Transcultural Nursing

This page was last updated on January 26, 2012

INTRODUCTION

Madeleine Leininger is considered as the founder of the theory of

transcultural nursing.

Her theory has now developed as a discipline in nursing.

Evolution of her theory can be understood from her books:

o Culture Care Diversity and Universality (1991)

o Transcultural Nursing (1995)

o Transcultural Nursing (2002)

Transcultural nursing theory is also known as Culture Care theory.

Theoretical framework is depicted in her model called the Sunrise

Model (1997).

ABOUT THE THEORIST

One of the first nursing theorist and transcultural global nursing

consultant.

MSN - Catholic University in Washington DC.

PhD in anthropology - University of Washington.

She developed the concept of transcultural nursing and the

ethnonursing research model.

For more details: http://en.wikipedia.org/wiki/Madeleine_Leininger

DEFINITIONS

Transcultural Nursing

Transcultural nursing is a comparative study of cultures to understand

 similarities (culture universal) and difference (culture-specific) across
human groups (Leininger, 1991).

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 ones 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.

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.

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.

Ethnic

refers to a group of people who share a common and distinctive culture

and who are members of a specific group.

Ethnicity

a consciousness of belonging to a group.

Cultural Identify
 the sense of being part of an ethnic group or culture

Culture-universals

commonalities of values, norms of behavior, and life patterns that are

similar among different cultures.

Culture-specifies

values, beliefs, and patterns of behavior that tend to be unique to a

designate culture.

Material culture

refers to objects (dress, art, religious arti1acts)

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

a person who crosses two cultures, lifestyles, and sets of values.

Diversity

refers to the fact or state of being different. Diversity can occur between
cultures and within a cultural group.

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

share a common social and cultural heritage that is passed on to

successive generations.,

Ethnic identity

refers to a subjective perspective of the person's heritage and to a

sense of belonging to a group that is distinguishable from other groups.

Race

the classification of people according to shared biologic characteristics,

genetic markers, or features. Not all people of the same race have the
same culture.

Cultural awareness

It is an in-depth self-examination of one's own background, recognizing

biases and prejudices and assumptions about other people.

Culturally congruent care

Care that fits the people's valued life patterns and set of meanings
-which is generated from the people themselves, rather than based on
predetermined criteria.

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.

Nursing Decisions
Leininger (1991) identified three nursing decision and action modes to achieve
culturally congruent care.

1. Cultural preservation or maintenance.

2. Cultural care accommodation or negotiation.

3. Cultural care repatterning or restructuring.

M A J O R C O N C E P T S [Leininger (1991)]

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.

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..

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.

APPLICATION TO NURSING

To develop 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 encourage in developing and maintaining a program of physical,

emotional and spiritual self-care introduce therapies such as ayurveda
and pancha karma.

HEALTH PRACTICES IN DIFFERENT CULTURES

Use of Protective Objects

Protective objects can be worn or carried or hung in the home- charms

worn on a string or chain around the neck, wrist, or waist to protect the
wearer from the evil eye or evil spirits.

Use of Substances .

It is believed that certian food substances can be ingested to prevent

illness.

E.g. eating raw garlic or onion to prevent illness or wear them on the
body or hang them in the home.

Religious Practices

Burning of candles, rituals of redemption etc..

Traditional Remedies

The use of folk or traditional medicine is seen among people from all
walks of life and cultural ethnic back ground.
Healers

Within a given community, specific people are known to have the power
to heal.

Immigration

Immigrant groups have their own cultural attitudes ranging beliefs and
practices regarding these areas.

Gender Roles

In many cultures, the male is dominant figure and often they take
decisions related to health practices and treatment. In some other
cultures females are dominant.

In some cultures, women are discriminated in providing proper

treatment for illness.

Beliefs about mental health

Mental illnesses are caused by a lack of harmony of emotions or by evil

spirits.

Problems in this life are most likely related to transgressions committed

in a past life.

Economic Factors

Factors such as unemployment, underemployment, homelessness, lack

of health insurance poverty prevent people from entering the health
care system.

Time orientation

It is varies for different cultures groups.

Personal Space

Respect the client's personal space when performing nursing

procedures.
 The nurse should also welcome visiting members of the family and
extended family.

NURSING PROCESS AND ROLE OF NURSE

Determine the client's cultural heritage and language skills.

Determine if any of his health beliefs relate to the cause of the illness or
to the problem.

Collect information that any home remedies the person is taking to treat
the symptoms.

Nurses should evaluate their attitudes toward ethnic nursing care.

Self-evaluation helps the nurse to become more comfortable when

providing care to clients from diverse backgrounds

Understand the influence of culture, race &ethnicity on the development

of social emotional relationship, child rearing practices & attitude toward
health.

Collect informationabout the socioeconomic status of the family and its

influence on their health promotion and wellness

Identifiy the religious practices of the family and their influence on

health promotion belief in families.

Understanding of the general characteristics of the major ethnic groups,

but always individualize care.

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.

Self-evaluation by the nurse is crucial as he or she increases skills for

interaction. .

CONCLUSION

Nurses need to be aware of and sensitive to the cultural needs of

clients.

The practice of nursing today demands that the nurse identify and meet
the cultural needs of diverse groups, understand the social and cultural
reality of the client, family, and community, develop expertise to
implement culturally acceptable strategies to provide nursing care, and
identify and use resources acceptable to the client (Andrews & Boyle,
2002).

REFERENCES

1. Murphy SC. Mapping the literature of transcultural nursing.J Med Libr

Assoc. 2006 Apr;94(2 Suppl):E143-51.

2. Leninger M. Culture Care Theory: A Major Contribution to Advance

Transcultural Nursing Knowledge and PracticesJournal of Transcultural
Nursing, Vol. 13 No. 3, July 2002 189-192.

3. Leininger M. Culture care diversity and universality: A theory of

nursing. New York: National League for Nursing Pres; 1991.

4. Leininger M.Transcultural nursing: Concepts, theories, research,

and practice. Columbus, OH: McGraw-Hill College Custom Series;
1995.

5. Andrews MM, Boyle JS.Transcultural concepts in nursing care. J

Transcult Nurs. 2002 Jul;13(3):178-80.

6. George Julia B. Nursing theories: The base of professional nursing

practice 5rd edition. Norwalk, CN: Appleton and Lange; 2002.

7. Kozier B, Erb G, Barman A, Synder AJ. Fundamentals of nursing;

 concepts, process and practice, Edn 7th, 2001.

8. Leninger M, McFarland M. Transcultural Nursing: Concepts, Theory,

Research, and Practice; Edn 3rd, McGraw-Hill Professional; New York,
2002.

9. Potter PA, Perry AG. Basic Nursing, 6th e