GROUP F

Group members
Mushtaq Ali
Gulsher solangi
Shahzeb khan
M. siddique
Rajesh kumar
Asif mehmood
Noureen
Musarat shaheen
Sajida sahar
1
3
rd
year 5
th
semester batch 2010-11
Faculty
Manzoor Ali
Lecturer
PNS LUMHS
Jamshoro
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TOPIC
Special Issues In The Delivery Of
Trans Cultural Nursing Care
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OBJECTIVES:
At the end of this presentation the learners will be able to;
1. Assess cultural specific aspects of pain experience
a. Discuss various treatment for pain (home remedies)
2. Explore dietary beliefs and practices of clients from different cultures
a. Identify strategies to facilitate dietary change
3. Demonstrate an understanding of health maintenance and disease prevention
models
a. Utilize health belief model in client care
b. Identify reasons for non-adherence to treatment
c. Explore religious beliefs and practices related to prevention and healing
in illness
4. Demonstrate an understanding regarding attitudes of society towards
stigmatized diseases.
a. Discuss societal knowledge regarding infectious diseases
b. Discuss societal attitudes towards infectious diseases
5. Describe spirituality and its relation with health and illness
a. Differentiate between healing and care
b. Identify different methods of spiritual healing
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Culture
Set of values, beliefs and traditions, that are held by a
specific group of people and handed down from
generation to generation.
Culture is also beliefs, habits, likes, dislikes, customs
and rituals learn from ones family.
Culture is the learned, shared and transmitted values,
beliefs, norms and life way practices of a particular
group that guide thinking, decisions, and actions in
patterned ways.
Culture is learned by each generation through both
formal and informal life experiences.

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Transcultural nursing:
Transcultural nursing is how
professional nursing interacts with the concept of culture.
Based in anthropology and nursing, it is supported by
nursing theory, research, and practice.
It is a specific cognitive specialty in nursing that focuses
on global cultures and comparative cultural caring,
health, and nursing phenomena.
It was established in 1955 as a formal area of inquiry and
practice.
It is a body of knowledge that assists in providing
culturally appropriate nursing care.

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Description

According to Madeleine Leininger, the pioneer
of transcultural nursing, transcultural nursing is a substantive
area of study and practice that focuses on the comparative
cultural values of caring, the beliefs and practices of
individuals or groups of similar or different cultures
According to MEDLINE, transcultural nursing is an area of
expertise in nursing that responds to the need for developing
global perspective within nursing practice in a world of
interdependent nations and people. As a discipline, it centers
on combining international and transcultural content into the
training of nurses. It includes learning cultural differences,
nursing in other countries, international health issues, and
international health organizations.

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Goals
The goals of transcultural nursing is to give
culturally congruent nursing care, and to
provide culture specific and universal nursing
care practices for the health and well-being of
people or to aid them in facing adverse human
conditions, illness or death in culturally
meaningful ways.

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Transcultural nurses

Nurses who practice the discipline of transcultural
nursing are called transcultural nurses.
Transcultural nurses, in general, are nurses who
act as specialists, generalists, and consultants in
order to study the interrelationships of culturally
constituted care from a nursing point of view.
They are nurses who provide knowledgeable,
competent, and safe care to people of diverse
cultures to themselves and others.
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1. Cultural specific aspects of pain experience:
1.1 Pain response and culture
It is well established that pain is a highly complex
phenomenon that involves biological, psychological,
and social variables.
Patients culturally-based responses to pain are often
divided into two categories: stoic and emotive.
Stoic patients are less expressive of their pain and
tend to grin and bear it. They tend to withdraw
socially.
Emotive patients are more likely to verbalize their
expressions of pain, prefer to have people around
and expect others to react to their pain so as to
validate their discomfort.

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Cont
If we use such broad generalizations to help understand
human behavior, however, we must always keep in mind
that while culture is a framework that directs human
behavior, not everyone in every culture conforms to a set
of expected behaviors or beliefs.
Any individuals experience of pain will manifest itself in
emotional and behavioral responses particular to his or
her culture, personal history, and unique perceptions
In many cultures around the world where belief is fates
are strong, people believe illness and injury are caused by
higher power.
For example: in Filipino patient hospitalized for shoulder
surgery admitted to his nurse that he was in severe pain.
However he was not taking his pain medication because
he believed that it was GODs will that he had such pain
and GOD would give him strength to bear it.

