TRANSCULTURAL CARING: _
A Mm GRADUATE LEVEL COURSE _

 

'Schoiariy iject for the Degree of Myst, '
MICHIGAN STATE UNIVERSITY
SHARON L OLSON '
1998 ,

 

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Michigan State
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Transcultural Caring:
A Pilot Graduate Level Course

by
Sharon L. Olson, R.N., PhD.

A Scholarly Project

Submitted to
Michigan State University
College of Nursing
in partial fulﬁllment of the requirements
for the degree of

Master of Science

College of Nursing

1998

Acknowledgments

This project is dedicated to the students of my ﬁrst transcultural class
in Okinawa, Japan. As Albert Einstein once said-"Our sense of being separate

is an optical delusion."

ii

ABSTRACT

TRANSCULTURAL CARING:
A PILOT GRADUATE LEVEL COURSE

by
Sharon L. Olson, R.N., PhD.

There is an increasing need for education and training in both
transcultural professional caring and transcultural collaboration. Current
curricula in nursing education can be strengthened to meet this challenge for
the new millenium.

This project develops a pilot graduate level course in Transcultural
Caring to ultimately prepare advanced practice nurses and other health and
human service professionals to work in an emerging integral culture where
transcultural caring and transcultural collaboration will be essential in the

personal and professional lived experience.

TABLE OF CONTENTS

List of Figures ................................................................................................... iv
Background of the Problem ............................................................................ 3
Statement of the Problem ............................................................................... 5
Goals and Objectives ........................................................................................ 5
Conceptual Definitions .................................................................................... 6
Conceptual Framework ................................................................................... 7
Conceptual Model ............................................................................................. 8
Review of Literature ......................................................................................... 9
Theories on Caring ............................................................................. 10
Culture Care ......................................................................................... 12
Validation ............................................................................................. 14
Project Development ...................................................................................... 16
Project Evaluation ........................................................................................... 18
Implications for Advanced Practice ............................................................. 23
Appendix A ....................................................................................................... 27
Appendix B ........................................................................................................ 29
Appendix C ........................................................................................................ 31

Appendix D ........................................................................................................ 38

iv

List of Figures

Fig. l: The Continuum of Transcultural Caring as Professional Growth ..... 8

The objective for this scholarly project was to develop a graduate level
course for advanced practice nurses and others in human health and service
professions. The new millennium will require a more uniﬁed,
comprehensive and collaborative transcultural approach to caring for
individuals, families and communities than currently exists. This hypothesis
is suggested based on the following three assumptions:

First, educators will need to consider a unifying framework (a
theoretical tether) that connects the interests and practices of a broad spectrum
of human health professionals for the purpose of fostering a transculturally
integrated worldview an_d transculturally unified collaboration. Such
integration cannot be based solely on Westernized models of health and
caring nor solely on models generated from within the nursing profession.

Second, current educational models addressing cross-culturalism,
diversity, and multiculturalism from a Western perspective will not be
adequate in the let century because they do not offer a theoretical and
practical link to real world collaboration in the emerging global village.

Third, developing course work supporting an emerging "integral
culture" will be helpful for a new vision in nursing education. Promoting
this new vision, however, will require courage and a paradigm shift from
modernistic academic beliefs characterized by competition, power, and long-
standing cross discipline hostilities, toward one called "integral culture" (Ray
(1996). The notion of integral culture represents an evolving appearance of
new values and worldviews that did not exist before World War H. This
emerging culture is increasingly reﬂecting higher standards of spirituality,
personal development, authenticity, and more interrelated views of other

people in an ecological context of one planet-one humanity (Ray, 1996,p.71).

This paper presents a two—fold problem as rationale for developing the
transcultural caring course as well as a literature review to support course
content. Additionally, summaries of the pilot course development and
evaluation procedures are provided with a final section on the how this new
course potentially impacts on advanced nursing practice in primary care.
Backng of the problem

America traditionally has been perceived as the great melting pot of
people and cultures espousing the notion of "E pluribus unum". The process
of assimilation and acculturation, however, no longer can be assumed as
effective and caring. Our approach to cultural diversity today seems to be
represented by the modernistic sentiment of "E pluribus-pluribus"—
everyone is different. This cultural viewpoint often supports an "I-thou"
notion, and an ever-changing standard of values. Modernistic philosophies
foster the tendency to "think apart" in ways that reductionistically analyze
holistic and ecological ideas into meaningless pieces. Such approaches
disintegrate into competing world views of humanity and caring (Ray, 1996,
p. 70). Various professions in each culture must then generate their own
models for what could be universal concerns. One such concern is caring.

Our towns and cities continue to develop into multicultural
communities with every aspect of life affected. In the United States there are
approximately 160 different major ethnic groups each with its own language,
as well as significantly diverse concepts of health, disease, care and treatment,
death and dying, pain and body image (Oosterwal, 1995, p. 1).

Acceptance of alternate beliefs about health and illness is made more
difficult for health professionals because of the rational, scientific and
biomedical Western educational process. (Barkauskas, Stoltenberg-Allen,
Baumann, Darling-Fisher, 1994). Yet a national survey by Ray (1996) found

that alternative health care accounts for thirty-seven percent of health care
received in the United States and reﬂects a 4% increase in five years (p.41). It
is suggested that much of what is considered "alternative" comes from
cultural traditions different from the Euro-centered allopathic model and
tends to be oriented toward life—quality and relational caring.

Perhaps the most compelling call for an increase in transcultural
professional caring and collaboration is what Veroff and Goldberger (1995)
refer to as "cultures in collision." The increase of violence (i.e., person
against person, community against community and nation against nation)
continues to escalate.

Compounding this trend are the enormous social problems—poverty,
hunger, epidemic disease, human rights abuses and environmental
degradation that threaten the lives and well-being of this global society.
Nurses, as well as other health care professionals, are increasingly challenged
to provide professional care that is relevant, purposeful and meaningful.
Many urgently need a theoretical prototype reﬂecting a more holistic and
collaborative transcultural caring perspective that is shared across disciplines.

