Transcultural Nursing Education Concept Analysis
Can transcultural Nursing be applied to African American Men who have sex with men (MSM)?
Jacqueline Watson
Gonzaga University
Theoretical Foundations of Nursing Practice
NURS 700
Debra Smith and Lin Murphy
November 9, 2014
According to Zander (2007) the term transcultural nursing was first established by Florence Nightingale due to her work in the Crimean war and her work in Australia with the Aborigines. Today; however, transcultural nursing care in healthcare focuses upon differences and similarities among cultures (Easterby et., al 2012, p. 81). Cultural nursing encompasses a nurses knowledge of different cultural values, beliefs, and practices which enables them to provide culturally sensitive or culturally competent nursing …show more content…
care to individuals of different heritages that seek medical treatment i. e, African American men who have sex with men (MSM) newly diagnosed with human immunodeficiency virus (HIV) (Leininger, 2012, p. 57). Meaning, the more culturally competent the provider the more the provider will be able to communicate with individuals from different heritages (Norton, 2014). Health care is defined as the diagnosing, treating, preventing illness, injury, and other physical, mental impairment in human beings. Each human being in America should be granted equal access to health care regardless of sexual orientation, race, cultural or religious beliefs. But the CDC (2011) reports that there are disparities in equal access to healthcare among African American men who have sex with men (MSM) compared to other ethnic groups.
Therefore, one of the Healthy People 2020 objectives is to reduce health care disparities for newly diagnosed HIV patients and address underlying factors that might increase the risk of contracting HIV; for example: to address the issue of increased rates of HIV infection within the African American (MSM) community and increase the number of those individuals who receive follow up treatment. Moreover, healthcare initiatives postulated by Healthy People 2020 and the National HIV/Acquired Immunodeficiency Syndrome (AIDS) Strategy is to; reduce HIV incidence; increase access by optimizing health outcomes; and reduce HIV disparities in health care. Therefore, the concept of transcultural nursing care as it relates to cultural sensitivity and competence is essential to the African American MSM survival.
One of the purposes of this paper is to utilize Carper’s (1975) aesthetics portion of “Fundamental patterns of knowing in nursing,” and design a culturally sensitive cognitive behavioral therapy program for African American MSM with HIV to decrease high risk sexual behaviors by incorporating a needs assessment to help cope with ethnic identity, self- esteem, sexual orientation, poverty, racism and discrimination. Wyatt (2009, p. 1942) postulates that for any cultural intervention to be successful within the African American community the program should encompass work to dispel the stigma associated with ‘HIV status, poverty, race, gender and sexual orientation because without these social determinants might reduce the effectiveness of any intervention unless these problems are addressed and monitored. Also, Wyatt (2009) asserts that ‘the cultural competence of investigator is an integral component of HIV prevention.’ In addition, developing this type of culturally sensitive program and linking this program to the sexual health model (SHM), will bridge the gap between health care providers, recipients of care, and the African American community. Moreover, the Therapeutic HIV and AIDS Treatment (THAT) program has been designed to decrease the stigmatism associated to African American MSM with HIV by utilizing ‘transcultural nursing care’ and to help decrease the spread of HIV. In order to provide transcultural nursing care for African American (MSM) with HIV terms like culture, cultural values, cultural diversity, attributes, respect and fostering in nursing care are concepts needed to be understood when providing care to these individuals. Here health care workers have an obligation to provide culturally competent care to diverse populations. The word culture refers to practices of a particular groups which guides thought processes, decisions, and actions. In addition, cultural values are the individual 's desirable or preferred ways of acting that governs actions or decisions. Moreover, cultural diversity in the nursing care process uses approaches which provide for culturally sensitive care based on the patients’ environment where they live or were born (Leininger, 2012, p58).