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Asian culture and pain response
Patients from Asian cultures may often exemplify stoicism in
the face of pain, which relates directly to strong cultural values
about self-conduct.
This behavior might be tolerated in very small children, but not
in adolescents and adults. In traditional Asian cultures,
preserving harmony in interactions with others is very
important, so an individual should never draw attention to
himself, especially in negative ways.
Though an individual may feel sadness or pain, it is not
customary to make this obvious. On a related note, some Asian
patients will be socialized to observe status differences between
people and will avoid making demands of health care
professionals for this reason.
Asian societies have traditionally emphasized status differences
between people based on variables such as age, sex, education,
and occupation.
A doctor or nurse will most surely be seen as a person of high
status, not to be questioned or bothered with complaints about
discomfort.
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Use of Protective Objects;
Protective objects are wearied and hanged at
home or chain around neck, wrist used to protect
from evil.
Use of Substances;
In some cultures it is believed that certain food
substances can prevent from illness. For example
eating raw garlic or onion can prevent from
illness.
Religious Practice:
In some cultures burning of candles, rituals of
redemption are done to prevent illness.
Healer:
Within a community, specific people are known to
have power to heal.

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1.2 Various Treatment for Pain (Home Remedies)

Pain is unpleasant feeling which can be reduced by exercise as a
remedy. It strengthens muscles, helping prevent re-injury and further
pain.
Chronic back pain is extremely discomforting for any individual.
Majority of people around the world suffer from back pain or neck
pain. For effective back pain treatment at home one must first
understand the problem.
Predominant cause of back pain is the improper posture that most of
these individual follows during their work at home.
Another prominent cause is the obesity among majority of population.
By correcting posture both during work and sleep one can get
immediate relief. Correct posture will not only provide relief but also
ensure that the problem stay away from you.
In different cultures several treatments are given to the patient in home

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Cont..
Icepacks can help reduce swelling and numb muscles and
joint pain
In some cultures prefers moist heat to reduce aches and
pain, for this process follow these guide lines
Use ice, never heat in first 48 hrs. After an injury and make
sure never to place an ice pack directly over the skin. Use
proper towel or cotton lining, after the 48hrs. Use heat or
alternate heat with cold.
Deep breathing not only reduces the stress associated with
chronic pain but it may also help to fight pain itself. You
can use deep breathing as an emergency pain or stress
reducing measures.
In some cultures religious rituals are done to treat disease.
Happy mood can also reduce anxiety.
Along with some home remedies it is important to follow
doctors recommended pain medication plan.

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2. DIETARY BELIEFS AND PRACTICES OF CLIENT FROM
DIFFERENT CULTURES
DIET: in nutrition, diet is sum of food consumed by a person or another
organism.
Dietary habits are the habitual decisions an individual or culture makes
when choosing what food to eat.
Proper nutrition requires ingestion and absorption of the fiber, vitamins,
minerals, carbohydrates and proteins.

Religious and Cultural Dietary Choices
Some cultures and religions have restrictions concerning what foods are
acceptable in their diet.
For example only halal foods are permitted by Islam. Buddhists are
generally vegetarians. The practice varies and eating meat may be
permitted depending on the people.
Many people choose food from animal sources to varying degree for
health reasons.
Raw foodies are another contemporary trend. These diets may require
tuning or supplementation such as vitamins to meet ordinary nutritional
needs

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2.1 Strategies to Facilitate Dietary Changes
As adult grow older, they have greater chances of developing certain
diet related disease such as hypertension, heart disease, cancer and
osteoporosis.
Older adults are more likely to require diet modification to control
diseases than younger adults but the diet should still reflect the
preference of the old adults.

Hypertension
It is estimated that 50-60% of the adults are at the risk of developing
high blood pressure. Untreated hypertension can lead to:
Stroke
Kidney failure
Heart failure
Heart attack
A high sodium intake is generally believed to increase risk of having
high blood pressure. Some people are able to lower their elevated blood
pressure by restricting sodium consumption. Other may significantly
decrease their blood pressure by increasing their calcium intake. Some
people need to control hypertension with medication which usually is a
diuretic. Fruits are usually rich in potassium.
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Heart Disease:
Heart attack is the leading cause of death and
illness. At the root of the cause for heart attack is a
disease called arteriosclerosis which is the
accumulation of plaque (cholesterol, fatty deposit)
on the inner lining of artery. Diet and nutrition are
the focus of attention in heart disease.

