Transcultural Nursing: Providing Cultural Care for the Elderly

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By Christina Orlovsky, senior staff writer

Throughout history, America has been called a melting pot-a place that draws people from all cultures to live and thrive together. What most cultures hope, however, is that in that pot, they are able to maintain the flavors that make them so unique.

For elderly ethnic Americans, cultural identity is one characteristic too precious to lose to the aging process-especially when a nursing home is their melting pot.

"Elderly people of all cultures really want to maintain their life ways-whatever routines or traditions they had in place before they went into the nursing home," said Marilyn McFarland, RN, Ph.D., co-author of Culture Care Diversity and Universality: A Worldwide Nursing Theory.

For this reason, McFarland has long been a proponent of transcultural nursing, a practice that supports health care providers' learning of cultural mores and beliefs in order to provide "culture specific or culturally congruent nursing care" to all people.

Transcultural nursing is a method that was introduced to the health care field by Madeleine Leininger, RN, Ph.D., FAAN, in the 1950s. Since then, Leininger has paved the way for the education of nurses interested in addressing the cultural needs of their patients as a way of providing them with comprehensive health care.

McFarland, who co-wrote her book with Leininger, feels that cultural care should be a concern of all nurses.

"It's very important for nurses to really find out about people's traditions, life ways and beliefs about health care, so they can honor them and combine them with professional care," she said.

Through an abundance of nursing school courses, continuing education classes and books and journals on transcultural nursing, nurses have the ability to educate themselves on successful methods of cultural assessment.

"There's a framework that guides nurses into asking questions about a patient's beliefs about health care, technology, religion, politics and the micro-political arena in the nursing home," McFarland said. "These are all important things for us to know."

Culture Clusters

What makes these issues so important is the growing number of ethnically diverse U.S. residents-and the elderly population that will continue to increase as Baby Boomers age.

According to the 2000 Census, there were more than 31 million foreign-born citizens living in the United States. Nearly 11 percent were 65 years and older. More than one-third were between the ages of 40 and 65.

The growing cultural diversity is most strongly felt in traditional "gateway" areas, such as New York City, the Miami metropolitan area and the southwestern border region from Southern California to Texas. However, in recent years, urban areas across the country are also seeing growth in foreign-born populations.

One of these regions is Chicago, which now ranks third among U.S. cities in its number of foreign-born residents.

In an effort to address the cultural needs of its growing population of ethnically diverse elderly residents, several nursing homes in the Chicago area have begun grouping residents according to ethnicity. In doing so, these facilities are able to provide traditional foods, language and activities for a variety of different cultures.

Kevin Kavanaugh, spokesperson for the Illinois Council on Long-term Care, acknowledged that this method is a growing trend among Chicago facilities, fulfilling a need that many patients and their families are supporting.

"There are many different ways that culture impacts the care that is provided," Kavanaugh said. "Groupings are based on meeting cultural needs in a variety of areas."

Kavanaugh provided the example of a Korean unit in one facility, where traditionally medicinal foods, such as seaweed soup, are served to residents; beds are lower to the ground for the comfort of a population used to sleeping closer to the floor; and religious activities and language are geared toward Korean residents.

What's most important, according to Kavanaugh, is to get the residents and their families involved, in order to learn exactly how a resident's cultural needs affect his health care needs.

"Whether a facility has separate units for different ethnic groups or there are different programs for people from different cultures, it's best if the facility talks to the family to see what they would like-especially if there's a language barrier," he said.

Another important factor, Kavanaugh said, is to avoid stereotypes that can lead to inaccurate assumptions about a patient's needs.

"You can't put people into boxes," he said. "Within every culture, there are subcultures-you can't make stereotypes and assumptions. Instead, you have to follow the concept of person-centered care, looking at the individual and making a thorough assessment to find out if what's important to the culture is really important to the person."

While not all experts agree that grouping residents is the best way to address their cultural needs, all share a common concern about treating each patient's needs on an individual level.

"If you can put people with similar values and traditions together, that might be helpful," McFarland said. "But first you have to think about assessing them as individuals and finding out what they're like and what they want.

"Sometimes, as nurses, we tend to think we have a good idea about a patient's needs just by looking at them," she added. "Really, all nurses need to do a cultural assessment and see how people want their care to be."

Making Quality Care Universal

In addition to cultural care provided in nursing homes, initiatives have been created to address cultural differences in all health care arenas.

The term "cultural competence" is used by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to describe the strategies used by health care providers to accommodate cultural differences while also providing quality health care to an increasingly diverse population.

While many JCAHO policies have been made to encourage cultural competency in all health care institutions, some culture care experts feel efforts still aren't strong enough.

"Culturally diverse care is a new fad now. Everyone is jumping on the bandwagon, even though it's been around for decades," said Victor Fernandez, RN, BSN, co-founder of CultureDiversity.org, a non-profit organization dedicated to increasing awareness of transcultural nursing.

"Today, medical and nursing schools have had an increase in cultural care curricula, and there's indoctrination in JCAHO," he added, "but the sad thing is that in the trenches, culture is not being addressed."

Like Kavanaugh and McFarland, Fernandez believes that in order to provide culturally diverse care, providers need to overlook the stereotypes that force assumptions about a patient and their needs.

"The duty for us as health care providers is to educate ourselves," Fernandez said.

"We can't just learn the stereotypes and think we know everything about a culture. That's just the overall picture," he added. "Nurses need to keep that picture in the background, but then take the time to learn about each patient: who he is, what he feels and, most importantly, what he needs."


Transcultural Nursing Society


Madeleine Leininger


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