A Transcultural

2 February 2017

As the world’s multi-cultural population increases, the significance of transcultural nursing in healthcare is strongly evident. Health care professionals are challenged by the need to understand the various cultural factors that influence a person’s response to health and illness and must develop attitudes and skills that will help them behave in culturally appropriate ways (Walsh & DeJoseph, 2003).

Transcultural nursing works as a formal education that equips nurses and other healthcare providers the knowledge regarding beliefs, values, and practices of different cultures in the society with the goal to produce a culturally competent practitioner, therefore, achieving patient satisfaction and positive outcomes (Leininger, 1999). The foundations for transcultural nursing had started with the purpose of compensating the complexities of healthcare needs of people belonging to different culture (Glittenberg, 2004; Tortumluoglu, 2006).

Hence, knowing the unique behavioural patterns and lifestyles of a specific culture enables the provider to perform culturally congruent, holistic and appropriate healthcare service (Streltzer, 2008).

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Campinha-Bacote’s framework of cultural competence (2002) provides a thorough and comprehensible process for healthcare professional to become culturally competent.

It guides healthcare practitioners in achieving the ability to effectively work within the context of the service users from a diverse cultural- ethnic background through keying out five essential components namely, cultural awareness, cultural knowledge, cultural skills, cultural encounter and cultural desire (Campinha-Bacote, 2011). Ryan, Carlton and Ali (2000) pointed out that the five constructs are functionally interdependent and must be covered.

Entailing that one will be ineffective without the others, and similarly absence of one component gets unsatisfactory consequences. Imagine a six-stringed acoustic guitar, if one string is not in tune with the others, once you play it the resulting notes and chords are out of tune making a nuisance instead of music. When an individual is aware that people are different from one another in terms of personality, attitude and behaviour, partially because of their cultural beliefs or backgrounds, that person is culturally aware (Rew, Becker, Cookston, Khosropour & Martinez, 2003).

Moreover, The University of Michigan School of Nursing (2000) added that awareness and examination of one’s own beliefs is also an important component of this concept to avoid prejudices and biases when working with service users. However, ethnocentrism, which is defined in Oxford English Dictionary (2003) as a character which assumes that one’s own group or belief is superior from the others, may weaken this construct. Awareness of this attitude would help health care provider in avoiding unjust service. Say, a Christian nurse was assigned to care for a dying atheist patient.

She believes that death means going to heaven or hell, while her patient may believe that death simply means ceasing to exist. Despite of these differences of beliefs, her job to provide excellent care for the patient and ensuring that his needs are met were not faltered (pricklypear, personal communication, April 08, 2006). Though, somehow findings from studies conducted by Rew et al (2003) point that conscious awareness of cultural diversity does not guarantee cultural competence. Nurses and other health care providers need a solid knowledge about a variety of populations, culture- specific phenomena (e. . , social support), and human responses to diversity to better understand their client (Meleis, 1996). In acquiring this knowledge, healthcare practitioners must concentrate on three specific issues: health-related beliefs, practices and cultural values; disease incidence and prevalence (Lavizzo-Mourey, 1996). Getting cultural knowledge about the patient’s health-related beliefs and values involves understanding their worldview which justifies how he interprets his illness and how it guides his thinking, doing, and being (Campinha- Bacote, 2002).

A concrete example is of an old Filipino faith healer who never consulted any clinician to diagnose the pain sensation he feels during urination. He believed that, it was spiritual opposition who inflicted the pain. Knowledge relating to the field of bio cultural ecology is also important when addressing disease incidence and prevalence among ethnic groups, This involves having accurate epidemiological data to guide decisions about treatment and treatment programs, health education, and screening in order to attain positive health care outcomes (Campinha-Bacote, 2002).

Therefore, a promising cultural competent nurse must be updated of current research studies conducted, and likewise initiating some research work himself. In incurring cultural knowledge, one should always remember that every individual is a unique blend of the variety found within each culture, an incomparable collection of life experiences, and the product of acculturation to other cultures (Capinha-Bacote, 2002). Thus, it is very vital that every health care provider develops the skill to culturally assess every client that will come to their care.

