1. Trans Cultural Nursing Concepts
and Assessment
By : Azhar Munawar
BSN Generic 3rd Year Student
College of Nursing, GTHS, Lahore.
Date: August 17th 2023
Unit # No. 07

2. Objectives
1. Describe concept of trans-cultural nursing.
2. Explain key concepts related to trans-cultural
nursing
3. Identify the components of cultural assessment
4. Integrate concepts of trans-cultural nursing care
throughout the life span
5. Identify nursing frameworks and theories applicable
to trans-cultural nursing
6. Examine culturally related issues across the life
span
7. Explore the role of family and cultural practices
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At the end of this unit learners will be able to:

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Introduction
Leininger defined transcultural nursing
as:
“A legitimate and formal area of study,
research, and practice focused on
culturally based care, values, and
practices to help cultures and sub-
cultures maintain or regain their health
and face difficulties or death in a
culturally congruent and beneficial
caring ways.”

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Culture
“Transcultural Nursing is a comparitive
study of cultures to understand
similarities(cuture universal) and
differences (culture-specific) across
human group.
“Culture is the knowledge, language,
values, customs, and material objects
that are passed from one person and
from one generation to the next in a
human group or society”

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Cultural Norms
“Cultural norms are the standards that govern behaviors of people in a
particular society e.g
• Wearing certain clothing or head coverings in religious settings
• Covering one’s mouth when yawning or sneezing
Cultural Values
“Cultural values refer to the collective beliefs, principles, and ideals
that guide the behavior, norms, and decision-making of a particular
group or society e.g
Individualism: This cultural value emphasizes personal freedom,
autonomy, and self- reliance.

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History of Transcultural Nursing
In 1950’s Medeleine M. Leininger, known as the foundress of
Transcultural Nursing, noted cultural differences between patients and
nurses while working with emotionally disturbed children.
This experience led to study clinical difference in perception of the care.
She recognized that health and illness states are strongly influenced by
culture and formulated the theory of Transcultural Nursing.
In 1991, she published ‘Culture Care Diversity And Universality: A
Theory Of Nursing’ Her theory has now developed into a discipline in
nursing.
In 1988, Transcultural Nursing Society initiated certification
examinations: certified Transcultural Nurse (CTN).

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Key Concepts
Related To Transcultral Nursing
1- Culturally competent care
2- Second concept that is important to Nurses are:

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Objectives Of Transcultral Nursing
• To highlight transcultural nursing framework to guide
nursing practice in diverse health care setting.
• To analyze major concerns and issues in providing
transcultural nursing
• To expand the theoretical basis for using this concept in
providing culturally competent and culturally congruent
nursing care.

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CULTURAL ASSESSMENT
“The main goal of the cultural
assessment is to gather
sufficient information from
the client that will enable the
nurse to implement culturally
congruent care.”

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1. Veteran, family & community
• Country of origin/current residents
• Ethnic identity
• Influence of the community
• Decision-making
• Language and communication
2. Religion/Spirituality
3. Nutrition: Food preferences, practices, prohibitions
Components
Of Cultural Assessment

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4. Financial status
5. Health beliefs and practices:
• Death
• Grief & bereavement
• Pain
• Non-traditional therapies
• Care of the body Organ donation
• For Veterans Curriculum

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The Giger and Davidhizar-
Transcultural Assessment Model
This model was
developed in 1988 in
response to the need for
nursing students in an
undergraduate program
to assess and provide
care for patients that
were culturally diverse.

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1-Communication
2-Space
3-Cultural
Organization
5-Environmental
Control
4-Time
Components
Of Cultural Assessment
Giger and Davidhizer (1991) proposed six cultural phenomena
that the nurse must understand to provide effective care for all
patients
6-Biological
Variations

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1.Communication:
Communication is the means by which culture is
transmitted and preserved. Both verbal and
nonverbal communications are learned in one’s
culture.
Verbal and nonverbal patterns of communication vary
across cultures, and if nurses do not understand the
client’s cultural rules in communication, the client’s
acceptance of a treatment regimen may be
jeopardized.

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1.Communication conti...
Accurate diagnosis and treatment
is impossible if the health-care
professional cannot understand
the patient.
Culture not only determines the
appropriateness of the message
but also influences all the
components of communication.

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Thus, an assessment of communication
should consider:
1) Dialect,
2) Style,
3) Volume, including silence,
4) Touch,
5) Context of speech or emotional tone,
and
6) kinesics, including gestures, stances,
and eye behaviour
Thus, an assessment of communication should consider:
1) Dialect(a particular form of a language)
2) Style,
3) Volume, including silence,
4) Context of speech or emotional tone,
5) Touch, and
6) kinesics, including gestures, stances, and eye
behaviour.

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2. Space:
Space refers to the distance between individuals when
they interact. All communication occurs in the context of
space.
There are four distinct zones of interpersonal space:
1)inmate zone (extends up to 1½ feet),
2) personal distance (extends from 1 ½ to 4 feet),
3)social distance (extends from 4 to 12 feet) and
4) public distance (extends 12 feet or more)

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3) Social organization:
Social organization refers to the social group
organizations with which clients and families may
identify.
4) Time Orientation
Time is an important aspect of interpersonal
communication. Some cultures are considered future
oriented, others present oriented, and still others past
oriented.

