TRANSCULTURAL NURSING

TRANCULTURAL NURSING
BY: ROMMEL LUIS C. ISRAEL III
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OBJECTIVES
At the end of the 8-hour lecture, the students
will be able to:
1. Define pertinent terms related to
transcultural nursing
2. Understand important concepts that cover
transcultural nursing care
3. Understand the importance of Transcultural
nursing care
4. Understand the concepts & Principles of
Transcultural Nursing care
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OBJECTIVES
1. Understand the theory of TN
2. Explain the philosophical beliefs
in TN theory
3. Identify the principles of
Culturalogical assessment
4. Identify the transcultural
communication mode
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THE CULTURE OF UNHATE
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I. DEFINITION OF TERMS
Ethics The basic concepts & fundamental
principles of right human conduct. It
includes study of universal values such as
the essential equality of all men and
women, human or natural rights,
obedience to the law of land, concern for
health and safety and, increasingly, also
for the natural environment.
Behavior a response of an individual or
group to an action, environment, person or
stimulus.
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• Values important and enduring beliefs or
ideals, shared by the members of a culture
about what is good and desirable and what is
not. Values exert major influence on
the behaviour of an individual and serve as
broad guidelines in all situations.
• Morality conformance to a recognized code,
doctrine or system of rules of what is right or
wrong and to behave accordingly. It is NOT
universal
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• Culture is a patterned behavioral response
that develops over time as a result of
imprinting the mind through social and
religious structures and intellectual and artistic
artistic manifestations.
• Culture is also the result of acquired
mechanisms that may have innate influences
that are primarily affected by internal &
external environmental stimuli.
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• Religion is a set of belief in a divine or super
human power/s to be obeyed and worshipped
as the creator and ruler of the universe.
• Ethnicity a consciousness of belonging to a
group.
• Acculturation individuals who have taken on,
usually observable features of another culture.
People of a minority group tend to assume
the attitudes, values, beliefs, practices of
dominant society resulting in a blended
cultural pattern.
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• Race the classification of people according to
shared biologic characteristics, genetic
markers or features. Not all people of the
same race have the same culture.
• Material Culture refers to objects (dress, art,
religious artifacts)
• Non- Material Culture refers to beliefs,
customs, languages, social institutions.
• Sub Culture composed of people who have
distinct identity but are related to a larger
cultural group
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• Culture Shock the state of being disoriented
or unable to respond to a different cultural
environment because of its sudden
strangeness, unfamiliarity, and incompatibility
to the stranger’s perception & expectations.
• Ethnic identity refers to a subjective
perspective of the person’s heritage and to a
sense of belonging to a group that is
distinguishable from other groups
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• Diversity refers to the fact or state of being
different. Diversity can occur between cultures
and within a cultural group
• Bicultural a person who crosses two cultures,
lifestyles and sets of values
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• Transcultural Nursing defined as a formal area
of study and practice focused on comparative
human-care differences and similarities of the
beliefs, values, and patterned lifeways of
cultures.
• Beliefs assumptions and convictions that are
held to be true, by an individual or a group,
regarding concepts, events, people, & things.
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II. IMPORTANCE, FOCUS, HISTORICAL
ASPECTS OF TRANSCULTURAL
NURSING
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A. Historical Development of TN
Madeleine Leininger, PhD., is considered to be the
mother of Transcultural Nursing.
It was in the mid 1950’s while working as the first,
graduate, child-psychiatric clinical nurse specialist in
the US, Madeleine Leininger discovered major
cultural differences among the children and parents.
There were no nursing theories or books on
transcultural care. But she was able to study on
anthropology and discovered that anthropological
and related cultural information has a close
relationship with nursing.
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The former Dean of the University of Washington
School of Nursing, Leininger coined the phrase and
began to study the concept after returning from a
trip to New Guinea.
On this trip in 1969, Leininger identified that nurses
needed to understand their patients' backgrounds in
order to provide care.
Thus, she launched the Transcultural Nursing program
at the university, and founded the Journal of
Transcultural Nursing to support the Transcultural
Nursing Society which she founded in 1974.
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B. Scope of Transcultural Nursing & Factors
Influencing Transcultural Nursing
1. Marked increase in immigration and the migration of
people within and between countries worldwide.
2. Implicit societal moral & professional expectation
that nurses other health care providers need to
know, understand, respond appropriately to care for
people of diverse cultures.
3. Rapid increase in the use of high technologies in
caring or curing with different responses and effects
on clients of diverse cultures.
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4. Increased signs of cultural conflicts, cultural clashes,
& cultural imposition practices between nurses &
clients of diverse cultures.
5. Marked increase in the number of nurses who travel
and work in different places in the world.
6. Anticipated legal defense suits against nurses
resulting from cultural negligence, cultural ignorance,
