Transcultural nursing attempts to discover the meaning, significance, and role of culture in the health of individuals and families, and to reflect these in nursing practice (Leininger, 1978). Early advocates of transcultural nursing included in their writings an overview of ethnic/racial minorities with brief descriptions of their cultures, and made recommendations as to how to develop nursing school curricula which would encourage sensitivity to minority group needs (Leininger, 1978; Spector, 1979). Though African Americans are the largest racial minority in the United States and African-American culture has been well-documented in the literature of the social sciences (Gutman, 1976; Herskovits, 1970; Nobles, 1974; Tuck, 1980), this culture has not been integrated well into transcultural nursing. Descriptions of African- American culture in nursing literature have been largely limited to the health practices of the group (specifically voodoo, medicinal or herbal cures, diet and faith healing), their cultural roots in West African traditions (Osborae, 1978), and major health care problems (Dennis, 1979; Spector, 1979). Such a limited description of African-American people does not allow for full realization of the goals of transcultural nursing.
Indeed, the absence of a broad description of African-American culture has contributed to health care delivery which is not sensitive to the needs of this ethnic/ racial group. This lack of sensitivity is exacerbated by the widely held assumption that African Americans do not have a culture distinct from the dominant societal culture. A prevailing myth is that African Americans were stripped of their own culture during slavery and have been assimilated into the dominant culture (Gordon, 1964), If transcultural nursing's goal is to provide nursing care appropriate to the cultural values of ethnic/racial groups, then the uniqueness of cultural groups must be fully recognized, and learnings about these unique groups must be implemented in a deliberate, organized manner. This is especially important in the case of such a large minority as African Americans.
One common fallacy of nursing curricula is that people have common experiences. Although there are certain areas of "humanness" allowing for a generalized view of nursing intervention, cultural differences must be considered prior to intervening. And these differing needs do not come into awareness unless there is familiarity with cultural views beyond one's ethnocentrism, or unless there are members of the ethnic/racial group present to make interpretations. Interchange with colleagues from various ethnic/racial backgrounds can facilitate this process. Liaison relationships with ethnic/ racial communities can also contribute relevant content to the curriculum.
Three models for integrating cultural differences in nursing curricula are described by Branch and Paxton (1976). The three models - cultural and racial diversity, humanism, and patient advocacy - are ways to make the curriculum more relevant to the needs of ethnic/racial minorities. These models provide mechanisms for considering ethnic/racial issues but they vary in the amount of cultural content required for effective practice.
It is imperative that the nursing curriculum reflect the composition of the population served by the faculty and students. In most nursing programs, assigning students to care for a cUent from an ethnic/ racial group is the vehicle through which cultural components are included in the curriculum. A few nursing programs also use value clarification groups to help students become aware of their values and note incidences of potential conflict. One criticism of such strategies is that they do not go far enough; they do not adequately integrate the cultures of minority groups into the professional body of knowledge. Students and faculty tend to ignore cultural differences when they are presented m an inconsistent, incidental manner. An additional problem is that values clarification and conflict resolution may imply deviance: differences between ethnic/racial groups are seen as pathological when viewed using the dominant American culture as the reference point.
To facilitate the use of transcultural concepts in nursing practice, descriptions of African-American culture must be systematically integrated into the curriculum. Through the processes of curriculum development and evaluation, central cultural content can be identified. The incidental assignment of students to clients from ethnic/racial groups will not fulfill this objective. Issues revolving around identifying one's support system, perception of illness, views of self, and society, types of illnesses, dietary preferences, methods of treatment, and commitment to treatment regimens are all inherent in a group's culture. Knowledge of the individual, family, and community is necessary to understand the health beliefs and practices of an ethnic/racial group. Such knowledge is also essential to individualizing patient care.
