In the 21st century the importance of considering the problem of cultural diversity in the context of different human activities increases. Nurses provide people with high quality medical care not only within the national boarders but within the complex system of the global society. Globalization poses a significant challenge to nurses whose services are crucial in order to save the lives of their patients. Transcultural nursing is an essential part of healthcare today because nurses need to appreciate cultural differences to provide personal individualized care.
The professional competence of nurses depends on understanding cultural diversity, beliefs and other factors that play a role in a patient’s willingness to seek medical attention and follow the instructions provided by the healthcare workers trying to help them. Following of basic rules of cultural interactions results in positive outcomes. The patient satisfaction is one of the most important indicators of the efficient nursing. This paper will consider of the problem of transnational nursing as a step for drawing up a strategy of enhancing the quality of medical services all over the world and promoting an innovative approach to the functioning of international health-care system.
First of all, the meaning of the term transcultural nursing. Doctor Madeleine Leininger is considered to be the founder of the transcultural nursing field. The main idea of her works is based on providing culturally competent nursing care that must be customized to fit with the patient's own traditions, practices, and lifestyle. . Through Leininger, transcultural nursing started as a theory of diversity and universal idea of cultural care. Transcultural nursing was originally established from 1955 to 1975. Quality health care requires bearing in mind cultural contexts which are different from their own. Preventing multicultural conflict or misunderstanding is vital for nursing services because in some cultures conflict can occur unexpectedly especially if there is a language barrier. The transcultural nursing is supported by nursing theory, research, and practice. Transcultural nursing is an area of expertise in nursing that responds to the needs of the global economy which must now be prepared to handle the varying healthcare needs within the nursing profession . The discipline continues to flourish due to the increased international cooperation related to medical best practices. This can be achieved through learning about cultural differences, varying medical practices, and organizational process and regulations.
There are eight main concepts of this theory. The first is cultural care, which refers to the multiple aspects of cultures that influence or enable people to improve their human condition or illness and practices related to death. Some cultures accept death and illness in different ways which should be considered before presenting a patient with potential health options. The second concept is cultural care diversity which refers to the differences in meanings, values, or acceptable modes of care. Some cultures hold different meanings for different practices and values which helps determine what each cultures determine are acceptable modes of care.
The third concept is cultural care universality which refers to similar meanings that are evident among different cultures. Universal practices are usually more readily accepted because they are already considered acceptable through different cultures, education programs, and organizations. The fourth concept involves explaining how nursing is a learned profession with a disciplined focused on care phenomena. The idea of nursing being a learned profession makes it clear that nurses just like any other person in the world can make mistakes, but the important idea of cultural care is sharing mistakes so everyone can learn and not make the same mistake again.
The fifth concept is worldview which refers to the way people look at the world and create their personal view of what life is about. Different cultures value different aspects of life which can include family, education, success, or finances. The sixth concept is the cultural and social structure dimensions which include factors related to religion, political or legal concerns, cultural values, economics, social structure, educational patterns, the use of technology, and ethno history that influence cultural responses of people within a cultural context. Some people do not consider the effects of religion and politics on an individual. As an example, older Americans used to wait until they were unable to ignore the pain or discomfort associated with their illness or condition before they would go to get medical care. This is a changing process in the American medical system, because of the shift from sick care to well care. Health refers to a state of well-being that is culturally defined and valued by a designated culture, but the definition or expectations related to good health continue to be different based on individual cultures.
The seventh concept is cultural care which refers to the preservation or maintenance nursing care activities that help patients from particular cultures to retain and use their core cultural care values related to healthcare concerns or conditions. Preservation and maintenance are becoming more acceptable and widely accepted as there is more research that proves the long lasting benefits of patients who are more willing to maintain their health instead of waiting for illness to creep up on them. The final concept is cultural care accommodation or negotiation which refers to creative nursing actions that help people to adapt, or negotiate with others in the healthcare community in order to attain the shared goal of optimal health for patients of a designated culture.
Scientist forecast the problem of intercultural cooperation between groups of people may result in patients refusing of modern medical treatment procedures. The lack of intercultural cooperation will facilitate the asymmetric of the level of medical assistance between developed and developing countries. To prevent this, health care providers need to be flexible in the design of international programs, policies, and services to meet the needs of the culturally diverse population they are likely to encounter. The process of recovering from illness includes the perception of the illness and coping skills of the patient. Many diseases require special treatment that is based on establishing conditions which are the same to the patient’s own cultural environment which can include prescription remedies or more natural remedies.
