NUR 3045 Transcultural Nursing Models & Nursing Practice Discussion

Cultural Assessment Models Dr Mitchell-Levy NUR 3045 Leininger’s Cultural Assessment Model • • • Biography and Career of Madeleine Leininger Madeleine Leininger was born on July 13, 1925 in Sutton, Nebraska. She earned several degrees, including a Doctor of Philosophy, a Doctor of Human Sciences, a Doctor of Science, and is a Registered Nurse. She is a Certified Transcultural Nurse, a Fellow of the Royal College of Nursing in Australia, and a Fellow of the American Academy of Nursing. Leininger’s Cultural Assessment Model • Madeleine Leininger’s theory of Transcultural Nursing, also known as Culture Care Theory, falls under both the category of a specialty, as well as a general practice area. The theory has now developed into a discipline in nursing. The Transcultural Nursing theory first appeared in Leininger’s Culture Care Diversity and Universality, published in 1991, but it was developed in the 1950s. The theory was further developed in her book Transcultural Nursing, which was published in 1995. In the third edition of Transcultural Nursing, published in 2002, the theorybased research and the application of the Transcultural theory are explained. Leininger’s Cultural Assessment Model • Transcultural nursing is a study of cultures to understand both similarities and differences in patient groups. Culture is a set of beliefs held by a certain group of people, handed down from generation to generation. In transcultural nursing, nurses practice according to the patient’s cultural considerations. It begins with a culturalogical assessment, which takes the patient’s cultural background into consideration in assessing the patient and his or her health. • Once the assessment is complete, the nurse should use the culturalogical assessment to create a nursing care plan that also takes the patient’s cultural background into consideration Leininger’s Cultural Assessment Model • Leininger’s model has developed into a movement in nursing care called transcultural nursing. • In 1995, Leininger defined transcultural nursing as “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.” . Leininger’s Cultural Assessment Model • • • • • Leininger developed new terms for the basic concepts of her theory. The concepts addressed in the model are: Care, which assists 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 lifeways to a specific individual or group that guide their thinking, decisions, actions, and patterned ways of living. Culture Care is the multiple aspects of culture that influence and help a person or group to improve their human condition or deal with illness or death. Culture Care Diversity refers to the differences in meanings, values, or acceptable forms of care in or between groups of people. Leininger’s Cultural Assessment Model • • • • • • • • Culture Care Universality refers to common care or similar meanings that are evident among many cultures. Nursing is a learned profession with a disciplined focus on care phenomena. Worldview is 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 spirituality, social structure, political concerns, economics, educational patterns, technology, cultural values, and ethnohistory that influence cultural responses of people within a cultural context. NUR 3045 Transcultural Nursing Models & Nursing Practice Discussion

Health refers to a state of well-being that is culturally defined and valued by a designated culture. Cultural Care Preservation or Maintenance refers to nursing care activities that help people from particular cultures to retain and use core cultural care values related to healthcare concerns or conditions. Cultural Care Accomodation or Negotiation refers to creative nursing actions that help people of a particular culture adapt or negotiate with others in the healthcare community in an effort to attain the shared goal of an optimal health outcome for patients of a designated culture. Cultural Care Re-Patterning or Restructuring refers to therapeutic actions taken by culturally competent nurses. These actions help a patient to modify personal health behaviors towards beneficial outcomes while respecting the patient’s cultural values Leininger’s Cultural Assessment Model • The nurse’s assessment of the patient should include a selfassessment that addresses how the nurse is affected by his or her own cultural background, especially in regards to working with patients from culturally diverse backgrounds. • The nurse’s diagnosis of the patient should include any problems that may come up that involve the healthcare environment and the patient’s cultural background. In addition, the nurse’s care plan should involve aspects of the patient’s cultural background when needed. • Finally, the nurse’s