ASSIGNMENT

TRANSCULTURAL NURSING

ON

Created to answer the need for developing a global

perspective in the practice of nursing in a world of
interdependent nations and people.
HP

INTRODUCTION

In health care delivery system , as in society, nurses have to deal

with people of similar as well as diverse cultural backgrounds . People have different
frames of reference and varied preferences regarding their health and health care needs.
Therefore acknowledging , respecting , and adapting to the cultural needs of patients and
significant others are important components of nursing care . Professional nursing care is
culturally sensitive, culturally appropriate and culturally competent.

Trans cultural nursing is a comparative study of cultures to understand

similarities (culture universal) and difference (culture-specific) across human
groups.
Trans cultural nursing is how professional nursing interacts with the concept
of culture based in anthropology and nursing, it is supported by
nursing theory, research, and practice.
The care delivered beyond national boundaries , the term international or
trans cultural nursing is used.
DEFINITIONS :
a) A humanistic and scientific area of formal study and practice in
nursing :which is focussed upon differences and similarities among
cultures with respect to human care, health and illness bases the
peoples cultural values , belief and practices to use his knowledge to
provide cultural specific or cultural congruent nursing care to the
people.(Leninger )
b) A legitimate and formal area of study, research and practice ,
focussed on culturally based care , values and practices to help
cultures or subcultures maintain or regain their health and face
disabilities or death in culturally congruent and beneficial caring
ways.
c) A culturally competent practice field

that is client centered and

research focussed.(Giger and David Hizer)

d) A field of nursing founded by Madeleine Leninger ,in which the nurse
transcends ethnocentricity and practices nursing in other cultural
environments.(Mosby)
e) A nursing speciality created to answer the need for developing a
global

perpective

in

the

practice

of

nursing

in

world

of

interdependent nations and people.

Goals:
To provide cultural specific care.
To discover the culturally relevant facts about the client to provide
culturally appropriate and competent care.
HISTORY

It was established in 1955 as a formal area of inquiry and practice. It is a body of

knowledge that assists in providing culturally appropriate nursing care .

Founder

As the initiator of and the leader in the field of trans cultural nursing,
Madeleine Leininger was the first professional nurse who finished a doctorate
degree in anthropology.

Leininger first taught a trans cultural nursing course at the University of

Colorado in 1966.

In 1998, Leininger was honoured as a Living Legend of the American

Academy of Nursing.

Leininger was the editor of the Journal of Tran cultural Nursing, the official
publication of the Tran cultural Nursing Society, from 1989 to 1995. She
authored books about the field of trans cultural nursing.

Through Leininger, trans cultural nursing started as a theory of diversity and

universality of cultural care. Trans cultural nursing was established from
1955 to 1975.

In 1975, Leininger refined the specialty through the use of the "sunrise
model" concept. It was further expanded from 1975 to 1983.

Its international establishment as a field in nursing continued from 1983 to

the present.

After being formalized as a nursing course in 1966 at the University of

Colorado, trans cultural nursing programs and track programs were offered
as masters and doctoral preparations during the early parts of the 1970s.

PURPOSE OF DEVELOPING TRANSCULTURAL PRACTICES

1.Nurses are central in providing culturally competent health care.
2.Combining the knowledge and patterns of transcultural advancements result in
improved nursing care.
3.To make Growing awareness and acceptance of diversity and willingness to
maintain and support ethnic and cultural heritage.
4.Increasing awareness among the consumers of what constitutes competent and
sensitive health care.

5Nursing profession continues to value holistic and comprehensive approach to

provide care.
6.Knowledge and use of cultural factors are integral part of client care.

Trans cultural nursing is an area of expertise in nursing

that

responds

to

the

need

for

developing

global

perspective within nursing practice in a world of

interdependent nations and people. As a discipline, it
centers on combining international and trans cultural
content into the training of nurses. It includes learning
cultural differences, nursing in other countries &
international health issues.

MODELS OF TRANSCULTURAL NURSING ;

1.The Giger Davidhizar Transcultural Assessment Model was developed in
1988 in response to the need for nursing students in an undergraduate program to
assess and provide care for patients that were culturally diverse.

