Author: Sandhya Lakra, BSc nursing student, Novia UAS
Supervisor: Anita Wikberg, RN, RM, PhD, Senior lecture, Novia UAS

Introduction

Since 1998 The World Health Organization recognize that the health status between ethnic and social groups in different countries must not be differentiated. Within the growing population in western countries like Britain and European countries, there's a challenge on adequate health care professionals' education and health care delivery to the ethnic  groups. Transcultural nursing is not a new idea, which was already identified by Florence Nightingale referred to as the lady with the lamp, regarding the needs of cultural care in those days. The study and practice of components of cultural competence in nursing focus on the cultural caring values, beliefs, and practices of individuals, groups of comparable or different cultures, to deliver culture-specific and universal medical care in promoting health and well-being. (Doody & Doody, 2012)

Britain is considered as a country that is rich in multicultural groups in Europe. Approximately 3 million people in England and Wales belong to black and other minor ethnic groups originally belonging to India, Pakistan, China, Africa, Bangladesh, and Saudi Arabia. Thus, it is required within this culturally diverse society that transcultural health care provide culturally competent care (Narayanasamy, 2003).

Transcultural nursing is becoming the key component within health care and a requirement for present nurses in delivering care, because of the growing multi-culture in the society of different parts of the world. The growth in a multi-culture society demands the nurses to be culturally competent in their daily nursing practices. The culturally competent nurse knows other cultures and therefore nurses have the skill to identify the patients' culture and plan nursing care in keeping with the patients' culture which is appropriate and satisfying the needs of the patients.  Additionally, nursing care is holistic, which implies planning care to satisfy patients' individual needs which incorporate physical, social, psycho-social, emotional, and spiritual needs, therefore it is important that the nurses identify these to provide patient-centred care. The nurse must be culturally competent to produce holistic care (Maier-Lorentz, 2008).

Care is what a patient requires, it gives dignity to the people and stimulates the unwell person to recover. Therefore, the nurses must take the initiative for their cultural competence and deliver care to the ethnic groups. This text will help the nurses to understand and deliver care to the patient belonging to a diverse group by identifying their needs (Doody & Doody, 2012).

Cultural competence

Cultural competence is a continuous process in which the nurses constantly desire to accomplish the potentiality and availability to care for the patient, individual, family or community, within their cultural context. The process of cultural competence contains five components that are interrelated to each other, those are cultural knowledge, cultural awareness, cultural skills, cultural desire, and cultural encounter. Each of these components is applied in caring for the patient (Campinha-Bacote, 2009).

From the nursing perspective, being culturally competent is the potentiality of knowing the cultural differences and providing quality care to the diverse population. A culturally competent nurse is thoughtful about matters associated with culture, race, ethnicity, gender, and sexual orientation. Moreover, the culturally competent nurses are skilled in communication, cultural assessment, and have required knowledge about health practices in several cultures. Culturally competent nurses continually try to supply effective health care to a diverse population that is suitable as per their culture. The whole description of cultural competence in nursing is a continuous process with an aim ahead of achieving the ability to work skilfully with the people of a culturally diverse population. Moreover, taking care of the diverse populations with a keen awareness of diversity to not hurt their feelings, having knowledge and skills in diverse culture care, and showing respect personally and professionally. Knowing the patient's culture, allows the nurses to deliver more essential and suitable care. For example, understanding one's culture or belief could also be the most essential factor for the treatment (Maier-Lorentz, 2008).

Cultural awareness

Cultural awareness is being aware of one's own culture first, the nurse's own culture influences them and their care of patients. Cultural awareness identifies the actual needs of various groups. Where the health care providers respect and become thoughtful to their values, beliefs, behaviour, and ways of solving their patient's problems as per their patient's cultural needs. Observing the behavior of others through one's own beliefs and values may impact the practices of others. One can avoid misunderstanding by recognizing one's prejudice towards others' behavior. Cultural awareness is vital because people tend to judge others in line with the quality of their own culture and practice. People tend to impose their cultural practices and values, and beliefs on others (Doody & Doody, 2012).

Nurses should remember and be able to identify the different cultures that the patients can have. To plan the delivery of care to the patients of various ethnic groups, it's important that the nurses can differentiate between the cultures to fulfil the wants of the patient together with observing their cultural requirements. While gathering the data about the patient's cultural norms, the nurses need to grasp that within the group, still there can be differences. Every individual has beliefs, values, practices which will be in a different way than their culture (Maier-Lorentz, 2008).

The nurses must develop sensitivity together with awareness for the group to whom they deliver care. Development of sensitivity includes understanding the similarities and differences between cultural behaviors with no judgment. The nurses must be willing and versatile in creating relationships and learning about the patient's culture. Building relationships may be a key factor to health harmony (Walton, 2011). 