& cultural imposition practices in working with
diverse cultures.
7. The rise in gender and special groups issues & rights
8. Growing trend to care with & for people whether
well or ill in their familiar or particular living &
working environment.
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The global view of transcultural nursing
This logo has served as a cognitive image and
philosophical guide to help nurses realize the large scope
of transcultural nursing.
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SIGNIFICANCE
• Cultural assessment can give meaning to
behaviors that might otherwise be judged
negatively
• If culture behaviors are not appropriately
identified, their significance will be confusing
to the nurse
• The 3rd millennium is challenging nurses and
other health care professionals to think and
act with a global perspective.
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• The goal of transcultural nursing has been to
prepare a new generation of nurses who
would be knowledgeable, sensitive,
competent, and safe to care for people with
different or similar lifeways, values, beliefs,
and practices.
• A major feature in the definition of
transcultural nursing is the focus on
comparative differences (diversities) and
similarities among cultures in relation to
humanistic care, health, wellness, illness, and
healing patterns.
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GOAL
The ultimate goal of transcultural
nursing is the use of relevant
knowledge to provide culturally
specific and culturally congruent
nursing care to people.
-Leininger
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•Culturally congruent care refers to
the complex integration of attitudes,
knowlede, and skills (including assessment,
decision making, judgments, critical
thinking, and evaluation) that enables the
nurse to provide care in a culturally
sensitive and appropriate manner.
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III. CONCEPTS & PRINCIPLES OF
TRANSCULTURAL NURSING CARE
HUMAN CARE – REFERS TO A SPECIFIC
PHENOMENON THAT IS CHARACTERIZED
TO ASSIST, SUPPORT, OR ENABLE
ANOTHER HUMAN BEING OR GROUP TO
ACHIEVE ONE’S DESIRED GOAL OR TO
OBTAIN ASSISTANCE WITH CERTAIN
HUMAN NEEDS.
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HUMAN CARING – IS FOCUSED
ON THE ACTION ASPECT OR
ACTIVITIES TO PROVIDE SERVICE TO
OTHER HUMAN BEINGS.
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Features of Culture:
1. It reflects shared values, ideals & meanings that are
learned & that guide human thoughts, decisions &
actions.
2. Have manifest (readily recognized) & implicit (covert
& ideal) rules of behavior & expectations.
3. Human cultures have material items or symbols such
as artifacts, objects, dress, & actions that have special
meaning in a culture.
Non-material cultural symbols such as hand gestures
or words when wanting to be cared for are important.
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4. Cultures have traditional ceremonial practices such
as religious rituals, food feasts, & other activities
that are transmitted intergenerationally & reaffirm
family or group ties & caring ways.
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5. Cultures have their local or emic (insider’s) views &
knowledge about their culture that are extremely
important for nurses to discover & understand for
meaningful care practices. Etic (outsider’s/ nurse’s)
views may be very different from emic views.
- Wayan traditional healing method in Bali -
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6. All human cultures have some intercultural
variations between & within cultures. Cultural
variation is an important concept to keep in mind
when studying individuals & different cultures. E.g
African-Americans & Italian-Americans show
cultural variations in their daily lifeways regarding
food & death.
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• Cultural blindness is the inability of a person to
recognize his or her own values, beliefs and
practices and those of others because of strong
ethnocentric tendencies (the tendency to view
one’s own culture as superior to others).
• Cultural Imposition is the tendency to impose
one’s cultural beliefs, values, and patterns of
behavior on a person or persons from a different
culture.
• Cultural Taboos are those activities governed by
rules of behavior that are avoided, forbidden, or
prohibited by a particular cultural group.
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• Ethnocentrism refers to the belief that one’s
own ways are the best, most superior, or
preferred ways to act, believe, or behave.
• Cultural Bias refers to a firm position or stance
that one’s own values & beliefs must govern
the situation or decisions.
• Cultural relativism refers to the position that
cultures are so unique & must be evaluated,
judged, & helped according to their own
particular values & standards.
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• Uniculturalism refers to the belief that one’s
universe is largely contituted, cenetered upon,
& functions from a one-culture perspective
that reflects excessive ethnocentrism.
• Multiculturalism refers to a perspective and
reality that there are many different cultures &
subcultures in the world that need to be
recognized, valued, & understood for their
differences & similarities.
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REMEMBER!!!
• The first important principle in Transcultural
nursing is to:
“KNOW THYSELF”
Some nurses and students may have long-
standing biases and prejudices about cultures
that make it difficult for them to become
effective transcultural nurses.
These prejudices can be offensive and hurtful
to clients and their families, which in effect
limits the nurse’s effectiveness with clients.
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IV. THEORY OF CULTURE CARE
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A. Goal of Culture care
To discover, document, interpret, explain & even
predict some of the multiple factors influencing
from an emic (inside the culture) & an etic (
the culture) view as related to culturally based
With the ethnonursing research method &
the reseracher was challenged to discover the
similarities & diversities about human care in
