Transcultural Nursing (Finals)
5 Stages of grief
Denial Anger Acceptance Bargaining Depression
Phase 5
Develop a culturally-based client-nurse care plan as co-participants for decision and actions for culturally congruent care. -short CAG
Transcultural Caring dynamics
Developed to help answer the following questions about caring for patients of diverse cultures a. How do beliefs, values, attitudes, and behaviors that make up your experiences affect how you give care? b. How does a person's culture, including y our own, affect health, illness, healing, and caring? c. How can y ou help patients find the cultural and material resources necessary to improve their health? d. How can y ou help create a transcultural caring environment in the workplace or in school? e. What does transcultural ethics mean to you?
Biomedical Belief system
Disease is caused by physiologic disturbances such as genetic disorders, biochemical imbalances, and infectious organisms. Pathologic alterations in tissues constitute evidence of disease.
Cultural Diversity
Each culture is made up of individuals whose beliefs and behavior reflect some aspects of their culture, but not all aspects
Descartes
Each person as a body machine
Symptoms of Grief
Emotional & Physical Shock, sadness, guilt, etc Fatigue, Nausea, Insomnia, Lowered Immunity, etc
Body Touching
human caring is largely culturally defined and valued as important modes of communication and human expression and for healing and well-being. The therapeutic value of touching as healing is known and used by nurses, but few nurses know about cultures and specific outcomes that go beyond American and Western nursing views
Folk Healthcare system
include shamans, herbalists, acupressurists, and acupunturists.
Ethnohistory
includes those past facts, events, instances, experiences of individuals, groups, cultures, and instructions that are primarily peoplecentered (ethno) and describe, explain, and interpret human lifeways within particular cultural contexts over short or long periods of time
3 Types of racism
individual, institutional, cultural
Cultural Racism
individuals or institutions claim their heritage is superior to other individuals or institutions
cultural blind spot syndrome
is a belief that "just because the client looks & behaves much the way y ou do, y ou assume that there are no cultural differences or potential barriers to care."
Simultaneous dual ethnocentrism
is a component of every healthcare professional-client relationship
Religion and Dying
F I C A Faith Importance of faith Community, is he/she part of it Address, how does she/he address these spiritual issue
Asian Culture
Family members in the ____ may wish to avoid discussing (sometimes withholding) information from a patient with a terminal illness or impending death.
Organizational Cultural Competence
Focuses on the collective competencies of the members of the organization and their effectiveness in meeting the diverse needs of the clients, patients, staff and community
Madeleine Leininger
Founder and Leader of Transcultural Nursing and Leader of Human Care Research
African American
Generally accepting of end-of-life care if educated on appropriate forms of pain management.
Black americans
Have a long documented history of mistrust regarding the American healthcare system
Aspects of Cultural Diversity
Health insurance and health care access Racial and ethnic minority communities Mental health Elderly Bariatric/obesity
Ritualistic Behavior / Ritual
is a set procedure for performing a task. There are many healthcare rituals, such as performing safety checks when preparing & administering medications
Clinical Death
is during this time that individuals can be revived by way of CPR.
Popular Health Care system
provides a major source of care for a variety of problems and complains.
Nurture Care
providing loving care and attention. It is providing physical and emotional care and nourishment. It is otherwise known as showing or having compassion.
Culture Encounter
refers to a situation in which a person from one culture meets or briefly interacts with a person from another culture.
Cultural Overidentification
refers to nurses who become too involved, overly sympathetic, or too compassionate with the people, situation, or a human condition. ● This occurs when nurses have deeply sympathetic, biased, and emotional feelinngs about a culture or situation such as with poverty stricken, homeless, abused, oppressed, or battered individuals.
low cultural context
refers to people having less commonly shared meanings of life experiences or values, making it difficult to quickly understand strangers.
Culture care therapy
refers to qualified, transcultural nurses who offer assistive, supportive, and facilitative healing reflections and practices to individuals who have experienced cultural pain, hurts, insults, offenses, and other related concern
Cultural Imports
refers to taking in or receiving ideas,techniques, material goods, or other items with the position they can be useful or helpful in this culture. C
Culture Time
refers to the dominant orientation of an individual or group to different past, present, and the future periods that guides one's thinking and actions.
