BakgrundPå grund av olika omständigheter tvingas allt fler människor fly från sina ursprungsländer, vilket leder till att allt fler länder blir mångkulturella. Ett mångkulturellt samhälle återspeglas i sin tur inom hälso- och sjukvården. Sjuksköterskor ställs inför stora utmaningar i vården av patienter som har andra kulturella bakgrunder. Därför är det viktigt att sjuksköterskor är kulturellt kompetenta samt kan kommunicera med patientersom inte har samma språk och kultur. SyfteSyftet var att beskriva sjuksköterskans upplevelser av transkulturell omvårdnad bland vuxna patienter. MetodEn litteraturöversikt som är baserad på 15 vetenskapliga artiklar genomfördes. Insamlingen av data gjordens genom att använda databaser PubMed och CINAHL ResultatResultatet av studien påvisade att sjuksköterskor står inför flera utmaningar inom området transkulturell omvårdnad vilken inkluderar bristande kulturkompetens, kommunikationsbarriärer, fördomar och individuella värderingar. Det blev tydligt att tillräcklig kulturell kompetens, effektiv kommunikation, respekt och ett välkomnande bemötande utgör betydande och avgörande faktorer för att kunna tillhandahålla meningsfull och värdig omvårdnad till patienter med en annan kulturell bakgrund. SlutsatsSjuksköterskor står inför utmaningar i vården av patienter med olika kulturella bakgrunder, vilket kan leda till osäkerhet och missförstånd. För att säkerställa kvalitativ vård behöver sjuksköterskor öka sin kunskap om transkulturell omvårdnad och utveckla effektiva kommunikationsstrategier. / Background Due to various circumstances, more and more people are forced to flee their countries of origin, which leads to more and more countries becoming multicultural. A multicultural society is in turn reflected in health care. Nurses are faced with great challenges in the care of patients who have other cultural backgrounds. Therefore, it is important that nurses are culturally competent and able to communicate with patients who do not share the same language and culture. AimThe purpose was to describe the nurse's experiences of transcultural nursing among adult patients. MethodA literature review based on 15 scientific articles was conducted. The collection of data was done by using databases PubMed and CINAHL ResultsThe results of the study showed that nurses face several challenges in the field of transcultural nursing which include lack of cultural competence, communication barriers, prejudices, and individual values. It became clear that sufficient cultural competence, effective communication, respect, and a welcoming attitude are significant and decisive factors in being able to provide meaningful and dignified care to patients with a different cultural background. ConclusionsNurses face challenges in caring for patients from different cultural backgrounds, which can lead to uncertainty and misunderstanding. To ensure quality care, nurses need to increase their knowledge of transcultural nursing and develop effective communication strategies.

Bakgrund: Vård i livets slut innebär en ofta svår och komplex vårdsituation med många faktorer som skall tas hänsyn till för att främja livskvalitet och en värdig död. I en globaliserad värld med ökad migration och mångkulturalism sker transkulturella möten i vården allt oftare. Detta betyder att vårdpersonal kommer möta människor från andra kulturella bakgrunder med skilda tankar om vad hälsa och sjukdom innebär. Detta ställer särskilda krav på sjuksköterskors kulturkompetens, då det ingår i det professionella ansvaret att tillgodose vård i livets slut som är personcentrerad. Syfte: Syftet var att beskriva vårdpersonals erfarenheter av transkulturella möten vid vård i livets slut. Metod: Tio kvalitativa vetenskapliga artiklar inom ämnet samlades in från databaserna CINAHL Complete och PubMed, för att sedan sammanställas i en litteraturöversikt. Resultat: Fyra huvudteman och fyra subteman identifierades totalt. “Kulturell kunskap och kompetens hos vårdpersonal” innehöll två subteman: “Osäkerhet och bristande kunskap” och “Strategier och förhållningssätt”. “Kulturens betydelse vid vård i livets slut” samt “Vårdpersonals kommunikation med patienter och deras anhöriga” var enskilda huvudteman. Slutligen var det fjärde huvudtemat “Familjen- och anhörigas centrala roll”, som innehöll två subteman: “Samverkan med familj och anhöriga” och “Stöd från familj och anhöriga”. Sammanfattning: Transkulturella möten vid vård i livets slut kan innebära