5.
Cultural specifics – values, beliefs, and
TRANSCULTURAL NURSING
(MODULE 4)
Transcultural Nursing – is the humanistic and
scientific study and practice in nursing which is
focused upon differences and similarities among
cultures with respect to human care, health, and
illness based upon the people’s cultural values,
beliefs, and practices, and to use this knowledge
to provide cultural specific or culturally
congruent nursing care to people.
Transcultural Nursing – comparative study of
cultures to understand similarities (culture
universal) and difference ( culture-specific)
across human groups. (Leininger)
Leininger (1991) notes the main goal of
transcultural nursing is to provide culturally
specific care. ·
TERMINOLOGIES:
1. CULTURE
● refers to norms and practices of a
particular group that are learned and
shared and guide thinking, decisions,
and actions
● a system of shared beliefs, values,
customs, behaviors, and artifacts that
members of society use to cope with
their worlds and with one another. It is
passed down from generation to
generation through learning.
2. Cultural Values – the individual’s desirable
or preferred way of acting or knowing something
that is sustained over a period of time and which
governs actions or decisions.
3. Cultural identity – the sense of being part
of an ethnic group or culture.
4. Culture universals – commonalities of
values, norms of behavior, and life patterns that
are similar among different cultures.
patterns of behavior that tend to be unique to a
designate culture
6. Material culture – refers to objects (dress,
art, religious artifacts)
7. Non –material culture –refers to beliefs,
customs, languages, social institutions.
8. Subculture – composed of people who have
a distinct identity but are related to a larger
cultural group
9. Bicultural – a person who crosses two
cultures, lifestyles, and sets of values.
10. Diversity – refers to the fact or state of
being different. It can occur between cultures
and within a cultural group.
11. Ethnic – large groups of people classified
according to common ancestry and national,
religious, tribal, language, or cultural origins.
12. Ethnicity – a sense of identity an individual
has. How one sees oneself and how one is seen
by others as part of a group on the basis of
presumed ancestry and sharing a common
destiny.
13. Ethnocentrism – the perception that one’s
own way is best when viewing the world. Our
perspective is the standard by which all other
perspectives are measured and held to scrutiny.
14. Ethnography – is the study of a culture. The
methodological approach of ethnographic
research central to the nurse’s ability to:
1. develop a heightened awareness of
culturally diverse needs of individuals
2. define a field for observation for study of
the environment and its people, as well
as the reciprocal relationship that exists
between the two.
15. Race – a tribe, people, or nation belonging
to the same stock; a division of humankind
possessing traits that are transmissible by
descent.
16. Ethnic groups – share a common social
and cultural heritage that is passed on to
successive generations.
17. Ethnic identity – refers to a subjective
perspective of the person’s heritage and to a
sense of belonging to a group that is
distinguishable from other groups.
18. Cultural shock – the state of being
disoriented or unable to respond to a different
cultural environment because of its sudden
strangeness, unfamiliarity and incompatibility to
the stranger’s perceptions and expectations at is
differentiated from others by symbolic markers (
cultures, biology, territory, religion)
19. Culturally diverse nursing care – an
optimal mode of health care delivery, refers to
the variability of nursing approaches needed to
provide culturally appropriate care that
incorporates an individual’s cultural values,
beliefs, and practices including sensitivity to the
environment from which the individual comes
and to which the individual may ultimately return.
20. Cultural awareness – it is an in-depth
self-examination of one’s own background,
recognizing biases, prejudices and assumptions
about other people.
21. Acculturation – changes or adaptations in
cultural beliefs, values, and traditions resulting
from contact with other cultures overtime.
● Borrowing of certain traits by one culture
from another and can have negative or
positive effects.
22. Culturally competent care – ability of the
practitioner to bridge cultural gaps in caring,
work with cultural differences and enable clients
and families to achieve meaningful and
supportive caring
Three (3) Nursing Decision and Action modes
to achieve culturally congruent care:
1. Cultural preservation and maintenance
2. Cultural care accomodation or
negotiation
3. Cultural care repatterning or
restructuring
Importance of Culture
Culture provides us with:
1. A sense of belonging
2. A sense of identity
3. A feeling of cohesiveness
4. A sense of connectedness to those who
came before and to those who will come
after
Globalization and Transcultural Nursing
- The globalization theme assumes one
has worldwide perspectives, knowledge
and competencies when discussed as
service.
