Noraleen B.

Cuenca
Transcultural Nursing

January 10, 2015

Activity 1.0
Cultural Competency

Culture is often described as the combination of a body of knowledge, a body of

belief and a body of behavior. It involves a number of elements, including personal
identification, language, thoughts, communications, actions, customs, beliefs, values,
and institutions that are often specific to ethnic, racial, religious, geographic, or social
groups. Culture has always been a part of human society it defines each individual,
regarding their roots, manners, beliefs and everything that mostly affect people. Cultures
definition varies, example of which, is defined by Merriam Websters dictionary as the
beliefs, customs, arts, of a particular society, group, place or time, others define culture
as the quality in a person or society that arises from a concern for what is regarded as
excellent in arts, letters, manners, and scholarly supports, whether we like or not we are
defined by our own each individual culture, on which we grew up upon.
Having different or similar beliefs is the quintessence of culture, it defines who we
are, may be from our parents, from our society we live in or from the school on where we
learned our first lessons in life, culture is passed from one generation to another, it is
parallel with time. As nurses we deal with different people, different races, educational
and socioeconomic background, ergo carrying with it are different culture that we
encounter as we go on our daily shift. For the provider of health information or health
care, these elements influence beliefs and belief systems surrounding health, healing,
wellness, illness, disease, and delivery of health services. The concept of cultural
competency has a positive effect on patient care delivery by enabling providers to deliver
services that are respectful of and responsive to the health beliefs, practices and cultural
and linguistic needs of diverse patients.
Cultural competency is critical to reducing health disparities and improving
access to high-quality health care, health care that is respectful of and responsive to the
needs of diverse patients. When developed and implemented as a framework, cultural
competence enables systems, agencies, and groups of professionals to function
effectively to understand the needs of groups accessing health information and health
careor participating in research-in an inclusive partnership where the provider and the
user of the information meet on common ground. To be culturally competent the nurse
needs to understand his/her own world views and those of the patient, while avoiding
stereotyping and misapplication of scientific knowledge. Cultural competence is
obtaining cultural information and then applying that knowledge. This cultural awareness
allows you to see the entire picture and improves the quality of care and health
outcomes. Adapting to different cultural beliefs and practices requires flexibility and a
respect for others view points. Cultural competence means to really listen to the patient,
to find out and learn about the patient's beliefs of health and illness. To provide culturally
appropriate care we need to know and to understand culturally influenced health
behaviors.

Since the perception of illness and disease and their causes varies by culture,
these individual preferences affect the approaches to health care. Culture also
influences how people seek health care and how they behave toward health care
providers. How we care for patients and how patients respond to this care is greatly
influenced by culture. Health care providers must possess the ability and knowledge to
communicate and to understand health behaviors influenced by culture. Having this
ability and knowledge can eliminate barriers to the delivery of health care. These issues
show the need for health care organizations to develop policies, practices and
procedures to deliver culturally competent care.
Cross, T., Bazron, B., Dennis, K., and Isaacs, M. (1989) list five essential
elements that contribute to an institutions or agencys ability to become more culturally
competent. These include:
1. valuing diversity;
2. having the capacity for cultural self-assessment;
3. being conscious of the dynamics inherent when cultures interact;
4. having institutionalized cultural knowledge; and
5. having developed adaptations of service delivery reflecting an understanding of
cultural diversity.
These five elements should be manifested at every level of an organization,
including policy making, administration, and practice. Further, these elements should be
reflected in the attitudes, structures, policies, and services of the organization.
Developing culturally competent programs is an ongoing process, There seems
to be no one recipe for cultural competency. It's an ongoing evaluation, as we continually
adapt and reevaluate the way things are done. For nurses, cultural diversity tests our
ability to truly care for patients, to demonstrate that we are not only clinically proficient
but also culturally competent, that we CARE..
Meyer CR.(1996) describes four major challenges for providers and cultural
competency in healthcare. The first is the straightforward challenge of recognizing
clinical differences among people of different ethnic and racial groups (eg, higher risk of
hypertension in African Americans and of diabetes in certain Native American groups).
The second, and far more complicated, challenge is communication. This deals with
everything from the need for interpreters to nuances of words in various languages.
Many patients, even in Western cultures, are reluctant to talk about personal matters
such as sexual activity or chemical use. How do we overcome this challenge among
more restricted cultures (as compared to ours)? Some patients may not have or are
reluctant to use telephones. We need to plan for these types of obstacles. The third
challenge is ethics. While Western medicine is among the best in the world, we do not
have all the answers. Respect for the belief systems of others and the effects of those

beliefs on well-being are critically important to competent care. The final challenge
involves trust. For some patients, authority figures are immediately mistrusted,
sometimes for good reason. Having seen or been victims of atrocities at the hands of
authorities in their homelands, many people are as wary of caregivers themselves as
they are of the care as individuals, nurses and health care providers, we need to learn to
ask questions sensitively and to show respect for different cultural beliefs. Most
important, we must listen to our patients carefully. The main source of problems in caring
for patients from diverse cultural backgrounds is the lack of understanding and
tolerance. Very often, neither the nurse nor the patient understands the other's
perspective.

