Transcultural Concepts in Nursing Care

290

Part Three Healthcare Systems

The classic definition of community uses a geographic boundary such as a village, town, or urban settlement/city to provide parameters for and context of the population being described. This sense may be conveyed somewhat by terms for neighborhoods such as Little Havana, Little Kabul, and Little Saigon, but such des ignations do not really convey the nature or quality of the refugee or immigrant experience, which tends to cross geographic boundaries. Although refugees from certain geographi cal areas such as Sudan tend to be resettled in common locations when they arrive in the United States, they may later move to be closer to relatives or families who came from the same village or region of their homeland. The sense of shared displacement or “uprootedness” that serves to unite and distinguish immigrant or refugee communities from other groups or communities is quite profound and cannot be ignored when planning for community-based health services. Immigrants and refugees are often seen by health professionals as dominated by psycho emotional experiences and consequences of relo cation. In other words, we focus on the effects of stress, relocation, and human rights violations. Indeed, much of the literature on immigrants and refugees focuses on PTSD. Although many immigrants and refugees have endured hor rific experiences, this focus alone is not holistic. This view, according to McEwen et al. (2015), focuses on the primacy of the individual (an American value) rather than the community and thus prescribes psychiatric treatment instead of addressing the sociocultural and economic bar riers at the macro level. It is at the macro level that transcultural healthcare providers must be engaged if they are to be effective participants in building healthy refugee and immigrant commu nities. This does not mean that individual health concerns should be ignored; it simply acknowl edges that healthcare can be more effective when incorporated within a community focus, espe cially when dealing with immigrant or refugee communities. An important aspect of community nursing is the collection of cultural data and the assessment of traditional values and practices and how they are maintained over time. The terms assimilation and acculturation are often used to describe how immigrants and refugees adapt and change over time in a new country. Both of these terms imply that newcomers modify their traditional cul tural traditions to adapt to the dominant culture. Integration may be a better term to describe the experience: it implies that an immigrant or refu gee incorporates certain aspects of the new cul ture into their lifestyle, such as language and food, while still maintaining their cultural traditions and values. Both individuals and groups may be resistant to some changes and retain many tra ditional cultural traits, and the nurse should not expect that any client must or should integrate into American culture. For example, Hispanics are the largest cultural/ethnic group in the United States, and in several large American cities, they constitute a large percentage of the population (U.S. Department of Health and Human Services, Office of Minority Health, n.d.). In some Hispanic communities, it is easier to speak Spanish and to maintain traditional cultural practices. Because traditional health beliefs and practices influ ence health and wellness, it is important for the nurse to understand the degree to which clients, families, and communities adhere to traditional health values and how nursing practice should reflect those values. Spector (2013), an early transcultural scholar, suggested that a person’s healthcare and behavior during illness may well have roots in that person’s traditional belief sys tem. Unless community nurses understand the traditional health beliefs and practices of their cli ents and communities, they may intervene at the wrong time or in an inappropriate way. Evidence Based Practice 11-3 describes the patient care experience of Hispanic patients who are under going a transplant procedure. Patients told the researchers that they valued four interdependent Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. Maintenance of Traditional Cultural Values and Practices