Transcultural Nursing

Dr. Tothie Castillo

 Culture
• Culture refers to the cumulative deposit of knowledge, experience, beliefs,
values, attitudes, meanings, hierarchies, religion, notions of time, roles, spatial
relations, concepts of the universe, and material objects and possessions acquired
by a group of people in the course of generations through individual and group
striving.
• Culture is the systems of knowledge shared by a relatively large group of people.
• Culture is communication, communication is culture.
• Culture in its broadest sense is cultivated behavior; that is the totality of a
person's learned, accumulated experience which is socially transmitted, or more
briefly, behavior through social learning.
 A culture is a way of life of a group of people--the behaviors, beliefs, values, and symbols that they
accept, generally without thinking about them, and that are passed along by communication and
imitation from one generation to the next.
• Culture is symbolic communication. Some of its symbols include a group's skills,
knowledge, attitudes, values, and motives. The meanings of the symbols are learned
and deliberately perpetuated in a society through its institutions.
• Culture consists of patterns, explicit and implicit, of and for behavior acquired and
transmitted by symbols, constituting the distinctive achievement of human groups,
including their embodiments in artifacts; the essential core of culture consists of
traditional ideas and especially their attached values; culture systems may, on the one
hand, be considered as products of action, on the other hand, as conditioning influences
upon further action.
 Culture is the patterns of learned and shared behavior and beliefs of
a particular social, ethnic, or age group. It can also be described as
the complex whole of collective human beliefs with a structured
stage of civilization that can be specific to a nation or time period.
Humans in turn use culture to adapt and transform the world they
live in.
What is the culture of the Philippines?
 The Philippines is a culture in which East meets West. The
Filipino people have a distinct Asian background, with a strong
Western tradition. The modern Filipino culture developed
through influence from Chinease traders, Spanish
conquistadors, and American rulers.
 Filipino people tend to be very hospitable, especially to
Western visitors (1). Because of their strong ties to
Spanish culture, Filipinos are emotional and passionate
about life in a way that seems more Latin than Asian
(1). This is easily seen in the works of contemporary
artists such as Rody Herera in his painting Unahan Sa
Duluhan.
 The family is the basic and most important aspect of
Filipino culture. Divorce is prohibited and annulments
are rare .
 The family is the safety net for indivuduals, especially
older people, during difficult economic times. Children
will often stay with their parents into adulthood, only
leaving when they get married. Political and business
ties are often influenced by family relationships.
 Two traits that many foreign visitors often have a difficult time
understanding are Pakikisama and Utang na Loob. Pakikisama
roughly means "getting along" and requires individuals overlook
slight improprieties or indiscretions for the sake of preserving
peace within the family, personal, or business relationship.
Utang na Loob refers to the custom of paying back one favor
with another. These traits emphasize the importance that
Filipino people place on maintaining pleasant interpersonal
relationships and puting the needs of the group ahead of the
individual.
 More than 80% of the population of the Philippines is
Roman Catholic. Fiestas in honor of the patron saint of
a town are quite common. Criticism of the Catholic
church is not taken lightly - and should be avoided.
 In the Philippines, people greet each other with a
handshake. A smile or raised eyebrows can mean
"Hello" or "Yes". Someone can be summoned with a
downward wave of the hand.
 Culture and Health
 Health is a cultural concept because culture frames
and shapes how we perceive the world and our
experiences. Along with other determinants of health
and disease, culture helps to define: How patients and
health care providers view health and illness.
 Impact of culture on health

 Health is a cultural concept because culture frames

and shapes how we perceive the world and our
experiences. Along with other determinants of
health and disease, culture helps to define:
• How patients and health care providers view health and illness.
• What patients and health care providers believe about the causes
of disease. For example, some patients are unaware of germ theory
and may instead believe in fatalism, a djinn (in rural Afghanistan, an
evil spirit that seizes infants and is responsible for tetanus-like
illness), the 'evil eye', or a demon. They may not accept a diagnosis
and may even believe they cannot change the course of events.
Instead, they can only accept circumstances as they unfold.
• Which diseases or conditions are stigmatized and why. In many
cultures, depression is a common stigma and seeing a psychiatrist
means a person is “crazy”.
• What types of health promotion activities are practiced,
recommended or insured. In some cultures being “strong” (or what
Canadians would consider “overweight”) means having a store of
energy against famine, and “strong” women are desirable and
healthy.
• How illness and pain are experienced and expressed. In some
cultures, stoicism is the norm, even in the face of severe pain. In
other cultures, people openly express moderately painful feelings.
The degree to which pain should be investigated or treated may
differ.
• The degree of understanding and compliance with
treatment options recommended by health care providers
who do not share their cultural beliefs. Some patients
believe that a physician who doesn’t give an injection may
not be taking their symptoms seriously.
• How patients and providers perceive chronic disease and
various treatment options.
 What is belief System

 The belief system of a person or society

 is the set of beliefs that they have about
what is right and wrong and what is true
 and false. . the belief systems of various
ethnic groups.
 What are the three belief system?
 For centuries, these belief systems have influenced
each other, and people's daily practices honored
different ideas and customs. The Cyrus Tang Hall of
China explores three central belief
systems: Buddhism, Confucianism, and Daoism.
Each tradition has distinct historical roots and
contributed to many practices
 Daoism emerged sometime during the Spring and
Autumn or Warring States periods (770-221 BC), a
time of intense conflict and political instability, but also
of profound intellectual creativity. Daoism celebrates
the “oneness” of all nature and advocates a natural
course of action, or in some cases, inaction. It is one
of China’s indigenous belief systems with roots in
nature worship
 he Dao, which means "the way," is the natural order of
the universe. Daoists strive to be in harmony with
this natural order. Rather than following particular
rules, Daoists cultivate a sense of naturalness, called
ziran. By being in tune with this, they believe they can
avoid violence, suffering, and struggle.
 Confucianism is based on the writings of Kong Fuzi,
also known as Confucius (551-479 BC), a philosopher
and teacher who developed a system of thought that
explained an individual’s place in society and a ruler’s
responsibility to his people.
 Confucianism believes in ancestor worship and human-centered
virtues for living a peaceful life. The golden rule of Confucianism is “Do
not do unto others what you would not want others to do unto you.”
 The Five Constant Virtues mean the Confucian virtues of benev-
olence (ren 仁 ), righteousness (yi 義 ), propriety (li 義 ),
wisdom (zhi 智 ), and trustworthiness (xin 信 ). As with the
Fundamental Bonds, these five virtues are the most significant
ones and thus serve as shorthand for all the Confucian virtues.
 Buddhists follow the guidance of Siddhartha Guatama,
who was believed to have lived in what is now Nepal
 Buddhism encourages its people to avoid self-indulgence but
also self-denial. Buddha's most important teachings, known as The
Four Noble Truths, are essential to understanding the religion.
Buddhists embrace the concepts of karma (the law of cause and
effect) and reincarnation (the continuous cycle of rebirth).
 Buddhism is one of the world's largest religions and originated
2,500 years ago in India. Buddhists believe that the human
life is one of suffering, and that meditation, spiritual and
physical labor, and good behavior are the ways to achieve
enlightenment, or nirvana.
 HISTORY OF
TRANSCULTURAL NURSING
 Transcultural nursing was established from
1955 to 1975. In 1975, Leininger refined the
specialty through the use of the "sunrise model"
concept. It was further expanded from 1975 to
1983. Its international establishment as a field in
nursing continued from 1983 to the present
 The foundations of transcultural nursing were laid
in the mid-1950s. In nursing, Peplau first
mentioned in 1950 that the cultures were an
important variable affecting mental health. The
growing interest in Leininger’s transcultural
nursing model has begun with population
changes and migration
 Leininger tried to promote transcultural nursing
movements. Much more attention was paid to
the care of individuals from different cultures in
the 1960s. Since 1960s, nurses have been
carrying out studies aimed at providing
particularly cultural care to people from all
communities/cultures. In 1962, King stated
that psychopathological behaviors differ from
culture to culture
 History
 Through Leininger, transcultural nursing started as
a theory of diversity and universality of cultural
care. Transcultural nursing was established from
1955 to 1975. In 1975, Leininger refined the
specialty through the use of the "sunrise model"
concept. It was further expanded from 1975 to
1983. Its international establishment as a field in
nursing continued from 1983 to the present.
 After being formalized as a nursing course in
1966 at the University of Colorado,
transcultural nursing programs and track
programs were offered as masters and
doctoral preparations during the early parts
of the 1970s.[1]
 In 1969, the International Council of
Nursing (ICN) began using cultural
content in nursing. The Transcultural
Nursing Society (TCNS) was established
in 1974 to train nurses in this area.
 Since 1989, “Journal of Transcultural
Nursing” has been published, aiming to train
nurses about transcultural care and improve
their practice. Evidence-based studies have
been conducted in this area. Today, there
are about 25 books and over 800 articles
covering research, theory and applications
related to transcultural nursing
 What is Transcultural Nursing?

