourage in developing and maintaining a program of physical and emotional self-care. Nurses need to be aware of and sensitive to the cultural needs of clients.
Today demands that the nurse:
_identify & meet the cultural needs of diverse groups _understand the social and cultural reality of the client _develop & implement culturally acceptable strategies to provide nursing care
_identify and use resources acceptable to the client Conclusion Determine the client's cultural heritage
Beliefs relate to the cause of the illness
Collect information about the socioeconomic status of the family, values
Identify the religious practices of the family
Understand the general characteristics of the major ethnic groups
Plan and implement nursing interventions that are adapted as much as possible to the client's cultural background. The increase in number of migrations worldwide
Increased cultural conflict
Use of alternative medicine and other non-medical practices
Thriving for holistic care and better outcomes All health disciplines are gradually incorporating transcultural knowledge Further explained by McFarland and Eipperle (2008) describing it as a foundational basis for educational programs to provide culturally congruent care.. Objectives: By the end of the presentation, the NURS 500 students should be able : Describe the major concepts of the theory
Correlate the theory to the practice
Identify the contribution of the theory to the case study
Express subjective view of the theory Miscommunication is a very frequent issue and it mostly happens when the patient and nurse do not speak the same language.
Intervention: Assign a nurse or an interpreter who speaks the same language to take care of the patient. I, Respected the patients space by providing a gentle touch, and maintaining eye contact while conversing with the patient that allows her to be more at ease and thus more comfortable to talk.
Through applying cultural knowledge, the patient at the end of the shift was comfortable as if it was her second home as she shared her books and stories with me. Incorporated cultural practices to the nursing care thus allowing the patient to adapt and abide to the medical regimen. the perception that one's own way is best when viewing the world (Geiger & Davidhizar, 1991)
is the study of a culture
care an optimal mode of health care delivery (Leininger, 1985)
relates to large groups of people classified according to common traits or customs
the individual's desirable or preferred way of acting or knowing something
is the general belief among the scientific community that race has no biological or natural basis
refers to norms and practices Major concepts and definitions Culture: refers to norms and practices
Cultural values: the individual's desirable or preferred way of acting or knowing something
Culturally diverse nursing: care an optimal mode of health care delivery (Leininger, 1985)
Ethnocentrism: the perception that one's own way is best when viewing the world (Geiger & Davidhizar, 1991)
Ethnic: relates to large groups of people classified according to common traits or customs
Race: is the general belief among the scientific community that race has no biological or natural basis
Ethnography: is the study of a culture quality of care Cultural blindness
and ethnocentrism Simple, holistic and comprehensive
Focuses on care as a core of nursing
Applicable to both individuals and groups
High confirmability and credibility of the empirical data taken from the patients Requires some basic anthropological knowledge
Misinterpretation of cultural values could lead to misjudgment Cultural shock to nurses
Does not focus on medical symptoms or spirituality
Contains confusing terminology References:
“Madeleine Leininger: Transcultural Nursing Theory.” (2012). NursingLibrary.
Gayzell de Jesus. A. (2011). Leininger’s Theory of Culture Care. Retrieved from http://nursingtheories.blogspot.com/2011/07/leiningers-theory-of-culture-care.html
Alligood. M.R. & Tome. A.M. (2010). Nursing theorists and their work. Nursing Science Quarterly. 7th ed. 455-475. Retrieved November, 2012 fromhttp://nsq.sagepub.com/content/25/2/203.extract#Leininger, M. (1991). Transcultural nursing: the study and practice field. Imprint, 38(2), 55-66.
Leininger, M. (1985). Qualitative research methods in nursing. New York
Grune & Straton.Tripp-Reimer, T & Dougherty, M.C. (1985). Cross cultural nursing research. Annual Review of Nursing Research, 3, 77-104
Doody.O & Doody. C. (2012). Intellectual disability nursing and transcultural care. British Journal of Nursing 21- 3. 174-180
Backford, J. & Street, A. (2002). Cultural conflict: the impact of western feminism(s) on nurses caring for women of non-English speaking background. Journal of Clinical Nursing11. 664–671
Vydelingum. V. (2006). Nurses’ experiences of caring for South Asian minority ethnic patients in a general hospital in England. Nursing Inquiry 13-1. 23–32
Ahsberg, E., Gebru, K., & Willman, A. (2006). Nursing and medical documentation on patients’ cultural background. Journal of Clinical Nursing, 16, 2056–2065.
