Multicultural nursing

The need for a multicultural approach in nursing

The WHO European Conference on patients' rights approved in Amsterdam on 28-30 March 1994 document Principles of Patients' Rights in Europe": General Framework. It is a set of principles to support and enforce the rights of patients of EU member countries. The document mentions the need to respect the patient's culture in connection with the provision of health care. Since our country was admitted to the EU, it is assumed that the national, cultural and ethnic structure of the population will change. Currently, the structure and number of immigrants are changing, we are no longer a country of first contact (with the exception of air transport). However, a gradual increase in the number of foreigners legally residing in our territory - for work, study, tourism - is expected. It is also possible to assume the share of our medical professionals in various international working groups, e.g. military or humanitarian. Therefore, it is important that the Czech healthcare system prepares for a greater diversification of clients (cultural, national, ethnic diversity, etc.).

In the Czech Republic, the issue of transcultural nursing was publicly presented for the first time in 2000 at the second nursing conference with international participation in Olomouc, which was organized by the Institute of Nursing Theory and Practice of the Faculty of Medicine UJEP. The conference was called Nursing on the threshold of the 3rd millennium and was attended by professionals from six European countries. The quality of nursing care is based on meeting the individual needs of patients, which requires nursing staff who have the appropriate knowledge and skills. Nurses must also learn how to treat patients of other cultures, other ethnicities, with different needs and priorities.

Explanation of the terms multicultural and transcultural

Both terms used to be used (and are still used today) to mean the same thing. However, there are specific nuances between the terms.

The concept of multiculturalism emerged in the world in the 1960s and 1970s. It assumes the preservation of the cultural identity of migrants . In other words, several representatives (groups) of different cultures live side by side in a single state (or a certain territory), which is fully preserved, respected and tolerated by other citizens (groups). So certain ethnic, cultural groups are homogeneous, they do not adopt elements of other cultures, at the same time their culture is not taken away from them. In the conditions of globalization and high mobility, it is difficult to preserve these homogeneous groups without being influenced by events in the country, opinions, attitudes, socio-cultural environment.

The concept of transculturalism We can say that it often follows the phase of multiculturalism, but now it happens that individual cultures mix, influence each other, and take elements of other cultures into their culture. It is an interaction between members of majority and minority companies and groups. We believe that the transcultural process cannot be avoided during migration .

The goal of multicultural nursing (MKO)

The goal of MKO is to provide appropriate and effective support and assistance in health and illness while respecting the specifics of each foreigner.

The meaning of MKO

Fulfill human needs so that:

1. the client had no need to refuse cooperation;
2. he did not feel dissatisfaction, humiliation, humiliation;
3. he preserved his dignity, his self-concept.

For this you need:

1. the nurse's knowledge of the multicultural area;
2. sensitivity and receptivity to the needs of clients from foreign countries or different ethnicities, understanding of clients.

Factors that affect MKO:

• increased population migration;
• demands of cultural minorities for adequate care;
• interest in the health, treatment and well-being of the client/patient, families, groups;
• holistic approach to the patient;
• self-understanding;
• close cooperation with the patient, mutual interaction;
• evaluation of the patient's health and expectations.

Multicultural education

Multicultural nursing has its roots in multicultural education.

Responding to health and illness is not only a biomedical issue, but also a psychosocial, cultural, ethnic and religious one. However, healthcare workers often do not pay attention to this (they don't want to, they can't do it, they don't know how to deal with spiritual topics, it's new for someone, etc.). Working with spiritual themes is as important as the healing itself. Even if we communicate with a foreigner in the same language, we are not aware of the differences in the cultural and ethnic perspective of the client or patient. It is necessary to gradually learn this, to find understanding for foreigners who come to the medical facility, to accept their opinions and attitudes.

Multicultural education serves this purpose, which is not rigid, constant, rigid, just as individual cultures, religious views, etc. are not rigid.

What does multicultural education mean?

• A transdisciplinary area where approaches are combined: pedagogy, cultural anthropology, intercultural psychology, sociolinguistics, etc. Focus = pedagogy – it's about education.
• It increases people's ability to understand and respect different cultures.
• cultures.

