Culture and Health

"But if everyone is genetically humming the same notes, why do people from different cultures and nations sing different melodies?"

"Why do people from various cultures view health and illness differently?"

"What role does culture play in people's expectations of professional nurses and nursing?"

Margaret M. Andrews, Ph.D., R.N. C.T.N. in Transcultural Nursing: concepts, theories, research & practice (xvi, 2002.)

Transcultural nursing and Madeleine Leininger (Leininger & McFarland, 2002)

History of transcultural nursing:

Madeleine Leininger envisioned transcultural nursing in the 1950s as a formal and essential study and practice. There was a critical need to prepare nurses in education and research needed to care for for the culturally different, neglected and vulnerable cultures and subcultures.

She prepared herself with a master's degree in nursing and a Ph.D. in cultural and social anthropology. Dr. Leininger did ethnographic research with the Gadsup of the Eastern Highlands of New Guinea in the 1960s. During this time, Dr. Leininger developed her theory of Culture Care Diversity and Universality and the ethnonursing research method.

A major shift in the history of nursing, she wrote the first qualitative nursing research book in 1985. Dr. Leininger has studied 15 other Western and non-Western cultures using the Culture Care theory and the ethnonursing research method.

"Today and in the future, cultures have the human rights to have their cultural values, beliefs, and needs respected, understood, and appropriately used within any caring or curing process..." M. Leininger (p.6, 2002)

Transcultural nursing is a formal area of study and practice

focused on comparative human-care (caring) differences and similarities

of the beliefs, values and patterned lifeways of cultures

to provide culturally conguent, meaningful, and beneficial health care to people.

(Leininger& McFarland, 2002)

Global factors influencing the need for transcultural nursing:

• increased migration worldwide
• worldwide increases and demands in health technologies, internet and electronic communications, bringing people closer together virtually or physically
• increase in the number of health care professionals from other cultures and to other cultures
• rise in cultural identities with health care consumers expecting that their beliefs, values and lifeways be respected
• marked increase in moral and ethical cultural concerns between cultures
• increased use of complementary or alternative medicines or therapies
• major shift in Western cultures from hospital to community-based health care related to concern with increasing health-care costs
• a growing gap between culture of the poor and the cultures of the rich showing a need for social justice and equal rights in health care
• increase in cultural and ethnic clashes and violence worldwide, influencing the health, survival, and death of people of diverse cultures.
• increased awareness that health anc culture cannot be divorced from the broader socio-economic-political context in which the individual is situated

Some myths about transcultural nursing:

"Common sense and a smile are all that is needed to care for other cultures."

Why this is a myth: Common sense and smile is generally helpful in this American/Western culture, but common sense and a smile may mean different things in other cultures.

"Anybody can teach culturally competent care."

Why this is a myth: Transcultural nursing is complex and requires diligent and extensive study in the theory and methods. Unprepared staff teaching transcultural nursing without graduate preparation in the theory and methods is educationally unsound and clinically unsafe (p. 33).

"Good medical and nursing psychosocial assessment will tell you everything you need to know about a client."

Why this is a myth: The human is a being who is embedded in a cultural context that influences his/her wellness and illness patterns and beliefs about caring modalities. Holistic culture care assessments are imperative to provide culturally congruent care.

"Having knowledge and experience and interaction with different cultures is sufficient in knowing how to take care of them."

Why this is a myth: Reflective experience needs to be grounded in ethnographically derived holding knowledge, not just on hunches and personal generalizations.

Aug. 17, 2004 :

Most People of Color are Lactose Intolerant (from diversityinc.com)

As many as 75 percent of all African Americans and Native Americans, 90 percent of Asian Americans, and 51 percent of the Latino population are lactose intolerant, according to the National Digestive Diseases Information Clearinghouse.

Want to Find Out More? Read 'Got Milk?' Ads: Culturally Competent or Culturally Insensitive? .

Notes from Exploring Medical Anthropology (Joralemon, 1999):

This book is an introduction to medical anthropology and discusses the following points:

• Every aspect of the person's experience of illness is shaped by the cultural frameworks of both the sufferer and the helper
• The society's economic and political structures play a critical role in the health risks and treatments that are available
• Ethnography provides the foundation for a holistic understandiing of sickness and healing
• Medical anthropology can play an active role in alleviating human suffering.

A work in progress.....please e-mail me for updates.

Selected references:

Andrews, M. Boyle, J. (1999). Transcultural Concepts in Nursing Care. Lippincott.Third Edition. Philadelphia .

Choudry, U. (2001). Uprooting and resettlement: Experiences of South Asian immigrant women. Western Journal of Nursing Research; 23, 376-394.

DiCiccio-Bloom, B. (2004). The racial and gendered experiences of immigrant nurses from Kerala , India . Journal of Transcultural Nursing. 15 (1):26-33.

Hagey, R. Choudry, U., Guruge, S., Turrittin, J., Collins, E., Lee, R. (2001). Immigrant nurses' experience of racism. Journal of Nursing Scholarship. 33(4), 389-394.

Joralemon, D. (1999). Exploring Medical Anthropology. Allyn & Bacon. Needhan Heights, MA.

Leininger, M. & McFarland, M. (2002). Transcultural Nursing: Concepts, Theories, Research, and Practice. 3 rd Edition. Columbus , OH

Spangler, Z. (1991) “Culture Care of Philippine and Anglo-American Nurses in a Hospital Context,” Culture Care Diversity and Universality: A Theory of Nursing. M. Leininger, ed. New York : National League of Nursing Press, 1991, pp.119-146.

Wolpert, A. (2003). A New History of India . Oxford University Press, New York .

United States. U.S. Department of Health and Human Services (2002). Projected Supply, Demand, and Shortages of Registered Nurses: 2000-2020. http://www.bhpr.hrsa.gov/healthworkforce/reports/rnproject/report.htm#chart1

United States. U.S. Department of Health and Human Services (2002). State Responses to Health Worker Shortages: results of 2002 Survey of States. Center for Health Workforce Studies, Albany , New York .

http://bhpr.hrsa.gov/nursing/htm.

Cultural Competence Standards

Bridging Language Barriers in Health Care

Kansas Minorities Face Health Care Disparities

Chinese Funeral Traditions

Traditional Native American Medicine

Transcultural Health Care

IMHER Institute of Minority Health, Education & Research

Information & Knowledge for Optimal Health (INFO) Project , Bloomberg School of Public Health

As human beings, our greatness lies not so much in being able to remake the world -- that is the myth of the atomic age -- as in being able to remake ourselves.

Mahatma GANDHI 1869-1948, Indian Political, Spiritual Leader

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