Special Issues in the Delivery of Trans- cultural

Nursing Care

Unit # 08
 OBJECTIVES
At the end of this unit learners will be able to :
• Cultural Specific Aspects of Pain Experience
• Various Treatment for Pain (Home Remedies)
• Dietary Beliefs and Practices of Clients from Different
Cultures
• Strategies to Facilitate Dietary Change
• Health Maintenance and Disease Prevention Model
Health Belief Model in Client Care
• Religious Beliefs and Practices Related to Prevention
and Treatment
• Attitudes of Society towards Stigmatized Diseases.
• Societal Knowledge Regarding Infectious Diseases.
• Spirituality and Its Relationship with Health and
Illness
• Methods of Spiritual Healing.
 Goal of trans culture nursing care
The goal of transcultural nursing has been to
prepare a new generation of nurses who would
be knowledgeable, sensitive, competent, and
safe to care for people with different or similar
life ways, values, beliefs, and practices in
meaningful, explicit(clear), and beneficial ways.
 Cultural Specific Aspects of Pain Experience

• It is well established that pain is a highly

complex phenomenon that involves biological,
psychological, and social variables.
• There are also culturally-based attitudes about
using pain medication. An understanding of
the impact of culture on the pain experience is
important in assuring effective and culturally-
sensitive patient care
• Patients from Asian cultures may often
exemplify stoicism in the face of pain, which
relates directly to strong cultural values
• a person who is assertive complains openly is
considered to have poor social skills. This
behavior might be tolerated in very small
children, but not in adolescents and adults.
• In many cultures around the world where
belief in fate and karma(good or bad luck) are
strong, people often believe illness and injury
are caused by a higher power.
• In some cultures, people believe that the
more disturbing a procedure is, the better it is
for them. So, an intravenous pain medication
would be preferred to analgesic tablets
• Pakistani patient, might believe that without
an injection, treatment is inadequate
• A Filipino or East Indian patient might reject
pain medications altogether out of fear of
harmful effects, including addiction.
• it is important to explain the rationale behind
use of pain medication to all patients, and to
ask patients from different cultural
backgrounds which type of medication is
preferred in their culture.
 Various Treatment for Pain (Home Remedies)

In every culture certain home management is

carried out for various health problems. This is
often a part of traditional practices which run
through generations. In case of pain various
home remedies are practiced. Examples are:
• The baking soda box for a sour stomach and
gas.. Simply mix baking soda with water and
drink.
• The most important home remedy for
backache is the use of garlic.
• Fish oil taken daily, is the least expensive and
most effective manner in which to eliminate
backache, joint pain, pains in the wrists.
• While sleeping, sleep on a firm mattress to
minimize back pain. Avoid sleeping face down.
• Ice therapy is also a good way to reduce pain
and swelling of the feet.
Some of the home remedies used in our culture is as
following

• Hot milk can be used for minimizing stomach acidity

and pain.
• Tooth paste is often applied locally for reducing pain
in burn.
• Hot application are used for traumatic pain and
swelling.
• Oil is used for ear ach.
• Body massage is also used for decreasing body
aches.
 Dietary Beliefs and Practices of Clients from
Different Cultures
• Any person choosing to satisfy nutritional
requirements is influenced by many variables
including, culture, socioeconomic status,
personal factors, and religion
• Some of the examples that identify the belief
and practices of various cultures regarding
food and nutrition
• Seventh Day Adventists don't eat meat.
• Navajo Indians don't eat fish.
• kosher foods (acceptable food in Jewish law) are
permitted by Judaism.
•  Halal foods  are permitted by Islam 
• Buddhist are generally vegetarian, the practice
varies and meat-eating may be permitted
depending on the sects.
 Strategies to Facilitate Dietary Change

• Nutrition education involves teaching the

client about the importance of nutrition,
providing educational materials
• Prior to beginning the education process, it is
helpful to assess what the patients already
knows about nutrition.
• Strategies recommended to promote healthful
eating among patients are given.
• Involve parents and attendants in nutrition
education.
• Provide role models for healthful eating
• Use incentives (no injection, no oral medicine
etc) to reinforce healthful eating
• Increase patients’ confidence in their ability to
make healthful eating choices
 
Health Maintenance and Disease Prevention
Model
• Prevention is an activity which reduces the bur
den of mortality or morbidity from disease.
• This model suggests that the natural history of
any disease exists on a field, with health at
one end and advanced disease at the other
• The goal is to maintain a healthy state and to
prevent disease or injury. It has been defined
in terms of three levels.
• Primary Prevention: It is to prevent a disease
or condition at a pre- pathologic state; to stop
something from ever happening
Specific Protection
use of specific immunization
attention to personal hygiene
use of environmental sanitation
protection against occupational hazards

Secondary Prevention: It is also known as “Health

Maintenance”. Seeks to identify specific illnesses or
conditions at an early stage with prompt intervention to
prevent or limit disability
Adequate treatment to arrest disease process and
prevent further complication.
Provision of facilities to limit disability and prevent
death.
• Tertiary Prevention: Occurs after a disease or
disability has occurred and the recovery
process has begun; Intent is to halt(Stop) the
disease or injury process and assist the person
in obtaining an optimal health status.

