By C Settley

Transcultural nursingWhen dealing with patients

belonging to other cultures, the nurse need to take many aspects into consideration.

Symbolic interactionism knowledge has to be implemented.

Madeleine Leininger’s theory of transcultural nursing in educational research theory is particularly relevant to the SA nursing scenario.

Transcultural nursing as defined by Leininger:a substantive area of study and

practice focused on comparative cultural care (caring) values, beliefs, and practices of individuals or groups of similar or different cultures with the goal of providing culture-specific and universal nursing care practices in promoting health or well-being or to help people to face unfavorable human conditions, illness, or death in culturally meaningful ways.

Transcultural nursingLeininger’s theory represents a

holistic and comprehensive approach to nursing.

Her theory aims to highlight nursing care measures that are in harmony with an individual’s cultural beliefs, practices and values.

Culturally congruent care: is the primary goal of transcultural nursing practice.

Culturally congruent care is possible when the following occurs within the nurse-client relationship:

• Care is to assist others with real or anticipated needs in an effort toimprove a human condition of concern or to face death.• Caring is an action or activity directed towards providing care.• Culture refers to learned, shared, and transmitted values, beliefs,norms, and lifeways of a specific individual or group that guide theirthinking, decisions, actions, and patterned ways of living.• Cultural care refers to multiple aspects of culture that influence and enable a person or group to improve their human condition or to deal with illness or death.• Cultural care diversity refers to the differences in meanings, values, or acceptable modes of care within or between different groups of people.• Cultural care universality refers to common care or similar meanings that are evident among many cultures.

Culturally congruent care is possible when the following occurs within the nurse-client relationship:

•Nursing is a learned profession with a disciplined focused on care phenomena.• Worldview refers to the way people tend to look at the world or universe in creating a personal view of what life is about.• Cultural and social structure dimensions include factors related to religion, social structure, political/legal concerns, economics, educational patterns, the use of technologies, cultural values, and ethno history that influence cultural responses of human beings within a cultural context.• Health refers to a state of well-being that is culturally defined and valued by a designated culture.

Culturally congruent care is possible when the following occurs within the nurse-client relationship:

• Cultural care preservation or maintenance refers to nursing care activities that help people of particular cultures to retain and use core culturalcare values related to healthcare concerns or conditions.• Cultural care accommodation or negotiation refers to creative nursing actions that help people of a particular culture adapt to or negotiate with others in the healthcare community in an effort to attain the shared goal of an optimal health outcome for client(s) of a designated culture.• Cultural care repatterning or restructuring refers to therapeutic actions taken by culturally competent nurse(s) or family. These actions enable or assist a client to modify personal health behaviors towards beneficial outcomes while respecting the client’s cultural values.

These statements are derived from Leininger’s key sources (Leininger 1976, 1981, 1991, 1995, 2002, but most specifically, 2001, pp. 44–45): Care is the essence and central focus of nursing. Caring is essential for health and well-being, healing,

growth, survival, and also for facing illness or death. Culture care is a broad holistic perspective to guide nursing

care practices. Nursing’s central purpose is to serve human beings in

health, illness, and if dying. There can be no curing without the giving and receiving of

care. Culture care concepts have both different and similar

aspects among all cultures of the world. Every human culture has folk remedies, professional

knowledge, and professional care practices that vary. The nurse must identify and address these factors consciously with each client in order to provide holistic and culturally congruent care.

These statements are derived from Leininger’s key sources (Leininger 1976, 1981, 1991, 1995, 2002, but most specifically, 2001, pp. 44–45):Cultural care values, beliefs, and practices are

influenced by worldview and language, as well as religious, spiritual, social, political, educational, economic, technological, ethnohistorical, and environmental factors.

Beneficial, healthy, satisfying culturally based nursing care enhances the well-being of clients.

Culturally beneficial nursing care can only occur when cultural care values, expressions, or patterns are known and used appropriately and knowingly by the nurse providing care.

These statements are derived from Leininger’s key sources (Leininger 1976, 1981, 1991, 1995, 2002, but most specifically, 2001, pp. 44–45):Clients who experience nursing

care that fails to be reasonably congruent with the client’s cultural beliefs and values will show signs of stress, cultural conflict, noncompliance, and ethical moral concerns.