This world is full of examples of cultural awareness. One example is, a Hindu Brahman patient who is a pure vegan admitted in the ward requires a protein rich-diet. It is usually recommended to take meat as a protein-rich diet. To a patient who is a Brahman, the nurses cannot advise meat as a source of protein, they could recommend some beans or nuts. The nurse would be able to give appropriate advice if only the nurse is aware of the patient's culture and beliefs. The patient would gain confidence by the culturally appropriate care of the nurse instead of getting offended.

Cultural Knowledge

Cultural Knowledge is the way of finding and gaining an education that is useful in developing a base about multi-culture, ethos, and healthcare-related beliefs and values. The nurses must understand the patients' and family's way of thinking that describes how they perceive their disabilities and what their thoughts about them are. The nurses must bear in mind differences within the culture that may exist thanks to different experiences and opinions. Cultural knowledge is very important in nursing care, as every individual experiences health and disability in numerous ways. There may be huge differences between different cultures and groups in understanding health and disability, where the nurses must know about both illness and culture associated with different groups (Doody & Doody, 2012).

The nurses have conveyed their weakness regarding their knowledge in delivering culturally competent care to various groups of patients. They need also convey their weakness in delivering culture sensitivity care to individuals thanks to a lack of enough cultural knowledge and skills. The fundamental nursing education does not give enough education to the nurses to prepare them for culturally competent nursing care to each individual consistent with their cultural sensitivity needs of various cultures (Maier-Lorentz, 2008).

The nurses should be provided academic courses such as reading and practising and other programs like traveling and social get together, that particularly focus on the development of nurse's skills and knowledge in delivering culturally competent nursing care. The nurses who can accept other's cultural beliefs would be able to make a cultural assessment, then the last part of the program would be evaluating themselves regarding their ability to supply culturally competent nursing care. Nurses having enough cultural knowledge could also be seen through the trust and satisfaction that the patient shows to the nurses by the care that the nurses give to them (Maier-Lorentz, 2008).

Cultural knowledge can be seen in different behaviour patterns. In Finland punctuality is one of the important characteristics of a person. If a person comes to Finland from some other country or culture, where being late for an appointment or a meeting is a common behaviour. If this person in Finland behaves in the same way by being late now and then, the person may lose his or her time with doctors, appointments in a hair salon or with the police, etc., where timekeeping is very important and is followed.

Cultural skill

Cultural skill is that the potentiality to gather applicable data associated with patient's presents problems, furthermore, as do a precise cultural-based assessment. To conduct a cultural-based assessment the nurses must find out how to conduct the assessment. cultural assessment is an examination of an individual or a group and communities, supported their culture, beliefs, values, and practice to plan the sort of care to be delivered, which is suitable for the patients. The nurses should know their skills in conducting a cultural assessment. They should as well know their skill in carrying out an accurate cultural assessment that is influenced by the patient's physical, biological, and physiological differences. While conducting a cultural assessment the nurses must not only ask some questions, the assessment should be carried out in a cultural sensitivity manner, and not be judgmental to the response given by the patients (Doody & Doody, 2012).

Conduction of cultural assessment of diverse groups is very important. This may help the nurses prevent assuming the similarities and differences between their own and patients' culture by viewing them and their behaviours. The nurses assess patients on an individual basis, based on individual needs. The nurses operate in a very culturally skilled manner, making use of their presentation skills by seeing the differences and diversity of an individual and their family. While making a cultural assessment the nurses must consider the standard of interaction with individuals or groups. Awareness of one's cultural position, attitude towards cultural differences, knowledge of various cultural practices, and cultural skills are required to scale back cultural unfairness and build cultural competence, which supplies the power to know, communicate, and effectively interact with individuals and groups of various cultures (Doody & Doody, 2012).

Culturally skilled nurses would organize a thought of care together with the patient to form a mutual goal and understanding that are suitable for the patient and compatible with their cultural values and beliefs. The patient will gain a sensation of trust with the nurse and be comfortable with the care, planned by the nurse, which is according to the patient's cultural beliefs and values. The patient will likely cooperate with the plan of care that was planned by the nurse because they feel respected when the nurse is anxious about their cultural sensitivity (Maier-Lorentz, 2008).

There might be some differences between cultures in expressing feelings. For example, a particular cultural group may have a higher level of anxiety tolerance, while the other group of cultural background may get worried or panic easily for every small little thing. The nurses with the cultural skills will be able to identify by their assessment skills in which ways, they will be able to provide information and care so that the patient cooperates with the nurse, rather than disagree with the treatment.

