Risnah Transcultural Nursing.... TRANSCULTURAL NURSING Risnah, Ahmad Sayuti Health Science Faculty of UIN Alauddin Makassar Jln. Sultan Alauddin No. 36 Samata, Gowa, South Sulawesi [email protected] Abstract : Transcultural nursing is one of the main areas in nursing which focuses on comparative and analytical study on the different cultures and sub-cultures in the world that appreciates caring, nursing services, values, and health-ill belief, as well as behavior types which aims to develop scientific and humanistic body of knowledge to give a place for nursing practice of certain culture dan universal culture (Marriner-Tomey, 1994). The theory of transcultural nursing emphasizes on the necessity of nurse roles in understanding the culture of the client. The nursing role in the theory of transcultural nursing is to facilitate the nursing system conducted by the common society with the professional nursing system through nursing education. The existence of the nurse roles in transcultural nursing theory is described by Leininger. Therefore, the nurse should be able to make decision with the nursing action plan that must be given to the society. Keywords :Transcultural Nursing, Nurse Introduction Both good and poor performance of a nurse can be affected by many factors; some of them will be discussed in the study of organizational culture. Organizational culture is the philosophy, ideology, value, assumption, belief, expectation, attitude, and the norms that are shared and binding in certain community (Gibson, 2006:30). Hospital as working environment is the situation and JOURNAL OF ISLAM AND SCIENCE 315 Volume 02 Number 02, DECEMBER 2015 Transcultural Nursing.... Risnah condition in the working environment itself as how the treatment of the superior and colleagues, workload, rewards for good performed employees, and so forth. Culture has an important role in creating good working environment. The existence of a good culture created within a firm will produce conducive working environment to form high motivation and working satisfaction of the employees so that they will have good performance. In the study conducted by Koesmono (2005), he states that culture, motivation, and working satisfaction affect the good performance either directly or indirectly. Good culture created in the hospital will greatly affect the nurse performance. Fair treatment to the nurse and good social relation among the nurses will create safe, comfortable, and conducive working environment that make all of them happy and satisfied in doing their job then have good performance. Ethnic culture is preparation media, learning, deployment, implementation, and the assessment of individual trust/belief as well as the standards and norms that regulate health-ill behavior. The cultural belief interprets wholesome experience of individual health-ill to adapt culturally with the cause of rational illness, rules in expressing symptoms, iteraction norms, strategies for help, and determine the desired results (Harwood, 1981; kleinman, 1980). For example, when waking up to go to school, it was experienced dry-throat and stomach cramp. Some beliefs appear like what problem will happen and what action should be taken to address the issue are arranged in the form of action. What is the cause of 316 JOURNAL OF ISLAM AND SCIENCE Volume 02 Number 02, DECEMBER 2015 Risnah Transcultural Nursing.... this case happening to me? What can be done to solve it? Should I stay at home or just go to school today? Who can be contacted to give help? What do the people think if I still stay at home? The answers of the questions and the action to solve it are influenced by the experience gained by the family and the larger ethnic groups. Most believe that special treatment at home by drinking tea can solve the dry-throat and stomach cramp, and go to work or school is hope. The others with other beliefs may give suggestion to visit a healer, stay at home, and do not tell others. Culture also has an influence in the development of nursing theories, for instance, the view that in providing nursing services, it will be better to be conducted by women because the women’s soul is in accordance with the need of nursing, but the change of identity in the process has changed along with the development of nursing as independent profession. Transcultural Nursing The theory was first proposed by Medeleine Leininger inspired by his personal experiences when working as Pediatric Nurse in the Midwestern United States in 1950. At that time, he saw a change in behavior among the children who came from different cultures. The difference made Leininger rethink the nursing profession. He identified that the knowledge of the nurse to understand the children’s culture was still less. In 1960, Leininger first used the terms, transcultural nursing, ethnonursing, and cross-cultural nursing. Finally in 1985, Leininger published his JOURNAL OF ISLAM AND SCIENCE 317 Volume 02 Number 02, DECEMBER 