 Transcultural nursing means being sensitive to

cultural differences as you focus on individual
patients, their needs, and their preferences. Show
your patients your respect for their culture by
asking them about it, their beliefs, and related
health care practices.
 Transcultural nursing 
 is how professional nursing interacts with the concept
of culture. Based in anthropology and nursing, it is
supported by nursing theory, research, and practice. It
is a specific cognitive specialty in nursing that focuses
on global cultures and comparative cultural caring,
health, and nursing phenomena. It was established in
1955 as a formal area of inquiry and practice. It is a
body of knowledge that assists in providing culturally
appropriate nursing care
 Description of transcultural Nurtsing
 According to Madeleine Leininger, the pioneer
of transcultural nursing, it is a substantive
area of study and practice that focuses on the
comparative cultural values of caring, the
beliefs and practices of individuals or groups
of similar or different cultures
 According to MEDLINE, transcultural nursing is an area
of expertise in nursing that responds to the need for
developing global perspective within nursing practice in
a world of interdependent nations and people. As a
discipline, it centers on combining international and
transcultural content into the training of nurses. It
includes learning cultural differences, nursing in other
countries, international health issues, and international
health organizations.[1]
 Goals
 The goals of transcultural nursing is to give
culturally congruent nursing care, and to provide
culture specific and universal nursing care
practices for the health and well-being of people or
to aid them in facing adverse human conditions,
illness or death in culturally meaningful ways.
[1]
 Founder
 As the initiator of and the leader in the field
of transcultural nursing, Madeleine Leininger
 was the first professional nurse who
finished a doctorate degree in anthropology.
Leininger first taught a transcultural nursing
course at the University of Colorado in 1966.
 In 1998, Leininger was honored as a Living
Legend of the American Academy of Nursing.
Leininger was the editor of the Journal of
Transcultural Nursing, the official publication
of the Transcultural Nursing Society, from 1989
to 1995. She authored books about the field of
transcultural nursing.[1]
 Transcultural nurses
 Nurses who practice the discipline of transcultural
nursing are called transcultural nurses.
Transcultural nurses, in general, are nurses who
act as specialists, generalists, and consultants in
order to study the interrelationships of culturally
constituted care from a nursing point of view.
They are nurses who provide knowledgeable,
competent, and safe care to people of diverse
cultures to themselves and others.[1]
 Why is Transcultural Nursing Important?

 Transcultural knowledge is important for nurses

to acquire in order for them to become sensitive to
the needs of patients from various
cultures especially as societies become increasingly
global and complex.
 UNDERSTANDING TRANSCULTURAL
NURSING

 Be aware of cultural trends while respecting individual patients’

preferences.
 A PATIENT'S BEHAVIOR is influenced in part by his cultural
background. However, although certain attributes and attitudes
are associated with particular cultural groups as described in the
following pages, not all people from the same cultural
background share the same behaviors and views.
 When caring for a patient from a culture different
from your own, you need to be aware of and respect
his cultural preferences and beliefs; otherwise, he
may consider you insensitive and indifferent,
possibly even incompetent. But beware of assuming
that all members of any one culture act and behave in
the same way; in other words, don't stereotype
people.
 The best way to avoid stereotyping is to view each
patient as an individual and to find out his cultural
preferences. Using a culture assessment tool or
questionnaire can help you discover these and
document them for other members of the health care
team.
 Keeping the caveat about
stereotyping in mind, let's take a
look at how people from various
cultural groups tend to perceive
some common behaviors and
key health care issues.
 Space and distance
 People tend to regard the space immediately around
them as an extension of themselves. The amount of
space they prefer between themselves and others to
feel comfortable is a culturally determined
phenomenon
 Most people aren't conscious of their personal space
requirements—it's just a feeling about what's
comfortable for them—and you may be unaware of
what people from another culture expect. For
example, one patient may perceive your sitting close
to him as an expression of warmth and caring;
another may feel that you're invading his personal
space.
 Research reveals that people from the United States,
Canada, and Great Britain require the most personal space
between themselves and others. Those from Latin America,
Japan, and the Middle East countries need the least amount
of space and feel comfortable standing close to others.
Keep these general trends in mind if a patient tends to
position himself unusually close or far from you and be
sensitive to his preference when giving nursing care.
 Eye contact

 Eye contact is also a culturally determined behavior.

