Introduction
As the dynamics of our world are continually changing and becoming more multicultural, healthcare providers are facing a challenge in providing cultural competent care to this multicultural population. Dr. Madeleine M. Leininger was the first to use the term “transcultural nursing” (TCN) in describing the blending of anthropology and nursing into a specialization in nursing. Anthropology is the scientific study of humans, past and present. Building on the physical, biological, social sciences and humanities, anthropologists use this knowledge to find solutions to human problems. Using the combined studies of nursing and anthropology, Dr. Leininger established TCN as a theory and evidence-based formal area of study and practice within nursing that focuses on people’s culturally based beliefs, attitudes, values, behaviors, and practices related to health, illness, healing and human caring (Leininger, 1991, 1995).
Learning objectives for the module:
Upon completion of the module, students will be able to:
- Define transcultural nursing.
- Discuss the contributions of transcultural theories to the advancement of transcultural study and practice.
- Explore the national standards for culturally and linguistically appropriate services in healthcare.
- Compare individual advanced practice cultural competence and organizational cultural competence.
Readings:
- Andrews & Boyle, J. Chapters 1,2
Websites:
- The Model of Cultural Competence Through an Evolutionary Concept Analysis: http://tcn.sagepub.com/content/15/2/93.full.pdf+html
Communication Between Cultures: http://www.youtube.com/watch?v=AlMf_RGlaQU
Topic 1: Theories of Transcultural Nursing
For over 50 years nurses have recognized the necessity to provide culturally specific care to a population that is increasingly becoming more racially and culturally diverse. Based on the knowledge that various races and cultures have different needs and requirements the need to develop culturally competent nursing care continues. In order to provide nurses with the foundations to be knowledgeable about the various cultures being seen in their practices transcultural models have been developed. Perhaps the most notable theorist, Dr.Madeline Leininger has provided the basic foundation for cultural competency in nursing practice. Other models by Purnell, and Giger and Davidhizer are also commonly used nursing cultural models.
Using any of these models allows nurses at all levels to gain knowledge and provide culturally competent care. Having a greater nursing knowledge of the culturally diverse needs of our patients is vital in improving the quality of healthcare.
Topic 2: Culturally Competent Nursing Care
In order for the nurse to begin the process of becoming a culturally competent provider, one must start with cultural self-assessment. Evaluation of their own unconscious biases, cultural stereotypes, prejudices, and tendencies to discriminate against those different than themselves will give them valuable insight. With increased study and education, these unconscious tendencies can be resolved. To aid in the educational process, the American Academy of Nursing (AAN) Expert Panel on Global Nursing and Health and Transcultural Nursing Society have developed guidelines for the practice of culturally competent nursing care. These include knowledge of cultures, education and training in culturally competent care, clinical reelection. Cross-cultural communication, culturally competent practice, cultural competence in health care systems and organizations, patient advocacy and empowerment, multicultural workforce, cross-cultural leadership, evidence-based practice and research. As universally accepted guidelines nurses worldwide have a framework for providing culturally competent care.
A five step problem solving process is provide to assist nurses in delivering culturally competent care. This five step process consists of
- a constructively critical self-assessment
- mutual goal setting with the client and other members of the health care team
- development of a plan of care
- implementation of the care plan
- evaluation of the plan.
Discuss It
| Module 2 | |
|---|---|
| Discussion | The culture of the deaf and hearing impaired is often overlooked because it is characterized as a nonethnic culture. What cultural characteristics do deaf people have in common with other cultural groups? If your client is both deaf and identifies with another cultural group as well, how does this affect your ability to provide quality cultural care?
Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text) for both posts. Refer to the Grading Rubric for Online Discussion in the Course Resource section. |
| Special Guidance on APA formatting in Discussion Posts APA formatting is required in discussion posts with the following two exceptions (due to limitations with the text editor in LIVE): double line space and indent 1/2 inch from the left margin. Discussion posts will NOT be evaluated on those two formatting requirements. All other APA formatting guidelines should be followed. For example, in-text citations must be formatted with the appropriate information and in the correct sequence (Author, year), reference list entries must include all appropriate information following guidelines for capitalization, italics, and be in the correct sequence. Refer to the APA Publication Manual 7th ed. for each source type’s specific requirements. Please let your instructor know if you have any questions. |
The culture of the deaf and hard of hearing is often overlooked because it is characterized as a nonethnic culture. What cultural characteristics do deaf people have in common with other cultural groups? If your client is both deaf and identifies with another cultural group as well, how does this affect your ability to provide quality cultural care?
Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text) for both posts. Refer to the Grading Rubric for Online Discussion in the Course Resource section.
Understanding the nuances of the patients culture as well as understanding the communication techniques for the Deaf culture is vital for providing competent care and a responsibility of the health care provider. Collaboration within our healthcare community may be key! Well done!
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Individuals who are involved in or affiliated with the Deaf culture do not view deaf or the use of signed language as a disability. Diversity within the Deaf community must be considered and awareness of factors such as racial background, hearing status, and communication mode fall under the broader identity of being deaf. Understanding Deaf culture and learning about ASL are essential to building rapport and strengthening the therapeutic alliance (Boness, 2016). However, not all Deaf persons identify within this community. When a client identifies with another cultural group it is imperative to have a basic understanding of the culture they identify with. View the patient as an individual and find out their cultural preferences. The approach to them receiving care and treatment may need to be altered, to provide culturally competent care. For instance, there may be a patient who is deaf and is a member of the LGBTQ community. The provider needs to understand the population’s history, unique health concerns, risks, and develop communication skills that avoid discrimination, and provide compassionate care. Health professionals should be aware that the LGBTQ population experiences higher rates of challenges due to discrimination, social pressures, sexual behaviors, and less healthcare access (Bass & Nagy, 2020).
Bass, B., & Nagy, H. (2020). Cultural Competence in the Care of LGBTQ Patients. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK563176/less1
Boness, C. L. (2016). Treatment of Deaf Clients: Ethical Considerations for Professionals in Psychology. Ethics & Behavior, 26(7), 562–585. https://doi.org/10.1080/10508422.2015.1084929
Historically, those afflicted with deafness or hard of hearing have been labeled as persons suffering from a disability. However, labeling an individual with a disability indicates there is an issue with deafness or being hard of hearing that needs to be “fixed” (Mauldin & Fannon, 2021). Many people who are deaf or hard of hearing do not feel as if they are disabled, but rather as individuals with their own unique cultural identity (Higgins, 2016). Characteristics the deaf and hard of hearing people have with other cultures include a common communication style (language/dialect), identity, and a shared heritage (Andrews et al., 2020). According to Mauldin and Fannon (2021), “People who are deaf and use ASL to communicate belong to a linguistic minority group in the United States and have historically identified as capital-D Deaf; the convention has largely been to use lower case deaf to describe an audiological status and a capital-D to denote cultural membership in a signing community” (p.4). If the client is both deaf and also identifies with another cultural group this added layer simply means the practitioner will need to be that much more vigilant in providing culturally competent care. The five steps for providing culturally competent and congruent care include self-assessment, mutual goal setting, care planning, implementation of care plan, and evaluation of care (Andrews et al., 2020). less1 UnreadUnread2 ViewsViews
Mauldin, L., & Fannon, T. (2021). They told me my name: Developing a deaf identity. Symbolic Interaction, 44(2), 339-366. https://doi.org/10.1002/symb.482
Higgins, M., & Lieberman, A. M. (2016). Deaf students as a linguistic and cultural minority: Shifting perspectives and implications for teaching and learning. Journal of Education (Boston, Mass.), 196(1), 9-18. https://doi.org/10.1177/002205741619600103
Andrews, M., Boyle, J. & Collins, J. (2020). Transcultural concepts in nursing care (8th ed.). Wolters Kluwer.