This requires sensitivity and more in-depth studying of cultures and sub-cultures (Meleis, 1996). The third component of Campinha-Bacote’s model of cultural competence (2002) is cultural skill. It is the capability to carry on a cultural assessment by gathering cultural data relevant to the patient’s presenting problem, at the same time conducting a culturally-based physical assessment accurately (Tortumluoglu, 2006 & Campinha-Bacote, 2011). According to the author, this construct plays a substantial part in planning nursing care for an individual.

Data gathered during assessment, especially in initial screening interview serves as the basis or guide in establishing a plan of care for the client. During this crucial process the health care provider should be aware how a client’s physical, biological, and physiological changes affect his/her ability to conduct an accurate and appropriate physical evaluation. Particularly, differences in body structure, skin colour, and visible physical characteristics, (Capinha-Bacote, 2002).

For instance, a well known man from a wealthy family came to an Out-Patient service, the nurse who is doing the screening was aware of the patient’s elite background, might get intimidated and may cause inaccurate assessment. Next, is cultural encounter; the process which encourages the health care provider to immerse himself to various cultural interactions with clients from culturally diverse backgrounds (Tortumluoglu, 2006). Cultural encounter may be experienced on real situation and through simulation or role playing (Shearer & Davidhizar, 2003; Walsh & DeJoseph, 2003).

Both, aid in modifying existing beliefs about a cultural group and prevent possible stereotyping. However, the author identified one obstacle that may encounter in this process specifically during assessment stage, which involves the language barrier between the care provider and the service user. This is especially possible if both came from different country of origin. The use of formally trained interpreter is strongly recommended if this situation occurs to avoid faulty data collection (Campinha-Bacote, 2002).

Finally, the fifth component of this model is cultural desire. This is the most crucial construct, since without desire, cultural awareness, knowledge, skills and encounters will not be gladly experienced. Cultural desire is a genuine passion and a commitment to become culturally competent health care provider ( Campinha-Bacote, 2003). Therefore, it is safe to say that every health care provider must be driven by cultural desire for this is the heart and soul of cultural competence.

In fact, the author strongly believes that this passion and unaltered commitment must be the fundamental construct of all the transcultural nursing models. Campinha-Bacote’s model embraces the experiential-phenomenological perspective. It supports the client as teacher of his culture and the clinician as learner. Furthermore, it recognises that culture is dynamic and always changing and there is more variation within a culture than among different cultures (Brathwaite, 2003).

Although Campinha-Bacote’s Cultural Competent model may have a strong track record of effectiveness (Carol, 2007; Rew et al; Tortumluoglu, 2006),  yet it is encouraged to spend time in research and evaluate the various models of transcultural nursing to determine which one is best for a particular client, organization or situation. Cultural competence recognizes the broad scope of the dimensions that influence an Individual’s personal identity.

Within the behavioural health system (which addresses mental illnesses), cultural competence must be a guiding principle, so that services are culturally sensitive and culturally appropriate prevention, outreach, assessment and intervention are provided (Stanhope, Solomon, Pernell-Arnold, Sands & Bourjolly, 2005) . This will be indicated in the following case. A 37 years old Irish, male, single, and a traveller from Northern Ireland was admitted for schizophrenia with retrograde amnesia in the nursing home. The client was referred by a social worker and was assessed by one of the nurses on duty.

The nurse noted that patient’s posture was quite slouch and has a good bearing. He wore clean and neat clothing appropriate for the weather. He was groomed plain and simple. His hair well combed. However, his nails were untrimmed both on hands and feet. The nurse noted the lesions and skin rashes on the client’s right foot and observed that he moved slowly during ambulation. Further, there were times that he looks straight in the eyes when questioned and when he answered, he glanced on the other people around him. The client was monosyllabic in communicating and was unable to recall long term memories.

He also looked disturbed and preoccupied at all times. During his first week in the institution, the client was noted to be unsociable. He preferred to stay inside his room and would just go out during meal time to join the other clients in the dining area. On one occasion, the carer had attempted to engage in a conversation with him. She found out that the client can’t recall anything from his past including his childhood, his family or where he lived before. He can’t even recall the number of the family members and the person he was in contact with prior to his admission in the institution.

Though he stated that his birthday falls on January 13, he can’t remember the exact year. Surprisingly, he was able to recall what he had for breakfast and lunch. It was also noticed that the patient has slight awareness of being sick and needing but denting it at the same time. He is aware that he is sick but he’s trying to blame it to others. Like when asked why he is in the institution on one interaction, he answered that his friends sent him there because of misconceptions. According to him he’s not guilty of any wrong doing and denied all the accusations on him.

