The ACCESS model: a transcultural nursing practice framework

As transcultural nursing is beginning to be a feature of health care in multiethnic and multicultural Britain, the need for transcultural health practice models is increasing. The focus of this article, the ACCESS model (Narayanasamy, 1999), was developed to offer nurses a framework to deliver transcultural nursing care. Since its introduction there has been increasing interest about it from practitioners, nurse educators and students of nursing. The aim of this study was to ascertain the usefulness of the ACCESS model by a questionnaire study. In the institution where this study took place, pre- and post-registration nursing students are introduced to this model along with other models of transcultural health care. Participants (n = 166) who received transcultural healthcare education completed questionnaires with statements about the usefulness of this model. A significant number of participants found the model to be very useful with respect to its various features. The conclusion of this study is that the ACCESS model offers a useful framework for nurses implementing transcultural care practice. It appears that students and practitioners are interested in this model because of its practice implications.     

Meeting diversity challenges: pathway of 'advanced' transcultural nursing practice in Australia

This paper aims to address the state of transcultural nursing in Australia. In an attempt to address the challenges of cultural diversity in nursing practice, the significance of research-based transcultural nursing knowledge is examined within the evolutionary changes of multicultural policies in Australia. Transcultural nursing research, building upon existing nursing knowledge, provides evidence to advance transcultural nursing practice. In order to promote 'adanced practice' in multicultural Australia, models of research-based transcultural nursing practice are examined and highlighted.     

Commentary: Global leadership in transcultural nursing practice, education and research

It is amazing what some women and men dare to do with their ideas in many places in the world. Creative thinking and actions are what the world needs most. Transcultural nursing has been an example of these attributes. While taking new actions may be troublesome to some people, yet new actions and new ideas can lead to a wealth of new knowledge and new ways to serve people. Transcultural nurses have taken such actions and are transforming nursing and health care in many places in the world.     

Mediation of transcultural nursing care in clinical context: a tightrope walk

Our wish for suggestions for a line of action regarding our contact with migrants in the clinical context has led us to an increased acceptance of "Transcultural Nursing" by Madeleine Leininger. However, an uncritical adoption of this theory without theoretical and historical background information produces in practice a stereotyped image of migrants, and a cultural rating of social and individual aspects instead of mutual understanding. Hence, from the present-day perspective, Leininger's model is not suitable to establish transcultural nursing care in practice. A theory not encouraging the analysis of socio-cultural backgrounds of one's own but the sight "from without" of the so-called alien--a theory that does not make interaction its main object but culture, cannot serve as a basis for transcultural nursing care. Up-to-date transcultural nursing care does not need the introduction of a specific nursing concept for migrants but an extension of nursing by a socio-cultural and migration-specific dimension. However, nursing care does not seem to accept this challenge, what with it being far easier to add the "Leininger Culture Care Theory" to the existing curricula as an additional model. Thus nursing loses the opportunity of grappling with the adoption of certain theories and models of other disciplines. Even though Leininger is herself a nurse, she has developed her model in her capacity as a cultural anthropologist using the background of anthropological theories. But, the supplying of transcultural nursing care demands also from cultural anthropologists an analysis of the concrete context of nursing care and its approaches. Only by bearing this in mind, cultural anthropology can counter effectively the danger of being marginalized as a fringe discipline, and of being reduced to the level of providing cooking recipes.     

A review of transcultural nursing

In this article, transcultural nursing is reviewed in the light of the literature mainly relevant to the British context. The key features of transcultural nursing are examined in the context of multicultural Britain as follows: definitions, racism, ethnocentrism, culture, diversity, transcultural health care practice and nurse education. Models of transcultural care practice and contemporary developments in cultural care are also explored. There is evidence from emerging literature that innovations are taking place in promoting transcultural care practice and education. However, the article concludes that much practice-based research is still needed to establish transcultural nursing in Britain.     

跨文化护理理论在中国护理管理中的应用

随着社会的发展,中国加入世界贸易组织(WTO)以后,护理人员的国际化人才流动成为了一种趋势.另外,中国是一个多民族的国家,其护理的服务对象来自于不同种族,其护理管理人员文化背景不同.这些都向护理管理者提出了更高的要求.     

The relevance of transcultural nursing to international nursing

Does transcultural nursing as taught in United States' nursing education programmes adequately prepare US nurses for experiences in international health as they assist with the implementation of changes in another country's health care delivery system? That's the question posed by Lydia DeSantis, who is concerned that US nurses need a broader perspective of health care and culture in order to effect changes needed at the national level of policy and decisionmaking to meet the challenges of the Declaration of Alma-Ata. Her concerns about the focus of transcultural nursing are also relevant to INR's international readers, as it offers another perspective on how to persuade policymakers in their countries to reassess and initiate the health programmes needed to attain WHO's HFA goal.     

