TRANSCULTURAL NURSING BY JOHN RICHARDSON SELWYN HOUNIUHI MIH

TRANSCULTURAL NURSING BY JOHN RICHARDSON SELWYN HOUNIUHI (MIH, BCHN&A, Dip OHSN, Dip THEOLOGY, RN, ATLS, CLSS. ) DIRECTOR OF NURSING SERVICES, NATIONAL REFERRAL HOSPITAL, SOLOMON ISLANDS

INTRODUCTION OUTLINE BACKGROUND AND SIGNIFICANCE LITTERATURE REVIEW DISCUSS THEORITICAL DEVELOPMENT OF TRANSCULTURAL NURSING AND HEALTH CARE. EXAMINE THE CONCEPT AND PRINCIPLES IN TRANSCULTURAL HEALTH CARE. DESCRIBE THE RELEVANCE OF CULTURAL DIVERSITIES TO THE HEALTH CARE DELIVERY. EXPLORE THE METHODS TO PROMOTE CULTURAL COMPETENCE IN TRANSCULTURAL NURSING AND HEALTH CARE.

MADELENE LEININGERS THE FOUNDER OF TRANSCULTURAL NURSING THEORY v. ESTABLISHED FROM 1955 TO 1975. v. THEORY OF DIVERSITY AND UNVERSALITY OF CULTURAL CARE. v SUNRISE MODEL CONCEPT

TOWARDS Nursing Excellence for Universal Health Care. Transcultural nursing

INTRODUCTION TRANSCULTURAL NURSING: A humanistic and scientific area of nursing study and practice. It focuses on how patterns of behaviour in health, illness and caring are influenced by cultural values and beliefs of specific groups. It require providers to identify cultural specific health care practices to meet the health needs of different cultural groups. It is the blending of anthropological means of inquiry with nursing theories of interventions and practices. Care is the critical component with holistic approach. Care that is culturally appropriate prevents unnecessary conflicts between clients and providers with different cultural backgrounds.

Background and significance an has now been condensed The world is becoming smaller to a global village. Due to improved communication, transportation and off shore opportunities and immigration laws. Result in increasing Migration from developing countries to the developed countries. (AAN 2007) Challenging Nurses and nursing care services globally. People seeking refugees is escalating to an alarming rate. (AAN 2007)-(Australia, PNG, NAURU 2015 -2016)

Background and significance According to Global commission on Internationals Migration 2003. World migration has doubled in the last 25 years. -175 million migrants around the globe In US 2003 the foreign born population was 33. 5 million (11. 7% of US Popn)(US census bureau 2003) In Canada 2001 immigrants were 5. 5 Million (Statistics Canada 2001)

Background and significance Health professionals migration . The WHO in its 2006 report revealed that 4 million nurses, midwives and doctors will be needed to fill the human resource gap in 57 developing countries especially in Oceania and sub-Saharan Africa. • Newman (2001) stated that the World is now faced with major health workforce crisis. Nurses who forms the majority of the health workforce is now becoming a global shortage. (Newman et , al. , 2001) • ICN Estimated that the under supply of nurses will rise from 140, 000 to 800, 000 by 2020 in the USA (ICN 2005) • ICN reports that If the best and brightest nurses are recruited for international work it affects the quality of care of ones own country. (ICN, 2005)

Background & significance • Solomon is not remote to this of migration in search for issue employment. • >20 Nurses migrating for employment in regional countries • • • 2015 - 2016 -> 1500 seasonal workers to Australia 2015 -2016 > 2500 students to Fiji, Vanuatu, PNG, ANZ and other countries in the region. > 100 Asian workers in Logging companies. > 50 workers in Mining and minerals companies Foreign shipping companies (Fishing in our waters) • The Nursing crisis results in poor health care services provision in health facilities • Nurses are leaving the country in search of better job opportunities overseas and locally to non-nursing jobs. • 2009 The National referral hospital bombarded by the Public of poor care (PSSC Report, 2009) • 2009 Vanuatu scheme: 45 nurses registered now returned but only a few return to work • 15 nurses left to Australia, New Zealand, Marshall Islands, Cook Islands & Fiji. • > 10 Nurses left for training-and never return. • This makes recruitment and retention of qualified nurses an ongoing challenge to health service administrator especially in SI causing poor quality of care.