It is relevant to note that characteristics of the stages of scholarly
activity include a period of time when relationships between theory,
research, practice, and philosophy become more apparent and then progress
to a viewpoint where pluralism in paradigms is encouraged. From that point
boundaries of domains become more identified and finally those domains
guide nursing practice, research and theory (Meleis, 1991, p.117). An
additional stage is suggested here—where the domain's boundaries are
opened to demonstrate a relevance across disciplines and foster collaboration.
Some nursing professionals believe, however, that in doing this nursing

theory's original goal is compromised (Barnum, 1990). Ownership of a theory

simply for the sake of calling it "our own" potentially creates professional
tunnel vision and greatly diminishes collaborative applications across
disciplines.

An emerging integral culture paradigm of one planet-one humanity
offers the opportunity for nursing education to take a leadership role in
demonstrating that nursing theories are particularly useful in fostering a
unifying spirit of collaboration among health professionals.

Statement of the Problem

Collateral background information supports the belief that there is an
increasingly pervasive need for education and training in both transcultural
professional caring and transcultural collaboration. Current curricula in
nursing tend not to address this need. Therefore, the goals of this pilot course
were to (a) address an increasingly pervasive need for increased transcultural
professional caring and transcultural collaboration, and (b) prepare advanced
practice nurses and other health and human service professionals for work in
an emerging integral culture where transcultural caring and transcultural
collaboration will be the fabric of a personal and professional lived
experience. The course objectives were as follows:

1. Analyze historic and epistemological dimensions of care and the
caring tradition.

2. Describe various care theory models and research that supports these
perspectives.

3. Explicate the nature, scope, and functions of care and caring and its
relationship to community service.

4. Provide examples that demonstrate that a culture's care meanings
and action patterns are largely embedded in its world view, social structure,

cultural values, language, and environment.

5. Explore the concept of self-care.

6. Identify barriers to professional self-care.

7. Explore common and differential care knowledge needed to guide
collaborative health care decision making with diverse groups in community
service.

8. Delineate future professional and personal applications of the caring
phenomena.

Conceptual Definitions

The following conceptual definitions are considered essential to a
transcultural caring course.

C_a_re;. An abstract and concrete phenomena related to assisting,
supporting, or enabling experiences or behaviors toward or for others with
evident or anticipated needs to ameliorate or improve a human condition or
life way (Leininger, 1995, p. 105).

Within the pilot course content, care also applied to the student's own
sense of well being and self care. In order to continue to be a caring presence
for another there is the implicit understanding that one must be able to first
care for her/ himself.

Culture care. The provision of human care to foster health, and well-
being in different environmental contexts and cultures (Leininger, 1995,
p.26).

Transcultural care. A concept which extends beyond understanding
discrete facts about various cultures to include validation of the differences
and commonalties in a shared humanity across the life span (Olson, 1996,

p. 8).
Validation. A communication strategy which involves a holistic,

genuine, nonjudgmental encounter that communicates an honoring of the

moment, gentle authenticity, witnessing and commitment to the best (or
higher) self. Validation's purpose is to support, facilitate, and enable
culturally congruent care for self and others in everyday experiences as well as

during times of crisis. (Olson & Schneider, 1997, p. 1 ) .

Conceptual Framework
The following analogy introduces the conceptual framework for the

continuum of transcultural caring and professional growth:

Envision students moving through several rooms sequentially.
Each room holds important artifacts (themes, ideas, concepts, skills,
knowledge) that these students incorporate into their learning 91113: if
these artifacts have meaning. Each room leads to another. As students
exit the final room, they will have accumulated(hopefully) enough
knowledge, motivation and skills to build a new room of their own
using the glue (validation) to hold it all together and make it useful.
Once the room is securely held together, spending time in it helps to
discern new professional roles of inﬂuence and unique new visions for
care.

This course relies on a combination of nursing and non-nursing
theories with the criterion that any theory must be relevant to a person's
professional practice or it will hold little meaning in the long run. Figure 1
below illustrates the continuum of transcultural caring professional growth.
The student begins at the top of the diagram, moving through ecological
theory (first room), followed by care theories (second room); and more
speciﬁcally, culture care theory (third room). With integration students
extend a congruent transcultural care perspective into an even broader
worldview. For the advanced practice nurse application is demonstrated
through a transcultural collaborative role which validates individuals,

families, communities, and national/ international relationships.

Student

t
A'II-IEORY

 

Ecological

 

Care

 

Culture Care

 

 

 

t
A INTEGRATION

llalidate
Congruent
Transcultural Care

 

 

Ilalidate
Integral Culture
World View

 

 

 

II
A APPLICATION
Advanced Practice Nursing
Transcultural Collaborative Roles

t Haﬁdaﬁon I uaﬂdaﬁon t

 

 

Individual] Communities National]
Families International

 

 

 

Figge I. The Continuum of Transcultural Caring as Professional Growth. (5.
Olson, 1997).

Justification for including theory is espoused by The National
Organization of Nurse Practitioner Faculties that set forth curriculum
guidelines published in 1990 (NONPF, 1990). They propose that nursing
curricula be grounded in nursing theory and research as well as the testing of
concepts. Speciﬁcally this framework is in concert with Domain 1
(Management of Client Health/ Illness Status) under the heading of

 

9

Nursing/ Health -Related Theory Application. Additionally, the broader term
of transcultural caring fits very well under Domain 4 (The Healing Role of
the Nurse).

Review of Literature

The transcultural caring course uses ecological theory as a foundation
for subsequent care and culture care theories. Additionally, the review of
literature includes the construct of "validation" which is considered integral
to application of transcultural caring and transcultural collaboration.

An Ecolggical Framework.

There is a growing recognition that chronic illness and lifestyle—related
health problems are now predominant and dramatically inﬂuenced by
environment. Antonovsky (1987) supported this ecological perspective by
noting that our society is coming to understand health not as the absence of
disease, but rather as the process by which individuals maintain their sense of
coherence (i.e., sense that life is comprehensible, manageable, and
meaningful) and ability to function in the face of changes in themselves and
their relationships with their environment.

