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Introduction: This article explores the historical and cultural background of the Inupiat community, highlighting health disparities and emphasizing culturally competent care's role in addressing them., Methods: Inupiat health beliefs, communication styles, family dynamics, and dietary habits are examined in relation to Western medical practices within tribal health systems. Strategies for cultural education include curriculum development, simulations, clinical assignments, and partnerships with Inupiat healthcare professionals., Results: Challenges in providing culturally competent care to the Inupiat community are identified, including barriers in nursing education and legal implications for nursing practice. Strategies for enhancing nursing cultural competency are outlined., Discussion: This paper advocates integrating cultural competency into nursing practices to improve care for the Inupiat community, focusing on training, education, and policy recommendations. It emphasizes the importance of respecting and integrating Inupiat cultural practices to enhance health outcomes and healthcare experiences., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

BACKGROUND Nursing education is an important part of the "9+3" vocational education program led by Sichuan Province. In the internship stage, nursing students of Tibetan ethnicity may have problems of intercultural adaptation in the process of getting along with patients, which may affect the effective nursing outcome. The purpose of this study was to clarify the current situation of transcultural adaptation of Tibetan trainee nurses and to provide more theoretical support and guidance. MATERIAL AND METHODS We collected 237 valid survey questionnaires, based on Ward's acculturation process model, from a total of 363 Tibetan trainee nurses in the "9+3" free vocational education program in Chengdu, Luzhou, and Nanchong of Sichuan Province. The SPSSAU project (2020), an online application software retrieved from https://www.spssau.com, was used for data coding and archiving. RESULTS The results of questionnaire and data analysis showed that the overall level of transcultural adaptation of Tibetan trainee nurses was that the number of people with poor adaptation was slightly higher than those with good adaptation, and most Tibetan trainee nurses were in the middle level. Meanwhile, sociocultural adaptation was better than psychological adaptation. There were no statistically significant differences among the 4 grouping variables: gender, student home region, the city where the internship hospital was located, and whether they were from a single-child family or not. CONCLUSIONS The results revealed that there was still transcultural maladjustment among Tibetan nurses in the internship stage, and the psychological maladjustment was more obvious than the sociocultural maladjustment. We provide countermeasures and suggestions to solve the problems of transcultural adaptation reflected in the research.

Objectives: to identify factors that interfere with the practice of exclusive breastfeeding in quilombola communities., Methods: qualitative research based on the Transcultural Theory proposed by Madeleine Leininger, performed with quilombola mothers. For data collection, we used the semi-structured interview, conducted from June 2018 to January 2019. Content analysis was guided by the interactive model of Miles and Huberman., Results: it was revealed that intergenerational cultural myths and customs interfere with breastfeeding practice, and identified the influence of professional nurses on best breastfeeding practices., Final Considerations: cultural and intergenerational factors favor early weaning and expose the child to illness.

Aim: This study examines the transcultural adaptation and the reliability and validity of the Turkish version of Perroca's Patient Classification Instrument., Background: Nurse managers need valid and reliable patient classification tools for determining patients' acuity or dependency levels on nursing care for measuring nursing workloads., Methods: This study was conducted in two stages in a private hospital in Istanbul, Turkey. First, the instrument was translated, and its content validation was analysed. In the second stage, data were gathered from 300 hospitalized patients and were analysed by factor analyses, Cronbach's alpha and Cohen's kappa., Results: Validity testing with ten experts revealed a scale-content validity index of 0.93. Exploratory factor analysis revealed a two-dimensional instrument with distinct factor loadings and a variance of 66.97%. The confirmatory factor analysis revealed that the fit indices were satisfactory. This instrument had an overall Cronbach's alpha coefficient of .86 and Cohen's kappa coefficient of .826., Conclusion: The study provides evidence that the Turkish version of Perroca's Patient Classification Instrument is a valid and reliable tool to determine patients' acuity levels on nursing care., Implications for Nursing Management: This instrument may be used by nurse managers to determine acuity levels of patients and measure nursing workload., (© 2020 John Wiley & Sons Ltd.)

