Variant characteristics of culture

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Theories, Models, and Approaches

Larry Purnell, PhD, RN, FAAN

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Cultural Theories, Models, and Approaches

Leininger: First nurse cultural theorist from early 1950s. She states it is for nursing only

Campinha-Bacote: basic simple model without complex constructs but applicable to all healthcare providers. Also has a Biblical based model.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Cultural Theories, Models, and Approaches

Giger and Davidhizar: Nursing only

Purnell: For all health care providers and is an example of a complexity and holographic conceptual model with an organizing framework.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Cultural Theories, Models, and Approaches

Papadopoulous, Tilki, and Taylor Model for Transcultural Nursing and Health

Andrews and Boyle Nursing Assessment Guide

Spector’s Health Traditions Model

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Cultural Theories, Models, and Approaches

Ramsden's Cultural Safety Model

Jeffrey’s Teaching Cultural Competence in Nursing and Health Care: Inquiry, Action, and Innovation

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Leininger’s Theory of Cultural Care

Diversity and Universality

www.madeleine-leininger.com

Leininger described the phenomena of cultural care based on her experiences.

Began in the 1950s with her doctoral dissertation conducted in New Guinea

www.tcns.org and go to theories and then to the Sunrise Enabler and her model is displayed as well as publications.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Transcultural Nursing

"Transcultural nursing has been defined as a formal area of study and practice focused on comparative human-care (caring) differences and similarities of the beliefs, values, and patterned lifeways of cultures to provide culturally congruent, meaningful, and beneficial health care to people.“

Leininger and McFarland text, 3rd ed.,2002, pp5-6.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Leininger: Purpose and Goal

To discover, document, interpret, explain and predict multiple factors influencing care from a cultural holistic perspective.

The goal of the theory was to provide culturally congruent care that would contribute to the health and well being of people, or to help them face disability, dying, or death using the three modes of action.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Leninger: Theoretical Tenets

Leininger’s tenets: Care diversities (differences) and universalities (commonalties) existed among cultures in the world which needed to be discovered, and analyzed for their meaning and uses to establish a body of transcultural nursing knowledge.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Leininger: Assumptions

Care is essence of nursing and a distinct, dominant, central, and unifying focus. Some would say that caring is not unique to nursing.

Care is essential for well being, health, growth, survival, and to face handicaps or death.

Culturally based care is the broadest means to know, explain, interpret, and predict nursing care phenomena to guide nursing care decisions and actions.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Leininger Assumptions

Nursing is a transcultural humanistic and scientific care to serve individuals, groups, communities, and institutions worldwide.

Caring is essential to curing and healing for there can be no curing without caring.

Cultural care concepts meanings and expression patterns of care vary transculturally with diversity and universality.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Leininger Assumptions

Every human culture has generic care knowledge and practices and some professional care knowledge that vary transculturally.

Culture care values, beliefs, and practices are influenced by the (rays of the sun see the Model).

Beneficial, healthy, and satisfying culturally based care influences the health and well-being of individuals, families, groups, and communities within the cultural context.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Leininger Assumptions

Culturally congruent care can only occur when individuals’, groups’, and communities’ patterns are known and used in meaningful ways.

Culture care differences and similarities between professionals and clients exist in all human cultures worldwide.

Culture conflicts, imposition practices, cultural stresses, and pain reflect the lack of professional care to provide culturally congruent care.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Leininger’s Sunrise Enabler to

Discover Culture Care

To view the model go to:

http://leiningertheory.blogspot.com/

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Leininger Orientational Theory Definitions

Cultural Care Preservation or Maintenance: all is well with the patient so encourage to continue what has been done

Cultural Care Accommodation or Negotiation: Needs some change. What is acceptable weight from the patient’s perspective

Cultural Care Repatterning or Restructuring: Practices are deleterious to overall health and need restructured: sexually promiscuous and has not been practicing safe sex

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Cultural Competence in the Delivery of Healthcare Services: A culturally Competent Model of Care

Dr. Josepha Campinha-Bacote but cannot display her model. Go to http://www.transculturalcare.net

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Process of Cultural Competence

Cultural Competence is a process not an event.