According to the ecological approach to development set forth by Urie
Bronfenbrenner (1989), the developing person is embedded in a series of
environmental systems that interact with one another and with the
individual to influence development across the life span. The relationship
between person and environments is also one of significant reciprocal
inﬂuence in the ecological framework (Sigelrnan 8r Shaffer, 1995).

Taking a broader world view, Ray (1996) suggested that the emerging
integral culture environment is perceived as one planet and one humanity.

Ecological sustainability of humankind and the planet therefore requires a

10

holism of care reﬂected in emergent politics, economics, organizations,
institutions, and ideologies ( p.79).

Theories on Caring.

The following theories support the development of course content
utilizing a central theme of caring.

Perhaps the ﬁrst person to comprehensively discuss the concept of a
caring relationship was Milton Mayeroff, a philosopher, who in 1981 wrote a
brief but powerful book, On Caring. Mayeroff saw caring as an existential
position that helped people grow while also serving to ground the one caring
more fully to stability in her/ his own life. According to Mayeroff, one can
care deeply for and organize one's life around an idea, ideal, or community.
Major concepts included knowing, alternating rhythms, patience, honesty,
trust, humility, hope and courage (p. 13).

Jean Watson (1988a,1988b) developed caring as a theory of nursing
drawing from the works of existential humanistic psychology and
philosophy, as well as from recent advances in physical science and
neuroscience. She incorporated metaphysical dimensions that are especially
relevant to the union that occurs between the caregiver and the client
through an interpersonal knowing called "empathy" (Montgomery, 1993, p.
31).

Gaut (1983) provided an analysis of caring and deﬁnes the necessary
and sufﬁcient conditions for caring within the health-care context. Three
general meanings associated with care are a) attention and concern, (b)
responsibility for or providing for, and (c) regard, attachment or fondness.
She also suggested that caring includes an action component as well as the

intention to care (p.315).

11

Additionally, good intentions are not enough to convey a caring
presence. There must be an awareness of the need for care, how to improve
the human condition, an intention to help, action, and that the proposed
change be based on what is good for the client.

According to Watson (1989), caring is a transpersonal, inter subjective,
mutual exchange between the nurse and the client that provides access to a
greater force or primal energy that creates a sense of harmony of mind, body,
and spirit that can potentiate self-healing.

Gilligan (1982) related that a caring relationship involves not only
seeing but responding to needs in a web of interpersonal connection. This
caring relationship draws on the feminists' position of seeing life as
dependent on connections as sustained by caring activities based on a bond of
attachment rather than a contract of agreement whereby responsibility
denotes as act of care.

Gadow (1984) described care as an end in itself and the highest form of
commitment to patients. She also identified that caring supports an
individual's interpretation of one's own reality:

the essence of nursing is the nurse's participation with the patient in
determining the unique meaning which the experience of health, illness,
suffering, or dying is to have for that individual [Gaddow, 1980, p.81].

Noddings (1984) noted that caring is based in receptivity. This means
caring is tied to a particular context in which caring relationships vary in
intensity and may be enduring or episodic depending on the strength of felt
obligation.

Care may be deﬁned in terms of the expressive interpersonal acts of
nursing such as comforting, touching and being with another person. These

12

acts tend to represent the artistic dimensions of nursing practice (Henderson,
1985).

Roach (1992) posited that caring is a human mode of being however,
the capacity to care does not automatically guarantee caring responses. She
contended that the capacity to care needs to be nurtured. She identiﬁed ﬁve
attributes of caring to include conscience, commitment, conﬁdence,
competence and compassion (p. 57).

If we think of caring and caring acts as attitudes and activities of
individuals, then the notion of a caring society or a caring context such as
family or community then the question is not how does society care but
rather h0w can society best equip individuals to care? What conditions are
necessary to support caring acts, what resources must be brought to create a
context where caring may occur? What is it that educators need to equip
students from many different health and human service professions to do
carework? The answer may lie within a unifying theoretical framework such
as culture care theory.

Culture care theory

Leininger's theory of transcultural care diversity and universality
provides an important theoretical framework for the transcultural caring
course. It was selected because it is a global theory representing the total range
of holistic phenomena for providing care from a transcultural perspective. It
also represents an ecological framework where environments play a crucial
role in nursing outcomes. The goal of the theory is to improve and provide
culturally congruent care that is beneﬁcial, ﬁts with, and is useful to the
client, family, or group (Leininger, 1991, p.39).

Four selective premises to guide this theory development include the
following (Leininger, 1995, p.103):

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1. Care is essential for human growth, well being, and survival and to
face death or disabilities.

2. Care is the essence of nursing and a distinct, dominant central, and
unifying focus.

3. Culture care is the broadest means to know, explain, account for and
predict nursing care phenomena, and guide nursing care practices.

4. Care (caring) is essential to curing and healing, for, there can be no
curing without caring.

Leininger's "Sunrise Model" uses a semi-circular upper segment
representing the world—view and cultural/ social dimensions that
dramatically inﬂuence perceptions of care and health. The lower segments
reﬂect care systems and dimensions or modalities of culturally congruent
nursing care with arrows suggesting the interrelatedness of these factors.
Together, both the upper and lower segments represent the universal ﬁeld
that nurses must consider to understand human caring and health (Fawcett,
1989). One may note however, that there is no schematic representation of
interface in the nursing decisions and actions modes (see Appendix A).

An ethnonursing qualitative research methodology typically is
employed to support research using Leininger's theory. In the past six years
the Journal of Transcultural Nursing has provided research studies with
excellent examples of the use of the theory with research ﬁndings in
approximately sixty cultures (Leininger, 1995, p. 110).

Relevant to development of this pilot course, Baker and Burkalter
(1996) reported ﬁndings from an evaluative study of the School of Nursing of
Texas A&M International University in Laredo that has opened its doors in
January 1995 reported ﬁndings of teaching transcultural nursing in a
transcultural setting. Evaluation of the initial semester based on

14

transcultural nursing and human caring in a transcultural context
demonstrated that through ongoing and open dialogue, students and faculty
were able to recognize their own values, beliefs, and behaviors that might be
repatterned or accommodated and those that should be preserved. In
particular, faculty experienced an increased awareness and respect for the
students' understanding and incorporation of the health beliefs of the
community into their nursing practice.( p. 13)

Validation.

