Transcultural Nursing and Environmental Control: Introduction

Madeleine Leininger

Who founded the field of transcultural nursing in the mid-1960s?

Transcultural Nursing Society

It is founded in 1974, is promoting interest in transcultural concepts and the education of transcultural nurses at the graduate level.

Rockefeller Foundation

Other international conferences, such as that supported by the _______ in October 1988 in Bellagio, Italy, have sought to promote international health care management.

Transcultural Nursing Society Newsletter and The Journal of Transcultural Nursing.

The Transcultural Nursing Society also published the ___

Culture

It is a patterned behavioral response that develops over time as a result of imprinting the mind through social and religious structures and intellectual and artistic manifestations. It is also the result of acquired mechanisms that may have innate influences but are primarily affected by internal and external environmental stimuli.

It is shaped by values, beliefs, norms, and practices that are shared by members of the same cultural group. It guides our thinking, doing, and being and becomes patterned expressions of who we are. These patterned expressions are passed down from one generation to the next.

According to Leininger (1985a, 1985b, 1991) and Leininger and McFarland (2006)

Culture is the values, beliefs, norms, and practices of a particular group that are learned and shared and that guide thinking, decisions, and actions in a patterned way.

Spector (2008)

contends that culture is a metacommunication system based on nonphysical traits such as values, beliefs, attitudes, customs, language, and behaviors that are shared by a group of people and are passed down from one generation to the next.

Andrews and Boyle (2008)

According to _________, culture represents a unique way of perceiving, behaving, and evaluating the external environment and as such provides a blueprint for determining values, beliefs, and practices.

Imperative

It is believed that demography is destiny, demographic change is reality, and demographic sensitivity is ____.

2010

In ____, 72.4% of the population in the United States was White of European descent; 12.6%, African-American; 16.3%, Hispanic American; 4.8%, Asian American; and 0.9%, American Indian

53%

It is projected that by the year 2020, only ___ of the U.S. population will be White of European descent. It is further projected that by the year 2021, the number of Asian Americans and Hispanic Americans will triple, while the number of African-Americans will double.

2070

If the 2010 census data on fertility, birth, and mortality are correct, conceivably it will be almost impossible to isolate and identify a “pure” race of Whites of European descent by the year ____

Affonso (1979)

According to _____, cultural assessment can give meaning to behaviors that might otherwise be judged negatively. If cultural behaviors are not appropriately identified, their significance will be confusing to the nurse.

Outline of Cultural Materials by Murdock et al. (2004)

One of the most comprehensive tools used for nursing cultural assessment is the ___________; however, this tool was developed primarily for anthropologists who were concerned with ethnographic descriptions of cultural groups. Although the tool is well developed and contains 88 major categories, it was not designed for nurse practitioners.

what to find out, why it is important, and how to do it.

Another assessment tool is in Brownlee’s (1978) Community, Culture, and Care: A Cross-Cultural Guide for Health Workers. Brownlee’s work is devoted to the process of practical assessment of a community, with specific attention given to health areas. The work deals with three aspects of assessment:

Criticized

Brownlee’s assessment tool has been ______ as being too comprehensive, too difficult, and too detailed for use with individual clients. Although this tool was developed for use by health care practitioners, it is not exclusively a nursing assessment tool.

Transcultural nursing

_________ as defined by Leininger (1991; Leininger & McFarland, 2006) as a “humanistic and scientific area of formal study and practice which is focused upon differences and similarities among cultures with respect to human care, health (or well-being), and illness based upon the people's cultural values, beliefs, and practices.”

The use of relevant knowledge to provide culturally specific and culturally congruent nursing care to people.

According to Leininger (1991), the ultimate goal of transcultural nursing is:

Rising of the sun

Leininger’s sunrise model symbolizes the ______ (care).

Worldview factors

The sunrise model depicts a full sun with four levels of foci. Within the circle in the upper portion of the model are components of the social structure and ______ that influence care and health through language and environment.

Lower half

The worldview factors influence the folk, professional, and nursing systems or subsystems located in the _____ of the model.

