1. UNIT ONE INTRODUCTION AND KEY CONCEPTS RELATED TO TRANSCULTURAL NURSING AND CULTURAL COMPETENCY

2. INTRODUCTION 2  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.

3. 3  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. INTRODUCTION

4. 4  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 INTRODUCTION

5. 5  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. INTRODUCTION

6. DEFINITION 6  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.

7. KEY CONCEPTS 7 Understanding the following central concepts is important for understanding the major transcultural models that explore the various aspects of Transcultural Nursing Phenomenon

8. Acculturation 8  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.

9. 9  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 Acculturation

10. 10  Culture is a learned, patterned behavioural response acquired over time that includes implicit versus explicit beliefs, attitudes, values, customs, norms, taboos, arts, and life ways accepted by a community of individuals  Culture is primarily learned and transmitted in the family and other social organizations, is shared by the majority of the group, includes an individualized worldview, guides decision making, and facilitates self worth and self-esteem Culture

11. 11  Cultural awareness is being knowledgeable about one’s own thoughts, feelings, and sensations, as well as the ability to reflect on how these can affect one’s interactions with others Cultural Awareness

12. 12 Cultural Competence  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

13. 13  Cultural Competence includes having general cultural as well as cultural-specific information so the health care provider knows what questions to ask

14. 14 Cultural Imposition  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

15. 15 Cultural Sensitivity  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

16. 16  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.

17. 17 Discrimination  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.

18. 18  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.

19. 19 Diversity  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

20. 20 Health Disparity and Healthcare Disparity  Health disparities are differences in the incidence, prevalence, mortality, and burden of disease and other adverse health conditions that exist among specific population groups

21. 21  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

22. 22  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

23. 23  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.

24. 24 Stereotyping  Stereotyping can be defined as the process by which people acquire and recall information about others based on race, sex, religion, etc.  Prejudice often associated with stereotyping is defined in psychology as an unjustified negative attitude based on a person’s group membership.  Stereotype includes having an attitude, conception, opinion, or belief about a person or group

25. 25  Stereotypes can have an influence in interpersonal interactions.  The beliefs (stereotypes) and general orientations expressed by attitudes and opinions can contribute to disparities in health care. “Some evidence suggests that bias, prejudice, and stereotyping on the part of healthcare providers may contribute to differences in care” and they may not recognize manifestations of prejudice in their own behaviour.

26. 26  However patients might react to providers’ behaviour associated with these practices in a way that contributes to disparities.  A healthcare provider who fails to recognize individuality within a group is jumping to conclusions about the individual or family

27. Ethnicity 27  A term that relates to races or large groups of people classified according to common traits or customs.

28. 28 Ethnocentrism  The perception that one's own way is best when viewing the world.

29. 29 Race  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).

30. 30 Ethnography  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).

31. 31 Culture shock  A disorder that occurs in response to transition from one cultural setting to another

32. HEALTH PRACTICES IN DIFFERENT CULTURES 32 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

33. 33  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. HEALTH PRACTICES IN DIFFERENT CULTURES

34. 34 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. HEALTH PRACTICES IN DIFFERENT CULTURES

35. 35 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. HEALTH PRACTICES IN DIFFERENT CULTURES

36. 36 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. HEALTH PRACTICES IN DIFFERENT CULTURES

37. 37 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. HEALTH PRACTICES IN DIFFERENT CULTURES

38. 38 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. HEALTH PRACTICES IN DIFFERENT CULTURES