Caring is a highly complex communication phenomenon that occurs
holistically. Gendron's (1988) dimension of "harmony" that involves
congruence of themes across channels to match the caregiver's response with
the patient's perspective is closely linked with the concept of "validation".
Within the transcultural course it was necessary to present the validation
concept in order that it could be used in a variety of ways both personally and
professionally.

Webster's College Dictionary (1995) deﬁned validation as "a
confirmation, substantiation or giving ofﬁcial sanction to". It is derived from
the Latin word valere thatmeans "to be strong"(p. 1472). Simon (1978)
suggested that validation is a communicated, holistic, genuine, recognition
of another in a creative, and nurturing way which enhances a person's self-
esteem, self-concept, and self-image.

Feil (1993) used validation as a "therapy" based on respect and
empathy for communicating with old-old populations who are diagnosed as
having Alzheimer's disease and related dementia's. Brieﬂy, Feil's validation
therapy uses the techniques of centering; trust building; rephrasing; polarity;
touch; music; reminiscence; ambiguity; imagining the opposite; genuine,

close eye contact; clear, low, loving tones of voice; mirroring; linking

15

behaviors with unmet human needs; identifying and using the preferred
sense.

Olson and Schneider (1990, 1997) suggest that validation has
applicability in everyday use as the art of genuine positive communication
with the self and with others to provide inner strength and maintain health
in everyday experiences as well as in times of crisis. These authors also
identify ﬁve key elements as of validation that include -appreciating and
savoring the moment; gentle honesty; suspension of judgment; witnessing;
and commitment to the "best self" (i.e., the concept of higher self and the
assets/ strengths of individuals). From a nursing perspective it is interesting
to note that these ﬁve elements are somewhat analogous to Benner's (1984)
competencies of maximizing participation, providing comfort and
communication, creating a climate, presence, and preserving personhood
within the helping domain.

Validation as used by Olson and Schneider (1997) and as deﬁned in the
conceptual deﬁnitions section is used in the transcultural caring course as a
key construct for conveying transcultural care and fostering transcultural
collaboration. Validation is therefore introduced into Leininger's model by
re-conﬁguring both the diverse health systems and the nursing care decisions
and action levels for the purpose of more clearly deﬁning how the theory is
applied (see Appendix B).

Finally, this educator has noted that two dangers may exist within this
transcultural framework. First, that advance practice nurses and other health
care provider's may lose themselves in the details of diversity. The danger
exists that caring practices and rituals then become the sole purpose of
research at the expense of a broader and more in-depth understanding of

caring within that particular culture. Also, professionals may stereotype

16

cultural groups through the belief that within a particular culture there are
uniform beliefs and uniform behavior patterns for care.
Project Development

This scholarly project comprised ﬁve phases (a) An extensive literature
review, (b) course materials development (see Appendix c), (b) piloting of
the course, (c) evaluation of the pilot, and (d) implementation of revisions.

This educator suggests that the method and framework used to teach this
concept is consistent with the basic assumptions of the care itself. This means
that as one commits to teach a course such as transcultural caring that the
individual must ﬁrst step back and analyze their o_w_n perceptions and values
around the meaning of care.

Baggmund. In the spring of 1996 this educator was approached by the
Department of Family and Child Ecology ( FCE)—Master of Science
Community Services program director, Dr. Norma Bobbitt, to teach two
courses for the Community Services Master's Program—Okinawa, Japan. In
addition to a Gerontology course this educator requested permission to pilot
the transcultural caring course.

This new course offering was in concert withthe College of Human
Ecology's mission statement that highlights that nations are integrally linked
and that American society can no longer exist as an isolated entity.

To that extent, the pilot transcultural course received full support from the
PCB Chairperson and the Dean of the College.

Location of the pilot course.
The pilot course was taught as part of the fall semester (1996) schedule

at Michigan State University—Okinawa, Japan. This location complemented
the teaching of course content in a highly diverse cultural setting.

17

Additionally, collaboration was initiated with the nursing faculty at the
University of the Ryukyus which was an extremely rewarding unanticipated
outcome.

Tact Group. Students in this course met the following criteria:

(a) Graduate level in their educational process, (b) Trained and/ or employed
in a variety of health and human services professions. (3) Students in the
class would represent multicultural perspectives.

These criterion were based on the following rationale:

1. Students must have progressed beyond undergraduate level
education to participate in critical thinking and an evaluative process of
caring theories.

2. A health and human service mix of professionals can facilitate a
collaborative multidisciplinary perspective in interpretation and application
of the course objectives.

3. A transcultural focus can be enriched if students are able to
contribute beliefs and interpretation of course content from their own diverse

cultural perspectives.

18

Participamig' Student Demographics. The target group for this course
pilot consisted ﬁfteen graduate students currently enrolled in the Master of

Science Community Services Okinawa Program. A brief demographic

 

 

summary is provided below.
Age (agrox) Gender Ethnicity Profession
Average: 30 yrs. Male: 3 African Amer. = 3 Active milit=6
Range 25 to 47 Female: 12 Hispanic = 3 Nurse admin=1
Asian =1 Ped ICU nurse=1
Anglo Amer. =8 Allied Health=1
Teacher =3

 

 

 

 

Comm. Service=3

 

All students have been in a military environment by career / family choice.

This new course was presented in three segments. First, theoretical

dimensions of caring were presented. Second, Leininger's theory was

discussed and applied from various cultural perspectives. Third, caring

concepts were applied to culture care theory with emphasis on application to

varied professional roles of the students.

Evaluation

For the Okinawa Community Services Program, objectives for the

course were rated on a Likert scale of 1(objectives not met) - 5 (objectives met).

Mean scores for each objective are noted in parenthesis.