In addition, it was noted that the patient has some problems on impulse control. At times he showed hostile, aggressive and sexual tendencies towards the staff and to the other clients. In view of the above circumstance, The “Cultural Competence” model of Campinha-Bacote(2002), offers the nursing staff the framework for rendering culturally relevant care to the culturally and behaviourally diverse psychiatric client. Initially, upon the client’s admission, general data of the client such as general appearance, ethnicity, gender, age, hobbies or work, disability, orientation and memory impairment was gathered.

The cultural challenge seen at this stage was first the different cultural background the client represents. Accurate knowledge concerning language, clothing and patient’s cultural, religious, or spiritual beliefs or practices that influence care must be obtained in order to perform culturally appropriate service (Streltzer, 2008). Tseng and Streltzer (2004) stressed that language is one tool through which culture expressed. Through language, a person communicates underlying conceptions, values, and attitudes that can be very different among different cultural systems.

Comprehending another person’s culture through his language can be therefore quite challenging, particularly when that language is very different from one’s own but with genuine interest and remaining nonjudgmental, probability of gathering relevant information will be assured. Another challenge noted was the diagnosed condition of the patient. Lack of understanding about Schizophrenia may pose a great problem to the nursing staff in this case. This disorder is identified with complex characteristics according to type. Basically, people with schizophrenia have an altered perception of reality, often a significant loss of contact with reality.

They may see or hear things that don’t exist, speak in strange or confusing ways, believe that others are trying to harm them, or feel like they’re being constantly watched (Smith & Segal, 2011). Obtaining cultural awareness pertained to this disorder must be consolidated among the management and staff. Like what Campinha-Bacote, (2002b) emphasized that cultural skill involves the ability to collect relevant cultural information about the patient’s history and presenting problems. Legally accessing patient’s records of past health, social, and environmental history is positively beneficial.

Finally, the greatest challenge identified in this case is the client’s unusual behaviour and psychomotor activity. People with schizophrenia tend to have unpredictable or inappropriate emotional responses. They may exhibit behaviours that appear bizarre and purposeless. Sometimes they lack of inhibition and impulse control which may pose danger to themselves, and to people around them. Moreover, apparent social withdrawal which usually manifests through inexpressive face, including a flat voice, lack of eye contact, and blank or restricted facial expressions is common (Campinha-Bacote, 2002b).

Cultural encounters may be difficult and uncomfortable at times, especially encounters with abnormal behaviours due to fear and diffidence. Good intentions and the nonverbal communication style of a psychiatric nurse can sometimes be interpreted as offensive and insulting to a specific cultural group. The psychiatric nurse must become more sensitive to the meaning of a culture’s nonverbal communication, such as eye contact, facial expressions, and use of touch, body language, and distancing practices when engaging in cross-cultural encounters (Current Nursing, 2011 & Peterson, 2004).

She must identify feelings that lead to patient’s poor social interaction. If client is unable to respond verbally or in a coherent manner, spending frequent short periods with client might be good start. Structuring times each day for brief interactions and activities with client on one-on-one basis is likewise helpful. These activities should work at the client’s pace and ability. Examples are looking through family pictures, watching TV, drawing or painting and other recreational activities that would enhance client’s attention and engagement (Tseng and Streltzer, 2004).

To sum it up, this culturally-related aspects of care in the client and there accompanying challenges won’t be addressed and overcome respectively, if cultural competency is not learned and demonstrated. A cultural desire must be developed and surged in each health care provider to effectively furnish the unmet, culturally-related needs of the client. Cultural desire is the motivation of the psychiatric nurse to “want to” engage in this uncomfortable situation. Carrying out all the planned care with the passion and humility to accept and respect differences, and be willing to learn from different world (Campinha-Bacote, 2002).

With the increase in diversity in an ever-changing society and the escalating need for nurses to be educated and skilled in transcultural nursing, every opportunity that would contribute to development of cultural competence should be seized. In conclusion, transcultural nursing was designed to equip and empower every carer, nurse, and any health care provider to embrace the challenges and hindrances that diverse cultures bear. Campinha-Bacote’s cultural competence model is one of the few effective tools suggested to utilize in whatever situation a service provider is in, may it be in clinical or mental health setting.

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