Friday, July 18, 2008

Group K:Transcultural Nursing...... a bridge to reach clients globally















Transcultural Nursing...... A bridge to reach clients globally

Madeleine M. Leininger
PhD, LHD, DS, CTN, RN, FAAN, FRCNA

Madeline Leininger was a pioneer nurse anthropologist. Appointed dean of the University of Washington, School of Nursing in 1969, she remained in that position until 1974. Her appointment followed a trip to New Guinea in the 1960’s that opened her eyes to the need for nurses to understand their patients’ culture and background in order to provide care. She is considered by some to be the "Margaret Mead of nursing" and is recognized worldwide as the founder of transcultural nursing, a program that she created at the School in 1974. She has written or edited 27 books and founded the Journal of Transcultural Nursing to support the research of the Transcultural Nursing Society, which she started in 1974.
Every human race has his/her different beliefs and culture may it be taught and passed on from one generation to the other. Even if we have the same language or dialect spoken we all have different culture and beliefs being followed as one of the norms in our society. And a part of our culture was our health beliefs and practices. In our group we categorize some of the health beliefs and practices into different age group based on experiences and research. This will give us awareness on how we could be able to render effective care to our clients, with certain age and background.
PRESCHOOL AND SCHOOL AGE
An ethnographic study of Latino pre-school children’s oral health in rural California revealed that, Latino children experienced a higher prevalence of caries than do children in any other racial groups in the U.S. The study conducted in 2005 focus on both recent immigrants and longer term residents of a small agricultural town in the central valley of California. Around 95% of the population of approximately 9,000 is of Latino largely Mexican origin.
Rural immigrant parents tend not to recognize dental caries in their children as a disease, but rather classified as visible discoloration on teeth and tend not to seek help unless this were accompanied with swelling and pain. Because tooth decay is viewed as a stain, when treatment is sought, parents often requested and expected cleaning. The high cost of restorative work therefore, is a surprise.
The mothers were educated by health care workers about baby bottle decay but claimed that the problem is the bottle nipple and not the sweet fluid content of the bottle. Many mothers claimed that as adults they never had a dental treatment nor dental caries when young and now their children have dental caries and they are unsure how to prevent it.
Migrant parent also reported major changes in diet since moving to the U.S., and also commented on how different their children’s diet is from their own when growing up. Major differences between their diets were the high consumption of sugar, sodas, and less access to fresh fruits and vegetable. Parents did not specifically associate these broad dietary changes with their children’s problems although they did connect the consumption of sweet substances with the subsequent advent of dental caries. Collectively all these understanding and actions on the part of care givers sets up Latino children for high rates of unrecognized and untreated oral disease.
ADOLESCENT
As depicted in Leininger’s Sunrise model culture, worldview, and social structure influences the individual’s care behaviors and beliefs which in turn affects their health and illness status. The nurse needs to clearly understand universal and specific cultural views of adolescents and clarify values in order to promote wellness in a culturally acceptable manner.
One of the most pressing problems of adolescence in many societies is engaging in risky sexual behaviors at an early age. In some societies, adolescent participation in risky sexual behaviours are treated as a measure of ‘manhood’, a sense of ‘belongingness’, a sign of ‘friendship’. The nurse through applying transcultural care concepts of Leininger should bear in mind these problems and study the deeply rooted societal and cultural origins of these.
Cultural beliefs and practices leading to risky sexual behavior do not only lead to this specific problem but to a myriad of problems related to such health practice including teenage pregnancy, sexually transmitted diseases, poor maternal and child health, etc. The nurse in these situations should devise a strategy in teaching adolescents about the effects of risky sexual behavior and actions to curb such incidents in ways that are meaningful to them.
There are a lot of universal and culture-specific issues concerning adolescents today. It is very important for a nurse applying transcultural care concepts to be sensitive not just to cultural and social background but also to the adolescent’s developmental issues and concerns.
Being an adolescent is indeed a big transition in our lives from an adventurous kid to a growing up girl/boy. We experience a lot of challenges like peer pressure and a lot of changes in our body. One of the things as an adolescent is when I have my menarche my mother asked me to jump in the stairs 3 times ,a part of our family’s culture I guess which I find very amusing.
As adolescents, we are expected to mingle with other person with the same age but some of us have a different upbringing so some tend not to "go with the flow" wherein others tend to be depressed and commit irrational behavior like suicide. Some committed suicide because of family problems, school, and failed relationships. Aside from personal and social challenges an adolescent faces, he/she also learn a lot of new things like drinking alcohol and smoking but it depends on how he/she will handle this, the parent's guidance will be of important issue here. Because not only this will affect personal relationships but also their health is at risk. I have this patient, 17 year old male who seek treatment in the emergency room who attempted to commit suicide by drinking sleeping pills because of a failed relationship with his girlfriend. As nurses we should understand them what they are experiencing now. We should treat them with empathy. Our responsibility is teaching them the importance of life and health. We should understand them because they behave differently depends on their family values, personal experiences and beliefs.