1. Analyze historic and epistemological dimensions of care and the caring

tradition. (4)

2. Describe various care theory models and research which supports these

perspectives. (4)

 

19

3. Explicate the nature, scope, and functions of care and caring and its
relationship to community service. (5)

4. Provide examples which demonstrate that a culture's care meanings and
action patterns are largely embedded in its world view, social structure,
cultural values, language, and environment. (5)

5. Explore the concept of self-care. (5)

6. Identify barriers to professional self-care. (4)

7. Explore common and differential care knowledge needed to guide
collaborative health care decision making with diverse groups in community
service. (4)

8. Delineate future professional and personal applications of the caring
phenomena. (5)

Bevis and Murray (1990) urged that "emancipatory education be built
on more equal relationships between teachers and students. Learning
together with students requires that teachers be able to absorb, differentiate,
and restructure complexity while being able to think both analytically and
synthetically. Particularly at the graduate level, pilot testing a course involves
engaging the students in ownership of helping to critique and evaluate course
content. Additionally, students were asked to provide further feedback
speciﬁc to the new course development. A summary of those ﬁndings is
included in Appendix D.

Implementation of Revisions.

As many educators would agree, any educational course offering must
be continually revised and improved to better meet standards of excellence in
teaching and foster improved student learning. Based on evaluation feedback,
the following changes have been incorporated into future course planning.

20

1. More information concerning integral culture will be added to the
theoretical section.

2. There will be an increase in the variety of readings which reﬂect application
of transcultural caring and transcultural collaboration.
3. Transcultural experiential activities will be strengthened to include

Internet "partnering" of students to collaborate on mutual problem solving of
health and human service related issues.

4. An experiential international study program will be developed as a long
range goal.

Implications for Advanced Nursmg' Practice and Egmry Care

Within a transcultural caring framework the advanced practice nurse
uses a variety of roles. They include but are not limited to:

Counselor. Provide validation for feelings and perspectives of
individuals/ families] communities life ways which reﬂects transcultural
caring.

Educator. Assist in teaching which validates and fosters transcultural caring
and transcultural collaboration between professional disciplines.
Collaborator. Facilitate a transculturally caring networking of resources and
professionals who share common caring perspectives.

Clinician. Enable and empower individuals/ families/ communities to
achieve and maintain a state of well-being through a transcultural caring and
transcultural collaborative process.

Within the primary care setting the transcultural nurse articulates the roles
deﬁned above through;

(a) Culture care preservation or maintenance. The opportunity to validate the

importance of preserving and maintaining cultural values as well as efforts of

21

individuals/ families/ communities to maintain well being, recover from
illness or face handicaps and/ or death.

(b) Culture care accommodation or negotiation. The opportunity to validate
the efforts of individuals/ families/ communities representing a designated
culture to adapt or negotiate with others for a beneﬁcial or satisfying health
outcome.

(c) Culture care re patterning or restructuring. The opportunity to validate
cultural values and actions/ decisions of individuals/ families/ communities
as they reorder, change or greatly modify their life ways for new, different and
beneﬁcial health care patterns.

Implications for Education.

This transcultural caring course was designed for graduate level
students, however, nursing education leaders might consider how and when
to incorporate transcultural caring theory into existing curricula to foster
improved outcomes of their students' professional performance.

Implications for Research.

It is suggested that as transcultural caring and transcultural
collaboration become a curricular option at both the undergraduate and
graduate level. Also, it will be insightful for graduate students to explore
theoretical care models through empirical and ethnographic studiesfrom a
transcultural perspective. Additionally, further research is encouraged
encompassing the concept of validation as it is utilized with Leininger's
Sunrise model at both the systems and nursing care decisions and actions

levels.

Conclusion

Benner (1984) suggests that both environmental and internal changes
in nursing call for increased attention to career development because the
expert nurse melds many roles into her/ his professional practice over time.
The mandate to individualize care through these many roles is increasingly
becoming more difficult. For nurses to provide care that is truly
transcultural- reaching beyond what separates us to care for people sharing
one humanity requires an openness to collaboration which is also
transcultural. This is our greatest challenge- and our greatest opportunity for

the new millennium.

23

References

Antonovsky, A. (1987). Unravelipg The Mystery Of Health: How
People Manage Stress And Stay Well. San Francisco: Jossey-Bass.

Baker, S. and Burhalter, N. (Jan/ June 1996). Teaching transcultural
nursing in a transcultural setting. Journgl of Transcultural Nursing, 7 (2),
10-13.

Barkauskas, V. Stoltenberg-Allen, K, Baumann, L, and Darling-Fisher,
C. (1994). Health and Physical Assessment. St. Louis; Mosby.

Barnum, B. (1990). Nursing Theory; Analysis, Application, Evaluation
(2nd ed.). Boston: Little, Brown 8: Co.

Benner, P. (1984). From Novice To Expert Menlo Park, California:
Addison-Wesley Publishing Company, Inc.

Bevis, E. 8: Murray, I (1990). The essence of the curriculum revolution:
emancipatory teaching. lournal of Nursing Education, __2_9, 326-331.

Bronfenbrenner, U. (1989). Ecological systems theory. In R. Vasta (Ed.),
Annals Of Child Development: Vol. 6. Theories Of Child Development.

Revised Formulations And Current Issues. Greenwich, CT. JAI Press.
Costello, R. (Ed.). (1995). Webster's College Dictionary. New York:
Random House.

Fawcett, J. (1989). Am lysis And Evaluation Of Conceptual Models Of
Nursing. Philadelphia: F. A. Davis.

Feil, N. (1993). The Validation Breakthrough. Maryland: Health
Professions Press, Inc.

24

Gadow, S l. (1980) Existential Advocacy: Philosophical Foundation Of
Nursing. In S. Spicker and S. Gadow, Nursing Images And Ideals. New York:
Springer.

Gadow, S. (1984). Touch and technology: Two paradigms of patient care.
lournal of Religion and Health 23(1),63-6k9.

Gendron, D. (1988). The Expressive Form of Caring. Monograph 2.
Persmtjve in Caring. Toronto: University of Toronto.

Gilligan, C. (1982). In A Different Voice. Cambridge, MA: Harvard
University Press.