Noraleen B. Cuenca
Transcultural Nursing

January 24, 2015

Activity 3.0
The Six Cultural Phenomena
proposed by Giger and Davidhizer

Communication. As the matrix of all thought and relationships among people,

communication provides the means by which people connect. It establishes a
sense of commonality with others and permits the sharing of information, signals,
or messages in the form of ideas and feelings. Communication is a continuous
process by which one person may affect another through written or oral
language, gestures, facial expressions, body language, space, or other symbols.
In a hierarchical sense, communication is of paramount concern in order to
render culturally competent care. While the factors that influence communication
are universal, they vary among culture-specific groups in terms of language
spoken, voice quality, pronunciation, use of silence, and use of nonverbal
communication. Communication is very important tools of a nurse/ health care
provider to better have an understanding of their patients with different races.

Space. Personal space is the area that surrounds a person's body; it includes the
space and the objects within the space. Personal space can also describe inner
space that filters the incoming stimuli that a person receives. Inner personal
space is dynamic, invisible lines of demarcation that may be divided into four
concentric areas of space:
1. the inner spirit core,
2. an area of thoughts and feelings perceived as unacceptable,
3. an area of thoughts and feelings perceived as acceptable, and
4. an area of superficial public image.
An individual's comfort level is related to both inner and outer personal space;
discomfort is experienced when personal space is invaded. Although personal
space is an individual matter and varies with the situation, dimensions of the
personal space comfort zone also vary from culture to culture. People perceive
physical and personal space through their biological senses. The cultural aspect
of space consists in determining the degree of comfort one feels in proximity to
others, in body movement, and in perception of personal, intimate, and public
space. Understanding and respecting each individuals personal space, is one of
the keys to ensure communication between health care provider and the patient,
this is to ensure responses from the patient, and will not make feel the patient
uncomfortable, making it hard to communicate.

Social Orientation. Cultural behavior, or how one acts in certain situations, is

socially acquired, not genetically inherited. Patterns of cultural behavior are
learned through a process called enculturation (also referred to as socialization),
which involves acquiring knowledge and internalizing values. Most people
achieve competence in their own culture through enculturation. Components of
social organization often vary by culture and differences may be observed in
what constitutes ones understanding of culture, race, ethnicity, family role and
function, work, leisure, church, and friends in day-to-day life. Each individual has
their own behavior and practices passed to them by each generation to the next
this things must be respected and the nurse must ensure that the patient has the
freedom to carry out or perform such practices to elevate sense of autonomy of
the patient and to enhance trust.

Time. Time has two distinct, though related, meanings. The first meaning is that
of duration, which is an interval of time. The second meaning is that of specified
instances, or points in time. These two meanings are related because a point in
time is identified as being the end of a time interval that starts at an arbitrary or
fixed reference point, such as the founding of Rome or the birth of Christ.
Because of these two distinct meaning, Time is perceived, measured and valued
differently across cultures. In essence, time is conceptualized in reference to the
lifespan in terms of growth and developments, perception of time in relation to
duration of events, and time as an external entity, outside our control. Allowing
the patient time is essential, not rushing any response to the patient will not put
the individual under pressure. And this will allow the patient to take time to think
about the responses he/she must give to the health care provider.

Environmental Control. Environmental control refers to the ability of an

individual or persons from a particular cultural group to plan activities that control
nature. Environmental control also refers to the individual's perception of ability to
direct factors in the environment. This definition in itself implies that the concept
of environment is broader than just the place where an individual resides or
where treatment occurs. In the most practical sense, the term environment
encompasses relevant systems and processes that affect individuals. In this
sense, the term Environment is more than just the place where one lives, and
involves systems and processes that influence and are influenced by individuals
and groups. In other words, culture shapes the understanding of how individuals
and groups perceive environments and how they process information this
information to maintain or restore health. Making sure that the environment I
manipulated to ensure that the patient feels safe and has very well ventilated,
this will make the patient less anxious encouraging therapeutic communication.