Objectives: The aim of this study was to determine the knowledge, attitudes, and prejudices of nursing students regarding the provision of transcultural nursing care to refugees., Methods: The sample of this comparative descriptive study was composed of 317 volunteering nursing students living in Ankara, Turkey. Descriptive statistics were presented as number, percentage, and mean ± standard deviation. The relationships among dependent and independent variables were analyzed with Pearson chi-square test. p ≤ 0.05 was accepted as statistically significant., Results: The mean age of the students was 21.19 ± 1.66 years; 88.6% were female. Only 30.0% (n = 95) of students (predominantly seniors) were educated on transcultural nursing. Statistically significant differences were found among grades of nursing students on the answers to the items, "Refugees are under coverage of general medical insurance system," "The concept of 'Health' differs from culture to culture," "Cultural features of the patient are important for caring nurse," "In order to provide care to only refugees and foreign patients, nurses from other cultures should be employed in hospitals," "Interpreters should be employed in hospitals 24 hours for services for refugees," and "According to my observations, refugees and their relatives admitted to the hospital are not respecting the healthcare workers and hospital rules." In addition, there was a statistically significant difference in students' comfort level with nursing care activities between those students who were literate in a foreign language and those who were not literate in a foreign language., Conclusions: Our findings show that attending lectures on transcultural nursing in a curriculum of seniors and being literate in a foreign language had a positive impact on the attitudes of students in terms of the provision of medical care to refugees. It is recommended that nursing programs integrate lectures on transcultural nursing into the curricula of all four grades of nursing education and encourage students in language learning to better serve our disadvantageous guests., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

To enable culturally congruent family health care nursing, the family belief systems theory proposed by Hohashi can be utilized. The family belief systems theory, developed through family ethnographic studies and questionnaire surveys conducted in the United States, Japan, China, Indonesia, and the Philippines, explains (a) structurization of a system, based on the family member's beliefs as cognition criteria, in which family member's emotions, decisions/acts, and physical responses (including health problems) occur; and (b) the process in which family beliefs are formed from family members' beliefs, by which intentional decisions/acts by the family (family decision making, family self-management, etc.) are performed. By identifying the mechanism of family belief systems, the nursing professional, through support for family/family members' beliefs, can completely change the intentional decisions/acts by the family.

The goals of the Andrews/Boyle Transcultural Interprofessional Practice (TIP) model are to provide a patient- or client-centered systematic, logical, orderly, scientific process for delivering safe, culturally congruent and competent, affordable, accessible, evidence-based, and quality care for people from diverse backgrounds across the life span. Key components of the TIP model include the context from which people's health-related values, attitudes, beliefs, and practices emerge; the interprofessional health care team; effective verbal and nonverbal communication among all team members; and a five-step systematic, scientific problem-solving process-assessment, mutual goal setting, and planning, implementing, and evaluating the effectiveness of therapeutic interventions and care. The model is applicable wherever nurses practice, teach, learn, lead, consult, and conduct research domestically and globally.

Transcultural nursing inspires us for humanness. The breadth of a culture is handed down through stories. Storytelling creates understanding and mutuality within a culture and between cultures. Deeper understanding can lead to better patient outcomes across variances in health, wellness, and social standing. The intentional use of storying by six nurses in a project called Story Care led to more appreciative understanding of the other's culture and raised awareness of self in interaction with another. The nurses, patients, and their families had deliberate opportunities to learn more about another who was culturally different, to understand how historical perspectives influence the dynamics of interactions, and to explore a sense of commonality and mutuality in nurse-patient engagements. As we strive for cultural intelligence, diversity, and inclusion in our organizations, transcultural nursing helps nurses connect to and be mindful of cultural ways in which we understand a patient's or population's vulnerability, determination, spirit, and strengths that give meaning to their whole health.

OBJECTIVE Our purpose was to discuss practices of cervical cancer prevention among Quilombola Women. METHOD This study used, in 2014, a qualitative research approach aiming twenty women from a quilombola community (people who live in quilombos, descendants of Afro-Brazilian slaves), which is located in Bahia. A semi-structured interview was developed by researchers in order to collect data. The Ethno-nursing Research method was used to analyze the data. RESULTS The use of cultural care through medicinal plants, and the nursing professional care (Pap Smear exam procedure) were stated by Quilombola women as serving as prevention practices against cervical cancer. However, most women stated that they did not use any prevention practices. CONCLUSION Social, cultural and health access issues are practices that are linked to the cervical cancer prevention among Quilombola Women. Therefore, it is indispensable to create an appropriate care plan for Quilombola women's reality.

