LESSON 3

TRANSFORMING OUR WORLD: THE 2030 AGENDA FOR SUSTAINABLE DEVELOPMENT

◦ The 2030 Agenda for Sustainable Development was adopted at the United Nations Summit in New York from 25 to 27 September 2015. The Agenda is a broad and universal policy agenda, with 17 Sustainable Development Goals (SDGs), with 169 associated targets which are integrated and indivisible. 

◦ Building on the Millennium Development Goals (MDGs), the 2030 Agenda seeks to guide Member States to transform their approach to achieve inclusive, people-centred and sustainable development with no one left behind

HISTORICAL AND FOUNDATIONS OF TRANSCULTURAL NURSING

Madeleine Leininger (July 13, 1925 – August 10, 2012) 

• was an internationally known educator, author, theorist, administrator, researcher, consultant, public speaker, and the developer of the concept of transcultural nursing that has a great impact on how to deal with patients of different culture and cultural background.  She is a Certified Transcultural Nurse, a Fellow of the Royal College of Nursing in Australia, and a Fellow of the American Academy of Nursing

• Her theory is now a nursing discipline that is an integral part of how nurses practise in the healthcare field today. 

TRANSCULTURAL NURSING (NATURE)  

In her classic, groundbreaking book titled “Nursing and Anthropology: Two Worlds to Blend,”Leininger (1970) analyzed the ways in which the fields of anthropology and nursing are interwoven and interconnected. 

Question: Relevance of Anthropology in Nursing?  

• Leininger used the term transcultural nursing (TCN) to describe the blending of nursing and anthropology into an area of specialisation within the discipline of nursing. Using the concepts of culture and care, Leininger established TCN as a theory and evidence-based formal area of study and practice within nursing that focuses on people’s culturally based beliefs, attitudes, values, behaviours, and practices related to health, illness, healing, and human caring (Leininger, 1991, 1995; Leininger & McFarland, 2002, 2006)  

• Transcultural nursing is a humanistic and scientific area of nursing study and practice that focuses on how patterns of behaviour in health, illness, and caring are influenced by the values and beliefs of specific cultural groups. It applies this knowledge in the planning and provision of culturally appropriate care.  

• TCN is sometimes used interchangeably with cross- cultural, intercultural, and multicultural nursing.  

• The goal of TCN is to develop a scientific cand humanistic body of knowledge in order to provide culture-specific and culture-universal nursing care practices for individuals, families, groups, communities, and institutions of similar and diverse cultures.

Culture-specific 

refers to particular values, beliefs, and patterns of behavior that tend to be special or unique to a group and that do not tend to be shared with members of other cultures. Culture-universal refers to the commonly shared values, norms of behavior, and life patterns that are similarly held among cultures about human behavior and lifestyles. 

CULTURE AND ANTHROPOLOGY  

To understand the history and foundations of TCN, we begin by providing a brief overview of anthropology, an academic discipline that is concerned with the scientific study of humans, past and present. Anthropology builds on knowledge from the physical, biological, and social sciences as well as the humanities. A central concern of anthropologists is the application of knowledge to the solution of human problems. Historically, anthropologists have focused their education on one of four areas: sociocultural anthropology, biological/physical anthropology, archaeology, and linguistics. 

CULTURE 

• One of the central concepts that anthropologists study is culture. A complicated, multifaceted concept, culture has numerous definitions. 

IMPORTANCE OF TRANSCULTURAL NURSING  

• Leininger’s Theory of Culture Care Diversity and Universality describes, explains, and predicts nursing similarities and differences in care and caring in human cultures (Leininger, 1991). Leininger cites eight factors that influenced her to establish TCN as a framework for addressing 20th- century societal and health care challenges and issues, all of which remain relevant today:

IMPORTANCE OF TRANSCULTURAL NURSING 

1. A marked increase in the migration of people within and between countries worldwide. 

2. A rise in multicultural identities, with people expecting their cultural beliefs, values, and ways of life to be understood and respected by nurses and other health care providers. 