The central purpose and goal of
Transcultural Nursing
- To prepare a new generation of nurses
who would be knowledgeable, sensitive.
competent, and safe to care for people
with different or similar lifeways values,
beliefs, and practices in meaningful,
explicit, and beneficial ways.
- To provide culturally congruent and
competent care.
Factors Influencing Transcultural Nursing
1. The marked increase in immigration and
the migration of people within and
between countries worldwide.
2. An implicit societal moral and
professional expectation that nurses and
other health care providers need to
know, understand, respect, and respond
appropriately to care for people of
diverse cultures.
3. The rapid increase in the use of high
technologies in caring or curing with
different responses and effects on
clients of diverse cultures.
 4. Related to increased signs of cultural
conflicts, cultural clashes, and cultural
imposition practices between nurses
and clients of diverse cultures.
5. The rise in gender and special groups
issues and rights.
6. The growing trend to care with and for
people whether well or ill in their familiar
or particular living and working
environments.
Researches in the practice of Transcultural
Nursing
Ethnonursing Research Method - refers to a
qualitative nursing research method focused on
naturalistic, open discovery and largely inductive
modes to document, describe, explain, and
interpret informants’ worldview, meanings,
symbols, and life experiences as they bear on
actual or potential nursing care phenomena.
Culture Care Theory, Research, and Practice
in Diverse Cultures
● Philippine Americans and Culture Care
● Japanese Americans and Culture Care
● Arab Muslims and Culture Care
● Elder Care in Urban Namibian Families:
An Ethnonursing Study
● Canadian Transcultural Nursing: Trends
and Issues
● Reflections on Australia and
Transcultural Nursing in the New
Millennium
● Anglo-American (US) Culture Care
Values, Beliefs, and Lifeways
● South African Culturally Based
Health-Illness Patterns and Humanistic
Care Practices
● Finnish Women in Birth: Culture Care
Meanings and Practices
Culture Care Assessment
- refer to the systematic identification and
documentation of culture care beliefs,
meanings, values, symbols, and
practices, which includes the worldview,
life experiences, environmental context,
ethnohistory, language, and diverse
social structure influences.
- The goal of the assessment is to obtain
a full and accurate account of the client
so that appropriate nursing care
decisions can be made with the client
for beneficial client health outcomes.
- The Sunrise Model serves as a guide to
assess different holistic factors that tend
to influence the clients' care and health.
TRANSCULTURAL NURSING
(MODULE 6)
Culturally Congruent Care
● Defines as the provision of care that is
meaningful and fits with cultural beliefs
and lifeways (Leininger)
● It is holistic and focuses on the complex
interrelationship of lifeways, religion,
kinship, politics, law, education,
technology, language, environmental
context, and worldview
Culturally competent nursing care
● Cultural competence has been defined
as a process, as opposed to an end
point, in which the nurse continuously
strives to work effectively within the
cultural context of an individual, family,
or community from a diverse cultural
background (Andrews & Boyle)
Culturally responsive care
❖ Centered on client's cultural
perspectives
❖ Integrates client's values and beliefs into
plan of care
❖ Develops self-awareness of nurse's own
culture, attitudes, and beliefs
❖ Examines nurse's biases and
assumptions about different cultures
❖ Nurse gains knowledge and skills to
create environment where trust can
develop
Cultural Concepts ➢ Situations in which health problems
➢ Culture arise
➢ Subculture ➢ Transcultural nursing
➢ Multicultural ➢ Providing care within differences and
➢ Heritage similarities of beliefs, values, and
➢ Diversity patterns of cultures
➢ Race
➢ Ethnicity American Association of Colleges of Nursing
➢ Nationality Competencies
➢ Religion
➢ Ethnocentrism ➢ Apply knowledge of social, cultural
➢ Prejudice factors that affect nursing, health care
➢ Racism across multiple contexts
➢ Discrimination ➢ Use relevant data sources and best
➢ Generalizations evidence in providing culturally
➢ Stereotyping competent care
➢ Promote achievement of safe and
Immigration quality outcomes of care for diverse
➢ Acculturation populations
➢ Incorporating traits from another culture ➢ Advocate for social justice including
➢ Assimilation commitment to the health of vulnerable
➢ Individual develops new cultural identity. populations and the elimination of health