evaluation should include a selfevaluation of attitudes toward caring for patients from differing cultural backgrounds. Leininger’s Cultural Assessment Model • In today’s healthcare field, it is required for nurses to be sensitive to their patients’ cultural backgrounds when creating a nursing plan. • This is especially important since so many people’s culture is so integral in who they are as individuals, and it is that culture that can greatly affect their health, as well as their reactions to treatments and care. • Thanks to Madeleine Leininger’s Transcultural Nursing theory, nurses can look at how a patient’s cultural background is involved in his or her health, and use that knowledge to create a nursing plan that will help the patient get healthy quickly while still being sensitive to his or her cultural background. Transcultural Nursing Theory • The Culture Care Theory defines nursing as a learned scientific and humanistic profession that focuses on human care phenomena and caring activities in order to help, support, facilitate, • 0r enable patients to maintain or regain health in culturally meaningful ways, or to help them face handicaps or death. The Sunrise Model is Leininger’s visual aid to the Culture Care Theory. Information taken from (http://www.nursing-theory.org/theories-and-models/leininger-culture-care-theory.php) Leininger’s Sunrise Model Spector’s Cultural Assessment Model • • • Rachel E. Spector, PhD, RN, CTN-A, FAAN retired as an associate professor at the William F. Connell Boston College School of Nursing, Chestnut Hill, Massachusetts. Her work focused on developing and teaching models of effective nursing care, “CULTURALCARE”, in multicultural populations. She has researched taught, practiced and consulted in this specialty for over 35 years and is the author of the books Cultural Diversity in Health and Illness, now in its 8th edition; CulturalCare: Guides to Heritage Assessment and Health Traditions; and Las Culturas de , la SALUD, published in Spain in 2003. Spector’s Cultural Assessment Model • The purpose of this book is to increase one’s knowledge of the dimensions and complexities involved in caring for people from diverse cultural backgrounds. It is an attempt to bring the reader into direct contact with the interaction between providers of care within the North American health care system and the consumers of health care. The staggering issues of health care delivery are explored and contrasted with the choices that people may make in attempting to deal with their personal health care issues. The major concepts applied to this text are holistic: HEALTH, defined as the balance of the person, both within one’s being – physical, mental, and spiritual and in the outside world – natural, communal, and metaphysical; ILLNESS, the imbalance of the person, both within one’s being – physical, mental, and spiritual and in the outside world – natural, communal, and metaphysical; and HEALING, the restoration of balance, both within one’s being – physical, mental, and spiritual – and in the outside world – natural, communal, and metaphysical. The capital letters are used to imply that these terms and others are being used to convey a holistic meaning. Spector’s Cultural Assessment Model • NUR 3045 Transcultural Nursing Models & Nursing Practice Discussion

People who identify with a traditional ethnocultural heritage may tend to define HEALTH and illness in a holistic way, and have health beliefs and practices that differ from those of the Western, or modern, health-care delivery system. • Imagine holistic HEALTH as a three-dimensional phenomenon that encompasses the following: body (the physical self), mind (feelings, attitudes, and behavior), and spirit (the I who I am). • HEALTH, in the traditional sense, is the state of balance within the body, mind, and spirit, and with the family, community, and the forces of the natural world. Illness is the opposite. • Many traditional HEALTH beliefs and practices exist today among people who know and live by the traditions of their given ethnocultural heritage. HEALTH, in this traditional context, has three dimensions each of which has three aspects, making a total of nine interrelated facets. Spector’s Cultural Assessment Model Appendix E page 376 Spector’s Cultural Assessment Model • • • • • It can be argued that the development of CULTURALCOMPETENCY does not occur in a short encounter with cultural diversity but that it takes time to develop the skills, knowledge, and attitudes to safely and satisfactorily deliver CULTURALCARE – a concept that describes holistic HEALTH care that is culturally sensitive, culturally appropriate, and culturally competent. CULTURALCARE is critical to meeting the complex nursing care needs of a given person, family, and