Relevance of Culture in Nursing - Essay Example

AIM: Shifting demographics and global trends have led to various practices of health care and health care professionals. Health care professionals,especially nurses, need to be cognizant of the preferred health care practices of the people served. Hence the current study identifies the relevance of culture to nursing in serving the individuals and families of varying cultural background and is related to different existing theories of nursing. The main purpose of the study is to review the relevance of culture to nursing and the theories incorporated into nursing to understand the cultural competence in practice Brief Outline: The study examines the reflection of cultural variations of race, ethnicity, and culture in the desirable or undesirabale outcome of characteristics in patient care. The study oulines the following: Meaning and relevance of term culture in health care and nursing. Main areas influenced by cultural relfection in nursing Major cultural factors influencing the nursing. Observation of cultural barriers like communication Theories proposed to the relevance of culture to nursing Usage of theories in practice. Background of the study: The ethnic cultures of remote tribal areas with sustained identity, values, and belief systems are now want to be recognized in a bicultural, pluralistic, and multi-cultural manner (Bucher, 2000). Culture has long been considered to play an important role in the practice of nursing to such areas. The historical development of the concept of culture is reviewed with emphasis on nurse scholars and anthropologists who have addressed culture as an area of inquiry. The meaning-centered perspective of culture, to include embodiment, is reviewed and recommended as a means of addressing the current emphasis on cultural diversity in nursing. This perspective is seen as having broad implications for both advancing theoretical development in nursing and for nursing practice. Cultural awareness in Nursing Practice. The practice areas influenced by culture: The identified areas to be influenced by cultural issues are mental health nursing, child- and family-centred care, care of the elderly, and men and women's health care, especially when the concern is to community health checkups. ISSUE AREAS: The major areas of concentration in studying the relevance of culture to Nursing are: Culture, race & ethnicity, Health and illness beliefs, Cultural issues in practice, cultural issues in mental health nursing, Cultural issues in child and family centred care, Cultural issues and the older person, Cultural issues in men and women's health care, Cultural issues in health care - racism in the health services, Professional cultures and health care, Culture and health inequalities, Race, culture and ethnicity in health education and health promotion. THE NURSING ISSUE: The place of preferred health practices according to the cultural needs of diverse people, is in the educational settings. Though many schools of nursing incorporated the content and cultural appropriate care, there is a lack of convincing evidence as to the best way to do it with reference to rlevancy of theory to the nursing practice. The cultural relevance to nursing is not a mere understanding the general knowledge of different patterns of culture by the nursing practitioners. The cultural generalities are rarely applicable to all individuals within a culture (Dreher & MacNaughton, 2002; Eliason & Macy, 1992). General knowledge often leads to stereotyping. The consequence of stereotyping is inadequate or negligent client care. A patient of a different culture may be labeled as "uncooperative, non-compliant or resistive" (Eliason & Macy, 1992, p. 14) to a health care regimen, when in reality, the care may be incongruent with the client's cultural beliefs and values (Leininger, 1989). Campinha-Bacote and Padgett (1995) wrote "non-compliance can be considered the failure of health care providers to provide culturally relevant care" (p. 31). When transcultural nursing knowledge is applied to a situation and cultural-specific interventions are implemented, the client's compliance to the medical regimen improves, health status improves, and use of health care services is initiated more frequently (DeSantis, 1991). since the late 1980s, the literature has proliferated with examples of how nursing schools incorporated cultural content, as well as methods of offering cultural clinical experiences. Some programs use local experiences and resources to promote culturally competent care. Others believe international experiences provide the most appropriate learning for culturally competent care. In 1986, the American Nurses Association (ANA) identified several approaches to integrate cultural diversity content into the curricula of nursing schools. The Association suggested