1. Transcultural Nursing By: Cindy Magirl, RN

2. Relevance to Nursing  Provides therapeutic and safe care to people of different cultures

3. Objectives  Increase awareness of cultural differences  Understand non-verbal cues used by different cultures  Promote a culturally competent nursing environment

4. 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)

5. Incompetent vs Competent Cultural Care http://www.youtube.com/watch?v=Dx4Ia-jatNQ

6. Cultural Health Beliefs Amish  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) 6

7. Cultural Health Beliefs Hispanics  Self care is seen as less important  Men are the primary decision makers  Tend to keep emotional problems within the family  Modesty Galanti (2003) 7

8. Cultural Taboos and Stereotypes http://www.youtube.com/watch?v=cHsfevWnW10

9. Theories  Culture Care Diversity and Universality  Giger and Davidhizar Transcultural Assessment Model

10. Culture Care Diversity and Universality  Madeleine Leininger developed theory in 1960’s  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  Sunrise model  Illustrates major components and interrelationships of culture care diversity and universality Maier-Lorentz, (2008) 10

11. 3 Modes of Action to Deliver Care 1)Preservation or Maintenance  Refers to nursing care activities that help people from particular cultures to retain and use core cultural values r/t healthcare concerns or conditions 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 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 Jones, & Bartlett (2014) 11

12. Sunrise Model

13. Giger and Davidhizar Model  Based on six cultural phenomena that shapes care  Communication  Verbal and nonverbal  Space  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) 13

14. Root Cause Analysis Education Social Segregation Rural Area Prejudices and Bias Culturally Congruent Care Culturally Congruent Care Lack of resources Interpreters Lack of Knowledge Stereotyping Expected to assimilate Racism Minorities

15. Recommendations for Quality and Safety Improvements ANA Standards Standard 7 Ethics The RN practices ethically. Standard 8 Education The RN attains knowledge and competence that reflects current nursing practice Standard 11 Communication The RN communicates effectively in a variety of formats in all areas of practice ANA (2010) 15

16. QSEN Competencies  Patient Centered Care  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.  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.  Safety  Minimizes risk of harm to patients and providers through both system effectiveness and individual performance. QSEN Institute, (2014) 16

17. Questions ??????????????????

18. References American Nurses Association, (2010). Scope and standards of practice (2 nd 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 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

19. 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