It is a field of educational activity, theory, practice, realized in schools, in institutions for adult education, lifelong education (courses for MKV teachers ).

• The field of scientific theory, research – supplies theory and practice with its new findings from the multicultural reality in which contemporary civilization is developing.
• The area of ​​infrastructure – creates an organizational and information base for theory, research and implementation of multicultural education.

Multicultural nursing draws from multicultural education.

Goals of multicultural education:

• rapprochement and cooperation between peoples, cultures, races;
• understanding and knowledge of foreign cultures, ethnicities, world religions;
• preparing youth for life in common Europe (globalization aspect);
• education for tolerance, respect, openness and coexistence in partnership with cultural diversity, which is understood as a positive value and enrichment;
• forming beliefs about human freedom, dignity and equality of every person without distinction.

Multicultural education is aimed at getting to know and understand diverse cultures – their recognized and expected norms, models, patterns of behavior, lifestyle, values, customs that are an expression of ethnicity, religion or other traditions.

On the basis of the acquired knowledge, experience and experiences, the skills to communicate, cooperate and positively solve misunderstandings, possible barriers, mutual insecurities or conflicts, which often arise precisely from ignorance or misunderstanding, are created.

Basic concepts in multicultural nursing

Culture

Culture has been a part of every human community since ancient times. E.g. specific gestures, methods of communication or other means of expression, ways of dressing, eating, specific foods and their preparation, lifestyle, habits and bad habits, etc. – are typical for a specific group of individuals. Cultural diversity is one of the central features of human life.

The concept of culture itself has many characteristics. The etymological origin of the word is in the Latin "Colo", "colere" and was originally associated with the cultivation of agricultural land ( agri cultura ). The Roman philosopher Marcus Tullius Cicero (106–43 BC) gave new meaning when he called philosophy the culture of the spirit ("cultura animi autem philosophia est") in the Tusculian Conversations (45 BC). This laid the foundation for the concept of culture as a characteristic of human education.

In his History of Anthropology, Václav Soukup presents three basic approaches to defining the scope and content of the term culture:

1. Anxiety disorders( axiology = the science of values) is based on the humanist and Enlightenment tradition of using this term in philosophy, art, and sciences. The axiological concept of culture is significantly evaluative. It limits cultural phenomena only to the sphere of positive values ​​that contribute to the cultivation and humanization of man and the progressive development of human society. The areas of spiritual values ​​of society such as art, science, literature, enlightenment, education, noble and progressive ideas, etc. are included in culture.

2. The global anthropological concept of culture includes in a culture not only positive values but all means and mechanisms through which a person as a member of society adapts to the external environment. This concept does not have an evaluative function. Thanks to this, it is possible to characterize and classify different communities in time and space according to their specific elements.

3. The reductionist concept of culture includes approaches for which it is typical to limit the scope of the concept to a certain slice of socio-cultural reality. In contrast to the global approach, semiotic views are developed in particular, which reduce the concept of culture to a system of signs, symbols and meanings shared by members of a certain society.

However, very simply we can say that culture includes everything created by man . Therefore, culture is not a tree, flowers, or animals, but buildings, lifestyle, interpersonal relationships, human communication, transport communication, ideas, and patterns…. It is a product of human thought and is material and immaterial.

The three elements of human culture:

ability of symbolic communication,

the capacity for institutionalized action,

the ability to create structures of organized power.

Culture characteristics:

Culture is a product of learning. It is not instinctive or innate. We adopt it after birth.

Culture is a product of teaching, it is passed from parents to children and to the next generations. Even animals can learn, but only humans transmit culture. The main carrier of culture is language.

Culture is social. It is born and develops within relationships between people.

Culture is adaptable. Habits, beliefs, values ​​change in connection with the social environment and people's needs.

Culture is integrative. The elements of culture tend to create a consistent and integrated system.

Culture is a collection of certain ideas. The individual activities of people may not always correspond to the customs and norms of society, because they correspond to different ideas of this or that individual.

Culture is supposed to bring satisfaction. Cultural habits persist as long as they fulfill their function and are a source of satisfaction. When this function passes, they are gradually abandoned.