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These differences in time orientation may become
important in health-care measures such as long-
term planning and explanations of medication
schedules.
Eg:Latin Americans, Native Americans, and Middle
Easterners are present oriented cultures and may
neglect preventive health care measures. They may
show-up late or not at all for appointments
4) Time Orientation Conti...

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5) Environmental control:
Environmental control refers to the ability of the person to
control nature and to plan and direct factors in the
environment.
Some groups perceive man as having mastery over nature;
others perceive humans to be dominated by nature, while
others see harmonious relationships between humans and
nature.
For example, Asians and Native Americans may perceive that
illness is a disharmony with other forces and that medicine is
only capable of relieving the symptoms rather than curing the
disease. These groups are likely to look for naturalistic

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6) Biological variations:
Biological variations are:
(1) body structure,
(2) skin colour,
(3) other visible physical characteristics,
(4) enzymatic and genetic variations,
(5) electrocardiographic patterns,
(6) susceptibility to disease,
(7) nutritional preferences and deficiencies, and
(8) psychological characteristics

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Concepts of Transcultural
Nursing Care Throughout Life Span:
• Illness and wellness are shaped by a various factors including
perception and coping skills, as well as the social level of the
patient.
• Cultural competence is an important component of nursing.
• Culture influences all spheres of human life. It defines health,
illness, and the search for relief from disease or distress.
• Religious and Cultural knowledge is an important ingredient
in health care.
• The health concepts held by many cultural groups may result
in people choosing not to seek modem medical treatment
procedures.

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• Health care provider need to be flexible in the design of
programs, policies, and services to meet the needs and concems
of the culturally diverse population, groups that are likely to be
encountered.
• The use of traditional or alternate models of health care
delivery is widely varied and may come into conflict with
Western models of health care practice.
• Culture guides behavior into acceptable ways for the people in
a specific group as such culture originates and develops within
the social structure through inter personal interactions.
• For a nurse to successfully provide care for a client of a
different cultural or ethnic to background, effective
intercultural communication must take place.

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Nursing Frameworks & Theories
Applicable To Transcultural Nursing:
1. Leininger’s Sunrise Model:
The model is based on the concept of culture care and shows 3
major nursing modalities that guide nursing judgments and
activities to provide ‘Culturally Congruent Care’
3 major modalities are
1) Cultural care preservation/ Maintainance
2) Cultural care Accommodation/Negotiation
3) Cultural care Repatterning/Reconstructing.

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Culturally Congruent Care:
The care that is beneficial and meaningful to the people being
served.
Culturally Diverse Nursing Care:
An optimal mode of health care delivery; It refers to the
variability of nursing approaches needed to provide culturally
appropriate care that incorporates an individuals cultural values,
beliefs and practices including sensitivity to the environment from
which the individual comes and to which the individual ultimately
return.

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2. Giger & Davidhizar’s
Transcultural Assessment Model:
Already explained on page no. 12
3. Narayanasamy’s Access Model:
ACCESS
a. A Assessment
b. C-Communication
c. C-Cultural Negotiation & Compromise
d. E-Establishing Respect & Rapport
e. S Sensitivity
1. S Safety

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4. Campinha-bacote’s
Cultural Competence Model:
1. Cultural awareness Cultural skill
2. Cultural knowledge
3. Cultural encounters
4. Cultural desire
CULTURALLY RELATED ISSUES:
• Beliefs about illness, causes and cures
• Nutrition and dietary practices
• Disorders specific to a particular ethnic group
• Religious beliefs about illness and death.

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ROLE OF FAMILY & CULTURAL PRACTICES
RELATED TO DEVELOPMENTAL STAGES:
1. Early Childhood
2. Middle Childhood
3. Adolescence
4. Adulthood

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Early Childhood:
From the moment of birth, children are absorbed into
culture. The ways that they are handled. Fed and
clothed are all influenced by their birth culture and
their caregivers’ approach to child rearing.
Different cultures have different beliefs with regard to
infants’ sleeping arrangements and whether or not
they should be left to cry or play alone.

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Middle Childhood:
Middle childhood, generally defined as the period from
ages 6 to 11, is a time when children are actively
socialized into their culture through family, school
and play.
During this time, children begin to learn the values
most upheld by their culture and are exposed to social
differences, such as categories of age, ethnicity, and
importantly, gender. Young children start to identify
themselves in terms of being a boy or girl, and this
self-concept affects their dress, their manner of play
and also the way that adults will interact with them.

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Adolescence:
Adolescence is a period when sexual maturation takes
place and young people undergo significant
physiological and social changes.
In some cultures, such as mainstream American
society and Western Europe, adolescence is regarded as
a time of preparation for adulthood, where
development is assessed according to building skills in
logic and problem solving, and demonstrating greater
levels of responsibility.

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Adulthood:
Stages of development suggest that during each part of
the lifespan, people achieve physical and social
milestones. Culture plays a large role in determining
development in adulthood, by helping structure ideas
about personal meaning and achievement, as well as
expected social roles.
Additionally, while many cultures emphasize the role
of women as mothers and caretakers, others lay stress
on women’s educational advancement and economic
self-sufficiency.

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Ask your students if they have any further questions
about the scope of the project or any important
deadlines.
Prof. Jamie Hailer
projects@jhailer.com
Office hours:
MON: 02.00pm–04.00pm

34. Thank You