Culture
refers to the learned, shared, and transmitted knowledge of values, beliefs, and lifeways of a particular group that are generally transmitted inter-generationally and influence thinking, decisions, and actions in patterned or in certain ways
Cultura Imposition
refers to the outsider's efforts, both subtle and not so subtle, to impose their own cultural values, beliefs, behaviors upon an individual, family, or group from another culture. (Leininger, 1978)
Cultural Exports
refers to the sending of ideas, techniques, material goods, or symbolic referents to another culture with the intention they will be valued and used to improve lifeways or to advance practices.
Socialization
refers to the social process whereby an individual or group from a particular culture learns how to function within the larger society (or country), that is to know how to interact appropriately with others and how to survive, work, and live in relative harmony within a society.
Social Time
refers to time for leisurely interactions and activities in which exact time is of less importance. Cyclic time may be used to refer to when certain activities occur each day, night, month, or during the year, and cultures regulate their activities as a cyclic rhythm of life
Sunrise Model
represents the structure of culture care theory by describing the relationship between anthropological and nursing beliefs and principles. Nurses use this model when making cultural evaluations of patients.
Universality
the nature of a being or an object that is held as common or universally found in the world as part of humanity.
Culture Care Theory
theory - attempts to provide culturally congruent nursing care through " cognitively based assistive, supportive, facilitative, or enabling acts or decisions that are mostly tailor-made to fit with individual, group's, or institution's cultural values, beliefs, and lifeways. "
Caring
thought of as a moral enterprise because it is universal in terms of seeking meaning and ultimately seeking the good of the self, other and the environment
Cultural Care
Identifies patterns of care and their uses
Phase 3 of short CAG
Identify and document recurrent client patterns and narrative (stories) with client meanings of what has been seen, heard or experienced. -short CAG
Personification
In this excerpt, daffodils are described as "tossing their heads in sprightly dance", which is an action that only humans can perform.
Holistic Belief system
In this system, illness develops when one does not properly care for the body
2 Major Categories of Cultural Competence
Individual and organizational
Native Hawaiian Culture
May prefer to have family present when discussing an unfavorable prognosis. Accepting of palliative care
Construct of culture conflict
Occurs when nurses work with mainly unknown cultures.
Culture specific care
Originated from culture care but refers to particular ways to have care fit a client's needs. ● To help nurses focus on and provide care that fits the client's specific cultural needs and lifeways. ● The care being given is tailor- made.
Expressivity
Other cultural groups tend to be more expressive about pain. They learned from childhood that when one is in pain, the appropriate response is to moan or cry. Indeed, some cultural groups believe that one of the best ways to cope with and relieve pain is to groan or scream.
Clinical Death
Oxygen can be given, the blood can be kept circulated and the heartbeat could be potentially restored.
Folk Healthcare system
Patients and their families may often move between popular, folk, and biomedical systems in various patterns of help-seeking behavior.
Transitioning dying
Patients begin to withdraw from the physical world around them in preparation for their final journey
Stoicism
People from cultures that value ____ tend to avoid vocalizing with moans or screams when they are in pain
Culture Context
totality of shared meanings and life experiences in particular social, cultural, and physical environments that influence attitudes, thinking, and patterns of living.
Institutional racism
universities, businesses, hospitals, medical offices manipulate or tolerate policies that unfairly restrict opportunities of certain races, groups, or cultures.
Complicated Grief
usually arises from the death of a loved one, where the loss has left a person stuck in a state of bereavement.
Culture Space
usually culture and gender related
Arab cultures
usually not willing to accept DNR
Coparticipation concept
valued by most cultures. Traditional linguistic nursing sayings are often troublesome to clients of different cultures and can lead to CULTURAL RESISTANCE and NONCOMPLIANT RESPONSES
Respectful care
way of intrinsically valuing a vulnerable individual; proper care not necessarily so.
Individualistic
Persons who are raised in a ____ culture have more latitude in how they behave and what they believe.
