Transcultural Nursing and Patient Care

Course Objectives: Transcultural Nursing

According to Andrews & Boyle (2012), the concept of transcultural nursing theory (TCN) has evolved in recent years to reference more broader concepts of culturally sensitive and culturally astute nursing. The world has grown more diverse, and healthcare must reflect this diversity. The core philosophy behind transcultural nursing is that for the nursing process and healthcare treatment in general to be effective, it must address the patient’s cultural needs. TCN combines an understanding of both anthropology and nursing to realize its fundamental objectives.

One of the most interesting concepts which emerged in the TCN model was the idea of care being both culturally universal and culturally specific. At first this confused me. But in the wake of the recent coronavirus pandemic, the need to balance both has become very evident. On one hand, it is absolutely critical to stem the tide of the pandemic with the use of vaccines and social distancing. On the other hand, because of previous encounters with the healthcare system, some patients may have very negative views of physicians and nurses. As noted in the textbook, “Culture influences a person’s definition of health and illness, when it is appropriate to self-treat” (Andrews & Boyle, 2012, p. 4). Addressing patient concerns, rather than dismissing them, is critical, including communicating when self-treatment may be inappropriate. Also, understanding why patients may have more difficulty obeying standardized recommendations about seeing providers, social distancing, and following guidelines due to income, geography, and healthcare customs, can help providers be compassionate and provide advice to patients that patients are more apt to follow.

One concept addressed in TCN that is very simple but which does not always receive adequate attention is that of health literacy and language. Patients who lack basic language skills or science education may not understand directions about how to self-administer medications at home, for example. Hospital stays are already shorter than in the past, and there is an explosion of chronic conditions patients must accept responsibility for self-management at home. Patients may be less apt to take a diagnosis of diabetes seriously, or the need to finish a regime of antibiotics even after feeling better, without an appropriate, comprehensible explanation.

The text stresses, for example, the need for an interpreter if a woman is not able to speak English well (or even if English is a woman’s second language), given the highly personalized experience of pain, and the difficulty of a physician or nurse understanding what the patient is expressing, if unfamiliar with the patient’s culture and language (Andrews & Boyle, 2012). In this instance, gender may also be a factor, as some women may feel uncomfortable admitting childbirth is painful, especially to a male provider. A nurse cannot always be fluent in every culture, but the nurse can at least be aware of and respectful of cultural differences.

As a nurse, as a result of this course, I have become more aware of my leadership role, and my responsibility to step in if I have concerns that culturally appropriate care is not being offered to a patient. It is also important to lead the way in offering guidance about integrating cultural assessment into more general health screening and assessment, including asking questions about the patient’s health goals, health practices at home, and health beliefs.

Quite often, when facing an acute health crisis, the focus is front and center upon the patient’s physical health situation alone. But this is why preventative care is so essential, so the provider has enough time to discuss daily routines, special cultural considerations regarding mental and physical health, and to foster bridges between the patient’s perception of the best way to govern his or her own health and the provider’s. The textbook stresses on an institutional level the need to assess the community for which the providers are caring, which encompasses family and kinship systems, not simply physical health data. These types of interpersonal systems can have a critical impact upon patient health, as well as the ways in which providers interact with caregivers.

A culturally competent care provider will thus first and foremost ask questions of patients, and seek out information about the patient’s community. A culturally competent care provider acting as a leader will urge the institution to do the same, and cast a wider outreach for the type of critical demographic data and knowledge that can enable more culturally sensitive care and continue to structure future approaches when all providers are interacting with community members. Of course, it is important to treat every patient as an individual, and to act as an advocate for the patient’s individual needs. That is the essence of good nursing. But a good nurse will also understand the extent to which individualism versus collectivism is present in the patient’s culture, and the types of influences to which the patient is subjected that can make the patient more or less able to obey standard, universalizing healthcare recommendations.