content be approached by 1) integrating the concepts throughout the curriculum, 2) teaching aspects of nursing care in a specific unit, or 3) offering a required or elective course in cultural diversity. In addition, since the late 1990s, there have been several efforts made to define and measure cultural competence outcomes. Thus the observation of local and international practices in relevance to culture on nursing will help the practitioners to identify the cultural competence. According to St. Clair and McHenry (1999), "self-efficacy is not cultural competence. . . [however] cultural awareness, sensitivity, and self-efficacy" (p. 234) will likely continue to be synonymous with cultural competency until the phenomena is further clarified. CULTURAL FACTORS: The relevance of culture to nursing is to be observed under cultural factors, such as: Environmental control (e.g., the practice of folk medicine or use of traditional healers) Biological (physical and genetic) differences among cultural groups, which can include not only body build, skin color and hair texture, but also healing responses, susceptibility to disease and nutritional variations Social organizations, such as families, that shape an individual's cultural development, beliefs and responses to major life events space and time orientation (e.g., some cultures are future-oriented and concerned with long-range planning while others focus on the present). In addition, communication is an integral part of nursing practice. To communicate effectively with patients from diverse cultures, nurses must have knowledge of different languages, verbal and nonverbal behaviors, use of silence and attitudes about eye contact. They must understand not only what is communicated but also how it is communicated PERSPECTIVE OF NATIVE AMERICAN TOWARDS HEALTH: Roberto Dansie (1997), Executive Director of Pit River Health Service in Burney, California tells us that there are common characteristics that most Native Americans, as well as other ethnic groups, share when it comes to healing and health. These include the following: Life comes from the Great Spirit, and all healing begins with Him. Health is due to the harmony between body, heart, mind, and soul. Our relationships are an essential component of our health. Death is not our enemy, but a natural phenomenon of life. Disease is not only felt by the individual, but also the family. Spirituality and emotions are just as important as the body and the mind. Mother Earth contains numerous remedies for our illnesses. Some healing practices have been preserved throughout the generations. Traditional healers can be either men or women, young or old. Illness is an opportunity to purify one's soul. COMMUNICATION AS A CULTURAL CONCERN IN NURSING: Communication Patterns and Language Patterns of communication and behavior are learned at a very early age. The following table (Shavanda, 1989) compares key differences in communication patterns between natives and non-natives: NON-NATIVES: NATIVES: Early demonstration of learning Seek to please Early age -- respect through silence, observation Speaks to many people who give perspective to life; no need to talk to those he is close to; companionship Converse at length with those he's close to; watch and give respect to those he does not know well Values conversation as a way to get to know others Values observance as a way of getting to know others Learn through trial and error Teacher expects native students to demonstrate knowledge Children: listen and learn; don't answer question or demonstrate skills unless know the answer or are adept at the skill Unable to meet expectations of non-native teachers due to way of learning "Put's best foot forward." Presents positive self-image and high hopes for the future Interprets native's not boasting or speaking of future as lack of self-confidence Not acceptable to "boast" nor to speak of future (makes it difficult for job interviews) Rapid communication Thinking before answering Longer pauses Must have closure for courtesy No closure (e.g. May hang up at the end of a telephone conversation without saying good-bye) Direct messages Indirect messages Silence in social interaction may feel uncomfortable to non-natives. While visiting, the Native person may not feel a pressing need for conversation. It is enough to enjoy the visitor's presence. Non-natives who do not understand this practice may make erroneous assumptions such as that the two people sitting in silence are angry with each other or that one is being rude to the other. The following table, from Noland and Gallagher (1989) may be helpful in illustrating the results of these differences in communication patterns and language between Alaska Natives and non-natives. What's Confusing to English Speakers About Athabascans What's Confusing to Athabascans About English Speakers