14/09/2015

Transcultural nursing; theory,

research, and practice

Kusman Ibrahim
Faculty of Nursing , Universitas Padjadjaran

Objectives
1. Discuss the importance and definition
of TN
2. Discuss the theories/models in the field
of TN
3. Discuss the ethnonursing as a research
method in TN
4. Discuss the implication of TN
knowledge for nursing practice

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The importance of TN
 Globalization is challenging nurses to think
and act with a global perspective
 The marked increase in migration of people
within and between countries worldwide
 Implicit societal moral and professional
expectation to know, understand, respect, and
respond appropriately to care for people of
diverse culture
 Rapid increase of the use of high technologies
in health care

The importance of TN
 Evidences of cultural conflicts, clashes, and
imposition practices between health providers and
clients of diverse cultures
 The increasing of the number of nurses who travel
and work in different places
 Anticipated legal defense suits against nurses
resulting from cultural negligence, ignorance, and
imposition practices
 The rise in gender and special group group issues
and right
 The growing trend to care with and for people in their
familiar or particular living environments.

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Definition of TN
A formal area of study and practice focused on
comparative human-care (caring) differences
and similarities of the beliefs, values, and
patterned lifeways of cultures to provide
culturally congruent, meaningful, and beneficial
health care for people
(Leininger, 2002)

The definition implies:

 Care needs to be systematically studied to learn
about human care in diverse and similar cultures
 Nurses need to be knowledgeable about their own
cultural care heritage and aware about the biases of
beliefs, prejudices to work effectively with clients
 Nurses need to use transculture-specific and
comparative knowledge to guide caring practices for
culturally congruent care
 Nurses should seek comprehensive, holistic, and
comparative culture care phenomena
 Maintaining an open learning-discovery process
about care and culture is imperative
(Leininger, 2002)

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The scope of TN

A Global Human Culture

Transnational Cultures

National (Societal) Cultures

Regional Provincial Cultures

Local Cultures

Theories related TN
 The theory of culture care developed by
Leininger since 1950s (Leininger, 2002)
 cultural diversity in health and illness,
developed by Spector since 1977 (Spector,
2000)
 transcultural nursing: assessment and
intervention, developed by Giger and
Davidhizar since 1991 (Giger & Davidhizar,
2004),
 Cultural competence model of care, developed
by Capinha Bacote since 1991 (Bacote, 2003).

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The theory of culture care developed by

Leininger

 Purpose; to discover and explain diverse and

universal culturally based care factors influencing the
health, well-being, illness, or death of individuals or
groups in order to provide culturally congruent, safe,
and meaningful care for clients of diverse or similar
cultures.
 Sunrise model  a cognitive map
 The three modes for congruent culture care;
preservation or maintenance, accommodation or
negotiation, repatterning or restructuring
 Recommend “ethnonursing” as the research method”

Sunrise Model (Leininger, 2002)

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Transcultural nursing: assessment and intervention, developed by

Giger and Davidhizar since 1991 (Giger & Davidhizar, 2004)

Cultural Competence Model

• Dr. Josie Campinha-Bacote described her model for culturally
competent care in 1991 and made revisions in 1998 and again in
2002, as described in her article “The Process of Cultural
Competence in the Delivery of Health care Services: A Model of
Care” (2002).
• Campinha-Bacote calls the model the “volcano model” because it is
formed by five interdependent constructs that she proposes represent
a volcano. The metaphorical eruption of the “cultural desire”
construct leads to gains in the other four constructs (Campinha-
Bacote, 2008).
• By including each of these constructs in one‟s practice, Campinha-
Bacote suggests the health care provider improves the effectiveness
of medical, nursing, or other health care interventions to promote
patient health. Campinha-Bacote describes cultural competence as
an “ongoing process or journey, not a final destination” (2002, 2003).

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The five constructs of Campinha-Bacote‟s

model (2002) :
1. Cultural awareness: A process of self-examination to determine one‟s
own cultural biases and prejudices.
2. Cultural knowledge: An active seeking of information about varying
cultures,“biological variations, diseases and health conditions, and
variations in drug metabolism found among ethnic groups (biocultural
ecology)” (CampinhaBacote, 2010a, para 3).
3. Cultural skill: The ability to conduct an assessment that includes
culturally relevant information.
4. Cultural encounters: An intentional self-exposure to persons, especially
patients, of differing cultures in order to eliminate preconceptions about
those different from oneself and improve interactions with members of
varying cultures.
5. Cultural desire: The motivation for becoming a more culturally
competent nurse;

The assumptions of the model:

1. Cultural competence is a process, not an event.

2. Cultural competence consists of five constructs: cultural
awareness, cultural knowledge, cultural skill, cultural
encounters, and cultural desire.
3. There is more variation within ethnic groups than
across ethnic groups (intraethnic variation).
4. There is a direct relationship between the level of
competence of health care providers and their ability to
provide culturally responsive health care services.
5. Cultural competency is an essential component in
rendering effective and culturally responsive services to
culturally and ethnically diverse clients

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Cultural Competence Model

(Doorenbos, Schim, Benkert, Borse, 2005)

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Ethnonursing

Ethnonursing is the study and analysis of the

local or indigenous people’s viewpoints, beliefs,
and practices about nursing care phenomena
and process of designated cultures
(Leininger, 1978)

General indications for ethnonursing

 Virtually no knowledge or very limited knowledge
about the phenomenon
 Researcher wants to grasp the totality of human life
style from their viewpoints and modes of knowing
and understanding life
 Use to obtain meanings-in-context data and
meaning-in-familiar or recurrent environmental
context
 Use to generate concepts, theories, and hypotheses
 Appropiate for cross-cultural comparative study
 To provide detailed accounts of events, situations,
and circumstances

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Steps and process

 Identify a domain of inquiry, area, or phenomenon to
be studied
 Explore available literature on the area of inquiry
 Prepare research instruments, plans, and approvals
 Identifying and choosing the people to be studied
 Observing, participating, interviewing, and validating
the data  analyzed simultaneously
 Presenting findings
 Writing report

Implication of TN knowledge for

nursing practice

 Nurses more confidence to care for clients

with diverse culture
 Improving clients’ satisfaction of nursing
care
 Improving quality of nursing care

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