UNIT ONE
INTRODUCTION AND KEY CONCEPTS
RELATED TO TRANSCULTURAL
NURSING AND CULTURAL
COMPETENCY
DR MAHMOUD MUSLEH
Objectives
2

After the completion of this chapter the student will
be able to

Identify the key concepts of transculture nursing.

Discuss the concepts of culture, ethnicity, race,
ethnocentrism, and stereotyping.

Describe the health practices in different
cultures.
INTRODUCTION
3


The concept of transcultural nursing appeared
less than 30 years ago since Madeleine
Leininger first began to develop a theory of
transcultural nursing as part of a doctoral study
in anthropology.
Much has changed in that time, and nursing
staff development and in-service educators
need to provide education within a multicultural
context in a timely manner.
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Transcultural Nursing was developed
because of the need to work with people
from widely divergent cultural atmosphere.
 People from various cultures and
subcultures are more common in today’s
world and these people are sensitive to
the preservation of their cultural heritage
and customs.

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

It is critical that nurses, because of their direct
patient care, understand and work effectively
within this diverse cultural atmosphere.
Transcultural scholars and academics refer to
care as a universal phenomenon that
transcends cultural boundaries, and their aim is
to incorporate transcultural nursing into nursing
curricula and clinical practices through a
research-based knowledge of cultures
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


The most important aspect in developing
cultural competence is understanding the
interrelatedness of cultural concepts.
It is suggested that these definitions be used as
a first step toward understanding the complex
and dynamic nature of culture.
Discussion of these definitions promotes
reflection on some of the challenges,
contradictions, and ambiguity inherent in the
process of becoming culturally competent.
DEFINITION
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
The term of transcultural nursing is sometimes used interchangeably with
cross-cultural, intercultural or multicultural nursing.

In analyzing the Latin derivations of the prefixes associated with these
terms, you will notice that trans means across, inter means between, and
multi means many

Transcultural nursing is an area of study or practice that takes into
account the specific values, beliefs, and ways of life of people of diverse
or similar cultures, with the goal of using this knowledge in creative ways
to provide culturally congruent care.
KEY CONCEPTS
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Understanding the following central concepts is
important for understanding the major
transcultural models that explore the various
aspects of Transcultural Nursing Phenomenon
Culture
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refers to knowledge, beliefs, behaviors, ideas, attitudes,
values, habits, customs, languages, symbols, rituals,
ceremonies, and practices that are unique to a particular
group of people.
CHARACTERISTICS OF CULTURE
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• Culture is learned and taught. Cultural knowledge is
transmitted from one generation to another. A person
is not born with cultural concepts but instead learns them
through socialization.
• Culture is shared. The sharing of common practices
provides a group with part of its cultural identity.
CHARACTERISTICS OF CULTURE
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• Culture is social in nature. Culture develops in and is
communicated by groups of people.
• Culture is dynamic, adaptive, and ever-changing.
Adaptation allows cultural groups to adjust to meet
environmental changes. Cultural change occurs slowly
and in response to the needs of the group. This dynamic and
adaptable nature allows a culture to survive.
Cultural Awareness
12

A cognitive process in which the nurse becomes
aware of and sensitive to the client’s cultural values,
beliefs, and practices

Subculture
is closely related to culture, but refers to subgroups who
deviate in certain ways from a dominant culture in values,
beliefs, norms, moral codes, and ways of living with some
distinctive features that characterize their unique lifeway's
Cultural Sensitivity
13

Cultural sensitivity is experienced when neutral
language–both verbal and nonverbal–is used in a
way that reflects sensitivity and appreciation for the
diversity of the other

It is conveyed when words, phrases, categorizations,
etc. are intentionally avoided, especially when
referring to any individual who may interpret them as
impolite or offensive
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

Cultural sensitivity is expressed through behaviours
that are considered polite and respectful by the other
Such behaviours may be expressed in the choice of
words, use of distance, negotiating with established
cultural norms of others, etc.
Acculturation
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
Acculturation is the process of incorporating some of the cultural
attributes of the larger society by diverse groups, individuals, or peoples

The process of acculturation is bi-directional, affecting both the host and
target individual or communities in culture contact.