Cultural patterns

They are learned and binding schemas for acting in certain situations. Objectively, they appear as customs, manners, laws, taboos. Sociology understands a cultural pattern as a system of forms of behavior, values ​​and norms, characteristic of a given society, which is generally accepted, imitated, enters into the process of socialization of individuals, is reproduced in cultural creations and stabilizes in habits and customs.

Enculturation

It is a process of integration, growing into one's own culture. It is an extremely important process, because this is how generations, society and its culture are preserved. It is a condition for the survival of society. A person who is born into a certain culture must learn to understand the meaning of individual things, but also of the whole world. He must understand his own culture, which he will pass on to the next generation.

Acculturation

Acculturation represents conscious or unconscious changes in cultural patterns. It is caused by the contact of two different and previously separate socio-cultural systems.

Acculturation includes:

Social learning, when an individual or group acquires and adopts the characteristic features of another culture through direct and prolonged interaction with another culture.

Passing on a new adapted culture from generation to generation. Adaptation of an individual of a foreign group to the behavior of another group (e.g. citizens from Vietnam adopt elements of our culture and abandon their culture).

Culture shock

It represents the feelings of disorientation and stress, experienced by people entering an unfamiliar cultural environment. It is mainly caused by unexpected, surprising findings that result from contact with an unfamiliar culture.

Culture shock has three stages:

The first stage, following the period of travel preparations, enjoyment and anticipation, is uncritical enthusiasm for a foreign culture. After arriving in your dream exotic land, everything will seem new, fantastically colorful, interesting, fragrant and wonderful compared to your home world. The natives will seem much more open, friendly and warm-hearted to you than all those cold and boring people who surround you at home.

The second stage of culture shock is sobering up, frustration and depression . While in the previous stage you saw only the positive aspects of the foreign world, now it turns in a mirror: you begin to think that you do not understand the foreign culture at all, that there is dirt on the street, the natives can seem stupid, sneaky and evil, and they are constantly trying to rob you . The food will be very hot, the buses will be overcrowded, you will realize that you are hot or cold, that you will be bitten by mosquitoes and so on. Weaker personalities withdraw into themselves, become depressed, hastily buy plane tickets and flee home, even if they originally planned a much longer stay.

But the psychological crisis will pass in a few days and only in the third phase, after the culture shock has subsided, will you see the world around you as it really is. But be prepared to go through all the stages of culture shock again after returning home. This time, however, you will be alternately fascinated and annoyed by your own culture, and you will miss the foreign country and its people.

Racism

It is an ideology that claims that the psychological qualities of individuals are linked to visible physical traits and that they can never change. Some races, according to racism, are naturally better and some are naturally worse. An inferior race must always remain inferior, it cannot "improve". Genocide is an extreme manifestation of racism (Jews and World War II, war conflict in the Balkans...).

The essence of racial theories and racist doctrines is the thesis of physical and psychological inequality, the inequality of human races. Racism singles out certain individuals and certain ethnic and linguistic groups with certain physical features or psychological characteristics. All other groups are inferior, in a subordinate position and, moreover, may be undesirable, i.e. not worthy of life. Racism is the theoretical basis for the violent control of some nations and states by other states. Racism results from hatred towards people of different races, intolerance of manifestations of different cultures and customs.

What are the products of racism:

A – Racial discrimination

It is a process of perception of differences, i.e. it is a social differentiation in which the normative principles of equality and equal treatment of all people in a group (state) are denied. In particular, this is the unauthorized discrimination of individuals or groups based on their belonging to a certain biological (racial) or social (professional, religious, political) category and putting some at a disadvantage over others.

B – Racial violence

This is violent (physical) behavior with a racial motive. The object is a member of a racially different group. It includes conduct: bodily harm, causing harm, killing, genocide…

Ethnicity, ethnicity, ethnic consciousness

The term ethnicity comes from ancient Greek, in which ethnos meant "tribe, race, nation", Latin term ethnicus = heathen, heathen. The theory of ethnic differentiation of mankind has ancient roots. In the Western European tradition, it means culturally differentiated groups of people. These terms are also often used to refer to nation, nationality, national minority, tribe, but this is not accurate.

