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.     

Community transformation through culturally competent nursing leadership: application of theory of culture care diversity and universality and tri-dimensional leader effectiveness model.

Transcultural knowledge and competency have become a critical need for nurses to accommodate the global trends in cultural diversity and health care disparities. Today, nurses are increasingly taking on leadership roles in community settings. This article addresses the application of Leininger's culture care theory with the sunrise model and Hersey and Blanchard's tri-dimensional leader effectiveness model as potential collaborating theories for capacity building and community transformation from a global, transcultural nursing perspective. The two theories, used in collaboration, view the provision of competent leadership as the delivery of effective, culturally congruent nursing care in promoting health and health equity at the community level.     

A transcultural core course in the clinical nurse specialist curriculum

For the nursing profession, the delivery of culturally congruent care must become a priority. Clinical nurse specialists are in a key position to promote change; however, formal preparation in transcultural care is urgently needed. Nurse educators are challenged to prepare clinical nurse specialists who are equipped to provide quality care to culturally diverse individuals and to collaborate with a multicultural workforce. The purpose of this article is to describe a transcultural core course in the clinical nurse specialist adult health curriculum. The course explores current issues in pluralism, diversity, and healthcare in relationship to clinical nurse specialist competencies. The article addresses the course components, including objectives, topics, teaching strategies, assignments, bibliography, class Web page, and course evaluation. A unique component is the evaluation of students' self-efficacy perceptions (confidence) concerning culture care of diverse individuals as measured by a psychometrically valid instrument, the Transcultural Self-Efficacy Tool. The article concludes with future implications for clinical nurse specialist education.     

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.     

Transcultural nursing assessment: a method for advancing nursing practice

Today a new generation of nurses with different cultural insights and a deeper appreciation of human life and values are developing a sensitivity for culturally appropriate individualized care. Although literature on clinical approaches in cultural diverse situations is mushrooming, relatively few theories on transcultural nursing provide a systematic method for comprehensive nursing assessment, which is necessary for both the nursing practitioner and the researcher to provide appropriate nursing care tailored for each client. Below an outline of the areas that need to be assessed when working with clients from multicultural populations.     

Meanings and expressions of care and caring for elders in urban Namibian families: a transcultural nursing study

Since Namibia's Independence in 1990, the population of elders--persons 65 years old and older--in urban communities is growing steadily. As such, requests for home health care, health counselling, respite care and residential care for aging members of society are overwhelming nurses and the health care system. This study expands transcultural nursing knowledge by increasing understanding of generic (home-based) patterns of elder care that are practised and lived by urban Namibian families. Guided by Madeleine Leininger's theory of culture care diversity and universality and the ethnonursing research method, emic (insider) meanings and expressions of care and caring for elders in selected urban households have been transposed into five substantive themes. The themes, which depict what carring for elders means to urban families, include: 1 nurturing the health of the family, 2 trusting in the benevolence of life as lived, 3 honouring one's elders, 4 sustaining security and purpose for life amid uncertainty, and 5 living with rapidly changing cultural and social structures. These findings add a voice from the developing world to the evolving body of transcultural nursing knowledge. Synthesis of findings with professional care practices facilitates the creation of community-focussed models for provisioning culturally congruent nursing care to elders and their families in urban Namibia.     

Cultural competence for critical care nursing practice.

Cultural information should be critically examined and appropriately used in the context of individual relationships. The increased ethnic minority population in the health care system mandates that differences be recognized and responded to. Furthermore, the linear and technologic environment of the critical care unit intensifies the potential for cultural dissonance and disempowerment of ethnic minorities. CCNs must be creative and willing to transform nursing care to meet the needs of all. Knowing one's self, being aware of limitations, and understanding the influence of culture on others are essential to being culturally competent and an effective CCN. Because nursing remains dominated by individuals from the majority culture, many have little experience with persons of diverse ethnicity. Increasing cultural knowledge and the numbers of minority nurses and translators in the ICU are only the start to providing holistic care to this country's diverse population. Patient outcomes should improve and nurses are greatly enriched from an understanding and achievement of cultural competency.     

