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Transcultural nursing theory and models:
The challenges of application
Irena Papadopoulos
Transcultural Health and Nursing, Middlesex University; Head, Research Centre for Transcultural Studies in Health, Middlesex University, London United Kingdom
Akram Omeri
Adjunct Associate Professor, School of Nursing, College of Health and Science, University of Western Sydney, Parramatta NSW
Article Text
The European Union has declared 2008 the European Year of Intercultural Dialogue. This is in recognition that Europe is becoming more culturally diverse. Globalisation has increased the multicultural character of many countries, adding to the number of languages, religions, ethnic and cultural backgrounds found in Europe and other continents.
In Australia, in contrast to many other countries, the diversity of the population was well established and recognised before multiculturalism was first coined in the late 1970s (OMA 1989). However, the response was in the main related to the diversity of the immigrant population minimising significant aspects of diversity such as class, gender and culture and care beyond multiculturalism. This has had enormous implications for nursing and health care (Milner 1993).
Today, in addition to 20 surviving Aboriginal dialects, more than one hundred other languages are spoken by people from culturally and linguistically diverse backgrounds (Department of Immigration & Citizenship 2008; Omeri & Ahern 1999). Communication between cultures remains a critical issue for the cultural understanding necessary for transcultural nursing practice to be effective.
The social and cultural determinants of health is emphasised by Leininger's Culture Care Theory (Leininger and McFarland, 2002). In more recent years, equal emphasis has been placed on the impact that social and organisational structures have on our health (Papadopoulos 2006).
In a diverse world, transcultural nurses strive to make a difference to the health and well being of people, irrespective of their cultural backgrounds transcultural nurse researchers across the world have been and continue to be engaged in the production of knowledge, which has the potential to make a difference for people at whatever point of the health/illness continuum they may be (Omeri 2008; 2002).
In order to foster excellence in transcultural nursing practice, the development and wide application of transcultural nursing standards is of paramount importance to advancing excellence in transcultural nursing practice. Work has already been undertaken in this area. The certification of designated transcultural nurses is based upon eight standards developed using Leininger's Theory of Culture Care Diversity and Universality and Campinha-Bacote's Model of Cultural Competence (Leininger 1991, 1998, 2006; Campinha-Bacote 2002). Standards provide agreed criteria by which practice may be evaluated and teaching and learning progressed (Andrews & Boyle 2008: 10).
It can be argued that transcultural nursing theory and models are the most appropriate for the 21st Century, as they cogently address the deficits of the bio-medical model which dominated both medicine and nursing in the 20th Century.
As the articles in this section demonstrate, transcultural nurses have the knowledge and tools to help them transform nursing and health care in many places in the world.
User friendly theoretical frameworks facilitate both the production of knowledge and its application. Marilyn McFarland and Marilyn K Eipperle in their article ‘Culture Care Theory: A proposed theory guide for nurse practitioner practice in primary care settings' (2008), propose just that. Utilising Leininger's Theory of Culture Care Diversity and Universality as a foundation, they put forward a guide for educational preparation for advanced practice nurses working in primary care. They demonstrate how through the application of this theory, education, research and practice are connected as essential components toward the provision of culturally congruent care to meet the healthcare needs of diverse individuals, families, groups, and communities by family nurse practitioners. This will go some way towards eliminating the health inequalities experienced by many marginalised communities and individuals.
In her article, ‘A partnership of a Catholic faith-based Health system, Nursing and American Indian traditional Indian medicine practitioners', Ann O Hubbert (2008) uses Leininger's theory to discuss how the creative thinking and actions of a group of people resulted in a cultural partnership which bridged the gap between the professionals and the lay people to bring about much needed improvements to the services provided to an American Indian community. We learn that two of the key foundations of the traditional Indian medicine philosophy are the seven aspects of life and the essence of a holistic individual. Knowing these, helps us understand the personhoods of the people of this community. Amazingly, even though differences exist in human behaviours and actions among cultures, the seven values of the sacred life discussed in this article, are also similar among cultures and different religions. These are respect, honesty, truth, humility, compassion, wisdom and unconditional love.