Gaut, D. (1986) Evaluating care competencies in nursing practice.
Topics in Clinical Nursing, 8 (2), 77-83.

Goldberger, N. & Veroff, J. (Eds). (1995). The Culture and Psychology
Reader. New York: New York University Press.

Henderson, V. (1985). The essence of nursing in high technology.
Nursing Administration marterly, 9(4), 1-9.

Leininger, M. (1991). Culture Care Diversiry And Universaliry: A
Theory Of Nursing. National League for Nursing.

Leininger, M (1995). Transcultural Nursing; Concepts, Theories,
Research & Practices (2nd Ed.) . New York: McGraw-Hill Inc.

Leininger, M and Watson, I. (Eds) The Caring Imperative In Education.
New York: NLN.

Mayeroff, M. (1971) On Caring. New York: Harper 8: Row.

Meleis, A. (1991). Theoretical NursingDevelopment & Prw
(2nd ed.) Philadelphia; J.B. Lippincott Co.

25

Montgomery, C. (1993). Healing Through Communication-The Practice
o_fg'gg, Newbury Park: Sage Publications.

National Organization of Nurse Practitioner Faculties. (1990).

Advgrlged nursing practice: Nurse Practitioner Curriculum Guidelines. Final
report, NONPF Education Committee.

 

Noddings, N. (1984) Caring: A Feminine Approach To Ethics And
Moral Education. Berkeley: University of California Press.

Olson, S. (1996) Validation: A Proposed Transcultural Nursing
Construct in Leininger's Theory of Culture Care Diversity and Universality.
(submitted for publication).

Olson, S. 8: Schneider J. (1990). 'The nature and nurture of validation."
New Realities. _(1)_, 25-28.

Olson,S. & Schneider, J. (1997). Validation: how we transform life
experiences. (submitted for publication).

Oosterwal, G. (1995). Health in Cross-Cultural Perspective (in process).

Tresolini, C. P. and the Pew-Fetzer Task Force. (1994) Health
Professions Education and Relationship-gentered Care. San Francisco, CA:
Pew Health Professions Commission.

Ray, P. (1996). The Integral Culture Survey: A Study of the Emergence

of Transformational Values in America. Sausalito,Ca.: Institute of N oetic
Sciences.

Roach, S. (1992). The Human Act Of Caring. Ontario: Canadian
Hospital Association.

Simon, S. (1978). Negative Criticism. Chesterﬁeld, MA: Values Press.

26

Symanski M. Make Room for Care: Challenges for Faculty of
Undergraduate Nursing Curricula. in Leininger and Watson The gg'pg
Immrative In Education. New York: NLN. pp. 137-142.

Sigelman, C. & Shaffer, d. (1995) (2nd ed.). Life-Span Human
Development. California: Brooks/ Cole Publishing Co.

Watson, I (1988a) Nursing: Human Science And Humgn Ca_r_e_. New
York: National League for Nursing.

Watson, J. (1988b) New Dimensions Of Hurmn Caring Theory.
Nursmg' Science Quarterly, 1(4), 175-181.

Watson, I. (1989, Oct). gm : a Core Value in Health Poligy-
Comuences. Paper presented at the American Academy of Nursing

Conferences, Denver, Co.

27

Appendix A

W
28

Leininger's Sunrise Model to Depict Theory of
Cultural Care '
Diversity and Universality
Cultural Care
World View
Cultural 81 Social Structure Dimensions

    
 

   
   

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,a Social . r Legal 3.
o \ Factors ‘, ,‘ Factors a ‘

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O

,' Religious :5 Langu e 8. Ethnphistory / Economic‘s

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,' ‘ - . ,_ ,4 Care Expressions! , .. . ‘ .
, Technological ‘r ., Patterns & Practices s Educational .
r Factors +1., A ‘ Factors
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[Ede 4—» Inﬂuenc—eli Cultural Care Repatteming/Restrggturing

 

 

Culture Congruent (Nursing) Care

ﬁgure 1 ,
Ldrunger's Sunrise Model
Leininger. M. Madeline. (1991) “Sunrise Model to Depict Theory of Culture Cars".

amaze arm [b’vem’zydi- [M'VersaéZm'A Tﬁmryorwumzhg p.43. ed. N ew York:

NationalzLeague for Nursing Press. Reprinted with permission.

 

29

Appendix B

 

30

Individuals, Families, Groups, Communities 8:
Institutions in Diverse Health Settings

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Cairn)? [are [b’rrers'z’r‘ydi- Lérz’vemfz’rz'A waryorwwszhg. p.43, ed New York
National League for Nursing Press. Adapted with permission.

 

31

Appendix C

32

Seminar in Transcultural Caring
PCB 892

Credits: 3 with 1 credit Ind. Study option
Instructor: Sharon Olson R.N., PhD.

Prerequisites: Graduate students or permission of the instructor. This course
is applicable to majors in a variety of health and human services fields.

Required Texts:
Mayeroff, M. (1971) On Caring. New York: Harper and Row.

Montgomery, C. (1993) Healing Through Communication. Newbury Park:
Sage Publications

Required Readings:
As Assigned

Course Overview:

Transcultural caring refers to the subjective and objective learned and
transmitted values, beliefs, and patterned lifeways that assist, support,
facilitate or enable another individual or group to improve their human
condition over the life cycle.

This course explores the major philosophical and professional
dimensions of various care theories in order that students develop an
understanding of transcultural caring in the context of their personal and
professional lives.

Students will gain skills in utilizing a transcultural care assessment of
an individual as it would apply in a community service role. Additionally,
students use cultural care theory to evaluate the concept of care within
various cultures. Course content reinforces qualitative research findings
which demonstrate that caring activities, behaviors, and processes link
diverse professionals by fostering an increasing sense of global
interdependence and mutual interrelatedness. This course is also applicable
to majors in a variety of health and human services fields.

