Overview of Transcultural Nursing – Flashcards

the knowledge, belief, art, morals, laws, customs, and any other capabilities and habits acquired by humans as members of society

being alert to and having knowledge of cultural preferences, aspects, or perspectives that may impact the health care experience, including communication, personal choices, or other elements

acknowledging one's cultural knowledge deficits using self-reflection, continuous self-evaluation, and consultation with others (including patients) to detect barriers to culturally competent care and address bias, or lack of knowledge or skills related to a culture other than one's own, to provide culturally appropriate care

a systematic appraisal or examination of individuals, families, groups, and communities in terms of their cultural beliefs, values, and practices

effective, individualized care that demonstrates respect for the dignity, personal rights, preferences, beliefs, and practices of the person receiving care while acknowledging the biases of the caregiver and preventing these biases from interfering with the care provided

making a value judgment on another culture from the vantage point of one's own culture

a group of people whose physical or cultural characteristics differ from the dominant culture or majority of people in a society

relatively large groups of people who share characteristics that identify them as a distinct entity

Nursing care to clients and families across cultural variations. The term transcultural nursing is used interchangeably with cross-cultural, intercultural, or multicultural nursing and refers to research-focused practice that focuses on patient-centered, culturally competent nursing. Transcultural nursing addresses the differences and similarities among cultures in relation to health, health care, and illness. Furthermore, it incorporates the care (caring) values, beliefs, and practices of people and groups from a particular culture without imposing the nurse's cultural perspective on the patient. The underlying focus of transcultural nursing is to provide culture-specific and culture-universal care that promotes the well-being or health of individuals, families, groups, communities, and institutions. All people, as well as the community or institution at large, benefit when culturally competent care is provided. When the care is delivered beyond a nurse's national boundaries, the term international or transnational nursing is often used.

The process by which members of a cultural group adapt to or take on the behaviors of another group

The inability of people to recognize their own values, beliefs, and practices and those of others because of strong ethnocentric tendencies (the tendency to judge others based on one's own culture)

The tendency to impose one's cultural beliefs, values, and patterns of behavior on a person or people from a different culture

Activities or behaviors that are avoided or prohibited by a particular cultural group

-Efforts to change the subject: This could indicate that the listener does not understand what was said and is attempting to talk about something more familiar. • Absence of questions: Paradoxically, this often means that the listener is not grasping the message and therefore has difficulty formulating questions to ask. • Inappropriate laughter: A self-conscious giggle may signal poor comprehension and may be an attempt to disguise embarrassment. • Nonverbal cues: A blank expression may signal poor understanding. However, among some Asian Americans, it may reflect a desire to avoid overt expression of emotion. Avoidance of eye contact may be a cultural expression of respect for the speaker among some Native Americans and Asian Americans.

• Greet the patient using the last or complete name. Avoid being too casual or familiar. Point to yourself and say your name. Smile. • Proceed in an unhurried manner. Pay attention to any effort by the patient or family to communicate. • Speak in a low, moderate voice. Avoid talking loudly. Remember that there is a tendency to raise the volume and pitch of your voice when the listener appears not to understand. The listener may perceive that you are shouting or angry. • Organize your thoughts. Repeat and summarize frequently. Use audiovisual aids when feasible. • Use short, simple sentence structure, and speak in the active voice. • Use simple words, such as "pain" rather than "discomfort." Avoid medical jargon, idioms, and slang. Avoid using contractions, such as don't, can't, won't. • Use nouns repeatedly instead of pronouns. Example: Do not say: "He has been taking his medicine, hasn't he?" Do say: "Does Juan take his medicine?" • Pantomime words (use gestures) and simple actions while verbalizing them. • Give instructions in the proper sequence. Example: Do not say: "Before you rinse the bottle, sterilize it." Do say: "First, wash the bottle. Second, rinse the bottle." • Discuss one topic at a time, and avoid giving too much information in a single conversation. Avoid using conjunctions. Example: Do not say: "Are you cold and in pain?" Do say (while pantomiming/gesturing): "Are you cold?" "Are you in pain?" • Talk directly to the patient rather than to the person who accompanied him or her. • Validate whether the person understands by having him or her repeat instructions, demonstrate the procedure, or act out the meaning. • Use any words that you know in the person's language. This indicates that you are aware of and respect the patient's primary means of communicating. • Try a third language. Many Indo-Chinese speak French. Europeans often know three or four languages. Try Latin words or phrases, if you are familiar with the language. • Be aware of culturally based gender and age differences and diverse socioeconomic, educational, and tribal or regional differences when choosing an interpreter. • Obtain phrase books from a library or bookstore, make or purchase flash cards, contact hospitals for a list of interpreters, and use both formal and informal networking to locate a suitable interpreter. Although they are costly, some telecommunication companies provide translation services.

