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Importance of Transcultural Nursing Competency

Ann Puruleski
Ferris State University
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Abstract
Transcultural nursing is an important aspect of the nursing practice. Nurses need to be educated
on various cultures while in nursing school so that they can provide competent care for their
patients. Nursing schools need to provide learning opportunities for students in both the clinical
setting and classroom setting. When the clinical experience reflects what students are learning in
the classroom setting, students are able to grasp the concept of transcultural nursing and be more
competent in their nursing abilities.
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Importance of transcultural nursing competency
Transcultural competency is important to nursing because it can impact the quality of care
that a patient wants or needs. Minorities make up one third of the population here in the United
States and is expected to increase to 54 percent by the year 2050 (Hart, Mareno, 2014, p 83). It is
important for nurses to be educated about other cultures besides their own. The PICO question
that this paper is researching is whether the education in the classroom leads to a better cultural
competency as opposed to clinical experience leading to better cultural competency for the
nursing student. The importance of this topic is to decipher what impacts competency more
between learning in class, as opposed to learning in the clinical setting. Nursing students need to
develop knowledge about various cultures in order to provide the best care for them. Minorities
face unequal treatment from the healthcare system (Hart, Mareno, 2014 p 83). This unfair
treatment creates an issue within healthcare and nurses have the possibility to decrease this issue.
The issue of nurses having a knowledge deficit about other cultures is going on across the world
in other countries such as Australia, New Zealand, and Canada. Since this problem is occurring
globally, it is a very widespread issue. By determining whether students learn better in the
clinical setting or in the classroom, nursing schools can help educate nursing students to be
competent in the care they provide for others of various cultures so that hopefully in the future,
nurses will be more competent. The various points of view that must be considered is that of the
nursing student, the people who are receiving care that are from a different culture, and the
nursing faculty that are educating the nursing students. This means that various points of view
must be considered so that we can fully understand how nursing students learn the best in terms
of cultural care, and how the faculty is able to provide a better education for the students. The
difference it makes for nurses to become involved is that the care provided to minorities and
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those of other cultures can improve and they can receive fair treatment. Nurses have the ability to
advocate for their patients, so nurses have the opportunity to make sure that these patients are
taken care of.
Theory
The transcultural nursing theory best describes the importance of transcultural nursing. The
transcultural nursing theory was developed by Madeleine Leininger (Williamson, Harrison,
2009, p762). This theory discusses the care that nurses need to provide to people of different
cultures to improve human conditions and life processes (Williamson, Harrison, 2009, p762).
Madeline Leininger believed that people who have a different culture have different expectations
for health care (Harrison, Williamson p 763). This belief led her to create the transcultural
nursing theory, she states that transcultural nursing is:
a formal area of study and practice focused on comparative holistic cultural care, health,
and illness patterns of people with respect to differences and similarities in their cultural
values, believes, and lifeways with the goal to provide culturally congruent, competent, and
compassionate care (Leininger, 1997, p 342).
For example, a nurse needs to complete a detailed intake form for a patient and identify the
patients culture. It is important for the nurse to identify the patients culture and complete a
cultural assessment so that the healthcare professionals are made aware of what the patient wants
and expects. From an interdisciplinary perspective, this affects every member of the healthcare
team because if someone from a different culture doesnt want to have certain medical help, they
have to respect the patients choice and input when it comes to deciding upon what to do for the
patient. By looking at this through a collaborative perspective, the team of healthcare
professionals needs to collaborate with the patient and decide what is best for the patient and to
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not overstep boundaries that the patient has in terms of their culture. The team of healthcare
professionals need to respect the choice of the patient and if they decide to not seek treatment
because it goes against their culture, that needs to be respected by everyone. It is important to
make sure that the patient is involved in the decision making process when it comes to making
choices about what medical treatments they want to receive. An example of this would be that in
Australia they require indigenous women living in a remote location have to give birth in
hospitals (Harrison, Williamson p 766). This creates an issue because the womens cultures are
not being respected. This removal of women from their communities has not improved their
birth outcomes (Harrison, Williams, p 766). By following the transcultural nursing theory,
nurses and nursing students can provide better care for patients of various cultures.