➢ Process of inclusion disparities
➢ Participate in continuous cultural
competency development
Cultural Self-Assessment
● To gain insights into the health-related
values, attitudes, beliefs, and practices Cultural Competence
that have been transmitted to you by ➢ Cultural desire
your own family ➢ Cultural awareness
➢ Cultural knowledge
➢ Cultural skills
Cultural Assessment ➢ Cultural encounters
The foundation for culturally competent and
culturally congruent nursing care
HEALTH Traditions Model
➢ Traditional
Psychomotor Skills ➢ Customs, beliefs, practices that have
➢ Selected examples of psychomotor existed for many generations without
skills changing
➢ Assessment ➢ Predicated on concept of holistic health
➢ Communication ➢ Describes what people do to maintain,
➢ Hygiene protect, and restore health
➢ Activities of Daily Living ➢ Describes health as balance of
➢ Religion person-body, mind, and spirit

Cultural Models of Nursing Care

➢ Culturally responsive care HEALTH Traditions Model
➢ Context in which client lives
 1. Body - All physical aspects
2. Mind - Cognitive and emotional
processes
3. Spirit - Both positive, negative learned
practices. Dreams, symbols, stories,
protecting forces, metaphysical/native
forces
HEALTH Traditions Model
Nine facets represented by:
➢ Traditional methods of maintaining
physical, mental, and spiritual health
➢ Traditional methods of protecting
physical, mental, and spiritual health
➢ Traditional methods of restoring
physical, mental, and spiritual health
Providing Culturally Responsive Care
➢ Nurse must use cultural knowledge by
acquiring awareness, attitudes, and
skills to care for diverse populations.
➢ Not possible to learn every cultural
perspective, but important to become
familiar with cultures in communities that
nurses serve
Health Beliefs and Practices
Magico-religious
➢ Health and illness controlled by
supernatural forces
➢ May believe illness is result of "being
bad" or opposing God's will
➢ Getting well also dependent on God's
will.
➢ Some cultures believe magic can cause
illness.
Scientific or biomedical
➢ Life controlled by physical and
biomechanical processes manipulated
by humans
➢ Illness caused by germs, bacteria, or
breakdown of the body
➢ Belief that pills, treatments, or surgery
will cure
Holistic
➢ Forces of nature must be maintained in
balance or harmony.
➢ Human life is one aspect of nature.
➢ When natural balance is disturbed,
illness results.
Folk medicine
➢ Beliefs and practices relating to illness
prevention and healing that derive from
cultural traditions rather than modern
medicine
➢ Thought to be more humanistic than
biomedical healthcare
➢ Consultation and treatment take place in
the community.
➢ May be less expensive than scientific or
biomedical care
➢ Frequently includes ritual practice by
healer or client
➢ More comfortable, less frightening to
client
Family Patterns
➢ Variables shaped by culture
➢ Authority figure in family
➢ Value placed on children, older adults
➢ Gender-role behavior
➢ Extent of family's involvement in
hospitalized client's care
➢ Needs of the extended family
➢ Naming systems
➢ Family and given name
Cross-Cultural Care: Cross-Cultural
Communication
 ● Because communication and culture are ● Use of:
acquired simultaneously, they are 1. Silence
integrally linked 2. Touch
3. Eye movement
Communication Style 4. Facial expressions
● CLAS standards for health care 5. Body posture
agencies
● Offer language assistance to individuals Space Orientation
with limited English proficiency to ● ntimate zone, personal zone, and social
facilitate timely health care access and public zones vary.
● Inform all individuals of availability of ● Be aware of client's response to
assistance services in preferred movement toward client
language, verbally and in writing 1. Explain procedure first
● 2. When possible, await permission
Communication Style
● CLAS standards for health care Personalizing space
agencies •Unless medically contraindicated
● Ensure competence of individuals •Objects of personal significance
providing language assistance
● Untrained individuals, minors Time Orientation
● Provide easy-to-understand print and 1. Past - Navajo Indians
multimedia materials and signage in the 2. Present
languages commonly used in service -African Americans
area -Important to avoid fixed schedules
3. Future
Verbal communication -Europeans, Americans
● Vocabulary, grammatical structure, voice -Culture of nursing, health care
qualities, intonation, rhythm, speed, -Punctuality valued
pronunciation, and silence
● Cultural values affect who initiates Nutritional Patterns
communication.
