Transcultural Nursing Theory and Models: The Challenges of Application
Papadopoulos, Irena, Omeri, Akram, Contemporary Nurse : a Journal for the Australian Nursing Profession
The European Union has declared 2008 the European Year of Intercultural Dialogue. This is in recognition that Europe is becoming more culturally diverse. Globalisation has increased the multicultural character of many countries, adding to the number of languages, religions, ethnic and cultural backgrounds found in Europe and other continents.
In Australia, in contrast to many other countries, the diversity of the population was well established and recognised before multiculturalism was first coined in the late 1970s (OMA 1989). However, the response was in the main related to the diversity of the immigrant population minimising significant aspects of diversity such as class, gender and culture and care beyond multiculturalism.This has had enormous implications for nursing and health care (Milner 1993).
Today, in addition to 20 surviving Aboriginal dialects, more than one hundred other languages are spoken by people from culturally and linguistically diverse backgrounds (Department of Immigration & Citizenship 2008; Omeri & Ahern 1999). Communication between cultures remains a critical issue for the cultural understanding necessary for transcultural nursing practice to be effective.
The social and cultural determinants of health is emphasised by Leininger's Culture Care Theory (Leininger and McFarland, 2002). In more recent years, equal emphasis has been placed on the impact that social and organisational structures have on our health (Papadopoulos 2006).
In a diverse world, transcultural nurses strive to make a difference to the health and well being of people, irrespective of their cultural backgrounds transcultural nurse researchers across the world have been and continue to be engaged in the production of knowledge, which has the potential to make a difference for people at whatever point of the health/illness continuum they may be (Omeri 2008; 2002).
In order to foster excellence in transcultural nursing practice, the development and wide application of transcultural nursing standards is of paramount importance to advancing excellence in transcultural nursing practice. Work has already been undertaken in this area.The certification of designated transcultural nurses is based upon eight standards developed using Leininger's Theory of Culture Care Diversity and Universality and Campinha-Bacote's Model of Cultural Competence (Leininger 1991, 1998, 2006; Campinha-Bacote 2002). Standards provide agreed criteria by which practice may be evaluated and teaching and learning progressed (Andrews & Boyle 2008: 10).
It can be argued that transcultural nursing theory and models are the most appropriate for the 21st century, as they cogently address the deficits of the bio-medical model which dominated both medicine and nursing in the 20th century.
As the articles in this section demonstrate, transcultural nurses have the knowledge and tools to help them transform nursing and health care in many places in the world.
User friendly theoretical frameworks facilitate both the production of knowledge and its application. Marilyn McFarland and Marilyn K Eipperle in their article 'Culture Care Theory:A proposed theory guide for nurse practitioner practice in primary care settings' (2008), propose just that. Utilising Leininger's Theory of Culture Care Diversity and Universality as a foundation, they put forward a guide for educational preparation for advanced practice nurses working in primary care.They demonstrate how through the application of this theory, education, research and practice are connected as essential components toward the provision of culturally congruent care to meet the healthcare needs of diverse individuals, families, groups, and communities by family nurse practitioners.This will go some way towards eliminating the health inequalities experienced by many marginalised communities and individuals.
In her article, 'A partnership of a Catholic faith-based Health system, Nursing and American Indian traditional Indian medicine practitioners', Ann O Hubbert (2008) uses Leininger's theory to discuss how the creative thinking and actions of a group of people resulted in a cultural partnership which bridged the gap between the professionals and the lay people to bring about much needed improvements to the services provided to an American Indian community. …