NCM_112- Mod 1: CONCEPTS IN THE CARE OF AT
They intensify
RISK AND SICK ADULTS
Lesson 1: Health Care Situations
10 Global Health Issues to Watch in the 2020s
 We have a lot to do before 2030, If we’re going to
achieve the Sustainable Development Goals
 Every year, we look at the top global health issues
coming our way in the next 12 months. But global
health is along game and it’s a brand new decade,
so this year, we’re looking ahead to the coming 10
years (Margarite Nathe, Principal Editor / Writer,
Intra health International)
1.Infectious Diseases & Potential Pandemics
In 2018, Bill Gates told Business Insider that the
coming disease maybe one like the 1918 flu – could kill
30 million people within six months, and that countries
should prepare for it like they would for war
Coronavirus
- Officially known as COVID -19
- There have been more than 45,171confirmed
cases globally across two dozen countries and more
than 1000 people have died.
- It has Global Health Officials very concerned
about just how prepared we are for this pandemic
- January 31, 2020, the WHO declared the
outbreak a Public Health Emergency of International
Concern
2.Health Workers Carry Huge Responsibility and
Huge Risk
Health worker, who died from coronavirus just two
moths after he tried to warn the world about SARS like
illness in Wuhan, China
In one Wuhan hospital, a single patient infected at
least ten health workers and four other patients, (New
York Times)
A Sierra Leone Physician who died of Ebola in the
same hospital where, just weeks before, he’d been
treating Ebola patients
Are on front lines of any infectious disease outbreak,
from measles to meningitis to polio
3.Fake news, pseudoscience, censorship or spin
Misinformation is responsible for far too many lives
cut short
Not only does misinformation spread disease, it
spread mistrust. This can have disastrous
consequences for frontline health workers and
journalist, including derailing their efforts to curb and
report on outbreaks.
How we present and consume information online will
have a direct impact on global health, not just for
humans, but for wildlife, plant life and the environment
we share
4.Our Warming, Storming Planet
2010s were the hottest decade on record. Not just
on land, but also at sea, where 90% of excess heat
from greenhouse gases is stored
Rising temperatures can change everything. Our
water quality, our air quality, the quality and quantity of
our food crops around the world.
heatwaves and storms, leading to floods and
wildfires
Health workers will see climate consequences in
their clinic waiting rooms
- In the coming decade, more and more frontline
health workers will see the consequences of our
changing climate in their clinic. They’ll need to be
ready to address the effects of hunger from failing
crops, chronic respiratory diseases caused by air
pollution and all the health challenges that come with
human displacement due to catastrophic weather
5.Strong Supply Chains
During the first week of the coronavirus outbreak in
China, health workers from eight hospitals in Hubei
Province, where the city of Wuhan is located, put out
an urgent call for medical supplies specially surgical
mask, goggles and gowns
”There are no beds, no resources” “Are we
supposed to just fight this battle bare handed” (nurse
said in an interview with CNN)
If we’re going to achieve universal health coverage
in the coming decade, supply chain management will
be more crucial than ever
“ No health program can succeed if the medicines
and health products people need aren’t available
when and where they need them. (Intra Health
International)
Without qualified, well trained human resources to
manage supply chains, we can’t make sure health
products are available, either day to day or during
emergencies
6.Digital Health
“ It’s been ten years since the first truly affordable
smartphone was introduced and unleashed a
transformations across the African continent” “ These
days, over 40% of all Africans use smartphones and
the technology generates 8.6% of GDP in sub –
Saharan Africa. But the tech transformation hasn’t
stopped with telecommunications. The field of digital
health has expanded too”
Health workers and officials around the world are
going to get more sophisticated in the way they
collect, share and analyze data.
From advanced image processing algorithms that
diagnose cancer and eye diseases the chatbots that
detect depression in real time – digital health tech
and its users will have to keep up with all new issues
around data security, machine learning and using
data to solve some of our biggest disease challenges
7.A Tidal Wave of Mental Health Needs
Suicide rates are the highest they’ve been since
World War II. (US, Time Reports)
Found that the rate of suicide attempts for black
youth in the US rose from 73% from 1991 to 2017
According to WHO, between 76% and 85% of the
people with mental health disorders in low – and
middle income countries receive no treatment for
their disorders, including depression, bipolar
disorder, schizophrenia, dementia, substance abuse
and developmental disorders.