Although most nurses are taught to maintain eye contact
when speaking with patients, people from some cultural
backgrounds may prefer you don't. In fact, your strong gaze
may be interpreted as a sign of disrespect among Asian,
American Indian, Indo-Chinese, Arab, and Appalachian
patients who feel that direct eye contact is impolite or
aggressive. These patients may avert their eyes when talking
with you and others they perceive as authority figures.
 An American Indian patient may stare at the floor during
conversations. That's a cultural behavior conveying respect,
and it shows that he's paying close attention to you. Likewise,
a Hispanic patient may maintain downcast eyes in deference
to someone's age, sex, social position, economic status, or
position of authority. Being aware that whether a person
makes eye contact may reflect his cultural background can
help you avoid misunderstandings and make him feel more
comfortable with you.
 Time and punctuality

 Attitudes about time vary widely among

cultures and can be a barrier to effective
communication between nurses and patients.
Concepts of time and punctuality are culturally
determined, as is the concept of waiting.
 In U.S. culture, we measure the passing and duration
of time using clocks and watches. For most health care
providers in our culture, time and promptness are
extremely important. For example, we expect patients
to arrive at an exact time for an appointment—despite
the fact that they may have to wait for health care
providers who are running late.
 For patients from some other cultures, however, time is a
relative phenomenon, and they may pay little attention to the
exact hour or minute. Some Hispanic people, for example,
consider time in a wider frame of reference and make the
primary distinction between day and night but not hours of
the day. Time may also be marked according to traditional
times for meals, sleep, and other routine activities or events.
 In some cultures, the “present” is of the greatest
importance, and time is viewed in broad ranges
rather than in terms of a fixed hour. Being
flexible in regard to schedules is the best way to
accommodate these differences.
 Value differences also may influence someone's sense of time and
priorities. For example, responding to a family matter may be more
important to a patient than meeting a scheduled health care
appointment. Allowing for these different values is essential in
maintaining effective nurse/patient relationships. Scolding or acting
annoyed when a patient is late would undermine his confidence in
the health care system and might result in more missed
appointments or indifference to patient teaching.
 Touch
 The meaning people associate with touching is culturally determined
to a great degree. In Hispanic and Arab cultures, male health care
providers may be prohibited from touching or examining certain parts
of the female body; similarly, females may be prohibited from caring
for males. Among many Asian Americans, touching a person's head
may be impolite because that's where they believe the spirit resides.
Before assessing an Asian American patient's head or evaluating a
head injury, you may need to clearly explain what you're doing and
why.
 Always consider a patient's culturally defined sense of
modesty when giving nursing care.
 For example, some Jewish and Islamic women believe
that modesty requires covering their head, arms, and legs
with clothing. Respect their tradition and help them
remain covered while in your care.
 Communication

In some aspects of care, the perspectives of health care providers,

patients, and families may be in conflict. One example is the issue
of informed consent and full disclosure. For example, you may feel
that each patient has the right to full disclosure about his disease and
prognosis and advocate that he be informed. But his family, coming
from another culture may believe they're responsible for protecting
and sparing him from knowledge about a serious illness.
 Similarly, patients may not want to know about
their condition, expecting their relatives to
“take the burden” of that knowledge and
related decision making. If so, you need to
respect their beliefs; don't just decide that
they're wrong and inform the patient on your
own.
 You may face similar dilemmas when a patient refuses pain medication or
treatment because of cultural or religious beliefs about pain or his belief in
divine intervention or faith healing. You may not agree with his choice, but
competent adults have the legal right to refuse treatment, regardless of the
reason. Thinking about your beliefs and recognizing your cultural bias and
world view will help you understand differences and resolve cultural and
ethical conflicts you may face. But while caring for this patient, promote open
dialogue and work with him, his family, and health care providers to reach a
culturally appropriate solution. For example, a patient who refuses a routine
blood transfusion might accept an autologous one.
 Holidays
 People from all cultures celebrate civil and religious
holidays. Get familiar with major holidays for the cultural
groups your facility serves. You can find out more about
various celebrations from religious organizations, hospital
chaplains, and patients themselves. Expect to schedule
routine health appointments, diagnostic tests, surgery, and
other major procedures to avoid such holidays. If their
holiday rituals aren't contradicted in the health care setting,
try to accommodate them.
 Diet
 The cultural meanings associated with food vary widely. For example,
sharing meals may be associated with solidifying social or business ties,
celebrating life events, expressing appreciation, recognizing
accomplishment, expressing wealth or social status, and validating social,
cultural, or religious ceremonial functions. Culture determines which
foods are served and when, the number and frequency of meals, who eats
with whom, and who gets the choicest portions. Culture also determines
how foods are prepared and served, how they're eaten (with chopsticks,
fingers, or forks), and where people shop for their favorite food.
 Religious practices may include fasting, abstaining from
selected foods at particular times, and avoiding certain
medications, such as pork-derived insulin. Practices may
also include the ritualistic use of food and beverages.
(See Prohibited Foods and Beverages of Selected
Religious Groups.)
 Many groups tend to feast, often with family and friends, on
selected holidays. For example, many Christians eat large
dinners on Christmas and Easter and traditionally consume
certain high-calorie, high-fat foods, such as seasonal cookies,
pastries, and candies. These culturally based dietary practices
are especially significant when caring for patients with
diabetes, hypertension, gastrointestinal disorders, and other
conditions in which dietary modifications are important parts
of the treatment regimen.
 Biologic variations
 Along with psychosocial adaptations, you also need to consider
culture's physiologic impact on how patients respond to treatment,
particularly medications. Data have been collected for many years
regarding different effects some medications have on persons of
diverse ethnic or cultural origins. For example, because of genetic
predisposition, patients may metabolize drugs in different ways or at
different rates. For one patient, a “normal dose” of a medication may
trigger an adverse reaction; for another, it might not work at all.
 Think of how antihypertensive drugs don't work as well for
African Americans as they do for white ones.) Culturally
competent medication administration requires you to consider
ethnicity and related factors—including values and beliefs
about herbal supplements, dietary intake, and genetic factors
that can affect how effective a treatment is and how well
patients adhere to the treatment plan.
 Environmental variations
 Various cultural groups have wide-ranging beliefs about man's
relationship with the environment. A patient's attitude toward his
treatment and prognosis is influenced by whether he generally
believes that man has some control over events or whether he's more
fatalistic and believes that chance and luck determine what will
happen. If your patient holds the former view, you're likely to see good
cooperation with health care regimens; he'll see the benefit of
developing behavior that could improve his health. Some American
Indians and Asian Americans are likely to fall into this category.
 In contrast, Hispanic and Appalachian patients tend to be
more fatalistic about nature, health, and death, feeling that
they can't control these things. Patients who believe that
they can't do much to improve their health through their
actions may need more teaching and reinforcement about
how diet and medications can affect their health. Provide
information in a nonjudgmental way and respect their
fatalistic beliefs.
 Recipe for success
 Clearly, you can't take a “cookbook” approach to caring for patients based on
their culture Clearly, you can't take a “cookbook” approach to caring for
patients based on their cultural heritage or background. Transcultural nursing
means being sensitive to cultural differences as you focus on individual
patients, their needs, and their preferences. Show your patients your respect
for their culture by asking them about it, their beliefs, and related health care
practices. They'll respond to your honesty and interest, and most will be
happy to tell you more about their cultureal heritage or background.
Transcultural nursing means being sensitive to cultural differences as you
focus on individual patients, their needs, and their preferences. Show your
patients your respect for their culture by asking them about it, their beliefs,
and related health care practices. They'll respond to your honesty and interest,
and most will be happy to tell you more about their culture
 Overcoming barriers to communication