en utmanande vårdsituation för vårdpersonal. Hänsyn till kulturella faktorer är emellertid viktig för att bevara värdigheten för patienter som befinner sig i livets slut. Litteraturöversikten belyser ett behov av utbildning för att stärka vårdpersonals kulturkompetens samt ett behov av förbättrade verktyg som kan stödja kommunikation vid förekomst av språkbarriärer. / Background: Care at the end of life can often mean a difficult and complex care situation with many factors that must be considered to promote quality of life and a dignified death. In a globalized world with increased migration and multiculturalism, transcultural encounters in a care context will occur more often. This means that health personnel will meet people from other cultural backgrounds with different ideas about what health and illness are. This places special demands on nurses' cultural competence, as it is part of the professional responsibility to provide end-of-life care that is person-centred and culturally adapted. Aim: The aim was to describe health personnel’s experiences of transcultural encounters during care at the end of life. Method: Ten qualitative scientific articles in the subject were collected from the databases CINAHL Complete and PubMed, and then compiled in a literature review. Results: Four main themes and four sub-themes were identified. "Cultural knowledge and competence of health personnel" contained two sub-themes: "Uncertainty and lack of knowledge" and "Strategies and approaches". "The importance of culture in care at the end of life" and "Health personnel’s communication with patients and their relatives" were individual main themes. Finally, the fourth main theme was "The central role of family and relatives", which contained two sub-themes: "Cooperation with family and relatives" and "Support from family and relatives". Summary: Transcultural encounters in care at the end of life can be challenging for health personnel. Cultural consideration is however important to preserve dignity of patients at the end of life. This literature review highlights a need for education to strengthen health personnel's cultural competence as well as a need for improved tools for communication in the presence of language barriers.

This qualitative study sought to explore the Hong Kong Chinese patient's perceptions of an Intensive Care experience and their views on the introduction of feng shui principles focussing on sleep orientations, dietary management and exercise regimes. The study explored the background of feng shui as an authentic traditional Chinese belief. It also explores if incorporating these feng shui principles into the health care setting would provide a positive effect for open-heart patients in an Intensive Care Unit at the Hong Kong Adventist Hospital in Hong Kong. The major inference drawn from this study is that Chinese patients seek culturally related experiences from the health care setting. The Chinese informants showed strong belief patterns in traditional practices of feng shui, however, practiced these within the confines of their homes as these experiences were denied to them in the hospital setting. / Health Studies / M.A. (Nursing Science)

This qualitative study sought to explore the Hong Kong Chinese patient's perceptions of an Intensive Care experience and their views on the introduction of feng shui principles focussing on sleep orientations, dietary management and exercise regimes. The study explored the background of feng shui as an authentic traditional Chinese belief. It also explores if incorporating these feng shui principles into the health care setting would provide a positive effect for open-heart patients in an Intensive Care Unit at the Hong Kong Adventist Hospital in Hong Kong. The major inference drawn from this study is that Chinese patients seek culturally related experiences from the health care setting. The Chinese informants showed strong belief patterns in traditional practices of feng shui, however, practiced these within the confines of their homes as these experiences were denied to them in the hospital setting. / Health Studies / M.A. (Nursing Science)