Therefore, the Sexual Health Model (SHM), according to Wyatt, (2009, p. 1941) promotes interconnectedness, sexual ownership, and body awareness from a cultural context. This author asserts that interconnectedness is the belief that being in a relationship and having a family defines identity and enhances personal value. The SHM promotes personal health, along with family ties and social networks, these are important component of interconnectedness, regardless of relationship status (Wyatt, 2009, p. 1942). Moreover, Wyatt (2009) postulates that sexual ownership refers to an individuals’ sexuality and this ownership requires that these individuals be responsible for their own sexual health, physical health and sexual orientation. This author believes that the SHM promotes skills to enhance personal control, as it relates to risky behaviors, and risky circumstances and self-protection. Furthermore, Wyatt (2009, p. 1942) asserts that body awareness is determined by cultural and religious beliefs in reference to touching, condom and contraceptive use, and some sexual practices. In addition, the SHM provides knowledge about the skills needed to identify and articulate problems that require treatment. However, this model does not incorporate caring.
A closer look into the term ‘care’ as it relates to healthcare is needed. According to Leininger (2012, p. 57) healthcare has a strong emphasis on curing which utilizes medical treatments i.e., medication, has become our societies major focus. The word ‘care’ is the cornerstone of nursing and cultural caring is a transpersonal part of nursing that concerns a patients’ inner life and deals with the person as a whole regardless of illness or disease (Leininger, 2012, p. 57). My scholarly paper raises the question, for African American men having sex with men (MSM) in Houston, Texas newly diagnosed with human immunodeficiency virus (HIV), how does an intervention of cognitive behavioral therapy (CBT) compared to no cognitive behavioral therapy, decrease high risk sexual behaviors after 16 weeks of therapy?
Leininger, (2012, p.57) postulates that caring is the most crucial to any curative process and medicine dominant emphasis on curing processes may well be neglecting caring behaviors and care needs of the patient. Zbilut (1978) asserts that some things cannot be known without participation in them; meaning that observation alone cannot fully explain how one knows another person (Walker, et., al., 1995, p. 199). Therefore, the concept of transcultural nursing care could be incorporated into a Therapeutic HIV Aids Treatment (THAT) program. Cara (2003) asserts that Jean Watson’s theory of ‘human caring’ includes humanistic altruism, faith and hope, sensitivity to self and others, developing trusting caring relationships, expressing positive/ negative feelings, creative individualized caring processes, transpersonal teaching /learning, supportive corrective mental, physical, societal, human needs assistance, existential phenomenological and spiritual forces. Also, Watson relates this theory to the person being cared, nurtured, understood and assisted. Moreover, this theory also incorporates the environment as it relates to culture. In short health is seen in terms of being in harmony and congruence between the self and the perceived experience of self.
Benner, et., al., (1989) maintains that the concept of care or caring has not fully been evaluated in nursing as it relates to nursing knowledge. Caring for African American MSM who have HIV who might participate in high risk sexual practices is the concept that I would like to focus on for my scholarly project. There is a pandemic of HIV within the African American community and culturally sensitive care is needed to change the high risk sexual behaviors of African American MSM within this community. In the United States, Human immunodeficiency virus (HIV) has grossly affected the African American community in disproportionate numbers when compared to other ethnic races. Within this community African American MSM have the highest number of reported cases of HIV. Nationally, of all the new reported cases of HIV, young African American men between the ages of 13-34 were most affected. African American MSM were diagnosed HIV 7.9 times higher than White MSM and 2.9 times higher than Latino MSM. Some social determinants that may have spread HIV in African American (MSM) community are: high risk sexual behaviors, poor negotiation skills to utilize condoms, legislation, poverty, incarceration and decreased access to healthcare (CDC, 2011). My belief is that more culturally sensitive programs need to be developed to decrease the spread of HIV within the African American community.
Dudas, (2012, p 317) summarizes Rodgers method of evolutionary concept analysis where the key words were cultural competence nursing and nursing education were searched in CINAHL and Medline databases over a five year period. This author concludes that 137 articles met inclusion criteria but only 30 articles were used. Moreover, this authors results revealed that there were three dimensions of cultural competence studied which were awareness, attitudes and behaviors. Dudas (2012 p. 317) postulates that more research studies are needed in regard to nursing cultural competence.