“We see people tied to their hospital beds or locked 2.Age – Increases or decreases susceptibility to
up at home. If we want to see healthy societies, people certain illnesses ( the risk of heart disease)
with mental health needs will need support too.” - Increases with age for both sexes
- The risk of birth defects and complications of
8.Heart Disease, Cancer and the Groundswell of pregnancy increase in women bearing children after
Noncommunicable Disease age 35
As people all over the world live longer than ever, 3.Environment – The physical environment in which
this and other noncommunicable diseases – including a person works or lives can increase the likelihood
obesity – related illnesses, hypertension, diabetes, that certain illness will occur
heart disease, mental illness – have become the 4.Lifestyle – Many activities, habits and practices
leading cause of death and disability worldwide involve risk factors. Lifestyle practices and behaviors
In the coming decade, countries will need resilient have positive or negative effects on health
health system and strong health workforces to meet - Stress can be a lifestyle risk factor if it is severe or
this challenge prolonged, or if the person is unable to cope
- Stress can threaten mental health and physical well
9.The Global Health Workforce being
Nurses, midwives, doctors, pharmacist, lab workers,
clinical officers – the range of jobs and responsibilities Common Causes of Disease
within health workforce is vast, and each one is crucial5. 1. Biologic agent
The 2020s are starting off with a focus on nurses 6. 2. Inherited genetic defects
and midwives. They make up 50% of the health 7. 3. Physical agents
workforce worldwide. 8. 4. Chemical agents
As we get closer to our ambitious global goal 9. – 5. Classification of disease
nothing short of universal health coverage, an AIDS 6. Tissue response to irritation/ injury ( fever,
free generation, and the end of extreme poverty – the inflammation)
global community has realized that nurses and 7. Faulty chemical or metabolic process
midwives will be the ones to get us there. That’s one 8. Emotional or physical reaction to stress
reason the WHO declared 2020 to be the Year of the
Nurses and the Midwife Common Causes of Disease According to
But to make real progress, the health workforce Etiologic Factors
needs more nurses and midwives at the top
 Hereditary
10. Our Ambitious 2030 Goals - Due to defect in genes of one or other parent which
We have a lot to do before 2030 if we’re going to get is transmitted to the offspring
close to achieving the Sustainable Development Goals  Congenital
We want to achieve an AIDS free generation. Family - Due to a defect in the development, hereditary
planning for all who need it. Universal health coverage. factors, or prenatal infection; present at birth ( cleft
Gender equality in health care. An end to maternal and lip, cleft palate )
child deaths and solutions for the 70.8 million people  Metabolic
who have now been forcibly displaced from their - Due to disturbances or abnormality in the intricate
homes due to war and other disasters process of metabolism
 Deficiency
Lesson 2: Chronic Illness - Results from inadequate intake of absorption of
essential dietary factors
Concept of Illness  Traumatic
Illness is a personal state in which the person feels - Due to injury
unhealthy or ill  Allergic
Illness may or may not be related to disease - Due to abnormal response of the body to chemical
Illness is a state in which a person’s physical, or protein substances or to physical stimuli
emotional, Intellectual, social development or spiritual  Neoplastic
functioning is diminished or impairment compared with - Due to abnormal or uncontrolled growth of cells
previous experience  Idiopathic
 Although nurses must be familiar with different kinds - Cause is unknown; Self originated; Of spontaneous
of diseases and their treatments, they are concerned origin
more with illness, which may include disease  Degenerative
- Results from the degenerative changes that occur
Etiology in tissue and organs
 Is the causation of the disease.  Iatrogenic
 Etiologic description includes identification of all - Results from the treatment of a disease
factors that act together to bring a disease condition
Greek word etio (causation) and ology (scientific Common Causes of Disease According to
study) Duration or Onset
 Acute Illness
Risk Factors of a Disease - Usually has a short duration and severe
- The sign and symptoms appear abruptly, are
1.Genetic and Physiological Factors - Heredity or intense and often subside after a relative short
genetic predisposition to specific illness, is a major period
physical risk factor
- Following an acute illness a person may return to
normal level of wellness
 Chronic Illness
- Slow onset. Persists, usually longer than 6 months
and can also affect functioning in and dimension
- Chronically ill person have a long term disease
process
- The client fluctuate between maximal functioning and
serious relapses that may be life threatening
Characterized by:
Remission – Period during which the disease is
controlled, symptoms are not obvious
Exacerbation – The disease become more active
again at future time, recurrence of pronounced
symptoms.