Cultural desire

Cultural desire is that the willingness of the nurses or the healthcare providers to require involvement within the process of being culturally competent. To be a culturally competent nurse, the nurse must have had cultural encounters, to have cultural knowledge, awareness, and skill they must be willing to provide care for a patient from a diverse culture in a tolerant way. Believing that culturally relevant care is very important in healthcare and their action should be in line with their feelings. The nurses who desire to learn about the various cultures of the patient are not worried, but see it as a challenge. They are never exhausted by the diversity but are motivated by the diversity before them and find new learning and challenges (Seaely, Burnett & Johnson, 2006).

“Cultural desire is seen as the motivation of the nurse”. It is often noticed that people do not care about the nurse's knowledge until they see what proportion they care about. It is not enough for the nurses only to mention that they respect the patient's beliefs, values, and behaviours, but also, they need to deliver culturally sensitive care. The nurses must have the real motivation or desire to produce care that is culturally suitable to the patients. Additionally, cultural desire could be an affection to be broad-minded and versatile with others and their culture, accepting their diversity and similarities, and be willing to be told from other cultures (Doody & Doody, 2012).

Cultural desire includes, when a nurse comes across new behaviour or beliefs in her workplace, for example, a husband taking treatment decisions for the wife that is a common practice in Arabic culture. The nurse would be willing or get motivated to learn about this particular practice rather than judging the couple.

Cultural encounter in nursing

Culture encounter may be a process that stimulates the nurses to directly involve patients from diverse cultural backgrounds. It mentions that the involvement between the nurses and patients increases the verbal and non-verbal communication in patients with diverse cultures. The nurses understand that their use of nonverbal communication is also misinterpreted or is offensive to individuals of various cultural backgrounds, where they need entirely different intending to that individual action. Cross-culture encounter sometimes allows the nurses to update, clarify, reconstruct and rethink other cultures, which the nurses have had known previously. A cross-cultural encounter can be on a local to international level, which helps within the development of cross-culture communication skills and increases awareness and knowledge about other cultures (Sealey, Burnett, & Johnson, 2006).

Interaction in cultural encounters is very important, although interaction with a few individuals or groups does not make anyone expert on these groups or individuals. These individuals or groups of the same cultural background might not exhibit the same values, practices, and beliefs, because differences exist among intraculturally instead of only the interculturally. Face-to-face interaction is vital to avoid stereotyping and failure to convey a verbal and nonverbal response correctly. These actions are often challenging but help the nurses in communication with the varied cultural background. The nurses must still work together with patients effectively (Doody & Doody, 2012).

The cultural encounter can happen among nurses, nurse-patient, and patient relatives. For example, a nurse working in a delivery room in one of the Asian countries, When the baby is born, the nurse cleans the baby and tries to put new clothes on the baby, but the mother of the baby would ask the nurse to put old clothes instead of new ones. The nurse finds out by asking the mother that, it is the belief of the mother's family, that putting new clothes on the new-born baby may bring bad luck to the family or the baby or someone could have evil eyes on the baby. By this incident, the nurses have now encountered a new cultural belief and learned about their practice.

Conclusion

Transcultural nursing has become a very popular and important factor of nursing care because of the diverse population of different cultures, races, beliefs, and backgrounds. Care is what a patient need. Every individual of a different cultural background has the right to get the type of care that is appropriate to them. To deliver care that is appropriate to the patient, the nurses need to be culturally competent. The nurses should be willing to learn and cooperate with individuals or families of diverse cultures to be culturally competent. The nurses should take it as a challenge to deliver transcultural nursing care rather than being exhausted. There are components of culturally competent which give a guideline to the nurses to develop cultural competence. Cultural awareness is the component that helps the nurses to identify the actual needs and develop the sensitivity and awareness to respect others' cultures and beliefs. Cultural knowledge is about learning about others and accepting it without placing any judgment. Nurses must understand their own culture first to understand other's cultures. To make an applicable cultural assessment, cultural skills are required which helps in identifying present problems and further solutions according to the patient's culture and beliefs. The cultural skills prevent the nurse to assume, by the patient's behavior and culture, because individuals of intracultural background may have different beliefs. The cultural desire is the key to cultural competence. The nurses should have the willingness or desire to provide culturally competent care for a patient of a diverse cultural group. A cultural encounter of the nurse-patient is the central component that allows the nurses to interact with the patients of a diverse cultural group. The cultural encounter by the nurses helps them to apply their knowledge about other cultural competence in practice. The nurses can obtain knowledge about different cultures by reading, participating in courses and education organized by different organizations and means of social media. Other ways of achieving cultural competence can be by travelling, observing the practices of different cultures of the patient or a colleague, practising, and interacting with people of a different culture.

References

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