Over the past several years, holistic nursing education has become more readily available to nurses working in high-income nations, and holistic practice has become better defined and promoted through countless organizational and governmental initiatives. However, global nursing community members, particularly those serving in low- and middle-income countries (LMICs) within resource-constrained health care systems, may not find holistic nursing easily accessible or applicable to practice. The purpose of this article is to assess the readiness of nursing sectors within these resource-constrained settings to access, understand, and apply holistic nursing principles and practices within the context of cultural norms, diverse definitions of the nursing role, and the current status of health care in these countries. The history, current status, and projected national goals of professional nursing in Rwanda is used as an exemplar to forward the discussion regarding the readiness of nurses to adopt holistic education into practice in LMICs. A background of holistic nursing practice in the United States is provided to illustrate the multifaceted aspects of support necessary in order that such a specialty continues to evolve and thrive within health care arenas and the communities it cares for.

Purpose: Nondisclosure of terminal prognosis in the context of intercultural interactions can cause moral distress among health care providers guided exclusively by informed consent. However, cultural humility can show that revealing and withholding prognostic information are two equally valid paths to the goal of protecting the patient from harm., Design: Assumptions and history giving rise to the preference for truth telling in the United States(US) are examined. Principles of biomedical ethics are described within the context of US, Chinese, and Latin American cultures. The process of cultural competence in the delivery of health care services is explained and introduces the concept of cultural humility., Implications for Practice: By focusing more on biases and assumptions brought forth from the dominant culture, health care providers may experience less moral distress and convey increased caring in the context of intercultural interactions and nondisclosure of prognosis of a terminal illness., (© The Author(s) 2015.)

The purpose of this article is to call attention to the lack of caregiver safety in conflict settings; to bring awareness to nurses and health care professionals of new challenges, specifically the deliberate targeting of health care professionals, that they may encounter in local armed conflict situations; and to address a gap in knowledge about the social and cultural factors surrounding 21st-century armed conflict that directly affect the provision of health care. I argue that these are of interest to transcultural nursing in that violent actors belong to a dangerous subculture, the understanding of which is important to transcultural nursing practice and caregiver safety. The article calls for increased focus on the protection of the nursing workforce and renewed attention on international humanitarian law and the Geneva Conventions that mandate the safety of global health care workers., (© The Author(s) 2015.)

Purpose: The study aimed to analyze the professional autonomy of Japanese nurses when caring for non-Japanese patients and to identify its contributing factors., Method: A descriptive cross-sectional design was used. Participants included 238 clinical nurses working at 27 hospitals in Japan. The Intercultural Sensitivity Scale (Chen and Starosta), and the Scale for Professional Autonomy in Nursing (Kikuchi and Harada) were used to measure intercultural sensitivity and professional autonomy. Stepwise multiple regression analysis was used to identify the most significant factors affecting professional autonomy., Results: Professional autonomy of Japanese nurses caring for non-Japanese patients was significantly lower than when caring for Japanese patients (142.84 vs. 172.85; p < .001). Contributing factors were intercultural sensitivity (p < .001), length of nurse experience (p < .05), and availability of interpretation service (p < .05)., Conclusion: Incorporating transcultural nursing content into training programs in schools and hospitals could enhance professional autonomy of Japanese nurses by promoting intercultural sensitivity., (© The Author(s) 2015.)

Anorexia must not be considered as a syndrome specific to a culture but as being linked to fast-moving sociocultural changes. Its occurrence can be favoured by certain transcultural phenomena, such as globalisation and the process of acculturation. The analysis of a clinical case of a young migrant with anorexia illustrates the complexity and need for complementary transcultural psychotherapy, to improve understanding and the future., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Background: The Christine E. Lynn College of Nursing at the Florida Atlantic University is grounded in the Nursing as Caring theory. A transcultural caring immersion experience for nursing students is provided within the tribal community of the United Keetoowah Band of Cherokees., Aims: The purpose of this study was to ascertain descriptions of nursing students' transcultural immersion experience., Design: A qualitative descriptive approach was used via the Talking Circle method. The consensual qualitative research analytical approach was used to categorize participant responses., Findings: Six themes emerged that are consistent with the Nursing as Caring theoretical key concepts: (1) persons are caring as diverse human beings, (2) persons care from a unique cultural perspective moment to moment, (3) persons are whole and complete in the moment when engaging with diverse others, (4) personhood is a process of living with meaningful purpose by diverse persons, (5) personhood evolves while caring for diverse others in nurturing relationships, and (6) connecting nursing as both a profession and a discipline occurs among unique and diverse persons., Conclusions: The findings from this study reveal the value of providing a transcultural caring immersion experience to students from a Nursing as Caring theoretical perspective., (© The Author(s) 2015.)