An ethnic group is a community in which participation is given by birth into that group and members have a sense of belonging. It is a designation of a historically created social group, a social unit with common and specific ethnic features. These are usually linguistic, cultural, religious traits, skin color, national or geographical origin of ancestors, etc. In ethnic groups, constant, once for all given and proven ways of group existence are maintained. An ethnic group maintains and passes on its cultural and social heritage to future generations.

Nation

This term defines mutually historically, culturally, economically and socially differentiated phenomena. This results in disunity and a certain possibility of dispute in defining the nation.

A nation is a distinctive and conscious cultural and political community, the formation of which is most influenced by common history and common territory.

The definition of a nation requires three criteria:

Criterion of culture – written language, religion, common history

Criterion of political existence – nations have their own state or autonomous status in a multinational state

Psychological criterion – individuals share a common awareness of their belonging to a certain nation. A strong national awareness that is consistent with subsequent action is called patriotism. Its extreme form is nationalism, when it comes to a clash with other nations.

Social and religious specifics of national groups and foreigners

Afghans

The territory of Afghanistan was inhabited from the 3rd millennium BC. It represented a crossroads between India, China, Asia and Persia. The influence of these great civilizations is still felt today. From the second half of the 7th century, the population began, professing domestic cults and Buddhism accept Islam (attacks by Islamic armies). In more accessible areas, Islamization went quickly, in mountainous areas the tribes resisted until the end of the 19th century. Muslim states arose and disappeared. The borders of today's Afghanistan were formed artificially at the turn of the 19th and 20th centuries as a buffer zone between Russia (conquering Central Asian territories from the north) and Great Britain, which was completing its domination over India in the south. 1919 - declared independence, enlightened Emir Amánullah at the head of the state - development of the country, founded schools, tried to give women some basic rights, opened workshops, promulgated the first constitution. 1928 his reforms caused riots. Further, various leaders at the head of the state, 1973–78 authoritarian republican regime, overthrown by a military coup by the People's Democratic Party of Afghanistan. A year later, the pro-Soviet faction of the party came to the head of the country. To stay in power - the invasion of Soviet troops into Afghanistan. The civil war continued even after the departure of the Soviet troops in 1989. In 1994, the Taliban movement begins to grow stronger, which loses power in 2001. American-British troops came to the country with the aim of overthrowing the Taliban. He provided the background for Al Qaeda. However, the violence in Afghanistan continued even after the presidential elections, the Taliban even bombarded Kabul with rockets. There are still riots.

Population and languages

It is not a homogeneous country. Afghans do not feel a sense of belonging to a common entity. It is difficult to estimate how many nationalities and languages ​​there are in Afghanistan - dozens of major ethnicities. Pashtuns – a nation of many millions, divided internally into dozens of other groups and tribes. Pashto is one of the two official languages ​​and has many dialects. Tajiks - the language is good – the second official language. It is used by most of the population. Further expanded knowledge of Russian.

Moral code

Afghans respect Islam as well as their home traditions. It is not possible to discuss the rules resulting from them. Afghans have a strong sense of belonging to a specific group to which they belong, most often to their family. A family includes several tens to hundreds of people. The feeling of kinship is stronger in men. An Afghan trusts a relative he has met for the first time more than a person he has known for a long time. The concept of friendship (i.e. a mutual feeling of trust, and support) does not actually exist for them according to their own choice. Collective responsibility – the guilt and merit of an individual fall on the whole family and therefore the family strongly demands behavior according to the recognized model. Afghans do not recognize laws other than those of their own community (smuggling, drug trade, weapons). Positive qualities - honor, bravery, hospitality - their observance is controlled by society. The fear that an Afghan would lose face can lead to such actions that are unimaginable to us - attitudes and cruelty towards women. If the shadow of suspicion of a woman's dishonesty could fall on a man, and also on the whole family, the heathen must be redeemed with blood. The fear of being labeled a coward forces him to behave aggressively. Hospitality is greater than ours. In the cities, unlimited hospitality is not observed so much, it is common to at least offer tea or invite the newcomer to a meal together. When an Afghan finds himself outside his own community, he usually adapts well to local customs. Once together, there is a danger that they will control each other and force themselves into collective hypocrisy.

Women

In traditional society, women are not supposed to go out alone and socialize with men except when accompanied by a husband or other relative. Outside the home, they wear a typical loose garment called a chador covering more thoroughly than is customary in most other Islamic countries.

