Marilyn R. McFarland

Chapter 3: Theoretical Basis for Transcultural Care

Margaret Andrews, PhD, RN, CTN, FAAN1 Jeffrey R. Backstrand, PhD2 Joyceen S. Boyle, PhD, RN, CTN, FAAN3 Josepha Campinha-Bacote, PhD, MAR, PMHCNS-BC, CTN-A, FAAN4 Ruth E. Davidhizar, DNSc, RN, APRN, BC, FAAN (deceased)5 Dawn Doutrich, PhD, RN, CNS6 Mercedes Echevarria, DNP, APN7 Joyce Newman Giger, EdD, APRN, BC, FAAN8 Jody Glittenberg, PhD, RN, FAAN, TNS9 Carol Holtz, PhD, RN10 Marianne R. Jeffreys, EdD, RN11 Janet R. Katz, PhD, RN12 Marilyn R. McFarland, PhD, RN, FNP-BC, CTN-A13 Gloria J. McNeal, PhD, MSN, ACNS-BC, FAAN14 Dula F. Pacquiao, EdD, RN, CTN15 Irena Papadopoulos, PhD, MA, RN, RM, FHEA16 Larry Purnell, PhD, RN, FAAN17 Marilyn A. Ray, PhD, MA, RN, CTN-A18 Mary C. Sobralske, PhD, RN, CTN19 Rachel Spector, PhD, RN, CTN-A, FAAN20 Marian K. Yoder, EdD, RN21 Rick Zoucha, PhD, PMHCNS-BC, CTN22

Ethnonursing: A Qualitative Research Method for Studying Culturally Competent Care Across Disciplines

Nurse anthropologist, Madeleine Leininger, developed the culture care theory and ethnonursing research method to help researchers study transcultural human care phenomena and discover the knowledge nurses need to provide care in an increasingly multicultural world. The authors propose that the ethnonursing method can be useful for research that addresses providing care in other disciplines, including education, administration, physical, occupational, and speech therapy, social work, pharmacy, medicine, and other disciplines in which research findings have implications for human care and health. The authors discuss the culture care theory and describe the ethnonursing research methods enablers, data analysis phases, and qualitative evaluation criteria. The theory is presented as a guide for using research findings to design culturally competent and congruent care to promote well-being among diverse people, groups, communities, and institutions. Resources include a reference list of key source publications, a discussion of exemplar studies, and samples of a theory-based, open-ended interview guide and data coding system.

Caring Some Reflections on the Impact of the Culture Care Theory by McFarland & Andrews and a Conversation With Leininger

This column is the first of two with a special focus on the construct of caring. In this dialogue, two Leininger scholars together address the questions related to the global impact on practice and the contribution of the model to scientific development in nursing. Then, in a special conversation, nurse theorist Madeleine Leininger offers her view of the impact of her work as well as some of her early experiences.

Visual Literacy in the Online Environment

Visual literacy combines words and graphics to enhance learning. Students are immersed in digital literacy and multimodal learning; therefore, it is important for educators to embrace visual literacy and strike out beyond printed text, PowerPoint slides, and discussion boards. This article describes the use of visual literacy as a tool to enhance student learning. An example demonstrating the application of visual literacy to teach transcultural nursing in an online environment is provided. The Web site containing a copy of the visual literacy teaching tool is also available to readers.

Developing a Culturally Competent Workforce through Collaborative Partnerships

Inthis article, the authors describe a federally funded project to implement a partnership model involving the Transcultural Nursing Society (TCNS) and two universities that have undergraduate and graduate programs in nursing. The overall goal of the project is to use transcultural nursing as a framework for developing the cognitive, affective, and psychomotor cultural competencies of nursing faculty, practicing .nurses, and nursing students. The purpose of this article is fourfold: (a) to describe the background and environmental context of the TCNS-university partnership; (b) to provide an overview ofthe project objectives, key partners, and organizational structure of the partnership; (c) to discuss the current and future project activities; and (d) to critically examine the benefits of partnering for both the TCNS and the two universities involved in this project.