Biological Variations. It is a well-known fact that people differ culturally. Cultural

differences are evident in communication, spatial relationships and needs, social
organizations (family, kinships, and tribes), time orientation, and ability or desire

to control the environment. Less recognized and understood are the biological
differences among people in various racial groups. It is becoming more evident to
nurses that a body of scientific knowledge does exist about biological cultural
differences. References to and information about biocultural differences are
mushrooming in the literature and have resulted in a field of study known as
biocultural ecology, which focuses on human adaptation and homeostasis. The
purpose of biocultural ecology is to transcend the fragmentation inherent in the
separation of culture, human biology, and ecology and the environment.
Biocultural ecology is an examination of diverse human populations by means of
this three-way interaction system and focuses on specific, localized individuals
and populations within a given environment. From the field of biocultural ecology
springs the phenomenon of biological variations. Data relative to all the variables
significant to people within a racial group are essential for complete
understanding of the people. Not only are no two persons alike but also no two
cultural or racial groups are alike, and all phenomena relative to both individuals
and cultural or racial groups must be understood. The need to understand the
biological variations is necessary in order to avoid generalizations and
stereotyping behavior. Biological variations are dimensions such as body
structure, body weight, skin color, internal biological mechanisms such as genetic
and enzymatic predisposition to certain diseases, drug interactions, and
metabolism. Each individual is unique in his/ her own ways, be it caused by their
culture or something else. This is one aspect that a health provider must be keen
of the nurse must ensure that the patient must not feel unwelcome because of
the difference he/she has than of the society, sense of belongingness and
acceptance must always be felt by the individual.
II.
What are the differences of the Giger and Davidhizer 6 cultural phenomena and
the Purnell and Paulanka 12 domains of culture?
The Model focuses on assessment and intervention from a transcultural nursing
perspective. In this model, the person is seen as a unique cultural being influenced by
culture, ethnicity, and religion. In response to the need for a practical assessment tool for
evaluating cultural variables and their effects on health and illness behaviors, a
transcultural assessment model is offered that greatly minimizes the time needed to
conduct a comprehensive assessment in an effort to provide culturally competent
care. The model has relevance for all healthcare providers in diverse environmental
contexts. While the 12 domains are more specific and is more centered to the daily living
of each individual and everything surrounding him/her.

Noraleen B. Cuenca
Transcultural Nursing

January 17, 2015

Activity 2.0
ASKED mnemonic by Campinha-Bacote

Delivering quality care is not just a walk in the park, you go on your clinical duty
administer medications to your is not as easy as it sounds, and that is not all. There are
many hindrances a nurse can face in giving quality care during his/her daily shift in the
hospital. Foreign internationals are not the only ones, who Filipino nurses have a
difficulty providing quality care; the hindrances are also present, even in caring for locals.
These are some of the hindrances that I find Filipino nurses have in providing
quality health care. First of which is cultural differences, the Philippines an archipelago
that is filled with many culture, each is different from the other. Language,
communication problem erupts when the patient and the nurse speak different tongues,
religion is also one of the most common problem nurses face, this becomes a problem
when the patient is against the medications and interventions given to him, because it is
strictly prohibited by his/her religion. Gender bias, some patients prefer male nurses over
female ones, and others prefer the other way around. These are some of the problems
that are very observable; other problems cannot always be identifiable during the first
interaction. Me also had a fair share of dealing with this hindrances, while I was on duty
I had a patient that was scheduled for blood transfusion, but the patients religion is very
much against it, nevertheless the patient was in dire need of blood, as a nurse I had this
confusion and ethical dilemma running through my mind, the common question usually,
you ask yourself what would do, normally you would respect the patients decision, but

also you would ask you are the epitome of life, you have swear to an oath to save lives
at all costs, this experience is very common in the hospital setting. The other experience
I had is always the problem, communication barrier. Understanding each other is very
difficult, when the patient youre taking care of speaks a different language that you are
not familiar with. Nonetheless you have to take care of your patient and provide the
quality care he/she deserves, communicating without speaking is very hard, but these
are the experiences that sharpen the skills of nurses. Making us very flexible and
versatile, adapting to each event and innovating to provide the quality care we swore to
provide to each of our patients. There are also tools that can help you, on how to deal
with these hindrances like the ASKED mnemonic created by Campinha-Bacote and its
stands for Awareness Skill Knowledge Encounters Desire; this tools helps to provide a
guide to formulate your own questions and to for yourself to provide the answer and to
have a better understanding on how to deal with these hindrances.