 Establishing an environment where cultural

differences are respected begins with effective
communication. This occurs not just from
speaking the same language, but also through
body language and other cues, such as voice,
tone, and loudness.
 The Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) requires facilities to have
interpreters available, so your facility should make a list
available. But at times you'll be on your own, interacting
with patients and families who don't speak English. To
overcome the barriers you'll face, use these tips.
 Tips:
• Greet the patient using his last name or his complete
name. Avoid being too casual or familiar. Point to
yourself, say your name, and smile.
• Proceed in an unhurried manner. Pay attention to any
effort the patient or his family makes to communicate.
• Speak in a low, moderate voice. Avoid talking loudly.
Remember, we all have a tendency to raise the volume and
pitch of our voice when a listener appears not to understand.
But he may think that you're angry and shouting.
• Organize your thoughts. Repeat and summarize frequently.
Use audiovisual aids when feasible.
• Use short, simple sentences and speak in the active voice.
• Use simple words, such as “pain” rather than “discomfort.”
Avoid medical jargon, idioms, and slang.
• Avoid using contractions, such as don't, can't, or won't.
• Use nouns instead of pronouns. For example, ask your patient's parent,
“Does Juan take this medicine?” rather than “Does he take this medicine?”
• Pantomime words, using gestures such as pointing or drinking from a cup,
and perform simple actions while verbalizing them.
• Give instructions in the proper sequence. For example, rather than saying,
“Before you take the medicine, get into bed,” you should say, “Get into
your bed, then take your medicine.”
• Discuss one topic at a time and avoid giving too much information in a
single conversation. For example, instead of asking, “Are you cold and
in pain?” separate your questions and gesture as you ask them: “Are you
cold?” “Are you in pain?”
• Validate whether the patient understands by having him repeat
instructions, demonstrate the procedure you've taught him, or act out the
meaning.
• Use any appropriate words you know in the person'slanguage. This
shows that you're aware of and respect his native language.
• See if you have another language in common. For example, many Indo-
Chinese people speak French, and many Europeans know three or four
languages. Try Latin words or phrases, if you're familiar with the language.
• Do what you can to pick up a language that many patients in your area
speak. Get phrase books from a library or bookstore, make or buy flash
cards, or make a list for your bulletin board of key phrases everyone on
staff can use. Your patients will appreciate your efforts, and you'll be
prepared to provide better care.
 Prohibited foods and beverages of selected religious groups

Hinduism

Allmeats
Animal shortenings

Islam

Pork

Alcoholicproducts and beverages (including extracts containing alcohol, such as vanilla

and lemon)
Animal shortenings

Gelatin made with pork, marshmallow, and other confections made with gelatin
 Judaism
 Pork
 Predatory fowl
 Shellfish and scavenger fish (shrimp, crab, lobster, escargot, catfish). Fish with fins and
scales are permissible.
 Mixing milk and meat dishes at same meal
 Blood by ingestion (blood sausage, raw meat); blood by transfusion is acceptable.
 Note: Packaged foods will contain labels identifying kosher (“properly preserved” or
“fitting”) and pareve (made without meat or milk) items.
 Mormonism (Church of Jesus Christ of Latter-Day Saints)
 Alcohol
 Tobacco
 Beverages containing caffeine stimulants (coffee, tea,
colas, and selected carbonated soft drinks)
 Seventh-Day Adventism
 Pork
 Certain seafood, including shellfish
 Fermented beverages
 Note: Optional vegetarianism is encourage
 Importance of Transcultural Nursing

1)There is a marked increase in the migration of
people within and between countries world wide.
 2) There has been a rise in multicultural identifies,
with people expecting their cultural belief, values,
and lifeways to be understood and respected by
nurses and other health care providers

3)The increased use of health care technology
sometimes conflicts with cultural values of clients.
 4)World wide there are cultural conflicts, clashes, and
violence that have an impact health care as more
cultures interact with one another
 5) There was an increase in legal suits resulting from cultural
conflict, negligence, ignorance, and imposition of health care
practices.
 6) There is an increase in the number of people travelling
and working in many different parts of the world.
 7) There has been a rise in feminism and gender issues, with
new demands on health care systems to meet the needs of
woman and children

8)There has been an increased demand for
community and culture based health care services in
diverse environmental contexts.
 MODELS OF TRANSCULTURAL
NURSING
 To help develop, test and organize the emerging body of
knowledge in Transcultural Nursing, it is necessary to have a
conceptual framework from which various theoritical
statements can emerge.  There are two popular models
widely used in the field 
 Leininger’s Sunrise Model 
 The Giger and Davidhizar: ‘Transcultural Assessment
Model’
 LEININGER’S SUNRISE MODEL
 The model is based on the concept of culture care and shows 3 major
nursing modalities that guide nursing judgments and activities to provide
‘Culturally Congruent Care’ 
 3 major modalities are
 1 Cultural care preservation/ Maintainance
 2) Cultural care Accommodation/Negotiation
 3) Cultural care Repatterning /Reconstructing
 Culturally Congruent Care: The care that is beneficial and meaningful to the
people being served.
 Culturally Diverse Nursing Care: An optimal mode of health care delivery; It
refers to the variability of nursing approaches needed to provide culturally
appropriate care that incorporates an individuals cultural values, beliefs and
practices including sensitivity to the environment from which the individual
comes and to which the individual ultimately return.
 THE GIGER AND DAVID HIZAR
TRANSCULTURAL ASSESSEMENT MODEL
 This model was developed in 1988 in response to the need
for nursing students in an undergraduate program to assess
and provide care for patients that were culturally diverse. 
Giger and Davidhizar have identified six cultural
phenomena that vary among cultural groups and affect
health care.
 Cultural competence in healthcare
 refers to the “ability of systems to provide care to patients
with diverse values, beliefs and behaviors, including the
tailoring of healthcare delivery to meet patients' social,
cultural and linguistic needs.” Being a culturally competent
health system requires behaviors, attitudes and policies
that support effective interactions in cross-cultural
situations.[4]
 Cultural competence has predominantly referred to the
culture and language of racial and ethnic minority groups,
it is increasing being used to encompass other groups,
such as people with disabilities and the LGBTQ
community among other groups. These populations have
been the primary subjects of studies of cultural
competence interventions.[5] Cultural competence has
also become linked with health literacy, an
acknowledgement that mutual understanding between
patients and providers calls for the integration of
culturally and linguistically competent and health literate
approaches.[2
 Cultural Competence and Patient Safety