Micro, middle, and macro

Also included in the sunrise model are levels of abstraction and analysis from which care can be studied at each level. Various cultural phenomena are studied from the __________ perspectives

Tripp-Reimer, Brink, and Saunders (1984)

In one of their first studies of its kind, analyzed selected culturally appropriate models and tools to determine whether the models significantly differed. They concluded that most cultural assessment guides are similar because they all seek to identify major cultural domains that are important variables if culturally appropriate care is to be rendered.

The process itself

Tripp-Reimer, Brink, and Saunders (1984) concluded that the same two limitations existed in each guide. The first limitation was the tendency to include too much cultural content, ultimately negating the “heart of the matter,” which is ____.

Geissler (1991)

Reported a study to determine the applicability of the North American Nursing Diagnosis Association (NANDA) taxonomy as a culturally appropriate assessment tool for use with diverse populations.

(1) impaired verbal communication, (2) social isolation, and (3) noncompliance in culturally diverse situations.

In Geissler’s study, three nursing diagnoses were analyzed to validate their cultural appropriateness:

“impaired verbal communication”

The NANDA nursing diagnosis of “impaired communication, verbal, related to cultural differences” is an excellent example of a client-oriented diagnosis that does not recognize linguistic cultural differences. The study concludes that the NANDA diagnosis of _________ connotes that the client's verbal communication and ability to understand and use language are impaired in some way.

Nurse

According to Geissler (1991), if the client in this situation is “verbally impaired,” the ____ is equally impaired.

Nonadherence

Rather than use the term noncompliance, Geissler (1991) suggests that the term _____ may be more appropriate because this term may more accurately reflect behavior resulting from cultural dissonance.

(1) transcultural nursing and culturally diverse nursing, (2) culturally competent care, (3) culturally unique individuals, (4) culturally sensitive environments, and (5) health and health status based on culturally specific illness and wellness behaviors.

The metaparadigm for the Giger and Davidhizar Transcultural Assessment Model includes:

Giger and Davidhizar

In the context of __________’s Transcultural Assessment Model (1990, 2002), transcultural nursing is viewed as a culturally competent practice field that is client centered and research focused. Although transcultural nursing is viewed as client centered, it is important for nurses to remember that culture can and does influence how clients are viewed and the care that is rendered.

Stokes (1991)

According to ______, nursing as a profession is not “culturally free” but rather is “culturally determined.” Nurses must recognize and understand this fact to avoid becoming grossly ethnocentric.

Culturally diverse nursing care

It refers to the variability in nursing approaches needed to provide culturally appropriate and competent care. Nurses need to use transcultural knowledge in a skillful and artful manner to render culturally appropriate and competent care to a rapidly changing, heterogeneous client population.

(1) communication, (2) space, (3) social organization, (4) time, (5) environmental control, and (6) biological variations

Culturally diverse nursing care must take into account six cultural phenomena that vary with application and use yet are evident in all cultural groups:

Cultural competence

As a heightened awareness of transcultural health care has been espoused, so too has the widened use of the term ________. There are as many varying definitions for this term as there are for the term culture.

Purnell and Paulanka (2008)

They suggest that cultural competence is the act whereby a health care professional develops an awareness of one’s existence, sensations, thoughts, and environment without letting these factors have an undue effect on those for whom care is provided.

Giger and Davidhizar’s Transcultural Assessment Model

Environmental control

It refers to the ability of an individual or persons from a particular cultural group to plan activities that control nature. It also refers to the individual's perception of ability to direct factors in the environment.

Environment

In the most practical sense, the term _____ encompasses relevant systems and processes that affect individuals (Sideleau, 1997).

Systems

_____ are organized structures that may influence and be influenced by individuals.

Processes

________ may be viewed as organized, purposeful patterns of operations. _______ generally include the dynamics and interactions between families, groups, and the community at large.

dyssynchronous relationship

When exchanging has purpose and is goal directed, the interaction and exchange processes are considered functional and useful. However, when the exchange has no purpose and lacks goal direction, a _________ occurs.

Biomedical model

Today the most widely accepted approach to health care is the _____. This model emphasizes biological concerns, which are considered by those who support this model as more “real” and significant than psychological and sociological issues (Kleinman, Eisenberg, & Good, 1978).

Kleinman, Eisenberg, and Good (1978)

According to them, the biomedical approach is culture specific, culture-bound, and value-laden.

