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- Rose Bonanno
‘Transcultural nursing is a comparative study of cultures to understand similarities (culture universal) and difference (culture-specific) across human groups’ (Leininger, 1991).
Transcultural Nursing is an area in nursing practice that focuses on how the ideals and principals of particular groups influence their behaviour when they are sick. Diverse cultures may express dissimilar kinds of needs when they are ill, (Gulbu, 2006). Clients will be more willing to accept their treatment when the health care professional can understand their cultural rules, (Pagliuca, Rodrigues, 2012). Being cultural competent is having the approach, awareness and ability to provide appropriate care to different populations, (Loftin et al., 2013). A patient’s perspective has to be seen within the whole context. Community dynamics such as social status and knowledge, distinguish individuals within racial groups, (Weiner et al., 2013). Whether we are French or Canadian, African or Norwegian, straight or gay, Catholic or Muslim, we are a mixture of cultures. Nursing students need to cultivate social skills to care for patients in a multi-cultural world, (Torsvik, Hedlund, 2008). Both the views of others and ourselves are equally essential in the understanding of illness (Simon et al., 2010).
Since I was a very young child I have always been aware that there are ‘different’ people. This was due to the fact that I always remember the British soldiers that used to roam the street and I could always realise that they spoke a language which at the time I did not understand, they wore shoes and clothes which were much different than the few that me or my family had. However in my child’s mind I always associated them with the good things, because although they were different they were of the same skin colour that I was and so it was no big deal if they stopped to talk to me or one of my friends. My parents would not mind when they would stop to say hello or to offer us sweets. As I grew older I realised that although there were differences between the way that we spoke and behaved there were also a lot of similarities. But seeing a coloured soldier was all too different. I would not even lift my eyes to talk to them let alone smile at them. This was due to the fact that my parents used to tell us dramatic stories where the bad guy was always black and so this implanted in me a certain fear of black people.
Growing up and travelling around made me aware of the different races that inhabit our world. In time I became used to seeing different coloured people, different races. However they were just a part of the world around me and I would never give it much thought until the first boat of immigrants started to come to our shores. Since most of them came from African countries, they were mostly dark coloured and ‘different’. And then the unthinkable happened. I had to nurse a ‘black’ patient. The first time that I walked on the ward and saw this black person, sitting in bed, between two white sheets, the first thing that comes to mind is the contrast. And then the problems start coming to mind. He must be dirty, he must carry a lot of infectious diseases, and he must smell. Secondly come the more rational questions. How am I going to communicate? How is he going to communicate back? How can we understand each other? So I did my best to ignore him all day. Luckily I was allocated duties in another part of the ward and so I could continue working without any bother. But my ‘luck’ ran out when one of my colleagues needed to go home early. And so it was now my turn to care for the patient. At some point he needed some water and since he had nothing on his bedside table he had to ring the nurse call. I remember walking up to him a little cautiously as if he might jump on me. I still remember that feeling of adrenaline rush that causes the fight-or-flight reaction after all these years. And then I arrived at his bedside and in low quiet voice, without raising his eyes, he asked for some water. Although I tried not to show it I was surprised. He had spoken to me in English!! That was the first surprise that I had from this thin-looking dark-coloured man. In return I voiced my surprise and asked him where he had come from. He told me that he was from Ethiopia. Although I had met the country in my geography lessons, way back when I was still at school, I hardly knew anything about the country. All that I knew was there somehow there was always a war there and that its capital was called Addis Ababa. I remember recalling Addis Ababa when he told me that his name was Addis.
Addis was a quiet man, softly spoken and of course by himself most of the time. He did not eat me, he did not kill me, and he did not smell foul. Seeing that we could communicate in English, I asked him about his story. He told me that he had run away from his country and that he had left a wife and two sons behind him. He said that he intended to find some work so that he could send money back to his family. He said that he was Orthodox Catholic, which again was another surprise for me. He always bowed his head when I would approach him and I thought that this was because he was shy. Another surprise was that he never ate meat on Wednesday, (and on Fridays as well, I got to know later). I was curious to know whether he missed his family and of course he did. He said that he usually phones them once every month, which again was a surprise to me, and he started telling me the how his wife travels a long distance to go to the city so that he can talk to her.
Encouraging logical reflective thinking is stressed in studies emphasising the benefits of using nursing stories in the course of learning (Torsvik, Hedlund, 2008).
The first experiences that I had with this patient made me stop and think. Why do we think that being somehow different in colour, beliefs or behaviour makes us superior? All in all if we think about people, no-one is really as different from one another as we make out to be. The trend for people to classify others on the basis of their ethnic group, or perceived physical appearance, and then assign social or educational importance to them – whether they are of high class or sub-standard status- is a fact that is well known in the Western culture,(Naylor, 1997). All people have feelings and families who they love. We all bleed when we are hurt, and no matter what colour we are, black or white, yellow or blue, our blood is always red. The idea that had been installed in me when I was young was very wrong and it is alright to accept diversity. Diversity makes the world a more colourful, richer place. However I remember vividly that I did notice at the time that I had never been taught anything about other cultures. The subject was sort of taboo. I feel that we are not prepared about different cultures and different religions. It is very important to know about these different cultures so that we become aware of how we can see to their needs if ever we are nursing them. I used to feel embarrassed when Addis used to bow his head to me. I thought that it was funny; I never knew at the time that it was a sign of respect. When we used to play and pretend that we are the queen did we not bow our head? Adding everything up now, it does make sense. Just like we bow to the queen, Addis was showing me a sense of great respect.