3. An increase in health care providers’ and patients’ use of technologies that connect people globally and simultaneously may become the source of conflict with the cultural values, beliefs, and practices of some of the people receiving care. 

4. Global cultural conflicts, clashes, and violence that impact health care as more cultures interact with one another. 

5. An increase in the number of people traveling and working in different parts of the world. 

6. An increase in legal actions resulting from cultural conflict, negligence, ignorance, and the imposition of health care practices. 

7. A rise in awareness of gender issues, with growing demands on health care systems to meet the gender- and age-specific needs of men, women, and children. 

8. An increased demand for community- and culturally based health care services in diverse environmental contexts (Leininger, 1995) 

Leininger’s Contributions to Transcultural Nursing Providing Culturally Congruent Nursing Care  

• Culturally congruent nursing care “refers to those cognitively based assistive, supportive, facilitative, or enabling acts or decisions that are mostly tailor- made to fit with an individual’s, group’s or institution’s cultural values, beliefs, and lifeways in order to provide meaningful, beneficial, satisfying care that leads to health and well-being” (Leininger, 1991,)

COMMUNICATION AND SELF-AWARENESS

Interprofessional Health Care Team 

1. Client 

2. The Client’s Family 

3. Credentialed Health Professionals 

4. Folk, Indigenous People, or Traditional Healers 

5. Religious or Spiritual Healers 

6. Other 

COMMUNICATION AND SELF-AWARENESS  

• The World Health Organization defines interprofessional collaboration as multiple health workers from different professional backgrounds working together with patients, families, caregivers, and communities to deliver the highest quality of care (World Health Organization, 2013)  

• Derived from the Latin verb communicare, meaning to share, communication refers to the meaningful exchange of information between one or more participants.

1. Verbal Communication 2. Non- Verbal Communication

COMMUNICATION AND SELF-AWARENESS  

• Whereas language refers to what is said, paralanguage refers to how it is said and relates to all aspects of the voice that are not part of the verbal message.  

• Being respectful and polite, using language that is understood by the other(s), and speaking clearly will facilitate verbal (or spoken) communication.  

• Nonverbal communication refers to how people convey meaning without words, for example, through the use of facial expressions, gestures, posture (body language), and the physical distance between the communicators (proxemics). 

Important Aspects of Communication 

1) Language 

2) Interpreters 

3) Greetings 

4) Silence 

5) Eye Contact and Facial Expressions 

6) Gestures 

7) Posture 

8) Chronemics 

9) Modesty 

10) Technology assisted Communication 

11) Literature, Arts, Music, and Dance 

INTERPRETERS

One of the greatest challenges in cross-cultural communication for nurses occurs when the nurse and client speak different languages. After assessing the language skills of the client who speaks a different language from the nurse, the nurse may be in one of two situations: either struggling to communicate effectively through an interpreter or communicating effectively when there is no interpreter. 

IMPORTANCE TERMS RELATED TO CULTURE  

• Attitude is a state of mind or feeling about some aspect of a culture. Attitudes are learned; for example, some people think that one culture is better than another.  

• A Belief is something that is accepted as true, especially as a tenet or a body of tenets accepted by people in an ethnocultural group.  

• Ideology consists of the thoughts and beliefs that reflect the social needs and aspirations of an individual or an ethnocultural group.  

• Cultural knowledge is all we know that characterises a particular culture. It can include descriptions such as those known as cultural dimensions and can also include other information that may explain why people conduct themselves in a particular way.  

• Cultural awareness has to do with an appreciation of the external signs of diversity, such as the arts, music, dress, foods, and physical characteristics.  

• Cultural sensitivity has to do with personal attitudes and not saying things that might be offensive to someone from a cultural or ethnic background different from that of the health-care provider’s cultural or ethnic background.  

