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Transcultural Health Care: A Culturally Competent Approach, 4th Edition Theories, Models, and Approaches Larry
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Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cultural Theories, Models, and Approaches ▪ Leininger: First nurse cultural theorist from early 1950s. She states it is for nursing only ▪ Campinha-Bacote: basic simple model without complex constructs but applicable to all healthcare providers. Also has a Biblical based model. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cultural Theories, Models, and Approaches ▪ Giger and Davidhizar: Nursing only ▪ Purnell: For all health care providers and is an example of a complexity and holographic conceptual model with an organizing framework. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cultural Theories, Models, and Approaches ▪ Papadopoulous, Tilki, and Taylor Model for Transcultural Nursing and Health ▪ Andrews and Boyle Nursing Assessment Guide ▪ Spector’s Health Traditions Model Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cultural Theories, Models, and Approaches ▪ Ramsden’s Cultural Safety Model ▪ Jeffrey’s Teaching Cultural Competence in Nursing and Health Care: Inquiry, Action, and Innovation Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Leininger’s Theory of Cultural Care Diversity and Universality www.madeleine-leininger.com ▪ Leininger described the phenomena of cultural care based on her experiences. ▪ Began in the 1950s with her doctoral dissertation conducted in New Guinea ▪ www.tcns.org and go to theories and then to the Sunrise Enabler and her model is displayed as well as publications. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Transcultural Nursing ▪ “Transcultural nursing has been defined as a formal area of study and practice focused on comparative human-care (caring) differences and similarities of the beliefs, values, and patterned lifeways of cultures to provide culturally congruent, meaningful, and beneficial health care to people.“ Leininger and McFarland text, 3rd ed.,2002, pp5-6. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Leininger: Purpose and Goal ▪ To discover, document, interpret, explain and predict multiple factors influencing care from a cultural holistic perspective. ▪ The goal of the theory was to provide culturally congruent care that would contribute to the health and well being of people, or to help them face disability, dying, or death using the three modes of action. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Leninger: Theoretical Tenets ▪ Leininger’s tenets: Care diversities (differences) and universalities (commonalties) existed among cultures in the world which needed to be discovered, and analyzed for their meaning and uses to establish a body of transcultural nursing knowledge. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Leininger: Assumptions ▪ Care is essence of nursing and a distinct, dominant, central, and unifying focus. Some would say that caring is not unique to nursing. ▪ Care is essential for well being, health, growth, survival, and to face handicaps or death. ▪ Culturally based care is the broadest means to know, explain, interpret, and predict nursing care phenomena to guide nursing care decisions and actions. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Leininger Assumptions ▪ Nursing is a transcultural humanistic and scientific care to serve individuals, groups, communities, and institutions worldwide. ▪ Caring is essential to curing and healing for there can be no curing without caring. ▪ Cultural care concepts meanings and expression patterns of care vary transculturally with diversity and universality. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Leininger Assumptions ▪ Every human culture has generic care knowledge and practices and some professional care knowledge that vary transculturally. ▪ Culture care values, beliefs, and practices are influenced by the (rays of the sun see the Model). ▪ Beneficial, healthy, and satisfying culturally based care influences the health and well-being of individuals, families, groups, and communities within the cultural context. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Leininger Assumptions ▪ Culturally congruent care can only occur when individuals’, groups’, and communities’ patterns are known and used in meaningful ways. ▪ Culture care differences and similarities between professionals and clients exist in all human cultures worldwide. ▪ Culture conflicts, imposition practices, cultural stresses, and pain reflect the lack of professional care to provide culturally congruent care. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Leininger’s Sunrise Enabler to Discover Culture Care To view the model go to: http://leiningertheory.blogspot.com/ Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Leininger Orientational Theory Definitions ▪ Cultural Care Preservation or Maintenance: all is well with the patient so encourage to continue what has been done ▪ Cultural Care Accommodation or Negotiation: Needs some change. What is acceptable weight from the patient’s perspective ▪ Cultural Care Repatterning or Restructuring: Practices are deleterious to overall health and need restructured: sexually promiscuous and has not been practicing safe sex Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cultural Competence in the Delivery of Healthcare Services: A culturally Competent Model of Care ▪ Dr. Josepha Campinha-Bacote but cannot display her model. Go to http://www.transculturalcare.net Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Process of Cultural Competence ▪ Cultural Competence is a process not an event. ▪ The process consist of five inter-related constructs: Cultural desire, cultural awareness, cultural knowledge, cultural skills, and cultural encounter. ▪ The key and pivotal construct is cultural desire. ▪ There is more variation within a cultural group than across cultural groups. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Process of Cultural Competence ▪ There is a direct relationship between healthcare professionals level of cultural competence and their ability to provide culturally responsive health care. ▪ Cultural competence is an essential component in delivering effective and culturally responsive care to culturally diverse clients. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cultural Desire ▪ . . . Cultural desire is defined as the motivation of the healthcare professional to “want to” engage in the process of becoming culturally competent; not the “have to”. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Concepts ▪ Cultural awareness is the self-examination and in-depth exploration of one’s own cultural background. ▪ Cultural knowledge is the process of seeking and obtaining a sound educational base about culturally diverse groups. ▪ Cultural Skills is the ability to collect relevant cultural data regarding the client’s presenting problem as well as accurately perform a culturally based physical assessment. ▪ Cultural encounter is the process which encourages the healthcare professional to directly engage in face-to-face interactions with clients from culturally diverse backgrounds. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition The Giger and Davidhizar Transcultural Assessment Model Dr. Joyce Giger Dr. Ruth Davidhizar (deceased) Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Giger and Davidhizar Assumptions ▪ The Giger and Davidhizar Transcultural Model postulates that each individual is culturally unique and should be assessed according to the six cultural phenomena. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Giger and Davidhizar Communication ▪ Communication embraces the entire world of human interaction and behavior. Communication is the means by which culture is transmitted and preserved. Both verbal and non-verbal communication are learned in one’s culture. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Giger and Davidhizar Space ▪ Space refers to the distance between individuals when they interact. All communication occurs in the context of space. ▪ Zones of personal space: intimate, personal, social, and consultative and public. Rules concerning personal distance vary from culture to culture. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Giger and Davidhizar Social Organization ▪ Social organization refers to the manner in which a cultural group organizes itself around the family group. Family structure and organization, religious values and beliefs, and role assignments may all relate to ethnicity and culture. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Giger and Davidhizar Time ▪ Time is an important aspect of interpersonal communication. ▪ Cultural groups can be past, present, or future oriented. ▪ Preventive health requires some future time orientation because preventative actions are motivated by a future reward. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Giger and Davidhizar Environmental Control ▪ Environmental control refers to the ability of the person to control nature and to plan and direct factors in the environment that affect them. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Giger and Davidhizar Biological Variations ▪ Biological differences, especially genetic variations, exist between individuals in different racial groups. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Boyle and Andrews Culturological Assessment ▪ Biocultural variations and cultural aspects of the incidence of disease ▪ Communication ▪ Cultural affiliations ▪ Cultural sanctions and restrictions ▪ Developmental considerations ▪ Economics ▪ Educational background Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Boyle and Andrews Culturological Assessment ▪ ▪ ▪ ▪ ▪ Health related beliefs and practices Kinship and social networks Nutrition Religion and spirituality Values orientation Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Ramsden Cultural Safety ▪ “the effective nursing practice of a person or a family from another culture, as determined by that person or family”, while unsafe cultural practice is “any action which diminishes, demeans or disempowers the cultural identity and wellbeing of an individual” (Nursing Council of New Zealand (NCNZ). Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Ramsden Cultural Safety http://culturalsafety.massey.ac.nz/RAMSDEN%20THESIS.pdf ▪ Assumes that nurses and the culture of nursing is exotic to people ▪ Gives the power of definition to the person served ▪ Concerned with human diversity ▪ Focus internal on nurse or midwife, exchanges power, negotiated ▪ A key part of Cultural Safety is that it emphasises life chances rather than life styles Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Papadopoulos, Tilki, and Taylor Cultural Awareness Self awareness Cultural identity Heritage adherence Ethnocentricity Stereotyping Ethnohistory Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Papadopoulos, Tilki, and Taylor Cultural Knowledge Health beliefs and behaviours Anthropological, Sociological, Psychological and Biological understanding Similarities and differences Health Inequalities Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Papadopoulos, Tilki, and Taylor Cultural Sensitivity Empathy Interpersonal/communication skills Trust Acceptance Appropriateness Respect Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Papadopoulos, Tilki, and Taylor Cultural Competence Assessment skills Diagnostic skills Clinical Skills Challenging and addressing prejudice, discrimination, and inequalities Copyright © 2013 F.A. Davis Company
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