Cancer:
The high fat diet is associated with heart disease
also may cause certain cancers.
Studies have shown that when a diet contains high
amount of fat and cholesterol, intestinal bacteria
break down these food stuffs into the substance that
can cause cancer directly or that promote the action
of the other cancer causing chemicals.

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Osteoporosis:
Osteoporosis is one of the most common problems
among older. Calcium is gradually lost from the
bones. It can be prevented by increasing calcium
intake in addition to getting plenty of exercise. While
large amount of calcium supplements are used by the
older women, such supplements can prevent from
osteoporosis.
Fluoride is also important to bone strength.
Osteoporosis is significantly less common in
communities served by fluoride water.
Vitamin C improves calcium absorption
Oxalic acid in spinach also prevents from
osteoporosis

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3. HEALTH MAINTANENCE AND DISEASE
PREVENTIOM MODELS
Injury Model:
Injury is the leading cause of death in children aging
1-5 years. Motor vehicle accidents, violence,
drowning and fall are leading cause of injuries in this
age group. 1-3 years old are particularly at risk of
death from drowning. Burns and fires are serious
cause of death and injuries.
Nutrition:
Balances dietary calories with physical activity to
maintain normal growth, sixty minutes of moderate
to vigorous play or physical activity daily, eat
vegetables and fruits daily.

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3.1 Health Belief Model in Client Care
The health belief model was one of the first and
remains one of the best known social cognition models.
It is health behavior change and psychological model
that was designed to predict behavioral responses to the
treatment to the treatment received by acutely and
chronically ill patients, but in more recent years the
model has been used to predict more general health
behaviors, the health belief model suggests that your
belief in the effectiveness of the proposed behavior will
predict the like hood of the behavior.
An example of health belief model would involve an
individuals opinion about a certain disease and
behavior to disease.

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3.2 Reasons for Non Adherence to Treatment:

Reasons for patients non adherence are complex. Researchers
have found that the relationship between information given to
patients and the extent to which instructions are followed is
not always string. Information alone does not see to affect the
degree to which patients follow recommendations given by
health professionals. Situational, personality or
socioeconomic factors often play a more important race in the
extent to which patient follow recommendations than do the
knowledge and understanding about what they are to do.
Both internal and external factors seen to influence weather a
patient follows health care advice. Internal factors include
patient characteristics such as age, culture, social background,
values, attitude and emotions caused by the disease.
External factors include a relation between patient and
physician or nurse. Support from family, health care
personnel and friends and the impact of health education.

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3.3 Religious Belief and Practices Related To
Prevention and Healing Illness
Faith Healing:
Faith healing is healing through spiritual means.
Believers assert that the healing of the person can be
brought about by the religious faith through prayer or the
rituals that according to adherent stimulate a divine
presence and power towards correcting disease and
disability.
Belief in divine intervention or healing is related to
religious belief. In common usage, faith healing refers to
intervention in initiating spiritual healing.

Research of Belief about Miraculous Healing:
A study of beliefs about miraculous healing among more
religiously committed has indicated that there are
significant differences in beliefs about miraculous
healing even among people within the same domination.

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In Christianity:
One use of term faith healing is in reference to the belief some Christians
that GOD heals people through the power of Holy Spirit often involving
the laying of hands. It is also called divine healing.
Christians physician Reginald B cherry views faith healing as pathway of
healing in which in which God uses both the natural and supernatural to
heal.

In Islam:
The Prophet serves as a primary model for how to live a healthy life.
Illness and suffering are the part of way GOD made the world. Muslim
generally does not see illness as divine punishment. GOD purpose or a
mean of cleaning away sins. Some Muslims also believe that jinn or
invisible spirit may inhibit the body and cause sickness.
During sickness, Muslims are to seek Gods with patience and prayers,
increase the remembrance of GOD to attain peace, ask for forgiveness,
given more in charity.
And read or listen more QURAN.
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4. UNDERSTANDING REGARDING ATTITUDES OF
SOCIETY TOWARDS STIGMATIZED DISEASES.
The Impact of Stigma
The stigma has a significant negative impact on psychosocial
function of people with mental illness through both experienced and
anticipated discrimination.
In the workplace, researchers have found that the people who have
received the label mentally ill
Are underemployed and earn less income than people, anticipate of
negative responses can also lead people with mental illness to
withdraw from or limit their social and occupational functions.
The impact of stigma is psychological as well people who have been
treated for mental illness, report emotional reactions to stigma
experiences ranging from anger and hurt to sad and discourage.
Negative impact contributes to the lower self-steam, social
withdrawal and reduced trust in others. Contacts with people with
mental illness to less stigmizing attitudes towards people with
mental illness, it seems that through these encounters members of
public learn that people with mental illness are not the dangerous.
Both personal and professional contact with people with mental
illness has been linked to reduce stigma.
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4.1 Societal knowledge regarding Infectious Diseases:
Infectious disease also known as transmissible
disease or communicable disease, comprise
clinically evident illness resulting from infection,
presence of pathologic agent in an individual host
organism