Other classification of disease may be described
as :
 Organic
- Results from changes in the normal structure, from
recognizable anatomical changes in an organ or tissue
of the body
 Functional
- No anatomical changes are observed to account for
the symptoms, present may result from abnormal
response to stimuli
 Occupational
- Results from factors associated with the occupation
engaged in by the patient ( Cancer among chemical
factory worker)
Other Classifications
 Familial
– Occurs in several individuals of the same family
( Hypertension, cancer)
 Venereal
– Usually acquired through sexual relation ( AIDS,
Gonorrhea)
 Epidemic
– Attacks a large number of individuals in a community
at the same time (SARS)
 Endemic
– Present more or less continuously or recurs in the
community
 Pandemic
– Epidemic diseases which extremely widespread
involving an entire country or continent
 Sporadic
- A disease in which only occasional cases occur
Terminologies
Disease – Disturbance of structure or of function of the
body or its constituents parts
- Lack of or inadequate adaptation of the organism to
his environment
- Failure of the adaptive mechanism to adequately
counteract the stimuli or stresses to which it is subject
resulting in disturbances in function and structure of
any part, organ or system of the body
Morbidity – Condition of being diseased
Morbidity Rate – The proportion of disease to health
in a community
Mortality – Condition or quality of being subject to
death
Epidemiology – Study of the patterns of health and
disease, its occurrence and distribution in man, for
the purpose of control and prevention of disease
Susceptibility – The degree of resistance the
potential host has against the pathogen
Etiologic Agent – One that possesses the potential
for producing injury or disease ( Streptococcus,
Staphylococcus)
Virulence – Relative power or the degree of
pathogenicity of the invading microorganism, the
ability to produce poisons that repel or destroy
phagocytes
Symptomatology – Study of symptoms
Symptom – Any disorder of appearance, sensation
or function experienced by the patient indicative of a
certain phase of a disease.
Sign – An objective symptom or objective evidence
or physical manifestation made apparent by special
methods of examinations or use of sense
Syndrome – A sets of symptoms, the sum of which
constituents a disease
- A group of symptoms which commonly occurs
together
Pathology – The branch of medicine which deals
with the cause, nature, treatment and resultant
structural and functional changes of disease
Diagnosis – Art or act of determining the nature of a
disease, recognition of a diseased state
Complication – A condition that occurs during or
after the course of an illness
Prognosis – Prediction of the course and of a
disease, medical opinion as to the outcome of a
disease process. Good prognosis means that there
is great possibility to recover from the disease and
poor prognosis means that there is great risk for
morbidity or mortality
Recovery – Implies that the person has no
observable or known after effects from his illness;
there is apparent restoration to the pre – illness state
Four Aspect of Sick Role
1.Clients are not responsible for their condition
2.Clients are excused from certain social roles and
tasks
3.Clients are obliged to try to get well as quickly as
possible
4.Clients or their families are obliged to seek
competent help
Three Distinct Criteria to Determine if a Person is
ill
1.The presence of symptoms
2. The perception of how they feel
3. Their ability to carry out daily activities

Effects of Illness
 Privacy
 Autonomy
 Financial Burden
 Lifestyle
 Family and Significant Others
Factors that Determine the Extent of Effect of
Illness
 The member of the family who is ill
 The seriousness and length of the illness
 Cultural and social customs the family follows
 The changes that can occur in the family
Role Changes
 Tasks reassignments and increase demands on
time
 Increase stress due to anxiety about the outcome of
the illness
 Financial problems
 Loneliness resulting from separation and pending
loss
 Change in social customs
Promoting Health and Wellness
Health Promotion - An activity undertaken for the
purpose of achieving higher level of health and
wellness
Chronic Condition
Are often defined as medical conditions or health
problems with associated symptoms or disabilities that
require long term management ( 3 months or longer)
Illnesses or diseases that have a prolonged course,
that do not resolve spontaneously, and for which
complete cures are rare
The specific condition may be a result of illness,
genetic factors, or injury; it maybe a consequence of
conditions or unhealthy behaviors that began during
childhood and young adulthood
Management of Chronic Conditions
 Includes learning to live with symptoms or
disabilities and coming to terms with identity changes
resulting from having a chronic condition
 It also consists of carrying out the lifestyle changes
and regimens designed to control symptoms and to
prevent complications
Causes of the Increasing Number of People with
Chronic Conditions
A decrease in mortality from infectious diseases,
such as smallpox, diphtheria and other serious
conditions
Longer life spans because of advances in
technology and pharmacology, improved nutrition,
safer working conditions and greater access to health
care
Improved screening and diagnostic procedures,
enabling early detection and treatment of diseases
Prompt and aggressive management of acute
conditions, such as myocardial infarction and acquired
immuno - deficiency syndrome (AIDS) and other
related infections
 The tendency to develop chronic illnesses with
advancing age
Lifestyle factors, such as smoking, chronic stress
and sedentary lifestyle, that increase the risk for
chronic health problems such as respiratory disease,
hypertension, cardiovascular disease and obesity
Characteristics of Chronic Conditions
 Managing chronic illness involves more than
managing medical problems. Associated
psychological and social problems must also be
addressed
 Chronic conditions usually involve many different
phases over the course of a person’s lifetime. There
can be acute periods, stable and unstable periods,
flare – ups and remission.
