Transcultural Nursing
By Kristyn Beaver
Ferris State University
Purpose of this presentation…
Transcultural nursing affects each and every one of us as
professionals. We meet people daily that have different
lifestyles, beliefs, practices, superstitions, and family lives
from our own. The professional nurse must be aware of
his/her own personal beliefs and culture to deliver
culturally competent nursing care effectively to their
patients. A book published in 2008 called Caring for the
Patients from Different Cultures by Geri-Ann Galanti was a
very good book. It gives many examples of different
cultures and how to best care for those individuals; some
will be shared in these slides. The readings chosen will
guide the participant through defining Transcultural
Nursing to the ability to give examples of appropriate
techniques to incorporate transcultural nursing into the
professional nurses practice.
Objectives
Define transcultural nursing
Define standards for practice regarding transcultural
nursing.
To reflect on and be aware of personal values, beliefs,
and culture that could affect patient care.
Give examples of transcultural nursing and how to
incorporate that into practice.
Defining culture…
Culture is not only our race, ethnicity, and
language; it is also shaped by our spiritual
beliefs and practices, our environment,
our economic background, physical and
biological makeup, psychological aspects
and also our political beliefs.
(Smith, 2013)
Demographics of the Michigan
79.3% White
14.1% African-American
4.4 % Hispanic
*0.6% Native American Indian
2.5% Asian
1.9% Are 2 or more races
Transcultural Theory…
Definition as stated by M. Leininger (1991) “Transcultural
nursing is a comparative study of cultures to understand
similarities (culture universal) and difference (culture-specific)
across human groups”(Nursing Theories, 2012, p. 1)
This theory looks at how each person views their health and their disease based on
their beliefs, religion, culture, and ethnicity (Leininger, 1991).
Other cultures may decide to seek alternative methods of healing before seeking
help from modern medicine; or they may not seek help at all based on their beliefs
(Leininger, 1991).
Nurses need to be flexible in planning care for people of different cultures to
increase compliance in treatment and improve outcomes overall (Leininger, 1991).
Transcultural Nursing
The Nurse
(Healthcare)
Family
The Patient
Patient
Centered
Care with
Great
outcomes
Roy’s Adaptation Model
Based on Roy’s Model (Roy, 1989 & Roy & Andrews 1991), there are some
assumptions that are made:
“People are bio-psycho-social being” that are in ever changing and adapting to
their environment.
“Health and illness are inevitable dimensions of the person’s life” *
The four modes of adaptation of the person is: “physiologic needs, self-concept,
role function and inter-dependence” *
Persons cope with their environmental changes based on their experiences.
“Nursing accepts the humanistic approach of valuing other persons’ opinions,
and view points” “Interpersonal relations are an integral part of nursing” *
*Nursing Theories ( Jan. 26, 2012) As retrieved from
http://currentnursing.com/nursing_theory/Roy_adaptation_model.html on June 11, 2013. p. 1.
What is diversity? What is stereotyping?
Based on: Think about those with
Age different attributes and how
Ethnicity you view them and react to
Religion them? Compare:
Race Hardworking ~ Lazy
Native Language Withholding ~ Generous
Health status Expressive ~ Quiet
Physical attributes
Suspicious ~ warm/open
Nationality
Aggressive ~ Gentle
Educational Status
Economic status Emotional ~ Unfeeling
Traditional ~ open to
change
Intelligent ~ Ignorant
(Healthy People 2020
worksheets)
Root Cause Analysis
The Issue: A universal issue regarding healthcare is the multicultural
patients and their unique problems, beliefs, family relations, experiences,
and culture; how do nurses deliver competent care specific to that person’s
particular needs and desires.
How can the issue be addressed? Every nurse explores his/her own beliefs
and practices and how these differences in culture could affect patient
care.
What can be done? Each nurse provides culturally competent care with
each patient’s; and family; unique identity taken into account to promote
best outcomes.
Quality & Safety Education for Nurses (QSEN)
Patient Centered Care:
Definition: “Recognize the patient or designee as a source of control and full partner in
providing compassionate and coordinated care based on respect for patient’s
preferences, values, and needs” (QSEN, 2013)
Knowledge: how can we empower patients and families in all aspects of healthcare
Examine safety and quality as well as cost containment to improve outcomes.
Need to understand pain and suffering.
Have knowledge on patients preferences, values, emotional status, family, and beliefs.
Skills: To provide patient centered care incorporating the patients values, beliefs, family
and needs of the patient.
Assess presence and extent of pain and suffering.
Assess emotional and physical status.
Ask family or patient their expectations of pain and pain relief.
Communicate!
Attitudes: Seek learning opportunities. *Value seeing healthcare situations “through the
patients eyes”, *be aware of personal beliefs and values in pain and pain management,
*patients expectations influence outcomes
Nursing Assessment Adaptation
Questions should be asked in an open-ended way
The Four “C’s:
1. “What do you Call your problem?”
2. “What do you think caused the problem?”
3. “How do you cope with your condition?”
4. “What concerns do you have regarding the condition?”