33

Course Objectives:
At the completion of the semester students will have the ability to:

1. Analyze historic and epistemological dimensions of care and the
"caring tradition".

2. Describe various care theory models and research which supports these
perspectives.

3. Explicate the nature, scope, and functions of care and caring and its
relationship to community service.

4. Provide examples which demonstrate that a culture's care meanings and
action patterns are largely embedded in its world view, social structure,
cultural values, language, and environment.

5. Explore the concept of self-care.

6. Identify barriers to professional self-care.

7. Explore common and differential care knowledge needed to guide
collaborative health care decision making with diverse groups in
community service.

8. Delineate future professional and personal applications of the caring
phenomena.

Instructional Methods

A seminar format will be the method of instruction. Required readings will
provide the focus for class discussion and lectures. Preparation for seminars
will enhance discussion and is an expectation of all students.

Evaluation

The grading scale to be used is the following: 90-100=4.0; 85-89=3.5; 80-84=3.0;
75-79=2.5; 70-74=2.0; 65-69=1.5; 60-64=1.0

Student evaluations and course grades will be based on the following:

1. Self-Evaluation of Seminar Participation (20 points)

Informed participation in this seminar is expected of all students
enrolled in the course. Each student will self-evaluate their
participation based on seminar attendance, preparation, contributions
to the discussion, and meeting their personal objectives. Students
should assign points to themselves based on a 0-20 point range.

2. Transcultural Care Assessment (40 points )

Students will identify an individual and complete a care assessment.
(handouts will be provided)

3. Interactive Transcultural Correspondence and Collaboration (40 points)
Through use of the internet students will identify a transcultural
professional partner/ student to collaborate with on four care oriented
case studies-each case study is worth 10 points. (guidelines and
handouts will be provided)

34

Course Outline

(Sessions 1-3) Theoretical Perspectives and Research

Objectives:

0 Analyze historic and epistemological dimensions of care and the "caring
tradition".

0 Describe various care theory models and research which supports these
perspectives.

(Sessions 4-6) Nature and Scope of Caring in Transcultural Caring

Objective:
OExplicate the nature, scope, and functions of care and caring and its
relationship to community service.

(Sessions 7-9) Global Perspectives-Theoretical Applications--Student
Presentations
Objectives:

0 Demonstrate how an identiﬁed caring concept can be synthesized into
Leininger's theory of Culture Care Diversity and Universality.

0 Provide examples of global caring perspectives which demonstrate that a
culture's care meanings and action patterns are largely embedded in its
world view, social structure, cultural values, language, and
environment.

(Sessions 10-12) Self-Care

Objectives:
0 Explore the concept of professional self-care.
0 Identify barriers to professional self-care.

(Sessions 13-15) Caring and the Collaborative Transcultural Decision Making
Process in Community Service
Objective:
0 Explore common and differential care knowledge needed to guide
collaborative health care decision making with diverse groups.

(Session 16) Future Professional [Personal Directions in the Caring
Knowledge
Objective:
0 Delineate future professional and personal applications of the caring
phenomena.

35

Additional References

Books:

Andrews, M.M. 8r Boyle, ].S. (1995) Transcultural Concepts in Nursing
Care. (2nd ed.). Philadelphia: J.B. Lippencott Co.

Benner, P. and Wrubel, I. (1989). The Primagy of Caring. Melo Park:
Addison-Wesley.

Chinn, P. (Ed.) (1991) Anthology on Caring. New York: National
League for Nursing Press.

Counts, D.R. & Counts, D.A. (Eds.) (1991). Coping with the Final
Tragedy: Cultural Variation in Dying and Grievirg, Amityville, New York:
Baywood Publ. Co., Inc.

Gaut, D. (Ed.) (1992) Caring: The Presence of Nursing. New York:
National League for Nursing Press.

Gaut, D. (Ed.) (1993) A Glﬂal Agenda for Caring. New York: National
League for Nursing Press.

Gaut, D. and Boykin,A. (Eds.) (1994) Caring as Healing: Renewal
Through Hope. New York: National League for Nursing Press.

Gaut, D. and Leininger, M. (1991) Caring: The Compassiolate Hea_l_gr_.
New York: National League for Nursing Press.

Leininger, M. (1995) Ir_a_r;scultural Nursing: ConceptsI Theories, and
Practices. (2nd ed.) Blacklik, OH: McGraw-Hill, Inc.

Leininger, M. (Ed.) (1991) Cultural Care, Diversity, and Universality: a
Theory of Nursing. New York: National League for Nursing Press.

Leininger, M. (Ed.), (1990) Ethical and MoralfDimensions of Ca_r_e.
Detroit, MI.; Wayne State University Press.

Leininger, M. (Ed.), (1990) Care: The Essence of Nursing and Health.
Detroit, ML: Wayne State University Press.

Leininger, M. and Watson, I. (Eds.) (1990) The Caring Imperative in
Education. New York: The National League for Nursing

Leininger, M. (1989) "Transcultural Nursing: A Worldwide Necessity
to Advance Nursing Knowledge and Practice." In]. McCloskey 8r H. Grace
(Eds), Nursing Issues. Boston: Little, Brown and Company.

Leininger, R.N., Ph.D. (1988). Caring -An Essential Human Need.
Detroit: Wayne State University Press.

Leininger, M. (Ed.), (1988) Care: Discovery and Uses in Clinical and
Community Nursing. Detroit, MI.: Wayne State University Press.

Mayeroff, M. (1971) On Caring. New York: Harper and Row.

Roach, S. (1992). The Human Act of Cm. Ottawa, Ontario: Canadian
Hospital Association Press.

Roach, S. (1998) Caring from the Heart: The Convergence between
Caring and Spirituality. Paulist Press.
Videotapes:
Human Care and Caring- IAHC Refocuses Nursing (1993)
IAHC Inc.

 

 

36

9/9650
Transcultural Culture Care Assessment (ethnohistory)

This assignment is to completed in TWO sessions with the individual. F eel free to organize the
questions to best meet comfort and rapport building for both you and the individual.

