◤

Introduction to
Transcultural
Nursing
Prelims Lec No.1
 ◤
Anthropology and Culture
▪ anthropology, an academic discipline that is concerned with the
scientific study of humans, past and present.
▪ Leininger defines culture as the “learned, shared, and transmitted
values, beliefs, norms, and lifeways of a particular group of people
that guide thinking, decisions, and actions in a patterned way....
Culture is the blueprint that provides the broadest and most
comprehensive means to know, explain, and predict people’s
lifeways over time and in different geographic locations”
(McFarland & Wehbe-Alamah, 2015a, p. 10).
◤

Anthropology and Culture

▪ Culture influences a person’s definition

of health and illness, including when it
is appropriate to self-treat and when
the illness is sufficiently serious to seek
assistance from one or more healers
outside of the immediate family.
 ▪ In a classic study of culture by the
◤ anthropologist Edward Hall (1984), three
levels of culture are identified: primary,
Anthropology secondary, and tertiary. The primary level
and Culture of culture refers to the implicit rules known
and followed by members of the group, but
seldom stated or made explicit, to
outsiders. The secondary level refers to
underlying rules and assumptions that are
known to members of the group but rarely
shared with outsiders. The primary and
secondary levels are the most deeply
rooted and most difficult to change. The
tertiary level refers to the explicit or public
face that is visible to outsiders, including
dress, rituals, cuisine, and festivals.
 ◤
Historical and
Theoretical Eight factors that influenced Leininger to establish
Foundations of TCN as a framework for addressing 20th-century
societal and health care challenges and issues
Transcultural
Nursing 1. A marked increase in the migration of
people within and between countries
worldwide

2. A rise in multicultural identities, with people

expecting their cultural beliefs, values, and
ways of life to be understood and respected by
nurses and other health care providers
 ◤

Historical and 3. An increase in health care providers’ and patients’ use of

Theoretical technologies that connect people globally and

simultaneously may become the source of conflict with the
Foundations cultural values, beliefs, and practices of some of the people
receiving care
of 4. Global cultural conflicts, clashes, and violence that impact
Transcultural health care as more cultures interact with one another

Nursing 5. An increase in the number of people traveling and

working in different parts of the world

6. An increase in legal actions resulting from cultural conflict,

negligence, ignorance, and the imposition of health care
practices
 ◤ 7. A rise in awareness of gender
issues, with growing demands on
Historical and
health care systems to meet the
Theoretical
Foundations of gender- and age-specific needs of
Transcultural men, women, and children
Nursing 8. An increased demand for
community- and culturally based
health care services in diverse
environmental contexts (Leininger,
1995)
 ◤

Transcultu
ral Nursing
(TCN)

This Photo by Unknown Author is licensed under CC

BY-SA-NC
 ◤ “a substantive area of study and
Transcultural practiced focused on comparative
Nursing cultural care (caring) values, beliefs,
and practices of individuals or groups
of similar or different cultures to
provide culture-specific and
universal nursing care practices in
promoting health or well-being or to
help people to face unfavorable
human conditions, illness, or death in
culturally meaningful ways.”
◤
Background

Born in Sutton, Nebraska

Its was due to her aunt who suffered form congenital health disease
that led her to pursue a career in nursing.
The first professional nurse to earn PhD in anthropology

Concept “Culturally Congruent Care”

Pioneer and Founder of the theory of Transcultural Nursing

Initiated and promoted worldwide certification of transcultural nursing

(general practice and special practice area)
◤ Transcultural Nursing

▪ AKA Culture Care Theory

▪ Both a specialty and a general practice area

▪ Involves knowing and understanding different

cultures with respect to nursing and
health-illness caring practices, beliefs and
values with the goal to provide meaningful and
efficacious nursing care

▪ 1st appeared in her theory book Culture Care

Diversity and Universality (1991)

▪ Transcultural Nursing (2002)

◤

Definition

Culture is the learned, shared and transmitted

values, beliefs, norms and life ways practices
of a particular group that guide thinking,
decisions and actions in patterned ways

Culture Identity- the sense of being part of an

ethnic group or culture
 Definition
◤

Subculture refers to groups that have values and norms that are
distinct from those held by the majority within a wider society.

