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Transcultural nursing

This document discusses Madeleine Leininger's theory of transcultural nursing. It provides definitions of key terms like culture, ethnicity, and acculturation. Leininger established transcultural nursing as a formal area of study in the late 1960s to address the need for culturally competent care. Her theory, depicted in the Sunrise Model, aims to understand healthcare from diverse cultural perspectives to provide caring practices that are culturally congruent.

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Presented By : Mr. Mahesh Chand MSC.NSG.
INTRODUCTION  A theory is a group of related concepts that propose actions that guide practice.  A nursing theory is a set of concepts , definitions , relationships , and assumptions or propositions derived from nursing models.
IMPORTANCE OF NURSING THEORIES  Nursing theory aims to describe , predict and explain the phenomenon of nursing.  It should provide the foundation of nursing practice , help to generate further knowledge.  Theory is important because it helps us to decide what we know and what we need to know.  The benefits of having a defined body of theory in nursing includes better patient care , enhance professional status for nurses , improved communication between nurses and guidance for research and education.
 Important question:  What might nursing and health services be like if transcultural nursing not been established as a formal area of study, research and practice in nursing and health care services beginning in the late 1960's?“  The idea to establish and develop a new field of transcultural nursing was difficult when I began this challenge in the late 1950's. It was at this time that I identified that culture and care were the missing and significant factors in nursing and health care services."
 "Why had culturally-based care not been central to nursing education and practice? “  "It was clear the faculty and students needed to be educated to teach and practice transcultural nursing. I held to my belief that if you believe in something important to human beings that some time and in some place this goal could become a reality."
ABOUT THE THEORIST  One of the first nursing theorist and transcultural global nursing consultant.  Born in sutton , nebraksha and lived on a farmwith four brothers and sisters .  In 1948 graduate from St Anthony school of nursing in Denver , colorado.  Msc - Catholic University in Washington DC.  PhD in anthropology - University of Washington.  She developed the concept of transcultural nursing and the ethnonursing research model.
TRANSCULTURAL NURSING  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:  Culture Care Diversity and Universality (1991)  Transcultural Nursing (1995)  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).
 "In 1974, it was time to establish the Transcultural Nursing Society." "In 1974, the first conference focused on transcultural nursing occurred in Hawaii with a large attendance, including deans, some physicians and other interested people. It was a highly successful conference." "By 1987 and early in the 1990's many outstanding transcultural nurses were teaching and practicing transcultural nursing. Several faculty and their students were beginning to transform nursing and health care in community agencies and hospitals. Transcultural nursing concepts, principles and practices were becoming incorporated into care of cultures."
DEFINITIONS 1) TRANSCULTURAL NURSING  Transcultural nursing is a comparative study of cultures to understand similarities (culture universal) and difference (culture-specific) across human groups (Leininger, 1991).
2) 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.
 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.
3) 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. 4) ETHNIC Refers to a group of people who share a common and distinctive culture and who are members of a specific group.
5) CULTURAL IDENTIFY The sense of being part of an ethnic group or culture. 6 ) CULTURE-UNIVERSALS Commonalities of values, norms of behavior, and life patterns that are similar among different cultures.
6) CULTURE-SPECIFIES Values, beliefs, and patterns of behavior that tend to be unique to a designate culture. 7) MATERIAL CULTURE Refers to objects (dress, art, religious arti1acts) 8) NON-MATERIAL CULTURE Refers to beliefs customs, languages, social institutions.
9) SUBCULTURE  composed of people who have a distinct identity but are related to a larger cultural group. 10) BICULTURAL  a person who crosses two cultures, lifestyles, and sets of values. 11) DIVERSITY  refers to the fact or state of being different. Diversity can occur between cultures and within a cultural group.
12) 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.
MAJOR CONCEPTS [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.
ASSUMPTIVE PREMISES  In order to support her theory, she formulated the following statements: 1. Human caring is a universal phenomenon, but the expressions, processes, structural forms, and patterns of caring vary among cultures. 2. Caring acts and processes are essential for human birth, development, growth, survival, and peaceful death
 3. Care has a biophysical, cultural, psychological, social and environmental dimension, and the concept of culture provides the broadest means to know and understand care. 4. Nursing is a transcultural phenomenon as nurses interact with clients, staff, and other groups, and requires that nurses identify and use intercultural nurse-client and system data.  5. Care behaviors, goals, and functions vary transculturally because of the social structure, worldview, and cultural values of people from different cultures. 6. Self and other care practices vary in different cultures and in different folk and professional care systems.
 7. The identification of universal and non universal folk and professional caring behaviors, beliefs and practices is essential to discover the epistemological and ontological base of nursing care knowledge. 8. Care is largely culturally derived and requires culturally based knowledge and skills for satisfying and efficacious nursing practices. 9. There can be no curing without caring but there can be caring without curing.
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 panchakarma.
THE SUNRISE MODEL Leininger has presented the Sunrise Model to visualise the different dimensions of her Culture Care Theory.
 The upper half of the circle represents a part of the whole socio-cultural structure and world view factors. These factors influence the care, patterns and expressions towards health and well-being of an individual, families, groups and institutions through language and environment. The same factors also influence folk and professional nursing, bridged by the nursing subsystem which can be seen in the lower half of the model. With the aid of the three types of nursing care, decisions and actions cultural congruent nursing care can be possibly achieved which is meaningful, beneficial and satisfying to people.
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 information about the socioeconomic status of the family and its influence on their health promotion and wellness  Identify 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  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.
THANK YOU