• Definition- pg 46 + 48 in Du Toit • Concepts within transcultural nursing care- pg 47 in Du Toit • Leininger’s transcultural nursing theory- pg 47-48 in Du Toit • Transcultural nursing assessment model of Giger & Davidhizar (transcultural variations)- pg 49-51 in Du Toit

1. By C Settley

2. Transcultural nursing
 When dealing with patients belonging to
other cultures, the nurse need to take
many aspects into consideration.
 Symbolic interactionism knowledge has to
be implemented.
 Madeleine Leininger’s theory of
transcultural nursing in educational
research theory is particularly relevant to
the SA nursing scenario.

3. Transcultural nursing as defined by
Leininger:
 a substantive area of study and practice
focused on comparative cultural care
(caring) values, beliefs, and practices of
individuals or groups of similar or
different cultures with the goal of
providing culture-specific and universal
nursing care practices in promoting health
or well-being or to help people to face
unfavorable human conditions, illness, or
death in culturally meaningful ways.

4. Transcultural nursing
 Leininger’s theory represents a holistic
and comprehensive approach to nursing.
 Her theory aims to highlight nursing care
measures that are in harmony with an
individual’s cultural beliefs, practices and
values.
 Culturally congruent care: is the primary
goal of transcultural nursing practice.

5. Culturally congruent care is possible when the following
occurs within the nurse-client relationship:
• Care is to assist others with real or anticipated needs in an effort to
improve a human condition of concern or to face death.
• Caring is an action or activity directed towards providing care.
• Culture refers to learned, shared, and transmitted values, beliefs,
norms, and life ways of a specific individual or group that guide their
thinking, decisions, actions, and patterned ways of living.
• Cultural care refers to multiple aspects of culture that influence and
enable a person or group to improve their human condition or to
deal with illness or death.
• Cultural care diversity refers to the differences in meanings, values,
or acceptable modes of care within or between different groups of
people.
• Cultural care universality refers to common care or similar meanings
that are evident among many cultures.

6. Culturally congruent care is possible when the following
occurs within the nurse-client relationship:
•Nursing is a learned profession with a disciplined
focused on care phenomena.
• Worldview refers to the way people tend to look at
the world or universe in creating a personal view of
what life is about.
• Cultural and social structure dimensions include
factors related to religion, social structure, political/legal
concerns, economics, educational patterns, the use of
technologies, cultural values, and ethno history that
influence cultural responses of human beings within a
cultural context.
• Health refers to a state of well-being that is culturally
defined and valued by a designated culture.

7. Culturally congruent care is possible when the following
occurs within the nurse-client relationship:
• Cultural care preservation or maintenance refers to nursing
care activities that help people of particular cultures to retain
and use core cultural care values related to healthcare
concerns or conditions.
• Cultural care accommodation or negotiation refers to
creative nursing actions that help people of a particular culture
adapt to or negotiate with others in the healthcare community
in an effort to attain the shared goal of an optimal health
outcome for client(s) of a designated culture.
• Cultural care repatterning or restructuring refers to
therapeutic actions taken by culturally competent nurse(s) or
family.These actions enable or assist a client to modify personal
health behaviors towards beneficial outcomes while respecting
the client’s cultural values.

8. These statements are derived from Leininger’s key sources
(Leininger 1976, 1981, 1991, 1995, 2002, but most
specifically, 2001, pp. 44–45):
 Care is the essence and central focus of nursing.
 Caring is essential for health and well-being, healing, growth,
survival, and also for facing illness or death.
 Culture care is a broad holistic perspective to guide nursing care
practices.
 Nursing’s central purpose is to serve human beings in health, illness,
and if dying.
 There can be no curing without the giving and receiving of care.
 Culture care concepts have both different and similar aspects
among all cultures of the world.
 Every human culture has folk remedies, professional knowledge,
and professional care practices that vary.The nurse must identify
and address these factors consciously with each client in order to
provide holistic and culturally congruent care.

9. These statements are derived from Leininger’s key sources
(Leininger 1976, 1981, 1991, 1995, 2002, but most
specifically, 2001, pp. 44–45):
 Cultural care values, beliefs, and practices are
influenced by worldview and language, as well as
religious, spiritual, social, political, educational,
economic, technological, ethno historical, and
environmental factors.
 Beneficial, healthy, satisfying culturally based
nursing care enhances the well-being of clients.
 Culturally beneficial nursing care can only occur
when cultural care values, expressions, or
patterns are known and used appropriately and
knowingly by the nurse providing care.

10. These statements are derived from Leininger’s key sources
(Leininger 1976, 1981, 1991, 1995, 2002, but most
specifically, 2001, pp. 44–45):
 Clients who experience nursing care that
fails to be reasonably congruent with the
client’s cultural beliefs and values will
show signs of stress, cultural conflict,
noncompliance, and ethical moral
concerns.
 Congruent: in agreement or harmony.

