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The United States today is one of the most culturally diverse nation on the earth. Although the dominant culture of the United States is Anglo American, this country is home to many other ethnic and cultural groups. The major ethnic minority groups that are usually distinguished in the United States are African Americans, Hispanics, Asian Americans, and Native Americans. When discussing ethnic and other minority groups, it is important to remember that tremendous diversity exists among the people who are commonly grouped together. The United States is rapidly becoming a multicultural, pluralistic society and sensitivity to cross-cultural populations is imperative. In 1990. 75% of the population in the United States were White of European descent (Anglo American), 12.3% were African-American. 9.0% were Hispanic American, 2.8% were Asian American and 0.7% were Native American.
It is projected that by the year 2021, the number of Asian Americans and Hispanic Americans will triple, while the number of African-Americans will double. Soon after 2050. it is expected that non-Hispanic whites will probably be the minority. About 2030, there will be a '"minority majority" in the under 18 population group. As of 1997. this group already constitutes the majority population in Hawaii and New Mexico and will soon be the majority in California and Texas. According to the Bureau of Census, from 1980 to 1990 the U.S. Hispanic population rose by 53%. the Native American population by 38%, and the Asian population by 108%. A record 19.8 million American (8% of the U.S. population) were born in other countries. Some 32 million people speak languages other than English at home. It is predicted that by the year 2000, racial and ethnic minorities will become a numerical majority, while white Americans will constitute approximately 48% of the population. It is projected that by the year 2021. The number of Asian Americans and Hispanic Americans will triple while the number of African-Americans will double.
Here is how the United States racial and ethnic mix will look in the coming years:
| White | Black | Hispanic | Asian | Native American Eskimo | |
|---|---|---|---|---|---|
| (Non Hispanic) | (Any Race) | ||||
| 1997 | 72.9% | 12.1% | 10.7% | 3.5% | 0.7% |
| 2005 | 69.9% | 12.4% | 12.6% | 4.4% | 0.8% |
| 2010 | 68.0% | 12.6% | 13.8% | 4.8% | 0.8% |
| 2015 | 66.1% | 12.7% | 15.1% | 5.3% | 0.8% |
| 2020 | 64.3% | 12.9% | 16.3% | 5.7% | 0.8% |
| 2030 | 60.5% | 13.1% | 18.9% | 6.6% | 0.8% |
| (Kiplinger Washington Letter. 1997) | |||||
The total population of the United States is now close to 269 million and by the year 2020, it is expected that the total population will be 323 million, which means that over 50 million people will be added in the next few decades. About 60% will be he result of more births than deaths and 40% from immigration, which will average 1.1 million a year, 820,000 legal and 280,000 illegal. Foreign-bones and their children will account for over half the growth.
There are three trends related to the population projections:
There are also vast differences in poverty rates. Median household income, and education (percentage of persons aged 25 who completed high school) across populations. For instance, the nurse working with an African American, Hispanic, or Native American client is more likely to see the results of poverty on healthcare i.e. health problems that tend to be more severe before seeking medical attention due to lack of trust in the system and lack of medical insurance, than if he or she was working with an Asian or White client. Statistics from 1992 indicate that the percentage of persons living below the poverty line is higher for African Americans (31.9%). Native Americans (30.9%), and Hispanics (28.1%). than for Asians (14.1%) or Whites (10.7%).
Considering the fact that the education level of the culturally diverse client may be far less than the nurse, it is imperative that he or she refrains from using professional terms to explain nursing procedures. It is also important not to assume that because a person is a member of a minority group that they are uneducated. The nurse can observe the client's reactions when addressing his or her health concerns to determine the comfort level with what is being said. Communicating across cultures will be addressed throughout this text and is the key to effective nursing strategies. Statistics from 1992 indicate that 80% of white persons aged 25 have completed high school, while Asians follow closely at 78%. African-Americans follow in third spot with 67% while Hispanics (52%) and Native Americans (47%) are least likely to have a high school degree at age twenty-five. (Bureau of Census, 1992)
In light of this statistical data, it is imperative that the nursing profession rapidly adapt itself to a changing heterogeneous society. Formal educational training programs for nurses need to integrate culturally competent care techniques in the curriculum, be willing to recruit minority' nursing students, and make the necessary adjustments to retain these students in their programs. Nursing professionals and nursing students need to be aware of the implications of working with clients across cultures. As our world continues to change and nurses are expected to work with clients who have diverse cultural values, beliefs, and lifeways, there is a need for transcultural nursing education to become competent, sensitive, and responsible to care for people of diverse cultures. The issue of transcultural nursing education will be addressed in the final chapter of this curriculum.