2015 Transcultural Nursing.... Risnah ideas and theories for the first time in 1988. The experts usually name it as transcultural nursing theory1. Leininger (1981:13), states that there are 28 nursing forms of caring that can be applied to all health professionals consisting of comfort, friendship, coping behavior, empathy, involvement, love, nutrient, support, and trust2. Leininger describes the theory of Sunrise Transcultural Nursing, so it is also known as Sunrise Model. The Sunrise Model symbolizes the essence of transcultural nursing which explains that prior to providing nursing care to the clients (individuals, families, groups, communities, institutions), the nurses should first have knowledge of the world-view about the dimensions and cultures as well as the social structures developing in various parts of the worlds (globally), and the community in the specific scope3. 1 Sukarnain. 2011. Konsep Dasar Keperawatan. Program Studi Keperawatan Universitas Islam Makassar: Makassar 2 J Christensen paula, W. Kenney janet. 2009. Proses Keperawatan Aplikasi Model Kenseptual. Buku Kedokteran: Jakarta 3 Asmadi. 2008. Konsep Dasar Keperawatan. Buku Kedokteran EGC: Jakarta 318 JOURNAL OF ISLAM AND SCIENCE Volume 02 Number 02, DECEMBER 2015 Risnah Transcultural Nursing.... Figure 1: Sunrise Model of Transcultural Nursing by Leininger (1981) Transcultural nursing is the major area in the nursing that focuses on comparative and analytical study on the different culture and sub-culture in the world that appreciates caring behavior, nursing services, values, health-ill beliefs, and behavior structures that aims to develop scientific and humanistic body of knowledge in order to make room on the particular and universal culture (Marriner-Tomey, 1994). Transcultural nursing theory emphasizes on the importance of the nurse roles in understanding the culture of the clients4. True understanding of the nurses about the clients’ culture either individuals, families, groups, or communities can prevent cultural shock or cultural imposition. Cultural shock occurs when the outside party (nurse) tries to effectively learn or adapt with the group family of certain culture (client). The client will feel discomfort, anxiety, and disoriented due to the differences in cultural values, beliefs, and customs. While culture imposition is the tendency of the nurses, either secretly or openly, to impose their cultural values, beliefs and culture, beliefs and habits/behavior to the individuals, families or groups from other cultures because they believe that their culture is higher than any other groups. 4 Asmadi. 2008. Konsep Dasar Keperawatan. Buku Kedokteran EGC: Jakarta JOURNAL OF ISLAM AND SCIENCE 319 Volume 02 Number 02, DECEMBER 2015 Transcultural Nursing.... Risnah Objective The intended use of transcultural nursing is to develop scientific and humanist scholarly tree so as to create nursing practice in a specific culture as the culture with the values and specific norms that are not owned by the other groups, such as the Dayak tribe in Kalimantan5. Universal cultures are values or norms believed and performed by almost all cultures, such as drinking tea culture, which can make the body fresh and health (leinger, 1978), or sport culture in order to look beautiful, health, and fresh. In the implementation of humanistic nursing practice, the nurses need to understand the basic theory and nursing practice based culture. The success of the nurses in providing nursing care depends on the ability to synthesize the anthropology concept, sociology, and biology with the concept of caring, nursing process, and interpersonal communication into the concept of transcultural nursing (Andrews & boyle, 1995). The culture that has become the habit is applied in the transcultural nursing care, negotiating, and restructuring the culture. Paradigm of Transcultural Nursing Paradigm of transcultural nursing is a perspective, perception, belief, values, and concepts in the implementation of nursing care in accordance with the cultural background. There are four central concepts of it, namely, human, health, environment, 5 Sudiharto. 2007. Asuhan Keperawatan Keluarga Dengan Pendekatan Keperawatan Transkultural. Buku Kedokteran EGC: Jakarta 320 JOURNAL OF ISLAM AND SCIENCE Volume 02 Number 02, DECEMBER 2015 Risnah Transcultural Nursing.... and nursing (leininger, 1984, Andrew & Boyle, 1995, & barnim, 1998). Human Human is individual or group who has the values and norms that are believed to determine decision and perform action (leininger, 1984 dalam barnu, 1998; Giger & Davidhizar, 1995; dan Andrew & Boyle, 1995). According to Leininger (1984), human has a tendency to retain his/her culture at all times and wherever he/she is. The clients who are hospitalized have to learn a new culture, the culture of the hospital, in addition to their own culture. Clients actively choose their culture. Clients actively choose the culture of the environment, including the culture from the nurses and all visitors at the hospital. Clients who are being inpatient learn to quickly recover and back home soon to start their daily activity as usual6. Health Health is overall activity of the clients in filling their life, which lies in the range of health-ill (Leininger, 1978). Health is a belief, value, and pattern of activity in the context of the culture used to preserve and maintain balanced/healthy condition. Health becomes the focus in the interaction between the nurse and the client. According to the Ministry of Health (1999), health is a state that enables someone to be productive. A healthy client is 6 Sudiharto. 