Chapter 3: Theoretical Basis for Transcultural Care

Abstract

I. INTRODUCTION A. Increasing diversity in global and local populations intensified the realization that current models of health education and health care delivery are not adequately responsive to the changing needs of populations. B. Widening health disparities across populations within countries and worldwide heightened the need for more comprehensive models and theories for care delivery that address social inequalities affecting populationbased health outcomes. C. This chapter provides a broad foundation for transcultural nursing and health care drawn from the social and behavioral sciences, philosophy and nursing to assist educators, practitioners and students to develop approaches to reduce differential outcomes of health care and education in populations. II. CONCEPTS IN CULTURALLY COMPETENT CARE A. The Concept of Culture 1. Culture is the complex whole, which includes knowledge, beliefs, art, morals, law, customs and any other capabilities and habits acquired by members of a society (Tylor, 1871). 2. Culture is an ideational system of shared ideas, concepts, rules and meanings that underlie and are manifested in the ways of life of human beings (Keesing & Strathern, 1998). 3. A set of explicit and implicit guidelines that individuals learn as members of a particular society, which guide how they view and affectively experience the world, and behave toward others, nature, supernatural forces, or gods (Helman, 2007) 4. Cultures are never homogeneous so one should avoid overgeneralizations or stereotyping about members of any group; differences between members of a particular group maybe just as distinct as differences across groups. 5. Levels of culture (Hall, 1984): a. Tertiary level-Explicit or manifest culture is the public facade that is visible to outsiders such as rituals, dress, cuisine, festivals. b. Secondary level-Underlying rules and assumptions known to members of the group but rarely shared with outsiders. c. Primary level-Deepest level of culture comprising implicit rules known and followed by members of the group but seldom stated. 6. Tertiary level is easily observed and manipulated but the deeper primary and secondary levels are most hidden, stable, and resistant to change. B. Worldviews 1. Worldview is the perspective taken by an individual or group to explain the universe and life events, and understand and cope with the world around them and with life's experiences. It is often based on a strong sense of connection to a homeland. 2. Worldviews are illustrated by health belief systems (Andrews, 2008; Purnell & Paulanka, 2008). a. Naturalistic paradigms are based on the belief that health and illness are caused by the harmony, unity, and balance between humans and the universe. Examples are: 1) Health and illness are influenced by the balance between opposing principles of yin and yang. Yin symbolizes feminine, winter and spring, cold, shady. Yang symbolizes masculine, summer and autumn, warm, sunny. 2) Health and illness are influenced by the balance among the four body humors, began in ...

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