Actively Dying
Physical signs and symptoms associated with death
alternative health care system
Practitioners of include chiropractors, homeopaths, neuropaths, and hypnotists.
Three modes of nursing care decision and actions
Preservation or maintenance Accommodation and/or negotiation Repatterning and/or restructuring
Subtypes of cultural care
Protective Comfort New types - touching care, reassurance care, filial care
Phase 1 of leininger short CAG
Record observations of what you see, hear or experience with clients (includes dress and appearance, body condition features, language, mannerisms and general behavior, attitudes and cultural features. -short CAG
Stereotyping
Refers to classifying or placing people into a narrow, fixed view with rigid, or inflexible, "boxlike" characteristics.
Discrimination
Refers to overt or covert ways of limiting opportunities, choices, or life experiences of others based on feelings or on racial biases.
Cultural Competence
Refers to the ability of health care providers and organizations to understand and respond effectively to the cultural and linguistic needs of the clients
Individual Cultural competence
Refers to the care provided for an individual client by one or more nurses, physicians, social workers, and/or other health care, education, social services professionals
12 - 18 hours
Rigor mortis will begin to set in several hours following death and be at its peak ________ following death.
48 hours
Rigor mortis will disappear ____ following death.
Hispanic Culture
Role of family is important
Rigor Mortis
Several hours after biological death occurs, ___ occurs
conspiracy of silence
Some clients use a _________ to show their dislike for nursing or medical care when it clashes with their cultural values and beliefs.
Phase 4 of short CAG
Synthesize themes and patterns of care derived from the information obtained in phases I, II, and III. short CAG
Catholic, Protestant
yes to organ donate and autopsy
Example of Culture Universality
○ Language and cognition ○ Society ○ Marriage ○ Myth, ritual, and aesthetics ○ Not to kill or do no harm ○ Technology
Culture
a particular way of life, which expresses certain meanings and values not only in art and learning, but also in institutions and ordinary behavior"
Care
As a noun is defined as those abstract and concrete phenomena be related to assisting, supporting, or enabling experiences or haviors toward or for others with evident or anticipated needs to ameliorate or improve a human condition or lifeway. As a verb is defined as actions and activities directed toward assisting, supporting, or enabling another individual or group with evident or anticipated needs to ameliorate or improve a human condition or lifeway or face death.
palliative care
is specialized medical care for people living with a serious illness, such as cancer or heart failure. Patients in _____ may receive medical care for their symptoms, along with treatment intended to cure their serious illness.
Ethnocentrism
is the belief that one's own culture or way of life is better than that of others
Caring
is the most unifying, dominant and central intellectual and practice focus in nursing around world
Medical Pluralism
it refers to the employment of more than one medical system or the use of both conventional and complementary and alternative medicine for health and illness
Culture Shock
may result when an outsider attempts to comprehend or adapt effectively to a different cultural group. The outsider is likely to experience feelings of discomfort and helplessness and some degree of disorientation because of the differences in cultural values, beliefs, and practices. Culture shock may lead to anger and can be reduced by seeking knowledge of the culture before encountering that culture.
jewish
no to autopsy and embalming under ordinary circumstances open caskets, nope
Roma Culture
no to institutional care
Disenfranchised Grief
occur when loss is devalued, stigmatized, or cannot be openly mourned.
Stereotyping
often a "quick fix" to classify people without understanding individual and group cultural differences.
Hindu
organ donate autopsy yes Bathing the body, need death must be peaceful not to be left alone until cremated
Generalized culture care
"Commonly shared professional nursing care techniques, principles, and practices that are and beneficial to several clients as a general essential human care need."
culturally congruent nursing care
All modalities require care coparticipation of the nurse and clients (consumers) working together to identify, plan, implement, and evaluate each caring mode for __________
Popular Health Care system
Also the basis for self-care groups such as alcoholics Anonymous and various cancer support groups.