Hinduism: -All meats -Animal shortenings/fats Islam: -Pork -Alcoholic products and beverages (including extracts, such as vanilla and lemon) -Animal shortenings -Gelatin made from pork, marshmallow, and other confections made with gelatin -Note: Halal is lawful food that may be consumed according to tenets of the Koran, whereas Haram is food that is unlawful to consume. Judaism: -Pork -Predatory fowl -Shellfish and scavenger fish (e.g., shrimp, crab, lobster, escargot, catfish). -Fish with fins and scales are permissible. -Mixing milk and meat dishes at same meal -Blood by ingestion (e.g., blood sausage, raw meat). -Note: Packaged foods will contain labels identifying kosher ("properly preserved" or "fitting") and pareve (made without meat or milk) items. Mormonism (Church of Jesus Christ of Latter-Day Saints): -Alcohol Beverages containing caffeine stimulants (coffee, tea, colas, and selected carbonated soft drinks) Seventh-Day Adventism: -Alcohol -Beverages containing caffeine stimulants (coffee, tea, colas, and selected carbonated soft drinks) -Pork -Certain seafood, including shellfish Fermented beverages -Note: Optional vegetarianism is encouraged.

Defined as complete systems of theory and practice that are different from conventional medicine. Some examples are traditional Eastern medicine (including acupuncture, herbal medicine, Oriental massage, and Qi gong); India's traditional medicine, Ayurveda (including diet, exercise, meditation, herbal medicine, massage, exposure to sunlight, and controlled breathing to restore harmony of a person's body, mind, and spirit); homeopathic medicine (including the use of herbal medicine and minerals); and naturopathic medicine (including diet, acupuncture, herbal medicine, hydrotherapy, spinal and soft tissue manipulation, electrical currents, ultrasound and light therapy, therapeutic counseling, and pharmacology).

Defined as techniques to facilitate the mind's ability to affect symptoms and bodily functions. Some examples are meditation, dance, music, art therapy, prayer, and mental healing.

Defined as natural and biologically based practices, interventions, and products. Some examples are herbal therapies (a plant or plant part that produces and contains chemical substances that act on the body), special diet therapies (such as those of Drs. Atkins, Ornish, and Pritikin), orthomolecular therapies (magnesium, melatonin, megadoses of vitamins), and biologic therapies (shark cartilage, bee pollen).

Defined as interventions based on body movement. Some examples are chiropractic (primarily manipulation of the spine), osteopathic manipulation, massage therapy (soft tissue manipulation), and reflexology.

Defined as interventions that focus on energy fields within the body (biofields) or externally (electromagnetic fields). Some examples are Qi gong, Reiki, therapeutic touch, pulsed electromagnetic fields, magnetic fields, alternating electrical current, and direct electrical current.

The biomedical or scientific worldview prevails in most health care settings and is embraced by most nurses and other health care providers. The basic assumptions underlying the biomedical perspective are that all events in life have a cause and effect, that the human body functions much like a machine, and that all of reality can be observed and measured (e.g., blood pressures, partial pressure of arterial oxygen [PaO2] levels, intelligence tests). One example of the biomedical or scientific view is the bacterial or viral explanation of communicable diseases.

The naturalistic or holistic perspective is another viewpoint that explains the cause of illness and is commonly embraced by many Native Americans, Asians, and others. According to this view, the forces of nature must be kept in natural balance or harmony. One example of a naturalistic belief, held by many Asian groups, is the yin/yang theory, in which health is believed to exist when all aspects of a person are in perfect balance or harmony. Rooted in the ancient Chinese philosophy of Taoism (which translates as "The Way"), the yin/yang theory proposes that all organisms and objects in the universe consist of yin and yang energy. The seat of the energy forces is within the autonomic nervous system, where balance between the opposing forces is maintained during health. Yin energy represents the female and negative forces, such as emptiness, darkness, and cold, whereas the yang forces are male and positive, emitting warmth and fullness. Foods are classified as cold (yin) or hot (yang) in this theory and are transformed into yin and yang energy when metabolized by the body. Cold foods are eaten when a person has a hot illness (e.g., fever, rash, sore throat, ulcer, infection), and hot foods are eaten when a person has a cold illness (e.g., cancer, headache, stomach cramps, "a cold"). The yin/yang theory is the basis for Eastern or Chinese medicine and is embraced by some Asian Americans. Many Hispanic, African American, and Arab groups also embrace the hot/cold theory of health and illness. The four humors of the body—blood, phlegm, black bile, and yellow bile—are believed to regulate basic bodily functions and are described in terms of temperature and moisture. The treatment of disease consists of adding or subtracting cold, heat, dryness, or wetness to restore the balance of these humors. Beverages, foods, herbs, medicines, and diseases are classified as hot or cold according to their perceived effects on the body, not their physical characteristics. According to the hot/cold theory, the person as a whole, not just a particular ailment, is significant. People who embrace the hot/cold theory maintain that health consists of a positive state of total well-being, including physical, psychological, spiritual, and social aspects of the person. According to the naturalistic worldview, breaking the laws of nature creates imbalances, chaos, and disease. People who embrace the naturalistic paradigm use metaphors such as "the healing power of nature." For example, from the perspective of many Chinese people, illness is viewed not as an intruding agent but as a part of life's rhythmic course and an outward sign of disharmony within.