Jeffreys, et. al., (2013, p 88-90) examined a tool for evaluating the extent of culturally specific care provided to a culturally diverse population. The authors wanted to determine the frequency of a cultural assessment conducted by nursing students and their professors. Moreover, the authors utilized the Cultural Competence Clinical Evaluation Tool (CCCET) at the end of the second semester of medical surgical nursing course. The total number of participants studied were 161 nursing students and professors. Results were analyzed using the content validity index (CVI) which was 0.91. ‘The validity of the coefficients provided evidence for internal consistency. In short, results revealed that student and professors took the tool seriously and that their responses were relatively similar. Both student and professors believe they had received adequate education in the area of nursing cultural competence.
Moreover, an article in the Boston Globe (Jonas, 2007), reports that a study conducted by a Harvard professor John Putman who sampled over 30,000 Americans revealed that the greater a communities diversity the less people of that community voted. The study also revealed that ‘all measures of civic health are lower in more diverse settings.’ In addition, this study came out at a time when America was considered the ‘melting pot’ for political debate on immigration to race based admission in schools. According to Jonas (2007) diversity makes people uncomfortable and reports that Putman’s study revealed that America is experiencing a social decline in social capital. Here social capital refers to social networks, friendships, religious affiliations and neighborhood associations. Jonas (2007) states that Putman views on American society showed that America will flourish if there is a high level of social capital. When social capital is high, communities are better and neighborhoods are nice to live in so people are healthier. Jonas (2007) reports that Putman believes to improve social participation in elections Americans need to support more English language courses and invest in their neighborhood community centers and other places which would allow for more meaningful interaction across ethnic lines.
Walker et., al.,, (1995, p. 42) would assert that a model case of cultural sensitivity is a “real life example of the use of a concept that includes all the critical attributes of the concept.” For example, a Wound Ostomy Continence Nurse (WOCN) has just taken a cultural diversity course offered by her hospital. She now is on a nursing floor and is ready to educate a post -operative ostomy patient on how to clean his stoma, change his colostomy bag and where to obtain the supplies. The WOCN is in the patients room introduces herself, educates both the wife and the husband on how he can care for the ostomy. She realizes that this patient is from the Middle East and is a Muslim. The WOCN cleanses the stoma washes her hands, changes gloves and now wants to give cleaning supplies to this male patient. She tells this patient that it would be much easier to clean the stoma with his right hand and grasps his hand precedes to place over the stoma. Well the man and his wife scream and yell at the nurse and tell her to leave the room immediately. The nurse leaves the room upset and dismayed, she cannot understand what happened. A colleague of the WOCN who just so happened to be from the Middle East also explained to the nurse that the right hand was to considered the clean hand and needed to be kept clean at all times.
Also, Walker, et. al., (1995, p. 43) presented the meaning of a contrary case as “a clear example of not being the concept” of cultural sensitivity. For example, a nurse has educated an African American man about the potential side effects, uses and reasons why this man should take his HIV medication. In fact, since there was a pharmacy in the building the nurse even picked up the patients prescription and brought the two medications to him. She allowed the patient who was taking a two pill combination of anti-retroviral medication to open and review medications. The nurse asked the patient if he had any questions. And the patient replied “No.” The nurse feels satisfied with her culturally competent care and walked this patient out of the building. The nurse observed the patient as he left the building and she saw him walk up to the trash can and throw his medications away. However, this nurse failed to ask this patient’s beliefs about HIV. Meaning, this patient believed that HIV was invented by the government to kill off all African Americans. Therefore, this patient believed that by taking medications approved by the government he would die. This nurse failed to understand the myth that most African Americans believe that the government invented HIV to kill off the African population (Hadiyah, 2011). This case is not an example of cultural caring or cultural sensitivity in nursing.
An invented case could be the belief that most individuals in today’s society might believe that medication is designed to cure sickness. Moreover, some African American MSM with HIV may believe that if I take anti-viral medications I am curing myself; therefore, it is okay to continue have unprotected sex.