Ethnicity is defined as the perception of one- self and a sense of belonging to a particular ethnic
group or groups. Ethnicity is not equivalent to race, which is a biological identification. Rather,
ethnicity includes commitment to and involvement in cultural customs and rituals (Douglas &
Pacquiao, 2010).

Race refers to a group of people who share such genetically

transmitted traits as skin color, hair texture, and eye shape or color.
◤ Culture-universals-commonalities of values,
norms of behaviors and life patterns that are
similar among different cultures.

Culture-specific- values, beliefs and patterns

of behavior that tend to be unique to
designate culture.

Material culture-refers to objects (dress art,

religious artifacts)

Non-material culture- refers to beliefs

customs, languages, social institutions
◤
Diversity- refers to the fact or state of being different.
Diversity can occur between cultures and within a cultural
group

Acculturation- people of minority group tends to assume the

attitudes, values, beliefs, find practices of the dominant
society resulting in a blend culture pattern.

Culture 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
strangers perceptions and expectations at is different from
others by symbolic markers (Culture, biology, territory,
religion)
 Adopted
How Cultures are ◤ Generic Care System

Professional Care System

Emic

Etic
 ◤
▪ Generic (folk or lay) care systems are
Generic (Folk culturally learned and transmitted,
or Lay) Care indigenous (or traditional), folk
Systems (home-based) knowledge and skills
used to provide assistive, supportive,
enabling, or facilitative acts toward or for
another individual, group, or institution
with evident or anticipated needs to
ameliorate or improve a human life way,
health condition (or well-being), or to
deal with handicaps and death
situations.
 ◤

Professional Care
Systems
▪ Professional care systems are defined as
formally taught, learned, and transmitted
professional care, health, illness, wellness,
and related knowledge and practice skills that
prevail in professional institutions, usually with
multidisciplinary personnel to serve
consumers.
 ◤
Emic

▪ Knowledge gained from direct experience or directly from those who have experienced it.
It is generic or folk knowledge.

Etic
• The knowledge that describes the professional perspective. It is
professional care knowledge.
 ◤
▪ 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 peoples valued life
patterns and set of meaning-
which is generated form 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
 Sunrise
◤ Model of Madeleine

Leininger’s Theory

The cultural care worldview flows into

knowledge about individuals, families,
groups, communities, and institutions in
diverse health care systems.
◤ Three modes of nursing
care decisions and
Cultural care preservation or
actions
Maintenance
▪ Cultural care preservation is also known
as maintenance. It includes those
assistive, supporting, facilitative, or
enabling professional actions and
decisions that help people of a particular
culture to retain and/or preserve relevant
care values so that they can maintain
their well-being, recover from illness, or
face handicaps and/or death.
◤ Three modes of nursing
care decisions and
actions
Cultural care accommodation or Negotiation

▪ Cultural care accommodation, also known as

negotiation, includes those assistive,
supportive, facilitative, or enabling creative
professional actions and decisions that help
people of a designated culture to adapt to or
negotiate with others for a beneficial or
satisfying health outcome with professional
care providers.
◤ Three modes of nursing
care decisions and
actions
Culture care repatterning or Restructuring

▪ Culture care repatterning or restructuring includes

those assistive, supporting, facilitative, or
enabling professional actions and decisions that
help clients reorder, change, or greatly modify
their lifeways for new, different, and beneficial
health care pattern while respecting the clients’
cultural values and beliefs and still providing a
beneficial or healthier lifeway than before the
changes were established with the clients.
(Leininger, 1991)
 Transcultural
◤

Nursing (TCN)

Goal: to develop a scientific and

humanistic body of knowledge in order
to provide culture-specific and
culture-universal nursing care
practices for individuals, families,
groups, communities, and institutions of
similar and diverse cultures.
◤
Topics No.2

Culturally Competent Nursing Care

A. Rationale for Culturally Competent Care

B. Definitions and Categories of Cultural Competence
C. Guidelines for the Practice of Culturally Competent Nursing Care
D. Cultural self-assessment and cultural assessment of clients
 ◤
1. Immigration and migration

The verb emigrate means to leave one country or region to settle in another;
immigrate means to enter another country or region for the purpose of living
Rationale for there.