Caring for a family member with dementia is stressful, and carers from all backgrounds often feel overwhelmed and under-supported. Professional and family carers' perceptions of the challenges and satisfactions of caring are influenced by culturally derived expectations. However, experiences of caring often differ from stereotypical norms. Experiences of carer stress and beliefs about the nature and extent of support that can be expected from social networks and statutory services may differ between cultural groups in the UK, but sensitive advice, information, and emotional and practical support are universally required. Transcultural comparisons reveal similarities between carers' needs and enable identification of values-based culturally congruent recommendations that nurses can use to promote black and Asian minority ethnic carers' confidence and wellbeing. This article, based on practice experience and a literature review, explores the effect of caring among different cultural groups and offers recommendations for culturally congruent interventions to support carers. It provides evidence-based guidance to enable nurses to meet their responsibilities for transcultural working, as laid out in the Care Act 2014. A scenario illustrates recommendations for practice.

This article provides a theoretic framework for culturally diverse practice, provides a model for developing cultural competency, and provides best-practice guidelines for conducting a cultural assessment on patients to identify their diverse needs to integrate into a patient-centered plan of care. The role of ethics is discussed to empower mutual respect, equality, and trust building in patients to promote positive health care outcomes. Cultural diversity tool kits from the National League for Nursing and the American Association of Colleges of Nursing are reviewed to provide educational resources to the front line nurse., (Copyright © 2015 Elsevier Inc. All rights reserved.)

By 2050, for the first time in U.S. history, almost half of elders will be from ethnic minority groups. To meet the needs of this rapidly diversifying population, nurses need to be able to marry transcultural nursing knowledge with gerontological nursing knowledge. The purpose of this article is to propose a new theoretical model for explaining health outcomes and health responses for older individuals in unique ethno-cultural groups and to discuss implications and applications of the model to transcultural gerontological nursing practice and research. The discussion will include (1) an overview of currently available theoretical knowledge in the area, (2) a description of the theory development process, (3) presentation of the proposed ethno-cultural gerontological nursing theoretical model, and (4) discussion of how this model can enhance nursing's contributions to reducing health disparities. This model is presented not as a finished product but as a basis for future discussion and refinement., (© The Author(s) 2014.)

Female genital mutilation is a common practice in many cultures, and has a range of complications. Many women in the UK have undergone the procedure and many girls are at risk. This article discusses the types of FGM and its complications, and explains how nurses can identify those who have had or are at risk of FGM and either offer support or specialist referral.

If we limit our gaze to epidemiologic or medicalized discourse about health disparities, we risk losing sight of the person living in a health disparity context. We may erase or make invisible the person from a health disparity group; pathologize difference at the population level and, by extension, stigmatize the individual; eliminate the upstream context or causes of disparities; and obscure the human story. For the continued viability of our ideas about health disparities, it is crucial that we maintain cognitive flexibility. The unconscious bedrock of trusted ideas about "culture" and "disparities" can be enriched through a humanized view of the person in the health disparities story. Transcultural nursing research complements the biomedical gaze, placing the patient at the center of a cultural context where health problems are embodied, place based, and socially constituted. Humanizing our practice depends on dialogues with those who experience health disparity conditions.

Every community is unique and has special strengths and health-related needs, such that a community-based participatory research partnership cannot be formed and implemented in a predetermined, step-by-step manner. In this article, we describe how the Community Partnership Model (CPM), designed to allow flexible movement back and forth through all action phases, can be adapted to a variety of communities. Originally developed for nursing practice, the CPM has evolved into approaches for the collaborative initiation and maintenance of community partnerships. The model is informed by the recognition that cultural, social, economic, and knowledge backgrounds may vary greatly between nurse researchers and their community partners. The Familias En Acción violence prevention project exemplifies the use of the CPM in a transcultural partnership formation and implementation process. The collaborative approaches of the model guide community and research partners to interconnect and move flexibly through all partnership phases, thereby facilitating sustainability and community self-advocacy.