Acculturation considers the psychological processes of cultural contact
between two or more cultural groups involving some degree of
acculturative stress and possibly syncretism leading to new cultural
variations and innovations
Cultural Competence
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


Cultural competence is defined as the attitudes,
knowledge, and skills necessary for providing
quality care to diverse populations
Competence is an ongoing process that involves
accepting and respecting differences and not letting
one’s personal beliefs have an undue influence on
those whose worldview is different from one’s own
Cultural Competence includes having general
cultural as well as cultural-specific information so
the health care provider knows what questions to
ask
Cultural Imposition
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


Cultural imposition intrusively applies the
majority cultural view to individual and families
Prescribing a special diet without regard to the
client’s culture, and limiting visitors to immediate
family borders is cultural imposition
In this context, health care providers must be
careful in expressing their cultural values too
strongly until cultural issues are more fully
understood
Discrimination
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

Discrimination occurs when a person acts on
prejudice and denies another person one or
more of his or her fundamental rights
Direct discrimination occurs when someone is
treated differently, based upon race, religion,
colour, national origin, gender, age, disability,
sexual orientation, familial/marital status, prior
arrest/conviction record, etc.
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


Indirect discrimination occurs when someone is
treated differently based on an unfair
superimposed requirement that gives another
group the advantage
Discrimination results in disrespect,
marginalization or disregard of rights and
privileges of others who are different from one’s
own background.
This may be evident in different forms such as
ageism, sexism, racism, etc.
Diversity
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
Diversity as an all-inclusive concept, and
includes differences in race, colour, ethnicity,
national origin, and immigration status (refugee,
immigrant, or undocumented), religion, age,
gender, sexual orientation, ability/disability,
political beliefs, social and economic status,
education, occupation, spirituality, marital and
parental status, urban versus rural residence,
enclave identity, and other attributes of groups
of people in society
Health Disparity and Healthcare Disparity
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

Health disparities are differences in the incidence,
prevalence, mortality, and burden of disease and
other adverse health conditions that exist among
specific population groups
The definition of health disparities assumes not only
a difference in health but a difference in which
disadvantaged social groups—who have
persistently experienced social disadvantage or
discrimination—systematically experience worse
health or greater health risks than more advantaged
social groups
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

Consideration of who is considered to be within
a health-disparity population has policy and
resource implications
A healthcare disparity is defined as a difference
in treatment provided to members of different
racial (or ethnic) groups that is not justified by
the underlying health conditions or treatment
preferences of patients
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
These differences are often attributed to
conscious or unconscious bias, provider bias,
and institutional discriminatory policies toward
patients of diverse socioeconomic status, race,
ethnicity, and/or gender orientation.
Labeling and Stereotyping
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
Problems arise when differences across and within
cultural groups are misunderstood. Misperception,
confusion, and ignorance often accompany
people’s expectations of others.

There are numerous ways in which people are
different and, thus, classified by others.
WAYS IN WHICH PEOPLE DIFFER
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• Age, gender & educational level
• Language
• Occupation
• Residence (rural, urban, suburban)
• Socioeconomic status
• Religion
• Functional abilities
• Cognitive abilities
• Racial composition
• Nationality
• Family structure and ties
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
Stereotyping is an expectation that all people
within the same racial, ethnic, or cultural group act
alike and share the same beliefs and attitudes.

Stereotyping results in labeling people according to
cultural preconceptions; therefore, an individual’s
unique identity is often ignored.
Ethnicity
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
A term that relates to races or large groups of people
classified according to common traits or customs.
Religion
is usually a formalized set of beliefs about the nature and
existence of God and an afterlife.
Ethnocentrism
 is the belief that one’s own culture is superior to all
others.
Race
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
A term related to biology, since members of the
same group share distinguishing physical
features such as skin colour, bone structure,
and blood group (Dowd et al., 1998).
Racism
is usually an intense dislike of others based on
race
Ethnography
29

The study of a culture. The methodological
approach of ethnographic research central to the
nurse's ability to develop a heightened awareness
of culturally diverse needs of individuals is to define
a field for observation for study of the environment
and its people as well as the reciprocal relationship
that exists between the two (Tripp-Reimer and
Dougherty, 1985).
Culture shock
30

A disorder that occurs in response to transition from one
cultural setting to another.

Example
a North A merican who goes to live in Japan may
experience culture shock through not fully understanding
the difference between the USA and Japan culture

Cultural bias : strong Cultural biases usually lead to open
resistance and negative relationships with clients and staff
Cultural blindness
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
refers to the inability of an individual to recognize or see
one's own lifestyle, values, and modes of acting as those
based largely on ethnocentric and biased tendencies.

The nurse was "blind" to recognize and accept what the
client did and had told her. She did not accommodate the
Arab-Muslim's prayer time
HEALTH PRACTICES IN DIFFERENT
CULTURES
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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 certain food substances can
be ingested to prevent illness
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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.

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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.
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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.
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Beliefs about mental health
 Mental illnesses are caused by a lack of
harmony of emotions or by evil spirits.
 Problems in this life are 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.
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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.
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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.