Deaf and hearing-impaired people face multi challenges that evolve around isolation, neglect, and deprivation of essential social services that affect their welfare and survival. They are often isolated in the community because they are presumed different from everyone else, (Mugeere et al., 2016). In every culture, one will find people who are deaf or hearing impaired. The cultural characteristic deaf people have in common with other cultural groups is that many deaf people are born to hearing parents. More so, deaf or hearing impaired can be found in any culture regardless of race, ethnicity, social-economic status, or education. Deaf people maintain intimate relationships using facial expressions, touch, sign language, eye contact which are like other cultural groups, (Mugeere et al., 2016). ReferencesMugeere, A., Atekyereza, P. R., Kirumira, E. K., & Hojer, S. (2016, May 26). Deaf identities in a multicultural setting: The Ugandan context. African journal of disability. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5433488/. less1 UnreadUnread5 ViewsViews
Marschark, M., Zettler, I., & Dammeyer, J. (2017, July 1). Social dominance orientation, language orientation, and deaf identity. Journal of deaf studies and deaf education. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881267/.
If my client is both deaf and identifies with another cultural group, this will affect my ability to provide quality care in the sense that it might be difficult to communicate or provide an interpreter in the new culture since different cultures have different variations in their mode of communication and identity expression, (Marschark et al., 2017).
The topic of whether deafness should be viewed as a culture or not is of debate. Deafness has always been seen as a physical impairment that is associated with cognitive and blindness disabilities. Recently, views of deafness as a culture have been raised, considering the condition as a trait and not disability. This is because deafness does not need to be corrected; it is not a pathology (Chovaz, 2016). The deaf and the hearing cultures have various common factors which influence communication with each other. One of them is that deaf people go to churches and attend school for the deaf, just like hearing people who also go to school and attend churches to attain education and religious purposes (Giger & Haddad, 2020). Moreover, both hearing and deaf people use the English language; the only difference is how they communicate it. ReferencesChovaz, C. J. (2016). The Differences in our similarities. The Journal of Deaf Studies and Deaf Education, 16(3). 416. https://doi.org/10.1093/deafed/enr002 more1 UnreadUnread5 ViewsViews
Giger, J. N., & Haddad, L. (2020). Transcultural nursing-e-book: Assessment and Intervention. Elsevier Health Sciences.
Andrews, M., Boyle, J., & Collins, J.W. (2020). Transcultural concepts in nursing care (8th ed.). Wolters Kluwer
If my client is deaf and identifies themselves with a particular cultural group, this will significantly influence how I will give quality and holistic care. This is because all cultural preferences of the patients must be respected while providing care. Providing quality care to clients that are deaf raises essential ethical consideration in relation to competency, assessment, confidentiality, evaluation, and diagnosis (Andrews et al., 2020). The nurse must therefore consider the relevant ethic codes that are required in providing treatment that is ethical. This is because the nurse is responsible for ensuring that the patient or client is comfortable and satisfied with healthcare services. Thus, all healthcare services providers must maintain a professional relationship with the client while also offering care in line with their culture and beliefs (Andrews et al., 2020).
The deaf and hearing impaired are considered a nonethnic culture, but can be linked to another culture and become a double minority such as a Russian patient who is also deaf (Andrews et al., 2020). Deaf patients have many of the same characteristics as other cultural groups which include, decreased comprehension due to a language barrier, decreased psychosocial well-being due to difficulty with social and interpersonal skills, economic dependence due to perceived disability, and decreased quality of life due to unnecessary limitations sometimes placed by healthcare providers (Andrews et al., 2020). Caring for a patient that is deaf or hearing impaired and also identifies with another cultural group, may require more help or interventions. All cultures, ethnic and nonethnic, have different needs that have to be taken into consideration. Cultural respect combines a body of knowledge, beliefs, and behaviors that are specific to ethnic, nonethnic, racial, religious, geographic, and social groups (NIH, 2017). Cultural respect ensures reduction in health disparities and improves access to quality and safe healthcare that is respectful and responsive to culturally diverse patients (NIH, 2017).
Andrews, M.M., Boyle, J.S. & Collins, J.W. (2020). Transcultural concepts in nursing care (8th ed.). Wolters Kluwer.
National Institutes of Health. (2017, February 15). Cultural respect. https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liason/clear-communication/cultural-respect
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