I feel that we are not prepared about different cultures and different religions. Studies show that although transcultural nursing studies and knowledge has been increasing, there still remains an absence of proper schooling methods in regards to this subject,(Mixer, 2008). It is very important to know about these different cultures so that we become aware of how we can see to their needs whenever we are nursing them. I used to feel embarrassed when Addis used to bow his head to me. I thought that it was funny; I never knew at the time that it was a sign of respect. When we used to play and pretend that we are the queen did we not bow our head? Adding everything up now, it does make sense. Just like we bow to the queen, Addis was showing me a sense of great respect. Some sort of national background can help evade misinterpretations and assist help-care professionals to deliver improved care, (Galanti, 2000).
In my opinion there is a need for a Cultural Consultancy Committee. Members would constitute a representative of the ethnic groups which are mainly found on the island. This committee would meet and discuss issues pertaining to their groups. They could also set up policies regarding the issues of communication and other problems that may arise whenever a person from their group is in hospital.
The committee might also be able to organise an annual conference in which information, maybe even in the form of leaflets in given to stakeholders.
They could also create a strategy, to have faith and community centred voluntary groups to whom a person can turn to in case of difficulty.
In its Action Plan to Reduce Health Disparities, (2010), the American Department of Health and Human Services, (DHHS) suggested that ‘activities may include language services, community outreach, cultural competency training, health education, wellness promotion, and evidence-based approaches to manage chronic conditions’.
‘Racial and ethnic minorities often receive poorer quality of care and face more barriers to seeking care, (DHHS, 2010).
Language and lack of education could be a strong barrier to communication. Perception and generalisation might also be tough obstacles. Respect and concern for people who are diverse from us will only be likely when people cultivate a better consciousness, compassion and empathy to others who are unlike us (Nayler, 1997). In a world where working with so many different people is no longer something out of the ordinary, it helps to have an ability to perceive the difference in cultures. Stimulating one’s awareness about gesticulating, the meaning of touch and private space, especially between different sexes and individuals with diverse beliefs, conceding that the quality of voice tone and facial expressions can either scare or comfort a person, will have a positive healing effect on people who are culturally different,( Papadopoulos,2012). Diversity can also be beneficial. It is a store for different ideas on how things are done and a chance to meet people with different thoughts and answers. Culturally experienced health care professionals guarantee patients fulfilment and optimistic outcomes, (Maier-Lorentz, 2008). For health care providers and specifically nurses, the necessity to make suitable and expert care available is acknowledged as vital l in view of the increasing variety among persons that they care for, (Loftin et al.,2013}.
American Department of Health and Human Services ; A Nation Free of Disparities in Health and Health Care, 2010, PG 17, http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
Galanti, G.A., 2000, An introduction to Cultural Differences, West J. Med; 172(5): 335-336, Retrieved June 18thfrom; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070887/
Gulbu,T., 2006, The implications of Transcultural Nursing Models in the Provision of Culturally Competent Care, Icus Nurs Journal, Issue 25, Jan.- Apr, 2006, Pg 1
Leininger, M. Culture care diversity and universality: A theory of nursing. New York: National League for Nursing Pres; 1991.
Loftin, C., Hartin, V., Branson, M., and Reyes, H., “Measures of Cultural Competence in Nurses: An Integrative Review,” The Scientific World Journal, vol. 2013, Article ID 289101, 10 pages, 2013. doi:10.1155/2013/289101
Loftin, C., Hartin, V., Branson,M., Reyes,H., Measures of Cultural Competence in Nurses: An Integrative Review, Scientific World Journal Volume 2013 (2013), Article ID 289101, 10 pages ,http://dx.doi.org/10.1155/2013/289101
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Mixer, S. (2008). Use of the culture care theory and ethnonursing method to discover how nursing faculty teach culture care. Contemporary Nurse: A Journal For The Australian Nursing Profession, 28(1-2), 23-36. doi:10.5172/conu.673.28.1-2.23
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Naylor, L., 1997, Cultural Diversity in the United States., Chapter 11, Race, Ethnicity and Culture, Pg 25., Publishers, Bergin and Garvey, Westport, CT., http://www.questia.com/read/15586212/cultural-diversity-in-the-united-states
Pagliuca, L. M. F., & , Rodrigues, M. E., (2012). Competency to provide cross-cultural nursing care for people with disability: a self-assessment instrument. Revista Brasileira de Enfermagem, 65(5), 849-855. Retrieved June 19, 2014, from http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672012000500020&lng=en&tlng=en. 10.1590/S0034-71672012000500020.
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Simon, M., Chang, E., & Dong, X. (2010). Partnership, reflection and patient focus: advancing cultural competency training relevance. Medical Education, 44(6), 540-542. doi:10.1111/j.1365-2923.2010.03714.x
Torsvik, M. & Hedlund, M. (2008) Cultural encounters in reï¬‚ective dialogue about nursing care: a qualitative study. Journal of Advanced Nursing 63(4), 389–396 doi: 10.1111/j.1365-2648.2008.04723.x
Weiner,L., Grady McConnell, D., Latella,L., Ludi, E., 2013, Cultural and religious considerations in pediatric palliative care, Palliat Support Care. 2013 February ; 11(1): 47–67. doi:10.1017/S1478951511001027.
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