Child vulnerability is a complex human phenomenon that varies contextually. This thesis explores the views of Iraqw and Datoga residents of Haydom village relating to child vulnerability using a concept analysis. The study is a mixed methods study carried out in three stages. The first stage is a non-empirical qualitative literature review; findings from this stage were used to construct questions for the subsequent stage of the study. The second stage of the study is empirical and qualitative, using a focused ethnographic approach. Semi-structured interviews were conducted with thirty-two adults of the Iraqw and Datoga ethnic groups. Five main themes emerged from a thematic analysis of these interviews; 1) antecedents: lack of resources, 2) contributing antecedents: intentional mistreatment, 3) defining attributes: deprivations in a young individual, 4) consequences: losses suffered, and 5) strategies: dealing with deprivation. Informants’ views were used to construct items for a questionnaire, which was administered in the third stage of the study. This quantitative stage involved eighty young adult respondents of the Iraqw and Datoga ethnic groups. The data in the third stage of the study was analysed statistically, and generally supported the findings of the second stage of the study. Significant Haydom findings congruent with the literature include that poverty and parental alcoholism are antecedents for child vulnerability, that fathers may be unreliable and that some children cope by persevering and working hard. Findings in Haydom that differ from the literature include the following: some people perceive large family size as a protective factor handicapped, illegitimate and foster children may be mistreated former wealth may predispose to lacking coping skills children as a resource child vulnerability has potential for deterioration, stasis or improvement informants suggested a limited range of strategies, including institutional care, with little stress on volunteerism unrelated fostering is unusual but acceptable to many people. This study recommends local identification of and advocacy for vulnerable children’s rights, and planning of evidence based but culturally acceptable strategies to help them. / Health Studies / (D.Litt. et Phil. (Health Studies))

Bakgrund: I ett alltmer mångkulturellt samhälle blir det märkbart hur förutsättningarna för en god hälsa skiljer sig mellan olika samhällsgrupper. Hälso- och sjukvården har som uppgift att främja hälsan hos alla patienter oavsett bakgrund. Detta ställer nya krav på den svenska sjukvården, då en mångkulturell utveckling leder till fler transkulturella möten i vården. Dessa möten innehåller ofta hinder som kan vara svåra att överbrygga, vilket kräver en kunskap om vilka faktorer som påverkar mötet och en medvetenhet om kulturens betydelse hos sjuksköterskan.   Syfte: Syftet med studien var att utifrån ett sjuksköterskeperspektiv belysa de faktorer som påverkar vårdrelationen i transkulturella möten.   Metod: En litteraturstudie baserad på 13 vetenskapliga artiklar var av nio kvalitativa och fyra kvantitativa. Resultatet analyserades och sammanställdes genom ett kvalitativt analysinnehåll.  Som teoretiska utgångspunkter användes en definition av kulturell kompetens och vårdrelation.   Resultat: Resultatet visar att kommunikation och språkbarriärer utgör det största hindret i den transkulturella omvårdnaden. Användning av tolk som hjälpmedel visade sig ha både för- och nackdelar. Organisatoriska hinder försvårade förutsättningen för en fungerande vårdrelation och kulturella skillnader visade sig kunna leda till konflikter i vårdmötet. Sjuksköterskan använde sig av olika strategier som hjälpmedel vilket illustrerade en viss kulturell medvetenhet, medan bristen på förståelse ledde till generaliseringar som resulterade i en diskriminering av patienter. Många sjuksköterskor saknar utbildning i transkulturell omvårdnad, vilket efterfrågades av merparten. De sjuksköterskor som genomgått en utbildning i kulturell kompetens uppgav positiva effekter som lett till en ökad medvetenhet.   Diskussion: Sjuksköterskan behöver bli medveten om de negativa konsekvenser som en bristande kommunikation och kulturella konflikter har för etablerandet av en vårdrelation till patienten. Enligt de dokument som styr professionen har sjuksköterskan en skyldighet att skapa de bästa förutsättningarna för en god omsorg om patienten. Okunskap och oförståelse leder till en diskriminering av patienten som inte hör hemma i vården. Utbildning i kulturell kompetens har bevisligen positiva effekter för att motverka generaliseringar och öka medvetenheten hos sjuksköterskan. För att främja en kulturell medvetenhet bör mer fokus läggas på dessa frågor i sjuksköterskans grund – och fortutbildning.

