Cultural Diversity and Nursing Using Leininger Model The concept of trans-cultural nursing came from Leininger and the principal goal was put as being to provide culturally specific care. The difficulties of this can be understood only when an individual understands the concepts behind 'culture, cultural values, culturally diverse nursing care, ethnocentrism, race and ethnography'. (The Basic Concepts of Trans-cultural Nursing) The definition given by Leininger was "A humanistic and scientific area of formal study and practice in nursing which is focused upon differences and similarities among cultures with respect to human care, health, and illness based upon the people's cultural values, beliefs, and practices, and to use this knowledge to provide cultural specific or culturally congruent nursing care to people." (The Basic Concepts of Trans-cultural Nursing) In this context it is important to know the parts of human life that we are referring to.

Culture is the norms and practices of a specific group of human beings that are learned and influence their thinking, decisions and activities. Culture values provide the guidance for acting in particular situations. Culturally diverse nursing care refers to an optimal mode of providing health care and this requires taking care of the cultural values, beliefs and practices of the person inclusive of sensitivity to the form that humans may come and return at the end of life. Ethnocentrism is what makes us believe that our way is the best in dealing with the world, and this is the standard to which all are measured. The term ethnic refers to identification of human groups and is made according to common traits or customs. Race is any of the various modes of human varieties that were thought to exist and cause differences in different humans. (The Basic Concepts of Trans-cultural Nursing)

The concerned patient was an individual from Saudi Arabia who had come for treatment of his lungs to United States. He was aged about 50 years and a member of the royal family in some way. The greatest difficulty in dealing with all individuals from Saudi Arabia is their strict insistence on religion. There is no freedom of religion there and all citizens have to be Muslims, and the practice of all other religions is prohibited. The legitimacy of the government is on governance according to the very conservative and strict interpretation of the Wahhabi school of Sunni Muslims and even acts against all other branches of Islam. The legal system is based on Sharia or Islamic law and those are claimed to have come from the Quran. The only national holidays that are observed in Saudi Arabia are the two Eids. (Encyclopedia: Status of religious freedom in Saudi Arabia)

One of the most powerful groups is the Muttawain or Religious Police. Any individual wearing any non-Muslim religious symbols is at risk. In 2001 there was an arrest of 14 Christians and imprisoned for conducting public worship services. There have been arrests even for worshipping in houses. This police make sure that all shops are closed during the periods of five daily prayers that they have and make sure that all individuals conform to the prescribed dress codes. (Encyclopedia: Status of religious freedom in Saudi Arabia) The problem is thus mainly in the conflict between his religion and the methods of treatment that have to be followed in United States. Apart from this, it may be understood that the person considered all non-Muslims to be inferior so far as being humans. Since he had not left Saudi earlier, this was a fixed concept in him.

The first question in nursing such a person who probably had a great knowledge of his religion was to fix up my own knowledge of his religion so that I did not end up hurting him inadvertently through my lack of knowledge of his religion. One of the main objectives of nurses to keep the patients in a happy condition as that would make them worry less about the disease. To achieve this, I also had to ask him what his thoughts and worries were. According to him, social relations with relatives, friends and the persons attending to them had become very crucial to him. He was not only concerned with his own personal nausea and irritability, and at the same time, he did not want to be a burden to the family and friends. Not being a burden to the family was very important...

(Underland, 2000)
He was at a critical age, being the eldest son of the family he was supposed to be taking most of the decisions, but he should inform others. There were suggestions to him that he goes back to Saudi, but that was like a loss of face to him. At the same time, he considered the doctors and nurses to be the experts and did not want to loose their constant care. He trusted the treatment that was going on and always said things like "I do not want my friends or colleagues to visit me because I don't want them to see me like this" or "I cannot expect my children to help me, they have enough with their own families." (Underland, 2000) It was clear that he liked to stay for the treatment here, though he was not happy with the country. Totally, one can say that this was the main reason for trying to understand his culture.

The Saudi Arabians do not like treatment in their own country for cancer as there is a large shortage of drugs that are used to manage cancer, there are also many restrictions in being able to prescribe narcotic analgesics and finally there is very little knowledge about proper care for cancer. This makes cancer care difficult in that country and forces many to leave the country for treatment in other areas. There are very strong inter-relationships among the Saudi families, the existing present poor status for cancer care, the readiness of the cancer patients and the caring individuals to accept the services in the hospitals and the general apathy of health care professionals to receive training in palliative care show that there is high need for starting them within the Saudi system. (Almuzaini; Salek; Nicholls; Alomar, 1998) This is probably well-known to many, but when one talks with a Saudi patient outside his homeland, he always insists that he would prefer to be at home as he is certain he will get certain facilities there, which he will not receive in United States. It is important to find out these elements and try to provide them to him as that will keep him in a better frame of mind and accept the other requirements of nursing.

This is a process of finding out and has to be done right at the beginning of dealing with the patient. This may be called the assessment or evaluation of the patient and this process begins when the nurse meets the patient and the collection has to continue all throughout the entire period that the patient stays in the hospital. Let us remember that in the United States it is not the custom to keep the patients in the hospital for longer periods or durations of time, and in certain individual cases, the patients may be coming to the hospital for the purpose of different types of tests and then returning after having the tests performed and having taken the required medicines. The process of finding out is systematic, purposeful and basic to the concept of planning for nursing and it is also very difficult to achieve. One of the major problems associated with it comes from the issues of biological differences which occur between different types of groups and this also leads to different types of skin colors. Though it is an important matter which is relevant here, many diseases show themselves up in terms of light and dark skin and these are the most fairly common types of diseases like anemia, problems of erythematic issues and jaundice.

If one is not careful enough then the normal variation may lead to being confused with some element of bruise or disease. Another related problem is with regard to acceptance of certain foods, and some of the clients may not accept certain types of foods. This was a matter that was being discussed with the patient and the other relatives or friends who came with him. Generally all Arabs like to have their own ethnic types of dishes and it should be given to them if it is possible and as long as it does not interfere or interrupt with the method of treatment. For this purpose, a suitable method of making arrangements is with regard to the family. There are also other restrictions like in relation to prayer, attempts of healers and also with regard to folk remedies. Most of the times these methods are tried and they fail before a person comes to the hospital. (Dennis; Small, 2003)…