These values are evident in the article ‘Bridging Generic and Professional Care Practices for Muslim Patients Through the use of Leininger's Culture Care Modes' by Hiba Webbe-Alamah (2008). Although the five tenets of Islam provide a strong practical framework for everyday living, they too, promote the values of respect, honesty, truth, humility, compassion, wisdom and unconditional love. These values come alive in the descriptions of the many Muslim generic care beliefs and practices provided in this article. Wise use of such information can help nurses provide sensitive and appropriate care.
Myrna AA Doumit and Huda Abu-Saad Huijer' (2008) address the importance of communication and truth telling in their article ‘Lebanese cancer patients: Communication and truth telling'. Notwithstanding the dangers of generalising, it has been the practice in the individualistic ‘West' to tell the patient their cancer diagnosis. On the other hand much has been published on how families in collectivist societies, such as the Lebanese, prefer to manage such information and request that any such diagnosis is not given to the patient direct. This article challenges that stereotype by providing evidence that the Lebanese patients who participated in this study consider it their right to know their diagnosis and that being more open about this will improve the levels of communication they have with their families and professional carers.
Despite the improvements in people's health in many countries due to biomedical and biotechnological advancements, huge health inequalities continue to persist both between countries and within countries. The continued development and application of research based Transcultural nursing insights has still a greater contribution to make to the peoples of the world as it realises its potential to contribute to the elimination of health inequalities.
References
Andrews M and Boyle JS (2008) Transcultural Concepts in Nursing Care 5th edn, Lippincott: Philadelphia.
Camphina-Bacote J (2002) The process of cultural competence in the delivery of healthcare services: A model of care, Journal of Transcultural Nursing 13: 181–184.
Department of Immigration and Citizenship (2008) Australian Government, National Agenda for a Multicultural Australia, accessed at http://www.immi.gov.au/media/publications/multicultural/agenda/agenda89/executive.htm on April 2008.
Department of Immigration & Citizenship (2008) Australian Government, National Agenda for a Multicultural Australia accessed at http://www.immi.gov.au/media/publications/multicultural/agenda/agenda89/language.htm on April 2008.
Leininger MM (1991) Culture Care Diversity and Universality: A theory of nursing, National League for Nursing Press: New York.
Leininger MM (1998) Twenty-five years of knowledge and practice development transcultural nursing society annual research conferences, Journal of Transcultural Nursing 9: 72–74.
Leininger MM and McFarland MR (eds) (2002) Transcultural Nursing: Concepts, Theories, Research and Practice, 3rd edn, McGraw-Hill: New York.
Leininger MM and McFarland MR (2006) Care Diversity and Universality: A worldwide theory for nursing 2nd edn, Jones & Bartlett: Sudbury MA.
Milner A (1993) Beyond culture, beyond multiculturalism, in Clark C, Forbes D and Francis R (eds) Multiculturalism, Difference and Post Modernism, pp.126-139 Longman Cheshire: Melbourne.
Office of Multicultural Affairs (1989) National Agenda for a Multicultural Australia, AGPS: Canberra.
Omeri A and Ahern M (1999) Utilizing culturally congruent strategies to enhance recruitment and recognition of Australian Indigenous nursing students. Journal of Transcultural Nursing 10: 150–155.
Omeri A (2002) Reflections on Australia and transcultural nursing in the new millennium, in Leininger M McFarland M (eds.) Transcultural Nursing Concepts, Theories, Research & Practice 3rd edn, McGraw Hill: New York.
Omeri A (2006) Transcultural nursing: the way to prepare culturally competent practitioners in Australia, in Papadopoulos I (ed) Transcultural Health and Social Care: Development of Culturally Competent Practitioners Ch 18, Churchill Livingstone, Elsevier: Edinburgh.
Omeri A (2008) Epilogue: Advancing transcultural nursing through collaboration, Advances in Contemporary Transcultural Nursing: Pathways of Cultural Awareness 2nd edn, Contemporary Nurse Journal 28(1–2): (in press).
Papadopoulos I (ed) (2006) Transcultural Health and Social Care: Development of culturally competent practitioners, Churchill Livingstone, Elsevier: Edinburgh.
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