 Disparities in healthcare extend to the patient safety

arena. For example, a study that looked at hospitals
across the country found that patients with limited
English proficiency were more likely to be harmed than
their English-proficient counterparts when they
experienced adverse events, and that harm was more
likely to be severe.[11] These findings extend to pediatric
populations, such as the study that found that
hospitalized Latino children are more likely to experience
an adverse event than non-Latino white children
 Patient safety events that can result from the failure to address culture,
language, and health literacy include diagnostics errors, missed screenings,
unexpected negative responses to medication, harmful treatment
interactions from simultaneous use of traditional medicines, healthcare-
associated infections, adverse birth outcomes, inappropriate care
transitions, and inadequate patient adherence to provider
recommendations and follow-up visits.
  For example, lack of understanding that a hospitalized
Asian woman would only communicate when a male
family member was present, led to a delay in obtaining
consent for a necessary surgery.[13] With growing
diversity in patient populations across the country, the
risk increases that differences between patients and
providers will contribute to missed care opportunities
and safety events.
Approaches to Improving Cultural Competence
 1. Language Assistance
 Language assistance, a strategy to overcome language barriers,
can take the form of bilingual clinicians and staff and qualified
foreign language and American Sign Language interpreters.[16]
 Successful language assistance relies on the adequacy of the
supply of interpreter services, policies on using them, and
training on how to access and work with interpreters. 
 2. Cultural Brokers
 Using a cultural broker is one potential strategy to enhance cultural
competence in healthcare. Cultural brokerage is the mediation between
the traditional health beliefs and practices of a patient’s culture and the
healthcare system.[18],[19] Interpreters, community health workers, and
patient navigators can play the role of a cultural broker by providing
context and by serving as a partner for both the patient and provider.
While the role of the cultural broker can vary depending on patient and
provider need, cultural brokers must be knowledgeable about the
cultural group they serve and be able to successfully navigate the
healthcare system. 
 3. Cultural Competence Training
 Cultural competence training programs aim to increase
cultural awareness, knowledge, and skills, leading to
behavior change.[20] Most reviews of cultural competence
training conclude that training has positive impacts on
provider outcomes, but as a standalone strategy training
may insufficient to improve patient outcomes without
concurrent systemic and organizational changes.[21]
 How Culture Influences Health

• Culture is a pattern of ideas, customs and behaviours shared by a

particular people or society. It is constantly evolving.
• The speed of cultural evolution varies. It increases when a group
migrates to and incorporates components of a new culture into their
culture of origin.
• Children often struggle with being ‘between cultures’– balancing the
‘old’ and the ‘new’. They essentially belong to both, whereas their
parents often belong predominantly to the ‘old’ culture.
• One way of thinking about cultures is whether they are
primarily ‘collectivist’ or ‘individualist’. Knowing the
difference can help health professionals with diagnosis and
with tailoring a treatment plan that includes a larger or
smaller group.
• The influence of culture on health is vast.  It affects
perceptions of health, illness and death, beliefs about causes
of disease, approaches to health promotion, how illness and
pain are experienced and expressed, where patients seek
help, and the types of treatment patients prefer. 
• Both health professionals and patients are influenced by their respective
cultures. Canada’s health system has been shaped by the mainstream beliefs
of historically dominant cultures.
• Cultural bias may result in very different health-related preferences and
perceptions. Being aware of and negotiating such differences are skills known
as ‘cultural competence’. This perspective allows care providers to ask about
various beliefs or sources of care specifically, and to incorporate new
awareness into diagnosis and treatment planning. 
• Demonstrating awareness of a patient’s culture can promote trust, better
health care, lead to higher rates of acceptance of diagnoses and improve
treatment adherence.
 How culture influences health beliefs

 All cultures have systems of health beliefs to explain what causes

illness, how it can be cured or treated, and who should be involved
in the process. The extent to which patients perceive patient
education as having cultural relevance for them can have a
profound effect on their reception to information provided and their
willingness to use it. Western industrialized societies such as the
United States, which see disease as a result of natural scientific
phenomena, advocate medical treatments that combat
microorganisms or use sophisticated technology to diagnose and
treat disease.
 Asians/Pacific Islanders are a large ethnic group in the United
States. There are several important cultural beliefs among
Asians and Pacific Islanders that nurses should be aware of. The
extended family has significant influence, and the oldest male in
the family is often the decision maker and spokesperson. The
interests and honor of the family are more important than those
of individual family members. Older family members are
respected, and their authority is often unquestioned. Among
Asian cultures, maintaining harmony is an important value;
therefore, there is a strong emphasis on avoiding conflict and
direct confrontation.
 Russian immigrants frequently view U.S. medical care with a degree
of mistrust. The Russian experience with medical practitioners has
been an authoritarian relationship in which free exchange of
information and open discussion was not usual. As a result, many
Russian patients find it difficult to question a physician and to talk
openly about medical concerns. Patients expect a paternalistic
approach-the competent health care professional does not ask
patients what they want to do, but tells them what to do. This
reliance on physician expertise undermines a patient’s motivation to
learn more about self-care and preventive health behaviors.
 Hispanics share a strong heritage that includes family and religion, each subgroup of
the Hispanic population has distinct cultural beliefs and customs. Older family
members and Hispanics share a strong heritage that includes family and religion, each
subgroup of the Hispanic population has distinct cultural beliefs and customs. Older
family members and other relatives are respected and are often consulted on important
matters involving health and illness. Fatalistic views are shared by many Hispanic
patients who view illness as God’s will or divine punishment brought about by previous
or current sinful behavior. Hispanic patients may prefer to use home remedies and may
consult a folk healer, known as a curandero.other relatives are respected and are often
consulted on important matters involving health and illness. Fatalistic views are shared
by many Hispanic patients who view illness as God’s will or divine punishment brought
about by previous or current sinful behavior. Hispanic patients may prefer to use home remedies and may
consult a folk healer, known as a curandero.
 Many African-Americans participate in a culture that centers on
the importance of family and church. There are extended kinship
bonds with grandparents, aunts, uncles, cousins, or individuals
who are not biologically related but who play an important role in
the family system. Usually, a key family member is consulted for
important health-related decisions. The church is an important
support system for many African-Americans.
 Cultural aspects common to Native Americans usually
include being oriented in the present and valuing
cooperation. Native Americans also place great value on
family and spiritual beliefs. They believe that a state of
health exists when a person lives in total harmony with
nature. Illness is viewed not as an alteration in a
person’s physiological state, but as an imbalance
between the ill person and natural or supernatural
forces. Native Americans may use a medicine man or
woman, known as a shaman.
 Cultural differences affect patients‘ attitudes about medical care
and their ability to understand, manage, and cope with the course
of an illness, the meaning of a diagnosis, and the consequences of
medical treatment. Patients and their families bring culture specific
ideas and values related to concepts of health and illness, reporting
of symptoms, expectations for how health care will be delivered,
and beliefs concerning medication and treatments. In addition,
culture specific values influence patient roles and expectations, how
much information about illness and treatment is desired, how death
and dying will be managed, bereavement patterns, gender and
family roles, and processes for decision making.
 Transcultural Perspective in child
bearing
 to improve the ability of healthcare providers to assess and
meet the sociocultural needs of childbearing families of
diverse cultural and social groups. The content of this course
is applicable to nurses and occupational therapists.
 Health care providers should be
 Discuss the relationship of culture, subculture, acculturation,
assimilation, ethnocentrism, and cultural relativism to healthcare
practice.
 Recognize a variety of ethnic and cultural beliefs and practices
related to childbearing and family.
 Identify needs unique to culturally diverse families who adhere to
traditional beliefs and practices regarding childbearing.
 Childbirth is a time of transition and social celebration in all
cultures.
 Culture also influences the experience of perinatal loss because
the meaning of death and rituals surrounding death are culturally
bound. Healthcare beliefs and health-seeking behaviors
surrounding pregnancy, childbirth, and parenting are deeply
rooted in cultural context. Culture is a set of behaviors, beliefs,
and practices, a value system that is transmitted from one
woman in a cultural group to another (Lauderdale, 2007).
 It is more than skin color, language, or country of origin. Culture
provides a framework within which women think, make decisions,
and act. It is the essence of who a woman is. The extent to which a
woman adheres to cultural practices, beliefs, and rituals is complex
and depends on acculturation and assimilation into the dominant
culture within the society, social support, length of time in the
United States or Canada, generational ties, and linguistic preference.
Even within individual cultural groups, there is tremendous
heterogeneity. Although women may share a common birthplace or
language, they do not always share the same cultural traditions (
Moore, Moos, & Callister, 2010).
 AFRICAN AMERICAN/BLACK
 Geophagia (ingestion of soil, chalk, or clay) may be present
during pregnancy
 Strong extended family support
 Matriarchal society
 Present time orientation
 May engage in folk practices (“granny,” “root doctor,” voodoo
priest, spiritualist) depending on background
 Tend to seek prenatal care after the first trimester
 AMERICAN INDIAN AND NATIVE ALASKAN
 Healthcare decision making by families/tribal leaders
 Often stoic; don’t make eye contact, limit touch
 Strong spiritual foundation
 May utilize a medicine man or shaman
 Present time orientation
 ASIAN AMERICAN AND PACIFIC ISLANDER
 Culturally and linguistically heterogeneous
 Healthcare decision making by families
 “Hot/cold” theory of illness (pregnancy considered a “hot” condition,
except among Chinese women, who consider it a “cold” condition)
 Hot or cold theory – gisease imbalance)
 Asians are often stoic.( means a person can endure pain or hardship
without showinh their feeling or complaining)
 Strong extended family support
 Asian fathers may choose not to attend the birth.
 Chinese postpartum focus on “doing the month”
 HISPANIC/LATINO
 Healthcare decision making by families
 Strong extended family support
 Prenatal care may not be valued because pregnancy is a healthy state.
 Enjoy strong extended family support
 Fathers may choose not to attend the birth.
 May use folk healers and Western medicine concurrently (curandero,
espiritualista, yerbero)
 Present time orientation
 Believe in the “evil eye”
 Postpartum maternal/newborn dyad vulnerable or delicate
 WHITE/CAUCASIAN
 Often considered a noncultural group
 Value autonomy and personal decision making
 Eastern European women avoid cutting or
coloring hair during pregnancy.
 Future time orientation
 Focus on achievement
 Transcultural Perspective in Nursing care of
Children