community. It is the provision of health care across cultural boundaries and takes into account the context in which the patient lives as well as the situations in which the patient’s health problems arise. CULTURALCOMPETENCY embraces the premise that all things are connected. Each facet discussed in this text – heritage, culture, ethnicity, religion, socialization, and identity – is connected to diversity – demographic change – population, immigration, and poverty. These facets are connected to health/HEALTH, illness/ILLNESS, and curing/HEALING, beliefs and practices, modern and traditional. All of these facets are connected to the health care delivery system – the culture, costs, and politics of health care, the internal and external political issues, public health issues, and housing and other infrastructure issues. In order to fully understand a person’s health/HEALTH beliefs and practices, each of these topics must be in the background of a provider’s mind. Spector’s Cultural Assessment Model • The way to CULTURALCOMPETENCY is complex; the book depicts five steps to climb to begin to achieve this goal. They are knowing: Personal heritage – Who are you?? What is your heritage? How deeply do you identify with your traditional heritage? What are your health/HEALTH beliefs, those of your family, and your reference community? • Heritage of others – demographics – Who is the patient, their family, and their reference community? How deeply does a given person identify with their traditional heritage? • Health and HEALTH beliefs and practices – competing philosophies such as allopathic and homeopathic. • Modern health care culture and system – all the issues and problems – including, but limited to the costs and other relevant issues related to modern health care delivery. • • Traditional HEALTH Care Systems – The way HEALTH CARE was for most and the way HEALTH CARE still is for many. Once you have reached the sixth step in the development of CULTURALCOMPETENCY, you are ready to open the door to CULTURALCARE. Information taken from (http://www.ojccnh.org/project/spector.shtml) Giger and Davidhizar’s Cultural Assessment Model • • • • Dr. Joyce Newman Giger holds an Associate Degree in Nursing from Kentucky State University, Frankfort; a Bachelor’s in Science in Nursing from Goshen College, Goshen, Indiana; a Master’s of Science in Education from Indiana University at South Bend; a Masters of Arts in Nursing and a Doctorate in Educational Administration from Ball State University, Muncie, Indiana. She also served as the first African American elected Chair of the Faculty Executive Committee, coming most recently from the University of Alabama at Birmingham where she served as Professor of Graduate Studies for eleven years. Dr. Giger, a fellow of the American Academy of Nursing, has authored approximately 135 articles, 14 book chapters, and 6 books on strategies to enhance the provision of culturally-appropriate care and has developed a model for assessing cultural phenomena relevant to the delivery of culturally appropriate care (Giger & Davidhizar, 1991; 1995; Giger, Davidhizar, & Wieczorek, 1993). Her textbook titled Transcultural Nursing: Assessment and Intervention, 5th Edition (2008) Mosby Year Book, Inc. has been adopted widely by schools of nursing and has been translated in French. In February 2003, it was selected for the 13th year as a “Brandon-Hill Best New Book.” In addition, her second international text on cultural assessment was released in July of 1998 on the care of Canadian clients. Giger and Davidhizar’s Cultural Assessment Model • • • • • • The late Dr. Ruth E. Davidhizar earned her BSN from Goshen College and her MSN in Psychiatric Nursing Education and DNS in Psychiatric Nursing Research from Indiana University. She received an honorary doctorate in Humane Arts from Andrews University. She was board certified as a psychiatric nursing practitioner and was inducted as a fellow in the Academy of Nursing in 1995. In 2006, she was elected as Transcultural Nursing Scholar by the Transcultural Nursing Society. In 1987, Ruth joined the faculty at Bethel College as an adjunct professor. In this role, along with that current Chair of that Division and that sitting faculty, she assisted in the creation of new innovative nursing program that included at that time a BSN, BSN-RN, and ADN program. During that time, she served with that founding Chair and faculty to develop and write the first NLN accreditation report which under the founding Chair became the first nursing program in history to receive NLN accreditation without having graduated its first generic nursing students. In 1990, she assumed the leader of the Division of Nursing. From 1990 until June of 2008, she served faithfully as a Professor