-The meta paradigm for this model includes

Trans cultural nursing

Culturally competent care

Culturally unique individual

Health and Health status

The model includes six cultural phenomena:

1.

Communication- it embraces the entire world of human interaction

and behaviour .Communication is the means by which culture is
transmitted and preserved. Both verbal and non verbal communication
are learned in ones culture.

2.

Time It is an important aspect of interpersonal communication.

Cultural groups can be past, present or future oriented .Preventive
health requires some future time orientation because preventative
actions are motivated by a future reward.

3.

Space-It refers to the distance between individuals when they interact.

All communication occurs in the context of space. Zones of personal,
social, and consultative and public. Rules concerning personal
distance vary from culture to culture .

4.

Social organization It refers to the manner in which a cultural group

organises itself around the family group. Family structure and
organisation, religious values and belief and role assignments may all
relate to ethnicity and culture.

5.

Environmental control- It refers to ability of person to control nature

& to plan and direct factors in the environment.

6.

Biological variations-like body structure ,skincolour ,nutritional

preferences. Psychological characteristics, susceptibility to disease.

Uses of Giger and David Hizer model

1.It is used to identify cultural beliefs from the six cultural phenomena.
2.It is used for structured interviews.
3.The model can enable the nurse in assessing individuals who are culturally
diverse in order to provide culturally competent care.
4.The model provide and process for assessing clients from different cultures in
order to be aware of differences and to plan appropriate strategies.

2.Purnells

model for cultural competence

This model was developed to provide an organising framework for nurses to use as
a cultural assessment tool. It includes a circular representation of global society,
community, family, and the person. The model is conceptualization from multiple
theories and a research base gained from organisational theories , anthropology
sociology ,anatomy & physiology ,biology , psychology ,religion ,history ,linguistics
,nutrition ,and the clinical practice setting in nursing and medicine.

 This model is a circle with an outlying rim representing global society

,second community , third family and innermost representing the person.
The interior of the concentric circles is divided into 12 pie shaped wedges
depicting cultural domains and their concepts.
The 12 domains are:
i.
ii.
iii.
iv.
v.
vi.

Overview /heritage
Communication
Family role and organization
Work force
Biocultural ecology
High risk behaviours

vii. pregnancy & child bearing practices

viii. death rituals
ix. spirituality
x. health care practice
xi. nutrition
xii. Health care practitioner

This model can be used in primary , secondary and tertiary

prevention.

USES OF PURNELL S MODEL :

i.
ii.

This model guides the development of assessment tools and planning

strategies and individualised intervention.
Used in as integrated nursing curriculum by including an overview of culture
and the model in a beginning course followed by specific units that

iii.
iv.

concentrate on selected domains that can be integrated into clinical courses.

It has been used by managers in organising framework to promote staff
acceptance in multicultural , multinational population in the workforce.
The model has been used to guide data collection and research as well as for
masters and doctoral students thesis ,dissertation and scholarly projects.

3.

Campinha :Bacotes Model of cultural competence

In this , model, cultural competence is viewed as process and not an end point ,
which one continually strives to achieve the ability to effectively work within the
context of an individual , family or community from a diverse cultural ethnic
background.
The model identifies

a) Cultural awareness :it is defined as the process of conducting selfexamination of ones own biases towards other cultures and in depth
exploration of ones cultural and professional background.
b) Cultural knowledge :it is defined as the process in which the health care
professionals seeks and obtain a sound information base regarding the world
views of different cultures and ethnic groups as well as biological variations,
diseases and health conditions and variations in drug metabolism found
among ethnic groups.
c) Cultural skills : it is the ability to conduct a cultural assessment to collect
relevant cultural data regarding the clients presenting problem as well as
accurately conducting a culturally based physical assessment.
d) Cultural encounters :it is the process which encourages the health care
professionals to directly engage in face to face cultural interactions and
other types of encounters with clients from culturally diverse background in
order to modify existing beliefs about a cultural group and to prevent passive
stereotyping.
e) Cultural desires : It is the motivation of health care professionals to want
up engage in the process of becoming culturally aware, knowledgeable ,
culturally skilful and seeking cultural encounters ,not the have to.
It is spiritual and pivotal construct of cultural competence that provides the
energy source and foundation for ones journey towards cultural competence.
Cultural desires stimulates the process of cultural competence.