One area of curriculum implementation where cultural differences are magnified is in psychosocial assessment. Items found in assessment tools need to be representative of the ethnic/ racial patients being assessed. Examples of needed items include these: What is the patient's perception of illness? How is this in keeping with the patient's culture? What elements of the dominant culture are health enhancing for this ethnic/racial group? Are there other societal influences which are detrimental or which hinder health maintenance? What are individual attempts at self healing? What cultural values demonstrate health beliefs? These questions will provide data which are specific for the ethnic/racial group. Such items should be used for assessment in addition to those cited in the literature such as dietary preferences and healing remedies.
Interpretation of the data must then be done with knowledge of the specific culture or in collaboration with colleagues from these ethnic/racial groups. Simple intuitive interpretations by nurses of the dominant culture are not valid for delivering quality health care.
An additional requirement for integrating cultural concepts is assistance to students in identifying and overcoming instances of institutional racism. Institutional racism is manifested when minority people are assessed using criteria from the majority culture, or when they receive insufficient care because of barriers in the health care delivery system. Inflexibility of programs, inadequate resources, insensitivity of staff, and lack of accesa to facilities all contribute to the underutilization of health facilities by African Americans (Hatch, 1979; Wan, 1977). Lack of minority health care providers further reduces the utilization of these facilities. Strategies must be developed to increase the awareness of nurses and eradicate these barriers to health care. Recruiting minority students into the nursing profession and teaching students to overcome their ethnocentrism are both useful strategies.
A final guide for curriculum development is utilization of research findings. Data are available which indicate the various health needs of African Americans and their utilization of health care facilities. However, there are only minimal data describing the responses of African Americans to certain nursing interventions. Inclusion of African Americans in ongoing nursing research would promote findings specific to them. Providing health care to African Americans could then be based on an assessment of the appropriateness of interventions rather than on assumptions about the generalìzabìlìty of nursing theory to all ethnic/racial minorities. Thus, a curriculum based on research which includes minority input is strongly recommended.
The nursing profession does not serve a monolithic population. The validity of nursing knowledge and interventions must be tested with all cultural groups. Whether the curriculum is established on the basis of cultural diversity, humanism, patient advocacy or other models, one must recognize that African Americans are a distinct ethnic/racial group, with their own culture- All aspects of their culture - values, beliefs, patterns of behavior, language, customs, philosophy of life, and ways of living - have been well documented in the literature. Now, strategies must be actively pursued to include this cultural diversity in nursing curricula.
- Branch, M.F., & Paxtoo, EP. (1976). Providing safe nursing care for ethnic people of color. New York: Appleton-Century-Crofts.
- Dennis, R.E. (1979). Health beliefs and practices of ethnic and religious groups, in Watkine, E. L., & Johnson, A.E. (Eds.), Removing cultural and ethnic barriers to health care. Chape) Hill: University of North Carolina.
- Gordon, M.M. (1964). Assimilation in American life: The role of race, religion, and national origins. New York: Oxford University Press.
- Gutman, H.G. (1976). the black family in slavery and freedom, 1750-1925. New York: Vintage Books.
- Hatch, J.W. (1979). Reducing barriers to utilization of health services by racial and ethnic minorities, in Watkins, E. L., & Johnson, A.E. (Eds. ), Removing cultural and ethnic barriers to health care. Chapel Hill: University of North Carolina.
- Herakovitz, M.J. (198OX Africanisms in secular life, in Rose, P. (Ed.), Slavery and its aftermath. New York: Atherton Press.
- Leininger, M. (1978). lranscultural nursing: Concepts, theories, and practices. New York: John Wiley and Sons.
- Nobles, W.W. (1974). Africanity: Its role in Black families. The Black Scholar, 6, 10-17.
- Osborne, O.K. (1978). Aging and the Black diaspora: The African, Caribbean, and African American experience, in Leininger, M. (Ed.), Transcultural nursing: Concepts, theories and practices. New York: John Wiley and Sons.
- Spector, R.E. (1979). Cultural diversity in health and illness. New York: Ap piéton- CenturyCrofts.
- Tuck, I. (1980). An analysis of intergenerational patterns in two African American families. (Unpublished dissertation, Greensboro, University of North Carolina.)
- Wan, T.T. (1977). The differential use of health services. Urban Health, 6, 47-49.