Learning in clinical nursing practice

In this study, a qualitative interpretivist perspective was used to analyze the following research question: How does clinical nursing practice facilitate learning? Forty nurses working in acute care, long-term care, and home care were interviewed about their clinical practice experiences and the learning that resulted. Data were analyzed using a constant comparative method. Study results indicate that clinical nursing practice facilitates both personal and professional development of nurses by fostering an examination of the concepts of self-respect, hope, control, vulnerability, acceptance, loss, and persistence. Implications for continuing educators and staff development instructors are drawn.     

Cultural considerations in child-rearing practices: a transcultural perspective

The nursing profession has begun to see the necessity of considering an individual's cultural belief system when providing nursing care. Leininger (1978), the founder of transcultural nursing, takes a strong position that "...a nurse should not be viewed as professional until she can effectively work with people in at least a bicultural setting, and the professional nurse should be prepared to respond effectively to people in our pluralistic world as an essential criterion of being professional" (pg. 141). To intervene effectively with the parent-child subsystem, the nurse must take into consideration the parental figure's belief system and cultural values. These cultural values give parents a sense of direction as well as meaning to their life. If nurses fail to respect and incorporate these values into nursing care, their ability to effectively help these parent-child subsystems is impaired and can limit this subsystem's progress toward their own culturally defined health state (Leininger, 1978). The purpose of the article is to provide nurses with a framework that can be used when interacting with families from diverse cultural backgrounds concerning the issue of discipline. This article emphasizes the need to incorporate a culturological assessment when implementing nursing interventions.     

Development of the nursing practice scale for end-of-life family conferences in critical care

ObjectivesThis study aimed to develop the Nursing Practice Scale for End-of-life Family conferences in critical care and to clarify the current status of nursing practice regarding family conferences.Research methodology/designWe conducted a cross-sectional, self-administered questionnaire survey with 955 critical care unit nurses in 97 hospitals. Content validity, factor validity and criterion-related validity, known-group validity, internal consistency and test–retest reliability were evaluated. Data were then analysed statistically.SettingAdult intensive care units or high dependency units in Japan.ResultsThree factors with 39 items were extracted through item analysis and confirmatory factor analysis as hypothesised (Factor 1: Preparation, Factor 2: Discussion and Factor 3: Follow-up), and the mean score per item for each factor was 3.57, 3.73 and 3.75, respectively. Nurses who had any certification or had worked in critical care unit for >5 years had a significantly greater score than the others. The Cronbach’s α were 0.86–0.96 and the intraclass correlation coefficients were 0.79–0.87.ConclusionThe Nursing Practice Scale for End-of-life Family conferences in critical care is a valid and reliable scale. This study could effectively facilitate communication among patients, their families and healthcare providers.     

Problem solving in clinical nursing practice

Problem solving in clinical nursing practice is the essence of good care delivery. This paper gives an overview of a research study which identified the cognitive problem solving process nurses use while delivering care. The study was conducted in the clinical setting and used a qualitative research methodology of observation, followed by in-depth semi-structured interview. The analysis of the study revealed diagnostic reasoning is the process used by clinicians. Information regarding the differences between novices and experts is offered as topics for discussion throughout the paper, and recommendations for changes to educational processes are made.     

The importance of transcultural nursing in cancer care

All patients around the time of cancer diagnosis are emotionally vulnerable. This sense of anxiety is further heightened for patients who are not fully integrated into the society in which they are receiving care because of the cultural shock and language barriers they may face. This article explores the author's experience of caring for a patient from China who was studying in the UK and was admitted with acute promyelocytic leukaemia. The patient had a limited grasp of English and was used to very different cultural norms. Bridging the cultural gap as outlined by Narayanasamy in the ACCESS model (2002) enabled the author to provide the important holistic nursing care that could be easily overlooked in these situations. There is a need for nurses to actively seek to understand cultural differences and take the opportunity to experience transcultural nursing.     

Health teaching in clinical nursing practice

The Nurses' Board of Western Australia identifies health teaching as one of five essential role competencies in its regulation of professional nursing practice. This implies that patient/client education is recognized as a fundamental component of health care, however there is mounting concern within the profession that nurses are not taking full advantage of teaching opportunities that present in clinical practice. This paper reviews literature about health teaching and suggests that patients should be better informed about their health status and future health maintenance.