different cultures.
The goal of the Theory was to provide culturally
congruent care that would contribute to the
being of people or help them face disabilities or
death.
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Ethnographic research - is a qualitative method
aimed to learn and understand cultural phenomena
which reflect the knowledge and system of meanings
guiding the life of a cultural group
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B. Philosophical Beliefs, Assumptions,
Hunches with the Culture Care Theory
Traditional nursing needed to shift to global
transcultural nursing in the immediate future to
serve people in meaningful ways.
Nursing was far to local, national & parochial in the
mid century and needed a theory to expand its
research, knowledge, & practice focus, Hence, the
development of Culture Care Theory.
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TRADITIONAL PRACTICES
1. USE OF PROTECTIVE OBJECTS
 Protective objects can be worn or carried or hung in
the home.
 Amulets are objects with magical powers, for all
walks of life and cultural and ethnic backgrounds is
example, charms worn on a string or chain around
the neck, wrist, or waist to protect the wearer from
the evil eye or evil spirits.
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2. USE OF SUBSTANCES
• Substances are ingested in certain ways or amounts
regimen, an effort must be made to determine if they are
worn or hung in the home.
• This practice uses diet and consists of many different
observances. It is believed that the body is kept in balance
balance or harmony by the type of food eaten so many
food taboos and combinations exist in traditional belief
systems. For example, snake oil, placenta, lizard.
• Jews also believe that milk and meat must never be mixed
or eaten at the same meal (Steinberg, 1947) mind, and
spirit, or the restoration of holistic health
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3. RELIGIOUS PRACTICES
• Another traditional approach to illness prevention, female
centers around religion and includes practices such as
from a divine source the burning of candles, rituals of
redemption, and In many instances a heritage consistent
person may prayer.
• Religion strongly affects the way people attempt to
prevent illness, and it plays a strong role in rituals
associated with health protection.
• Religion dictates social, moral, and dietary practices
designed to keep a traditional healer (Kaptchuk and
Croucherl987)
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4. Traditional Remedies
• The admitted use of folk or traditional medicine
increasing, and the practice is seen among people from
all walks of life and cultural ethnic back ground. Many of
the remedies have been used and passed on for
generations.
• The pharmaceutical, must be made to determine
properties of vegetation-plants, roots, tested stems,
flowers, seeds, and herbs-have been studied tested,
cataloged, and used for countless centuries.
• Often, these ingredients can be antagonistic or synergistic
to prescribed medications. Over dose may occur.
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5. Healers
• The healer may be male or and is thought to have
received the gift of healing In many instances a heritage
consistent person may consult a traditional healer before,
instead of, or in conjunction with a modern health care
provider.
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5 Basic Interactional Phenomena:
1. Culture encounter or contact refers to a situation in
which a person from one culture meets or briefly
interacts with a person from another culture.
- A nurse having brief encounters with people from
another culture or a cleint seldom grasps &
understands strangers & their cultural lifeways.
- E.g. Nurses giving tours or making brief visits
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2. Enculturation refers to the process by which one
learns to take on or live by a particular culture with
its specific values, beliefs & practices
- E.g. nurses become enculturated into local hospitals,
community agencies & other health services to
accept & maintain practice expectation
- A child becomes enculturated when he or she shows
acceptable behavior of the cultural values, beliefs &
actions
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3. Acculturation refers to the process by which an
individual or group from cultura A learns how to take
on many values, behaviors, norms & lifeways of
culture B.
- E.g. Vietnamese refugee who migrates to the US
initially retains their own traditional values but after
10 years had become acculturated and took on the
anglo-american lifeways
- It is therefore important for nurses to determine if
they are living by traditional or new cultural values
for quality care outcomes
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4. Socialization process whereby an individual or group
from a particular culture learns how to function
within the larger society that is to know how to
interact appropriately with others & how to survive,
work & live in relative harmony within a society.
- It is different from acculturation because the goal of
socialization is to learn how to adapt to & function in
a large society with its dominant values, ethos or
national lifeways.
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5. Assimilation refers to the way an individual or group
from one culture very selectively & & usually
intentionally selects certain features of another
culture without necessarily taking on many or all
attributes of lifeways that would declare one to be
acculturated.
- E.g. An american nurse may handle differently the
placenta & umbilical cord after delivery from that of
an Arab nurse. Both nurses may assimilate some
practices of Arab nurse in handling the placenta but
not all, and vice versa.
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Terms related to TN Concept:
Cultural Backlash – refers to negative feedback or
unfavorable outcomes after nurses have been
working or consulting with cultures for brief periods.
E.g. Host country being served by foreign nurse feels
their efforts failed to help the people in meaningful
or beneficial ways. As a result, the host country
expresses negative views & feelings to the consultant.
consultant.
52

