Cultural or Transcultural Focus Cultural and transcultural focuses in nursing involve the study of the shared environment of a group, aiming to understand how culture influences health and healthcare practices. This focus is crucial for nurses as they strive to provide culturally competent care to diverse populations. Understanding cultural factors can significantly impact patient interactions, treatment adherence, and overall health outcomes. Despite the increasing importance of cultural competence in nursing, the actual implementation of these concepts in practice has often been limited. Many nursing curricula give only cursory attention to cultural issues, and as a result, few nurses emerge as true cultural experts.
With projections indicating that by 2030, racial and ethnic minorities will comprise the majority of the U.S. population, the need for more in-depth nursing research focused on culture is paramount. The persistence of health disparities between Euro-Americans and other groups underscores the urgent need for culturally informed nursing practices. This demand necessitates a reevaluation of nursing education and an increase in culturally competent training for healthcare providers.
Perspective Differences
Within the realm of cultural/transcultural research (C/TCR), various perspectives exist regarding the meaning and application of the terms. While some researchers view “cultural” and “transcultural” as synonymous, others argue for distinct definitions based on disciplinary origins. For instance, those in the Leininger tradition advocate for the term “transcultural nursing” as a formal area of study focused on the intersections of culture and caring in nursing.
This divergence of opinion highlights the complexity of cultural studies in nursing, emphasizing the need for a common language and framework. Researchers must articulate their definitions and the relevance of their studies to avoid confusion and ensure that their findings contribute meaningfully to nursing knowledge.
Variety of Research and Clinical Journals
Cultural and transcultural research appears in a multitude of research and clinical journals. Some studies, particularly those involving interventions or randomized controlled trials, can be found in the Cochrane Database of Systematic Reviews. A keyword search using terms related to disease, nursing interventions, and cultural groups can yield relevant studies.
Recent reviews have examined race and ethnicity as variables in nursing research, highlighting health disparities among vulnerable populations and the application of cultural competence guidelines in oncology research. However, researchers should be cautious of several pitfalls:
- Descriptive Labels: Often, racial or ethnic group names are merely descriptive labels, and findings may fail to advance genuine cultural understanding.
- Interchangeable Terms: Race, culture, and ethnicity are frequently used interchangeably, leading to ambiguities.
- Evolving Terminology: Names for cultural groups change over time, which can affect the relevance and applicability of research findings.
- Definition Variability: The meaning of cultural competence can evolve, complicating efforts to standardize practices.
- Inadequate Databases: Resources focused on specific populations may be lacking or insufficient.
- Cultural Misinterpretation: Research may not effectively link findings to cultural groups, potentially conflating cultural influences with socioeconomic factors.
- Unaddressed Variables: Cultural findings may not distinguish between culture and other external factors like history and politics.
Much of the quantitative C/TCR is based on established theories, such as Leininger’s culture care theory, self-care models, health-seeking behavior, and health belief models. Newer frameworks, such as the transtheoretical model of behavior change, are also gaining popularity. Studies are increasingly focused on the cultural appropriateness of existing models, ensuring they resonate with specific populations’ realities.
For example, health belief models have faced criticism for not adequately addressing real barriers to care, spirituality, and the interconnectedness of individuals within cultural contexts. Investigating explanatory models of illness is a promising trend, as it parallels comprehensive patient histories and addresses the multifaceted nature of disease and health.
Culture-specific models, such as those targeting HIV prevention among Latinos, are also being developed, illustrating the importance of context in nursing research. Initiatives to create culturally competent organizations and diverse workforces are represented in administrative journals, highlighting the administrative and systemic aspects of cultural competence in nursing.
Data Collection Strategies
Data collection strategies in C/TCR are diverse, yet certain methods are more frequently utilized. While physiological measurements are commonly employed, qualitative methods like focus groups, interviews, ethnographies, participant observation, and written questionnaires stand out in cultural research.
Qualitative approaches, in particular, have been recognized for their effectiveness in C/TCR, provided that investigators remain aware of the complexity of culture in research encounters. The prevailing trend has been toward intracultural, descriptive studies conducted on a small scale. Typically, these studies focus on health knowledge, beliefs, practices, or concepts like self-efficacy within a specific cultural group.
