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Trans-cultural nursing concepts and assessment

UNIT# VII TRANS-CULTURAL NURSING CONCEPTS AND ASSESSMENT


OBJECTIVES:
At the end of this session learners will be able to:
1- Describe concept of transcultural nursing.
a. Explain key concepts related to transcultural nursing.
b. Identify the components of cultural assessment.
- Integrate concepts of transcultural nursing care throughout life span.
!- Identify nursing frameworks " theories applicable to transcultural nursing.
a. Examine culturally related issues across the life span.
b. Explore the role of family " cultural practices related to the de#elopmental stages.
TRANSCULTURAL NURSING:
Transcultural nursin a humanistic and scientific area of nursing study and practice that focuses
on how patterns of beha#ior in health$ illness$ and caring are influenced by the #alues and beliefs
of specific cultural groups.
According to %adeleine &eininger $ the pioneer of transcultural nursing$ transcultural nursing is a
substanti#e area of study and practice that focuses on the comparati#e cultural #alues of caring$
the beliefs and practices of indi#iduals or groups of similar or different cultures.
!E" CONCEPTS RELATED TO TRANSCULTRAL NURSING:
1- 'ulturally competent care
- (econd concept that is important to )urses are:
a. Emic *iew-is +insiders, perception.
b. Ethic *iew-is external or +outsider-s perception
OBJECTIVES O# TRANSCULTRAL NURSING:
.o highlight transcultural nursing framework to guide nursing practice in di#erse health care
setting
.o analy/e ma0or concerns and issues in pro#iding transcultural nursing
.o expand the theoretical basis for using this concept in pro#iding culturally competent and
culturally congruent nursing care.
CULTURAL ASSESSMENT:
+.he main goal of the cultural assessment is to gather sufficient information from the client that
will enable the nurse to implement culturally congruent care,
COMPONENTS O# CULTURAL ASSESSMENT:
1iger and Da#idhi/er 213314 proposed six cultural phenomena that the nurse must understand to
pro#ide effecti#e care for all patients: 'ommunication$ (pace$ (ocial
5rgani/ations$ .ime$ En#ironmental 'ontrol$ and 6iological *ariation. A 6asic 'ultural
Assessment %odel containing these six primary elements is presented here to help you gather the
necessary data.
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Trans-cultural nursing concepts and assessment
$% COMMUNICATION:
%iscommunication is a fre;uent problem in hospitals. .he most ob#ious is when the patient and
hospital staff do not speak the same language. (o there must be good communication skills in a
nurse.
&% SPACE:
<articularly the comfort le#el related to personal space - comfort in con#ersation$ proximity to
others$ body mo#ement$ perception of space. Eye contact$ space$ and touch practices may be #ery
different than your sphere of reference.
'% SOCIAL ORGANI(ATION:
<atterns of cultural beha#ior learned through enculturation. 8ecogni/e and accept that indi#iduals
from culturally di#erse backgrounds may desire #arying degrees of acculturation into the
dominant culture.
)% TIME:
'oncept of the passage of time$ duration of time$ and points in time. 'ountries such as England
and 'hina seem to be past oriented. .hey #alue tradition$ doing things the way they ha#e always
been done. Indi#iduals from these countries might be reluctant to try new procedures.
*% ENVIRONMENTAL CONTROL:
Abilities of persons to control nature. 9ealth practices$ #alues$ definitions of health and illness.