Cultural Overidentification – refers to nurses who
become too involved, overly sympathetic, or too
compassionate with the people, situation, or a human
condition. Resulting to nontherapeutic action.
Cultural Pain – refers to suffering, discomfort, or being
greatly offended by an individual or group who
shows a great lack of sensitivity toward another’s
cultural experience.
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Culture bound – refers to specific care, health, illness,
& disease conditions that are particular, quite unique,
& usually specific to a designated culture or
geographical area.
Cultural Universals – refer to commonalities among
human beings or humanity that reveal the similarities
or dominant features of humans.
Culture Care – cognitively learned & transmitted
professional & indegenous folk values, beliefs &
patterned lifeways that are used to assist, facilitate or
enable another individual or group to maintain their
well-being or health.
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Cultural care conflicts – refers to signs of distress, concern
& nonhelpful nursing care practices that fail to meet a
client’s cultural expectations, beliefs, values & lifeways.
Culture time – refers to the dominant orientation of an
individual or group to different past, present & future
periods that guides one’s thinking & actions.
Social time - refers to time for leisurely interactions &
activities in which exact time is of less importance
Cyclic time - when certain activities occur each day, night,
month or during the year. Regulate activities as a cyclic
rhythm of life
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Cultural space – variations of cultures in the use of
body, visual, territorial & interpersonal distance to
others.
a. Intimate zone 0-18 inches
b. personal zone  18 in- 3ft
c. social/ public  3-6 ft.
Body Touching– how different cultures touch same/
opposite sexes in public.
high context culture, many things are left unsaid, letting
the culture explain
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Cultural context – totality of shared meanings & life
experiences in particular social, cultural & physical
environments that influence attitudes, thinking, &
patterns of living.
High Context Culture - people are deeply involved,
knowing each other & the situation, sharing & respecting
values & beliefs almost instantly. Many things are left
unsaid, letting the culture explain.
E.g. African, Filipinos, Finnish, Brazilian, Japanese, Korean,
French, Greek, Indian, Italian
Low Context Culture - people having less commonly
shared meanings of life experiences or values,
making it difficult to quickly understand strangers.
E.g. American, Australian, English, Irish, German
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Kinds of Care:
1. Generic care - refers to culturally learned &
transmitted lay, indigenous (traditional), & largely
emic folk knowledge & skills used by cultures.
2. Professional care - refers to formally &
cognitively learned etic knowledge & practice
skills that have been taught & used by faculty &
clinical services.
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Generic (Emic)- Professional (Etic)
-Humanistically oriented
-People based with practical &
familiar referents
-Holistic & integrated approach with
focus on social relationship,
language, & lifeways
-Focus largely on caring
-Largely non-technological using folk
folk remedies & personal
relationships
-Focuses on prevention of illnesses,
disability & maintaining lifeways
-Using high-context communication
-Relies on traditional & familiar folk
caring & healing
-Scientifically oriented
-Clients to be acted on with
unfamiliar techniques & strangers
-Fragmented & nonintegrated
services with focusing on physical
body & mind
-Focus is largely on curing, diagnosis,
diagnosis, & treatments
-Largely technological with many
diagnostic tests & scientific
treatments
-Focuses on treating diseases,
disabilities, & pathologies
-Uses low-context communication
-Relies on biophysical emotional
factors to be assessed & treated
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THEORETICAL TENETS
1. Care Diversities (differences) & universalities
(commonalities) existed among & between cultures
in the world
2. Worldview, social structure factors such as religion,
economics, education, technology, politics, kinship
(social), ethnohistory, environment, language, &
generic & professional care factors would greatly
influence cultural care meanings, expressions, &
patterns in different cultures.
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THEORETICAL TENETS
3. Three major care actions and decisions to arrive at
culturally congruent care for the general health and
well-being of clients or to help them face death or
disabilities.
3 Theoretical Practice modes/ care actions:
a. Culture care preservation/ maintenance
b. Culture care accommodation & or negotiation
c. Culture care restructuring & or re-patterning
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a. Culture care preservation/ maintenance
 Retain and or preserve relevant care values so that
clients can maintain their well-being, recover from
illness, or face handicaps and/or death.
b. Culture care accommodation & or negotiation
 Adapt or negotiate with the others for a beneficial or
satisfying health outcome
c. Culture care restructuring & or re-patterning
 Records, change, or greatly modify client’s life ways for a
new, different and beneficial health care pattern
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“Let the sun shine and rise”
 Figuratively means to have nurses open
their minds to informants to discover many
different factors influencing care in their
culture with their meeaning & the ways
they influence the health & well-being of
people.
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Ethnonursing Research
 Refers to a qualitative nursing research method
focused on naturalistic, open discovery & largely
inductive (emic) modes to document, describe,
explain & interpret informant’s worldview, meanings,
symbols, & life experiences as they bear on actual or
potential nursing care phenomena.
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V. CULTURAL ASSESSMENTS
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Culural Care Assessments
 Refer to the systematic identification &