Types of Grief
Anticipatory Grief Disenfranchised Grief Complicated Grief
Biomedical Belief system
Arose from the teaching of René Descartes, a 17th century philosopher
Biomedical Health Care system
Consistent with western values of self-reliance and individualism, the American medical system encourages patients to learn as much as possible about their illnesses
component of the process of cultural competence
Cultural Competence Awareness Knowledge Skill Encounters Desire
Hospice Care
focuses on the care, comfort, and quality of life of a person with a serious illness who is approaching the end of life. At this point, it may not be possible to cure a serious illness, or a patient may choose not to undergo certain treatments
Nursing Intervention Concept
generally not used in transcultural nursing. "only professionals know best"
Culture context
gives meaning to understand situations and clients and as a powerful guide for nursing actions or decisions.
buddhist
goal is peaceful death. no organ donate. incense after death
belief
guide the choices people make when they seek symptom relief and the cure for illness.
Culture Care
has been defined as the cognitively learned and transmitted professional and indigenous folk values, beliefs, and patterned lifeways that are used to assist, facilitate, or enable another individual or group to maintain their well-being or health or to improve a human condition or lifeway"
Health by western
health is characterized by the hierarchy of needs.
Cultural Diversity
Cultural diversity refers to the variations and differences among and between cultural groups resulting from differences in lifeways, language, values, norms, and other cultural aspects
Supernatural Belief system
Cultural groups that believe in the ______ model may view illness as a sign of weakness, a punishment for evil-doing, or retribution for shameful behavior such as disrespect toward elders.
Human Behavior
Cultural values dictate ______ to a vast extent.
Cultural Similarities
Culture encourages each of us to think, feel, and then act in certain prescribed ways
Biomedical Practitioners
pay primary attention to physical complaints and pathophysiologic changes and at the same time, these _________ deemphasize mental and emotional problems and the psychosocial component of disease.
Cultural Backlash
phenomenon that occurs when a culture has been "bought" or encouraged to use another culture's values, material goods, beliefs, and lifeways. This often proves to be unsuitable and leas to serious unfavorable outcomes.
Prejudice
preconceived ideas, beliefs, or opinions about an individual, group, or culture that limit a full and accurate understanding of the individual, culture, gender, event, or situation.
Native americans
prep body may be done by fam organ donate not pref
Biological Death
and is called the point of no return, meaning that once the brain dies, CPR will not be able to bring that person back.
Cultural Backlash
another phenomenon that is important to understand in transcultural nursing. It refers to negative feedback or unfavorable outcomes after nurses have been working or consulting with cultures (often overseas) for brief periods. The host country being served by a nurse(s) from another country feels their efforts failed to help the people in meaningful or beneficial ways. As a result, the host country or agency expresses negative views and feelings to the consultant, practitioner, or home agency.
Professiona care
are defined as formally taught, learned, and transmitted professional care, health, illness, wellness, and related knowledge and practice skills that prevail in professional institutions, usually with multidisciplinary personnel to serve consumers.
Black Americans
are less likely to formally prepare for the end of life
Loose Culture
are more prominent in western societies like America. These cultures are based on the belief that a person's life belongs to that person, which is in alignment with the founding fathers' Bill of Rights.
Beliefs
are the tenets or convictions that people hold to be true.
5 Basic Interactional Phenomena
5 BASIC CONCEPTS: 1. Culture encounter 2. Enculturation 3. Acculturation 4. Socialization 5. Assimilation
4-6 Minutes
There is ______ minutes window in which patients can be revived with CPR. WIthout CPR, in approximately 4-6 minutes after clinical death (the cessation of heart beat), brain cells will begin to die from lack of oxygen
Biological Death
There is a 4-6 minute window in which patients can be revived with CPR. WIthout CPR, in approximately 4-6 minutes after clinical death (the cessation of heart beat), brain cells will begin to die from lack of oxygen
4 Fundamental Ways of Knowing
These are applicable to all paradigms. 1. Personal (Personal Knowledge) 2. Empirical (Scientific Knowledge) 3. Ethical (Moral Knowledge) 4. Aesthetic (Artistic Knowledge or the Art of Nursing)
Popular Health Care System
This involves self-treatment, is the first source of care most people use, regardless of culture.
Simile
This phrase shows an indirect comparison between I/ the speaker and a cloud, using the word "as"
Biomedical Healthcare system
This system is geared to conquer disease by battling the onslaught of microorganisms and diseased cells, as well as the breakdown of body's organs due to aging.
