Transcultural Nursing By Kristyn Beaver Ferris State University
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 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, selfconcept, 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? Based on: Age Ethnicity Religion Race Native Language Health status Physical attributes Nationality Educational Status Economic status What is stereotyping? Think about those with different attributes and how you view them and react to them? Compare: Hardworking ~ Lazy Withholding ~ Generous Expressive ~ Quiet Suspicious ~ warm/open Aggressive ~ Gentle 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 4 C’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 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. , Mc. Farland, M. R. , Andrews, M. M. , Leininger, M. (2009). “Caring: some reflections on the impact of the culture care theory by Mc. Farland 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 (4 Ed. ) Philadelphia, Pennsylvania. University of Pennsylvania. Michigan Census information retrieved from http: //factfinder 2. 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 Nursing 2013. 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).
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