In 1950, before the onset of statistical evidence that indicates vast differences in population rates across cultures, Madeleine Leininger conceptualized transcultural nursing as an entirely new and distinct area of study and practice. Her anthropological insights made her realize that the world was becoming one in which all humans would soon be known to one another by the end of this century. Leininger defined transcultural nursing as a field of nursing that is focused on the comparative study and analysis of different cultures and subcultures in the world with respect to their caring behavior, nursing care, and health-illness values, beliefs, and patterns of behavior. According to Leininger, the goal is to develop a scientific and humanistic body of knowledge in order to provide culture-specific nursing care practices.
Several worldwide factors gave rise to Leininger establishing the transcultural nursing theory as a special!} and general area for research, education, and practice.
The first and major factor is the current and projected marked increase in the migration of people within and between countries worldwide.
With this migration came a second factor in which there is a rise in multicultural identities, with persons expecting that their cultural beliefs, values, and lifeways will be respected and understood. Respecting the rights of all humans as cultural beings led to the increased demand for caregivers to learn and practice transcultural health care in which clients are provided culturally sensitive and competent care.
The third factor and rationale for transcultural nursing has been the marked increase in high technology with its impact on healthcare. Some culturally diverse clients have never been in a hospital and others have never been exposed to high technology tests and treatments and may view them as evil forces or spirits that can cause more harm than help. As a result of this fear, some clients have refused treatments, been non-compliant, or left the hospital. The day has come for health professionals to be knowledgeable and sensitive to differences among cultures in order to gain client and family cooperation and to prevent negative client outcomes.
The fourth area to consider are cultural factors related to family, urban, and rural violence that may not be fully understood among health professionals that are called upon to serve those in distress. Nurses need in-depth study of specific cultures to develop prevention modes, understand cultural violence and protect themselves.
A fifth factor influencing transcultural nursing has been a marked increase in the number of nurses traveling and working in different places both in the United States and abroad. Without even basic holding or reflective knowledge of a culture, serious problems can occur with clients and the recently hired nurse. With the use of transcultural nursing concepts, principles, and skills, the nurse in a foreign culture will have more confidence and ways to deal with cultural differences.
A sixth factor that is often difficult for some nurses to realize who have never studied cultures or transcultural nursing, is the growing number of legal suits against health professional because of cultural negligence, ignorance, and imposition practices in health care practices. It is predicted that cultural defense cases involving health care providers will increase and nurses will be called to testify regarding their observations, experiences, and practices regarding cultural negligence and other violations.
A seventh factor to be considered is the rise in feminism with women taking active leadership roles and monitoring their health care rights and needs and those of their children. Nurses are in a unique position to observe these changes and desires and to support women and children in their health care needs. Transcultural nursing and anthropological knowledge is also greatly needed to understand and help women and children deal with cultural stresses, violence and gender role problems.
The eighth factor giving rise to the importance of transcultural nursing is the growing trend in health care that will be community-based and driven both by diverse and similar cultures. Culturally diverse clients will seek new alternative types of health care services that are in accord with their cultural needs and values. This trend is occurring now with home health care in which nurses are expected to care for patients across cultures. As cultural consumers take charge of their values and lifeways within their home settings, they will expect nurses to anticipate and understand their home care needs, language, and cultural beliefs and practices. Transcultural nursing knowledge will be in great demand as home health care personnel recognize that in order to provide services for persons from the specific cultures, they need to anticipate and understand their home health care needs, language, cultural beliefs and practices.
In order to become culturally competent in this vastly changing society, it is important that the healthcare professional in any setting have knowledge of the culturally diverse group they are working with in the following areas:
Understanding persons across cultures with their wide-ranging cultural variations is challenging. Knowledge is the first step towards understanding and appreciating a culture different than one's own. Below are some guidelines for learning to appreciate these differences.
This manuscript is dedicated to the acquisition of skills necessary to communicate across cultures, to begin the process of gaining knowledge needed to work effectively with culturally diverse clients, and to not only accept differences, but appreciate them as well. In the following chapters, these issues will be addressed so that nurses can begin the process of integrating transcultural concepts in their nursing philosophy and practice.