• Cultural competence in health care is having the knowledge, abilities, and skills to deliver care more congruent with the patient’s cultural beliefs and practices. Increasing one’s consciousness of cultural diversity improves the possibilities for health-care practitioners to provide culturally competent care.

CULTURAL DIVERSITY  

 is the existence of a variety of cultural groups within a society. 

VARIANT CHARACTERISTICS OF CULTURE:  

• Nationality: One cannot change his or her nationality, but over time many people have changed their names to better fit into society or to 13 decrease discrimination. For example, many Jews changed the spelling of their last names during and after World War II to avoid discrimination.  

• Race: Race cannot be changed, but people can and do make changes in their appearance, such as with of cosmetic surgery.  

• Color: Skin color cannot usually be change on a permanent basis. 

CULTURAL DIVERSITY : VARIANT CHARACTERISTICS OF CULTURE

Age: Age cannot be changed, but many people go to extensive lengths to make themselves look younger. One’s worldview changes with age. In some cultures, older people are looked upon with reverence and increased respect. Age difference with the accompanying worldview is frequently called the generation gap.  

Religious affiliation: People can and do change their religious affiliations or self identify as atheists. However, if someone changes his or her religious affiliation—for example, from Judaism to Pentecostal or Baptist to Islam—a significant stigma may occur within their family or community.  

Educational status: As education increases, people’s worldview changes and increases their knowledge base for decision making.  

Socioeconomic status: Socioeconomic status can change either up or down and can be a major determinant for access to and use of health care.  

Occupation: One’s occupation can change. Of course, an occupation can be a health risk if employment is in a coal mine, on a farm, or in a high-stress position. In addition, someone who is educated in the health professions would not have as much difficulty with health literacy.  

Military experience: People who have military experience may be more accustomed to hierarchical decision making and rules of authority.  

Political beliefs: Political affiliation can change according to one’s ideology. One of the major reasons for migration is ideological and political beliefs.  

Urban versus rural residence: People can change their residence with concomitant changes in ideology with different health risks and access to health care. 

 Enclave identity: For people who primarily live and work in an ethnic enclave where they can get their needs met without mixing with the world outside, they may be more traditional than people in their home country.  

Marital status: Married people and people with partners frequently have a different worldview than those without partners.  

Parental status: Often, when people become parents—having children, adopting, or taking responsibility for raising a child—their worldview changes, and they usually become more futuristic.  

Sexual orientation: Sexual orientation is usually stable over time, but some people are bisexual. In addition, people who are incarcerated may engage in same-sex activity but return to a heterosexual lifestyle when released from prison. Gender reassignment is now a possibility for some, although a significant stigma may occur.  

Sex and Gender: Sex is not necessarily binary and can be fluid. Sex identity may include males, females, transgender man or transgender woman and/or other gender nonconforming individuals. Not all individuals identify with the gender assigned to them at birth. Additionally, men and women may have different concerns in regards to type of work and work hours, pay scales, and health inequalities.  

Physical characteristics: One’s physical characteristics may have an effect on how people see themselves and how others them and can include such characteristics as height, weight, hair color and style, and skin color.  

Immigration status (sojourner, immigrant, or undocumented status): Immigration status and length of time away from the country of origin also affect one’s worldview. People who voluntarily immigrate generally acculturate and assimilate more easily.  

Length of time away from the country of origin: Usually, the longer people are away from their culture of origin, the less traditional they become as they acculturate and assimilate into their new culture. 

CULTURAL UNIVERSALITY  

• Defined as being anything common that exists in every human culture on the planet yet varies from different culture to culture, such as values and modes of behavior.  

• Examples of elements that may be considered cultural universals are gender roles, the incest taboo, religious and healing ritual, mythology, marriage, language, art, dance, music, cooking, games, jokes, sports, birth and death because they involve some sort of ritual ceremonies accompanying them, etc. 

RACISM  

Prejudice, discrimination, or antagonism directed against a person or people on the basis of their membership in a particular racial or ethnic group, typically one that is a minority or marginalized.