 The healthcare staff in paediatric care is challenged by

people from various ethnic backgrounds. The challenge is
related to providing culturally competent care and
effectively communicating with people from diverse
cultural and ethnic backgrounds who have different health
beliefs, practices, values and languages
 Language barrier, social and cultural differences between
care providers and patients are some of the challenges in
cross-cultural care encounters AMONG CHILDREN These
challenges have been related to healthcare professionals’
level of understanding and respect for the patients’ values
and feelings, diversity in populations, lack of resources,
prejudices and biases. Challenges also include caregivers’
lack of familiarity with cultural diversity and patients’
unfamiliarity with the healthcare system in the context of
the new country.
 This also to child care in Sweden. Knowledge of cross-
cultural care encounters is a necessity in Sweden with its
population of 9.6 million, including 1.5 million first-
generation immigrants and half-a-million second-
generation immigrants.

 Many studies highlight the importance of cultural

background, language and religion in the care of families.
Immigrant parents of children in the hospital emphasise
the importance of care providers respecting their cultural
norms and values and of care providers learning
culturally competent strategies to comfort families during
their difficult times in the hospital
 The increasing diversity in the Swedish population
means that nurses in paediatric care encounter a large
number of children and parents from different
cultures. According to a Swedish study, foreign-born
parents often feel that they are in a position of
powerless dependence in relation to healthcare staff in
the Swedish paediatric care.

, It
is important to address the minority ethnic parents’ own
experiences and expectations of culturally competent care as
well as their experiences of cross-cultural care encounters in the
Swedish healthcare context. The term minority ethnic parent is
used to include not only those who migrated to a country but
also those who were born in a country and describe their ethnic
background as other than that of the majority population. This
study will describe minority ethnic parents’ experiences and
expectations of care encounters and culturally competent care
in a multi-ethnic society such as Sweden.
 Transcultural Perspective in Nursing
care of the Adults
 Longer life spans and the aging Baby Boomer generation will
lead to large population of older adults aged 65 years old and
older who will seek services.
 Delivering culturally appropriate care to clients is set by how
available and affordable national, state, and local health care
resources for older adults.
 and affordable national, state, and local health care resources for older adults.

There are three areas of influences for older adults that guide
their help seeking behaviors:
a. Societal and economic factors; affordability and accessibility
b. Cultural
values, practices, patterns of caregiving and
available community resources
c. Family, individual lifestyles, health, and coping behaviors
 Societal Level
a. Demographics – ethnicity and income level, low literacy
b. Socioeconomic status – fixed income, increased health-
related expenses, delayedretirement
c. Theories of Aging – Explain patterns of behavior
 Cultural Level
 O Differences in culture and ethnicity shape health and illness
behaviors and actions
O Specifically:
Physical functioning – Mobility/exercise
Social and emotional well-being: Acculturation, family/peer
support
Quality of life – Satisfaction and happiness
Beliefs and practices – Remedies, traditional healers, self-
care
 Older adults continue to meet developmental
tasks:
 Satisfaction of basic needs, such as safety, security and dignity
 Fulfillment of integrity and self-actualization
 Maintaining self-esteem and choice about where he/she will live
 Engaging in meaningful activityoMay embrace increased
religion/spirituality
 Continuum of Care
 oOlder adults generally require three types of care:
Intensive personal health services
Health maintenance and restorative care
Coordinated services
 oNurses assess that values of independence and self-reliance may be very
strong for some older clients; they may refuse any assistance;
the nurse should evaluate clients’ behaviors relative to underlying issues
 Community-based services for older adults
oIn home care
Skilled nursing facility, assisted living
Community resources: home delivered meals
Local or church-affiliated volunteer visitors
Day programs in communities and adult day care
Volunteering within the community and the educational system
 CULTURAL DIVERSITY IN
HEALTHCARE WORKFORCE
 What is cultural diversity in health care?
 The ability of healthcare providers to offer services that meet the
unique social, cultural, and linguistic needs of their patients. In short,
the better a patient is represented and understood, the better
they can be treated.
 Understanding the Benefits of Diversity for the Healthcare
Workforce and for Patients

 Diversity: It’s important in life, it’s important in culture, and

it’s incredibly important in healthcare. So important, in fact, that lives literally
depend on it.
 Think of the countless individuals who enter hospitals and clinics every day
looking for help. They include people from every race, creed, gender, and age
—a melting pot of humanity. And to best communicate, understand, and treat
those patients with the best care possible, it’s vital they see themselves within
the healthcare workforce.
 What is Diversity in Healthcare?