(Galanti, 2008 p. 2-5)
QSEN continued
Teamwork and Collaboration:
Definition: “Function effectively within nursing and intra-professional teams, fostering open
communications, mutual respect, and shared decision-making to achieve quality patient
care” (QSEN, 2013)
Knowledge: *Be aware of varying communication styles.
Be aware of own knowledge and what you can contribute to the team.
Identify barriers and facilitators of effective team.
Skills: * Choose communication styles that diminish the risk associated with authority
gradients among team members.
Solicit input from other team members.
Clarify roles and function within own scope of practice.
Act with integrity consistently and respect differing views.
Communicate effectively
Attitudes:
Respect others
Value others’ contributions
Contribute to conflict resolution
Appreciate risks associated with handoffs among providers and across transitions in care.
(QSEN, 2013)
Communication Key
Points
Be aware of patients nonverbal communication.
Avoid using “positive” and “negative” when giving test results.
Avoid using “yes” or “no” questions. Ask open ended questions like:
“What questions do you have” instead of “do you have questions?”.
Remember the 4C’s questions discussed earlier. They will be most
helpful.
Use professionally trained interpreters whenever possible. IF they
aren’t available, use the telephone interpreters. Avoid using family as
interpreters (if possible).
Avoid using gestures to communicate, they can mean other things in
other cultures.
Be aware of eye contact in each culture. Some cultures view this as
aggressive behavior and some view lack of eye contact as a sign of
respect. (Galanti, 2008).
Nursing Standards
The Nursing Standards that would be relevant to this subject:
Standard 7: Quality of Practice. In this standard the nurse improves
the quality of nursing practice by including patients and families in
their healthcare needs and goals, then outcomes will improve.
Standard 8: Education . The nurse grows in knowledge of the art and
science of nursing by seeking new learning opportunities, engaging
in ongoing continuing education and seeking out new experiences.
Standard 11: Collaboration. In working with and collaborating with
other members of the healthcare team; along with the patient and
family, outcomes will improve. Nurses aide in referrals to other
agencies for help such as home healthcare. Communicating with the
patient and family will allow the patient to have control of their own
life. Ultimately, the goal is to have the patient functioning in the best
capacity that he/she can.
Standard 12: Ethics. To give culturally competent care is being an
ethical nurse. (ANA, 2004)
Religion and Spirituality
Jehovah’s Witness
Refusal of blood transfusions
Don’t celebrated birthdays or other holidays
Can be rejected by their religious community if they accept blood
transfusion.
Think of the role that Jehovah's Witness have played in bringing
about “bloodless surgeries.” (Galanti, 2008)
Religions continued…
Muslim:
They follow a diet free of Pork and alcohol.
They follow day time fasting during their religious holiday of
Ramadan.
Autopsies are permitted only for medical and legal issues;
otherwise they do not allow.
Burial: Cremation is not done. Bodies are washed by same sex
person and burial is usually with in 24 hours.
(Galanti, 2008).
Religions continued…
Jewish:
Sabbath starts at sundown on Friday and ends at sundown on
Saturday. They do no work or anything that is perceived as work;
cooking, making phone calls, or driving.
End of life: when a person dies, it is custom that a family member
remain with the body as a sign of respect.
Orthodox Jewish will follow a Kosher diet; forbid eating pork, shell
fish, and the mixing of meat and dairy products.
Boys are circumcised on the eighth day of life.
(Galanti, 2008)
Religions continued…
Roman Catholic:
Some religious symbols used by Catholics to bring comfort and
strength: Rosaries, Scapulars and Crucifixes and other Religious
statues.
Sacrament of the sick or the laying of hands.
Most do not believe in birth control. They appose abortion of
any kind.
They do not believe in euthanasia. It is believed that life should
end naturally when God chooses to take them.
Families!
Key Points to remember with families…
Men are the decision makers in many cultures. Be aware that
a patient may need or want to discuss decisions with the
family before making a decision.
There are many cultures who value interdependence and not
independence. Be aware not to impose personal beliefs of
independence on someone who does not wish to be so.
In many cultures families will want to stay with the patient,
please honor this as much as possible. Include family in care and
treatments when appropriate.
Ask the patient what they know of their condition, family
members may be trying to protect a loved one from a bad
prognosis or diagnosis.
Show families that you care about their loved one.
(Galanti, 2008)
Roles of Men and Women
Key Points to remember…
Women as housewives and mothers: not every culture views
independence the same as the US. In fact, in most, it is the
woman’s job to be the housekeeper for their in-laws (such as
Asian and Hispanic)
Men make the decisions in many cultures.
Men are the spokespersons and the authority figures in most
cultures.
Many cultures favor having sons. Male dominant cultures.
Sexual segregation.
Female genital cutting.
Staff Relations Key Points to remember…
Nurses and Doctors
Foreign-born physicians and other staff too, should be given
American Culture classes as American Culture is different from
their native country.
American nurses use a team approach when caring for patients;
this isn’t so in other cultures. Doctors (men) have a higher
status than nurses (women) in those cultures.
Try to avoid giving assignments that might conflict with
religious convictions (p.147)
Keep the lines of communication open. Open-communication is
essential.
Remember if you speak other languages, if this is done in the
work-place, it can be considered rude to other staff; they feel
excluded. (Galanti, 2008).
