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Course: Fundamentals of Nursing�Topic: Transcultural Nursing

The Nurses International Community

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Module Goals

Learners will be able to:

Describe health belief model and how they impact care of the client.
Describe the significance of culture in the clients’ care.
Define Transcultural nursing.
Discuss how the nurse provides culturally appropriate care.

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Health Belief Model (HBM)

First developed in 1950’s by social psychologists working in the U.S. Public Health Services

To explain why so few people were participating in programs to prevent and detect disease

Initially developed to explain and predict health related behaviors
One of the most widely used cognitive model and health behavior theory, in:

Research study of people’s behavioral responses to health
Developing behavior change strategies for health promotion programs

National Cancer Institute, 2005

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Health Belief Model

HBM proposes that a person’s likelihood of adopting a health behavior depends on

Perceived Susceptibility
Perceived Severity
Perceived Benefits
Perceived Barriers
Cues to Action
Self-efficacy

National Cancer Institute, 2005

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Health Belief Model

Perceived Susceptibility

Defined as ‘Beliefs about the chances of getting a condition’
Change in client’s health behavior depends on the level the client believes their risk is to getting an illness

Perceived Severity

Defined as ‘Beliefs about the seriousness of a condition and its consequences’
Change in client’s health behavior depends on how severe or negatively consequential client believes the condition to be

National Cancer Institute, 2005

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Health Belief Model

Perceived Benefits

Defined as ‘Beliefs about the effectiveness of taking action to reduce risk or seriousness’
Change in client’s health behavior depends on how effective the client believes the proposed action is in reducing threat to illness or disease.

Perceived Barriers

Defined as ‘Beliefs about the material and psychological costs of taking action’
Change in client’s health behavior depends on how client interprets the obstacles to performing the recommended health action.

National Cancer Institute, 2005

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Health Belief Model

Cues to Action

Defined as Factors that activate “readiness to change”
Change in client’s health behavior depends on stimulus provided to trigger acceptance of the recommended health action
Intensity of cues needed varies between individual

Self-efficacy

Defined as ‘Confidence in one’s ability to take action’
Change in client’s health behavior depends on the client’s perception of her/his competency to perform proposed health action.

National Cancer Institute, 2005

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Health Belief Model Implications to Nursing

Nurse has responsibility to:

Promote health
Prevent illness
Restore health
Alleviate suffering

HBM can be used as a guide by nurses to-

Understand ‘why’ of the client’s health behaviors
Identify client needs in respect to health promotion/prevention of illness/restoration of health/alleviation of suffering.
Develop effective strategies to help client adopt healthy behavior

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Critical Thinking Exercise

Tim has a history of heavy alcohol use and smoking, leading to a stroke at 59 years of age. He was hospitalized for two months, and except for less mobility in his left fingers, he recovered well. Since then he stopped smoking and drinking, and started eating healthy diet and doing morning exercises. Now he is 68 years old and he gets yearly colon cancer screenings. His father died of colon cancer, and his nephew Dave is 39 years old and lives close by. Dave is a chain smoker and drinker, and does not get yearly medical tests. Despite family members encouraging him to quit smoking and drinking and getting tested for colon cancer, he has not given up on those habits.

Use Health Belief Model to discuss differences between Tim and Dave regarding smoking and drinking habit.

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Answer:

Perceived Susceptibility

Tim had already suffered stroke. That experience possibly made him believe that he is highly susceptible to getting stroke again. Thus he changed his drinking and smoking habits. The stroke and hospitalization for 2 months also potentially made him more aware of other preventable medical issues, such as colon cancer. He started taking precautionary action against colon cancer, with a preventative screening.

Dave on the other hand has not suffered from any illness related to drinking and smoking, nor is he very old. So, he may not perceive himself as susceptible to serious health conditions as Tim does.

Perceived Severity

Having faced with the disease condition and its consequences, Tim’s perception of the severity of the disease condition is higher than that of Dave’s. This could be the reason Tim adopted healthier habits than Dave.

Perceived Benefits

Not having second episode of stroke after changing health habits, Tim must feel that not drinking/smoking is effective in preventing/reducing risk of stroke. However, Dave may not perceive quitting smoking/drinking as effective an action in reducing negative health consequences as Tim perceives it to be.

Perceived Barriers

For Tim, benefits of quitting drinking/smoking outweigh the barriers or obstacles of quitting smoking/drinking, after having to experience a hospitalization. Dave might feel that giving up the habit of drinking/smoking is difficult regardless of what other people say to him about its negative consequences.

Cues to Action

Fortunately Tim recovered from the stroke with minimal residual side effects, and it was a strong cue for him to adopt healthy habits. Dave had not perceived any cues from his uncles’ stroke experiences. Family members also advising him to stop smoking/drinking does not seem to be severe enough for him to adopt healthy habits.

Self-efficacy

Due to bad experience, Tim felt he was capable of giving up smoking/drinking rather than to suffer from a potentially debilitating condition such as stroke. Dave on the other hand is not able to believe that he can give up the habit of smoking/drinking.

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Cultural perspective plays a big role in shaping client’s health beliefs and behavior!

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Culture and Beliefs In Client Care

Definitions of culture:

‘...the shared patterns of behaviors and interactions, cognitive constructs, and affective understanding that are learned through a process of socialization. These shared patterns identify the members of culture group while also distinguishing those of another group.’

University of Minnesota, 2019

‘...shared knowledge and schemes created by a set of people for perceiving, interpreting, expressing, and responding to the social realities around them.’

