History and Theoretical

Foundation of
Transcultural Nursing
Dr. L. M. Adarlo
 Learning Objectives
1. Identify the origin of transcultural nursing.
2. Describe the need for transcultural nursing in contemporary
society.
3. Determine the resources available in transcultural nursing and
health care.
 Introduction
✘ 21st Century - opened the door for nurses to
increase eagerness and enthusiasm in learning
different cultures
✘ Transcultural nursing became a separate course
in BSN Program.
✘ Nurses must be aware and sensitive to the
unique health and illness beliefs, practices and
culture of the client.
✘ Nurses must Acknowledge and embrace
different cultures in a non-judgmental manner.
 Dr. Madeleine Leininger
❖ is the foundress of transcultural nursing and establish
transcultural nursing to become an integral part of
academic study and practice.
❖ She quoted in the press, that the transcultural nursing
is essential to meet the challenging world and
changing health needs to transform the old practices
and ideas into new ones through education (Andrews,
2008).
❖ She also stated that the anthropology and nursing
must be intertwined so that each field must be
benefiting with each contribution on knowledge and
experiences leading to a new bridlepath in research
and thinking.
 History of
Transcultural Nursing
 Dates to Remember…

✘ 1950 - Peplau stated the importance of culture as an essential

aspect affecting mental health. Dr. Leininger while working with
the emotionally disturbed children, noticed that there were
cultural differences between the nurse and patients.
✘ 1954 - Dr. Leininger the study on the various cultural
differences in the perceptions of care.
✘ 1960 - much attention was provided in caring for individuals
with different culture, and since then, nurses have been
searching for studies with a goal of rendering a cultural
appropriate care to individuals with diverse cultural
background.
✘ 1973 - the first transcultural nursing academic department in
University of Washington School of Nursing was established.
.
 Dates to Remember…
✘ 1974 – founded the Transcultural Nursing Society. It aimed to
provide the necessary knowledge for all the nurses and health
care professionals in education, research and management;
develop, perform the needed skills and be a culturally sensitive
nurse.
✘ 1989 - The Journal of Transcultural Nursing (JTN) with Dr.
Madeleine Leininger as founding editor, was published as
official publication for the dissipation of the transcultural
concepts, theories, and research findings.
✘ 1991 - the publication of Culture Care Diversity and
Universality, A Theory of Nursing was made in 1991, - Culture
Care Diversity and Universality and Sunrise Model.
✘ 1995 - 2nd edition of Transcultural Nursing Concepts, Theories,
Research and Practices was published.
Theoretical Foundation of TCN
✘ The foundation of transcultural
nursing is based on the cultural
concepts and its relation to health
beliefs, values practices of the
patient, family members, and
significant others.
✘ Culture is termed as the
knowledge, norms, belief, morals,
laws, customs, habits, traditions
and other capabilities acquired
and developed by humans as
members of the society that can
passed down through generations
✘ Culture serves as a pattern on
how each person’s think, and
act.
✘ The key components that can
best describe culture are
ethnicity, race, and minority
status.
✘ Ethnic culture can be learned
through language and
socialization, shared by same
cultural groups, influenced by
environmental and technical
factors and it is usually
dynamic and ever changing.
 Key Concepts
Transcultural Nursing
✘ sometimes used interchangeably with cross cultural,
intercultural, or multicultural nursing.
✘ It refers to a research-focused practice culture field that
deals on patient centered, culturally competent nursing
with the integration of caring values, beliefs, practices of
people and groups from a distinct culture without
imposing the nurse’s cultural perspective on the patient.
✘ It should be culture specific and culture universal care
in the promotion of wellness of individuals, families,
groups, communities, and institutions.
 Key Concepts

Culture-specific refers to a certain values, beliefs,

and patterns of behavior which cannot be shared
with members of another culture. Culture-universal, a
frequently and comparably adhered shared values,
norms of behavior and life patterns among cultures
concerning human behavior and lifestyle.

Minority refers to a group of people who possess a

different physical and cultural feature from the
majority.
Factors that influenced the creation of
Transcultural Nursing
• migration of people within and
between countries worldwide is
increased.
• growth in the multicultural identities
respected by nurses and healthcare
team members
• usage of health care technology give
rise to dispute with the client’s cultural
values.
• conflicts in the culture can create
clashes and violence in the healthcare
worldwide
Factors that influenced the creation of
Transcultural Nursing
• huge count of traveler and overseas
workers in different parts of the world.
• cultural conflicts, negligence, illiteracy,
cause an increase in the legal suits
• gender issues and feminism with new
demands on health care system has
been increasing
• the demand for community and
culturally based healthcare services
increased in diverse environmental
context.
 Transcultural Nursing
TN allows nurses to…
effectively communicate with diverse cultural
and linguistic backgrounds clients
assist clients with mental health problems
comprehensively assess the culture
expression of pain with appropriate actions
to relieve the discomfort
assess the parent child relationship
motivate the parents to discipline their
children to promote health and prevent
illness, physically and emotionally.
 Transcultural Nursing
Aims to deliver culturally congruent care that is
suitable for patient’s life patterns, values and
system of meaning, in which people
themselves created.