The basic idea of transcultural nursing begins with diversity self-awareness and diversity awareness. Diversity self-awareness is reflecting on one’s own cultural identity and the realization of our one’s cultural values. Diversity awareness involves recognizing important similarities and differences within and between various cultural groups. This process appears to be the most comprehensive when we recognize the range of similarities and differences that influence the professional collaboration and strategy of treatment. Diversity exists based on the birthplace, citizenship, migration history, reasons for migration, ethnicity, race, food, educational background, religion, language, lifestyle, gender, socioeconomic status, kinship, family networks, employment skills, politics, past discrimination and bias experiences, health status, health risk, age, insurance coverage and other variables. Each factor can make a patient more or less likely to participate in their healthcare and necessary treatment plans.
The lack of knowledge about international diversity may lead to some undesired outcomes in treatment. In complex situations, nursing incompetence and intolerance can result in health deterioration of the patient. As an example nurses need to be aware of diet restrictions patients may have that are not related to their healthcare, but more closely related to relgigion like Kosher Jewish people, or Muslims who do not eat certain types of meat. Even the smallest delay in time needed to resolve a problem may have negative outcomes. Equally negligent is a nurse who does not assess patients for folk medicine use. It is well known fact that using medical components to which the person is adjusted has positive effects. So in the act of transcultural communication nurses can get important information that will be useful in drawing up the plan of treatment. Also long-lasting barriers in communication may arise when nurse makes assessment on physical appearance rather than performing an individualized cultural assessment. Unfortunately, lots of cases today may involve issues concerning cultural incompetence.
The first step for nurses is to determine the client's cultural heritage and language skills, which can help determine if any of the patient’s health beliefs relate to the cause of the illness or to the problem. Some patients are firm believers in home remedies, but in some cases the home remedy could be causing the problem to get worse. Nurses need to collect information about all home remedies the patient is using to treat their symptoms. Some nurses should evaluate their attitudes toward ethnic nursing care especially if they rarely come in contact with people who have differing cultures and values than themselves. . This can be achieved by having regular diversity meetings in the medical organization which can give caregivers the opportunity to discuss differences in care before the patient is in need of care. It is also important to understand the influence of culture, race ðnicity on the development of social emotional relationships, child rearing practices & attitudes toward health and well-being. This is especially important for nurses who are working in the pediatric discipline because people from different cultures have different norms and expectations related to raising children which can create scenarios where the patients or their patients can be offended by the behavior or attitude of the medical caregiver.
Another area is the need for self-evaluation which can help nurses become more comfortable providing care to clients from diverse backgrounds. What is important is self-evaluation can be achieved through e-mailing simple surveys to gauge how nurses would respond to a particular scenario. To make people feel comfortable the survey should be completed ibn private so the nurse can receive their feedback privately. Then it falls on the nurse to seek assistance to make themselves more culturally sensitive.
Nurses need to identify religious practices of the family because they influence health promotion belief in families. Some practices may be embarrassing so it makes sense to ask the patient if any of their potential visitors should leave the room during the interviewing process.
Understanding of the general characteristics of the major ethnic groups, is needed, but each nurse should look to personalize their care to meet the needs of their patients, not the other way around. The nursing diagnosis should include potential problems in their interaction with the health care system and problems involving the effects of their culture because it will allow the next shift of caregivers to understand what is going on with their patient without having to re-interview the patient over and over again. There is nothing that angers patients and their families more than nurses and other medical professionals continuing to ask the same questions over and over again because it shows a level of incompetence that is not good for the medical industry as a whole.
The planning and implementation of nursing interventions should be adapted as much as possible to the client's cultural background, but should also meet all appropriate medical standards and expectations. Medical best practices are more important than meeting cultural needs, but these practices need to be explained and why it is better than what the patient is looking for. Evaluations should include the nurse's self-evaluation of attitudes and emotions toward providing nursing care to clients from diverse sociocultural backgrounds. Additionally, these evaluations should also include the feedback from other nurses and other medical professionals in order to make sure discrimination and biases have no place in the medical field. There are some commonly used standards and requirements for nurses to be followed by. Some of them are mentioned above in simplified forms. The references to the full texts of documents which consist additional standards can be found in bibliography. There is not enough attention is paid to the problem of nursing tolerance within the system of medical education. The importance of knowing how to work in multicultural environment is crucial because it reflects the background of nurses and their professional expertise.
