Transcultural nursing and health care issues in urban and rural contexts.

The distinction between urban and rural health care has been based largely on population density, with little attention given to contextual meaning of patterns related to the lifeways of the people. When considering sociocultural factors, the differentiation becomes more complex. In this paper some of the transcultural nursing issues and challenges are discussed in relation to cultural context and health care trends in urban and rural settings. Four urban-rural health-related issues with transcultural dimensions are examined. Migration patterns, diversity among rural communities, utilization of services, and change related to intervention strategies are identified as transcultural nursing knowledge and practice in relation to urban and rural contexts.     

Transcultural Nursing Research to Transform Nursing Education and practice: 40 Years

In this article, an overview of some major trends, philosophical perspectives, and theoretical perspectives are presented, along with selected transcultural nursing research findings, primarily from the theory of culture care using the ethnonursing research method. A substantial body of transcultural nursing knowledge with health or well being outcomes has been forthcoming since transcultural nursing was launched in the 1950s. The author contends that transcultural nursing knowledge of Western and non-Western cultures is urgently needed to meet health needs in a multicultural world. Some misconceptions and reflections are offered to advance transcultural nursing research, education, and practice. For "newcomers" to transcultural nursing, some basic readings are recommended.     

Themes of rural health and aging from a program of research

The culture and diversity of rural life and limitations of rural health systems to meet the changing health needs of an aging population lead to problems of obtaining appropriate care in rural America. In a program of nursing research involving three ethnographic studies in rural Colorado, transitions of older adults across differing levels of heath care were explored. The sample totaled 425 participants, of whom 25% were Hispanic. Five major themes emerged: circles of formal and informal care; integration of faith, spirituality, and family with health status; crisis nature of health care transitions; nursing homes as a housing option; and changing spirit of traditional rural nursing. Recommendations for providers included making their practices congruent with rural culture, being fully informed of available resources, facilitating acceptable health care decisions, and integrating physical, mental, and spiritual health care for elders and their families.     

Classification tree model identifies home-based service needs of Japanese long-term care insurance consumers

ABSTRACT Objectives: To clarify care receivers' needs and unmet needs for home help or home nursing services during daytime and/or nighttime hours, and to identify the characteristic of elders who are most likely to need home care services. Design and Sample: We used a chi‐squared automatic interaction detection technique to analyze data from 92 care management researchers, who interviewed 280 caregivers. Measures: Demographic information, assessments of the statuses and service needs of elders. Results: We found that care receivers had more unmet needs at night than during the day. Daytime home help was needed by elders who (1) lived alone or (2) lived with just one person and whose primary caregiver was not their wife. Nighttime home help was needed by those who required assistance eating, and whose primary caregiver was male. Daytime home nursing was needed by elders who (1) received medical treatment instead of day care or (2) did not receive medical treatment, but had difficulty eating. Nighttime home nursing was needed by those who had unstable illnesses and whose medical treatments continued during the night. Conclusions: Our findings may help public health nurses assess community needs in order to effectively and efficiently manage health care resources.     

城市社区空巢老人内心感受探讨

目的：探讨空巢老人日常生活中的真实感受,以便帮助并指导空巢老人促进心理健康,提高生活质量。方法：采用定性研究方法,以半结构式的开放性访谈问卷对21位城市社区空巢老人进行个体化的深入访谈,使用定性资料的内容分析法进行资料分析。结果：在情感方面,有些空巢老人表现出适应、自立、充实、乐观、知足的正性情绪,有些老人表现出被遗忘感、失落感、烦闷感、孤独感、无助感、无望感、压抑感、拖累感等负性情绪,空巢老人的情绪与幸福感密切相关,多方面原因相互作用影响老人的内心感受。结论：空巢老人的情绪复杂多样,针对其产生的原因,老人家属及社区人员应引起重视,采取积极措施减少负性情绪的发生。     

