Cultural Competence Care

Transcultural Nursing and Globalization: History

and Impact Facts

Transcultural Nursing: Essential Knowledge Dimensions (Part 1) Social developers use the term culture to refer to the sum of all material and spiritual values that have been created and passed on to future generations and the tools for creating and transmitting these values. It also illustrates the extent to which man has authority over the natural and social environments in which he lives, as well as the amount to which he controls the two.

Having a culture that differs from one community to another, and which is therefore experienced differently by everyone, affects how individuals perceive phenomena such as health, illness, happiness, and sadness and how they experience them. It is important to recognize, value, and practice cultural recognition, value, and practice when caring for the health, whose nature and meaning vary from culture to culture. Nurses play an integral role in health care, and cultural factors may affect how nurses perform their duties. Taking the patient's cultural values, beliefs, and practices into account are integral to providing holistic nursing care to a patient. A nurse must respect cultural values and lifestyles and be compassionate and humane in providing care for her patients. In the current economic climate, individuals need nursing care that is both affordable and acceptable based on current economic conditions. As part of the care process, it is beneficial to recognize and understand the cultural practices of the target communities and the barriers to providing quality health care to these communities. There is an urgent need for nurses in multicultural societies to explore new ways of providing culturally sensitive care, to be aware of how culture impacts the

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definition of health illness, and to build bridges between the care process and the needs of individuals from diverse cultural backgrounds. (Bayram Değer, 2017).

There is an utmost need for nursing professionals to be adaptable to deal with cultural diversity, as this issue can damage the excellence of the care they provide to their patients. During the delivery of care, nurses are required to understand diverse cultures, which is why nursing transcultural models provide nurses with the foundation to do so. In nursing practice around the world, these models are continuously being developed as they guide the training of nurses everywhere (Albougami et al. 2016).

1. Transcultural Nursing and Globalization: History and Impact Facts Cultures can be defined as collections of material and spiritual values created through the process of social development as well as a collection of tools used to create, pass down, and demonstrate the extent to which a man has exerted control over his natural and social environment. It has been said that culture is a set of beliefs, attitudes, behavior, customs, and traditions, as well as values that are learned and shared. These values are maintained through learning and teaching values, attitudes, and actions (Bayram Değer, 2017).

The following definitions indicate that culture is a non-written connection between the past and the present, bridging individuals within a society who are connected through their shared pasts. It is also significant to understand that the concept of "culture" also differs within each community and, consequently, can have an enormous impact on how individuals perceive phenomena such as health, illness, happiness, and sadness and how these feelings are perceived expressed. It should also be noted that culture affects the perception of health, and the perception differs according to the health cultures. Biology, environment, and cultural practices determine an individual's ability to maintain health. During human life, several aspects are affected by cultures, including parental attitudes, child-rearing patterns, how children are raised, the languages they speak, how they dress, how they believe, how they treat patients, how they are fed, and how funerals are conducted (Bayram Değer, 2017).

Madeleine Leininger, a transcultural nurse, developed the Transcultural Nursing Theory or Culture Care Nursing Theory and discovered while working as a nurse that a lack of cultural and care knowledge was preventing nurses from understanding the many variations required to support compliance, healing, and wellness in inpatient care. She developed the theory of Transcultural Nursing because of these observations. According to this theory, culturally congruent nursing care is provided by cognitively based acts, decisions, or facilitations that are tailored to fit the cultural values, beliefs, or lifeways of the individual, group, or institution (Gonzalo. 2021).

Madeleine Leininger defined transcultural nursing in 1995 as a substantial field of study and practice that focuses on comparative cultural care (caring) and values, beliefs, and practices among

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individuals or groups from similar or diverse cultures. A nursing care practice that promotes health or well-being in culturally meaningful ways or helps people cope with unfavorable human conditions, illness, or death.

The Transcultural Nursing Theory was developed in the 1950s and first published by Leininger in 1991 in his book Culture Care Diversity and Universality (Culture Care Diversity and Universality). She published her work Transcultural Nursing in 1995, in which she furthered her theory and developed it further. A detailed discussion of theory-based research and transcultural theory applications can be found in Transcultural Nursing, the third edition, which was published in 2002. The field of nursing focuses on analyzing and comparing cultures regarding nursing and health- related practices, beliefs, and values so that nursing care services can be tailored to the patient's cultural values and health-illness contexts and thus provide meaningful and effective nursing care. The nursing field is regarded as a learned one (Gonzalo. 2021).