Introduction The clinical community in Western society has long practised medicine as organized by "two dominant principles: 1) the principle of essentialism which states that there is a fixed "natural" border between disease and health, and 2) the principle of specific treatment which states that having revealed a disease, the doctor can, at least in principle, find the one, correct treatment. These principles have served as the legitimization of the traditional, hierarchical organization of health-care" (Jensen, 1987:19). A main feature of medical practices based on these principles has been to address specific kinds of problems impeding or decaying health. This research is centrally concerned with essentialism and the institutional fixation of problems as two important nodal points of Canada's biomedical value and belief system. More specifically, I hope to show in an organized way how these principles shape staff knowledge of client and culture in a community health centre (CHC) in Lethbridge, Alberta. My analysis is based on four guiding points: 1) that in our polyethnic society health care institutions are massively challenged with actual and perceived cultural diversity and cross cultural barriers to which their staff feel increasingly obliged to respond with their services; 2) while the client cultural diversity is "real", institutional responses depend primarily on how that diversity is imagined by staff -often as a threat to a health institution's sociocultural world; 3) that problem-specific, medicalized thinking is central in this community health centre, even though its mandate is health promotion and this problem orientation often combines with medical essentialism to reduce "culturally different" to a set of client labels, some of which are problematic; and 4) while a "lifestyle model" and other models for health promotion are at present widely advocated and are to be found centrally in this institution's (CHC) charter, they have led to little institutional accomodation to cultural diversity. In this thesis my aim is to present an ethnographic portrait of a community health centre, where emphasis is given to the distinctive formal and informal "formative processess" (Good 1994) of social construction of certain perceived common core challenges facing the Canadian biomedical community today - challenges concerning cultural difference and its incorporation into health care perception and practice. I am particularly interested in institutions subscribing to a "health promotion model" of health care, a term I have borrowed from Ewles and Simnett (1992). Ewles and Simnett descrive the meaning of "health promotion" as earlier defined by WHO (World Health Organization): this perspective is derived from a conception of "health" as the extent to which an individual or group is able, on the on hand, to realise aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is, therefore seen as a resource for everyday life, not the objective of living; it is a positive concept emphasising social and personal resources, as well as physical capacities (Ewles & Simnett, 1992:20) Health is therefore concerned with "a state of complete physical, mental and social wellbeing, and not merely the absence of disease and infirmity" (Ewles and Simnett, 1992:6), I am interested in determing how threats to this defintion prevail in a community health centre's ideology of preventive care, and how that ideology encodes dimensions of diversity. I, however, want to go much further than this by exploring everyday staff discourse and practice, to understand how client cultural diversity is formed and informed by what staff do and say. How, in short, do individuals based in a health promotion organization socially construct their clients as objects of institutional concern? We need, as Young (1982) suggest, "to examine the social condition of knowledge production" in an institutionalized health care service provision subculture. There are, I believe, also practical reasons for conducting this research. Over the past ten years the Canadian health care system increasingly has had to focus on two potentially contradictory goals: reducing costs, and lessening persistent inequalities in health status among key groups and categories of persons in the Canadian population. Many now argue that one of the most central dimensions of the latter - of perisistent health inequalities in Canada - is ethnocultural. Few would seriously argue, for example, that Canadian First Nation health statistics are anything but appalling. Moreover, radical changes in immigration patterns over the past three decades have greatly increased urban Canadian cultural diversity. Caring "at home" now assumes international dimensions (McAdoo, 1993; Butrin, 1992; Buchignani, 1991; Indra, 1991, 1987; Galanti, 1991; Dobson, 1991; Waxler-Morrison, 1990; Quereshi, 1989). A growing voiced desire to provide more pluralistic health care and health care promotion has become persistently heard throughout the clinical community in Canada (Krepps and Kunimoto, 1994; Masi, 1993). Even so, for many health professionals cultural difference evidently remians either irrelevant or a threat to the established order of things. Applied research on health care institutions undertaken to investigate how better to meet these challenges nevrtheless remains very incomplete and highly concentrated in two broad areas. One of these is structural factors within the institution that limit cross-cultural access (Herzfeld, 1992; Hanson, 1980). Some of these studies have shown the prevalence of a strictly conservative institutional culture that frequently makes frontline agency