● Verbal communication Staple foods
● Interactions between people who speak ● How food is prepared
different languages are difficult. ● How food is served
● Translator
● Converts written material from one Food-related cultural behaviors
language to another ● Whether to breastfeed or bottle-feed
● Food as remedy for illness
Interpreter
● Transforms the message expressed in a Religious practice and diet
source language into its equivalent
● Cultural broker for accessing nuances
and hidden sociocultural assumptions Factors to consider for cross-cultural
● If English second language, client may communication
lose command under stress ● Communication with family members
and significant others
Nonverbal communication ● Space, distance, and intimacy;
● Meaning to the client nonverbal communication
● Meaning in client's culture ● Language
 ● Sick role behaviors ● Goal is to provide adequate care to
client's of any culture.
● Consider how culture influences client's
Nursing Management response to health conditions
Developing self-awareness
● Nurses identifies own cultural beliefs 3. Planning
and assumptions. ● Steps in developing cultural
competenceBecome aware of own
SKED pneumonic cultural heritage
● Awareness ● Become aware of client's heritage and
● Skill health traditions
● Knowledge ● Become aware of adaptations client
● Encounters made to live in another culture
● Desire ● Form nursing plan with the client that
incorporates cultural beliefs about health
Nursing Management maintenance, protection, and restoration
Conveying cultural sensitivity
● Spend time with client and convey 4. Implementing
genuine desire to learn their values and ● Cultural preservation and maintenance
beliefs ● Cultural accommodation and negotiation
● Address by last name ● f client chooses to follow only cultural
● Introduce self by full name practices, nurse and client must adjust
● Be authentic and honest about the client's goals.
culture
● Use language that is culturally sensitive 5. Evaluating
● Consider what client thinks about his or ● Client's cultural perspectives
her health problem, illness, and ● Actual client outcomes compared with
treatment goals and expected outcomes
● Ask about anything you do not ● If not achieved, consider whether client's
understand belief system has been adequately
● Conveying cultural sensitivity included as influencing factor
● Show respect for client's values, beliefs,
and practices
● Show respect for client's support people
● Obtain client's trust

Nursing Management

1.Assessing
● Depicts the questions to ask
● Designed to enhance the process
● Identification with traditional cultural
heritage
● Heritage consistent
● Acculturation into dominant culture
2. Diagnosing
● NANDA focused on care provided in
United States
● Based on Eurocentric cultural beliefs
DECENT MIDTERM UNIT ● Ethnocentrism
Question 1
Question 7
____________ is the knowledge, belief,
All of the following are the factors
art, morals, laws, customs, and any other
influencing transcultural nursing
capabilities and habits acquired by
EXCEPT?
humans as members of society.
● The marked increase in the number
● Culture
of nurses who travel and work in
● Cultural values
different places in the world.
● Transcultural Nursing
● The marked increase in immigration
● Cultural identity
and the migration of people within
and between countries worldwide
Question 2
● The rise in gender and special
Ethnic cultures are characterized by the
groups issues and rights.
following EXCEPT? ● The slow increase in the use of
● Dynamic and ever changing high technologies in caring or
● Shared by members of diverse caring with different responses
cultural group and effects on clients of diverse
● Learned from birth through cultures
language/socialization
● Influenced by certain conditions Question 8
(environmental) The focus of this construct is on
approaching the Individual patient or
Question 3
community with humility and taking a
Transcultural Nursing was envisioned in
learner role rather than assuming a
the early 1960s as a formal and essential
position of sufficient knowledge
area of study and practice.
regarding any particular group.
● False
● cultural sensitivity
● culture awareness
Question 4
● cultural competence
Founder of transcultural nursing is?
● cultural diversity
● Dorothea Orem
● Madeleine Leininger Question 9
● Florence Nightingale
Non-material culture include?
● Patricia Benner
● Dress
● Religious artifacts
Question 6
● Beliefs
The perception that one's own way is
● Art
best when viewing the world is?