For nurses who work abroad it is necessary to define their own attitude to diversity awareness organizing workplace in appropriate way. According to the Marianne R. Jeffreys - a professor at the City University of New York (CUNY) - Multicultural Workplace Competence involves following components:
C ARING sincerely about one’s own and co-workers’ cultural values, and beliefs (CVB) is the first step towards developing multicultural workplace competence
O NGOING diversity awareness and sharing of CVB among co-workers fosters a workplace climate that openly embraces diversity and encourages dialogue
M ULTIDIMENSIONAL aspects of multicultural workplace competence include cognitive (knowledge), practical (communication skills), and affective (attitudes) dimensions
P ROACTIVE cultural dialogue and sharing among co-workers opens up discussion, decreasing the risk of unintentional cultural mistakes, pain, and conflict
E THICS and patient advocacy underscore the need for multicultural workplace collaboration based on research, theory, personal, and clinical experience
T RUST is an essential component for building multicultural workplace harmony that begins with self-disclosure and demonstrated respect for diverse values
E DUCATION for developing cultural competence must include formal formats such as continuing education, college courses, and/or an advanced certificate program
N ETWORKING with experts in various cultures will assist one in becoming more culturally competent with patients and more culturally sensitive with co-workers
C ONFIDENCE for cultural learning and initiatives should be realistic, avoiding overconfidence and low confidence behaviors
E VALUATION appraisal of strategies implemented and learning outcomes achieved provide guidance for future innovations within multicultural workplace settings
Consequently, multicultural workplace as a category has very broad meaning and its purpose is to facilitate everyday nursing operational environment and assist nurses in carrying out their functions. All health professionals need to provide culturally competent care. Learning-based theoretical support, research evidence, and collaboration are required for implementing culturally competent treatment.
The way of solving the problem of multicultural nursing intolerance on the level of particular hospital usually includes fines after complaints made by the patients. But to my point of view this is rather not effective instrument because it does not prevent occurring of the same problems in future. There should be measures aimed at understanding the reason of such a conflict. Then some special courses and so on need to be established for nurses to increase their competence in dealing with multicultural conflicts.
In last 5 years, the demand for transnational nurses has dramatically increased. The Cultural Nursing Society was established in order to enhance the quality of culturally congruent, competent, and equitable care that results in improved health and well-being for people worldwide. This society organizes different international courses for nurses from all over the world to promote the usage of practical sides of the transcultural nursing. The society classifies the general goals of transnational nursing communities into four basic components which includes advancing cultural competence for nurses worldwide, to advancing scholarship of the discipline, develop strategies for advocating social change for culturally competent care, and promote a sound financial non-profit corporation.
The Cultural Nursing Society edits the Journal of Transcultural Nursing with different theoretical articles published. There are models of cultural competence in health care delivery which was suggested by Campinha-Bacote and views cultural competence as the ongoing process in which the healthcare provider continuously strives to achieve the ability to effectively work within the cultural context of the client (individual, family, community). This model requires health care providers to see themselves as becoming culturally competent rather than already being culturally competent. According to this model the process of cultural nursing communication involves the integration of cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire. This concept is actively used in practice.
Conclusion
The practice of the competent nursing nowadays in large part depends on the ability of nurses to identify and meet cultural needs of diverse groups of individuals, use resources acceptable to the client, understand the social and cultural reality of the client, family, and community and finally develop expertise to implement culturally acceptable strategies to provide nursing care. Working within diverse cultural environment complicates the process of providing medical assistance. Therefore, special level of professional expertise and background is needed to make right actions while interacting with patients from other cultures. From different circumstances it is clear that harmony in interpersonal relations increases chances to get positive outcomes from treatment. To become good at transcultural communications nurses should gain practical experience through participating in different events aimed at enhancing their own cultural diversity. Well-organized nursing workplace is also can be considered as an important component of transcultural nursing. As the result of following international nursing standards more effective medical system may be expected as achieved all over the world.
References
Andrews, M. M. (2002). Transcultural concepts in nursing care. Philadelphia: Lippincott Williams & Wilkins.
Jeffreys, M. R. (2006). Teaching Cultural Competence in Nursing and Health Care: Inquiry, Action, and Innovation. New York: Springer.
Leininger M. M., M. M. (2006). Culture Care Diversity and Universality: A Worldwide Nursing Theory (2-nd edition ed.). Boston: MA: Jones and Bartlett.
Leininger, M. M. (2002). Essential transcultural nursing care concepts, principles, examples,and policy statements (3rd Edition ed.). New York: NY: McGraw-Hill.
