24
Unit 1
Contemporary concepts in nursing
culturally sensitive or comprehensive care, culturally com-
petent or appropriate nursing care (NMBA, 2008; Giger &
Davidhizar, 2008), culturally congruent (Leininger, 2001), and
culturally safe nursing care (NCNZ, 2011).
The concept of culture has been, and is, interpreted differ-
ently by researchers, theorists, and practitioners interested in
human interaction, the differences in interpretation reflecting
underlying differences of emphasis and belief. The original
definition of
culture
is ‘that complex whole which includes
knowledge, beliefs, art, morals, laws, customs, and any other
capabilities and habits acquired by humans as members of
society’ (Tyler, 1871, cited in Rohner, 1984).
Since that time, the notion of culture has been refined and
reformulated in line with prevailing theoretical traditions.
The theme of ethnic variations of a population based on race,
nationality, religion, language, physical characteristics, and
geography has been included, and some theorists have argued
for a clear differentiation between ethnicity and race, arguing
that contemporary ‘ethnic’ conflicts are fuelled by a ‘racialised’
conception of ethnicity (Giger, Davidhizar & Purnell, 2007a).
Other theorists, not concerned solely with ethnic identity,
have maintained that culture encompasses a wider range of
social characteristics, such as disability, gender, social status,
class, physical appearance (e.g. weight, height), ideologies
(e.g. political views), and sexual orientation (NCNZ, 2011).
In addition to a focus on the content of culture, the source
of a person’s cultural orientation has also been analysed. The
founder of the theoretical tradition of transcultural nursing,
Madeleine Leininger (2001), has argued, for example, that
culture is knowledge that is learned and transmitted. This
knowledge consists of values, beliefs, rules of behaviour, and
lifestyle practices that guide designated groups in their thinking
and actions in patterned ways. An emphasis on the continuity
of culture is tempered by the acknowledgement that cultures
are not static but change both within and across generations.
Giger, Davidhizar and Purnell (2007b) contend that culture
develops over time as a result of an imprinting on the mind that
results from the influences of the social, religious, intellectual
and artistic structures. The concept of ethnic culture employed
in this chapter encompasses the following notions:
•
It is learned from birth through language and
socialisation.
•
Its core values are shared by members of the same cultural
group who have, therefore, a common sense of identity,
belonging, and distinctiveness.
•
It is influenced by specific conditions related to
environmental and technical factors, and to the
availability of resources.
•
It is dynamic and ever-changing.
Cultural diversity
has also been defined in a number of ways.
Often, skin colour, religion, and geographic area are used to
identify social diversity, with ethnic minorities being consid-
ered the primary sources of cultural diversity (Dayer-Berenson,
2011). However, as mentioned earlier, there are many bases
or sources of cultural diversity. Cultural diversity occurs
within Indigenous groups, and this diversity has been further
increased by the outcomes of settlement, colonisation, and
intermarriage. A second generation migrant may, for example,
take on some of the cultural traits of his or her parents and
some of the culture of his or her country of residence. In
acknowledging the cultural differences that may influence
healthcare delivery, the nurse must recognise both the cultural
heritage of the patient and his or her own cultural heritage.
The concept of
culturally competent nursing care
refers
to the provision of effective, individualised care that considers
cultural values, is culturally sensitive, and incorporates cultural
skills (Wilkinson, 2007). Culturally competent nursing care
is a dynamic process that requires comprehensive knowledge
of culture-specific information and an awareness of, and sen-
sitivity to, the effect that culture has on the care situation. It
requires the nurse to integrate this knowledge and awareness
into the plan of care (Dayer-Berenson, 2011). Reflecting on
and exploring one’s own cultural beliefs and how they might
conflict with the beliefs of the patient being cared for is the
first step to becoming culturally competent. Concepts that are
helpful in exploring the relationship between culture, health,
and healthcare include the following:
•
Acculturation.
This is the process by which members of
a cultural group adapt to, or learn how to take on, the
values and behaviours of another cultural group.
•
Cultural blindness.
This is the inability of a person to
recognise his or her own values, beliefs, and practices
and those of others because of strong ethnocentrism
(the tendency to view one’s own culture as superior to
another, or other, cultures).
•
Cultural imposition.
This is the tendency to impose one’s
cultural beliefs, values, and patterns of behaviour on a
person or persons from a different culture.
•
Cultural taboos.
These are activities governed by rules of
behaviour that are avoided, forbidden, or prohibited by a
particular cultural group.
Culturally competent nursing care
is based on the understand-
ing that complexity and diversity exist
within
a cultural group,
and that the nurse is, therefore, unable to possess culturally
specific information on which to base clinical decisions. To
gain the required knowledge, the nurse must work with each
person to identify the cultural beliefs and practices that are
important to his or her health experience. Identifying and
exploring the areas of conflict and the power dynamic between
them are the first steps in becoming culturally safe and com-
petent. Understanding the diversity within subcultures is also
important.
Subcultures and minorities
The term
subculture
denotes a group of people who share
characteristics that enable them to be identified, and identify
themselves, as a distinct entity within a larger cultural group.
Examples of Australian subcultures based on ethnicity (i.e.
subcultures with common traits such as language or ancestry)
include Indigenous Australians, Europeans of Italian or Greek
heritage, Middle Eastern and Asian people. In New Zealand
ethnic subcultures include Ma¯ori, European, Pacific and Asian
peoples. Within each subculture, further divisions exist (e.g.
language groups and clans of the Aboriginal and Torres Strait
Islander people and the
iwi
[tribe] or community groups of
Ma¯ori).
Subcultures may also be based on religion, occupation
(e.g. nurses, doctors, other members of the healthcare team),
or shared disability or illness (e.g. the deaf community).
Alternatively, subcultures may be based on age (e.g. infants,
children, adolescents, adults, older adults), gender (e.g. male,
female), sexual orientation (e.g. homosexual or bisexual men
or women), or geographic location.