Some Culture Profiles that can be
helpful…
African American
Discrimination and Slavery
Religion is very important. Be aware of giving privacy for
prayer.
Men are seen as the spokesperson for the family, but usually
it is the woman who is really in “charge”.
Visiting the sick is tradition; usually after church Sunday.
There is a high tradition of the use of herbal remedies. Be
aware of this when taking medication history.
Some believe in voodoo and will seek voodoo practitioner
for remedies for such illnesses of the GI tract or
psychological disorders.
(Galanti, 2008)
Anglo-American’s
Middle and upper-class will often be well educated on their illness.
Will use the internet to search for information.
Independence and privacy are valued.
Most will show emotional control; be stoic.
Most husbands and wives will make decisions together.
Usually will favor aggressive treatments to illness and will want to
know diagnosis and prognosis.
Stoicism is expected with dealing with death.
Depending on socioeconomic status, patients will be either
present time oriented (Lower) or future time oriented (middle to
upper).
(Galanti, 2008)
Asian
Value Family. Value sons.
Is a hierarchical culture. Wives will let husbands make decisions.
Tremendous respect for the elderly.
Will agree with nurses or doctors, even if they do not
understand or agree. Ask questions like “what questions do you
have” instead of asking “do you have questions”.
Are usually stoic with regards to pain. Offer pain medications
when they might be needed and insist when appropriate.
Believe in body hot/cold balance (or Ying-Yang).
Herbal remedies are common. Be aware of this when taking
medication history.
The number “4” is seen as signifying death in the Korean,
Japanese, and Chinese culture. (Galanti, 2008)
Hispanic Culture
Family oriented. Inquire about patients family. Are reluctant to
discuss family issues outside of family.
Sometimes the family might withhold fatal diagnosis from a
patient for protection, upon admission ask family to whom
information about condition should be given.
Balance hot/cold foods. Might prefer to drink hot/warm fluids
instead of iced.
When complimenting a child, be sure to touch the child to
avoid giving the child the “evil eye”.
Being heavy (fat) is seen as healthy. Foods are high fat and
salt. This will become an issue when dealing with diabetic
patients.
Middle-Eastern
Male dominant culture.
Might be loud and very expressive; especially at a death of a
family member.
Communication is seen as going both ways; if they share
information, then you should as well.
Psychological or emotional problems are dealt with within the
family and may not be receptive to seeking outside help.
Muslim is the dominant religion; but not the only religion within
this group.
Family will consider it an honor to care for elderly or ill family
members. Both men and women care for family members just
in different manners (Wehbe-Alamah, 2011).
Native Americans
Value family immensely.
May be very stoic, especially with pain. Offer pain medication when
appropriate. Patient may not say they are in pain, they may say that
“something isn’t right”. So be aware, they might not say anything
again about it.
Can expect long pauses when talking as the person is thinking on
what to say.
Might be quite expressive when a death occurs.
Cutting of hair is done during times of mourning, so ask about
cutting hair before doing it and ask if they want to keep the hair
should it need to be cut.
Traditional and western medicines are both used. Be aware of
alternative healing practices that might be used.
References:
American Nurses Association (2004) Nursing’s scope and standards of practice. Silver
Spring, Maryland. Nursebooks.org.
Clarke, P.N., McFarland, M.R., Andrews, M.M., Leininger, M. (2009). “Caring: some reflections on
the impact of the culture care theory by McFarland and Andrews and a conversation with
Leininger” Nursing Science Quarterly. 2009 22:233. doi.: 10.1177/089431409337020
Douglas, M.K., Pierce, J.U., Rosenkoetter, M., Pacquiao, D., Callister, L.C., Hattar-Pollara,M.,
Lauderdale, J., Milstead, J., Nardi, D., Purnell, J., (2011). “Standards of practice for culturally
competent nursing care: 2011 update” Journal of Transcultural Nursing. 2011 22:317
Galanti, G.A. (2008). Caring for Patients from Different Cultures (4Ed.) Philadelphia, Pennsylvania.
University of Pennsylvania.
Michigan Census information retrieved from
http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml.
Narayanasamy, A., and White, E. (2004) “A review of transcultural nursing” Nurse Education
Today 2005 25,102-111.
Nursing Theories; Transcultural Nursing retrieved from http
://currentnursing.com/nursing_theory/transcultural_nursing_html on June 11, 2013.
Site last updated on Jan. 26,2012.
Nursing Theories: Roy’s Adaptation Model retrieved from
http://currentnursing.com/nursing_theory/Roys_adaptation_model.html on June 11, 2013.Site
last updated Jan. 26,2012.
References continued:
Smith, L.S., (2013). “Research for cultural competence”.
Nursing 2013. Retrieved from Nursing2013.com on May 31,
2013..
Quality & Safety Education for Nurses Competencies (2013).
Retrieved from http://
qsen.org/competenceis/prelicensure-lesas/ on June 15, 2013.
Wehbe-Alamah, H. (2011). “The use of culture care theory with
Syrian Muslims in the mid-western United States” The
Online Journal of Cultural Competence in Nursing and
Healthcare 1 (3).