Congruent: in agreement or harmony.

Giger & Davidhizar ‘s Transcultural variations- Communication- verbal and non verbal

(facial expression, eye contact, touch)

- Eg eye contact….. Is it a sign of respect or not in your culture?

- Watch your patients reactions

- Clear communication and mutual understanding is important

Transcultural variations

Transcultural variationsSpace Refers to the area surrounding the patient’s

bodyCertain cultural groups keep a distance between

themselves and others while others do notSuch contact-orientated people regard

noncontact others as shy, impersonal, boring, cold or rude

Vice versa seen as rude, bossy or pushyNurses operate mostly within the personal

spaces of patients and must be understanding when someone feels embarrassed or affronted

Transcultural variationsTime and tempoSome groups do not attach

importance to punctualitySome may be irritated when others

arrive lateThe nurse normally have to work

‘fast’ – this may seem to the patient that you are uninterested and they feel that they do not get the attention that they deserve

Transcultural variationsBiological variationsKnowledge of growth, development, nutrition

and other biological factors is important as it influences nursing care

Some cultures attach positive value to large people while others are obsessed with being thin

There are also rules for the type of foods and how they are prepared

Transcultural variationsEnvironmental controlRefers to the ability to control

factors in immediate environmentScientific or traditional

Transcultural variationsSocial institutionsFamiliesEducationEconomic institutionsReligious groupsPolitical institutions

Scenario 1Susan Williams, a very happy and empathic

nurse, who loves to hug and comfort her patients, is on duty today in the casualty department. A bus of foreign tourists from Dubai was involved in an accident and the tour operator brought Mr Amari in for an assessment. Mr Amari seems distant and does not want to look at any of the nurses. He forcefully jerked his hand back when nurse Williams reached out to touch him. He said: “ ني which was translated ”!واتاشيas “do not touch me”, by the tour operator.

Scenario 1Susan Williams, a very happy and empathic

nurse, who loves to hug and comfort her patients, is on duty today in the casualty department. A bus of foreign tourists from Dubai was involved in an accident and the tour operator brought Mr Amari in for an assessment. Mr Amari seems distant and does not want to look at any of the nurses. He forcefully jerked his hand back when nurse Williams reached out to touch him. He said: “ ني which was translated ”!واتاشيas “do not touch me”, by the tour operator.

Scenario 2Mr Lee is from Asian descent and regards eye

contact as impolite. A language barrier also exists, which makes communication between staff and Mr Lee difficult. He always seems to keep a distance between himself and others. The doctor informed him that he needs to be in his room by 9am for doctor’s rounds, but he was not in the ward when the rounds had started. In addition, Mr Lee is a vegetarian and suffers from iron-deficient anaemia.

Q 1: Identify four (4) cultural variations that are evident from this scenario.

Scenario 2 Mr Lee is from Asian descent and regards eye contact as impolite. A

language barrier also exists, which makes communication between staff and Mr Lee difficult. He always seems to keep a distance between himself and others. The doctor informed him that he needs to be in his room by 9am for doctor’s rounds, but he was not in the ward when the rounds had started. In addition, Mr Lee is a vegetarian and suffers from iron-deficient anaemia.

Answers to Q1:

Communication Space Time and tempo Biological variations

Q 2: Reflect upon Asian culture and explain how you should accommodate the patient’s (Mr Lee’s) cultural needs in a caring environment such as a hospital.

Answers to Q2

Get an interpreter to assist in communication. Try and refrain from making eye contact with Mr Lee.But when having to do so, explain to him the reason

why- for possible observation or examination.Mr Lee seems not to attach importance to

punctuality hence it is important to explain to him why he needs to be at his bed with the start of doctor’s rounds.

Mr Lee suffers from iron deficiency but he is a vegetarian and iron comes from meat so he does not get any iron in his diet.

It is important to explain this to him.

Referenceshttp://

www.usask.ca/nursing/predeparture/section09.php

https://www.uni-graz.at/en/studying/for-prospective-students/enrolment-for-applicants-and-new-entrants/language-examinations/