Transcultural Concepts in Nursing Care


Part Three Healthcare Systems

Introduction An understanding of culture and cultural con cepts contributes to the nurse’s knowledge and facilitates culturally competent nursing care in community-based settings. Currently, many nurses practice in community settings with clients from a wide variety of cultural back grounds; this trend is expected to increase with more nurses moving from acute care institutions to community settings (Institute of Medicine, 2011). The care of clients in the community can be extremely complex, calling for a high level of nursing skill. Cultural diversity is also expected to increase in the United States. Significant changes in the healthcare system, including an increased emphasis on health promotion and disease pre vention, have influenced nurses to make changes in their practice and the settings in which care is delivered. Concepts such as health equity, diver sity, partnership, empowerment, and facilitation now form the basis for community-based nursing practice with individuals, families, and aggregates in the community. An aggregate is a collection of people who can be thought of as a whole because they happen to be in the same place at the same time. For some time, national nursing associa tions, including the National Institute of Nursing Research, have urged an aggregated community and population focus in both nursing research and practice. Involving clients in planning for and pro viding community nursing services is the founda tion of culturally competent care and involves learning individual and community perspec tives to plan and provide community-aggregated services. Specialized community interventions that are culturally relevant to the people served are built on collaboration and partnerships between com munity leaders, health consumers, and healthcare providers. When community residents or health consumers are involved as partners, community based services are more likely to be responsive to locally defined needs, are better used, and are sustained through local actions. Specialized community interventions are complex and often

very time-consuming. They require a high level of nursing knowledge and skill in working with and relating to different individuals and groups. In many instances, the complexity is increased when clients and nurses are from different cul tures. Nurses must understand how to help com munity members from various cultural groups to work with community leaders and healthcare providers forming partnerships that are respon sive and structure nursing and healthcare in ways that are culturally sensitive and appropriate. It is often the cultural factors that influence whether a particular population will choose to participate in community-based health services. For exam ple, if the healthcare providers speak Spanish, a Spanish-speaking population might be more inclined to participate in the health program. There is always a need for continuing commu nication among healthcare providers and com munity residents that is characterized by mutual understanding and respect. This understanding and respect form the basis for culturally relevant and competent nursing care.

In this chapter, the terms community nursing , community-based nursing , community health nursing , and public health nursing are used interchangeably, even though they have differ ent meanings in some settings and in different contexts (Rector, 2022). Whether the nurse is employed as a public health nurse or a com munity health nurse in a health department or practices in a community-based setting, they need the knowledge and skills to provide cul turally competent care. The practice of nursing in a community setting requires that nurses be comfortable with clients from diverse cultures and the broader socioeconomic context in which nurses personally live. As the popula tion continues to grow in diversity, health dis parities have become more apparent in diverse populations and are now a vital area of focus for researchers and practitioners. Care that is not congruent with the client’s value system is likely to increase the cost of care because it compromises quality and inhibits access to services (Gainsbury, 2017). Furthermore, Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

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