Lederach,1995, as cited in University of Minnesota, 2019

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Image by Heifer.org (2017). World Ark (p12-13). From https://media.heifer.org/world-ark/2017/World_Ark_2017_Summer.pdf

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Culture and Beliefs In Client Care

Components of culture-

Non-material culture: values, beliefs, symbols, and language

Material culture: Society’s physical objects like tools/technology, clothing, eating utensils, means of transportation

Sociology: Understanding and

changing the social world, 2010

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Culture and Beliefs In Client Care

There are variations between cultural groups regarding beliefs and behaviors related to-

Meaning of health, illness, and death
Causes of disease
How illness and pain are experienced and expressed
Decision making process to seek help from healthcare provider
Preference of the treatments

Canadian Paediatric Society, 2018

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Culture and Beliefs In Client Care

Some examples of cultural differences related to healthcare-

Sitting close is perceived as an expression of caring in Japan, while in United States it may be felt as invasion of personal space.

Eye to eye contact may be interpreted as a sign of disrespect among Asian

Touching a person’s head may be impolite in some cultures because that’s where they believe the spirit resides

Understanding transcultural nursing, 2005

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Why should a nurse care about culture of another country?

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Nurse Should Care Because…..

Globalization/migration has increased the exposure of nurses to caring for people from various cultures around the world.

Every client has the right to culturally acceptable and appropriate care.

Often client’s cultural beliefs and behaviors and beliefs about health dictate their reception of health care services/information provided and their willingness to abide.

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Culture and Beliefs in Client Care

Demonstrating awareness of client’s culture and beliefs promotes:

Trust and respect between care provider and clients
Acceptance of diagnoses and treatments by clients
Client’s adherence to treatment
Adoption of healthy behaviors by clients
Client’s willingness to seek health care in future

Lack of cultural relevance may deflect the client from seeking appropriate healthcare or making healthy decisions.

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Transcultural Nursing

Dr. Madeleine M. Leininger, founder of the theory ‘Transcultural Nursing’, stated that-

"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."

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Transcultural Nursing

An integral part of nursing practice

Provides nursing care to the clients whose cultural background is different to that of the nurse
Is aware of the self and client’s culture and beliefs, recognizes the differences, and provides care that remains respectful of the difference

Provides culturally competent nursing care!

Understanding transcultural nursing, 2005

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Transcultural Nursing

Culturally Competent Care

Care that respects diversity in the client population and cultural factors that can affect health and health care, such as language, communication styles, beliefs, attitudes, and behaviors

Cultural competence require knowledge, attitudes, and skills that enable caring for people across different languages and cultures

Murphy, K., 2011

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Transcultural Nursing: Cultural Competence

KNOWLEDGE:

Acquire knowledge base of cultures of client and community, especially in relation to healthcare practices and beliefs.

ATTITUDE:

Become aware of the rules of interactions within cultures that will help better understand attitudes of the client;
Become aware of one’s own attitude, biases and prejudices

SKILLS:

Learn new communication skills to simplify language for any client, regardless of primary language
Learn to adapt to new and different situations in flexible way

Murphy, K., 2011

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Transcultural Nursing

Ways to provide culturally competent care:

Greet with smile and use low/moderate tone to speak
Proceed in an unhurried manner
Listen to the client and pay attention to any effort client/family makes to communicate
Use short, simple sentences, with simple words
Repeat and summarize frequently, and have client repeat the information
Use any appropriate words you know in the client’s language
Get phrase books from library,make flash cards, list of key phrases; client will appreciate the effort

Understanding transcultural nursing, 2005

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Transcultural Nursing (Continued)

Be aware of cultural trends while respecting individual clients' preferences.

Consider that not all people from the same cultural background share the same behaviors and views.

Understanding transcultural nursing, 2005

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Remember

Client has right to culturally appropriate care!

&

Nurse ensures that through transcultural nursing practice!

Understanding transcultural nursing, 2005

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References:

Canadian Paediatric Society, Caring for Kids New to Canada. (2018, March). How culture influences health. Retrieved on September 3, 2021 from https://www.kidsnewtocanada.ca/culture/influence

Murphy, K. (2011). The importance of cultural competence. Nursing Made Incredibly Easy!, 9 (2), 5. https://journals.lww.com/nursingmadeincrediblyeasy/Fulltext/2011/03000/The_importance_of_cultural_competence.1.aspx

National Cancer Institute. (2005). Theory at a glance: A guide for health promotion practice (2nd ed. pgs 13-15). http://www.sbccimplementationkits.org/demandrmnch/wp-content/uploads/2014/02/Theory-at-a-Glance-A-Guide-For-Health-Promotion-Practice.pdf

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References:

Sociology: Understanding and changing the social world. (2010). Available under the terms of a Creative Commons Attribution-NonCommercial-ShareAlike license. https://open.lib.umn.edu/sociology/chapter/3-2-the-elements-of-culture/

Understanding Transcultural Nursing (2005, January). Nursing,35, p- 14,16,18,21,23. https://journals.lww.com/nursing/fulltext/2005/01001/understanding_transcultural_nursing.3.aspx#:~:text=Transcultural%20nursing%20means%20being%20sensitive,and%20related%20health%20care%20practices.

University of Minnesota, The Center for Advanced Research on Language Acquisition[CARLA]. (2019). What is Culture? https://carla.umn.edu/culture/definitions.html

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