The antecedent of cultural sensitivity is diversity the ‘it’ factor is what makes one person different from another person and is comprised of belief systems, cultural language, attitudes, tradition, mores, religion and of course race. Our awareness of cultural sensitivity is an acknowledgement of our own culture so we can know who we are; therefore, we are able to have an awareness of different cultural perspectives. More specifically, cultural competence is related to cultural sensitivity and acknowledging a persons’ different culture and doing our best to have a knowledge about the different cultural practices. In addition, being aware or culturally sensitive employs a knowledge of ones’ own culture in relation to other peoples’ culture and making considerations by either adapting nursing care within the confines of the health care institution. Understanding multifaceted transcultural nursing care and cultural sensitivity is having respect and fostering competent communication with an actualization of self leads to effective interactions and satisfaction within oneself that everything possible was done to communicate with an individual that was perceived different from ourselves. For example, language might be a barrier to fostering a culturally sensitive relationship. Therefore, nursing care needs to incorporate some phrases or words of foreign languages or the ability to obtain a medical translator who can assist in the transmission of a message. Moreover, culturally sensitive nursing care leads to more effective communication with individuals of perceived different cultures.
In short THAT program will provide African American MSM with HIV cultural sensitive care or transcultural nursing care by providing participants with respect, negotiation skills, self –esteem building, dispelling myths about HIV, sharing medical information, free condoms, supportive community resources and fostering a culturally sensitive environment that accepts race, sexuality, and gender roles.
References
Cara, C. (2003). A Pragmatic View of Jean Watson’s Caring Theory. Retrieved from: www.humancaring.org
Chinn, P. L., Kramer, M. K., Benner, P., & Wrubel, J. (1989). The Primacy of Caring, 1989. In P. Benner, & J. Wrubel, Theory and Nursing. Integrated knowledge development (Fifth ed., pp. 230-232). Storrs, Connecticut: Mosby, Inc.
Dudas, K., I.
(2012). CULTURAL COMPETENCE: An evolutionary concept analysis. Nursing Education Perspectives, 33(5), 317-321. Retrieved from http://search.ebscohost.com.proxy.foley.gonzaga.edu/login.aspx?direct=true&db=rzh&AN=2012052687&site=ehost-live
Easterby, L., M., Siebert, B., Woodfield, C., J., Holloway, K., Gilbert, P., Zoucha, R., & Turk, M., W. (2012). A transcultural immersion experience: Implications for nursing education. ABNF Journal, 23(4), 81-84. Retrieved from http://search.ebscohost.com.proxy.foley.gonzaga.edu/login.aspx?direct=true&db=rzh&AN=2011746736&site=ehost-live
Hadiyah, C. (2011, June 8, 2011). Impact of HIV/AIDS on the African American Community: Myths and Facts [Champions of Change comment]. Retrieved from www.whitehouse.gov.blog/2011/06/08impact-hivaids-african-american-c0mmunity-mythsandfacts
Jeffreys, M., R., & Dogan, E. (2013). Evaluating cultural competence in the clinical practicum. Nursing Education Perspectives, 34(2), 88-94. Retrieved from http://search.ebscohost.com.proxy.foley.gonzaga.edu/login.aspx?direct=true&db=rzh&AN=2012317650&site=ehost-live
Jonas, M. (2007). The downside of Diversity: A Harvard political scientist finds that diversity hurts civic life. What happens when a liberal scholar unearths an inconvenient truth. The Boston Globe. Retrieved from
www.boston.com/news/globe/ideas/articles/2007/08/05
Leininger, M. (2012). The Phenomenon of Caring Part V Caring: The Essence and Central Focus of Nursing. International Journal of Human Caring, 16(2), 57-58. Retrieved from web.b.ebscohost.com.proxy.foley.gonzaga.edu
The Center for Disease Control and Prevention (2011) Disparities of diagnosis of HIV between Blacks/African Americans and other racial ethnic population 37 states [Press release]. Retrieved from http://www.CDC.gov
Neff, J. A., & Crawford, S. L. (1998). The health belief model and HIV risk behaviours: A causal model analysis among anglos, african-americans and mexican-americans. Ethnicity & Health, 3(4), 283-299. Retrieved from http://search.ebscohost.com.proxy.foley.gonzaga.edu/login.aspx?direct=true&db=rzh&AN=1999060238&site=ehost-live
Norton, D., & Marks-Maran, D. (2014). Developing cultural sensitivity and awareness in nursing overseas. Nursing Standard, 28(44), 39-43. Retrieved from http://search.ebscohost.com.proxy.foley.gonzaga.edu/login.aspx?direct=true&db=rzh&AN=2012674109&site=ehost-live
Relf, M. V. (2001). Gay identity, battering and HIV risk behaviors in men who have sex with men: An empirical test of a theoretical model (immune deficiency). Johns Hopkins University). , 239 p. (UMI Order AAI3006333.) Retrieved from http://search.ebscohost.com.proxy.foley.gonzaga.edu/login.aspx?direct=true&db=rzh&AN=2002053022&site=ehost-live. (2002053022).