The non-nursing theory that reflects the importance of learning about transcultural nursing
is the, transformational learning theory. The transformational learning theory:
supports an active learning approach and enables nurse educators and trainers to create an
environment in which the nurse can self-reflect and consider how his/her own perspective
affects patient care, especially when the patients needs, beliefs, and values do not match
his/her own (Kozub, p 314)
This theory correlates with the issue of cultural competency among nursing students. Nursing
students need to be able to learn and adapt to new situations that can arise in the clinical setting
so that the patient receives the best quality and safe care that they deserve. By using this theory,
nursing students can further develop their cultural assessment skills. This theory can be
incorporated to demonstrate issues from a collaborative perspective. For example, members of
the health care team taking care of a patient need to educate each other on various cultures if a
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team member has not taken care of a patient from a certain culture. By making sure the health
care professionals feel confident and competent in their care, the patient will have a better
healing environment while in their care. Also, health care professionals need to make sure that
they are self-aware of their own beliefs, prejudices, and feelings towards others of a different
culture (Williamson, Harrison, 2009, p764). By being self-aware health professionals are able to
set aside their personal differences and focus on the patient to make sure they maintain patient-
centered care.
Assessment
The Commission on Collegiate Nursing Education and the National League for Nursing
Accrediting Commission have outlined requirements for ensuring that undergraduate and
graduate nurses are able to provide culturally competent nursing care (Hart, Mareno, 2014,
p83). By assessing the environment in the classroom and clinical setting, nursing faculty should
be providing opportunities for students to enhance their cultural competency. Challenges that
could be faced by nursing students in the clinical environment is that they are not competent to
take care of someone who has a different culture than theirs. Also, challenges that could be faced
in the classroom is that nursing faculty might not be prepared to teach about culture (Hart,
Mareno, 2014, p87). This does not affect only nursing students, it affects nurses and the entire
team of healthcare providers as well. The quality and safety of the care that nursing students
provide for patients can be impacted if they are unable to establish open communication with the
patient. If the patient doesnt feel comfortable expressing what they expect from the providers, or
are unable to communicate in English, they may receive care that is against their culture. This
communication barrier establishes a challenge for the nursing student and the healthcare team.
By identifying the need for an interpreter, it helps to ensure that the patient is able to
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communicate what is going on, what they expect from the healthcare team, and allows them to
be a part of the decision making process with their health. The nursing student would also be
able to complete the cultural assessment with the help of the interpreter.
Inferences
From the research conducted on transcultural nursing, the research shows that nursing
students learn more when they are in the clinical setting or on a transcultural immersion
experience (Larsen, Reif, 2011, p350). Overall, students completing an immersion experience
had significant improvements in their cognitive, practical, and affective transcultural self-
efficacy scores (Larsen, Reif, 2011, p352). Students had direct experience with socioeconomic
issues, religious practices, ethnic foods, traditional health beliefs, gender roles, discrimination,
and the home environment (Larsen, Reif, 2011, p351). The research also shows that when the
clinical experience reflects what the students are learning in class, the students are able to learn
more about transcultural nursing and cultural assessments. The interpretation of this data shows
that nursing schools need to focus on making sure that the students are educated transcultural
nursing so that students are more confident in themselves when they need to conduct a cultural
assessment.
