Transcultural Concepts in Nursing Care

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Chapter 11 Culture, Family, and Community

family member but also determine how well the family can meet family health needs. Just how well families can meet the needs of each family member will determine how, when, and where interventions will take place. A cultural orienta tion assists the nurse in understanding cultural values and interactions, the roles that family members assume, and the support systems avail able to the family to help them when health needs are identified. The family is usually an individual’s most important social unit and provides the social context within which illness occurs and is resolved. Health promotion and maintenance also occur within the family group. Some traditional health beliefs and practices pro mote the health of the family because they are generally family and socially oriented. Frequently, traditional beliefs and practices reinforce fam ily cohesion. Some values are more central and influential than others; given a competing set of demands, these central values will typically deter mine a family’s priorities. In families that adhere to traditional cultural values, the families’ (or tribe’s and/or community’s) needs and goals often will take precedence over an individual’s needs and goals. The culturally competent nurse can recog nize and use the family’s role in promoting and maintaining health. This requires an appreciation of the family context in health and illness and how this varies among cultures (Leininger, 1978). In addition to identifying and meeting the cul tural needs of clients and families, the community health nurse must consider social and cultural factors on a community level to understand and respect cultural values, mobilize local resources, and develop culturally appropriate health pro grams and services. Important factors to con sider include the influence of demographics on healthcare, subcultures within refugee and immi grant populations, degree of acculturation and/or maintenance of traditional values and practices, Cultural Factors Within Communities

and access to health and nursing care for these population groups. In addition, new and important areas of nursing practice are incorporating transcultural concepts to reach underserved or vulnerable populations that are at high risk in our rapidly changing society. Demographics and Healthcare During the 21st century, the United States and many other countries will face enormous demographic, social, cultural, and environmen tal changes. The United States is becoming more diverse, and it is incumbent on nurses to be pre pared to respond appropriately as the health status of individuals differs dramatically across cultural/ ethnic groups and social classes. Certain groups in the United States face greater challenges than does the general population in accessing timely and needed healthcare services. Major indicators such as morbidity and mortality rates for adults and infants show that the health status of many racial/ethnic minority Americans in the United States is substantially worse than that of White Americans. Health status is worse among those who are medically underserved —those popu lations who have inadequate access to qual ity healthcare. Community nurses must assess groups within the community in a very sensi tive manner; often those characteristics that we assume are related to the group’s culture may be influenced by other factors such as economic factors, trauma experienced in the migration experience, or racism.

Subcultures or Diversity Within Communities

Caring for diverse groups within the community has been a focus of public health nursing since the days of Lillian Wald, an early nurse leader. Home care was provided to residents of low-income areas of cities, particularly recently arrived immi grants. Because nurses were not from the same cultural background as their clients, they had to deal with cultural differences between themselves Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.