documentation of culture care beliefs, meanings,
values, symbols, & practices of individuals or
groups within a holistic prespective, which
includes the worldview, life experiences,
environmental context, ehtnohistory, language, &
diverse social structure influences.
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A. Principles for Cultaroligical Assessment
(Guide)
1. Show genuine & sincere interest in the
client as one listens to and learns from the
client.
2. Give attention to gender or class
differences, communication modes (with
special language terms), & interpersonal
space.
3. Study the Sunrise model before doing the
assessment
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4. Remain fully aware of one’s own cultural
biases & prejudices
5. Be aware that clients may belong to
subcultures or special groups such as the
homeless, AIDS infected, drug users,
lesbians, gays, deaf & the mentally
retarded. Avoid Stereotyping
Stereotyping – refers to seeing people in
rigid, fixed ways with prejudged views
about them & their lifeways
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6. Nurses need to know their own culture &
areas of competencies along with their
deficits to become culturally competent
practitioners.
7. Clarify & explain at the outset to the
individual, family, or group the focus &
purpose of the assessment, including times
to visit with them about their health care
beliefs & practices.
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8. Seek holistic view of the client’s world within his
or her environmental context by focusing on
familiar & multiple factors depicted in the Sunrise
Model that influence care, illness, or well-being
9. Remain an active listener & to discover the
client’s emic lifeways, beliefs, & values as well as
etic professional ways. Create a trusting climate.
10. Reflect on learned transcultural holding
knowledge about the client’s culture & research-
based care & health knowledge available today.
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Special Author Insights
1. Clients from non-western cultures like to talk first about
their family & their caring values & health beliefs,
whereas Western cultures like to talk initially about
medical treatments, tests, medications, technologies &
highly personal life & illness experiences.
2. Real secret for an effective culturalogical care assessment
is to remain an active learner & reflector
3. Negative experiences or stories are usually told at the
end of the sessions along with valuable & sacred cultural
secrets. Reason is to be sure one is trusted.
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Special Author Insights
4. The nurse will have a better opportunity to
assess a client at home since the nurse is able to
see first hand the naturalistic environment &
material culture items & often to meet family
members.
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B. Transcultural Communication Modes
Requires understanding the verbal & non-
verbal modes.
Kinesics – body movements’s
communciation modes, which include
posture, facial expressions (smile/anger),
gestures, eye contact & other body
features.
Proxemics – use & perception of
interpersonal or personal space in
sociocultural interactions.
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Pointers when utilizing Interpreters:
1. Be sure the interpreter knows the client’s
cultural language & knows the culture
2. Discuss in advance what you are doing in the
assessment & its purposes to the client
3. Insist on an exact interpretation from the
client, not the interpreter’s views of a desired
response.
4. Write out terms in both languages to check
when you are in doubt about the terms spoken
or the interpreter’s interpretation.
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5. Try to get an interpreter of the relatively same
age as younger clients, as children & teenagers
may often communicate different integrational
knowledge leading to errors in the data
6. Try to know a few words or phrases in the
language being interpreted to occasionally
check if the interpreter is sharing ideas
accurately & completely
7. Always thank the interpreter afterward, &
recheck ideas or observations that are unclear
to you.
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Leininger’s short Cultralogical Assessment
Guide (Model B)
Phase I Record observations of what you see, hear or experience with
clients (dress, appearance, body condition features, language,
mannerisms & general behavior, attitudes & cultural features
Phase II Listen to & learn from the client about cultural values, beliefs,
daily & nightly practices related to care & health in the client’s
environmental context. Give attention to generic (folk) practices
& professional nursing practices
Phase III Identify & Document recurrent client patterns & narratives
(stories) with client meanings of what has been seen, heard or
experienced
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Phase IV Synthesize themes & patterns of care
derived from the information obtained in
phases I, II, & III
Phase
V
Develop culturally-based client-
nurse care plan as co-
participants for decisions &
actions for culturally congruent
care
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1. English – Anglo American
(Direct) A B
2. Southeast Asians
(Circular, talks to others)
3. Europeans
(Through several persons)
4. Russians
(Indirect)
5. Arabs
( direct & Indirect)
6. Mexican
(Kept with extended family)
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Indicators of Stranger Indicators of Trusted Friend
Active to protect self & others.
Suspicious & Questioning
Less active to protect self.
Attentive to what researchers does &
says
More signs of accepting
Skeptical about researchers motives &
works. May question how findings will be
used by the researcher or stranger.
Signs of working with & helping the
researcher as a friend.
Reluctant to share cultural secrets &
views as private knowledge.
Willing to share. Offers mostly local
views, values & interpretations
spontaneously or without probes.
Uncomfortable to become friend or to
confide in stranger. May come late, be
absent, withdraw at times from
researchers.
Signs of being comfortable & enjoying
friendship
Tends to offer inaccurate data Wants research truths to be accurate
regarding beliefs, people, values &
lifeways.
82