● Ethnicity Question 10
● Ethnography
● Ethnic identity
These are the individual's desirable or ● A sense of disconnection to those
preferred way of acting or knowing who came before and to those
who will come after
something that is sustained over a
● A feeling of cohesiveness
period of time and which governs
● A sense of identity
actions or decisions.
● Cultural universals Question 16
● Cultural specifics Commonalities of values, norms of
● Cultural identity
behavior, and life patterns that are
● Cultural values
similar among different cultures?
Question 11 ● Cultural values
● Culture universals
Material culture Include the following
● Cultural identity
EXCEPT?
● Culture
● Customs
● Art Question 17
● Religious artifacts.
The Sunrise Model serves as a guide to
● Dress
assess different holistic factors that tend
Question 12 to influence the clients' care and health.
Ethnonursing research method is ● True
directed to discover both universal and
Question 19
diverse culture care phenomena.
Race share a common social and
● False
cultural heritage that is passed on to
Question 14 successive generations.
A subjective perspective of the person's ● False
heritage and to a sense of belonging to a
Question 20
group that is distinguishable from other
Cultural shock is the state of being
groups is?
oriented or able to respond to a different
● Ethnic groups
cultural environment
● Ethnicity
● Ethnic identity ● False
● Race
Question 21
Question 15 The following are the benefits of culture
Culture provides us with the following care assessment EXCEPT?
EXCEPT? ● Enhanced patient centered care
● A sense of belonging ● Reduced health similarity
● Improved communication
● Better diagnostic accuracy
 ● Insult
Question 22 ● Okey
The diversity of care reveals the ● Money
● Zero
common nature of human beings and
humanity, whereas, universality of care
Question 27
reveals the variability and selected,
In this country, the term "thank you" is
unique features of human beings.
considered a form of payment.
● False
● India
● China
Question 23
● Indonesia
The following are high context cultures ● Mexico
EXCEPT?
● Swiss Question 28
● Latin Americans "We know what's best for you; if you
● Japanese don't like it you can go elsewhere." This
● Arabs
is an example of?
● Cultural blindness
Question 24
● Discrimination
All but one are invisible cultural roots.
● Ethnocentrism
● Beliefs ● Cultural imposition
● Decision making styles
● Expectations Question 29
● Values
"We just aren't equipped to serve people
like that." This statement is an example
Question 25
of?
High context culture are cultures that
● Stereotyping
rely heavily on words to convey meaning
● Ethnocentrism
in communication.
● Discrimination
● False ● Cultural blindness

Question 26 Question 30
In Brazil this gesture means? "She's like that because she's Asian - all
Asians are nonverbal."
● Cultural blindness
● Ethnocentrism
● Discrimination
● Stereotyping

Question 32
Culture is a learned thing-
 ● True ● B,C,E
● B,C
Question 33 ● A,B,C
Biologically designated groups of people ● B,C,D
whose distinguishing features such as
Question 36
skin color are inherited. This is?
The nurse is conducting a health
● Cultural disparity
interview for a patient. Which
● Culture
● Cultural diversity assessment question is an example of
● Race an open-ended question?
A "Did you have this problem before?"
Question 34
B. "What do you think caused your illness?"
_________ is collection of people who
C"How do you want us to help you with your
have common origins and a shared
problem?"
culture and identity, with a common
D. "How different is this problem from the
geographic origin, race, language,
one you had previously?"
religion, values, and food preferences.
E. "Is there someone with whom you want
● Cultural diversity
us to talk about your care?"
● Ethnocentrism
● B,C
● Culture
● C,D
● Ethnic group
● D,E
● A,B
Question 35
Question 37
The nurse is assessing patients from
Under the supervision of the registered
different cultural backgrounds. Which
nurse, a nursing student is caring for a
actions should the nurse perform to
patient from different cultural
obtain a systematic cultural
background. Which action performed by
assessment?
the student nurse indicates the need for
A. Overlook the patient's beliefs about
further teaching on transcultural
health care
nursing?
B. Establish trusting relations with the
● Advocating for the patient
patient
considering his or her world view,
C. Obtain information by asking open-ended ● Asking the patient open-ended
questions questions
D. Gather arca demographic information ● Speaking to the patient's family
members about the cultural aspects
from census data
● Offering generalized opinions
E. Obtain information about economic
during the assessment of the
backgrounds patient's world view.