Cultural Competence in the Undergraduate Nursing Curriculum

Although health care providers and health care systems have increasingly acknowledged the need for culture-specific care in a global society, its implementation has remained daunting. Thus, integrating cultural competence into nursing education is no longer a choice but a requirement that builds on the values of the racially and culturally diverse population of the United States for optimal health care. The need has never been greater for nurses who understand the health implications of the demographic shifts that are shaping an American society whose African American, Hispanic, Asian, and Native American constituents compose a significantly growing portion of the population and whose health care needs will need to be served in health care settings that range from their homes to health care institutions. This article provides a blueprint on how our undergraduate program integrated cultural competence education throughout the curriculum.     

A Model for Delivering Culture-Relevant Care in the Community

Abstract The increase in cultural diversity of the urban populations of the United States is presenting a challenge for the delivery of culturally relevant care by community health care nurses. We developed a model for delivering such care built on key theoretical concepts derived from community health nursing, transcultural nursing, self-efficacy, and social support theories.     

Health beliefs related to diarrhea in Haitian children: building transcultural nursing knowledge

Regardless of where they live or under what circumstances, mothers throughout the world seem to have a compelling desire to provide the best possible health care for their children (Huston, 1979). Haitian mothers living in the Dominican Republic were no exception. The health beliefs and practices of these mothers related primarily to diarrhea among their children which demonstrated a concern and resourcefulness that is commendable. The results of this study clearly indicate the importance of transcultural nurses conducting culturally relevant research as a basis to develop sound health programs in developing countries. Diarrhea was identified as the single most important threat to a child's health in these communities. That mothers did not know about the correct ingredients and/or proportions for oral rehydration solutions (Western views) was of interest. Although the Dominican government makes some commercial packets of ORS, most of the women interviewed did not have ready access to this product. This finding reflected the need for transcultural nurses to offer to teach mothers how to make ORS using the sugar, salt, and water they had available. Since the mothers' perception that diarrhea was a dangerous threat to their children's health, was verified by childhood mortality statistics in the bateys, it would seem that ORS could make a significant impact on the health status of the children. Breastfeeding also was a major health belief factor associated with the treatment of diarrhea. Even though the majority of mothers believed breast feeding should be continued if a child had diarrhea, a number believed it should be discontinued. Nurses working with CHWs will need to emphasize the importance of breastfeeding and help them to develop creative ways of communicating this information to the mothers. The second most dangerous threat to the child identified by the mothers was respiratory ailments. This suggests a new area of concentration for future research and training of CHWs. A host of new questions related to respiratory problems such as health beliefs, causative factors, course of disease, traditional treatments, mortality rate, etc. need to be investigated. When transcultural nurses plan health care programs for women and children in other cultures, it is important to recognize the concerns mothers have for their children, and their intense desire to nature and care for them. In this study, mothers willingly participated and demonstrated active interest in learning to use methods to improve the health and well being of their children. It is well documented (Lieban, 1977) that established health beliefs are not automatically discarded when new knowledge is made available, but that exploration and incorporation of new information when presented in a culturally relevant framework does occur. An understanding of local beliefs surrounding health is fundamental to the development of appropriate transcultural nursing interventions.     

Addressing the need for education: curriculum development for nurses about intellectual and developmental disabilities

People with disabilities and national and international agencies are voicing their views, forcing health care providers to look at how people with disabilities are treated in the health care system and to find ways to help them achieve equal access to quality care. Education about nursing care of patients with I/DD is limited in basic nursing education programs and for nurses who are in practice. A number of developmental disabilities nursing projects are addressing this need with curriculum development that has validated the need for education and has begun testing the various methods of instruction. As the curriculum is disseminated in written or Internet-accessible formats, nurses in education and practice will be able to find resources that target a specific topic area or a set of comprehensive instructions to acquire a better understanding of the comprehensive needs of people with I/DD and better ways to provide care. There is a need for a greater integration of curriculum about nursing care of people with developmental disabilities into basic nursing education at all levels and further evaluation of the impact of this curriculum on nursing care for people with I/DD. The hope is that these efforts can improve the education of nurses and other health care providers for the direct benefit of individuals with intellectual disabilities.     