Major Infectious Diseases
Food Or Water Borne Diseases:
Bacterial diarrhea
Hepatitis A and E
Typhoid
Vector Norn Diseases:
Dengue fever
Malaria
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Animal Contact
Disease:
Rabies
Bacterial Diseases:
Diphtheria
Pertussis
Tetanus
Tuberculosis
Leprosy
Meningitis


Protozoan Disease:
Malaria
Cholera
Typhoid
Sexual Transmitted
Diseases (STDs):
HIV/AIDS
Syphilis
Gonorrhea
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4.2 Societal Attitudes towards Infectious Diseases:

Negative public reaction to emerging infectious disease
can adversely affect population health.
The ability to public health institutions diseases, negative
reactions may vary from denial to panic to stigmatization.
Denial or minimization of threat of an infectious disease
by the population can increase transmission.
Alternatively, an overreaction to the threat of infectious
disease can over whelm public health systems and leads
to sever economic loses in areas affected by the disease.
Stigmatization can increase problems of person with
disease and facilitate transmission because person with or
at risk for the disease may avoid seeking health care.
The quantity of information conveyed to the public by
various epidemiological characteristics of the disease e.g.
mode of transmission is important.
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5. SPIRITUALITY AND ITS RELATIONSHIP WITH HEALTH AND ILNESS:

We pray because we believe in God answers prayers and God
can directly intervene in human affairs. He is also the great
physician who can cure us with or without help of a skilled
medical doctor.
There are also scientific explanations about the connection
between spirituality and health. Here are just a few of the
scientific findings. Prayer increases our hope, which
strengthens of immune system and lead to health enhancing
actions.
A religious life style reduces risk factor and increase
protective factors.
Faith contributes to our sense of meaning and purpose, which
is important for optimal functioning, physiological and
psychologically.
Traditional prescription of daily devotions and weekly prayer
meeting may not be enough to reap the full health benefits.

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5.1 Difference Between Healing And Cure:

We may not be able to cure every disease but people can indeed be
healed.
Cure is focused on a disease and healing is related to individual as whole
when we seek cure a disease and healing is related to individual as
whole.
When we seek to cure a disease our focus is on the disease and process of
eliminating that disease. Since a healing involves improving the quality
of life for the individuals as a whole, a disease may still be targeted but in
concert with the intent to improve the quality of ones daily life.
An example of healing would be the process where a disease is
controlled or reduced to a point where a persons quality of life may be
such that the disease no longer interferes with their daily productivity.
Healing includes liberation from the disease even if the disease still be
present.
We are a lifestyle, health and healing co-operative because each of those
concepts is at the heart of what we do every day. Healing is the process
of cultivating quality of life and quality of life is our mission.

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5.2 Methods of Spirituality:
Spiritual healing is defined as overcoming the spiritual root causes of
problems by spiritual means.
There are two generic methods of spiritual healing. There are two choices
that apply to all who have a problem that has its root cause in spiritual
healing.

Spiritual Remedies
This is where either someone else or the affected person himself performs
a certain specific act to alleviate a certain problem at a spiritual level. The
benefit of this rapid relief is brought to the affected person. Spiritual
remedies include application of holy ash, holy water, healing through
mantras.

Spiritual Practices:
When person does spiritual practice, he builds his own ability to protect
himself against harmful elements in the spiritual dimensions
The first method of healing mostly brings about cure of root cause
spiritual problems.

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References:
http://en.wikipedia.org/wiki/Transcultural_nursing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/
http://en.wikipedia.org/wiki/Social_stigma
http://www.wikihow.com/Deal-With-the-Stigma-of-Mental-
Illness

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