Nursing students' self-efficacy in providing transcultural care

The aim of any health care service is to provide optimal quality care to clients and families regardless of their ethnic group. As today's Australian society comprises a multicultural population that encompasses clients with different cultural norms and values, this study examined undergraduate nursing students' self-efficacy in providing transcultural nursing care. A sample of 196 nursing students enrolled in the first and fourth year of a pre-registration nursing program in a Western Australian University were invited to participate in a survey incorporating a transcultural self-efficacy tool (TSET) designed by Jeffery [Unpublished instrument copyrighted by author, 1994]. The findings revealed that fourth year students, exposed to increased theoretical information and clinical experience, had a more positive perception of their self-efficacy in providing transcultural nursing skills than the first year students. In addition, the study found that age, gender, country of birth, languages spoken at home and previous work experience did not influence the nursing students' perception of self-efficacy in performing transcultural care. The study supports the notion that educational preparation and relevant clinical experience is important in providing nursing students with the opportunity to develop self-efficacy in performing effective and efficient transcultural nursing in today's multicultural health care system. It is for this reason that educators need to focus on providing students with relevant theoretical information and ensure sufficient clinical exposure to support student learning in the undergraduate program.     

Harmonizing: a North American Indian approach to management of middle ear disease with transcultural nursing implications.

In a grounded theory study of Canadian Indian family management of persistent middle ear disease, harmonizing was identified as the major strategy employed in the process of learning to manage. This finding resulted in a recasting of the substantive theory of management identified in an earlier study of Caucasian families. Although families from both cultures advance and retreat on the continuum of learning to manage in response to the relationship with the health care system, the effects of the disease on the child, and the amount of disruption in family life, culture was found to influence the ways in which these families learned to manage. In general, native families harmonized by integrating the experience into their reality in contrast with their Caucasian counterparts who attempted to direct or take charge of the experience. Factors that influenced native Indian management included autonomy of the child, perceptions of health and illness, expectations of the health care system, orientation to present and past time, and listening skills. These findings significantly contributed to the development of transcultural nursing knowledge.     

Cultural perspectives on nursing in the 21st century.

By the year 2000, more than one fourth of the US population will consist of individuals from culturally diverse groups. Increasing numbers of international visitors and exchange students will use the US health care delivery system, and US nurses will engage in international interchanges with increasing frequency. To keep pace with these population and health care trends, US nurses will need to base their nursing care on a theoretically sound foundation that draws on knowledge from the physical, natural, and behavioral sciences, as well as on research-based theories from transcultural, cross-cultural, and international nursing. The purposes of this article are to (1) trace past, present, and future population trends among minority groups in the United States; (2) examine the ways in which transcultural nursing has provided a framework for meeting the health care needs of culturally diverse people; (3) identify current issues and trends in transcultural nursing; and (4) suggest ways in which nurses can prepare for the increasing numbers of culturally diverse individuals who are projected to need nursing care in the future.     

From their own voices: the lived experience of African American registered nurses.

This phenomenological study described the lived experience of African American registered nurses providing nursing care to individuals, families, and communities in southeast Louisiana. Data were collected from 13 African American registered nurses using semistructured interviews and a focus group. Analysis of the phenomenological data revealed two essential themes, (a) connecting with the patient and (b) proving yourself; and four incidental themes, (a) a fulfilling dream, (b) being invisible and voiceless, (c) surviving and persevering, and (d) mentoring and role modeling. The findings revealed that the general perception among participants was that they were not fully accepted as equal professionals by their Caucasian nurse colleagues, other health care providers, and sometimes patients. The findings of the study indicate the immediate need to address and resolve the issues of diversity within the nursing profession. Nursing will also have to reform its system and practices to embrace and support diversity.     

城市社区高龄老人生存现状调查

目的 了解杭州市部分社区高龄老人的生存现状,为政府及社区制定依托家庭护理和社区护理的养老服务政策提供参考依据.方法 采用便利抽样法选取杭州5个社区80岁及以上的老人为调查对象,使用调查问卷进行面对面调查,实际调查454名,调查率为71.2％.结果 高龄老人文化程度低,女性低于男性(P＜0.05);73.1％的老人与配偶或子女孙辈居住,20.7％的老人独居;高龄老人慢性病患病率高,为87.2％,失能比例高.结论 社区高龄老人慢性病患病率高,失能比例高,政府与社区应加强社区高龄老人的慢性病管理和老年护理工作,有针对性地增加家庭护理内容,给予女性高龄老人、独居老人及失能老人更多的关注与护理,以整体改善社区高龄老人的生存质量.     