The Presentation of Self They do not speak. They talk too much. They keep silent. They always talk first. They avoid situations of talking. They talk to strangers or people they don't know. They play down their abilities. They brag about themselves. The act as if they expect things to be given to them. They don't help people even when they can. They deny planning. They always talk about what is going to happen later. The Distribution of Talk They avoid direct questions. They ask too many questions. They never start a conversation. They always interrupt. They talk off the topic. They only talk about what they are interested in. They never say anything about themselves. They don't give others a chance to talk. They are slow to take a turn in talking. They just go on and on when they talk. The Contents of Talk They are too indirect, to inexplicit. They aren't careful about how they talk about people or things. They don't make sense. They just leave without saying anything. They have to say good-bye even when they see you are leaving. Body language Communication can be viewed as an iceberg. Verbal language transmits approximately 35% of the message, while nonverbal communication transmits the remainder. Nonverbal communication is culture specific and affected by beliefs, values, social rules and communication premises. Because body language is culturally specific, miscommunication can occur when definitions of another culture are used for interpreting meaning. The following examples form Wolcoff (1989) help to illustrate this: BODY LANGUAGE NON-NATIVE MEANING NATIVE MEANING Nodding head "I understand what your are saying" "I hear what your are saying" Raised eyebrows "I'm surprised by what I am seeing or hearing" "Yes"; "I agree with what you are saying" Furrowed brow "I'm listening very carefully to what you are saying" "I question the truth in what I am seeing or hearing" "No" "I'm displeased with you" Tapping pencil "I am distracted" "I am impatient" Sighing "I am tired" "I am bored" Arms tight to body "I am cold" "I want to maintain an impersonal distance" No eye contact "I am lying to you" "I respect you" 'Reflective practice' in NURSING: Wolcoff (1989) shares the following hints to improve communication with Alaska Native clients: Take a few minutes to visit to set the person at ease. Talk about common ground: art, music, recreation, weather, dancing, fun things. Don't talk down. Don't speak in a loud tone of voice to elders unless you know they are hard of hearing. The spoken language is traditionally quiet. Speaking loudly may be interpreted as anger or rudeness. Listen, listen, listen. Don't talk so much or so fast. Allow time for questions. QUESTION OF 'RELEVANCE OF THEORIES TO NURSING': Although the use of theory-guided research has long been urged, it is important that the theoretical basis and major concepts of studies are at least relevant and ideally appropriate to the studied group to avoid the error of cultural imposition (Leininger, 1994; Porter & Villarruel, 1993; Villarruel, 1996). For example, health belief models have been criticized for placing the burden of health on the individual without recognizing the importance of cultural norms and groups (Lipson & Steiger, 1996). Ashling-Giwa (1999) provided a comprehensive critique of the cultural adequacy of the Health Belief Model, the Theory of Reasoned Action, the Theory of Planned Behavior, and the Trans theoretical Model of Behavior Change for increasing breast cancer screening among African American women. Ashling-Giwa concluded that these models overlooked real (rather than merely perceived) environmental and socio-ecological barriers to care, relied mainly on notions of volitional control of health, and did not deal with the cultural themes of interconnectedness among women and families, health socialization involving alternative approaches to care and women's primary obligations to others, and religiosity that characterize much African American culture. At the concept level an examination of the content validity of a measure of social support among Navajo women revealed that many items were unacceptable because of incompatibility with their cultural values of stoicism, self-reliance, and non-disclosure of personal information (Higgins & Dicharry, 1991). Models and Theories of Nursing IN RELEVANCE TO CULTURE: Following are the few theories and models on nursing relevant to cultural affect with special attention to Madeleine Leininger's Theory of Cultural Care, Diversity and Universality: Leininger, M. M. (1973, March). An open health care system model. Nursing Outlook, 21, 171-175. Leininger, M. M. (1975). Conflict and conflict resolution. American Journal of Nursing, 75, 292-296. Leininger, M. M. (1977). Cultural diversities of health and nursing care. Nursing Clinics of North America, 12(1), 5-18. Leininger, M. M. (1981). Transcultural