Culturally 2. Health Tourism

Competent
Care patients travel to other countries for medical and surgical health care needs.

3. Natural and Human-made disasters

provide care for refugees (people who flee their country of origin for fear of
persecution based on ethnicity, race, religion, political opinion, or related reasons)
and other casualties of civil unrest or war in politically unstable parts of the world.
◤
Interprofessional collaborative
practice
refers to multiple health providers from different professional backgrounds
working together with patients, families, caregivers, and com- munities to
deliver the highest quality care (World Health Organization [WHO], 2010).

Culturally competent care is an extension of interprofessional collaborative

practice --- involving clients and their families; credentialed or licensed
health professionals; folk or traditional healers from various philosophical
perspectives, such as herbalists, medicine men or women, and others; and
religious and spiritual leaders, such as rabbis, imams, priests, elders,
monks, and other religious representatives or clergy, all of whom are
integral members of the interprofessional team.
 ◤
Guidelines for the Practice of Culturally Competent Nursing Care
◤
◤
Categories of Cultural Competence

▪ There is no universally accepted definition of cultural

competence.

▪ “evolved from diverse perspectives, interests, and needs and

are incorporated in state legislation, Federal statutes and
programs, private sector organizations, and academic settings”
 ◤
2 Major Category of Cultural
Competence

▪ (1) individual cultural competence, which refers to the care provided for an individual client
by one or more nurses, physicians, social workers, and/or other health care, education, or
social services professionals, and

▪ (2) organizational cultural competence, which focuses on the collective competencies of

the members of an organization and their effectiveness in meeting the diverse needs of their
clients, patients, staff, and community.
 ◤
“Before nurses can provide culturally competent care
for individual clients or contribute to organizational
cultural competence, they need to engage in a
cultural self-assessment to identify their cultural
baggage”

Cultural baggage refers to the tendency for a

person’s own culture to be foremost in his/her
assumptions, thoughts, words, and behavior. People
are seldom consciously aware that culture influences
their world view and interactions with others.
Process of delivering culturally congruent and competent
◤ nursing care for individual clients
 ◤
Cultural is a personal and professional journey that
emphasizes strengths as well as areas for
Self-Asse continued growth, thereby enabling nurses
to set goals for overcoming barriers to the
delivery of culturally congruent and
ssment competent nursing care

nurses critically reflect on their own

culturally based attitudes, values, beliefs,
and practices and gain insight into, and
awareness of, the ways in which their
background and lived experiences have
shaped and informed the person the nurse
has become today.
 Prelims Activity No. 2
◤
• Define/explain the cultural
human tendencies affecting
bias cultural competence.
• Group Activity
ethnocentrism
• Individually write down your
cultural imposition answer in your outline
notebooks
cultural stereotyping
• As a group send it via email
prejudice ([email protected])\
• Deadline of group activity:
discrimination.
Sept 10, 2022
 ◤

Cultural
Assessment ▪ It is the foundation for culturally competent and
of Clients culturally congruent nursing care

▪ Collection of Data

▪ There are two major categories of data

a. subjective data
b. objective data (what health
professionals observe about clients
during the physical examination
through observation, percussion,
palpation, and auscultation)
◤ Cultural Assessment of Clients
▪ Cross-cultural communication is based on knowledge of many
factors, such as the other person’s values, perceptions, attitudes,
manners, social structure, decision-making practices, and an
understanding of how members of groups communicate both verbally
and nonverbally.

“The family is the basic social unit in which children are raised and where
they learn culturally based values, beliefs, and practices about health and
illnesses. The essence of family consists of living together as a unit.
Relationships that may seem obvious sometimes warrant further
exploration when the nurse interacts with clients from culturally diverse
backgrounds”
◤
In step two, mutual
◤ goals are set, and objectives are established to meet the goals and
desired health outcomes.

In step three, the plan of care is developed using approaches that are client centered and
culturally congruent with the client’s socioeconomic, philosophical, and religious beliefs,
resources, and practices.

In step four, decisions, actions, treatments, and interventions that are congruent with the
patient’s health-related cultural beliefs and practices are implemented by those team
members who are best prepared to assist the client.