Being diagnosed with a metastatic brain tumour can be devastating as it is characterized by very low cure rates, as well as significant morbidity and mortality. Given the poor life expectancy and progressive disability that ensues, patients and family members experience much turmoil, which includes losses that bring about changes to family roles, routines and relationships. Crisis and conflict are common during such major disruptions to a family system, as individual members attempt to make sense of the illness experience based on cultural and spiritual beliefs, past experiences and personal philosophies. It is imperative health care providers strive towards increased awareness and knowledge of how culture affects the overall experience of illness and death in order to help create a mutually satisfactory care plan. Providing culturally-competent care entails the use of proper communication skills to facilitate the exploration of patient and family perspectives and allows for mutual decision making. A case study will illustrate the challenges encountered in providing culturally-competent care to a woman with brain cancer and her family. As the patient's health declined, the family entered into a state of crisis where communication between family members and health care professionals was strained; leading to conflict and sub-optimal outcomes. This paper will address the ethical dilemma of providing culturally-competent care when a patient's safety is at risk, and the nursing implications of upholding best practices in the context of differing beliefs and priorities.

Background: There is limited literature available identifying and describing the instruments that measure cultural competence in nursing students and nursing professionals., Design: An integrative review was undertaken to identify the characteristics common to these instruments, examine their psychometric properties, and identify the concepts these instruments are designed to measure., Method: There were eleven instruments identified that measure cultural competence in nursing. Of these eleven instruments, four had been thoroughly tested in either initial development or in subsequent testing, with developers providing extensive details of the testing., Results: The current literature identifies that the instruments to assess cultural competence in nurses and nursing students are self-administered and based on individuals' perceptions. The instruments are commonly utilized to test the effectiveness of educational programs designed to increase cultural competence., Conclusions: The reviewed instruments measure nurses' self-perceptions or self-reported level of cultural competence but offer no objective measure of culturally competent care from a patient's perspective which can be problematic. Comparison of instruments reveals that they are based on a variety of conceptual frameworks and that multiple factors should be considered when deciding which instrument to use.

Worldwide, at least 6.9 billion people have an impairment-producing health condition. Insensitive encounters with healthcare providers (HCPs) can result in negative appraisals, fear, and avoidance, but little is known about what things are commonly perceived as insensitive. A review of published narratives describing negative encounters with HCPs was conducted. Narrative analysis was used to compare, contrast, and synthesize six themes describing the common negative encounters: (a) ignoring or minimizing their knowledge, (b) detached interpersonal interactions, (c) placing a negative skew on their life quality, (d) lack of HCP knowledge related to their complete needs, (e) assuming they should be asexual and childless, and (f) an inherent power differential. The medical model of disability is perceived by individuals with impairment-producing health conditions to inform negative encounters perceived as insensitive. This preliminary knowledge is important so we can address educational needs, plan future research questions, and establish clinical practice improvements.

Community-based nurse researchers strive to develop collaborative partnerships that are meaningful to the health priorities of participants and relevant to their sociopolitical realities. Within the context of global inequity, intersecting forces of privilege and oppression inevitably shape the research process, resulting in tensions, contradictions, and challenges that must be addressed. This article has 3 purposes: to examine the political context of mining corporations, to describe common health threats and challenges faced by mining-affected communities, and to reflect on research with a mining-affected Indigenous community in Guatemala whose health and capacity for self-advocacy are impacted by a legacy of colonialism. Using an anti-colonial lens, the authors discuss 3 central tensions: community agency and community victimhood, common ground and distinct identities, and commitment to outcomes and awareness of limitations. They conclude by offering methodological suggestions for nurse researchers whose work is grounded in anti-colonial perspectives.

Inadequate knowledge of the influence of lifestyle on clinical outcomes contributes to the difficulties many African Americans experience with type 2 diabetes mellitus (T2DM). This pilot study examined a 12-week church-based culturally targeted diabetes self-management education (DSME) intervention for middle-aged and older African Americans with T2DM. Quantitative data were collected at baseline and at 12 weeks and included questionnaires and anthropometric measures. There were significant increases in medication adherence (p = .006), healthy eating (p = .009), and foot care adherence (p = .003). The intervention had a clinically significant effect on systolic blood pressure, blood lipids, physical activity, and waist circumference. Church-based culturally targeted DSME interventions may result in improved outcomes for African-American adults with T2DM. The authors discuss the value of community-based interventions that target behavioural changes in populations of chronically ill patients, particularly those who historically have been disenfranchised and/or underserved.

This article examines the available evidence about intramuscular injection techniques to generate simple evidence-based or best practice guidelines for implementation in the developing world. Giving intramuscular injections is considered a core nursing skill, and millions are performed around the world every day. Intramuscular injections are more commonly used in resource-poor environments, but there is limited education of nurses on its proper administration. The findings in the literature conclude that the vastus lateralis muscle is the preferred site for intramuscular injections, particularly in resource-poor settings.