NRSG 748: Theories for Practice and Research: Individual, Family, and Community

I enjoyed reading your great discussion and examples of assimilation and multiculturalism! Your rich past and present experiences give you many examples of assimilation and multiculturalism! The assimilation expectations I notice most are those of the patient/client fulfilling the sick/wellness roles we learned about in nursing school—the “shoulds”. There really are no “shoulds”—just choices, and it is our job as nurses to point out choices when needed and to facilitate when voiced. The balance between assimilation and multicultural advocacy is crucial in our work and it sounds like you’re very sensitive to keeping a balance.

Quoting one of your classmates: “I skimmed through several articles in the Second Quarter, 1998, edition of Sigma Theta Tau Reflections, devoted to equity and diversity. I found it very interesting to read of similarities in nursing's struggles and triumphs. In the August and September 1998 issues of AJN on Cultural Competence, a round table discussion raised many of the same questions that Professor James did related to how to teach or "catch" nurses to encourage more culturally competence.” When our cultural sensitivity is high, we often can catch and model ethical advocacy no matter what culture we’re addressing. Here are a couple of good “Caught Stories” from fellow classmates:

By CA – “I cared for a patient who was Hindu in the ICU. Based on their cultural/religious beliefs, they had a family with her constantly. We had to address the family member only even though the patient understood us. The patient was the mother of the family and was believed to be sacred and old foreign teachings say to serve the mother as her voice. I wish I had more time to dive into this area with the family member, but unfortunately I didn't. The patient also held a sheet up over her face to cover her mouth. At times I could see her smile through the sheet at me when I spoke to her family member. The family told me that her face and hair are usually covered, but they brought her to the hospital in a hurry and didn't have her headpieces, but said that everyone in the family understood that your life comes before needing to bring a headpiece. Once understanding the mother's need to retain her privacy I got a pillowcase and covered her head with it. She put her hand on mine, which was still on her new "headpiece" and just patted my hand. That was the deepest conversation of all that I had with her, but it meant a lot.”

And another “Caught Story” about a culture you may not have considered a culture:

By JT: “…….It reminds me of a care plan I made as a senior nursing student. The man was an alcoholic with terminal liver failure. My plan was 15 pages. It covered diet restrictions, living arrangements, medication, education about his disease, etc. --the usual thing. But halfway through my "presentation" to him, he said politely, as though to a child, "Miss Aaron, I know you really want to help me. But you see, I'm what you call a wino, and I live in a place you call skid row. And I'd really like to tell you that I will follow all your instructions and get better, but in actual fact, as soon as I get out of here, I'm going to buy a gallon of wine and go back to my cardboard box on the street and drink it."

Nursing at a Crossroads

Nursing is at a crossroads to move beyond cultural destructiveness, cultural incapacity, and cultural blindness. It is up to us nurses to strike the delicate balance between preserving cultural beliefs and values, and customs while sharing our own that may be different. The debate exercises you did in an earlier module hopefully helped you formulate thoughtful and yet sensitive and respectful retorts. The ANA has several position statements that you probably will want to copy for your files about cultural diversity, discrimination and racism, ethics and human rights, and many others (American Nurses Association | Reading Room: Position Statement Index) . I want to highlight the ANA

You can order copies of the Standards of Clinical Nursing Practice and Scope and Standards of Advanced Practice Registered Nursing if you don’t already have them. The sections on ethics emphasize maintaining client confidentiality and advocacy; upholding clients’ rights of self-determination, truthful disclosure, privacy, and confidentiality; and respecting their dignity and cultural beliefs. APNs are expected to deliver care in a nonjudgmental and nondiscriminatory manner that is sensitive to client diversity.

Wenger wrote about "Transcultural Nursing and Health Care Issues in Urban and Rural Context", in the Journal of Transcultural Nursing, 4(2), 1992. She explored values and beliefs that determine the context of rural and urban healthcare. She stated that the actors in culture should determine practice, not the observer (nurse). She noted that cultural context may be high or low. The context refers to the level of dependency in interchange of human and environment (does this systems talk sound familiar?!). Family communication is high context, but stranger communication is low context. High context equals high involvement and has much less intergenerational and kinship knowledge and is less responsive to change. Low context provides less intergenerational and kinship knowledge and is more readily responsive to change. Rural context is high, urban context is low (not sure I agree with this). Nurses can strive to understand cultural context and use it to cultivate acceptance and cooperative partnerships in health care.

Do some searching on Transcultural Nursing on the Internet. Check out these sites:

Transcultural Nursing Society – Marilyn Leininger’s society site

Cultural Diversity.org for many other interesting cultural sites

DiversityRx where language and culture affect quality health care, including legal issues and policies.

Nursing Theory, Practice & Research

One classmate, VL, said, “Most of the sites recognize that there is a danger associated with transcultural nursing theories and models because there is an assumption that people can be categorized, rather than individualized, by virtue of race, culture, and ethnicity. Superficial knowledge leads to stereotyping. Cross-cultural professionals need to be non-judgemental, and have an attitude of respect, interest, and inquiry. All of the sites noted language as a big barrier. Some groups that were mentioned, but aren't often mentioned, is the deaf cultural group and also the gay/lesbian cultural groups. “

On Cultural Diversity, Collaboration

Speaking of the Mexican-American, nurse-doctor, and male-female cultures……..In the March/April 2001 Nursing Research (50[2], 123-128), Hojat, et al. conducted a study of 639 physicians and nurses in the US and Mexico. They found, as hypothesized, that US physicians had a more positive view of physician-nurse collaboration than Mexican physicians; there were no gender differences in these physician groups, meaning women docs’ attitudes about collaboration were no different than men docs—interesting, don’t you think?! Nurses, on the other hand, had significantly more positive attitudes about collaboration than physicians.

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