According to Madeleine Leininger's theory, several assumptions must be made:

1. Even though cultures perceive, know, and practice care differently, there are some similarities among them.

2. In the context of cultural care, values, beliefs, and practices are often shaped and embedded by worldviews, languages, religions (or spiritualities), kinships (socioeconomic), political (or legal), technological, economic, educational, ethnohistorical, and environmental contexts.

3. The concept of human care is universal across cultures and manifests in various forms, including expressions, actions, patterns, and lifestyles.

4. Nursing care practices are guided by cultural care, the most comprehensive approach to understanding, explaining, interpreting, and predicting nursing care phenomena.

5. It is important to note that there are generic or folk healthcare practices, professional practices differ across cultures, and caregivers (generic) and professional caregivers will have cultural similarities and differences.

6. The primary focus of a nurse is to provide care, and although healing and curing cannot occur without care, care may still be provided in the absence of a cure.

7. Care and caregiving are essential for human survival, growth, health, well-being, healing, and the ability to cope with disabilities and death.

8. Nurses serve human beings around the world as a central goal in their role as a transcultural care discipline and profession; when ethnically based nursing care is helpful and healthy, it contributes to the health and well-being of the client(s), regardless of whether the client is an individual, a group, a family, a community, or an institution, within the context of their surroundings.

9. Nurses can provide culturally appropriate nursing care only if they are familiar with their patients. Nurses utilize the client's patterns, expressions, and cultural values in an appropriate and meaningful

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manner.

10. The client of nursing care may experience stress, non-compliance, cultural conflicts, or ethical or moral concerns if the nursing care is not reasonably culturally congruent (i.e., compatible with and respectful of the client's values, beliefs, and lifeways) (Gonzalo. 2021).

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The Evolutionary Phases of Transcultural Nursing Knowledge

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McFarland (2019).

Transcultural nursing aims to enhance nurses' awareness of cultures and their need for culturally sensitive care. Nursing and health care services lack two crucial dimensions, namely culture and care, which the author has discussed in several publications (Leininger,1995).

In addition, nursing education and training programs were necessary to prepare nurses for this new profession. Every member of any discipline should acquire knowledge of the core concepts, principles, and features of their discipline to guide their thinking and actions. For nurses to better understand this discipline, this type of instruction should be accompanied by relevant publications. In this way, the author and founder of the field shared her vision, thinking, and conceptual approach to transcultural nursing. She has published several articles and a definitive textbook on transcultural nursing since 1978. As a result of this outstanding book, nurses have gained a greater understanding of transcultural nursing (Leininger, 1978).

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In the 1980s, nursing was ignored as a discipline due to its involvement in various nursing and medical concerns that hindered intellectual and theoretical exploration. Despite the considerable debate over whether nursing is a profession or a discipline, extraordinarily little attention was paid to nursing as a field of study. Nursing as a discipline, particularly transcultural nursing, presented a new challenge. In the field of study known as disciplines, specialized fields of study reflect an in-depth and comprehensive understanding of a particular topic. The study and practice of any legitimate field strive to be recognized within society as a discipline. The discipline scholars are committed to advancing knowledge in their area of research and are interested in doing so. Discipline scholars seek to establish, maintain, and utilize knowledge in a particular field in society and at work. (Leininger 1994). Those within the discipline know it because they thoroughly understand the subject matter and can apply the research findings in their daily work. In addition to conferring a certain level of status upon its members, their members highly value disciplines.

Authentic disciplines require diverse perspectives as part of their theoretical basis. A unique feature of the theory is that it combines certain aspects of anthropology (culture) with nursing (care) in a highly integrated and interdependent manner (Leininger, 2008).

2. Essential of Transcultural Nursing Care Concepts and Policy Statements for Culturally Congruent Health Care Practice. Nursing is often referred to as transcultural nursing or cross-cultural care, which refers to a diversity of aspects of healthcare delivery that are culture-related and can have an impact on disease management, the well-being, and the pateints’ health. As a transcultural nurse, the primary focus will be on providing culturally congruent, meaningful, high-quality, and safe healthcare to patients from various cultures, no matter how similar or diverse they may be. By studying diverse cultures, healthcare professionals can gain a deeper understanding of how diverse cultures are similar and how they differ, which in turn helps them to provide better care for their patients. A person's cultural background influences health and illness perceptions. Taking care of patients from various cultural backgrounds requires cultural competence on the part of nurses (Leininger, 2002). The development of a patient's healthcare plan considers the patient's beliefs and heritage as part of cultural care. Nursing professionals should also be aware that people come from diverse cultures and races, which necessitates the provision of care tailored to their specific needs (Lowe & Archibald, 2009).