and Dean of the School of Nursing and Dean of Faculty in the MSN program. Dr. Davidhizar has authored more than 850 articles, book chapters, and books on strategies to enhance the provision of culturally-appropriate care and has developed a model for assessing cultural phenomena relevant to the delivery of culturally appropriate care Giger and Davidhizar’s Cultural Assessment Model • • • • Giger and Davidhizar’s Transculural Assessment Model The Giger and Davidhizar Transcultural Assessment Model was developed and field tested in 1988 (2008) by Joyce Newman Giger and the late Ruth Elaine Davidhizar. The Model focuses on assessment and intervention from a transcultural nursing perspective. I n this model, the person is seen as a unique cultural being influenced by culture, ethnicity, and religion. In response to the need for a practical assessment tool for evaluating cultural variables and their effects on health and illness behaviors, a transcultural assessment model is offered that greatly minimizes the time needed to conduct a comprehensive assessment in an effort to provide culturally competent care. The metaparadigm for the Giger and Davidhizar Transcultural Assessment Model includes: Transcultural nursing: A culturally competent practice field that is client centered and research focused. Culturally competent care: A dynamic, fluid, continuous process whereby an individual, system, or health care agency finds meaningful and useful care delivery strategies based on knowledge of the cultural heritage, beliefs, attitudes, and behaviors of those to whom they render care. Cultural competence connotes a higher, more sophisticated level of refinement of cognitive skills and psychomotor skills, attitudes, and personal beliefs. Giger and Davidhizar’s Cultural Assessment Model • To develop cultural competency, it is essential for the health care professional to use knowledge gained from conceptual and theoretical models of culturally appropriate care. Attainment of cultural competence can assist the astute nurse in devising meaningful interventions to promote optimal health among individuals regardless of race, ethnicity, gender identity, sexual identity, or cultural heritage. • Culturally unique individuals: An individual is culturally unique and as such is a product of past experiences, cultural beliefs, and cultural norms. • Culturally sensitive environments: Culturally diverse health care can and should be rendered in a variety of clinical settings. Regardless of the level of care, primary, secondary, or tertiary knowledge of culturally relevant information will assist in planning and implementing a culturally competent treatment regime. • Health and health status: Health and health status is based on culturally specific illness and wellness behaviors. An individual’s cultural beliefs, values, and attitudes all contribute to the overarching meaning of health for each individual Giger and Davidhizar’s Cultural Assessment Model • Giger and Davidhizar* have identified six cultural phenomena that vary among cultural groups. These are • Environmental control—The ability of members of a particular cultural group to plan activities that control nature or direct environmental factors. Included are the complex systems of traditional health and illness beliefs, the practice of folk medicine, and the use of traditional healers. These play an extremely important role in the way clients respond to healthrelated experiences, including the ways in which they define health and illness and seek and use health-care resources and social supports. • Biological variations—People from one cultural group differ biologically (physically and genetically) from members of other cultural groups: – Body build and structure – Skin color – Enzymatic and genetic variations – Susceptibility to disease – Nutritional variations Giger and Davidhizar’s Cultural Assessment Model • Social organization—The family unit, (nuclear, single-parent, or extended family) and the social group organizations (religious or ethnic) with which clients and families may identify. • Communication—Communication differences are presented in many ways, including language differences, verbal and nonverbal behaviors, and silence. • Space—Personal space and territoriality involves people’s behaviors and attitudes toward the space around themselves and are influenced by culture. The following terms indicate different types of space and relate to acceptable behaviors within these zones: • • – Intimate zone: extends up to 1 1/2 feet. – Personal distance: extends from 1 1/2 to 4 feet. – Social distance: extends from 4 to 12 feet. – Public distance: extends 12 feet or more. Time orientation—The viewing of the time in the present, past, or future varies among different cultural gr …