Islam stipulates that the right hand , is intended for doing clean things, and the left hand for impure things . Afghans may find it offensive or impolite to be handed something with the left hand. When greeting, Afghans shake hands more often than we do. However, it is not customary for a foreign man to greet a woman in this way. Women sometimes reach for a compromise and wrap the given hand in a scarf or cover it with a sleeve. Friends of the same sex kiss each other on the cheeks when greeting each other.

Albanians

Albanians who live or have lived in the Czech Republic are from Kosovo. It is a territory originally inhabited by Illyrian tribes, later it was Romanized, at the beginning of the Middle Ages it was ravaged by the raids of the Huns, then by the raids of the Germanic tribes and finally by the Slavs. Long periods are represented by the dominance of the Byzantine and Bulgarian empires, in the middle of the 12th century. the Serbian state (north of Kosovo) began to fight for Kosovo. 15th century - under the rule of the Ottoman Empire. 1737 – Habsburg rule.

Values

They are influenced by customary law, which rests on solidarity, word of honor, family equality, neighborly help, national pride. It is possible to completely rely on a besa - i.e. a word of honor, a promise, a commitment, even more than a written contract. Albanians value friendship. If we show friendship to someone, they see it as an obligation and will want to reciprocate the help.

Family members have an obligation to contribute to the sustenance of the family according to their abilities. They have the right to be cared for by their family. The effort to take care of the family leads young people to look for work abroad, which is especially noticeable in recent years.

A lot of neighborly help is typical - tools, repairs, loans, field work...

Nation and nationality have enormous value. Albanians can be considered great patriots and even nationalists. In recent years, the nation has even prevailed over the family. Due to this, the blood feud that was common in the past could be abolished. Another value is land. They have a close relationship with the territory they see as their own. In more remote, especially mountainous areas, weapons have value, which can be understood as a manifestation of a man's maturity. Social prestige is important for Albanians. On the one hand, families cooperate and help each other, on the other hand, they compete with each other for status in society. The dream of Albanian youth is to own a Mercedes. Albanian values ​​do not include patience and a quiet demeanor. Arguments between Albanians can be fierce and involve physical violence. If they agree, suddenly the conflict disappears and it is as if it did not exist.

Habits and ways of life

It is also based on traditional customary law. Albanians are a community close together and at the same time closed to foreign elements. The percentage of ethnically mixed marriages was the lowest of all the nations of the former Yugoslavia. Also, communist ideology took hold here least of all the nations of the former Yugoslavia.

The axis of society is the family, the axis of the family is the house. Especially in the countryside, but also in big cities, three generations live together in one house or homestead. In places, a traditional extended family is maintained. Households of brothers and their parents live together, share all income and raise children together. The space of the house is divided for different generations to use. They eat together, often washing their hands before eating in a joint ceremony. Old men tend to have their own room, younger men are together in another, women and children are in the women's part of the house (kitchens). When a visitor comes, they all gather together. Not coming would be considered impolite. The guest has a place of honor opposite the door, men sit around him along the walls, women are closer to the door. Everyone has to see each other. Houses usually have a two-meter-high wall with a gate that covers the house, at least from the front. Privacy is highly valued. A wall separates the sacred space of the home from the world outside. Inside, scrupulous order is kept, but small rubbish is thrown out. Closedness tends to be balanced by hospitality. If someone is invited over the threshold, they can sleep in the house, not just be entertained. He is taking off his shoes in front of the entrance to the house. For the duration of the visit, the guest is equal to the elder of the family. The traditional model of hospitality according to common law orders the host to see off the guest some distance, even several kilometers.

Links

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• Nursing care for Roma patients
• Multicultural nursing - Jewish minority

References

• IVANOVÁ, Kateřina, Lenka ŠPIRUDOVÁ and Jana KUTNOHORSKÁ. Multicultural Nursing I.  1st ed. 2005. 248 pp.  ISBN 80-247-1212-1

1. IVANOVÁ, K., ŠPIRUDOVÁ, L., KUTNOHORSKÁ, J. Multicultural Nursing I . Prague: Grada, 2005. ISBN 80-247-1212-1