 Diversity in any workplace means having a workforce comprised of

multiple races, ages, genders, ethnicities, and orientations. In other
words, it refers to when the medical and administrative staff of a
healthcare facility represents a wide range of experiences and
background.
 In modern society, healthcare diversity can refer to a number of
qualities, including but not limited to the following characteristics:
 Characteristics:
• Race Religion
• Ethnicity Political beliefs
• Gender Education
• Age Physical abilities and
disabilities
• Sexual orientation Socio-economic status
• Eduaction
 Even military service is considered a unique background
and experience that should be included in diversity.
 Espousing diversity in healthcare can lead to cultural
competency, the ability of healthcare providers to offer
services that meet the unique social, cultural, and linguistic
needs of their patients.
 In short, the better a patient is represented and understood,
the better they can be treated.
 Why is Healthcare Diversity So Important?
 Diversity in the workplace carries a host of benefits for healthcare employers,
their staff, and their patients. Those benefits include:
 A. Higher Employee Morale
 Diversity creates a stronger feeling of inclusion and community for healthcare
workers, which makes the workplace feel safer and more enjoyable.
 B. Better Care for Diverse Populations
 A healthcare staff should be as diverse, if not more diverse, than the patient
base they are treating. This helps ensure that no matter who walks through
the door, there is someone on staff who can identify with them, communicate
with them, and better serve their individual nee
 C. Higher Employee Retention
 This goes hand-in-hand with improved morale. The
happier and safer healthcare workers feel in the
workplace, the longer they will stay.
 D. Better Recruitment
 A commitment to diversity helps when recruiting new
healthcare workers and administrative staff. It allows
you to cast a wider net to attracted new talent and it
offers a stronger hiring proposition for candidates
who may consider working at your hospital or clinic.
 E. Stronger Individual Motivation
 When there is a lack of diversity, minority healthcare workers
may feel stifled or unable to express their unique talents and
personality traits. This is a natural inclination for people
when they are more concerned with fitting in as opposed to
“being themselves.” That added pressure can lead to
increased stress, reduced morale, and it may event inhibit
them from speaking up when their perspective is needed most.
A diverse work environment sends the message that a
worker’s cultural and ethnic background is an advantage that
should be respected, if not celebrated.
 F. Better Problem Solving
 A wide range of perspectives can lead to more creative solutions when solving
problems during an emergency or even during routine patient-care. Allowing
for new ideas and diverse perspectives can also lead to greater innovation and
operational excellence.
 G. Better Results
 As illustrated by our section on healthcare diversity statistics, diverse
healthcare teams get better results, period. This shows that medical teams who
embrace diversity provide better healthcare.
 Final note on the benefits of healthcare diversity—
 It’s worth mentioning that while diversity is important, diversity without inclusion
is ineffective. Not only do healthcare teams need to represent a variety of
backgrounds, but each member needs to be given a voice.
 What are the Risks of Lacking Healthcare Diversity?
 1. Communication Breakdown
 Be it the result of a language barrier, differences in philosophy, differences in
cultural norms (& expectations), or even cultural bias, lack of diversity can
lead to communication breakdown with patients. And when patients cannot
fully communicate or express their needs, dangerous mistakes can occur.

 2. Limited Perspectives
 Lack of healthcare diversity can lead to limited perspective when providing
patients with medical care, psychological treatment, and social support. It can stunt
innovation and creative thinking, but more importantly, it could impede critical
observations surrounding a patient’s diagnosis, medical history, or other socio-
economic factors that may affect their health and well-being.
 3. Lack of Role Models
 Mentorship plays a critical role in our medical system. Doctors, nurses,
medical assistants, and administrative personnel will always need the
support of a mentor to guide them in their respective professions. It’s
important for healthcare workers to have role models they can look up to
and emulate throughout their careers. A lack of diversity can make it
difficult for minority healthcare workers to find mentors with whom they
identify and learn from. In turn, this can thwart their professional
growth and their ability to provide the best patient care.
 4. Lack of Future Diversity
 Albeit an obvious consequence, it is an important one to the future success
of any healthcare organization. The less diverse your medical staff is today,
the harder it will be to foster it within your team tomorrow.
 5. Bias
 Bias does not always have to be explicitly expressed within a healthcare
setting for it to become a problem. Bias can still impact decisions made for
patients when it is embedded in the policies and procedures of a healthcare
organization. This is referred to implicit bias within a system. Greater
diversity can stymie the destructive effects of implicit bias in patient care.
 How to Promote Diversity in Healthcare
 Here of some of the ways members of a healthcare staff can promote diversity in the workplace.
 1. Create a Welcome Environment
 Foster an environment of inclusiveness in every area possible. Make sure
that all voices are heard, and that all coworkers feel safe to share their
perspectives.
 2. Address Issues of Bias Quickly and Openly
 Often the victims of bias or discrimination are reluctant to come forward
themselves for fear of repercussion or other forms of retaliation. Supporting
co-workers in these times and reporting cases quickly and transparently are
vital to creating a safe working environment for everyone.
 3. Encourage Diverse Applicants
 Do you know someone who would be a wonderful fit in the
healthcare community? Encourage them to pursue their
dreams!
 4. Diversity for More Than Diversity’s Sake
 Always remember, the point of encouraging diversity in your
hospital or clinic isn’t to have a diverse hospital or clinic… it’s
to have a better hospital or clinic. As explained above, a diverse
workforce can provide a rich array of experiences and
understanding that can only enhance the patient-care
experience and draw more success to your hospital or clinic.
 5. Listen
 Sometimes the best action you can take to promote diversity and
creating an open work environment is by
simply listening. Listening (without interjecting or suggesting fixes)
helps each of us understand new perspectives, opens our minds to
unseen needs, and shows co-workers or patients that their opinion
matters.
 Diversity Training
 Another way to nurture greater diversity in a healthcare staff is
through diversity and cultural competence training.
 Diversity training helps by:
• 1. Increasing cultural understanding and skills
• 2. Teaching how to respond to cultural differences
• 3. Increasing awareness of personal and subconscious biases
• 4. Identifying potential barriers to care
• 5. Improve intercultural communication skills
 Diversity is Vital to Patient Care
 Creating diversity in healthcare isn’t just important, it’s vital. Language,
culture, and ethnicity can easily create barriers, and in an industry where
lives hang in the balance and every second could mean the difference
between life and death, delays and obstacles can quickly become deadly.
 But diversity isn’t something that can be created overnight. It requires a
leadership dedicated to increasing cultural awareness and inclusion. It
requires co-workers who are willing to take the time to learn about each
other. It means being willing to identify and address personal biases. And
it means boldly opening ourselves up to discomfort for the greater good of
our patients.
Transcultural aspects of pain perception and pain management

 The perception and the expression of pain are dependent on

the socialization of the patient, his or her health literacy and
his or her ability to name and localize pain. Patients who grew
up in a western medical system know the expectations of
doctors/ physicians/ health care workers or nurses to exactly
localize and describe the pain, while patients from other
cultural backgrounds might not be acquainted with the same
codes and rather experience and describe pain as whole-body
phenomenon.
 Through the expression of pain many things can be transmitted that
are not necessarily organ-centered. Headache can be an idiom of
distress for overload, helplessness, and perceived loss of control.
Pain is also differently perceived if the cause of pain is rooted in e.g.
traumatizing experiences or pain is caused by an illness. These often
very complex circumstances are important for therapeutic aims and
therapeutic options and need a comprehensive bio-psycho-social
approach and the active involvement of the patient and his lived
world.
 Japanese patients use fewer pain meds than comparable patients elsewhere, and
doctors prescribe fewer. Global makers of pain treatments have struggled to get
underneath this fact and explain why their global marketing strategies don’t take hold.
 When we want to know why patients, doctors or caregivers are behaving a certain way,
we look for elements of the cultural playbook that they’re manifesting. Ethnographic,
observational, in-context methods are the go-to approaches, with lots of attention to
the semiotic environment that constantly sends out messages about what matters.
 When it comes to pain relief, there at least two cultural principles to consider. One is
Gaman, a concept rooted in Zen Buddhism. It means ‘perseverance’ but in reality it
connotes a way of life, a willingness to deny your own wishes for the greater cause of
fitting harmoniously into a group
 What Is Transcultural Nursing?