A literature review of the language needs of nursing students who have English as a second/other language and the effectiveness of English language support programmes

Australia is increasingly becoming a culturally diverse country, with this trend being reflected in nursing education as significant numbers of students enrol from backgrounds where English is a second/other language (ESL). These students will enable the provision of culturally competent care that a culturally diverse health system requires (Ohr et al., 2010), however they require significant levels of support to not only achieve academically in their nursing programme, but also to perform at the expected level during clinical placements (Boughton et al., 2010). Difficulties communicating with colleagues, patients and their families in the clinical setting have been identified among the challenges that ESL nurses face (Boughton et al., 2010; Jeong et al., 2011). A review of the literature indicates sporadic research into the education of nurses from ESL backgrounds. This paper discusses and raises awareness of common themes such as the challenges of adjusting to Western culture and using the advanced and technical English required by higher education and healthcare. This paper also discusses mixed results reported from a number of English language support programmes. This indicates a need for further research in this area to strengthen support for these nurses who can assist in the provision of culturally competent care.     

Assessing culturally diverse pediatric clients

For many pediatric nurses, providing culturally sensitive care among children of diverse backgrounds is frustrating and time-consuming because elements of cultural care theory were not assimilated into their educational programs. Using a transcultural model developed by Giger and Davidhizar (1995), pediatric nurses can now integrate a holistic and efficient assessment into the child's treatment plan. Essential health beliefs and practices are synthesized into the model's six components to assist the pediatric nurse in providing culturally appropriate care.     

Urinary incontinence – meeting a transcultural challenge in Sydney, Australia

The universal phenomenon of immigration is a continuous reality in many developed countries. As a consequence, nurses and other health professionals are expected to recognize, understand, take action and interact favourably with people from diverse cultural backgrounds . Nurses need to become culturally competent and develop their knowledge, skills, behaviours and values in transcultural nursing in order to deliver optimum care to the multiethnic cultures accessing health care. However, the combination of a paucity of systematic research and the lack of formal education programmes has resulted in poor development in this area. Many concepts relevant to cross‐culture are poorly understood, valued and studied. The first author describes how she established a urology/continence nurse‐led clinic for local non‐English speaking Chinese residents in South East Sydney. The authors give recommendations for nurses who wish to establish similar clinics to provide culture‐specific urological and continence care required for multiethnic populations.     

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.     

Embracing diversity among students and patients

Our country is becoming increasingly culturally diverse. On the basis of the U.S. Department of Health and Human Services statistics, it is predicted that, by the Year 2010, minority cultures will represent 32% of the U.S. population and 50% by the Year 2050. These figures identify a need for nurses to become educated and sensitive to the different cultural behaviors and traditions of the patients for whom they will provide care. Not only are patients diverse, but students studying to become nurses display the same cultural diversity as well. To understand and acknowledge diversity can help us to grow and learn about different cultures. By sharing pieces of our culture, we can experience increased cultural awareness. This will enhance our nursing practice and improve our role as health care practitioners.     

Health and social care futures in Ireland: the need for cross-boundary work

Fundamental changes are taking place in health and social care. The drivers for these changes include new discoveries, new treatments and globalization and the need to examine and consider cross-boundary work. This paper will outline some of the issues generated from a research project that aimed to provide an all-Ireland perspective on health and social care futures and to examine the implications of these trends both for nursing specifically and health and social care generally. Cross-boundary working is important in relation to health and social care futures. This incorporates cross-boundary working to include interprofessional, intraprofessional and interagency but also cross-border working with the Republic of Ireland. There is a great potential for cross-boundary work in nursing as we look towards the future. Nonetheless, it needs to be acknowledged that working across sectors, departments and even borders is not easy and barriers do exist. Some of the implications for nursing include the need to re-examine nursing roles and span the boundaries of our profession with the increasing development of nurse-led services. In addition nurses need to develop ways of "working together" strategically with others to achieve the public health agenda.