Walker, L.O and Avant, K. (1995). 13. In strategies for theory construction in nursing (third ed., pp. 199-201). Prentice- Hall international: Appleton and Lange.
Wyatt, G. (2009). Enhancing Cultural and Contextual Strategies to Reduce HIV/Aids Among African Americans . American Journal of Public Health, 99(11), 1941-1945. http://dx.doi.org/102105?AJPH.2008152181
Zander, P. E. (2007). Cultural competence: Analyzing the construct. Journal of Theory Construction & Testing, 11(2), 50-54. Retrieved from http://search.ebscohost.com.proxy.foley.gonzaga.edu/login.aspx?direct=true&db=rzh&AN=2010101646&site=ehost-live
Jacqueline Watson
Gonzaga University
Theoretical Foundations of Nursing Practice
NURS 700
Debra Smith and Lin Murphy
November 9, 2014
According to Zander (2007) the term transcultural nursing was first established by Florence Nightingale due to her work in the Crimean war and her work in Australia with the Aborigines. Today; however, transcultural nursing care in healthcare focuses upon differences and similarities among cultures (Easterby et., al 2012, p. 81). Cultural nursing encompasses a nurses knowledge of different cultural values, beliefs, and practices which enables them to provide culturally sensitive or culturally competent nursing …show more content…
care to individuals of different heritages that seek medical treatment i. e, African American men who have sex with men (MSM) newly diagnosed with human immunodeficiency virus (HIV) (Leininger, 2012, p. 57). Meaning, the more culturally competent the provider the more the provider will be able to communicate with individuals from different heritages (Norton, 2014). Health care is defined as the diagnosing, treating, preventing illness, injury, and other physical, mental impairment in human beings. Each human being in America should be granted equal access to health care regardless of sexual orientation, race, cultural or religious beliefs. But the CDC (2011) reports that there are disparities in equal access to healthcare among African American men who have sex with men (MSM) compared to other ethnic groups.
Therefore, one of the Healthy People 2020 objectives is to reduce health care disparities for newly diagnosed HIV patients and address underlying factors that might increase the risk of contracting HIV; for example: to address the issue of increased rates of HIV infection within the African American (MSM) community and increase the number of those individuals who receive follow up treatment. Moreover, healthcare initiatives postulated by Healthy People 2020 and the National HIV/Acquired Immunodeficiency Syndrome (AIDS) Strategy is to; reduce HIV incidence; increase access by optimizing health outcomes; and reduce HIV disparities in health care. Therefore, the concept of transcultural nursing care as it relates to cultural sensitivity and competence is essential to the African American MSM survival.