ADULTHOOD



A common theory is that adulthood is the real test of life, to experience the world from a first-person standpoint instead of through the parents. Then the adult can pass those experiences down to younger people and they can experience them when they become adults. In this stage, there are noticeable changes in how adults view on their careers / finances and Marriage/ family. Most of these adult live their life in a fast pace. As a nurse I encounter clients who are an American businessman who is an occasionally smoker and drinker for annual physical check up. Despite admitted in the hospital he’s still focusing his attention on his work rather than his health. He’s the breadwinner of the family. He has 4 kids studying in a private school and his wife works as a cashier in a grocery store I didn’t stopped him in doing his work but when laboratory test and physical assessment will be given to him I just told him to stop for a while and cooperate. I oriented him the importance of annual check-up and having a healthy lifestyle.
Another situation experienced among expectant mothers in Filipino-Chinese women they consult a Chinese conception calendar because some would like to have their first born to be a boy. An experience of one of our groupmates also told us when she was caring for a Filipino-Chinese woman who had been admitted to their floor. She asked her to contact her obstetrician because she have to give birth before lunch even if she’s not in active labor, as one of the many beliefs that Chinese have about labor and delivery. She was quite surprised by her request but she found out that it was just one of the many beliefs that the Chinese have about labor and delivery. She was brought to the delivery room before 10 am.
Some would like their first born to be a boy, others say that they consult a Chinese conception calendar for this. The calendar is supposed to predict whether you will have a girl or boy. Personally she was able to consult this when she was pregnant with my first born, the sex of my baby was accurately predicted.
OLDER ADULTHOOD/ GERIATRIC
The theory of Leininger paved its way in the study of human culture. Culture of an individual shapes ones view of aging. Which explains that older adult is also a heterogeneous group of people. With the increasing population of baby boomers, nurses should expand their roles in the care of individual or group of older adults not only in the hospital but in the community as well. As you read the succeeding text of my blog, I hope this will make you understand why older adults behave the way they do and how nurses should deliver personalized care.
Among older adults, one of us had been able to care for a 70 y/o white American client who was due for a cataract extraction. She oriented the client with the physical set-up and hospital policy. Her wife visited her and left after 2 hours. The client told me that in the United States visitors do not stay for a long time on the patient’s room in which he is fine with it. Looking at this patient we will notice that as long as they can do things by themselves they won’t bother in asking for assistance. In this situation older people experience a feeling of fulfillment if they can have a sense of control even with alteration in health condition.
Another adult patient she had was a 69 y/o who is due for CABG, three days prior to operation he was already admitted in the hospital to undergo clearance before he undergo surgery. She oriented him with the physical setup and rules. She discussed to the client visiting hours and number of visitors and companionallowed. He asked if he could have some considerations because he is expecting a lot of relatives. The request was granted. In this scenario as nurses we act as advocate of our clients, though there are rules to follow sometimes we will have to bend some as long as we are not bypassing any authority. We should know how to assert ourselves in behalf of our patients. Her Filipino client was used to that culture wherein there is strong family ties especially in times of health illness the presence provides comfort and security being the head of the family.
REFERENCES:
Isaacs B. An introduction to geriatrics. London: Balliere, Tindall and Cassell, 1965
Geiger, J.N. & Davidhizar, R.E. (1991). Transcultural nursing: assessment in intervention. St. Louis: Mosby-Year Book.
Leininger, M. (1991). Transcultural nursing: the study and practice field. Imprint, 38(2), 55-66.
Merck $ Co. The Merck Manual of Geriatrics.1995-2007 Merck & Co., Inc., Whitehouse Station, NJ, USA
www.baby-talk.co.uk/chinese_calendar.htm
http://www.tcns.org/
Andrews,M. and Boyle,J. "Competence in Transcultural Nursing Care" The American Journal of Nursing vol 97 no.8 august 1997.pp16AAA,16BBB,16DDD,Lippincott Williams and Wilkins
Silvestri,L. (2006). Saunders Comprehensive Review for the NCLEX-RN Examination. 3rd Edition. Singapore :Elsevier.
AƱonuevo,C.et al(2000).Theoretical Foundations of Nursing.Philippines:UP Open University.

Group members: Cherry Sagge, Marlon Salazar, Michael San Juan, Jay Ar Santiguel, Laarni Sarad, Marie Jam Separa, Clarisse Elise Sintor, Ma. Cristina Setubal, Elsie Santiago

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