Ethnic Communities’ Council of Victoria Inc. Statewide Resources Centre, (2006). Cultural competence guidelines and protocols. Carlton:
Lo, Y. (2012). The importance of transcultural nursing in cancer care. British Journal of Nursing, 24(4), 32-37. Thank you Questions Intellectual disability nursing and transcultural care. Aims to guide registered nurses to care for intellectually disabled patients in Ireland by identifying ethnicity and addressing the component of transcultural care outlined by Campinha-Bacote (2002; 2003) and Cortis (2003 Main Concepts Cultural awareness Cultural Skills Cultural knowledge 2 4 5 Cultural encounter Cultural desire Nurses’ experiences of caring for South Asian minority ethnic patients in a general hospital in England. The interviews were transcribed in such a way as to preserve the richness of the interaction among the participants. Eight themes The success of health care provision depends on its ability to respond to the needs of individuals. Good quality care requires an understanding of ethnic and cultural identity and its impact on care. Such understanding can be obtained by proper cultural assessments leading to appropriate rehabilitation plans, holistic care and higher satisfaction. Results: we are doing our best we treat everyone the same we don’t understand them It’s is not our fault They are very helpful we don’t have racism here it’s not rational what they believe I know how they feel Results The study revealed a local service response to government policies in addressing inequality in accessing health services. However, such initiatives have made little difference to nurses’ knowledge and cultural competence in enabling them to provide culturally sensitive care, raising questions about the quality of service provision. Vydelingum. V. (2006). The aim of the study was to describe the nurses’ experiences of caring for South Asian patients, in a medical directorate of a general hospital in the south of England. Backford, J. & Street, A. (2002). Cultural conflict: the impact of western feminism(s) on nurses caring for women of non-English speaking background The purpose of this paper was to discuss the impact of liberal feminist approaches on the nursing practices of nurses who cared for women of different ethnicity and race. The study found that the efforts of liberal feminist nurses to treat all people the same meant that women from different cultural backgrounds did not always receive equal care. Doody.O & Doody. C. (2012). Leininger was a pioneer in transcultural nursing and her theory inspired the birth of many other models.
One of those models is the ACCESS model by Narayanasamy in 1999. What does the model propose? A study in Sweden was conducted in 2005 that utilized the sunrise enabler model developed by Leininger to draw conclusions about nurses and physicians cultural assessment of patients. Analyzed 121 deceased patient records, and focused on identification of the entries (sentences, phrases, etc..) to code the information sought.
Then the authors categorized the entries using the Sunrise model. Ahsberg, Gebru & Willman, 2006 Technological factors: No entries were found in this study, in the records, to indicate that nurses discussed the use of hospital based technological equipment with patients.
Religion and philosophical factors: “Relatives want a Moslem mortician to collect the patient’s body” Kinship and social factors:
“The patient was not informed the first days, relatives did not want it.
On the day 3, the patient received the information together with the daughter, grandchild and interpreter.”
Cultural values, beliefs and life ways: “The daughter and her husband will themselves, after death, dress the patient in private clothes” Political and legal factors: “He had stayed in a refugee camp the last 6–7 years.”
Economic factors: “The patient wants to meet the welfare officer regarding contribution to the trip…/application of donation of money for his son’s trip.”
Educational factors: The patient’s educational level is important, as it will influence the healthcare giver’s judgment the communication method to use. Ahsberg, Gebru & Willman, 2006 Do nurses document cultural assessment? Nurses and physicians do document their cultural assessment of the patients, however the documented entries were partly atomistic and insufficient as cultural assessment.
Cultural assessment is crucial to provide culturally congruent care.
(Ahsberg, Gebru & Willman, 2006) First what is cultural competence?
“The ability to identify and challenge one’s own cultural assumptions, one’s values and beliefs. It is about developing empathy and connected knowledge, the ability to see the world through another’s eyes, or at the very least, to recognize that others may view the world through different cultural lenses” (Ethnic Communities’ Council of Victoria Inc., 2006) Now, what are the qualities of a culturally competent nurse? Culturally competent nurse must possess:
Knowledge of how one's own culture shapes attitudes, perceptions and behaviors
A valuing of diversity
Willingness to learn about other peoples cultures
Knowledge of the language and cultural practices
The skills to feel comfortable and communicate effectively
Awareness of stereotyping of certain cultures. (Ethnic Communities’ Council of Victoria Inc., 2006) Case study 2 64 y.o Kurdish patient
previously known healthy
presented with abdominal pain and increased abdominal girth
Found to have liver Cancer.
Speaks only Kurdish, and doesn't know about her illness
Daughters speak German only Nursing diagnosis: Ineffective communication related to inability to speak arabic/english with the healthcare givers manifested by inability to comprehend questions and verbal commands. I, Checked the list of foreign language speakers in the hospital
Called the nurse shift administrator to help me contact the related person
Assigned person arrived late, thus the management was delayed.
This hinders patient's safety and satisfaction.