Cultural or Transcultural Focus and Nursing Care

Afza.Malik GDA

Trans-cultural Focuses In Nursing 

Cultural or Transcultural Focus and Nursing Care

Cultural Transcultural Focus,Perspective Differences ,Variety of Research and Clinical Journals  ,Data Collection Strategies,Methodological Research,Major Needs of C/TCR.

Cultural Transcultural Focus

    Cultural/transcultural focus is the study of the environment shared by a group seeking meaning for its existence. Nurse investigators pursue this focus to understand the association of culture to health and to provide culturally competent care. 

    Although this focus is growing within research, its impact on patient care has been limited. Culture receives only cursory emphasis in most curricula or practice settings, and few nurses are cultural experts. 

    In light of projections that racial and ethnic minorities will be the majority in the United States by 2030 and the persistence of major health disparities between Euro Americans and others, more and better nursing research on culture is needed.

Perspective Differences 

    Different perspectives on the meaning of cultural/transcultural research (C/TCR) exist. To some, the terms are essentially synonymous and questions of disciplinary origin are unimportant. 

    Researchers in the Leininger tradition regard transcultural nursing as the proper term for a formal, worldwide area of study and practice about culture and caring within nursing.

Variety of Research and Clinical Journals 

    Cultural/transcultural research is found in a great variety of research and clinical journals. Some C/TCR studies (particularly interventions and randomized controlled trials) may be found in the Cochrane database for evidence-based practice using a keyword search based on such terms as the disease name, nurses and care, nurses and intervention, and names of racial or cultural groups. 

    Recent reviews of C/TCR include race and ethnicity as nursing research variables (Drevdahl, Taylor, & Phillips, 2001), health disparities among vulnerable populations as published in Nursing Research over five de cades (Flaskerud et al., 2002), and application of the Oncology Nursing Society's cultural competence guidelines to published oncology research (Phillips & Weekes, 2002), Searchers are cautioned that:

(a) The names of racial or ethnic groups are often used only descriptive labels, and findings do not advance true cultural knowledge.

(b) Race, culture, and ethnicity lack consensual definitions and are often used interchangeably.

(c) Acceptable names for groups change over time (e. g. Negro, Black, Afro-American, African American).

(d) The name of the highest stage of cultural knowledge changes over time, with cultural competence or cultural proficiency being currently preferred.

(e) Databases on special populations are often nonexistent or inadequate.

(f) Although reports specify a focus on a cultural group, discussion may not relate findings to that group.

(g) Findings ascribed to culture are often not distinguished from the effects of socioeconomic status, history, or political structures.

    Most quantitative C/TCR is theory based. Frequently used frameworks include Leininger's culture care theory, self-care, health seeking behavior, health belief models, stress and coping, self-efficacy, and transitions. 

    The transtheoretical model of behavior change is becoming popular. Reports are now appearing on the cultural appropriateness of existing frameworks for particular groups. 

    For example health belief models have been criticized for inadequately recognizing real (rather than perceived) barriers to care, spirituality, and the interconnectedness (rather than the individuality) of African-American women. 

    Studies seeking explanatory models of illness are increasing, a welcome trend since this approach, which parallels an intake history and involves all aspects of the disease course and clinical encounter, seems relevant and practical to clinicians as well as researchers. 

    Culture-specific models such as McQuiston and Flaskerud's (2000) model for HIV prevention among Latinos are under development. Studies of model development to promote culturally competent organizations and build culturally diverse workforces, such as the Diversity Competency Model and the Leininger-based Model of Culturally Competent Leadership, are increasingly represented in administrative journals.

Data Collection Strategies

    Although most data collection strategies, including physiological measurements are used in C/TCR, the most frequently used are focus groups, interviews, ethnographies, participant observation, and written questionnaires. 

    Qualitative approaches have long been recognized as well-suited to C/TCR and are frequently used. However, the realization of their potential depends on the investigator's awareness of or openness to the complexity and pervasiveness of culture in the research encounter (Morse, 2001).

    The overwhelming majority of C/TCR has been intracultural, descriptive, small scale, and nonprogrammatic. The typical study is an interview or survey on health knowledge, health beliefs and practices, or a concept like selfefficacy within one designated group conducted by a single investigator. 

    However, cross-national nursing studies, studies with large sample sizes, studies done by interdisciplinary or international teams, and programmatic research are becoming more frequent.

    Active C/TCR programs and their principal investigators include diabetes education for Mexican-Americans (Brown), diabetes management in ethnically diverse families (Chesla et al., 2004), HIV risk reduction interventions for impoverished Latina and Asian women (Flaskerud, et al., 2000), cardiovascular health for African American school children (Harrell, McMurray, Gansky, Bandiwula, & Bradley, 1999).

    Condom use in African-American adolescents (Jemmott, 2000), HIV prevention among Latinos (Mc Quiston & Flaskerud, 2000, 2003), and health needs of South American, Middle Eastern, and Korean women (Meleis, 1996). The dearth of programmatic nursing research on Native-American health is noteworthy.

 Methodological Research

    Methodological research, including studies of recruiting and retaining subjects and instrumentation, is growing rapidly. The quality of measurement in C/TCR is improving steadily. 

    The standards for rigorous translation are widely recognized, and both the cultural fit of items and the psychometric properties of an instrument for the target group are increasingly being reported and studied. Instrument reading level is receiving considerable attention in recognition of the prevalence of low literacy and low English proficiency in many populations (Weinrich, Boyd, & Herman, 2004). 

    Instruments such as the Cultural Self-Efficacy Scale and the Cultural Awareness Scale are being developed to measure the outcomes of programs to promote multicultural awareness.

Major Needs of C/TCR

    There are three major needs in C/TCR. First is the need for more intervention studies (Douglas, 2000). Recent estimates of the pro- portion of interventions in the C/TCR literature range from 3.6% to 14%. More investigators must move from descriptive studies to interventions to randomized controlled trials. 

    The sheer volume of very similar studies of the health beliefs, family values, sex roles, and the importance of family decision making, folk remedies, or spirituality within certain groups suggests a sufficient base for intervention studies. 

    A second great need is for application of existing guidelines for culturally competent research (Meleis, 1996; Phillips & Weekes, 2002; Porter & Villaruel, 1993; Villaruel, 1996). Research needs to be planned to be culturally competent. 

    Culturally competent research is broader than efforts to select culturally appropriate instruments or to recruit appropriate subjects. Application of these guidelines should mesh nicely with the third great need of C/TCR, which is for research to be planned and con- ducted with greater community involvement.

    More studies, particularly programmatic studies, are needed of Native-American health. Studies of multiracial or multiethnic persons are rare but urgently needed, given the growing numbers of people who identify themselves as having multiple heritages. 

    Studies of rural, occupational, and sexual subcultures (groups not defined by race or ethnicity) are needed, as are comparative explorations of cultural perspectives on ethics. Folk and alternative healing practices and their possible combinations with biomedical approaches, need systematic, sensitive study. 

    Studies of cultural adaptations of care in homes, the development of brief rapid strategies for cultural assessment, and development of the economic case for culturally competent care are needed to insure that culture is considered in this era of managed care, case management, and ever briefer inpatient stays.

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