12. Giger & Davidhizar ‘s Transcultural
variations
- Communication
- verbal and non verbal
(facial expression, eye
contact, touch)
- Eg eye contact….. Is it
a sign of respect or
not in your culture?
- Watch your patients
reactions
- Clear communication
and mutual
understanding is
important

13. Transcultural variations

14. Transcultural variations
 Space
 Refers to the area surrounding the patient’s body
 Certain cultural groups keep a distance between
themselves and others while others do not
 Such contact-orientated people regard
noncontact others as shy, impersonal, boring, cold
or rude
 Vice versa seen as rude, bossy or pushy
 Nurses operate mostly within the personal
spaces of patients and must be understanding
when someone feels embarrassed or affronted

15. Transcultural variations
 Time and tempo
 Some groups do not attach importance to
punctuality
 Some may be irritated when others arrive
late
 The nurse normally have to work ‘fast’ –
this may seem to the patient that you are
uninterested and they feel that they do
not get the attention that they deserve

16. Transcultural variations
 Time and tempo
 Emergencies require that the nurse act
fast and without delay.
 One minute can cause serious damage eg
brain or kidney failure.
 “thinking on your feet’.

17. Transcultural variations
 Biological variations
 Knowledge of growth, development, nutrition and other
biological factors is important as it influences nursing
care
 Some cultures attach positive value to large people
while others are obsessed with being thin
 There are also rules for the type of foods and how they
are prepared

18. Transcultural variations
 Biological variations
 Difficult to be fully informed about other customs.
 Dangers will have to be discussed.
 Patients have to accept some responsibility.

19. Transcultural variations
 Environmental control
 Refers to the ability to control factors in
immediate environment
 Scientific or traditional

20. Transcultural variations
 Environmental control
 Many patients have different ways of
controlling their illnesses.
 Folk medicine: eg the position of the
moon, attending church, etc
 Supernatural
 Nursing care mainly based on the
scientific approach.

21. Transcultural variations
 Social institutions
 Families
 Education
 Economic institutions
 Religious groups
 Political institutions
 Different cultural facets are presented by
these institutions.

22. Scenario 1
 Susan Williams, a very happy and empathic nurse,
who loves to hug and comfort her patients, is on
duty today in the casualty department.A bus of
foreign tourists from Dubai was involved in an
accident and the tour operator brought Mr Amari
in for an assessment. Mr Amari seems distant and
does not want to look at any of the nurses. He
forcefully jerked his hand back when nurse
Williams reached out to touch him. He said:
“‫ﻧﻲ‬ ‫”!واﺗﺎﺷﻲ‬ which was translated as “do not touch
me”, by the tour operator.
 Q 1: Identify cultural variations that are evident from
this scenario.

23. Scenario 1
 Susan Williams, a very happy and empathic
nurse, who loves to hug and comfort her
patients, is on duty today in the casualty
department. A bus of foreign tourists from
Dubai was involved in an accident and the
tour operator brought Mr Amari in for an
assessment. Mr Amari seems distant and
does not want to look at any of the nurses.
He forcefully jerked his hand back when
nurse Williams reached out to touch him. He
said:“‫ﻧﻲ‬ ‫”!واﺗﺎﺷﻲ‬ which was translated as “do
not touch me”, by the tour operator.

24. Scenario 2
 Mr Lee is from Asian descent and regards eye
contact as impolite.A language barrier also exists,
which makes communication between staff and
Mr Lee difficult. He always seems to keep a
distance between himself and others.The doctor
informed him that he needs to be in his room by
9am for doctor’s rounds, but he was not in the
ward when the rounds had started. In addition,
Mr Lee is a vegetarian and suffers from iron-
deficient anaemia.
 Q 1: Identify four (4) cultural variations that are
evident from this scenario.

25. Scenario 2
 Mr Lee is from Asian descent and regards eye contact as impolite.A language barrier
also exists, which makes communication between staff and Mr Lee difficult. He
always seems to keep a distance between himself and others.The doctor informed
him that he needs to be in his room by 9am for doctor’s rounds, but he was not in
the ward when the rounds had started. In addition, Mr Lee is a vegetarian and
suffers from iron-deficient anaemia.
 Answers to Q1:
 Communication
 Space
 Time and tempo
 Biological variations
 Q 2: Reflect upon Asian culture and explain how you should
accommodate the patient’s (Mr Lee’s) cultural needs in a caring
environment such as a hospital.

26.  Answers to Q2
 Get an interpreter to assist in communication.
 Try and refrain from making eye contact with Mr Lee.
 But when having to do so, explain to him the reason
why- for possible observation or examination.
 Mr Lee seems not to attach importance to punctuality
hence it is important to explain to him why he needs to
be at his bed with the start of doctor’s rounds.
 Mr Lee suffers from iron deficiency but he is a
vegetarian and iron comes from meat so he does not
get any iron in his diet.
 It is important to explain this to him.

27. References
 http://www.usask.ca/nursing/predeparture
/section09.php
 https://www.uni-graz.at/en/studying/for-
prospective-students/enrolment-for-
applicants-and-new-entrants/language-
examinations/