Transcultural
Nursing
By: Cindy Magirl, RN
Relevance to Nursing
Provides therapeutic and safe care to
people of different cultures
Objectives
Increase awareness of cultural
differences
Understand non-verbal cues used by
different cultures
Promote a culturally competent
nursing environment
What is culture?
• Culture is the values, beliefs, norms, and life practices that are
learned, shared, and handed down (Leininger, 1985)
• the beliefs, customs, arts, etc., of a particular society, group,
place, or time
• a particular society that has its own beliefs, ways of life, art,
etc.
• a way of thinking, behaving, or working that exists in a place
or organization (such as a business)
(http://www.merriam-webster.com/dictionary/culture)
Incompetent
vs
Competent Cultural Care
•
http://www.youtube.com/watch?v=Dx4Ia-jatNQ
Cultural Health Beliefs
Many Amish do not have health insurance
Utilize home remedies and folk medicine
Faith healing (healing by touch)
Significant disability does not inhibit productivity
Define illness as a failure to function in the work role
instead of in terms of symptoms
Will seek traditional medicine if needed
Believe that sin causes illness
Weyer, Hustey, Rathbun,
Armstrong, Anna, Ronyak, & Savrin
(2003)
Amish
6
Cultural Health Beliefs
Self care is seen as less important
Men are the primary decision makers
Tend to keep emotional problems within the family
Modesty
Galanti (2003)
Hispanics
7
Cultural Taboos and Stereotypes
• http://www.youtube.com/watch?v=cHsfevWnW10
Theories
Culture Care Diversity and
Universality
Giger and Davidhizar Transcultural
Assessment Model
Culture Care Diversity and Universality
 Culturally based care that “fits” or is congruent, meaningful, and
relevant to cultures that contributes to the quality of life for
individuals, groups, families, communities, and institutions
(Leininger, 2007)
 Esscence of caring
 Defined diversity as perceiving, knowing, and practicing care in
different ways
 Universality is the commonalities of care
 One of the earliest nursing theories and remains the only theory
focused specifically on transcultural nursing with a culture care focus
Maier-Lorentz, (2008)
Madeleine Leininger developed theory in 1960’s
Sunrise model
 Illustrates major components and interrelationships of culture care
diversity and universality
10
3 Modes of Action to Deliver Care
1) Preservation or Maintenance
2) Culture care accommodation or negotiation
 Refers to creative nursing actions that help people adapt or
negotiate in an effort to attain the shared goal of an optimal
health outcome
Jones, & Bartlett (2014)
 Refers to nursing care activities that help people from
particular cultures to retain and use core cultural values r/t
healthcare concerns or conditions
3) Culture care restructuring or re-patterning
 Refers to therapeutic actions taken by culturally competent
nurses. Helps a patient modify personal health behaviors
toward outcomes respecting cultural values
11
Sunrise Model
Giger and Davidhizar Model
Based on six cultural phenomena that shapes care
Communication
 Verbal and nonverbal
 Area surrounding a persons body
Social Organization
 Identification with family, kinsman, jobs, and religious groups
Time
 Social time vs clock time
Environmental Control
 Ability to direct factors in the environment
Biological Variations
 Vary among racial groups
Beachy, Hershberger, Davidhizar, &
Giger (1997)
Space
13
Root Cause Analysis
Education
Stereotyping
Lack of Knowledge
Lack of resources
Interpreters
Rural Area
Social
Segregation
Expected to
assimilate
Culturally
Congruent
Care
Racism
Minorities
Prejudices
and Bias
Recommendations for Quality
and Safety Improvements
• ANA Standards
• The RN practices ethically.
• Standard 8 Education
• The RN attains knowledge and competence
that reflects current nursing practice
ANA (2010)
• Standard 7 Ethics
• Standard 11 Communication
• The RN communicates effectively in a
variety of formats in all areas of practice
15
QSEN Competencies
Patient Centered Care
Teamwork and Collaboration
 Function effectively within nursing and inter-professional teams,
fostering open communication, mutual respect, and shared
decision-making to achieve quality patient care.
QSEN Institute, (2014)
 Recognize the patient or designee as the source of control and
full partner in providing compassionate and coordinated care
based on respect for patient’s preferences, values, and needs.
Safety
Minimizes risk of harm to patients and providers through both
system effectiveness and individual performance.
16
Questions
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References
American Nurses Association, (2010). Scope and standards of practice
(2nd Ed.). Silver Spring, MD: Retrieved from http//: Nursebooks.org.
Beachy, A., Hershberger, E., Davidhizar, R., & Giger, J., N. (1997). Cultural
implications for nursing care of the Amish. Journal of Cultural Diversity
4(4) 118-126. Retrieved from Document Delivery Department
<docdel@gvsu.edu>
Galanti, G. (2003). The Hispanic family and male-female relationships:
An overview. Journal of Transcultural Nursing 14, 180-185.
doi:10.1177/104365960301400304
Jones and Bartlett Learning, (2014). Birth of transcultural nursing to
current theories and conceptual models for cultural diversity. Retrieved
from
http://samples.jbpub.com/9780763756505/56505_CH01_Dayer.pdf
References
Leininger, M. M. (1985). Transcultural care diversity and universality: A
theory of nursing. Nursing and Healthcare 6(4), 209-212.
Leininger, M. (2007, January). Theoretical Questions and Concerns:
Response
From the Theory of Culture Care Diversity and
Universality Perspective [Electronic version]. Nursing Science
Quarterly, 20(1), 9-15. doi:10.1177/0894318406296784
Maier-Lorentz, M. (2008). Transcultural nursing: Its importance in
nursing practice. Journal of Cultural Diversity 15(1) 37-43
QSEN Institute, (2014). Retrieved from
http://qsen.org/competencies/graduate-ksas/
Weyer, S. M., Hustey, V. R., Rathbun, L., Armstrong, V. L., Anna, S. R.,
Ronyak, j., & Savrin, C. (2003). A look into the Amish culture: What
should we learn? Journal of Transcultural Nursing 14, 139-145.
doi:10.1177/1043659602250639