• with their cultural values, When people migrate they move beliefs and life ways. (Leininger, 2007) So health care providers need to be prepared to address their health needs. Although acculturation had been widely used in the health care services several inconsistencies exists in defining the concept. (AAN, 2007) Defining attributes should include interaction between two cultures which includes change, learning, adaptation and socio cultural context. (ICN 2007)

LITTERATURE REVIEW The ever-increasing multicultural population in the Pacific Region poses a significant challenge to nurses providing individualized and holistic care to their patients. (Sam Savage, 2008) This requires nurses to recognize and appreciate cultural differences in healthcare values, beliefs, and customs. (Leininger 1991)

Literature Review A study on finding information on immigrants and refugees concluded that Health care providers working with immigrants and refugees need to find access information related to patient care and direct patients to culturally appropriate health information. (Danielle M. Carlock, 2007). A study done on Korean American found that there is high prevalence of depression and suicide due to differences in language, culture and lifestyle (Paja. Donnelly, 2007) A study on Hispanic acculturation found that acculturation have an effect on all health care practices and outcomes among the Hispanic population. (A. Amelia Siatkowski, 2007) A study on Anglo Americans by Janice Crist and associates 2007 concluded that Interventions must include strategies that preserve important aspects of population culture. ( Janice. D. Crist et al, 2007)

LITERATURE REVIEW Marlene reports that According to the U. S. Bureau of the Census (2000), over 30% of the total population, or one out of every three persons in the United States (U. S. ), is comprised of various ethnicities other than non. Hispanic Whites. (AAN, 2007) Additionally, the U. S. Department of Commerce (2000) projects a steadily growing population of persons from ethnicities other than non. Hispanic Whites, comprising 50% of the whole population by 2050. Yet, while the U. S. population continues to rapidly grow in diversity, nurses have remained a homogenous group. Transcultural nursing is an essential aspect of healthcare today. (Sam savage 2008 )

LITERRATURE REVIEW Approximately 90% of all Registered Nurses are Caucasian. (U. S. Bureau of the Census, 2000), It is estimated that there are only 2% Hispanic Registered Nurses in the nursing profession ((Minority Nursing Statistics, 2005). This statistic highlights that the U. S. has a significant multicultural population today.

Literature review knowledge and skills in Nurses must acquire the necessary cultural competency. Culturally competent nursing care helps ensure patient satisfaction and positive outcomes. It identifies factors that define transcultural nursing and analyses methods to promote culturally competent nursing care. The need for transcultural nursing will continue to be an important aspect in health-care. (Maier-Lorentz et al, 2008)

Literature review the U. S. population and the The escalating cultural diversity in few number of non-Caucasian registered nurses calls attention to the need for addressing the issue of transcultural nursing. Because of the escalating multicultural society in the United States, transcultural nursing is a vital constituent of nursing care, mandating that nurses are culturally competent in their daily practice. Culturally competent nurses have knowledge of other cultural ways and are skilled in identifying particular cultural patterns so that an individualized care plan is formulated that will help meet the established healthcare goals for that patient (Gustafson, 2005).

either we do nothing or do We are now at the crossroads something to help others. All studies reveal that “all health care providers need to be prepared to meet the cultural needs of all clients & Patients. Be prepared to avoid cultural shocks Minimize Ethnocentrism, cultural imposition, cultural blindness, imposing cultural pains on others. Let us not judge others by the color of their skin but let us improve to communicate with them to learn from them.

TRANSCULTURAL NURSING Transcultural nursing has become a key component in Healthcare and a requirement for today's practicing nurses because of the soaring multicultural phenomenon occurring in our global population. (AAN 2007) The need for Transcultural health care has risen due to travel nurses, language barriers and rise in human rights and expectations, cultural conflicts, violence, and law suits. We needs to help others through assisting, supporting them to improve their condition or face death and disability with dignity. We need to be caring and understand the cultural values and cultural practices of our clients or patients.

TRANS CULTURAL NURSING cont. ’ Transcultural Nursing ensures that as professionals we need to consider seriously that: “ No one choose to be born, to the Race they are, the disability they may have, the country they live, the socioeconomic status they are brought up, or the skin color they have. • • • So each individual person deserves to be respected for who they have become. We need to respect how they respond to the different environment and environmental influences. We only provide guidance to them if that influence is harmful to their health and well being” and their environment. …(JRSHOU-2013)

CULTURE, KINSHIP & HEALTH • values Plays an important Culture, Kinship and cultural role in the life and well being of each individual. • Some Values are common and some are unique and others are different from Society to society. • Our cultural believes, values and customs are influenced by both external and internal influences such as our grandparents, family members, friends, teachers, religion. , etc.

