I Table of Content
II List of figures
2 Cultural competence in health care
2.2 Cultural dimensions by Hofstede
2.3 Transcultural Nursing by Leininger
3 Religious Comparison
3.1 Christian patients
3.2 Islamic patients
II List of figures
F igure 1: The Five Original Dimensions of National Culture by Hofstede (adapted from Hofstede Insights, n.d., n.p.)
F igure 2: Leininger´s Sunrise Enabler to Discover Culture Care (McFarland & Wehbe- Alamah, 2018, p. 19)
Globalisation and strong migratory movements mean that today every person is confronted with different cultures. In medicine, these changes are also noticeable. The medical care of patients takes place across cultural borders, which requires a corresponding perception of cultural differences on the part of the nursing staff. But also, the ability to incorporate the associated cultural changes into their professional competencies. Not only migrants from a group of foreign patients, but also business travellers or tourists, health tourists or migrants living in the country. The biggest problem, the care of culturally different patients is not the language barrier. This can, for example, be solved by an interpreter. It is much more difficult to understand each other if there are different cultural concepts, attitudes or views of life which prove to be important factors for successful care. Great challenges are, among other things, different views on family structures, understanding of roles, the status of women or religiously determined food prohibitions or touch taboos. Transcultural nursing is a central topic dealing with such challenges in care. Overall, the ability to recognise, understand and respond to the needs of different cultural groups and individuals is a major challenge. The aim of transcultural nursing is thus to be able to integrate the skills for such care into everyday working life in a suitable way (Lenthe, 2016).
In the following the term culture is defined and the model of the cultural dimensions of Hofstede is presented. A definition of the concept of Transcultural Nursing follows and a model of the founder M. Leininger’s is presented. Subsequently, the differences in the care of Christian and Islamic patients are exemplarily described.
2 Cultural competence in health care
The term "culture" comes from the Latin word "cultura", which means cultivation, care, arable farming (Hofstede, Hofstede, & Minkov, 2010). Today, culture is understood as a pattern of values and conviction that is reflected in our behaviour (Dochterman & Grace, 2001). It is used particularly in the humanities, natural sciences and social sciences, but there is usually no uniform definition of the term in everyday use (Lenthe, 2016). Anthropologists Kroeber and Kluckhohn compiled a list of more than 160 different definitions of the term culture in 1952 (Thomas, 2008). Kluckhohn presented after that a definition that integrates many of these perspectives.
“Culture consists of patterned ways of thinking, feeling and reacting, acquired and transmitted mainly by symbols, constituting the distinctive achievement of human groups, including their embodiment in artefacts; the essential core of culture consists of traditional (i.e., historically derived and selected) ideas and especially their attached values.” (Thomas, 2008, p. 27).
In Western languages, culture mainly describes education, art, literature and religion. Hofstede describes culture as a part of mental software. The mental software describes patterns of thinking, feeling and action. Culture forms the level after human nature. Human nature is what every human being has in common and forms the universal level. We have inherited feelings such as fear, joy, sadness and shame. How an individual deals with these feelings, however, is again influenced by culture. Because culture is nothing innate, we learn it through our social environment (Hofstede, Hofstede, & Minkov, 2010).
2.2 Cultural dimensions by Hofstede
In order to distinguish the different cultures, Hofstede surveyed over 110,000 employees from IBM branches in 74 different countries between 1967 and 1993. He developed questionnaires with more than 100 different points and asked the employees how they behave in certain situations. On this basis, he finally put together four different dimensions. The approach made it possible to capture culturally specific imagination models and to bring them into a system in order to be able to differentiate between different cultures. The dimensions are always points of view and not characteristics of the human being (Lenthe, 2016). The four dimensions according to Hofstede are power distance index, individualism and collectivism, masculinity and femininity, and uncertainty avoidance index (Hofstede, 2001). In the later 1980s, Hofstede added long-term orientation and short-term orientation, which are regarded as the fifth dimension. The figure shows the various dimensions in a bundled form, which is finally further explained in an abridged version (Hofstede, Hofstede, & Minkov, 2010).
Abbildung in dieser Leseprobe nicht enthalten
Figure 1: The Five Original Dimensions of National Culture by Hofstede (adapted from Hofstede Insights, n.d., n.p.)
Power Distance Index measures attitudes towards respect for authorities. Hofstede defined that as „ (…) the extent to which the less powerful members of institutions and organizations within a country expect and accept that power is distributed unequally.” (Hofstede, Hofstede, & Minkov, 2010, p. 61). A high-power distance stands for very unequally distributed power and a low power distance stands for an even distribution. The studies showed that in societies with great power distances the hierarchies are respected and thus instructions from higher authorities are assumed. At the same time, prosperity and power cannot be separated. In societies with a small power distance, on the other hand, there are no hierarchies, since all meet at the same eye level. People expect to be involved in decisions. Power and prosperity do not belong directly together (Hofstede, 2001).
The dimension individualism versus collectivism describes how individuals are integrated into a society and how they belong to it. An individualistic society places the individual in the foreground. Self-realization is very much in the foreground. It is expected that everyone takes care of himself and his immediate family. Open and clear words are considered sincere in this society. In comparison to that, in collectivist cultures the identities of individuals are founded in communities. Self-respect depends here heavily on others. In these cultures, interdependence becomes very important. The well-being of the group/community is in the foreground, only then the well-being of the individuals follows. Often the choice of a spouse in these cultures is not voluntary, because it is not about the connection between two individual people, but about the connection of two families (Hofstede, Hofstede, & Minkov, 2010).
Masculinity versus femininity describes the degree to which traditional gender roles are emphasized in a society. Which behaviour patterns are assigned to the individual sexes differs from society to society. Hofstede defines a masculine society as follows:
“(…) when emotional gender roles are clearly distinct: men are supposed to be assertive, tough, and focused on material success, whereas women are supposed to be more modest, tender, and concerned with the quality of life.” (Hofstede, Hofstede, & Minkov, 2010, p. 140).
These companies attach great importance to performance. In family life, the father is responsible for the facts and the mother for feelings. Boys play with other boys to compete. The professions are also highly gender-specific, with the professions for women being considered less qualified. A feminine society exists, “when emotional gender roles overlap: both men and women are supposed to be modest, tender, and concerned with the quality of life.” (Hofstede, Hofstede, & Minkov, 2010, p. 140). Professional life and private life are separate in these societies, people only work to be able to live. Leisure time is much more important than money. Gender-specific occupations exist only to a limited extent (Hofstede, Hofstede, & Minkov, 2010).
The next dimension Uncertainty avoidance describes “(…) the extent to which the members of a culture feel threatened by ambiguous or unknown situations.” (Hofstede, Hofstede, & Minkov, 2010, p. 191)
The reason the fifth dimension was added later was that this dimension had not been found in the original research, due to the fact that the relevant question had not been asked. Hofstede labelled this new dimension long-term versus short-term orientation and was defined as follows:
“long-term orientation stands for the fostering of virtues oriented toward future rewards- in particular, perseverance and thrift. Its opposite pole, short-term orientation, stands for the fostering of virtues related to the past and present-in particular, respect for tradition, preservation of “face,” and fulfilling social obligations.” (Hofstede, Hofstede, & Minkov, 2010, p. 239).