The student will select an individual representing a culture other than their own to interview using
the questions listed below. Please feel free to add additional questions for clarity or better
understanding of the individual. Your information about this person is gleaned not only from
verbal responses but also their mannerisms, expressive styles, and gestures. Note that silence also
conveys transcultural messages. Papers are to be typed, double spaced. (40 points)

DUE:Sept. 24

1. Provide a brief introduction of individual- (no names please)- why did you choose this person?
Their approximate age? (do not ask) Specify their ethnicity- (do not assume) What
historical ancestral information do they have?

2. How does the person describe her/his "family"? Include your evaluation of how important the
family is to this individual. How are children, elders perceived?

3 .Explore the environmental living context of the person. Where do they reside? How long? What
do they perceive as the advantages? Disadvantages?

4. How do they feel about technology in their home-- VCR/s,computers, etc.

5. What rituals/traditions do they recall as important when they were young. Are these continued
within their own family? Altered? Are there new rituals/traditions they have created/

6. What importance do they impart to religious/spiritual beliefs/values?

7. What importance do they impart to educational values- what are their beliefs?

8. What importance do they impart to political involvement?

9. What is the importance of food rituals? ( you may need to give an example) Are their any food
taboos/preferences-

10. How does the individual feel about traditional cultural clothing use for festivals? Everyday
wear?

1 1. Discuss folk (generic/emic) health care/cure practices used by the extended family members
and/or themselves.

12. Discuss the use of professional (etic) health care/cure practices

13. Discuss ways the individual-
prevents illness-
preserves/maintains wellness-
cares for self -

14. Finish your interview with the opportunity for the individual to ask you any questions.
Example: You have been very helpful in allowing me to ask you these questions- Do you
have any that you would like to ask me?"

15. Summary- Provide a brief summary of following:

A. How did you feel the interview went overall?
B. What did you do well?
C. What would you have done/said differently?

37

9/96 50

FCE 892 Seminar in Transcultural Caring

Concept Paper (40 points)

The purpose of this assignment is twofold. First, to help students apply Leininger's theory
of Culture Care Diversity and Universality. And second, to demonstrate how an identiﬁed can'ng
concept can be synthesized into this model by a Community Service professional.

You will need a minimum of 5 references ( use APA -1994-fonnat). Three references are
required as they relate to the ethnic group while two references are required for the caring
concept. Length of the paper is not to exceed 5 pages (reference page is extra) typed and double
spaced. Please be prepared to discuss progress on your paper during the last hour of class on
October 3rd.

Paper Due date: FRIDAY- October 4 by 4:00PM at the MSU ofﬁce.
(Note: self-evaluation is due Oct. 3- OR by 4pm on October 4th at the MS U ofﬁce.)

l.(5points) Identify a particular ethnic group and a caring concept of interest to you. Brieﬂy
discuss why you chose them.

2.(15 points) Brieﬂy discuss this ethnic group's a) religious/philosophical factors; b)kinship &
social factors; c)cultural values and lifeways; d) political influences; e) economic factors; 0
educational factors and d) technological factors. (Some ethnic groups encompass an
extremely diverse population so try to narrow it down)

3.(5 points) Select a Community Service agency (either an actual agency or one that you would
like to see available in the future) and brieﬂy discuss how these services must interface
with emic perspectives of the particular ethnic group.

4.(15 points) Provide examples which reﬂect how the caring concept you identiﬁed is applied in
your role as a Community Service professional in order to:
A) Preserve and/or maintain the culture care
B) Accommodate and/or negotiate the culture
C) Repattem and/or restructure the culture

Appendix D

39

Transcultural Caring -Student Course Evaluation PCB 892
(Summary of ﬁndings)

This new course was presented in three segments. First, we explored
the theoretical dimensions of caring. Second, we familiarized ourselves with
Leininger's Culture Care theory. Third, we attempted to blend caring
concepts into Leininger's work and apply her theoretical Sunrise Model in a
professional role.

From your perspective, how did you feel about this approach?
0 it is important to set a theoretical foundation first

0 spend more time on Leininger's theory

0 useful

0 strengthen the second segment

Did they feel inclusive enough? If not, what would you have added?
0 yes

Were they balanced by degree of information application?
0 no. more application

0 more time on Leininger's theory

0 explore other theories

What were the strengths of the course?

0 opening new doors to new ideas

0 the readings were insightful and comfortable
0 application of the process

What were it's limitations?

0 length of the course

0 locating some specific cultural information was difficult because of
accessibility.

0 everything applying so much to mainly nursing and health care

0 time

0 we can't do fieldwork

How did it "fit" with your educational /personal goals?

0 it will fit someday when I reach my goal.

0 the concepts can make me a better person,hence I can professionally do a
higher quality job.

0 this was one of the most important courses because I can use this
information in my ministry, work and at home.

0 in my present job this was all very applicable—in my personal life it was

very validating.

40

How did it "fit" with your educational [personal goals?(cont.)

0 it assisted in identifying potential community service programs that were
not considered until the course.

0 fits with both my personal and professional goals

0 reinforced my need to remember to take care of myself.

0 new insights

0 a broader perspective on caring

Please comment on the texts and reading materials.

0 validation-great, Healing through Communication-good

0 need more readings

0 the Mayeroff book is very important

0 there was a lot of reading at the beginning of the course- it would have been
nice to spread it out a little more.

0 use the modified Leininger model because it may be applicable to a broader
range of community service professionals.

0 a few different articles or earlier introduction of Leininger would be helpful.

0 we should have read Leininger's book

Please comment on the assignments.

0 both assignments were very challenging but well worth it
0 library research was very useful

0 I enjoyed the interview

What information did you find most helpful?

Ovalidation

0 validation and the fact that caring is not hard to improve and apply.

0 the various articles on caring

0 how to use the computers at the library and applying Leininger's model
0 self care and validation

0 risks of caring

0 interviewing someone from a different culture

What information did you find least helpful?

0 attributes of caring and Leininger's model/ theory

If you were teaching the course- what changes would you make?

0 change to a combination of assignments

0 practicing more on application

0 outline the final paper earlier in the course

0 more specific examples applied to Leininger's model relative to
Community Service

Other Comments:

0 caring concepts need to be expressed across other Community Service

course offerings.

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