Another major way in which people view the world and explain the causes of illness is the magico-religious worldview. This view's basic premise is that the world is an arena in which supernatural forces dominate, and that the fate of the world and those in it depends on the action of supernatural forces for good or evil. Examples of magical causes of illness include belief in voodoo or witchcraft among some African Americans and people from Caribbean countries. Faith healing is based on religious beliefs and is most prevalent among selected Christian religions, including Christian Science, whereas various healing rituals may be found in many other religions, such as Roman Catholicism and Mormonism (Church of Jesus Christ of Latter-Day Saints). Of course, it is possible to hold a combination of worldviews, and many patients offer more than one explanation for the cause of their illness. As a profession, nursing largely embraces the scientific or biomedical worldview; however, some aspects of holism have begun to gain popularity, including various techniques for managing chronic pain, such as hypnosis, therapeutic touch, and biofeedback. Belief in spiritual power is also held by many nurses who credit supernatural forces with various unexplained phenomena related to patients' health and illness states. Regardless of the view held and whether the nurse agrees with the patient's beliefs in this regard, it is important to be aware of how the person views illness and health and to work within this framework to promote patient care and well-being.

People of some cultures believe in folk or indigenous healers. For example, nurses may find that some Hispanic patients may seek help from a curandero or curandera (spiritual healer, folk doctor, shaman), espiritualista (spiritualist), yuyero (herbalist), or sanador (healer who manipulates bones and muscles). Some African American patients may seek assistance from a hougan (voodoo priest or priestess), spiritualist, root doctor (usually a woman who uses magic rituals to treat diseases), or "old lady" (an older woman who has successfully raised a family and who specializes in child care and folk remedies). Native American patients may seek assistance from a shaman or medicine man or woman. Asian patients may mention that they have visited herbalists, acupuncturists, or bone setters. Several cultures have their own healers, most of whom speak the native tongue of that culture, make house calls, and charge significantly less than healers practicing in the conventional medical health care system.

Know Thyself Because the nurse-patient interaction is the focal point of nursing, nurses must consider their own cultural orientation when conducting assessments of patients and their families and friends. The following guidelines may prove useful to nurses who want to provide culturally appropriate care: • Know your own cultural attitudes, values, beliefs, and practices. • Recognize that despite "good intentions," everyone has cultural "baggage" that ultimately results in ethnocentrism (judging another culture based upon standards from one's own culture). • Acknowledge that it is generally easier to understand those whose cultural heritage is similar to your own, while viewing those who are unlike you as strange and different. • Maintain a broad, open attitude. Expect the unexpected. Enjoy surprises. • Avoid seeing all people as alike—that is, avoid cultural stereotypes, such as "all Chinese like rice" or "all Italians eat spaghetti." • Try to understand the reasons for any behavior by discussing commonalities and differences with representatives of ethnic groups different from your own. • If a patient has said or done something that you do not understand, ask for clarification. Be a good listener. Most patients will respond positively to questions that arise from a genuine concern for and interest in them. • If at all possible, speak the patient's language (even simple greetings and social courtesies are appreciated). Avoid feigning an accent or using words that are ordinarily not part of your vocabulary. • Be yourself. There are no right or wrong ways to learn about cultural diversity.

• What is the patient's country of origin? How long has the patient lived in this country? What is the patient's primary language and education level*? • What is the patient's ethnic background? Does he or she identify strongly with others from the same cultural background? • What is the patient's religion, and how important is it to his or her daily life? • Does the patient participate in cultural activities such as dressing in traditional clothing and observing traditional holidays and festivals? • Does the patient have any food preferences or restrictions? • What are the patient's communication styles? Is eye contact avoided? How much physical distance is maintained? Is the patient open and verbal about symptoms? • Who is the head of the family, and is he or she involved in decision making about the patient? • What does the patient do to maintain his or her health? • What does the patient think caused the current problem? • Has the advice of traditional healers been sought? • Have complementary and alternative therapies been used? • What kind of treatment does the patient think will help? What are the most important results that he or she hopes to get from this treatment? • Does the patient observe cultural or religious rituals related to health, sickness, or death?