One of the purposes of this paper is to utilize Carper’s (1975) aesthetics portion of “Fundamental patterns of knowing in nursing,” and design a culturally sensitive cognitive behavioral therapy program for African American MSM with HIV to decrease high risk sexual behaviors by incorporating a needs assessment to help cope with ethnic identity, self- esteem, sexual orientation, poverty, racism and discrimination. Wyatt (2009, p. 1942) postulates that for any cultural intervention to be successful within the African American community the program should encompass work to dispel the stigma associated with ‘HIV status, poverty, race, gender and sexual orientation because without these social determinants might reduce the effectiveness of any intervention unless these problems are addressed and monitored. Also, Wyatt (2009) asserts that ‘the cultural competence of investigator is an integral component of HIV prevention.’ In addition, developing this type of culturally sensitive program and linking this program to the sexual health model (SHM), will bridge the gap between health care providers, recipients of care, and the African American community. Moreover, the Therapeutic HIV and AIDS Treatment (THAT) program has been designed to decrease the stigmatism associated to African American MSM with HIV by utilizing ‘transcultural nursing care’ and to help decrease the spread of HIV. In order to provide transcultural nursing care for African American (MSM) with HIV terms like culture, cultural values, cultural diversity, attributes, respect and fostering in nursing care are concepts needed to be understood when providing care to these individuals. Here health care workers have an obligation to provide culturally competent care to diverse populations. The word culture refers to practices of a particular groups which guides thought processes, decisions, and actions. In addition, cultural values are the individual 's desirable or preferred ways of acting that governs actions or decisions. Moreover, cultural diversity in the nursing care process uses approaches which provide for culturally sensitive care based on the patients’ environment where they live or were born (Leininger, 2012, p58).
Therefore, the Sexual Health Model (SHM), according to Wyatt, (2009, p. 1941) promotes interconnectedness, sexual ownership, and body awareness from a cultural context. This author asserts that interconnectedness is the belief that being in a relationship and having a family defines identity and enhances personal value. The SHM promotes personal health, along with family ties and social networks, these are important component of interconnectedness, regardless of relationship status (Wyatt, 2009, p. 1942). Moreover, Wyatt (2009) postulates that sexual ownership refers to an individuals’ sexuality and this ownership requires that these individuals be responsible for their own sexual health, physical health and sexual orientation. This author believes that the SHM promotes skills to enhance personal control, as it relates to risky behaviors, and risky circumstances and self-protection. Furthermore, Wyatt (2009, p. 1942) asserts that body awareness is determined by cultural and religious beliefs in reference to touching, condom and contraceptive use, and some sexual practices. In addition, the SHM provides knowledge about the skills needed to identify and articulate problems that require treatment. However, this model does not incorporate caring.
A closer look into the term ‘care’ as it relates to healthcare is needed. According to Leininger (2012, p. 57) healthcare has a strong emphasis on curing which utilizes medical treatments i.e., medication, has become our societies major focus. The word ‘care’ is the cornerstone of nursing and cultural caring is a transpersonal part of nursing that concerns a patients’ inner life and deals with the person as a whole regardless of illness or disease (Leininger, 2012, p. 57). My scholarly paper raises the question, for African American men having sex with men (MSM) in Houston, Texas newly diagnosed with human immunodeficiency virus (HIV), how does an intervention of cognitive behavioral therapy (CBT) compared to no cognitive behavioral therapy, decrease high risk sexual behaviors after 16 weeks of therapy?
Leininger, (2012, p.57) postulates that caring is the most crucial to any curative process and medicine dominant emphasis on curing processes may well be neglecting caring behaviors and care needs of the patient. Zbilut (1978) asserts that some things cannot be known without participation in them; meaning that observation alone cannot fully explain how one knows another person (Walker, et., al., 1995, p. 199). Therefore, the concept of transcultural nursing care could be incorporated into a Therapeutic HIV Aids Treatment (THAT) program. Cara (2003) asserts that Jean Watson’s theory of ‘human caring’ includes humanistic altruism, faith and hope, sensitivity to self and others, developing trusting caring relationships, expressing positive/ negative feelings, creative individualized caring processes, transpersonal teaching /learning, supportive corrective mental, physical, societal, human needs assistance, existential phenomenological and spiritual forces. Also, Watson relates this theory to the person being cared, nurtured, understood and assisted. Moreover, this theory also incorporates the environment as it relates to culture. In short health is seen in terms of being in harmony and congruence between the self and the perceived experience of self.