VI. INTEGRATING GENERIC &
PROFESSIONAL HEALTH CARE
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Generic (Emic)- Professional (Etic)
-Humanistically oriented
-People based with practical &
familiar referents
-Holistic & integrated approach with
focus on social relationship,
language, & lifeways
-Focus largely on caring
-Largely non-technological using folk
folk remedies & personal
relationships
-Focuses on prevention of illnesses,
disability & maintaining lifeways
-Using high-context communication
-Relies on traditional & familiar folk
caring & healing
-Scientifically oriented
-Clients to be acted on with
unfamiliar techniques & strangers
-Fragmented & nonintegrated
services with focusing on physical
body & mind
-Focus is largely on curing, diagnosis,
diagnosis, & treatments
-Largely technological with many
diagnostic tests & scientific
treatments
-Focuses on treating diseases,
disabilities, & pathologies
-Uses low-context communication
-Relies on biophysical emotional
factors to be assessed & treated
84

A. Understanding Cultures & Tribes of
Nursing, Hospitals & Medical Culture
The nurse & other cultures:
Nurse’s Culture (Center)
- Medical culture
- Nursing culture
- Client’s culture
- Health agency culture
- Hospital culture
- Other cultures
- Community cultures
85

B. Ethical, Moral & Legal Aspects of TN
Principles that guide moral action:
1. Principle or rules considered more than
the interests of the individual
2. Are expected to be applicable across all
such cases or situations
3. Provide culturally shared reasons to
support or defend the decision or action
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Approaches:
1. Deontological – focuses on the
importance of duty & the inherent
rightness or wrongness of a moral action
2. Teleological or consequentialist – focuses
on the value (good or bad) of anticipated
consequences
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Principles of Bioethics:
Non-maleficence – to act so as not to inflict
harm
Beneficence – to act to benefit another
Justice - to act fairly
Respect for autonomy – to act in respect of
another as an autonomous person
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Self Examination Questions to avoid Cultural
Imposition:
1. What are my ethical beliefs & practices,
& how can they influence the client’s
health & well-being?
2. How can nurses with strong ethnocentric
values, biases, & actions prevent ethical
dilemmas that lead to cultural imposition
practices & ethical conflicts?
89

