Textbook of Medical-Surgical Nursing 3e

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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.