he Transcultural Nursing Society, Inc.

, promotes culturally competent care, a tool to provide nursing

care for our broader-base clientele.If we are to decrease health and health care disparities more
attention must be paid to cultural values, beliefs, and practices, which includes spirituality and
complementary and alternative therapies. Health care workers should adapt and include diverse
practices, patient and family care are compromised,leads to good health outcomes,

culturally competent providers value diversity and respect individual differences regardless of ones
race, religious beliefs, or ethnocultural background. Development of dynamic interpersonal
relationships that promote a positive influence on each persons interpretation of and response to
health care in a multicultural environment.

Purnell model as a framework to simply health assessments and interventions quickly and
accurately while enabling culturally relevant care.

Health care organisations to be attentive to cultural diversity and cultural competency, culture is
defined as the totality of socially transmitted behavioural patterns, beliefs, values, customs,
lifeways, arts and all other products of human work and thoughts characteristics of a populations of
people that guide their worldwide and decision making.
Culture is learned first in famiy, then in school,and then in the community, and other social
organizations. Culture has powerful influences on health and illness.

Healthcare providers must recognize, respect, and integrates clients cultural beliefs and practices
into health prescriptions to eliminate or mitigate health disparities and provide client satisfaction.

Leininger defines culturally competent care as the use of sensitive, creative, and meaningful care
practices to fit with the general values, beliefs, and lifeways of clients for beneficial and satisfying
healthcare, or to help them with difficult life situations, disabilities, or even death.

Lack of Minorities: Healthcare beliefs, values, and practices of many nurses may differ dramatically
from those of their patients. The lack of minority representation among nurses may further limit
nurses' access to those who might provide information about the cultural or ethnic groups they
represent. However, it is important to keep in mind that there can be as many differences among
members of the same cultural group as there are differences between cultural groups. For example,
second-generation immigrants who become acculturated to their new county's values and norms
may share the attitudes and beliefs of the majority, host population, while more recent immigrants
from the same country may hold fast to their own traditions.

Additional Factors: In today's managed healthcare environment, nurses must make quick, accurate
decisions that critically impact on patients' survival, quality of life, and satisfaction with the
healthcare experience. Often stressed out and frustrated by that environment, nurses are hard-
pressed to find the time to learn new practices and alter their behaviors to become culturally
competent. Finally, within schools of nursing, culturally specific curricula are limited,5 and many
faculty members feel illprepared to teach what cultural content is available.

Stepping Up to Competence
To begin using the model, find your own step of competence on the staircase. In evaluating
yourself, be sure to ask friends or colleagues for their assessment. Your initial level probably
depends on your selfawareness, motivation, communication skills, education about diversity,
exposure to other cultures, and cultural assessment skills. Of course, the trick is to honestly evaluate
your own knowledge and skill level. This exercise may raise questions about your own cultural
identity. For instance, are you ethnocentric in your beliefs? Ethnocentricity - the belief that your
way of seeing the world is better than others' - can make intercultural interaction nearly impossible.
Next, develop a personal strategy for moving up the steps on the staircase. At each step, you can
build on skills learned at the previous one, implement strategies for change, and prepare to advance
to the next step.
For nurses at steps one or two, several strategies can lead to new knowledge and insight about
cultural influences on healthcare.
· First, learn how culture plays a role in determining your own healthcare attitudes, practices, and
beliefs. For example, what traditional folk practices have been passed down to you from your
parents and grandparents in managing healthcare problems?
· Second, broaden your knowledge by discussing cultural issues with trusted coworkers or
acquaintances from different cultural or racial groups. Be prepared to step outside of your own
cultural comfort zone with your patients. For example, one white nurse had always felt awkward
simply talking about something as routine as hair care for her black patients. She finally broached
the subject with a trusted black colleague and not only gained new knowledge, but found a
colleague with whom she could explore future culturally sensitive issues, such as the effects of race
and religion on styles of grieving.
· Third, see a movie, read a book, or attend a workshop or conference about a particular cultural
group for whom you are providing care. Nurses at step three should adopt a cultural assessment
model to ensure the systematic collection of relevant cultural data for care planning. For example,
some models direct the nurse to first determine what a patient believes to be the nature and cause of
the illness and its appropriate methods of treatment, so that the subsequent plan of care is culturally
congruent with the patient's attitudes and beliefs. References citing such models are listed in the
sidebar entitled "Sources for Cultural Assessment Models."
At step four, nurses should begin to develop skills in troubleshooting issues tangential to diversity.
For example, nurses need to be able to confront peers who display culturally insensitive behaviors.4
Ignoring or denying these behaviors limits the entire staff's ability to provide culturally competent
care because patients often evaluate the quality of their healthcare experience by their interactions
with the entire nursing staff. Nurses at level four should encourage nurse managers and human
resources
personnel to provide support in this area through staff development and other self-enrichment
programs. Building skills in conflict resolution will strengthen nurses' ability to manage cultural
conflicts with skill, diplomacy, and professionalism.
Nurses at levels five and six can continue their development through practical application of their
knowledge and skills. They can lead workshops and conferences, conduct clinical research, or write
about the effectiveness of selected cultural interventions. These nurses provide leadership through
modeling and by helping other nurses to confront diversity issues. For example, one nurse manager
had an informal staff meeting where she facilitated a group discussion about a particular nurse's
inability to work effectively with members of a specific cultural group. Because the nurse manager
modeled culturally competent behaviors and had established an atmosphere of trust, nurses were
able to openly discuss the real issues with minimal defensiveness and anger.

. A culturally competent nurse acknowledges that communication is often a function of one's culture
and accepts differences in styles without being judgmental. Culturally aware nurses also learn to
become flexible and understanding when planning and implementing policies, such as visiting
hours.communicating effectively,

Keep an open mind and listen actively to what patients have to say about illness. Active listening
involves restatement of what's being said to ensure accurate interpretation of the message and
clarify patients' issues and concerns.

Also, discuss alternatives to the proposed treatment plan and establish mutually determined goals
and interventions.