workers gate-keeprs, who actively (if unconsciously) maintain client-institution stratification (Ervin, 1993; Demain, 1989; Ng, 1987; Murphy, 1987; Foster-Carter, 1987; de Voe 1981). In addition, extensive research has been conducted on disempowered minority groups. This research has examined the frequency, effectiveness and manner with which ethnic and Native groups make use of medical services. Some institutional research on cross-cultral issues shows that under appropriate conditions health professional like nurses have responded effectively to client needs by establishing culturally sensitive hiring and training policies and by restructuring their health care organizations (Terman, 1993; Henderson, 1992; Davis, 1992; Henkle, 1990; Burner, 1990). Though promising, this research remains radically insufficient for learning purposes. In particular, little work has been done on how such institutions come to "think" (Douglas, 1986) about cultural difference, form mandates in response to pressure to better address culturally different populations and work them into the institution's extant sub-cultral ideas and practice (Habarad, 1987; Leininger, 1978), or on how helping instiutions categorize key populations such as "Indians" or "Vietnamese" as being culturally different, or assign to each a suite of institutionally meaningful cultural attributes (as what becomes the institution's working sense of what is, say, "Vietnamese culture"). This is so despite the existence of a long and fruitful ethnographic institutional research tradition, grounded initially in theories of status and role (Frankel, 1988; Taylor, 1970; Parson, 1951), symbolic ineractionism (Goffman, 1967, 1963, 1961), ethnomethodology (Garfinkle, 1975), and organizational subcultures (Douglas, 1992, 1986, 1982; Abegglen & Stalk, 1985; Ohnuki-Tierney, 1984; Teski, 1981; Blumers, 1969). More recent work on anthropological social exchange theory (Barth, 1981), on institutional and societal discipline (Herzfeld, 1992; Foucault, 1984, 1977), on the institution-client interface (Shield, 1988; Schwartzman, 1987, Ashworth, 1977, 1976, 1975), and on framing the client (Hazan, 1994; Denzin, 1992; Howard, 1991; Goffman, 1974). I also hope that this study makes a contribution to the study of health care and diversity in southern Alberta. Small city ethnic relations in Canada have been almost systematically ignored by researchers, and similar research has not been conducted in this part of Alberta. Local diversity is significant: three very large Indian reserves are nearby, and the city itself has a diverse ethnic, linguistic and ethno-religious population. Also, significant province wide restructuring of health care delivery was and is ongoing, offering both the pitfalls and potentials of quick institutional change. Perhaps some of the findings can contribute to making the future system more responsive to diversity than the present one. / 202 p. ; 29 cm.

Child vulnerability is a complex human phenomenon that varies contextually. This thesis explores the views of Iraqw and Datoga residents of Haydom village relating to child vulnerability using a concept analysis. The study is a mixed methods study carried out in three stages. The first stage is a non-empirical qualitative literature review; findings from this stage were used to construct questions for the subsequent stage of the study. The second stage of the study is empirical and qualitative, using a focused ethnographic approach. Semi-structured interviews were conducted with thirty-two adults of the Iraqw and Datoga ethnic groups. Five main themes emerged from a thematic analysis of these interviews; 1) antecedents: lack of resources, 2) contributing antecedents: intentional mistreatment, 3) defining attributes: deprivations in a young individual, 4) consequences: losses suffered, and 5) strategies: dealing with deprivation. Informants’ views were used to construct items for a questionnaire, which was administered in the third stage of the study. This quantitative stage involved eighty young adult respondents of the Iraqw and Datoga ethnic groups. The data in the third stage of the study was analysed statistically, and generally supported the findings of the second stage of the study. Significant Haydom findings congruent with the literature include that poverty and parental alcoholism are antecedents for child vulnerability, that fathers may be unreliable and that some children cope by persevering and working hard. Findings in Haydom that differ from the literature include the following: some people perceive large family size as a protective factor handicapped, illegitimate and foster children may be mistreated former wealth may predispose to lacking coping skills children as a resource child vulnerability has potential for deterioration, stasis or improvement informants suggested a limited range of strategies, including institutional care, with little stress on volunteerism unrelated fostering is unusual but acceptable to many people. This study recommends local identification of and advocacy for vulnerable children’s rights, and planning of evidence based but culturally acceptable strategies to help them. / Health Studies / (D.Litt. et Phil. (Health Studies))

