Editorial

Transcultural Nursing: The global agenda

Marilyn 'Marty' Douglas
School of Nursing, University of California, San Francisco CA, United States of America

Juliene G Lipson
School of Nursing, University of California, San Francisco CA, United States of America

PP: 162 - 164

Article Text

Transcultural nursing must be more than caring for the patients or clients who come through our doors. It is not and cannot be solely about those we serve in our small corner of the world. Just as the fluttering of butterfly wings on one side of the world can contribute to the formation of hurricanes half way around the globe, social, political and economic events in one hemisphere affect the lives of people in the other half. This reality is becoming more evident with each passing day as globalisation becomes more firmly rooted and the internet reaches the farthest corners of our planet. We are becoming global citizens, tied inextricably to each other. What affects one group of citizens has an impact on the lives of every other group. This interdependence, along with a sense of obligation and our common humanity, underlies the imperative for social justice when addressing the health care needs of our fellow world citizens.

In the paper by Pacquiao (2008) that follows in this section, the author outlines the skills needed for world citizenship and describes how these skills form the basis for providing culturally competent care for vulnerable populations, particularly those who have migrated because of political, economic or environmental dangers. Within this framework, she explains the concepts of social justice, human rights and compassion in relation to cultural competence. She offers a number of strategies for teaching these abstract concepts and skills to health care students and practitioners.

Perhaps the timing of a new millennium has made the desire for change almost palpable in the air we breathe. Old political administrations are being defeated by electorates or parties who want to overturn that which has been, even if the new younger voices have not yet been tested. The mood is one of wanting something different from the old way of doing things, whether it is in Australia or the United States, Kenya, Russia, or the Middle East. But change can also cause chaos if it is not accomplished with care, especially when this change occurs within an unstable social or political context.

In the world today there are many examples of change, chaos, unrest and increasing social inequality, which have resulted in many people on the move. Motion and chaos seem to define this current historical period. Whether from war that shifts populations to refugee camps, or the hopelessness of poverty that drives the able-bodied to seek work in more promising economies, many become refugees, pawns in human trade, asylum seekers, or voluntary migrants. Large numbers of nurses are among these resettled migrants, many recruited from the developing countries by the western industrialised countries whose aging populations need increased nursing care. These nurses face tremendous challenges, potential exploitation, and numerous barriers to the optimal use of their professional skills. Transcultural nursing mandates that the principles of social justice, human rights and cultural competence extend as much to our professional colleagues as they do to our patients and clients.

In the paper by Mireille Kingma (2008) the author summarizes the scope and magnitude of the international nurse recruitment efforts and identifies the types of abuse, discrimination and exploitation reported by migrant nurses. The position of the International Council of Nurses (ICN) is presented along with its key principles for ethical recruitment and employment practices. In addition, ICN's educational standards for assisting internationally-recruited nurses to adapt to their new environment are cited, as well as strategies for integrating these nurses into the host country's organisational structure. Culturally competent nurses can help make the transition easier for their international colleagues by encouraging their education and professional growth through mentorship, compassion, patience and support. Ultimately, the learning becomes bidirectional; the mentor gains new insights about health care beliefs and practices from the mentee and vice versa.

Vulnerable populations, whether on another side of the globe or indigenous to our own country, are a particular focus in transcultural nursing. The health care values, beliefs and practices of these populations may be as different from our own as those from another continent. Yet we may be blind to our own biases and prejudices because of the prolonged exposure of living within a dominant society that has isolated and stigmatised these populations. One of the first steps in the process of gaining cultural competence entails self-reflection. One aspect is examining our own practice for evidence of racial discrimination that can lead to disparities in health outcomes due to the inherent biases of health care professionals.

In Section 4 of this issue, the authors of two papers address culturally competent care of indigenous populations. McMurray and Param (2008) describe how structural, historical and political factors have contributed to the negative health status and health outcomes of Australia's Aboriginal and Torres Strait Islander peoples. Included in these structural factors are barriers to health care access as well as biases of health care professionals themselves, especially when assessing and analysing health problems. Strategies for overcoming these barriers and biases are recommended by indigenous health professionals and organisations of professional health care providers in Australia. In the second paper, Wilson (2008) describes her research that explores the health perceptions of Mā-ori women and their interaction with ‘mainstream' health care services. Results of her study provide guidance for her recommendations for culturally competent practice for these Mā-ori women.

Finally, these two papers also illustrate the need for using culturally-appropriate research methods when investigating health problems of vulnerable populations. Sensitivity to the cultural norms of the group is necessary throughout the research process. To give an example from the US, permission of the tribal chief of an Indian population is required by institutional research review boards before initiation of any research with a tribe. However, obtaining this permission may be accompanied by difficulties in conducting the research. In some tribes, but not others, health care practices are considered the secret purview of the tribal healer and can- not be shared outside the tribe (Struthers et al 2005). Therefore the research may be limited by the questions that can be asked and the findings that may be published. Sensitivity to these issues can prevent a violation of trust, which could interfere with cross cultural communication and lead to misleading findings and irrelevant recommendations for practice.

The papers in this section illustrate the nature and scope of transcultural nursing as a global endeavour. By incorporating the principles of social justice, human rights, compassion, and human dignity, transcultural nurses aim to provide culturally competent care to fellow world citizens, irrespective of their cultural origins, human condition or social situation. By integrating our clients' cultural practices into their health care plan, we improve the probability of achieving positive health outcomes and meeting the primary objective of the World Health Organization (WHO), that of ‘attainment by all peoples of the highest possible level of health'.

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