¶ … Transcultural Nursing Care Transcultural nursing is one of the hot concepts in professional healthcare at this time and there's a good reason for that. Transcultural nursing allows for healthcare that takes into consideration the multicultural backdrop and lived history of the individual, allowing for healthcare to be delivered in a manner which is most accessible to the individual, as well as meaningful. Transcultural nursing allows for care to be defined within the context of culture, allowing for the most culturally competent care to occur when values are acknowledged: thus, in order for this to happen there needs to be a high level of scholarship involved. This paper will examine the concepts put forth in a peer-reviewed article on transcultural care in nursing, "The Process of Cultural Competence in the Delivery of Healthcare Services: A Model of Care" by Campina-Bacote (2002). This paper will use the concept analysis presented in the book Theoretical Basis for Nursing by McEwan and Willis as a means of analyzing the arguments and findings put forth in the article.

Concept Analysis

The first step in concept analysis as we've examined it in class is to select a concept. The concept here is effective transcultural nursing. The model for transcultural nursing care view cultural competence in health care as "the ongoing process in which the healthcare provider continuously strives to achieve the ability to effectively work within the cultural context of the client… this ongoing process involves the integration of cultural awareness, cultural knowledge, cultural skill, cultural encounters and cultural desire" (Campina-Bacote, 2002). The second step in concept analysis is to determine the aims or purposes of analysis: in this case it would be to understand the uses and nuances which are connected to transcultural nursing theory and how it works. In this step it would be first essential to determine the assumptions of the model: cultural competence is a process; cultural competence consists of the five constructs of cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire (Campina-Bacote, 2002). Other assumptions of this model include the belief that there is more variation within ethnic groups than across ethnic groups; there is a direct connection between competence of healthcare providers and their ability to provide culturally responsive care; cultural competence is essential when it comes to offering clients culturally responsive services (Campina-Bacote, 2002).

The third step within this form of concept analysis is to determine all potential uses of the concept as possible. This is essential as according to Capina-Bacote, all the branches of the transcultural tree are inter-connected. "The constructs of cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire have an interdependent relationship with each other, and no matter when the health care provider enters into the process, all five constructs must be addressed or experienced" (2002). However in order for the pillars of this concept to be put into adequate use, there has to be an overwhelming desire on behalf of the healthcare provider to offer care that is culturally responsive: cultural desire includes a passion to be open and honest with people, to embrace both similarities as well as differences and to have a willingness to learn from others as cultural informants.

The fourth step in this concept analysis is to determine the defining attributes of the concept. The defining attribute are as follows: a healthcare professional needs to understand the responsibility that he has in order to engage in continuing education and to constantly update him on the values and backgrounds of a range of cultures. Other attributes include the ability to apply relevant aspects of the culture to one's work as a physician in diagnosing, treating and communicating with patients. Finally there has to be an ability to use one's varied multi-cultural understanding in a manner which is accurate and effective and which takes into consideration the immediate needs of the patient.

Model Cases

When it comes to using and applying transcultural care, a strong model case would be when a nurse entered the room of an Iranian patient and found the patient huddled on the floor mumbling: the nurse thought that the patient had fallen out of bed, but in reality, the patient was praying. The nurse interrupted the patient, and tried to assist the patient back into bed. In this case, the patient was, "…practicing her religion...

Since she was scheduled for surgery the next day, she thought it was especially important to pray. Devout Muslims believe they must pray to Mecca, the Holy Land, five times a day. Traditionally, they pray on a prayer rug placed on the floor. If the nursing staff had some understanding of Muslim customs, they could have arranged to provide the patient some privacy during certain times of the day so she could pray" (culturaldiversity.org).
A borderline case that was related to this issue was one which occurred with a deaf patient, who was unable to communicate to her nurse her desire to be helped out of bed so that she could pray. This case is borderline because deafness is not so much an issue about culture and ethnicity as it is about someone's handicap. A case which was completely illegitimate was one concerning an artist who wanted to be given paints in her hospital room so she could paint the walls, as she said the process would be largely therapeutic to her. This case is completely irrelevant as while one can appreciate and understand and even be touched by art, it still doesn't fall into the realm of culturally relevant or cultural care. Furthermore, even if it did, there are a host of safety issues and concerns that are connected to painting one's hospital walls.

The final step in this process of concept analysis is to determine the antecedents and consequences. In this case, the antecedents have already been discussed. The antecedents are things like cultural education, desire to learn, responsibility and vigilance. The consequences of transcultural care are obvious: it can generate more precise and more relevant healthcare that makes patients feel better understood and more open to the treatment regime that they receive.

Application in Healthcare Practice

When this concept was applied correctly to a real situation in my healthcare practice, the results were truly beneficial and astounding: a Hispanic woman needed a hysterectomy and she spoke no English. When I was brought on to the case, I found that the hospital staff had been using the woman's son primarily as a means of translating to her and interpreting to her the nuances of the situation. While the hospital staff said that he was translating the body parts accurately, I had a feeling that this might not be the case, as I am aware that "it is inappropriate for Hispanic male to discuss her private parts with his mother the embarrassed son had explained that a tumor would be removed from her abdomen and pointed to the general area. The woman became quite angry and upset because a Hispanic woman's status is derived in large part from the number of children she produces" (culutraldiversity.org). I immediately summoned for a same-sex interpreter to be gotten for this patient as there needed to be a higher level of honesty and forthrightness about the procedure that she was facing. When the patient found out that a hysterectomy was on the table, she became furious and refused to have the operation, even though the interpreter explained in no uncertain terms that the hospital staff thought it was in her best interest for specific reasons. While we had to go forward with an alternative line of treatment, it is apparent that the patient would have sued the hospital had a hysterectomy occurred without her knowledge. "Even speaking the same language is not always sufficient. Cultural rules often dictate who can discuss what with whom. In general, it is best to use a same sex interpreter when translating matters of a sexual or private nature" (cultural diversity.org). Thus, whenever I don't speak the same language as one of the patients, I always make sure the translator is the same gender and I try not to use a family member, as family members have their own biases and agendas.

Summary

This paper has used concept analysis to reach a higher and more comprehensive understanding of how the transcultural nursing model works. Ultimately, this paper has found that while transcultural nursing is essential in the modern healthcare environment, it's not infallible. In order for transcultural nursing to work in the most effective manner, it has to be applied clearly and vigilantly with an educated and devoted team of healthcare professionals. Understanding the fundamental pillars that make up culturally relevant care is the first step as is a strong devotion and desire to respond in an appropriate manner.