Benner, et., al., (1989) maintains that the concept of care or caring has not fully been evaluated in nursing as it relates to nursing knowledge. Caring for African American MSM who have HIV who might participate in high risk sexual practices is the concept that I would like to focus on for my scholarly project. There is a pandemic of HIV within the African American community and culturally sensitive care is needed to change the high risk sexual behaviors of African American MSM within this community. In the United States, Human immunodeficiency virus (HIV) has grossly affected the African American community in disproportionate numbers when compared to other ethnic races. Within this community African American MSM have the highest number of reported cases of HIV. Nationally, of all the new reported cases of HIV, young African American men between the ages of 13-34 were most affected. African American MSM were diagnosed HIV 7.9 times higher than White MSM and 2.9 times higher than Latino MSM. Some social determinants that may have spread HIV in African American (MSM) community are: high risk sexual behaviors, poor negotiation skills to utilize condoms, legislation, poverty, incarceration and decreased access to healthcare (CDC, 2011). My belief is that more culturally sensitive programs need to be developed to decrease the spread of HIV within the African American community.
Dudas, (2012, p 317) summarizes Rodgers method of evolutionary concept analysis where the key words were cultural competence nursing and nursing education were searched in CINAHL and Medline databases over a five year period. This author concludes that 137 articles met inclusion criteria but only 30 articles were used. Moreover, this authors results revealed that there were three dimensions of cultural competence studied which were awareness, attitudes and behaviors. Dudas (2012 p. 317) postulates that more research studies are needed in regard to nursing cultural competence.
Jeffreys, et. al., (2013, p 88-90) examined a tool for evaluating the extent of culturally specific care provided to a culturally diverse population. The authors wanted to determine the frequency of a cultural assessment conducted by nursing students and their professors. Moreover, the authors utilized the Cultural Competence Clinical Evaluation Tool (CCCET) at the end of the second semester of medical surgical nursing course. The total number of participants studied were 161 nursing students and professors. Results were analyzed using the content validity index (CVI) which was 0.91. ‘The validity of the coefficients provided evidence for internal consistency. In short, results revealed that student and professors took the tool seriously and that their responses were relatively similar. Both student and professors believe they had received adequate education in the area of nursing cultural competence.
Moreover, an article in the Boston Globe (Jonas, 2007), reports that a study conducted by a Harvard professor John Putman who sampled over 30,000 Americans revealed that the greater a communities diversity the less people of that community voted. The study also revealed that ‘all measures of civic health are lower in more diverse settings.’ In addition, this study came out at a time when America was considered the ‘melting pot’ for political debate on immigration to race based admission in schools. According to Jonas (2007) diversity makes people uncomfortable and reports that Putman’s study revealed that America is experiencing a social decline in social capital. Here social capital refers to social networks, friendships, religious affiliations and neighborhood associations. Jonas (2007) states that Putman views on American society showed that America will flourish if there is a high level of social capital. When social capital is high, communities are better and neighborhoods are nice to live in so people are healthier. Jonas (2007) reports that Putman believes to improve social participation in elections Americans need to support more English language courses and invest in their neighborhood community centers and other places which would allow for more meaningful interaction across ethnic lines.
Walker et., al.,, (1995, p. 42) would assert that a model case of cultural sensitivity is a “real life example of the use of a concept that includes all the critical attributes of the concept.” For example, a Wound Ostomy Continence Nurse (WOCN) has just taken a cultural diversity course offered by her hospital. She now is on a nursing floor and is ready to educate a post -operative ostomy patient on how to clean his stoma, change his colostomy bag and where to obtain the supplies. The WOCN is in the patients room introduces herself, educates both the wife and the husband on how he can care for the ostomy. She realizes that this patient is from the Middle East and is a Muslim. The WOCN cleanses the stoma washes her hands, changes gloves and now wants to give cleaning supplies to this male patient. She tells this patient that it would be much easier to clean the stoma with his right hand and grasps his hand precedes to place over the stoma. Well the man and his wife scream and yell at the nurse and tell her to leave the room immediately. The nurse leaves the room upset and dismayed, she cannot understand what happened. A colleague of the WOCN who just so happened to be from the Middle East also explained to the nurse that the right hand was to considered the clean hand and needed to be kept clean at all times.