2007. Asuhan Keperawatan Keluarga Dengan Pendekatan Keperawatan Transkultural. Buku Kedokteran EGC: Jakarta JOURNAL OF ISLAM AND SCIENCE 321 Volume 02 Number 02, DECEMBER 2015 Transcultural Nursing.... Risnah continuously and productively prosperous and balanced. Productive means the ability to foster and develop the quality of life as optimal as possible. The clients have wider opportunities to function themselves as good as possible wherever they are. The client and the nurse have the same goal that it is to maintain the healthy state in the range of adaptive health-ill (leininger, 1978). The given nursing care aims to improve the clients’ ability to actively choose the appropriate culture with their health status; the clients have to learn the environment. Holistic and humanistic health is the target health to be achieved by the clients because it involves the more dominant clients’ participation7. Environment Environment is whole phenomenon that affects the development, belief, and client’s behavior. Environment is seen as a totality of the client’s life with its culture. There are three forms of the environment, they are, physical environment, social environment, and symbolic environment. Those three forms of the environment interact with the human to form a certain culture. Physical environment is the natural environment and the environment created by human such as the equatorial regions, mountains, dense settlement, and the tropical climate. The physical environment is able to create a certain culture such as the shape of 7 Sudiharto. 2007. Asuhan Keperawatan Keluarga Dengan Pendekatan Keperawatan Transkultural. Buku Kedokteran EGC: Jakarta 322 JOURNAL OF ISLAM AND SCIENCE Volume 02 Number 02, DECEMBER 2015 Risnah Transcultural Nursing.... Eskimos’ houses that are almost closed/no openings (Andrew & Boyle, 1995). The rural or urban area can lead to the patterns of certain diseases such as acute respiratory infection of the infants that occurs in Indonesia mostly in the urban areas (Ministry of Health, 1999). Bring (1984 in Kozier & Erb, 1995) states that the client’s response to new environment for example the hospital is influenced by the values and forms believed by the clients. Nursing Nursing is the science and tips given to the client based culture (Andrew & boyle, 1995). Nursing is an integral part of health care, based on tips / nursing care in the form of the comprehensive bio-psycho-socio-spiritual services addressed to the individuals, families and society, either healthy or sick that covers the entire process of human life. Cultural negotiation is the nursing intervention and implementation to help client to adapt with a certain culture that gives benefit to his/her health. The nurse helps the client to choose and determine the other culture that more support the improvement of the health status. For instance, the client who is pregnant has eating restriction like smells fishy, then the client can replace fish with other sources of animal protein. Restructuring the client’s culture is conducted if the owned culture adverses his/her health status. The nurse tries to restructure the client’s lifestyle who usually smokes to not smoke. JOURNAL OF ISLAM AND SCIENCE 323 Volume 02 Number 02, DECEMBER 2015 Transcultural Nursing.... Risnah The use of nursing process should become the nurse’s culture8. The Nurse’s Role in Transcultural Nursing Theory “And the believing men and believing women are allies of one another. They enjoin what is right and forbid what is wrong, and establish prayer, and give zakah, and obey Allah and His Messenger. Those – Allah will have mercy upon them. Indeed, Allah is Exalted in Might and wise.” [QS. At-Tawba (9): 71] In this case, the nurse facilitate between the nursing system conducted by the general public and professional nursing system through nursing care. The existence of the nurse’s role is described by Leininger. Therefore, the nurse should be able to make decision with the nursing action plan that should be given to the public. If it is adjusted with the nursing process, it becomes the stage of the nursing action plan. 8 Sudiharto. 2007. Asuhan Keperawatan Keluarga Dengan Pendekatan Keperawatan Transkultural. Buku Kedokteran EGC: Jakarta 324 JOURNAL OF ISLAM AND SCIENCE Volume 02 Number 02, DECEMBER 2015