In step five, the client and members of the health care team collaboratively evaluate the
care plan and its objectives to determine if the care is safe; culturally acceptable,
congruent, and competent; affordable; accessible; of high quality; and based on
research, scientific evidence, and/ or best practices.
 ◤
Organizational Cultural Competence

Cultural competence requires that organizations have the following characteristics:

▪ A defined set of values and principles and demonstration of behaviors, attitudes, policies, and
structures that enable them to work effectively cross-culturally

▪ The capacity to (1) value diversity, (2) conduct self-assessments, (3) manage the dynamics of
difference, (4) acquire and institutionalize cultural knowledge, and (5) adapt to diversity and the
cultural contexts of the communities they serve

▪ Incorporation of the previously mentioned items in all aspects of policy making, administration,
practice, and service delivery and systematic involvement of consumers, key stakeholders, and
communities
 ◤

Cultural Competence in the Health History and

Physical Examination

A. Cultural Assessment
B. Transcultural Perspectives on the Health History
 Cultural Assessment
◤
▪ AKA culturologic assessment - a systematic, comprehensive
examination of individuals, families, groups, and communities
regarding their health-related cultural beliefs, values, and
practices.

▪ Goal: to determine the nursing and health care needs of people

from diverse cultures and intervene in ways that are culturally
acceptable, congruent, competent, safe, affordable, accessible,
high quality, and based on current research, evidence, and best
practices

▪ cultural assessment consists of both process and content

 ◤
Transcultural Perspectives on the Health
History
“The purpose of the health history is to gather subjective data—a term that
refers to things that people say or relate about themselves. The health
history provides a comprehensive overview of a client’s past and present
health, and it examines the manner in which the person interacts with the
environment. The health history enables the nurse to assess health
strengths, including cultural beliefs and practices that might influence the
nurse’s ability to provide culturally competent nursing care. The history is
combined with the objective data from the physical examination and the
laboratory results to form a diagnosis about the health status of a person”
 Transcultural Perspectives on the Health
◤
History
There is wide variation in health history formats, most contain the
following categories:
biographic data,
reason for seeking care,
review of medications and allergies,
present health or history of present illness,
past history,
family and social history,
and review of systems.
◤
Present Word Document
◤
Transcultural Perspectives on the Physical
Examination

▪ Height

▪ Body Proportions

▪ Weight

▪ Vital Signs
◤
Transcultural Perspectives on the Physical
Examination

▪ See document
◤
Transcultural Perspectives in Clinical
Decision Making and Actions

▪ Leininger suggests three major modalities to guide nursing

decisions and actions for the purpose of providing culturally
congruent care that is beneficial, satisfying, and meaningful to
clients: cultural care preservation or maintenance, cultural care
accommodation or negotiation, and cultural care repatterning or
restructuring
◤
The Influence of
Cultural and Health
Belief System on
Health Care Practices
◤
Cultural Belief Systems

▪ develop from the shared experiences of a social group and are

expressed symbolically.

▪ The use of symbols to define, describe, and relate to the world

around us is one of the basic characteristics of being human.
 ◤
Health Belief Systems

▪ health-related attitudes, beliefs, and practices, frequently referred to as

health belief systems. People embrace three major health belief
systems or worldviews: magico-religious, scientific (or biomedical),
and holistic, each with its own corresponding system of health beliefs.
 Health Belief Systems
◤

Magico-Religious Health Paradigm

▪ the world is an arena dominated by supernatural forces.

▪ The fate of the world and those in it, including humans, depends on the
actions of God, the gods, or other supernatural forces for good or evil.

▪ Many Latino, African American, and Middle Eastern cultures are

grounded in the magico-religious paradigm.

▪ Some African and Caribbean cultures, such as Voodoo, have aspects

of magic in their belief systems
 Health Belief Systems
◤
Scientific or Biomedical Health Paradigm

▪ life is controlled by a series of physical and biochemical processes that can

be studied and manipulated by humans.

▪ When the scientific paradigm is applied to matters of health, it is often

referred to as the biomedical model.