 Each phase brings sits own set of physical,
psychological and social problems and each requires
its own regimens and types of management
 Keeping chronic conditions under control requires
persistent adherence to therapeutic regimens
 Failing to adhere to a treatment plan or to do so
consistently increases the risk of developing
complications and accelerating the disease process
includes learning to live with symptoms or disabilities
and coming to terms with identity changes resulting
from having a chronic condition
 It also consists of carrying out the lifestyle
changes and regimens designed to control
symptoms and to prevent complications
The Challenges of Living with Chronic Condition
include the Need to accomplish the Following
 Alleviate and manage symptoms
 Psychologically adjust to and physically
accommodate disabilities
 Prevent and manage crises and complications
 Carry out regimens as prescribed
 Validate individual self – worth and family
functioning
 Manage threats to identity
 Normalize personal and family life as much as
possible
 Live with altered time, social isolation and
loneliness
 Establish the networks of support and
resources that can enhance quality of life
 Die with dignity and comfort
Applying the Nursing Process Using the Phases
of the Chronic Illness System
Step 1: Identify Specific Problems and the
Trajectory Phase
- The first step is assessment of the patient to
determine the specific problems identified by the
patient, family, nurse and other health care
providers. Assessment enables the nurse to identify
the specific medical, social and psychological
problems likely to be encountered in a phase
Step 2: Establishing and Prioritizing Goals
- Once the phase of illness has been identified for a
specific patient, along with the specific medical
problems and related social and psychological
problems, the nurse helps prioritize problems and
establish the goals of care. Identification of goals must
be collaborative effort with the patient and family
Step 3: Defining the Plan of Action to Achieve
Desired Outcomes
- Once goals have been established, it is necessary to
identify a realistic and mutually agreed – on plan for
achieving them including specific criteria that will be
used to assess the patient’s progress.
- The identification of the person responsible for each
task in the action plan is also essential. In addition,
identification of the environmental, social and
psychological factors that might interfere with or
facilitate achieving the desired outcome is an important
part of planning
Step 4: Implementing the Plan and Interventions
-This step addresses implementation of the plan.
Possible nursing interventions include providing direct
care, serving as an advocate for the patient, teaching,
counseling , making referrals and case managing (ex.
Arranging for resources)
- Nurses can help patients implement the actions that
allow patients to live with the symptoms and therapies
associated with chronic conditions, thus helping them
to gain independence
- The nurse works with each patient and family to
identify the best ways to integrate treatment regimens
into their ADLs to accomplish two task:
1. Adhering to regimens to control symptoms and
keep the illness stable
2. Dealing with the psychosocial issues that can
hinder illness management and effect quality of life
Step 5: Following Up and Evaluating Outcomes
-The final step involves following up to determine if the
problem is resolving or being managed and if the
patient and family are adhering to the plan.
-This follow up may uncover the existence of new
problems that interfere with the ability of the patient
and family to carry out the plan, or previously
unexpected problems.
-Maintaining the stability of the chronic condition while
preserving the patient’s control over his or her life and
the patient’s sense of identity and accomplishment is a
primary goal.