Chapter 4: Cross-Cultural Communication

II. nAture of cross-culturAl communIcAtIon A. Cross-cultural communication skills are critical in a global society where encounters with diverse groups are part of everyday life. All interactions are cross-cultural, as human beings tend to be bounded by a set of symbols and meanings that have been culturally imprinted in time (Samovar, Porter & McDaniel, 2004). B. Communication is a process that occurs whenever meaning is attributed to behavior or the residue of behavior. 1. Cross-cultural or intercultural communication is between individuals and groups whose perceptions and symbol systems are distinct enough to alter the communication event (Samovar & Porter, 1995). Differences can occur across and within the same groups. 2. Communication is symbolic, as it uses verbal, nonverbal, and visual representations to create shared meanings. 3. Culture and communication are intricately bound; one cannot understand communication without understanding its social and cultural context. 4. Communication is a complex process; language is at best an approximation of reality. 5. In communication, one can only infer about the other; hence, seeking and giving feedback, facilitating comfort in the exchange, listening and observing, and using other resources, such as interpreters, are critical. c. Elements of Cross-Cultural Communication 1. Perception (Singer, 1987) a. Process by which an individual selects, evaluates, and organizes stimuli from the external world. b. Based on beliefs, values, and attitude systems 2. Verbal processes—how we talk to each other and think 3. Nonverbal processes—use of actions to communicate

Healthcare provider compliance with the 2013 ACC/AHA Adult Cholesterol Guideline recommendation for high-intensity dose statins for patients with coronary artery disease

Background Atherosclerotic cardiovascular disease is the foremost cause of death for U.S. adults. The 2013 ACC/AHA Adult Cholesterol Guidelines recommend high‐intensity dose statins for individuals with coronary artery disease (CAD). Objective To determine healthcare provider compliance with the Cholesterol Guideline recommendation specific to high‐intensity dose statins for patients with CAD. Methods A retrospective chart review was conducted to determine compliance rate. A questionnaire was developed to evaluate healthcare provider beliefs, attitudes, and self‐confidence toward this recommendation. Results Of the 473 patients with CAD, 67% were prescribed a high‐intensity dose statin. Patients with non‐ST segment myocardial infarction and ST segment myocardial infarction were more likely to be prescribed a high‐intensity dose statin versus a moderate or low‐intensity dose. Healthcare providers strongly agreed with this guideline recommendation. Conclusion There exists a dichotomy between intention to prescribe and actual prescribing behaviors of high‐intensity dose statin for patients with CAD. HighlightsPatients with CAD are inconsistently provided high‐intensity dose statins.Healthcare providers agreed and intended to provide high‐intensity dose statins.High‐intensity dose statins are superior in reducing secondary CAD events.Shared decision‐making allows for variability in statin dosing.New ACC/AHA lipid performance measures allow for less intense statin dosing.

Advancing Cultural Assessments in Palliative Care Using Web-Based Education

Research supports the premise that cultural competence in health care improves care delivery and patient outcomes. Despite efforts to promote patient-centered care and respect for choices across the illness trajectories, cultural considerations of palliative care remain poorly understood. The purpose of the study was to determine if, after completing cultural competence education, registered nurses working in a combined palliative care and hospice unit increased their cultural awareness, sensitivity, and cultural assessment documentation. The study used a quasi-experimental design and took place in a 1070-bed Midwestern hospital. Fifteen registered nurses participated. The intervention consisted of 3 Web-based cultural competence education modules. A preintervention and postintervention electronic chart audit identified 80 charts meeting inclusion criteria. The charts’ cultural assessment data, which had been completed by nurses upon patient admission, were extracted and analyzed. The nurses also completed the Cultural Competence Assessment tool preintervention and postintervention. Analysis of the postintervention data showed the nurses had increased their cultural awareness, sensitivity, and cultural assessment documentation. These findings support the use of Web-based education and show how this format can translate cultural competency knowledge into nursing practice. Providing this education is an important component in creating an environment that provides culturally congruent palliative care.

CultureCopia(c): Developing a Computer-based Electronic Transcultural Simulation Game Based on Leininger's Culture Care Theory

● To foster digital-based engagement and cultural competence learning through the use of educational computer gaming ● To promote customized culturally diverse learning experiences ● To promote long-term memory and transfer of cultural competence knowledge for application to clinical nursing practice ● Six modules (lessons) come with the game ● The Instructor has the option to create more modules ● Multiple frame types: ■ Narrative/Story Frame ■ Video Frame ■ Multiple Choice Question Frame ■ Sorting Question Frame ■ Matching Question Frame ■ Feedback Frame Students earn points towards their virtual charity for each correct answer.