Transcultural nursing: a selective review of the literature, 1985–1991

This paper reviews selected work, published in nursing journals between 1985 and 1991, on the subject of transcultural nursing The papers were selected by the use of a computerized literature search at the Royal College of Nursing library, using the keywords transcultural, multicultural, crosscultural and cultural The benefits and limitations of such an approach will be discussed along with an introduction to transcultural nursing The Journal papers were then reviewed under eight headings, theory and concepts, nurse education, health education and patient teaching, clinical, counselling, sexuality, care of the child and research Common themes and problems are discussed     

Transcultural nursing: how do nurses respond to cultural needs?

The aim of the study was to explore how nurses responded to the cultural needs of their clients. From the transcultural point of view, healthcare providers must deliver a service that is culturally sensitive and appropriate. However, for a variety of reasons, there is growing concern that the cultural healthcare needs of minority ethnic groups are not met adequately. This study was done to outline nurses' activity in transcultural care. Empirical data were obtained from a sample of registered nurses (n = 126) who were invited to complete questionnaires pertaining to cultural care. As a result of data analysis, the quantitative findings are presented as tables and the qualitative data as categories and themes. The findings suggest that most respondents felt that patients' cultural needs should be given consideration. Cultural aspects of care seem to be a feature of the overall nursing picture within a multicultural context of health care. Many participants claimed that they responded to the cultural needs of patients. Some felt that patients' cultural needs are adequately met; such needs are perceived as religious practices, diets, communication, dying, prayer and culture. Furthermore, a significant number of respondents suggested that they would like further education in meeting the cultural needs of their patients. This study offers some insights into transcultural healthcare practice, and, in accordance with the findings, identifies strategies for improving these practices for nursing and nurse education.     

The spiritual care meanings of adults residing in the midwest

Only limited nursing knowledge exists as theoretical guidance for nurses in providing spiritual care. Using Leininger's theory of culture care diversity and universality, the purpose of this ethnonursing research study was to discover the embedded spiritual care meanings, expressions, lived experiences, and practices of adults residing in the Midwest and their perceptions of spiritual nursing care. Data were collected through interviews of 6 key and 12 general informants. Five universal spiritual themes were supported by the findings. Culture care modes were used to explicate spiritual knowledge that can be integrated into nursing practice.     

"Nobody ever asked me before": understanding life experiences of African American elders.

With the unprecedented growth in the African American elderly population, there exists an urgent need to prepare nurses to deliver culturally competent care. The purpose of this study was to increase the knowledge available about the cultural heritage, worldviews, and life experiences of African American elders. Reminiscence interviews were conducted with African American elders living in a medium-sized northeast urban community. Data were analyzed using Spiegelberg's phenomenological Method. The following themes emerged: (a) nobody ever asked me before, (b) stories of discrimination, (c) coping with discrimination, (d) the hurt of discrimination, and (e) self-discoveries. Nurses, through the use of reminiscence, can gain insight into the cultural heritage, worldviews, and life experiences of African American elders and improve their ability to deliver culturally competent care to this population.     

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.     

Transcultural mental health nursing. 1: Benefits and limitations

Mental health nurses often have to respond to the needs of clients from a diverse cultural background and ethnicity. The cultural needs of mental health clients can be met by transcultural nursing. In this article, the first of two parts, transcultural nursing is explained in terms of its assumptions, benefits and limitations and the emerging literature in this area of mental healthcare practice is highlighted. The second article will review the terms 'race', 'culture' and 'ethnicity' to illustrate their centrality in transcultural care. Following this, some aspects of mental health problems are presented in the context of cultural variation. Finally, the ACCESS model (Narayanasamy, 1998) (Assessment, Communication, Cultural negotiations and compromise, Establishing respect, Sensitivity and Safety) is suggested for use in transcultural care in mental health nursing.