Transcultural nursing
Transcultural nursing is a specialized approach to nursing that emphasizes the importance of providing culturally sensitive and meaningful health care to individuals from diverse backgrounds. This practice emerged in response to a growing recognition of the role that culture plays in health and well-being, advocating for patient involvement in medical decisions akin to the informed consent process. Pioneered by Madeleine Leininger in the 1950s, transcultural nursing focuses on "culturally congruent care," ensuring that medical practices are appropriate for patients’ cultural contexts, even if they differ from the nurse's own experiences.
The discipline has evolved to incorporate various cultural considerations, such as dietary restrictions and traditional healing practices, and recognizes phenomena like culture-bound syndromes—health conditions that are understood within specific cultural frameworks. Transcultural nursing training includes education on cultural differences and international health issues to equip nurses with skills to address the needs of marginalized populations effectively. This field has expanded beyond nursing to include other health care professionals and has fostered critical discussions about cultural competency in medical practice.
Overall, transcultural nursing aims to create a health care environment that is safe and respectful of the cultural, spiritual, and emotional needs of patients, recognizing that effective care requires meaningful engagement with their unique cultural backgrounds.
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Subject Terms
Transcultural nursing
Transcultural nursing is the study and practice of nursing in and across different cultures with the goal of providing health care to people that is meaningful and beneficial while at the same time culturally sensitive. It is compatible with a broader movement in medicine to make the patient more involved in medical choices. Just as the doctrine of informed consent calls for patients to be as informed as possible about the treatments available to them (rather than leave these choices in the hands of their doctors, as in earlier generations of practice), transcultural nursing involves interacting with the patient on a deeper level by engaging the patient’s culture. A term often used in transcultural nursing is "culturally congruent care," meaning medical care that is culturally appropriate for the patient even if it may be unfamiliar to the nurse, in contrast with earlier paternalistic or antagonistic approaches.
Background
As a nursing theory, transcultural nursing was pioneered by Madeleine Leininger (1925–2012) in the 1950s at a time when the social sciences were maturing, especially in their treatment of cultural power dynamics and the heritage of colonialism. As the European empires were dismantled in the wake of World War II and the civil rights movement sought equal rights and treatment for African Americans and other ethnic minorities, medical science and social work were becoming more porous to their influence. After publishing several papers on the topic and incorporating units on transcultural nursing into other courses, Leininger taught the first transcultural nursing course in 1966 at the University of Colorado.
Leininger’s transcultural nursing theory is sometimes also referred to as the Culture Care theory, especially in texts building on her original works. The Transcultural Nursing Society (TCNS) was founded in 1975, representing a considerable step forward for the discipline, which while always acknowledging Leininger’s considerable influence and importance, was able to expand beyond her personal sphere. Since 1983, transcultural nursing has been taught and practiced in multiple countries and by international organizations.
Training in transcultural nursing involves incorporating into traditional nursing training the teaching of cultural differences (in general), nursing practices in other countries, the particulars of international health organizations, and important international health issues. In 1988 TCNS started offering certification for certified transcultural nurses (CTNs). It also presents the Leininger Transcultural Nursing Award annually to creative leaders in the field. The Journal of Transcultural Nursing began publication in 1989, with Leininger serving as its first editor. The discipline is also supported by the Journal of Multicultural Nursing and Health (formerly the Journal of Multicultural Nursing) and the Journal of Cultural Diversity, both published since 1994.
Overview
Early successes in transcultural nursing involved disseminating simple changes to practices, such as not serving pork to Muslim patients and respecting other food taboos, and offering hot water instead of ice water to Latino patients recovering from surgery because of traditional Latin American practices surrounding hot and cold foods during the healing process.
Conceptually, transcultural nursing and health care overlap with the term culture-bound syndrome, which is used in the health care fields and anthropological literature to refer to symptoms of a nonpathogenic disease recognizable only within a specific culture, without objectively observable biochemical or structural biochemical changes. Older literature used the term folk illness, and limited discussion to developing nations, and traditional health care tended to treat such illnesses as hysteria. Transcultural nursing was the first discipline to take them seriously, though individual practitioners, social workers, and missionaries had done so before, albeit without an articulated theory to work with.
Examples of such culture-bound syndromes include susto, a "fright sickness" found in Latin American cultures, and shenkui, a Chinese anxiety syndrome thought to be caused by the individual’s loss of semen and male energy. Transcultural nurses and other health care practitioners have pointed out that traditional literature on culture-bound syndromes rarely acknowledges that many of the conditions listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) are themselves culture-bound to North America and Western Europe but rarely treated as culture-bound syndromes: that is, certain conditions are treated as normal, mainstream, or orthodox, while others are deemed exotic. One of the goals of transcultural health care is to break down this artificial boundary.
Interest in transcultural health care originated in Leininger’s nursing theory work, but has spread to other medical practitioners, as well as pharmacists, missionaries, social workers, physical therapists, mental health workers, trauma specialists, first responders and disaster relief workers, and policy makers whose work deals with marginalized populations such as American Indians, Native Hawaiians, immigrants, and refugees. Several years after the founding of the TCNS, literature on colonialism, anthropology, and psychiatry encouraged a dialogue that led to the establishment of transcultural psychiatry, addressing psychiatric services in a cultural context and with an eye to cultural and ethnic diversity.
Transcultural nurses are especially equipped to deal with marginalized and vulnerable groups, and those that have had, or come from cultures that have had, inadequate access to health care or other necessary resources. A key element of transcultural nursing is commitment to the belief that health care means receiving care in an environment that promises not only physical and emotional safety, but spiritual and cultural safety as well—concepts that the health care professions had not traditionally addressed until the late twentieth century. Furthermore, culture and care are conceived of as intertwined: properly providing the latter requires understanding and engaging with the former, something taken for granted because it is second nature when both provider and patient come from the same culture.
Bibliography
Andrews, Margaret, and Joyceen Boyle. Transcultural Concepts in Nursing Care. Philadelphia: LWW, 2015. Print.
Giger, Joyce Newman. Transcultural Nursing: Assessment and Intervention. 7th ed., Elsevier, 2017.
Holland, Karen. Cultural Awareness In Nursing and Health Care: An Introductory Text. 3rd ed., Routledge, 2018.
Leininger, Madeleine, and Marilyn McFarland. Transcultural Nursing: Concepts, Theories, Research, and Practice. New York: McGraw, 2002. Print.
Leininger, Madeleine, ed. Caring: An Essential Human Need. Detroit: Wayne State UP, 1988. Print.
McFarland, Marilyn, and Wehbe-Alamah Hiba. Leininger’s Culture Care Diversity and Universality: A Worldwide Nursing Theory. New York: McGraw, 2014. Print.
Munoz, Cora, and Joan Luckmann. Transcultural Communication in Nursing. Clifton Park: Delmar, 2004. Print.
Murphy, Sharon C. "Mapping the Literature of Transcultural Nursing." Journal of the Medical Library Association 94.2 Suppl. (2006): E143–51. NCBI. Web. 22 Aug. 2016.
Potter, Patricia A., Anne Griffin Perry, and Patricia Stockert. Fundamentals of Nursing. St. Louis: Mosby, 2016. Print.
Purnell, Larry. Transcultural Health Care: A Culturally Competent Approach. Philadelphia: Davis, 2013. Print.
"What Is Transcultural Nursing?" University of Texas of the Permian Basin, 17 May 2017, degree.utpb.edu/articles/nursing/what-is-transcultural-nursing.aspx. Accessed 28 Feb. 2018.