nursing: Its progress and its future. Nursing and Health Care, 2(7), 365-371. Leininger, M. M. (1984). Transcultural nursing: An overview. Nursing Outlook, 32(2), 72-73. Leininger, M. M. (1986). Care facilitation and resistance factors in the culture of nursing. Topics in Clinical Nursing, 8(2), 1-12. Leininger, M. M. (1990). The significance of cultural concepts in nursing. Journal of Transcultural Nursing, 2(1), 52-59. Leininger, M. M. (Ed.). (1991). Culture care diversity and universality: A theory of nursing. New York: National League of Nursing. Leininger, M. (1992). Theory of culture care and uses in clinical and community contexts. In M. Parker (Ed.), Theories on nursing (pp. 345-372). New York: National League for Nursing. Leininger, M. M. (1995). Transcultural nursing: Concepts, theories, research, and practice (2nd ed.). New York: McGraw-Hill. Reynolds, C. L., & Leininger, M. (1995). Madeleine Leininger: Cultural care diversity and universality theory. In C. M. McQuiston & A. A. Webb (Eds.), Foundations of nursing theory: Contributions of 12 key theorists (pp. 369-414). Thousand Oaks, CA: Sage Publications, Inc. Cameron, C., & Luna, L. (1996). Leininger's transcultural nursing model. In J. J. Fitzpatrick & A. L. Whall (Eds.), Conceptual models of nursing: Analysis and application (3rd ed., pp. 183-197). Stramford, CT: Appleton & Lange. Leininger, M. (1996). Transcultural nursing administration: What is it Journal of Transcultural Nursing, 8(1). Tomey, A. M., & Alligood, M. R. (Eds.). (1998). Nursing theorists and their work (4th ed.). St. Louis: Mosby. OBSERVATION OF A Theory of Nursing: Culture Care Diversity and Universality Madeleine Leininger, worldwide founder and global leader of transcultural nursing, has long argued that care is the central and unifying domain that characterises nursing (Leininger 1967, 1978, 1984, 1990, 1991). In asserting this position, Leininger has been careful to clarify that although care has primacy in nursing, its practice is not universal, and that nurses need to be aware that how care is conceptualised, constructed and practiced varies across and even within different cultures. Leininger has repeatedly warned nurses that if they do not practice transcultural nursing then, no matter how well intended their practices of nursing are, they risk 'cultural imposition'; that is, practising nursing in a way that imposes cultural (ethnocentric) expressions of care that may be nontherapeutic and even harmful. In other words, a failure to practice culturally informed nursing care could result in people receiving nursing that is 'toxic service', rather than therapeutic care (Kanitsaki 1996, 2000). Transcultural nursing promotes congruent culture care practices at all local levels around the world as well as at the global level. It is important to understand, however, that these culturally congruent care practices are under threat. This is because diverse and universal congruent cultural care practices are not necessarily reflected in the new global care practices (eg corporatised health care services) as prescribed and rationalised (economically and now technologically) by dominant and vocal health practitioners, organizations, and more recently globalised computer software packages. In light of this threat, it is morally imperative that nursing care practices locally and globally are examined continually and critically to ensure that they are culturally meaningful, therapeutically effective and moral, and not beholden to imperialist (and possibly alienating) values imported through IT and other imposed frameworks for care. This is extremely important, particularly when we speak about care practices in contexts where imperialistic ideologies and economic, social, political and IT processes influence not just the distribution of resources, but also the caring roles and practices in a given (local) health care domain. Usage of theories: The usage of above theories in the context of socio-cultural impact is in the following ways: 1. Theories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenon. (holistic view of people) 2. Theories must be logical in nature. (inherent logic- more known about client, increased opportunity to provide care) 3. Theories should be relatively simple yet generalizable. (necessary concepts are incorporated in such a manner that the theory and its model can be applied to many different settings) 4. Theories can be the bases for hypotheses that can be tested or for theory to be expanded according to socio-cultural behavioral modifications. 5. Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them. 6. Theories can be utilized by the practitioners to guide and improve their practice. (example of research finding which can guide and improve nursing practice; care is universal, the meaning of care diverse) 7. Theories must be consistent with other validated theories, laws, principles but will leave open unanswered questions that need to be investigated. (concept of importance of knowing client as a person rather than as a problem) Additional findings from Leininger (1991) on RElevance & USAGE of culture to Nursing: Cultural context & care values influence the expression and meaning of care. To understand care meanings and uses often require knowledge of the culture. High technology nursing practices in Western cultures increase the distance between clients and nurses. Generic care is little understood and valued by nurses and other health providers. Key and general informants for the studies have expressed positive feelings about the research. Clients believe that health providers must understand their ideas, beliefs, and life ways before clients can be helped appropriately. Transcultural nursing- a learned sub field or branch of nursing which focuses upon the comparative study and analysis of cultures with respect to nursing and health-illness caring practices, beliefs and values with the goal to provide meaningful and effacious nursing care services to people according to cultural values and health illness context. Ethnonursing- the study of nursing care beliefs, values, and practices a cognitively perceived and known by a designated culture through their direct experience, beliefs, & value system. CONCLUSION: The study on Relevance of culture to Nursing has observed the ethno cultural aspects of bursing in the changing global scenario of services. The study observed the various influencing factors and factors to be influenced by the cultural changes in nursing. The study tries to illustrate communication as a cultural barrier to nursing under the culture of non-native patients in Alaska, under communicative health care programme. The study has observed the difference between few verbal and non verbal communications observed in clietn care in nursing as an example to understanding of cultural difference. As a recent practice of service, the study tries to identify the solution under the 'Reflective Practice' for nursing. As a main theme, the study further relates to the observation of Relevancy of nursing practices to theories, Related Models & theories on Cultural relevancy to Nursing and their usage. As a relted theory the study closely observes the Madeleine Leininger's "Theory of Cultural Care, Diversity and Universality" and observes the findings proposed to the cultural relevance to nursing. The study finally observes that transcultural nursing theory and practices provide a powerful culturecare lens through which caring and healing knowledge and practices can be discovered, developed and applied in nursing education, research and practice. REFERENCES: Ann Marriner Tomey, Martha Raile Alligood. (2002) Book info: Nursing Theorists and Their Work, Available from Accessed on 20 june 2005. Bowler IM., Stereotypes of women of Asian descent in midwifery: some evidence., Comment in: Midwifery. 1993 Mar;9(1):1-2., PMID: 8492731 [PubMed - indexed for MEDLINE], Available from < http://www.ncbi.nlm.nih.gov/entrez/query.fcgicmd= Retrieve&db=pubmed&dopt=Abstract&list_uids=8492726> Accessed on 20 june 2005. Bruni, N. 1988., A critical analysis of transcultural theory. Australian Journal of Advanced Nursing 8(3) 26-31. D'Cruz,V. and Tham, G. 1993., Nursing and nursing education in multicultural Australia: a Victorian study of some cultural, curriculum and demographic issues. David Lovell Publishing, Melbourne. Idrus, L., 1988. Transcultural nursing in Australia: Response to a changing population base. In: M. J. Morse (ed). Recent advances in nursing: Issues in crosscultural nursing, pp. 81-91, Churchill Livingstone, Edinburgh. Johnstone, M., 1994. Bioethics: a nursing: a perspective, 2nd edn, Ch. 5:'Transcultural ethics', pp.139-156,WB Saunders/Bailliere Tindall, Sydney. Kanitsaki, O., 1983. Acculturation, A New Foreword:TransculturalDimension to Nursing, The Australian Nurses' Journal 13(5) 42-45 & 53. Kanitsaki, O. (1992) Transcultural nursing:An introductory teaching package for nurse lecturers and teachers, School of Nursing, Lincoln Faculty of Health Sciences, La Trobe University, Melbourne. Leininger, M. M. (Ed.). (1991). Culture care diversity and universality: A theory of nursing. New York: National League of Nursing. Leininger, M. (1992). Theory of culture care and uses in clinical and community contexts. In M. Parker (Ed.), Theories on nursing (pp. 345-372). New York: National League for Nursing. Leininger, M. (1991) Culture care diversity and universality: a theory of nursing. National League for Nursing Press, New York NY OLGA KANITSAKI, October 2003. Transcultural nursing and challenging the status quo, Availablr from < http://www.contemporarynurse.com/15.3/15-3pv.htm --> Accessed on Accessed on 20 june 2005. Read More