+% BIOLOGICAL VARIATION:
8acially related body structure$ skin color$ hair texture$ and other physical characteristics=
en/ymatic and genetic #ariations= electrocardiographic patterns= susceptibility to disease=
nutritional preferences and deficiencies$ and psychological characteristics.
'onsistent with the abo#e mentioned cultural phenomena$ 6oyle and Andrews 213>34 propose
that nurses need to assess eight areas reflecting cultural #ariation$ and encourage the nurse to
gather the following data:
o 9istory of the origins of the patients? culture.
o *alue orientations$ including #iew of the world$ ethics$ and norms and standards of
beha#ior as well as attitudes about time$ work$ money$ education$ beauty$ strength$ and
change.
o Interpersonal relationships$ including family patterns$ demeanor$ and roles and
relationships.
o 'ommunication patterns and forms.
o 8eligion and magic.
o (ocial systems$ including economic #alues$ political systems$ and educational patterns.
o Diet and food habits.
o 9ealth and illness belief systems$ including beha#iors$ decision making$ and use of
healthcare pro#iders.
CONCEPTS O# TRANSCULTURAL NURSING CARE T,ROUG,OUT LI#E SPAN:
Illness and wellness are shaped by a #arious factors including perception and coping skills$ as
well as the social le#el of the patient.
'ultural competence is an important component of nursing.
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Trans-cultural nursing concepts and assessment
'ulture influences all spheres of human life. It defines health$ illness$ and the search for relief
from disease or distress.
8eligious and 'ultural knowledge is an important ingredient in health care.
.he health concepts held by many cultural groups may result in people choosing not to seek
modern medical treatment procedures.
9ealth care pro#ider need to be flexible in the design of programs$ policies$ and ser#ices to meet
the needs and concerns of the culturally di#erse population$ groups that are likely to be
encountered.
.he use of traditional or alternate models of health care deli#ery is widely #aried and may come
into conflict with @estern models of health care practice.
'ulture guides beha#ior into acceptable ways for the people in a specific group as such culture
originates and de#elops within the social structure through inter personal interactions.
Aor a nurse to successfully pro#ide care for a client of a different cultural or ethnic to
background$ effecti#e intercultural communication must take place.
NURSING #RAME-OR!S . T,EORIES APPLICABLE TO TRANSCULTURAL NURSING:
$% LEININGER/S SUNRISE MODEL:
.his model demonstrates the inclusi#eness of culture in e#eryday life and helps to explain why
cultural assessment needs to be comprehensi#e.
.he central purpose of the theory is to disco#er and explain di#ersed and uni#ersal culturally
based care factors influencing the health$ well-being$ illness or death of indi#iduals or groups "
to use research findings to pro#ide culturally congruent$ safe and meaningful care to clients of
di#erse or similar cultures
&% GIGER . DAVID,I(AR/S TRANSCULTURAL ASSESSMENT MODEL:
$- 'ommunication
&- (pace
'- (ocial organi/ation
)- .ime
*- En#ironmental controls
+- 6iological #ariations
'% NARA"ANASAM"/S ACCESS MODEL:
ACCESS
a. AB Assessment
b. 'B'ommunication
c. 'B'ultural )egotiation " 'ompromise
d. EBEstablishing 8espect " 8apport
e. (B(ensiti#ity
f. (B(afety
)% CAMPIN,A-BACOTE/S
CULTURAL COMPETENCE
MODEL:
'ultural awareness
'ultural skill
'ultural knowledge
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Trans-cultural nursing concepts and assessment
'ultural encounters
'ultural desire
CULTURALL" RELATED ISSUES:
6eliefs about illness$ causes and cures
)utrition and dietary practices
Disorders specific to a particular ethnic group
8eligious beliefs about illness and death
ROLE O# #AMIL" .CULTURAL PRACTICES RELATED TO DEVELOPMENTAL STAGES:
Earl0 C1il21332:
Arom the moment of birth$ children are absorbed into culture. .he ways that they are handled$ fed
and clothed are all influenced by their birth culture and their caregi#ers? approach to child rearing.
Different cultures ha#e different beliefs with regard to infants? sleeping arrangements and whether or not
they should be left to cry or play alone. .hese different approaches to early childhood care can affect
cogniti#e and emotional de#elopment$ as well as contribute to the growth of the child?s self-confidence$
risk taking beha#iors and feelings of security.
Mi22l4 C1il21332:
%iddle childhood$ generally defined as the period from ages C to 11$ is a time when children are
acti#ely sociali/ed into their culture through family$ school and play. During this time$ children begin to
learn the #alues most upheld by their culture and are exposed to social differences$ such as categories of
age$ ethnicity$ and importantly$ gender. :oung children start to identify themsel#es in terms of being a
boy or girl$ and this self-concept affects their dress$ their manner of play and also the way that adults will
interact with them. Additionally$ during middle childhood$ different cultures place different emphasis on
learning and skill set de#elopment.
A23l4sc4nc4:
Adolescence is a period when sexual maturation takes place and young people undergo
significant physiological and social changes. In some cultures$ such as mainstream American society and
@estern Europe$ adolescence is regarded as a time of preparation for adulthood$ where de#elopment is
assessed according to building skills in logic and problem sol#ing$ and demonstrating greater le#els of
responsibility. 9owe#er$ in many other cultures$ adolescence is not #iewed as separate from adulthood$
but rather as the time for beginning formal labor acti#ities and commencing childbearing.
A2ult1332:
(tages of de#elopment suggest that during each part of the lifespan$ people achie#e physical and
social milestones. 'ulture plays a large role in determining de#elopment in adulthood$ by helping
structure ideas about personal meaning and achie#ement$ as well as expected social roles. In a culture that
#alues material success$ de#elopment in adulthood is measured according to one?s ability to participate in
the market economy. Additionally$ while many cultures emphasi/e the role of women as mothers and
caretakers$ others lay stress on women?s educational ad#ancement and economic self-sufficiency.
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