Overall, the outcomes would include better quality and safety of care provided, and more
compassionate care by the student nurse. The outcomes of teaching more about transcultural
nursing would lead students to having a higher level of confidence in themselves when they are
faced with having to care for patients of different cultures. This would also impact the quality of
care provided by the students since students will be able to identify the patients needs and what
they could be at risk for based on their culture. By teaching more about transcultural nursing,
students will be able to provide better holistic care since they can take care of the patients entire
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well-being. Consequences that can occur for nursing students from the lack of cultural education
would include that the students are not comfortable taking care of patients from other cultures,
the quality of care can be impacted if there is a need for an interpreter. Other consequences that
could occur include the safety of the patient is compromised. For example, if nursing students,
nurses, and other health professionals cant talk to the patient because of a language barrier, the
patient might not get the services they need.
Recommendations
Realistic intervention strategies that could be used by nurses and nursing students is
making sure that they are educated and competent enough to perform a cultural assessment on a
patient, and what to do if there is a communication barrier. There are several ways that nursing
school faculty can make help improve students with their cultural competency (Hart, Mareno,
2014, p87) The first example is students and faculty can become more self-aware of their own
cultural biases so that they can work past these beliefs they hold. Also, faculty could introduce a
theory class that involves teaching about cultural concepts, communication, health literacy and
health disparities (Hart, Mareno, 2014, p87). In the clinical setting, clinical instructors could
make sure that they give their students patients who are of a different culture, or speak a different
language. This would allow the student to gain experience that would help them to build their
cultural assessment skills. According to Reif and Larsen,
strategies documented in the literature for teaching cultural concepts include integration
of the concepts across the curriculum and stand alone courses of varying lengths using
various methodologies such as case scenarios, lecture, discussion, and audiovisual
material (Reif, Larsen, 2011, p351). By linking clinical and cultural content in the
classroom helps enhance students cultural competency (Reif, Larsen, 2011 p 351).
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In the clinical setting, faculty could encourage students to take part of a transcultural
immersion. This would help
By increasing class work and clinical experience, students are able to gain more
knowledge about transcultural nursing and will be more prepared to provide quality care for
more diverse patients.
The third ANA standard states that, the registered nurse identifies expected outcomes
for a plan individualized to the healthcare consumer or the situation (ANA, 2010, p.35). This
standard means that we are to define the outcomes for the patient in terms of their culture,
values, and ethical considerations (ANA, 2010, p.35). By identifying outcomes with the patient,
nursing students are able to create a plan individualized to that patient with respect towards their
culture. In the classroom setting, students need to be educated on the importance of creating a
plan with the patient that go against the patients culture.
The seventh ANA standard states that, the registered nurse develops an individualized
plan in partnership with the person, family, and others considering the persons characteristics or
situation, including but not limited to values, beliefs, spiritual and health practices, preferences,
choices, developmental level, coping style, culture, and environment, and available technology
(ANA, 2010, p.36). This allows the student nurse to have the ability to create a plan that is
unique to the patient and allows them to adapt it to the patients culture.
The eighth ANA standard is about education. It states that, the registered nurse attains
knowledge and competence that reflects current nursing practice (ANA, 2010, p.49) As nursing
students and future nurses, students need transcultural nursing education to be culturally
competent as a nurse. By using this ANA standard as an intervention, students will be able to
better identify the needs of the patients from various cultures since they will have been taught
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about transcultural nursing. Through education in the class room and clinical setting students
learn about various things in regard to culture. The quality of care that is provided by students
will increase because students will have the knowledge they need to make sure that they identify
potential problems the patient may be at risk for, and to better take care of the patient without
overstepping cultural boundaries.
The first QSEN that relates to transcultural nursing is patient centered care. It is
important for nursing students to make sure that care is patient centered. For patients of diverse
cultures, it is especially important that students perform a cultural assessment on them in order to
make sure that they are providing the appropriate care that they want, and to make sure that the
patient is comfortable with receiving that care. Students need to make sure that they patient is
involved in the decision making process so that if they refuse certain aspects of the medical care,
that students are aware of this before treating them.