 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.
 Becoming a Transcultural Nurse
 Transcultural nursing is nursing with a primary focus on care that is
culturally sensitive and inclusive.
 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.
 What Are the Educational Requirements for Transcultural Nurses?

 Transcultural nurses must begin their careers by obtaining

licenses as registered nurses (RNs). Essentially, there are two
educational pathways that lead toward licensure. Prospective
transcultural nurses can begin their educational process by
earning either a four-year Bachelor's of Science in Nursing (BSN)
 or by earning a two-year Associate's Degree in Nursing (ADN).
 Upon obtaining either of these educational degrees, one must
then take and pass the NCLEX-RN (Nursing Council Licensure
Examination). The last step is to apply with the state's licensing
agency to become a fully registered nurse.
 Are Any Certifications or Credentials Needed?
 Because transcultural nursing is a relatively new sub-specialty of
nursing, certification in the field has only been available since
1987. Although certification is an entirely voluntary process, most
employers see it as necessary for employment. A certification in
transcultural nursing demonstrates a registered nurse's
commitment to mastery in the specialty.
 Furthermore, it exhibits to co-workers and future
patients that your knowledge and skill level are both
current and up to par with national standards. Both
advanced and basic transcultural nursing certifications
are available via the Transcultural Nursing Society.
However, those seeking advanced certification in
transcultural nursing will first need to complete a 
master's degree or doctorate in nursing to be qualified.
 Where Do Transcultural Nurses Work?

 Transcultural nurses can be found working in the

following healthcare settings:
• Hospitals
• Community clinics
• Outpatient facilities
 What Does a Transcultural Nurse Do?
 Transcultural nurses seek to provide culturally congruent and
competent care to their patients. Providing culturally congruent care
means providing care that fits the patient's valued life patterns.
 Since this will vary from culture to culture, transcultural nurses are
expected to be familiar with a wide variety of cultures and their
corresponding values.
 Providing culturally competent care refers to the ability of the
transcultural nurse to bridge cultural gaps in caring, as well as
working with cultural contrast to enable clients and families to bring
about meaningful care.
 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:
• A. Communicate with foreign patients and their loved ones
• B. Educate families on patients' medical status
• C. Act as a bridge between a particular patient's culture and
healthcare practice
• D. Determine the patient's cultural heritage and language skills
• E. Determine if any of the patient's health beliefs relate to the cause of their
illness or problem
• F. Collect information on any home remedies the person is taking to treat their
symptoms
• G. Understand the influence of culture, race, and ethnicity on the development of
social and emotional relationships, child rearing practices, and attitude toward
health
• H. Collect information about the socioeconomic status of the family and its
influence on their health promotion and wellness
 How do transcultural Nurses handle
language Barriers?
 When it comes to language barriers, transcultural nurses
need to assess the patient's ability to speak, understand,
and read English. Some patients may understand some
spoken English, but are unable to read instructions that are
in English or vice versa. Assessing individual language
needs helps nurses determine the best way to implement
interventions via translation.
 The best way to ensure healthcare terminology is translated
appropriately is to have qualified interpreter clinical staff
available - ideally in person. Qualified staff should be certified in
translating a particular language, as the focus is on medical
terminology. While patients' family members may be able to
translate, they may not be familiar with medical terminology, and
therefore potentially critical information may be misinterpreted.
Moreover, healthcare facilities may provide written instructions,
patient handouts, and/or electronic communication (such as e-
mail) in different languages.
 There are also language phone lines available. Health care
providers can call an interpreter service and initiate a conference
call in which an interpreter relays all the information. While
helpful, this method can be time-consuming and sometimes non-
clinical personnel are translating. Certain complex medical issues
need further description or explanation, which increases the
chances of interpretation errors. A newer method to overcoming
language barriers is face-to-face language apps. Using an iPod or
similar device, health care providers can get an interpreter for
face-to-face translating.
 How Nurses use Transcultural Nursing of the Job

 Nurses who provide transcultural nursing care for their patients are
nursing professionals who study the relationships of cultural care
from the point of view of professional nurses.
 As transcultural nurses, they provide safe, competent, and
knowledgeable nursing care for those in diverse cultures.  By
studying the similarities and differences of diverse cultures, nurses
can provide nursing care to all human groups. 
 Nurses use transcultural nursing in a number of ways on their
jobs.  The first thing that they need to know is the religion,
language, and cultural heritage of their patients.  This
information can be helpful to determine if any of their cultural
or religious beliefs are the root cause of their current medical
conditions.  
 Some people may exercise their right to use home remedies
based on their cultural beliefs, and these remedies may have
lead to their illness.  It is the transcultural nursing knowledge
that can prevent the patient’s condition from worsening.
 Certain religious and cultural groups do not believe in ingesting
certain medications that may contain ingredients that are
prohibited in their particular religious and cultural
groups.   Nurses use their transcultural nursing skills to identify
these aspects of their cultures and religions to prevent
violating their beliefs.
 Some cultures believe that the male is the dominant figure and
should provide medical treatment to patients.  Nurses need to
know this information so that they can make the adjustments
needed to care for these patients.
 Nurses also use transcultural nursing when caring for the mental
health of their patients.  They need to know that certain cultures
believe that certain mental conditions take place because of a
lack or religions harmony, and these individuals may not believe
that factors other than medical treatment and therapies can
alleviate their bodies of these mental conditions.   I
 It is important to understand the diverse religions and cultures of
each patient to provide care that does not violate any of their
cultural and religious beliefs. 
 How to Study for Transcultural Nursing in Nursing School

 The diverse cultural and religious groups create a need for

nursing students to understand how these groups operate to
provide nursing care.  Here are a few tips that can help
students prepare to study for transcultural nursing
examinations.
• Study various cultures and religions. It is easy to find information on
other cultures and religions to prepare for the course exams. The
Internet, novels, and special groups can all provide insight on various
cultures and religions.
• Volunteer to provide transcultural nursing care.  The best way to
learn about transcultural nursing is to volunteer in medical facilities.
Nursing student can learn from the patients and the experienced
nursing staff.
• Create diverse study groups. Study groups that consist of those
from diverse groups can provide some insight on transcultural
nursing content.  Nursing students can use each other as study
tools.
 Transcultural nursing provides specialized care for a diverse group
of people.  The course prepares nurses for the difficult task of
providing care and treatment for those with varying religious and
cultural health needs. Nursing students are prepared to work in
medical facilities across the world providing diverse nursing care.