Uses

It is used in the development of transcultural nursing standards.

The model is useful in incaring for all people because in reality we all belong
to the same race the human race with all basic needs however these needs
expressed differently.
It is utilised in the development of the TCN standards.

Cultural knowledge

Cultural skills

Cultural world views , Theoretical &

conceptual frameworks

Cultural assessment tools

Cultural
awareness

Cultural encounter

Cultural sensitivity and

cultural biases

Cultural exposure and

cultural practice

Cultural competence

4.Leningers

Model of Transcultural nursing :

Leninger developed a theory of trans cultural nursing that depicts a relationship

between the differences and commonalities in health beliefs and practices of
people from different countries or geographical regions. The model was named as
The Sunrise Model embraces the idea that cultural are embedded in each other and
their application is both broad and holistic.
The basic domains to review when conducting a cultural assessment.
a)
b)
c)
d)
e)
f)

Lifestyle norms
Cultural norms and values
Cultural taboos and myths.
Ethnocentric tendencies and world views
Health and life care rituals
General features that the client perceives as different from or similar to

other cultures.
g) Folk and professionals health illness systems used.
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.

Implications for nursing

1. Incorporate factors from the patients religious and cultural background in
health care ,
influences in her personal life. As the nurse become more sensitive to the impo
2. Be aware of the significance of culture influence on peoples lives.
3. Identify biases in ones own life.
4. Make an effort to learn as much as possible about the whole belief system of
the religion and culture of patients.
5. Display
an accepting , nonjudgmental, objective attitude about patient's
religious and cultural beliefs.
6. Practice techniques of observation and listening to acquire knowledge of beliefs
and values of patients to whom care is being given.
7. Make it easy for the hospitalized
patient to carry out his religious
practices as long as they do not significantly disturb others.
8. Accommodate the religious and
cultural dietary practices of patients as
much as possible .

9. Take into consideration the cultural role of the family member who makes the
most important decisions
such as husband, father, mother grandmother or
another respected elder.
10. Seek assistance of a respected family member , clergyman ,or folk
medicine practitioner.
11. Health practices are a part of the overall culture and that changing them may
have widespread implication for the person.
12. communicate in a nonthreatening
manner .
13. Use validating techniques in communication .

Practical uses of Leninger Model:

It can be utilized individuals , families, groups and communities.

It can be used in different nursing fields of specialization.
It focuses on the nurses approach to care culture care.
It views man holistically.
It fosters respect trust and good compliance of treatment.
It create good interpersonal relationship skills.
It presents the world in different aspects.
Provide holistic, culture specific assessment tool.

Provide wide selection of research problems.

Importance of trans cultural nursing

Trans cultural nursing is an essential aspect of healthcare today. The everincreasing multicultural population in the United States poses a significant
challenge to nurses providing individualized and holistic care to their patients.
This requires nurses to recognize and appreciate cultural differences in healthcare
values, beliefs, and customs. Nurses must acquire the necessary knowledge and
skills in cultural competency. Culturally competent nursing care helps ensure
patient satisfaction and positive outcomes. This article discusses changes that are
important to trans cultural nursing. It identifies factors that define trans cultural
nursing and analyzes methods to promote culturally competent nursing care. The
need for trans cultural nursing will continue to be an important aspect in
healthcare. Additional nursing research is needed to promote trans cultural
nursing.

 FUTURE DIRECTIONS IN TCN

With the inevitable trend towards TCN, all nursing education, research and
practice will become Trans culturally based, hopefully by the year 2020 or earlier.
Meanwhile, an incredible amount of TCN leadership is needed to adequately
prepare nurses to function in our growingly academically prepared to teach TCN
and to practice in a culturally competent way. Nursing service and other major
organizations need to become trans cultural institutions. Communication with
nurses from countries everywhere echo nurses' eagerness to prepare themselves in
trans cultural nursing, especially those frustrated in the caring of immigrants and
people of diverse cultures.

IMPORTANT DEFINITIONS:
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.

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
socio-cultural 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).

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