-Based on the follow up and evaluation, consideration
of alternative strategies or revision of the plan may be
warranted
Lesson 3 - Cultural And Health Ethnic Disparities
And Culturally Competent Care
Transcultural Nursing
A formal area of study and practice focused on
comparative holistic culture care, health and illness
patterns of people with respect to differences ad
similarities to their cultural values, beliefs, and lifeways
with a goal to provide culturally congruent, competent,
and compassionate care. (Leininger, 1997)
A substantive area of study and practice focused on
comparative cultural care values,beliefs, and practices
of individuals or groups of similar or different culture.
(Murphy, 2006)
Transcultural nursing is a distinct nursing specialty
which focuses on global cultures and comparative
cultural caring, health, and nursing phenomena.
The transcultural nurse looks to respond to the
imperative for developing a global perspective within
the nursing field in an increasingly globalized world
of interdependent and interconnected nations and
individuals. 
The primary aim of this specialty is to provide
culturally congruent nursing care.
 To be an effective transcultural nurse, you should
possess the ability to recognize and appreciate
cultural differences in healthcare values, beliefs, and
customs.
Transcultural nurses shouldn't only be familiar with
the religious customs, values, and beliefs of patients,
but also how someone's way of life, their modes of
thought, and their unique customs can immensely
affect them in how they deal with illness, healing,
disease, and deaths.
A transcultural nurse helps their patients by
providing culturally sensitive care to patients hailing
from all around the globe. These nurses often treat
patients who are migrants, immigrants, or refugees.
Transcultural nurses work not only in foreign
countries, but also right here in our diverse cities,
applying their knowledge to their local nursing
position, and sometimes helping integrate their
philosophies into nursing practices at clinics and
hospitals.
Medical – surgical Nursing 14th edition volume 1
( Brunner and Suddarth’s) Copyright 2018
Is used interchangeably with cross cultural,
intercultural or multicultural nursing and refers to
evidenced-based practice that focuses on patient
centered, culturally competent nursing.
Addresses the differences and similarities among
cultures in relation to health, health care and
illnesses
It incorporates the care values, beliefs and
practices of people and group from particular culture
without imposing the nurse’s cultural perspective on
the patient.
Focus of transcultural nursing is to provide
culturally appropriate care and competent care that
promotes well being or health of individuals, families,
groups, communities and institution.
Define as providing care to patients and families
across cultural variations.
What Are the Roles and Duties of a Transcultural
Nurse?
The functions and obligations of transcultural
nurses include, but aren't limited to, the
following:
Communicate with foreign patients and their loved
ones
Educate families on patients' medical status
Act as a bridge between a particular patient's
culture and healthcare practice
Determine the patient's cultural heritage and
language skills
Determine if any of the patient's health beliefs relate
to the cause of their illness or problem
Collect information on any home remedies the
person is taking to treat their symptoms
Understand the influence of culture, race, and
ethnicity on the development of social and emotional
relationships, child rearing practices, and attitude
toward health
Collect information about the socioeconomic status
of the family and its influence on their health promotion
and wellness

Transcultural Nursing Theory

Madeleine Leininger Culture Care Diversity and
Universality

Madeleine Leininger’S Transcultural Nursing; Culture

Care Diversity
While it is important to look at a patient as a whole
person from a physiological, psychological, spiritual,
and social perspective, it is also important to take a
patient’s culture and cultural background into
consideration when deciding how to care for that
patient. After all, the values and beliefs passed down
to that patient from generation to generation can have
as much of an effect on that patient’s health and
reaction to treatment as the patient’s environment and
social life.
The Transcultural Nursing theory developed by
Madeleine Leininger (1950 -2012) is now a nursing
discipline that is an integral part of how nurses practice
in the healthcare field today.
Beginnings of Theory
In mid 1940’s working with med – surgical patients
she began to realize how the concept of human care
was important in nursing
After WWII, she worked as a clinical specialist in
child mental health in a child guidance center
Children were from culturally diverse backgrounds
due to immigration
Began to notice behavioral differences and
questioned the cultural aspects of these differences in
relation to care
Searched the known psychoanalytic and mental
health theories
Her continued observations, questioning and linking
the concepts of human care and culture led to her
establishing the theory of culture care and transcultural
nursing. ( Cameron, C. & Luna, L. 2005)
Sunrise Model
Definitions
Caring – Action or activity towards providing care
Care – Assist others with real or anticipated needs to
promote health and wellness
Culture – Learned, shared and transmitted values,
beliefs, norms of a group that influence behavior
Cultural Care – Aspects of culture that influence or
enable a person to deal with illness or death
Culture Care Diversity and Universality
Diversity – Differences in meanings, values or care
of different groups of people
Universality – Common care or similarities among
cultures.