Also, Walker, et. al., (1995, p. 43) presented the meaning of a contrary case as “a clear example of not being the concept” of cultural sensitivity. For example, a nurse has educated an African American man about the potential side effects, uses and reasons why this man should take his HIV medication. In fact, since there was a pharmacy in the building the nurse even picked up the patients prescription and brought the two medications to him. She allowed the patient who was taking a two pill combination of anti-retroviral medication to open and review medications. The nurse asked the patient if he had any questions. And the patient replied “No.” The nurse feels satisfied with her culturally competent care and walked this patient out of the building. The nurse observed the patient as he left the building and she saw him walk up to the trash can and throw his medications away. However, this nurse failed to ask this patient’s beliefs about HIV. Meaning, this patient believed that HIV was invented by the government to kill off all African Americans. Therefore, this patient believed that by taking medications approved by the government he would die. This nurse failed to understand the myth that most African Americans believe that the government invented HIV to kill off the African population (Hadiyah, 2011). This case is not an example of cultural caring or cultural sensitivity in nursing.
An invented case could be the belief that most individuals in today’s society might believe that medication is designed to cure sickness. Moreover, some African American MSM with HIV may believe that if I take anti-viral medications I am curing myself; therefore, it is okay to continue have unprotected sex.
The antecedent of cultural sensitivity is diversity the ‘it’ factor is what makes one person different from another person and is comprised of belief systems, cultural language, attitudes, tradition, mores, religion and of course race. Our awareness of cultural sensitivity is an acknowledgement of our own culture so we can know who we are; therefore, we are able to have an awareness of different cultural perspectives. More specifically, cultural competence is related to cultural sensitivity and acknowledging a persons’ different culture and doing our best to have a knowledge about the different cultural practices. In addition, being aware or culturally sensitive employs a knowledge of ones’ own culture in relation to other peoples’ culture and making considerations by either adapting nursing care within the confines of the health care institution. Understanding multifaceted transcultural nursing care and cultural sensitivity is having respect and fostering competent communication with an actualization of self leads to effective interactions and satisfaction within oneself that everything possible was done to communicate with an individual that was perceived different from ourselves. For example, language might be a barrier to fostering a culturally sensitive relationship. Therefore, nursing care needs to incorporate some phrases or words of foreign languages or the ability to obtain a medical translator who can assist in the transmission of a message. Moreover, culturally sensitive nursing care leads to more effective communication with individuals of perceived different cultures.
In short THAT program will provide African American MSM with HIV cultural sensitive care or transcultural nursing care by providing participants with respect, negotiation skills, self –esteem building, dispelling myths about HIV, sharing medical information, free condoms, supportive community resources and fostering a culturally sensitive environment that accepts race, sexuality, and gender roles.
References
Cara, C. (2003). A Pragmatic View of Jean Watson’s Caring Theory. Retrieved from: www.humancaring.org
Chinn, P. L., Kramer, M. K., Benner, P., & Wrubel, J. (1989). The Primacy of Caring, 1989. In P. Benner, & J. Wrubel, Theory and Nursing. Integrated knowledge development (Fifth ed., pp. 230-232). Storrs, Connecticut: Mosby, Inc.
Dudas, K., I.
(2012). CULTURAL COMPETENCE: An evolutionary concept analysis. Nursing Education Perspectives, 33(5), 317-321. Retrieved from http://search.ebscohost.com.proxy.foley.gonzaga.edu/login.aspx?direct=true&db=rzh&AN=2012052687&site=ehost-live
Easterby, L., M., Siebert, B., Woodfield, C., J., Holloway, K., Gilbert, P., Zoucha, R., & Turk, M., W. (2012). A transcultural immersion experience: Implications for nursing education. ABNF Journal, 23(4), 81-84. Retrieved from http://search.ebscohost.com.proxy.foley.gonzaga.edu/login.aspx?direct=true&db=rzh&AN=2011746736&site=ehost-live
Hadiyah, C. (2011, June 8, 2011). Impact of HIV/AIDS on the African American Community: Myths and Facts [Champions of Change comment]. Retrieved from www.whitehouse.gov.blog/2011/06/08impact-hivaids-african-american-c0mmunity-mythsandfacts
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