Ability to effectively work within the

cultural context
In this essay, the concepts of transcultural nursing to be discussed are those of Campinha-Bacotes
The Process of Cultural Competence in the Delivery of Healthcare Service, Purnells Model for
Cultural Competence and Giger and Davidhizars Transcultural Assessment Model. A case study will
also be presented with regards cultural challenges encountered during the period of caring for the
client.
Campinha-Bacote (2002) defines her model as the ongoing process in which health care provider
continuously strives to achieve the ability to effectively work within the cultural context of the client
which includes the individual, family and community. This process involves the integration of cultural
awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire. She defined
cultural awareness as the process of conducting self-examination of own biases towards other
cultures and the in-depth exploration of ones cultural and professional background. It is when
people interact with people from different culture, where belief and practices they consider
appropriate is sometimes inappropriate in another party (Quappe and Cantatore, 2007). On the other
hand, cultural knowledge is the process in which the healthcare practitioner searches the information
based on the patients cultural history specifically health-related beliefs, practices and cultural
values, diseases and population specific treatment and outcomes (Campinha-Bacote, 2002). These
three components could form the basis for quality indicators that measure the cultural competence of
health care providers (Lavizzo-Mourey and Mackenzie, 1995). Cultural skill is the ability to conduct
assessment to collect relevant information regarding the patients health condition and to conduct
culturally based physical examination. Leininger (1978: 85-86) defined a cultural assessment as a
systematic appraisal or examination of individuals, groups, and
communities as to their cultural beliefs, values, and practices to determine explicit needs and
intervention practices within the context of the people being served. Cultural encounter, according
to Campinha-Bacote (2002), is the process that encourages the health care provider to directly
engage in cross-cultural interactions with clients from culturally diverse backgrounds. She added that
directly interacting with clients from diverse cultural groups will modify ones existing beliefs about a
cultural group and will prevent possible stereotyping that may have occurred during the process. She
noted further that cultural encounters also involve an assessment of the clients linguistic needs.
Using a formally trained interpreter may be necessary to facilitate communication during the
interview process in order to prevent faulty and inaccurate data collection.
Cultural desire is the motivation of the health care provider to want to, rather than have to, engage in
the process of becoming culturally aware, culturally knowledgeable, culturally skillful, and familiar
with cultural encounters ( Campinha-Bacote, 2002:182)
The Purnell Model for Cultural Competence was originally developed as a cultural assessment for
nurses that can be applied for primary, secondary, and tertiary prevention (Purnell, 2000). Purnell
believes that health care providers who can effectively assess, plan, and intervene in a culturally
competent manner have increased opportunities to improve the health of the person, family, or
community under their care. He included that the model can also guide nurses in the development of
assessment tools including data collection, strategies in planning, and individualized intervention
(Tortumluoglu, 2006).
The Giger and Davidhizar Transcultural Assessment Model could help nurses in assessing clients
from different cultures. The author finds this model important for the nurse to assess the client
through personal interview as an effective strategy to obtain data and observe the clients behaviour
and practices. The model guides the nurse to be aware of the differences, identify cultural beliefs
and plan strategies on how he/she will interact with the client. Strategies include interview questions
and observational guidelines to assess culturally diverse individuals in order to provide the care they
need (Tortumluoglu, 2006).
The Giger and Davidhizar Transcultural Model postulates that each individual is culturally unique
thus should be assessed in accordance to the six cultural phenomena: communication, space, social
organization, time, environmental control and biological variations. This model is created to help
nurses assess and provide care for patients who are culturally diverse (Giger and Davidhizar,
2002a).
Communication is an act or an instance of transmitting. It is the means by where cultures and
behaviours are transmitted and preserved. Nurses must also take into consideration the types of
communication used, whether verbal and non-verbal, throughout the entire caring process. The
American Society of Radiologic Technology (1998) added that in communication; vocabulary,
grammatical structure, voice qualities, rhythm, speed, silence, facial expressions and body posture
vary from culture to culture. For a nurse to successfully provide care for a client of a different cultural
or ethnic to background, effective intercultural communication must take place.
Another cultural phenomenon that should be considered in assessment is space. This refers to the
distance between individuals when they are interacting with each other. Personal space is an
individual matter and varies with the situation; dimension and personal space comfort proximity
varies from culture to culture (Giger & Davidhizar, 2004). Health care worker with direct care of the
client must be aware of this and respect how people of various cultural background views with their
personal space (American Society of Radiologic Technology, 1998).
Social Organization refers to the manner how people of different culture gather themselves around
as a family. Family is a unit in the society which is composed of members as a subsystem. Giger
and Davidhizar (2004) consider family as a system. A system as defined is a group of interrelated
parts or units that form a whole. Within the family system, the subsystems refer to the ways in which
the members relate themselves with one another. How a particular culture views the family unit
possibly affects how a member of the system is treated when one experiences health imbalances
(Giger and Davidhizar, 2004).
Time is considered as an integral part in the cultural phenomenon. People perceive time uniquely,
though awareness and concept of time is only a product of human mind. People of some cultures
consider time as past, present and future. Various cultures focus on the past and are tradition-
based: others are present-oriented and live for today; others look towards the future and tend to
postpone immediate gratification in favour of future gain. In some cultures, for instance, among
Asian origin, time is out looked as flexible, and so there is no need to rush or be prompt except for
emergency cases. Nonetheless, nurses are expected to be time conscious. Emphasis is given to the
importance of punctuality and good time keeping so as not to disrupt the routines being practiced in
the workplace.