Nursing – Learned profession with a disciplined
focus on care phenomenon
Health – State of well being that is culturally defined
and valued by the culture
Dr. Leininger distinguishes between emic and etic
perspective of culture:
Emic – refers to an insiders view and knowledge of
the culture
Etic - means the outsider’s viewpoints of the culture
and reflects more on the professional angles of
nursing
Transcultural Theory Concepts
 Uses culture to understand behavior
 All cultures are not alike
 Culture influences all spheres of life. It defines
health, illness and the search for relief from diseases
or distress
 Each person viewed as unique with differences
that are respected
Cultural Competence is a combination of culturally
congruent behaviors, practice attitudes and policies
that allow nurses to work effectively in cross cultural
situations.

Cultural Competence is important in nursing

 She criticizes the nursing metaparadigm concepts of
person, environment, health and nursing;
 She considers nursing a discipline and a profession
and the term “nursing “ cannot explain the
phenomenon of nursing
 The term “person” is too limited and culture bound to
explain nursing, as the term “person” does not exist in
every culture
 The concept of “health” is not distinct to nursing as
many disciplines use the term
 Instead of “environment” Leininger uses the concept
“environmental context” which includes events with
meaning and interpretations given to them in particular
physical, ecological and sociopolitical and or cultural
settings
Ethnohistory
Apart form cultural and environment context,
ethnohistory is also meaningful when examining care
from the cultural perspective.
It refers to past events and experiences of
individuals or groups, which explain human life ways
within particular cultural contexts over short or long
periods
Primary Themes and Sunrise Model
The concept of culture was derived from
anthropology and the concept care was derived from
nursing
The ultimate goal of the theory is to provide cultural
congruent nursing care practices
If one fully discovers care meanings, patterns and
process, one can explain and predict health or well
being
Health and care behaviors vary among cultures,
therefore nursing care cannot be determined through
superficial knowledge and limited contact with a
cultural group
Nursing care must be based on knowledge by
examining social structure, world view, cultural values,
language and environmental contexts
This is depicted in sunrise model
Care Modalities
 Dr. Leininger does not use the term nursing
intervention because it communicates the ideas of
cultural interference and imposition practices.
 She prefers the care modalities term because it has
a connotation of nurse and individual working together
to implement care
Three Modalities
There are three modes/ modalities for guiding
nursing care judgements, decisions or actions to
provide appropriate, beneficial and meaningful care:
- Preservation and/ or maintenance
- Accommodation and/ or negotiation
- Re – patterning and / or restructuring
 These modes have substantively influenced nurses
ability to provide culturally congruent nursing care and
have fostered the development of culturally competent
nurses.
Health Disparities
Are preventable differences in the burden of
disease, injury, violence or oportunities to achieve
optimal health that are experienced by socially
disadvantaged populations.
Lower quality of health care than nonminorities and
are at greater risk for declining health.
Reasons for disparities including low
socioeconimic status, health behaviours, limited
access to health care because of poverty or
disability, environmental factors, direct and indirect
manifestations of discrimination.
Other causes also include lack of comprehensive
health insurance, overdependence on publicly
funded facilities and barriers to health care such as
insufficient transportation, geographic location, cost
of services and the low numbers of minority health
care providers.
Culturally Competent Nursing Care
Defined as an 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.
Is a dynamic process that requires comprehensive
knowledge of culture specific information and an
awareness of, and sensitivity to, the effect that
culture has on the care situation.
It requres that nurses find meaningful and useful
care delivery strategies based on knowledge of the
cultural heritage, beliefs, and behaviours of those to
whom they render care.
Also incorporates the delivery of interventions that
are congruent with a given culture.
It involves a complex integration of attitudes,
knowledge and skills (including assessment, decision
making, judgements, critical thinking and evaluation)
that enables nurses to provide culturally appropriate
care.