Goal of short culturalogical assessment guide
To provide respectful, meaningful, and competent care to people of diverse cultures that leads to health and well-being or to face death or disabilities of individuals or groups
Holistic Belief System
To restore health, the person must restore equilibrium to the body.
Cultural Resistance & Noncompliant Response
Traditional linguistic nursing sayings are often troublesome to clients of different cultures and can lead to
Essence of caring, Transcultural Caring Ethics, Transcultural Context, Universal source
Transcultural Caring dynamics, four elements
self-reflective awareness, transcultural caring, influence, and knowledge complexity science
Transcultural consciousness; a combination of;
there is pressure to change attitude
Unless there _________, some people never progress beyond fear, dislike, & distrust to the next stage of acceptance.
Holistic Belief system
Unlike Western medicine, this system emphasizes illness prevention and health maintenance.
Ghanaian Culture, South african
Usually they prefer to die at home with little or no medical assistance.
albert pike
WHAT WE HAVE DONE FOR OURSELVES A LONE DIES WITH US; WHAT WE HAVE DONE FOR OTHERS A ND THE WORLD REMAINS AND IS IMMORTAL
Collective Society
When rules of thought and behavior are more rigid, it is
Campinha-Bacote
Who proposed cultural competence
Filipino
Will accept palliative care and pain control
East Asian
Will accept palliative care, dying at home can bring bad luck
Jamaican
Will seek health care but may believe in a possible cure despite terminal illness. Generally, accept end-of-life care
Egyptian
Yes to care, no to euthanasia
Cultural Values
_____ dictate human behavior to a vast extent.
Health
_____ is not simply an individual's physical state; it is intimately intertwined with social, cultural, and societal structures in place in communities, nations, and the world.
Generic Care
________ systems are culturally learned and transmitted, indigenous (or traditional), folk (home-based) knowledge and skills used to provide assistive, supportive, enabling, or facilitative acts toward or for another individual, group, or institution with evident or anticipated needs to ameliorate or improve a human life way, health condition (or well- being), or to deal with handicaps and death situations.
Communication Style
_________ in different cultures are distinctive customs for conveying information
Caring
a complex, relational concept that relies on the intricate interactions between individuals and others in their life world
high cultural context
cultural values, social structure, and environmental factors provides a holistic and totality view of the client within an environmental setting
Chinese Culture
culture maintains a patriarchal or hierarchical family structure.
values
culture's standard for discerning what is good and just in society. deeply embedded and critical for transmitting and teaching a culture's beliefs.
comfort care
defined as a patient care plan that is focused on symptom control, pain relief, and quality of life. It is typically administered to patients who have already been hospitalized several times, with further medical treatment unlikely to change matters.
Geert Hofstede
developed a framework that can be used to describe culture-based differences between social groups, including those that impact communication.
Anticipatory Grief
develops before a significant loss occurs rather than after.
Haitan Culture, Kenyan, Korean
die at home
individual racism
discrimination of individuals because of their visible biological characteristics, such as skin color or eyelid folds.
Aspects of culture in sunrise model
eligious, financial, s ocial, technological, educational, legal, political, and philosophical dimensions
Muslims
embalming and cremation, no autopsy, only for legal/medical after death, body should face MECCA OF THE EAST Body is prepared by same gender
Death
2 ways can be classified; clinical and biological
7 stages of adjustment
1. Fear 2. Dislike 3. Distrust 4. Acceptance 5. Respect 6. Trust 7. Like
Communication & Efficacy
A person's culture can make them naturally efficient at ____ but it can also reduce their ____
What can nurses do to address racism?
Acknowledge the inequalities ● Evaluate own thoughts and feelings ● Support systemic change ● Take a patient-centered approach
Phases of dying
Actively dying Transitioning Imminent Death
Strategies in the cultural grief
Assurance, Educate, Active listening, focus
A-S-K-E-D
Awareness Skill Knowledge Encounter Desire
Health Care Systems
Biomedical Popular Folklore Alternative
3 Major Types of health belief
Biomedical Supernatural Holistic
End of life care
Care given to people who are near the end of life and have stopped treatment to cure or control their disease. End-oflife care includes physical, emotional, social, and spiritual support for patients and their families.