The subject of this dissertation is culturally diversified nursing care provided to adherents of the selected religious minorities. The theoretical part of the dissertation is concerned with transcultural nursing care and also with the characteristics of the selected religions. The practical part of this dissertation includes processing and evaluation of the data acquired during the conducted research. There were three objectives set at the beginning. The first objective was to explore the particularities of nursing care provided to adherents of the selected religious minorities. In order to achieve the set objective, a method of half-structured interview with representatives of different minorities (Centre of Muslim Communities, Diamond Way Buddhism and Czech Orthodox Church) living in the Czech Republic was utilized. Seven representatives of each minority took part in the interview. The results of the research related to the first objective showed that there is a range of defects when it comes to providing nursing care to adherents of different religion. Hospitalization in particular was one of the main subjects of the whole interview. Most of the respondents had negative experience when it comes to staying in hospital environment. All the negative experience resulted from and was connected to their religion. The interview also disclosed new information needed for providing considerate nursing care. The new information were disclosed as a result of the interview conducted with each minority and relate to catering, hygiene, dying or refusing medical treatment. The second objective was to monitor nurses? experience with multi-cultural nursing care and the last objective was to determine the nurses? awareness of nursing care fields, in which the adherents of the selected religious minorities in the Czech Republic are particular. In order to achieve the objective related to the quantitative part of the research, a method of survey (questionnaire) was utilized. The questionnaire was given to the nurses from all the hospitals in South-Bohemian Region. The results in this part showed experience of nurses with multi-cultural nursing and their knowledge of nursing care fields, in which the adherents of the selected religious minorities are particular. Although the most of the nurses have come across multi-cultural nursing, they still do not know the particularities of the selected religions completely. The analysis of the results shows that providers of nursing care are getting more and more aware of multi-cultural nursing, which will certainly have a positive impact, in the future, on satisfying the needs connected to religion of individual patients. Based on the results of the research, an informational material intended for nurses was prepared, which contains brief descriptions of the selected religious minorities living in the Czech Republic and their particularities in the field of providing culturally considerate nursing care. Furthermore, standards for nursing care were created for each one of the selected religious minorities. Preparation of material for accreditation of educational courses for nurses also took place. The material is focused on multi-cultural nursing and the selected religious minorities. In order to further improve the care provided to the adherents of different religions, a nursing anamnesis draft was created, which also focuses on needs connected to religion.

In my thesis I deal with the issue: What is allowed and what is forbidden in nursing an Islamic believer. I have chosen this topic because it is a very interesting and topical issue. In the Czech Republic area great changes in terms of the population composition have occurred recently. The number of foreigners of various cultural backgrounds, religions and custom practice has increased and thus the need of multicultural nursing has risen. Therefore it is necessary to find out if we are ready to care for patients who are Islamic believers. The number of Islamic believers in our country is growing constantly and they are not only tourists and foreigners but also Czech converts. Due to the extensive and comprehensive character of the issue the theoretical section of the thesis was divided into three parts. The introduction is focused on basic information on multicultural nursing. The transcultural model of nursing by Gigerova and Davidhizarova was used both for a special part of the theory and in the research part for developing the processual standard. The second part in focused on general information on Islam, i.e. on the history of the origination of the religion, its history in our country and on the principles of Islam. The special and most substantial part is dedicated to nursing specifics in the care for these patients, such as food, hygiene, family life, the issue of life saving interventions and the issue of death. On the basis of the model mentioned above nursing evaluation was carried out. In the practical section four objectives were stated: to learn nurses´ knowledge of the issue, to examine the conditions in hospitals in terms of nursing care for Islam believers, to find out if the attitude of the medical staff is influenced by prejudice against Islamic believers and to establish nursing standards in the care for Islam believers. The objectives were stated under assumption that nurses in the South Moravian region are better informed than nurses in the South Bohemian region and conditions in South Moravian hospitals are better adapted to the needs of nursing care for Islamic believers. The other assumption were that nurses´ attitude to care for Islamic believers is influenced by prejudice and also that the nursing standard development is considered to be benefiting for providing these patients with a complex nursing care. The research was conducted in the South Bohemian and South Moravian regions by using questionnaires handed out to nurses. I can say that the objectives were achieved, the first three hypotheses were not confirmed and the fourth, relating to the benefit of the nursing standard, was confirmed.