Illness

____ can be defined as an individual’s perception of being sick.

Disease

____ is diagnosed when the condition is a deviation from clearly established norms based on Western biomedical science.

50%

Illness can and does occur in the absence of disease: approximately ___ of visits to physicians are for complaints without a definite basis.

Health care behavior

The term _____ is defined as the social and biological activities of an individual that are based on maintaining an acceptable health status or manipulating and altering an unacceptable condition

Health status

The term _____ is defined as the success with which an individual adapts to the internal and external environment.

health status

Health care behavior influences (h)____, which in turn influences health care behavior.

Cultural health practices

________ are categorized as efficacious, neutral, dysfunctional (Pillsbury, 1982), or uncertain.

Efficacious

According to Western medical standards, _______ cultural health practices are beneficial to health status, although they can differ vastly from modern scientific practices. Because ________ health practices can facilitate effective nursing care, nurses need to actively encourage these practices among and across cultural groups.

Neutral

_______ cultural health practices have no effect on the health status of an individual. Although some health care practitioners may consider _____ health practices irrelevant, the nurse must remember that such practices may be extremely important because they might be linked to beliefs that are closely integrated with an individual's behavior.

“the ritual disposal of the placenta and cord”

In Greene's classic work (1981) several examples of neutral practices were cited, including:

Dysfunctional

_____ cultural health practices are harmful. An example is the excessive use of such items as overrefined flour and sugar. The nurse must be aware of practices that are ____ and should work to establish educational training programs that help individuals identify ___ health practices and develop beneficial practices.

Uncertain

These practices included such things as swaddling a newborn infant to maintain body temperature and using an abdominal binder for mother and infant to prevent umbilical hernias.

Values

_____ may be viewed as individualized sets of rules by which people live and are governed.

Cultural values

_____ are often acquired unconsciously as an individual assimilates the culture throughout the process of growth and maturation.

Value orientations

Kluckhohn and Strodtbeck (1973) defined ______ as “complex but definitely patterned principles which give order and direction to the ever-flowing stream of human acts and thoughts as they relate to the solution of common human problems.”

Temporal orientation

_________ refers to the method by which persons from particular cultural groups divide time. Time is generally divided into three frames of reference: past, present, and future.

Activity orientation

_____ refers to whether a cultural group is perceived as a “doing”-oriented culture, which is oriented toward achievement, or as a “being”-oriented culture, which values “being” and views people as an important link between generations. In other words, the “doing”- oriented culture values accomplishments, whereas the “being”-oriented culture values inherent existence.

Relational orientation

_____ from a cultural perspective distinguishes interpersonal patterns. More specifically, it refers to the way in which persons in a culture set goals for individual members.

Lineal, individualistic, and collateral.

Relational orientations are found in three modes:

Lineal

When the ____ mode is dominant within a particular cultural group, the goals and welfare of the group are viewed as major concerns.

Individualistic

Cultures in which the dominant mode is ____ value individual goals over group goals. Thus each individual is responsible for personal behaviors and ultimately is held accountable for personal accomplishments.

Collateral

When the _____ mode is dominant in a cultural group, the goals and welfare of lateral groups such as siblings or peers are of paramount importance.

People-to-nature orientation

_______ implies that people dominate nature, live in harmony with nature, or are subjugated to nature.

Innate human nature orientation

The _________ distinguishes an individual’s human nature as being good, evil, or neutral.

Locus-of-control construct

When a reinforcement is perceived as following some action but not being entirely contingent upon (personal) action then in our culture it is typically perceived as a result of luck, chance, and fate, as under the control of powerful others, or unpredictable because of the great complexity of the forces surrounding [the individual]. When the event is interpreted in this way by an individual, this is labeled as a belief in external control. If a person perceives that the event is contingent upon his own behavior or his own permanent characteristics, we have termed this a belief in internal control (Rotter, 1966).

Social learning theory

The locus-of-control construct originates in _____

Folk medicine

_____, or what is commonly referred to as “Third World beliefs and practices,’ is often called strange or weird by nurses and other health professionals who are unfamiliar with ____ beliefs.

Natural or unnatural

The folk medicine system classifies illnesses or diseases as _________

Natural events

_______ have to do with the world as God made it and as God intended it to be. Thus, natural laws allow a measure of predictability for daily life. Unnatural events, on the other hand, imply the exact opposite because they upset the harmony of nature or from evil.