Care in old homes,

Physical rehabilitation etc.
  
Health Belief Model in Client Care

The Health Belief Model (HBM) is a

psychological model that attempts to explain
and predict health behaviors.
 Concept Definition Application

Define
Health Belief Model in Client Care population(s) at risk, risk
levels; personalize risk based on a
Perceived One's opinion of chances of getting
person's features or behavior;
Susceptibility a condition
heighten perceived susceptibility if
too low.

One's opinion of how serious a Specify consequences of the risk and

Perceived Severity
condition and its consequences are the condition

One's belief in the efficacy of the Define action to take; how, where,
Perceived Benefits advised action to reduce risk or when; clarify the positive effects to
seriousness of impact be expected.

One's opinion of the tangible and

Identify and reduce barriers through
Perceived Barriers psychological costs of the advised
reassurance, incentives, assistance.
action

Provide how-to information,

Cues to Action Strategies to activate "readiness"
promote awareness, reminders.

Confidence in one's ability to take Provide training, guidance in

Self-Efficacy
action performing action.
 Reasons for Non Adherence to Treatment

The medical advice to the individual is a major

concern in every medical specialty. Both internal
and external factors influence whether a patient
follows health care advice. Internal factors
include patient age, culture, social background,
values, attitudes, and emotions caused by the
disease. External factors include the relationship
between the patient and the physician or the
nurse, family, health care personnel, and friends.
Experts agree on the following main reasons
patients do not adhere to treatment plans (non-
compliance or non-adherence
• Denial of the problem. Many diseases and
conditions, in particular those that are
asymptomatic, are easy to ignore, even when
they have been diagnosed.
• The cost of the treatment
• The difficulty of the regimen. Patients may
have trouble following the directions. For
example, taking a pill in the middle of the
night.
• The unpleasant outcomes or side-effects of
the treatment. 
• Lack of trust
• Previous experience

Nurses and other health care professionals must

do more than merely give the patient
information. They must also be able to identify
potential barriers to patient learning and the
ability to follow treatment recommendations
 3 Religious Beliefs and Practices
Related to Prevention and Treatment
An organized belief system of worship and
practices that generally has a focus on a God or
super natural power.
• Certain religions and belief systems promote
alternative perspectives toward vaccination.
Religious objections by Muslim
• Buddhists believe Organ and tissue donation is
considered an act of charity and love, and
transplants are morally and ethically
acceptable to the Catholics.
 
Attitudes of Society towards Stigmatized
Diseases
Stigma is an unfavorable attitude and belief
directed toward some one or something. For
example believing that HIV is great punishment
for moral misconduct.
women are responsible for transmitting HIV and
other STIs in our community etc. Negative
attitudes about them create injustice which
leads to negative actions and discrimination.
• Stigma and discrimination exist worldwide,
although they marked themselves differently
across countries, communities, religious groups
and individuals.
• When Stigma is acted upon, the result is
discrimination which includes illogical actions
against the affected person i.e. exclusion,
restrictions, denials etc.
• In our society the patients with leprosy and HIV
are labeled as stigmatized very often while some
of the infections like Hepatitis are normally
perceived.
 Societal Knowledge Regarding Infectious
Diseases
• Public awareness of infectious diseases plays
an important role in disease control; a lack of
reasonable knowledge of infectious diseases
leads to low detection rates, the interruption
of treatment, discrimination and stigma.
• In Pakistan the rural and illiterate people have
very little or no knowledge of infectious
diseases as compare to educated and urban
people. Similarly the awareness rate about the
transmission of infections is the same
Raising the level of knowledge of infectious
diseases could not only help the general
population to protect them, but also promote
those suspected suffer of being infected to seek
medical help early and treat more completely.
Spirituality and Its Relationship with Health and Illness

• Spirituality is directly related with individual’s

health and healing process. Spirituality fulfills
specific needs by giving meaning to life, and
helping the processes of illness, crises, and
death. It also plays a role to give a sense of
security for present and future and guide daily
habits.
 Methods of Spiritual Healing

• Islamic Spiritual Healing is based on the

knowledge extracted from Quran and Sunnah.
Recent scientific research indicates that affirming
belief in God or Allah makes a critical contribution
to our physical health. When people call upon
faith, they activate neurologic pathways for self-
healing. The Muslim prayer consists of contact
prayer (Salat), Zikr or remembrance of Allah and
recitation of the Qur'an.
 Summarization
Whatever the culture or the circumstances are,
the nursing care provider must take into
consideration the whole person. Making sure
not to impose one’s own beliefs on others but
be respectfully and surely that it does not
interfere with the healthcare delivery. A nurse
has to consider all the aspects of cultural
difference like pain experience, food habits,
spiritual and religious beliefs.