Culture and Nursing nurses and other health care The third millennium is challenging professionals to think and act with a global perspective as they encounter and assist people from virtually every place in the world today. Our world has become conceptually smaller yet more complex and diverse. Nurses are now assisting people from many different cultures with their concerns, beliefs, values and way of life. Therefore we need a new field of nursing We need Transcultural nursing world wide. Nurses need to adopt Transcultural concepts, principles and research-based knowledge to function in our present diverse world. Globalization, Transculturalism, Transcultural nursing, cultural congruent care and ideas will become meaningful to nurses as we serve the culturally different.

Culture & Health care Culture and Kinship plays an important role in patient care and health care provision. When ignored it creates gaps resulting. Dissatisfaction –Patients & General Public LOS –increases Costs – Increases Staff burnout Staff depersonalization Staff Migration-resulting in high staff turnover Poor outcome and out put Delivery of care that is culturally appropriate prevents unnecessary conflicts between clients and provider from varied cultural backgrounds. It also increases client satisfaction, improve client adherence to regimen agreed upon by the Nurse.

Transcultural nursing: Its importance in nursing practice. Transcultural nursing is an essential aspect of healthcare today. The ever-increasing multicultural population in the Pacific region poses a significant challenge to nurses providing individualized and holistic care to their patients. This requires nurses to recognize and appreciate cultural differences in healthcare values, beliefs, and customs. Nurses must acquire the necessary knowledge and skills in cultural competency. Culturally competent nursing care helps ensure patient satisfaction and positive outcomes.

Solomon Islands culture In SI culture family is central to our lives. The health and well-being of our families is vital to us. Our unity as a family is central to our lives. Our health system is almost free thus we need to take into serious consideration our Kastom & cultural values.

Culture in SI-Kastom and cultural values – as distinct from the ‘ Kastom - Denotes culture and tradition western way. Kastom includes matters related to social and cultural relationships Based on the fundamental constructs of land bloodlines (including kinship, clan, line, residence and language [wantok – one talk] – critical to the way the country functions. Cultural traditions are continuously in interaction with each other and modern ways. The different demands of Kastom and modernity create an underlying tension that outsiders need to understand (e. g. demands on a person due to funeral arrangements, etc. ) There is cultural diversity both within and between provinces and countries (e. g. Bride price)

SI-Religion the way people think in the Churches have a strong impact on Solomon Islands. Churches play a very strong role in communal life, especially in rural areas. Christian concepts are often invoked in political discourse, even at national level (usual to start a meeting with a prayer) Churches are influential in politics. Churches run and staff health clinics and hospitals and play an active role in education. People are active in church activities and will make relatively substantial contributions to churches. Churches are vehicles for social mobilization.

Family - kinship Extended family (kinship unit) is the relationship based on culturally recognized connections between parents and children, extending to siblings and through parents to more distant relatives. Definition of a relative – different to the way Australians define it – e. g. uncles and aunts have similar authority and responsibilities for children as parents. Strong kinship ties cut across and supersede responsibilities of government, public service, and other modern structures. Associated family responsibilities and obligations – may appear to our western eyes as ‘nepotism Requests and expectations of kin can rarely be denied, creating demands on those in employment and power that lead to misappropriation and corruption.

Culture & Health Need to focus on assessment and analysis of cultural diversities as related to clinical practice. Explore the unique interactions of culture and cultural values. Health believes and the impact these have on the utilization of health care systems. The theory of culture care diversity and universality that forms the basis of the relationship between culture and health.

The danger associated with cultural nursing theories and models is the assumption that people can be categorized, rather than individualized, by virtue of race, culture, and ethnicity. People can not be put into little culturally specific boxes nor labeled by virtue of culture and race. Do not assume that the criteria for a certain cultural group are true for every patient who belong to that racial, ethnic, or cultural group.

Transcultural Nursing area of practice in A humanistic and scientific nursing Focused upon differences and similarities among cultures Respect to human care, health, and illness Based upon the people's cultural values, beliefs, and practices, Use this knowledge to provide cultural specific or culturally congruent nursing care to people. . Leininger

TCN TERMINOLOGIES The main goal of transcultural nursing is to provide culturally specific care. But before transcultural nursing can be adequately understood, there must be a basic knowledge of key terminology such as culture, cultural values, culturally diverse nursing care, ethnocentrism, race, and ethnography…………Leininger (1991)

Culture Refers to norms and practices of a particular group that are learned and shared which guide thinking, decisions, and actions. CULTURAL VALUES The individual's desirable or preferred way of acting or knowing something that is sustained over a period of time and which governs actions or decisions.