Moreover, certain aspects of culture are particularly relevant to healthcare and nursing professions. Race, ethnicity, and culture are all factors that contribute to cultural competency. Culture refers to beliefs, assumptions, values, and norms observed and transmitted from generation to generation. The concept of culture, as defined by Ingram, is a learned way of seeing the world transmitted through social interaction from one group to another. As well as the beliefs, values, norms, and behaviors of its citizens, the philosophy of a nation is reflected in its language, food, dress, and social institutions. Furthermore, culture can influence various aspects of human life in addition to health and

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preferences regarding managing health conditions. Many countries are experiencing multicultural trends because of globalization and mass immigration (Ingram, 2011).

Each culture has its own distinct characteristics. As a result, there may be significant differences between individuals from diverse cultures. Everyone should be treated as a unique individual, and their differences should be acknowledged and respected. A person of the same race may undoubtedly have a diverse cultural background. Races are classified according to physical characteristics, such as skin color.It is an identifying characteristic of a culture, as well as an attribute that describes that culture. Like ethnicity, ethnicity is a marker of cultural membership based on a shared history. Ethnicity continues with a person throughout their life (Martin et al.,2007).

Culturally competent nurses can provide high-quality care in a variety of cross-cultural environments. A culturally competent individual possesses behaviors, practices, and policies that are appropriate for the culture. Nurses need to be culturally competent. Providing culturally congruent healthcare does not primarily aim to provide healthcare to ethnic or racial minorities but to improve healthcare delivery by considering differences in age, gender, religion, and socioeconomic status (Hearnden, 2008).

Professionals in the healthcare field, especially nurses, should take the time to educate themselves about diverse cultures and understand them. Understanding a patient's religious and cultural background is of utmost importance when providing healthcare. A better understanding of these beliefs may encourage healthcare professionals to evaluate their cultural and religious beliefs, which may influence their treatment methods. Cultural awareness refers to an individual's thoughtful of their cultural background, differences, and biases. Acculturation, on the other hand, involves becoming acquainted with a new culture. Adapting nursing practices to the cultural norms of the workplace is an important consideration for nurses (Albougami et al. 2016).

Culturally competent nursing care should adhere to the following standards:

The American Academy of Nursing's Expert Panel for Global Nursing and Health has collaborated with the Transcultural Nursing Society to develop a set of guidelines relating to cultural competence in nursing.

As outlined in the definition, these standards are based on social justice. According to social justice, every individual or group can have fair and equal opportunities in all aspects of life, including social, educational, economic, and in this case, healthcare. Applying social justice principles and ensuring culturally competent care may reduce health inequalities. Nursing professionals must be educated to deliver culturally competent care due to an increasing diversity of patient populations, regardless of their geographic location, and a worldwide shortage of nurses (Expert Panel on Global Nursing & Health, 2010).

Professionals in the nursing field can use these 12 standards to enhance their cultural competence in their practice, administration, education, and research. Even though no single set of nursing standards reflects all the values of the global nursing community, the authors hope that the work will create a "best practices" approach to improving culturally competent nursing care and healthcare

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worldwide. Each standard has a description, a rationale, and suggestions about implementing it. Social justice and human rights are the cornerstones of all standards established by the International Council of Nurses. At the system or government level, impartiality and objectivity are manifested in politics, economics, and social policies (Expert Panel on Global Nursing & Health, 2010).

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Culturally competent nursing care can be implemented in accordance with the following guidelines:

Nursing should be culturally competent to work effectively in cross-cultural situations (Office of Minority Health, 2014). Health disparities among culturally diverse and vulnerable populations must

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be addressed through this strategy. Culturally competent health care can mitigate the social, economic, political, and environmental disadvantages that may lead to unequal contact to health care and deprived health outcomes. To advocate for vulnerable populations and reduce health disparities, nurses must provide culturally competent care to diverse populations.

