Beyond Transculturalism: Critiques of Culture Education in Nursing

Journal of Nursing Education

July 2008, Vol.47 No.7

The nursing disciplines approach to healthcare delivery for diverse populations
has emphasized transcultural nursing theories in education, research and practice.
These theoretical frameworks emerged from the pioneering work of Leininger and they
are largely similar in scope and perspective to her Culture care diversity and
Universality Theory. The prevalence of transcultural nursing theories is reflective, in part
of the professional value for inclusivity in education, practice and research that accounts
for healthcare needs of highly diverse populations. Despite the movement toward
standardization of cultural curricular content, there remains a lack of consensus
regarding the pedagogical approaches to cultural education in nursing. The nursing
literature reflects a schism in the discipline regarding foundational theoretical
perspectives and conceptualizations of culturally competent health workers. There are
variety of philosophical approaches apparent in nursing that influence curricular design
and educational processes. Many nurses have acquired an educational background
grounded in positivist philosophical perspectives, as evidence by the disciplines
continued adherence to the medical model.
Another prevalent philosophical tradition in nursing is humanism. A liberal
humanist perspective is reflected in the disciplines approach to transcultural nursing. A
humanist perspective emphasizes notions of equality and individual freedom, and
operates on an assumption of human commonality among people. Transcultural
theories dominate current pedagogical approaches to cultural and human diversity
education in nursing. The overall goal of transcultural nursing is to use this accumulated
base of cultural knowledge to develop nursing actions that will promote health behaviors
among clients and foster culturally sensitive and congruent care.
The integration of critical perspectives could potentially transform nursings
approach to cultural education. Critical theories are not dominated by a single model,
but reflect orientations that expose and analyze power imbalances that often go
unrecognized. Another important commitment is the commitment to freeing oneself and
others from oppressive societal structures and norms. A critical approach to nursing
science and practice involves examining ways in which categories of social difference
are constructed and operate in structural systems of privilege and power.
Multiculturalism and transcultural nursing are critiqued for the lack of clarity in defining
concepts of culture, race and ethnicity. Contemporary definition focus on race as
socially constructed system of categories based on phenotypic traits rather than as
biologic reality. Socially constructed differences that exist between the nurse and the
client on the basis of cultural, racial or ethnic identities are purportedly bridged by an
increase in nursing knowledge about other cultures

Reflection:
Nurses can easily adopt to different cultures and races. Thats why Madeline
Leiningers theory is helpful for all nurses. This theorist states that care is the essense of
nursing and the dominant, distinctive and unifying goal of nursing. She also emphasizes
that human caring although a universal phenomenon, varies among cultures in its
expressions, processes and patterns and is largely culturally derived. Nurses should
innovate approaches to prepare a workforce that responds to the diverse needs of
people from a wide variety of cultural backgrounds, languages and worldviews.
Transcultural nursing theory and multicultural nursing education tend to reflect a
liberal, humanist standard point that assumes health care contexts are situated within
an egalitarian and equitable society. The prevalent stance in nursing education is to
avoid confronting or naming structural systems of power and their effects in health care
contexts. In transcultural nursing theory, racism is rarely mentioned and in the nursing
profession in general, racism is euphemized or denied. Hence, refusal to address
racialized systems in nursing education has effects on both parties. Addressing the
health care needs of diverse populations has been an enduring value in nursing
education and practice. There are complex influences that contribute to denial and
discomfort in addressing racism in nursing.
A critical theory approach has the goal of eradicating the manifestations of
oppression in our everyday clinical practice as well as in our nursing theories and
curriculum. In this regard, the translation of theory to nursing practice entails the
examination of ones social privilege operates as power inequities in our relationship
with our clients and co-staff. In all aspect of Nursing, caring is a necessary factor in
giving out holistic care, and being transparent, open minded and acceptance of ones
culture is one of the key in rendering the best care to patients.