The second QSEN is teamwork and collaboration. Nursing students need to collaborate
with their nurses and other health providers to make sure that everyone is aware of what the
patient expects from the healthcare team. By working as part of a team, a nursing student is able
to collect more information about the patient. An example of how the nursing student can
accomplish this is to request an interpreter to translate for them or even if the patient needs to
talk to someone from their religious community. Patient centered care involves everyone who is
part of the team working with the patient, including the student nurse. For the nursing student
involved in the clinical setting, it allows them hands-on experience to be able to learn what goes
on and helps the student to improve their skills and competency. In the classroom, teamwork
involves the professor working with the students to help ensure cultural competency is achieved
by properly teaching students about the importance of cultural assessments.
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The third QSEN is evidence-based practice. Research shows that when students receive
cultural immersion opportunities they become more culturally competent and are able to provide
better patient centered care. Nursing students would be more able to perform evidence-based
practice once they are able to establish a care plan that is appropriate for the patient of a different
culture. Evidence also shows that nurses who completed a graduate degree have a higher level of
cultural competency as opposed to nurses who only completed an undergraduate degree.
The fourth QSEN is quality improvement. By improving the quality of the education
nursing students receive in the classroom on cultural competency, it improves the quality of care
that students provide for patients of various cultures. Evidence-based practice is always finding
new ways to improve the quality of care that is provided for patients. By improving the quality of
the education nursing students receive, future nurses will have more skills and confidence in the
care they provide to patients.
The fifth QSEN is safety. It is imperative that students provide safe care for patients,
which is taught throughout nursing school. Safety is important with transcultural nursing because
health providers need to make sure that they do not do anything that could harm the patient or go
against their culture. By including the patient in all aspects of the decision making process, it
helps the patient feel safe since the care can be individualized to them and their culture will be
respected.
Conclusion
Transcultural nursing is an important area of study that needs to be taught more in
nursing schools. Furthermore, cultural competency has been specified as a core competency by
the National League for Nursing and the American Association of College of Nursing (Hart,
Mareno, 2014, p.83). By adapting a transcultural immersion into the nursing school curriculum,
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students are able to have a hands-on learning experience with another culture. Research has
shown students learn the most when education in the classroom reflects what students are doing
in the clinical setting.
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References
American Nurses Association. (2010). Nursing scope and standards of practice. Silver Spring,
MD: Author.
Jeffreys, M. R., & Dogan, E. (2013). Evaluating Cultural Competence in the Clinical Practicum.
Nursing Education Perspectives, 34(2), 88-94.
Kozub, M. L. (2013). Through the Eyes of the Other: Using Event Analysis to Build Cultural
Competence. Journal Of Transcultural Nursing, 24(3), 313-318.
doi:10.1177/1043659613481809
Larsen, R., & Reif, L. (2011). Effectiveness of Cultural Immersion and Culture Classes for
Enhancing Nursing Students Transcultural Self-Efficacy. Journal Of Nursing Education,
50(6), 350-354. doi:10.3928/01484834-20110214-04
LeMone, Priscilla; Lillis, Carol; Lynn, Pamela; Taylor, Carol R. 2011. Fundamentals of Nursing;
The Art and Science of Nursing Care, 7th Edition. Philadelphia; Lippincott Williams &
Wilkins, 2011. Print
Maier-Lorentz, M. (2008). Transcultural nursing: its importance in nursing practice. Journal Of
Cultural Diversity, 15(1), 37-43.
Mareno, N., & Hart, P. L. (2014). Cultural Competency Among Nurses with Undergraduate and
Graduate Degrees: Implications for Nursing Education. Nursing Education Perspectives,
35(2), 83-88. doi:10.5480/12-834.1
QSEN. (2011). Quality and safety competencies. Retrieved from
http://qsen.org/competencies/pre-licensure-ksas/
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Williamson, M., & Harrison, L. (2010). Providing culturally appropriate care: a literature review.
International Journal Of Nursing Studies, 47(6), 761-769.
doi:10.1016/j.ijnurstu.2009.12.012