The process consist of five inter-related constructs: Cultural desire, cultural awareness, cultural knowledge, cultural skills, and cultural encounter.

The key and pivotal construct is cultural desire.

There is more variation within a cultural group than across cultural groups.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Process of Cultural Competence

There is a direct relationship between healthcare professionals level of cultural competence and their ability to provide culturally responsive health care.

Cultural competence is an essential component in delivering effective and culturally responsive care to culturally diverse clients.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Cultural Desire

. . . Cultural desire is defined as the motivation of the healthcare professional to “want to” engage in the process of becoming culturally competent; not the “have to”.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Concepts

Cultural awareness is the self-examination and in-depth exploration of one’s own cultural background.

Cultural knowledge is the process of seeking and obtaining a sound educational base about culturally diverse groups.

Cultural Skills is the ability to collect relevant cultural data regarding the client’s presenting problem as well as accurately perform a culturally based physical assessment.

Cultural encounter is the process which encourages the healthcare professional to directly engage in face-to-face interactions with clients from culturally diverse backgrounds.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

The Giger and Davidhizar Transcultural Assessment Model

Dr. Joyce Giger

Dr. Ruth Davidhizar (deceased)

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Giger and Davidhizar Assumptions

The Giger and Davidhizar Transcultural Model postulates that each individual is culturally unique and should be assessed according to the six cultural phenomena.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Giger and Davidhizar Communication

Communication embraces the entire world of human interaction and behavior. Communication is the means by which culture is transmitted and preserved. Both verbal and non-verbal communication are learned in one’s culture.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Giger and Davidhizar

Space

Space refers to the distance between individuals when they interact. All communication occurs in the context of space.

Zones of personal space: intimate, personal, social, and consultative and public. Rules concerning personal distance vary from culture to culture.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Giger and Davidhizar

Social Organization

Social organization refers to the manner in which a cultural group organizes itself around the family group. Family structure and organization, religious values and beliefs, and role assignments may all relate to ethnicity and culture.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Giger and Davidhizar

Time

Time is an important aspect of interpersonal communication.

Cultural groups can be past, present, or future oriented.

Preventive health requires some future time orientation because preventative actions are motivated by a future reward.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Giger and Davidhizar Environmental Control

Environmental control refers to the ability of the person to control nature and to plan and direct factors in the environment that affect them.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Giger and Davidhizar

Biological Variations

Biological differences, especially genetic variations, exist between individuals in different racial groups.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Boyle and Andrews Culturological Assessment

Biocultural variations and cultural aspects of the incidence of disease

Communication

Cultural affiliations

Cultural sanctions and restrictions

Developmental considerations

Economics

Educational background

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Boyle and Andrews Culturological Assessment

Health related beliefs and practices

Kinship and social networks

Nutrition

Religion and spirituality

Values orientation

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Ramsden Cultural Safety

"the effective nursing practice of a person or a family from another culture, as determined by that person or family", while unsafe cultural practice is "any action which diminishes, demeans or disempowers the cultural identity and wellbeing of an individual" (Nursing Council of New Zealand (NCNZ).

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Ramsden Cultural Safety

http://culturalsafety.massey.ac.nz/RAMSDEN%20THESIS.pdf

Assumes that nurses and the culture of nursing is exotic to people

Gives the power of definition to the person served

Concerned with human diversity

Focus internal on nurse or midwife, exchanges power, negotiated

A key part of Cultural Safety is that it emphasises life chances rather than life styles

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Papadopoulos, Tilki, and Taylor

Cultural Awareness

Self awareness

Cultural identity

Heritage adherence

Ethnocentricity

Stereotyping

Ethnohistory

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Papadopoulos, Tilki, and Taylor

Cultural Knowledge

Health beliefs and behaviours

Anthropological, Sociological,

Psychological and Biological understanding

Similarities and differences

Health Inequalities

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Papadopoulos, Tilki, and Taylor

Cultural Sensitivity

Empathy

Interpersonal/communication skills

Trust

Acceptance

Appropriateness

Respect

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Papadopoulos, Tilki, and Taylor

Cultural Competence

Assessment skills

Diagnostic skills

Clinical Skills

Challenging and addressing prejudice, discrimination, and inequalities