Biomedical Healthcare system
Combines the Western biomedical beliefs that originated with Descartes and the traditional American values of self-reliance, individualism, and aggressive action.
4 care under transcultural care therapist
Comfort care Continuity care Nurture care Respectful care
Caring Tool
Compassion Advocacy Respect Interaction Negotiation Guidance
Healthby Newman
It is an expanded consciousness.
Biological Death
It is at this time that the cells in other organs, such as kidneys or eyes, will also begin to die.
Acculturation
It refers to the process by which an individual or group from Culture A learns how to take on many (but not all) values, behaviors, norms, and lifeways of Culture B.
Enculturation
It refers to the process by which one learns to take on or live by a particular culture with its specific values, beliefs, and practices.
Assimilation
It refers to the way an individual or group from one culture very selectively and 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.
Adenosine Triphosphate
It results from the loss of ______ which makes muscles become stiff with the loss of energy flow
Rigor Mortis
It results from the loss of adenosine triphosphate (ATP) which makes muscles become stiff with the loss of energy flow
EMIC
Knowledge gained from direct experience or directly from those who have experienced it. It is generic or folk knowledge.
ETIC
Knowledge that describes the professional perspective. It is professional care knowledge.
Transcultural Nursing
Leininger's model has developed into a movement in nursing care called ________
phase 2 of short CAG
Listen to and learn from the client about cultural values, beliefs, and daily (nightly) practices related to care and health in the client's environmental context. Give attention to generic (home or folk) practices and professional nursing practices. - short CAG
LEARN model
Listen, Explain, acknowledge, Recommend, Negotiate
Japanese
May accept assistance, often at home
Iranian
May accept pain medication
Amish Culture, Indian Culture, libyan
May accept palliative care
Cuban
May be reluctant to accept palliative care
Hispanic
May have reservation regarding accepting end of life care
Native American Culture
May not be willing to discuss terminal status as it is thought to hasten death.
Biomedical Healthcare System
Teaching patient self-care is also an important component of Western medicine
Rigor Mortis
Temporary rigidity of muscles occurring after Death
cultural stereotypes
The ancients first formed __________ when they came upon a new race or tribe. They quickly had to decide if the people were safe to encounter. Since there wasn't much time to figure if the group was safe or not, judgments were made towards the race or tribe as a whole, and not on an individual basis
Values and beliefs
The first, and perhaps most crucial, elements of culture are
Health by Watson
The harmony of body, mind, and spirit.
Holistic Belief System
The major premise of this system is that there are natural laws that govern everything and every person in the universe. To be healthy, a person must remain in harmony with the natural laws and be willing to continually adjust and adapt to changes in the environment.
Health & Care
The meaning of _______ in any culture or society determines the type of _____ that is most appropriate and effective
Culturally congruent care
The nursing goal is "to provide culturally congruent nursing care, which is defined as those assistive, supportive, facilitative or enabling acts or decisions that include culture care values, beliefs, and lifeways to provide meaningful, beneficial and satisfying care for the health and well-being of people, or for those facing death or disabilities".
Imminent
The patient has transitioned into this last phase of the dying process and death can occur at any point now
Invaluable guide to discover new knowledge
a. Holistic view of the cultures and not just nursing diagnoses, symptoms, disease and medical views b. Reach out and help people with diverse cultures c. Keep in mind to value clients' abilities to tell their story and to share their care knowledge and practices
Mecca of the east
after death, in muslims, body should face _______
Racism
belief that race is a fundamental determinant of human traits and capacities and that racial differences produce an inherent superiority of a particular race
Collective Cultures
believe a person's first obligation is to society. And, they must sacrifice their needs to benefit the greater good
Clinical Death
comes first and is when a person's heart stops beating
Universality
commonalities among human beings or humanity that reveal the similarities or dominant features of humans.
Continuity care
concerned with quality of care over time. It is the process by which the patient and his/her physician-led care team are cooperatively involved in ongoing health care management toward the shared goal of high quality, cost-effective medical care.