3. In what kinds of clinical illnesses or
contexts do nurses tend to impose their
professional & personal ethical beliefs or
values on clients, families, or groups?
4. In what ways can nurses prevent cultural
imposition or pain & best handle ethical
or moral dilemmas?
5. What are the potential legal
consequences associated with the nurse
who violates a client’s ethical values?
90

UNIVERSAL PRINCIPLES: (western/ non-western)
1. Principle of Moral Justice – to redress the gap
between the rich & poor worldwide
2. Principle of cultural respect & human rights –
to preserve human cultural heritage, values,
beliefs & lifeways
3. Principle of benefits of the common good - to
justify & support shared resources for the
betterment of human beings & sociocultural
justice
91

4. Principle to serve & protect others from
destructive acts
5. Principle of frequent ethical & moral
assessments - to strengthen ethical &
moral decisions in beneficial ways in
diverse & similar cultures.
92

Questions to be considered:
1. What are the basic nutritional needs of
people transculturally?
2. How do religion, worldview, emotions,
education, & social & ecological factors
influence food uses & consumption
transculturally?
3. Are there common foods that tend to be
eaten or avoided in different cultures
when well or sick?
93

4. What foods tend to support wellness
patterns over time in different cultures?
5. What factors often lead to changes in food
patterns of production, consumption &
usage?
6. What foods tend to be most beneficial
throughout the lifecycle for infants, children,
& adults transculturally?
94

C. Transcultural Food Functions, Beliefs &
Practices
Universal Functions & Uses of Food:
1. Food for biophysical needs
2. Food for human relationships –
establishing & maintaining social &
cultural relationships with friends, kinfolk,
strangers & others
3. Food to assess interpersonal distance –
assess social relationships or
interpersonal closeness or distance
between people
95

4. Food to cope with stress – symbolic use of
food is to cope with emotional stresses,
conflicts & traumatic life events
5. Food for rewards & punishments
6. Food to influence status
7. Food to treat & prevent illness
96

VII. UNDERSTANDING DIFFERENT
CULTURES & INTEGRATION OF
TRANSCULTURAL NURSING IN
DIFFERENT CULTURES
97

TRANSCULTURAL NURSING

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