▪ In this model, disease is viewed metaphorically as the breakdown of the

human machine because of wear and tear (stress), external trauma (injury,
accident), external invasion (pathogens), or internal damages (fluid and
chemical imbalances, genetic or other structural changes). Disease causes
illness, has a more or less specific cause, and has a predictable time course
and set of treatment requirements.
 Health Belief Systems
◤

Scientific or Biomedical Health Paradigm Forms

Determinism, which states that a cause-and- effect relationship exists for all
natural phenomena.

Mechanism, assumes that it is possible to control life processes through

mechanical, genetic, and other engineered interventions.

Reductionism, according to which all life can be reduced or divided into smaller
parts; study of the unique characteristics of these isolated parts is thought to
reveal aspects or properties of the whole, for example, the human genome and its
component parts.

Objective materialism, which states that what is real can be observed and
measured. There is a further distinction between subjective and objective realities
in this paradigm
◤
Holistic Health Paradigm
▪ the forces of nature itself must be kept in natural balance or harmony.

▪ Human life is only one aspect of nature and a part of the general order of the
cosmos.

▪ Everything in the universe has a place and a role to perform according to natural
laws that maintain order.

▪ Disturbing these laws creates imbalance, chaos, and disease. The holistic
paradigm has existed for centuries in many parts of the world, particularly in
American Indian and Asian cultures.

▪ health is viewed as a positive process that encompasses more than the absence of
signs and symptoms of disease.

▪
◤
Holistic Health Paradigm

▪ For example, in the biomedical model, the cause of tuberculosis

is clearly defined as the invasion of mycobacterium. In the
holistic paradigm, whereby disease is the result of multiple
environment–host interactions, tuberculosis is caused by the
interrelationship of poverty, mal- nutrition, overcrowding, and
mycobacterium.

▪ Chinese concept of yin and yang, in which the forces of nature

are balanced to produce harmony.
◤
Health and Illness Behaviors

▪ Three sets of factors influence the course of behaviors and

practices carried out to maintain health and prevent disease: (1)
one’s beliefs about health and illness; (2) personal factors such
as age, education, knowledge, or experience with a given
disease condition; and (3) cues to action, such as
advertisements in the media, the illness of a relative, or the
advice of friends.
◤
◤
◤
Types of Healing Systems

▪ healing system refers to the accumulated sciences, arts, and

techniques of restoring and preserving health that are used by
any cultural group.
◤
Types of Healing Systems

1. Self-Care

For common minor illnesses, an estimated 70% to 90% of all

people initially try self-care with over-the-counter medicines,
megavitamins, herbs, exercise, and/or foods that they believe have
healing powers.

The use of over-the-counter medications, or nonprescription

medications, is a common form of self-care. Dietary supplements
such as herbs, vitamins, minerals, or other substances are very
popular and used extensively in the United States.
◤
Types of Healing Systems
2. Professional Care Systems

A scientific or biomedical systems, are formally taught, learned, and

transmitted professional care, health, illness, wellness, and related
knowledge and practice skills that prevail in professional
institutions, usually with multidisciplinary personnel to serve
consumers.

Professional care is characterized by specialized education and

knowledge, responsibility for care, and expec- tation of
remuneration for services rendered.
 Types of Healing Systems
◤

3. Folk Healing System

A folk healing system is a set of beliefs that has a shared social dimension and reflects
what people actually do when they are ill versus what society says they ought to do
according to a set of social standards (Andrews, Ybarra, & Matthews, 2014).

The key consideration that defines folk systems is their history of tradition: many folk
healing systems have endured over time through oral transmission of beliefs and
practices from one generation to the next. A folk-healing system uses healing practices
that are often divided into secular and sacred components.

Folk healers (sometimes referred to as traditional, lay, indigenous, or generic healers),

most of whom speak the native tongue of the client, sometimes make house calls, and
usually charge significantly less than health care providers in the professional care system
◤
TYPES OF HEALING SYSTEM

▪ 4. Complementary, integrative, and alternative health system

- complementary, integrative and alternative health is an umbrella

term for hundreds of therapies based on health care system off
people from around the world. Some of theses therapies have
ancient origin in Egyptian, Chinese, Greek and American Indian
cultures.

- Allopathic or biomedicine is the reference point, with all other

therapies being considered complementary.