E.g.
Instead of advising the client to take their oral medication
on the scheduled time, the nurse should assess first their
lifestyle patterns such as eating and sleeping habits, beliefs
about the medication they are about to take and then plan a
schedule appropriate for each client’s needs, to make the
care meaningful and beneficial.
 Major Criticisms
Unclear Nurses were not Discrimination
terminologies encouraged to get
involved with the
politics, economic,
and social agendas

failure to Racism were

appreciate the not given
link between attention
knowledge and
power
Culturally Competent Nursing Care
Cultural competency is defined by the
National Institute of Health (2015) as services
delivered by the health care providers that are
respectful and responsive to the health
beliefs, practices, cultural and linguistic needs
of the diverse clients.

Cultural competency does not occur

overnight, but rather it takes time to flourish
the needed knowledge, skill, attitude to
become culturally competent and be able to
deliver a safe and quality care.
Culturally Competent Nursing Care
In order for a nurse to provide a culturally
competent care to a patient with divergent
cultural background, it is vital to go in for
cultural self-assessment.
The nurse should be aware of his/her own
cultural beliefs, health related values and
practices passed on from their parents,
grandparents to overcome ethnocentric
tendencies and cultural custom thus keeping
them from having biases and discrimination
against members of various groups with
different cultural background from them.
 Culturally Competent Nursing Care
❖ Some of the psychomotor skills useful in
transcultural nursing are
• assessment
• communication
• hygiene
• activities of daily living
• religion
❖ Assessing the culture, utilizing some
techniques for assessing cultural variations in
health and illness, is a required skill to
become culturally competent and to provide
a culturally congruent care
 Culturally Competent Nursing Care
❖ In establishing rapport with the patient, an
effective communication, verbal or nonverbal
should be implemented for a nurse patient
interaction.
❖ Cross- cultural communication is essential in
assessing how people from various cultural
backgrounds communicate with each other.
❖ Nurses should be aware of the signs that
convey cultural differences in the use of
silence, eye contact, touch, space, distance,
and facial expression.
 Culturally Competent Nursing Care

• For the hygiene, skin and hair care for

various ethnic/racial background is an
important cultural consideration.
E.g.
Assisting a Chinese American post stroke client
to regain the use of chopsticks as part of
rehabilitation program.
?
 Cultural Competence
Health History and Physical Examination

• Cultural assessment or culturological nursing assessment is a systematic,

comprehensive examination of the cultural beliefs, values and practices of individuals,
families and communities pertaining to their health.
• Cultural assessment identifies the health care needs of people, so that proper
nursing diagnosis will be formulated, for proper planning and execution of culturally
congruent and meaningful actions. (Leininger& McFarland2002).
• For every nurse – client interaction, cultural assessment is essential as culture
influences one’s health status.
• Cultural assessment involves process and content.
Process means the client approach through verbal and non-verbal communication,
including the sequential steps on how the data are taken.
Content is the categories of the actual data gathered
 Cultural Competence
Health History and Physical Examination

❖ The goal of the health history is to collect

• subjective data
• present and past history
• family history
• social history, lifestyle,
• health strength,
• cultural beliefs and practices
❖ Review of Systems is done to provide culturally competent nursing care.
❖ Collection of objective data is also needed thru physical assessment and the
laboratory results related to the health problems presented, to form a nursing
diagnosis.
❖ Make sure that the specific language spoken by the client is documented, the
cultural affiliation and the source of history taken, any interpreter not related to
the client present for a non-speaking English patient.
 Cultural Competence
Health History and Physical Examination

❖ Contradicting to the usual techniques in performing health assessment, cultural

assessment is invasive, more time is needed since it requires establishing a
trusting relationship between participants.

❖ Miscommunication usually arises in intercultural transactions because of variations

in verbal communication between the nurse- client interaction and differences in
analyzing one’s behaviors.

❖ The skills needed by nurse in the performance of a comprehensive cultural

assessment of individuals and communities should be patterned and guided with
different models and tools, including
✓ Leininger Sunrise Model
✓ Giger Davidhizar’s Transcultural Assessment Model
✓ Purnell Model for Cultural Competence
❖ This is use for better understanding of the factors influencing their values, beliefs
and practices.
Purnell’s Model for Cultural Competence