However, there is a growing movement toward cross-national nursing studies, large sample sizes, interdisciplinary teams, and programmatic research. Active C/TCR programs include diabetes education initiatives for Mexican-Americans, diabetes management in ethnically diverse families, and HIV risk reduction interventions for Latina and Asian women. Other studies have targeted cardiovascular health among African American children and condom use among African American adolescents.
Despite these advancements, the field still exhibits a notable lack of programmatic nursing research concerning Native American health, indicating a need for more comprehensive exploration of cultural health practices among indigenous populations.
Methodological Research
Methodological research in C/TCR is gaining traction, focusing on the recruitment and retention of subjects and the development of measurement instruments. The quality of measurements in C/TCR is steadily improving as researchers adopt more rigorous standards for instrument validation. Cultural fit and the psychometric properties of tools used for specific populations are increasingly scrutinized.
Attention to instrument reading levels has become critical, recognizing the prevalence of low literacy and limited English proficiency in many communities. Tools such as the Cultural Self-Efficacy Scale and the Cultural Awareness Scale are being created to measure outcomes related to multicultural awareness initiatives.
Importance of Methodological Rigor
The shift towards rigorous methodology not only enhances the validity of research findings but also ensures that culturally relevant interventions can be accurately assessed. This methodological rigor will facilitate a deeper understanding of cultural dynamics in health and nursing, ultimately improving patient care.
Major Needs of C/TCR
There are several critical needs within C/TCR that must be addressed to enhance its impact and relevance in nursing practice.
1. Increased Intervention Studies
The current proportion of intervention studies in C/TCR literature is estimated to be between 3.6% to 14%. There is a pressing need for more researchers to transition from descriptive studies to interventions and randomized controlled trials. The existing base of knowledge on health beliefs, family values, and other cultural factors provides a solid foundation for developing impactful interventions.
2. Application of Culturally Competent Research Guidelines
More research must be conducted in line with established guidelines for culturally competent research. This approach ensures that studies are not only relevant but also ethical and sensitive to the populations being studied. Culturally competent research goes beyond merely selecting appropriate instruments or recruiting suitable subjects; it involves a comprehensive understanding of the cultural contexts that shape health behaviors and outcomes.
3. Greater Community Involvement
There is a critical need for research to be planned and conducted with increased community involvement. Engaging communities in the research process fosters trust and ensures that studies address the actual needs and concerns of the population. This involvement can lead to more relevant findings and ultimately better health outcomes.
Additional Research Areas
- Native American Health: More extensive research is needed on the health of Native American populations, focusing on culturally relevant practices and health beliefs.
- Multiracial and Multiethnic Studies: Given the growing diversity of the U.S. population, studies focusing on individuals with multiple heritages are urgently needed.
- Rural and Occupational Subcultures: Research on rural, occupational, and sexual subcultures can provide insights into health challenges faced by these groups.
- Comparative Ethics Studies: Exploring cultural perspectives on ethics can enhance the understanding of ethical dilemmas in healthcare across different populations.
- Folk and Alternative Healing Practices: Systematic studies on folk and alternative healing practices, including their integration with biomedical approaches, are necessary for a holistic understanding of health.
- Cultural Assessment Strategies: Development of brief, effective strategies for cultural assessment in clinical settings is crucial for providing culturally sensitive care.
- Economic Case for Culturally Competent Care: Research demonstrating the economic benefits of culturally competent care can help to justify investments in training and resources.
Conclusion
The transcultural focus in nursing is an evolving field that addresses the profound impact of culture on health and healthcare delivery. As the U.S. population becomes increasingly diverse, the importance of culturally competent care will only grow. Nursing research must adapt to meet these challenges, emphasizing intervention studies, community involvement, and the application of culturally competent guidelines.
By recognizing and addressing the needs of various cultural groups, nursing can improve health outcomes and reduce disparities in care. Ongoing research and education in transcultural nursing will be essential in equipping nurses to provide the highest quality of care in a multicultural society. As we move forward, the integration of cultural considerations into nursing practice will play a vital role in shaping the future of healthcare.