These Guidelines for Implementing Culturally Competent Nursing Care are intended to provide nurses across the globe with a universally applicable guide to help them integrate cultural competency into their clinical practice, research, education, and administration, especially for nurses providing direct patient care. These guidelines address a variety of topics, including cultural awareness, education and training in culturally competent care, critical reflection, cross-cultural communication, culturally competent practice, cultural competence within healthcare organizations and systems, patient empowerment, cultural competence within healthcare organizations and systems, multicultural workforces, cross-cultural leadership, and evidence-based practice (Douglas et al. 2014).

By including this guideline in all nursing curricula and healthcare practice settings, the American Academy of Nursing recommends that culturally competent care be provided. A nursing education program focusing on cultural competency and workforce diversity is essential for enhancing clinical

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skills, attitudes, and resource utilization in all nursing specialties and settings serving culturally diverse populations. Research-based interventions can link culturally competent nursing care to improved health outcomes. Further research on the outcomes of culturally competent care will be needed to identify interventions that may reduce health disparities in these vulnerable populations.

References

Albougami, A. S. (s. f.). Comparison of Four Cultural Competence Models in Transcultural Nursing: A Discussion Paper. http://clinmedjournals.org/articles/ianhc/international-archives-of-nursing- and-health-care-ianhc-2-053.php?jid=ianhc (http://clinmedjournals.org/articles/ianhc/international-archives-of-nursing-and-health-care-ianhc-2- 053.php?jid=ianhc)

Değer, V. B. (2018, 19 septiembre). Transcultural Nursing. IntechOpen. https://www.intechopen.com/chapters/61494 (https://www.intechopen.com/chapters/61494)

Douglas, M.K., et al. (2014). Guidelines for Implementing Culturally Competent Nursing Care. Journal of Transcultural Nursing. 2014;25(2):109-121. doi:10.1177/1043659614520998

(https://tcns.org/wp- content/uploads/2018/03/Standards_of_Practice_for_Culturally_Compt_Nsg_Care-Revised_.pdf)

Expert Panel on Global Nursing & Health (2010). Standards of Practice for Culturally Competent Nursing Care. (s. f.). https://tcns.org. https://tcns.org/wp- content/uploads/2018/03/Standards_of_Practice_for_Culturally_Compt_Nsg_Care- Revised_.pdf (https://tcns.org/wp- content/uploads/2018/03/Standards_of_Practice_for_Culturally_Compt_Nsg_Care-Revised_.pdf)

Gonzalo, A. B. (2021, 19 agosto). Madeleine Leininger: Transcultural Nursing Theory. Nurseslabs. https://nurseslabs.com/madeleine-leininger-transcultural-nursing-theory/ (https://nurseslabs.com/madeleine-leininger-transcultural-nursing-theory/)

Hearnden M (2008) Coping with differences in culture and communication in health care. Nurs Stand 23: 49-57].

Ingram, R. (2011). Using Campinha-Bacote's process of a cultural competence model to examine the relationship between health literacy and cultural competence. J Adv Nurs 7: 695-703.].

Leininger M (2002) Culture care theory: a major contribution to advance transcultural nursing knowledge and practices. J Transcult Nurs 13: 189-192,

Leininger, M. (1978). Transcultural Nursing. (First book focused on transcultural nursing.) (Reprinted in 1994 by Greyden Press, Columbus, OH.)

Leininger, M. (1994). Transcultural nursing education: A worldwide imperative. Nursing and Health Care, 15(5),254-257.

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Leininger, M. (1995). Transcultural Nursing Concepts, Theories, Research and Practice. Columbus, OH: McGraw Hill College Custom Series.

Lowe, J., and Archibald, C. (2009) Cultural diversity: the intention of nursing. Nurs Forum 44: 11-18.].

Madeleine Leininger (2008). The Evolution of Transcultural Nursing with Breakthroughs of Discipline Status. (s. f.). www.madeleine-leininger.com. http://www.madeleine- leininger.com/cc/evolution.pdf (http://www.madeleine-leininger.com/cc/evolution.pdf)

Martin, M.L.et al. (2007) Integrating an evidenced-based research intervention in the discharge of mental health clients. Arch Psychiatr Nurs 21: 101-111.].

McFarland, M.R., and Wehbe-Alamah, H.B. (2019) Leininger’s Theory of Culture Care Diversity and Universality: An Overview with a Historical Retrospective and a View Toward the Future. Journal of Transcultural Nursing. 2019;30(6):540-557. doi:10.1177/1043659619867134

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