Culturally diverse nursing care An optimal model of health care delivery. Refers to the variability of nursing approaches needed to provide culturally appropriate care that incorporates an individuals cultural values, beliefs, and practices. Also including sensitivity to the environment from which the individual comes and to which the individual may ultimately return. (Leininger, 1985)

Ethnocentrism The perception that one's own way is best when viewing the world (Geiger & Davidhizar, 1991). Our perspective is the standard by which all other perspectives are measured and held to scrutiny. ETHNIC Relates to large groups of people classified according to common traits or customs.

RACE Though many definitions there appears to be no exist, established agreement on any scientific definition of race. What we do find though, is the general belief among the scientific community that race has no biological or natural basis ETHNOGRAPHY Is the study of a culture. The methodological approach of ethnographic research central to the nurse's ability to develop a heightened awareness of culturally diverse needs of individuals, To define a field for observation for study of the environment and its people, as well as the reciprocal relationship that exists between the two (Tripp-Reimer & Dougherty, 1985).

STEREOTYPE An ending point. No attempt is made to learn whether the individual in question fits the statement. GENERALIZATION A beginning point. It indicates common trends, but further information is needed to ascertain whether the statement is appropriate to a particular individual.

CULTURAL COMPETENCE needs to understand To be culturally competent the nurse his/her own world views and those of the patient While avoiding stereotyping and misapplication of scientific knowledge. Cultural competence is obtaining cultural information and then applying that knowledge. This cultural awareness allows you to see the entire picture and improves the quality of care and health outcomes. Adapting to different cultural beliefs and practices requires flexibility and a respect for others view points. Cultural competence means to really listen to the patient, to find out and learn about the patient's beliefs of health and illness. To provide culturally appropriate care we need to know and to understand culturally influenced health behaviors.

and their causes varies by The perception of illness and disease culture, These individual preferences affect the approaches to health care. Culture also influences how people seek health care and how they behave toward health care providers. How we care for patients and how patients respond to this care is greatly influenced by culture. Health care providers must possess the ability and knowledge to communicate and to understand health behaviors influenced by culture. Having this ability and knowledge can eliminate barriers to the delivery of health care. These issues show the need for health care organizations to develop policies, practices and procedures to deliver culturally competent care.

Leininger’s Sunrise Model The Sunrise Model: Is relevant because it enables nurses to develop critical and complex thinking These thoughts should consider, and integrate: cultural and social structure dimensions in each specific context, besides the biological and psychological aspects involved in nursing care.

TRANSCULTURAL NURSING SUNRISE MODEL

From these theories it sets the framework for nursing care decisions and guide nursing research and teaching. Anthropology and culture: central to care in nursing. Dr Leininger put culture and care together and called it “CULTURE CARE THEORY’ using the sunrise enabler as a guiding framework with factors at the top of the sunrise model as affecting care. Interestingly we look at theories as it affects generic care and professional care. We cannot provide culturally congruent care without the incooperation of generic care and professional practice. The three concepts of Leininger theory are, Know thyself, Holding Knowledge and Respect others.

Five essential elements that contribute to an institution’s or agency’s ability to become more culturally competent These include: 1. Valuing diversity; 2. Having the capacity for cultural self-assessment; 3. Being conscious of the dynamics inherent when cultures interact; 4. Having institutionalized cultural knowledge; and 5. Having developed adaptations of service delivery reflecting an understanding of cultural diversity. These five elements should be manifested at every level of an organization, including policy making, administration, and practice. These elements should be reflected in the attitudes, structures, policies, and services of the organization. (Cross, T. , Bazron, B. , Dennis, K. , and Isaacs, M. 1989)

PATIENTS CULTURAL ASSESMENT AND CARE MODEL Ethnodermography Ehnohistory Cultural Values and customs Religious/Spiritual Values, Holidays & custom. Generic care practices Professional care practices Cultural care preservations/Maintenance Cultural care accommodation/Negotiations Cultural care repartitioning & restructuring Comparison of cultures to own culture Application to care plan.

TAGIO TUMAS