 ● A,B
Question 38 ● A,B,C
The nurse is explaining the concept of ● B,C,D
being culturally competent to another
Question 40
nurse. Which are components of cultural
Which statement Is TRUE regarding
competence? Select all that apply.
culturally congruent care?
A. Cultural difference
● In culturally congruent cars,
B. Cultural desire
transcultural nursing enables
C. Cultural encounters primary health care providers to
D. Cultural skills deliver uniform services irrespective
E. Cultural knowledge of health beliefs.
● Culturally congruent care bridges
F. Cultural awareness
gaps to provide supportive care for
● E, F
patients from certain cultures.
● B,C,D,E,F
● Culturally congruent care has
● A,B,C
predetermined criteria from which
● A,C,D,E
patterns of life and the system of
meaning are generated
Question 39
● Culturally congruent care
The nurse is learning about the impact of sometimes diverges from the
different cultures on nursing. Which are values of the professional health
the benefits of culturally congruent care system.
care? Select all that apply.
Question 41
A. It will help the nurse to deliver different
Which of the following cultural
remedies for an illness as practiced in the
competency recognizes biases,
patient's culture.
prejudices, and assumptions about other
B. It will help the nurse to deliver the
people?
specific kind of health care that is expected
● Cultural awareness
from patients who belong to a different
● Cultural knowledge
culture. ● Cultural desire
C. It will help the nurse to identify the ● Cultural skills
similarities and differences of various
Question 42
patients across different cultures.
The use of transcultural nursing
D. It will help the nurse to interpret the
knowledge is founded on the goal of?
needs of the patient who belongs to a
● Eliminating cultural differences
different culture.
● Establishing system-centered health
E. It will help the nurse to interact with
policy.
different people in their language
● A,D,E
 ● Delivering culturally sensitive
care that is Free of inherent
biases
● Increasing client compliance to
Western medical model.
● Awareness of actions that can be
expected of persons in a given
culture.
● Awareness of personal
stereotypes based on culture.

Question 43 Question 46
The major purpose of culturally Which of these cultural phenomena are
congruent nursing care is to enable the among those considered essential and
nurse to? are evidenced among all cultural
● Provide care in a culturally groups? Select all that apply.
sensitive manner. A. Communication
● Change his or her beliefs to meet
B. Space
the patient's needs.
C. Social organization
● Be aware of his or her own cultural
beliefs and values. D. Time
● Refrain from making judgments E. Environmental control
when patients are wrong F. Biological variations
● F
Question 44
● E
Transcultural nursing is viewed as ● B,D
culturally competent practice field that ● A,C
is?
Question 47
● Client centered and research
focused Which statement best Illustrates what
● Spiritually centered and research the nurse should consider when
focused reflecting upon the patient's context?
● Nurse centered and research
● Employment and economic status of
focused
the patient.
● Concerned with difference between
● Folk and traditional health beliefs
but not within cultural groups
and attitudes
● Social, political, historical and
Question 45
structural situations impacting
The principle that is most important to the patient.
the provision of culturally competent ● Preferences for Western versus
care is the nurse's: Eastern traditions
● Knowledge of specific behavior that
Question 48
is typical of a person in a given
culture. Which statement below best describes a
● Sensitivity to what the physician culturally competent nurses?
says about a person in the cultural ● Having the desire to partner or
group of the patient collaborate with the patient.
 ● Having the attitude, knowledge,
and skills necessary to provide
quality care to culturally diverse
patients and groups
● Having the motivation to provide
quality care to assigned patients
● Having the knowledge of multiple
languages to address various
patients' needs.

Question 49
In Leininger's Sunrise Model, "generic or
folk systems" refers to:
● Systems of medicine that are
antiquated and no longer useful
● Western medicine
● Health practices of the elderly
● Traditional health care practices
and belief systems used as
alternatives to Western medicine

Question 50
The culturally competent nurse
recognizes that the most appropriate
time for performing a cultural
assessment is?
● During the physical examination
● After the nurse has met with the
patient and the family
● During each patient nurse encounter
● When obtaining a health history