Research Article
G
lobal migration has increased dramatically in
this century. During the period from 2000 to
2017, the total number of international migrants
increased from 173 to 258 million people, an
increase of 85 million (49%) (United Nations,
2017). According to a policy statement from the American
Academy of Pediatrics (2004), by 2020, it is predicted that
44.5% of children aged 0 to 19 years in the USA will be from
a racial or ethnic minority group. This rapid change in the
Investigating intercultural effectiveness
of paediatric nurses in a Turkish hospital
Medine Yılmaz, Hatice Yıldırım Sarı, Meltem Ünlü and Perihan Yetim
ABSTRACT
Background: Cultural competence, an important part of patient-centred care,
has been on the nursing agenda for many years. Aim: The aim of this study
was to measure the intercultural effectiveness level of paediatric nurses,
and to explore relationships between the level of intercultural effectiveness
and some sociodemographic variables in paediatric nurses. Method: The
study was conducted at I
·
zmir Tepecik Training and Research Hospital’s
children’s clinics in Turkey. A convenience sample of 98 paediatric registered
nurses practising at the hospital was evaluated. To collect the study data,
a sociodemographic characteristics questionnaire, a Cultural Approach in
Nursing Care form and the Intercultural Effectiveness Scale (IES) were used.
Results: The participating paediatric nurses’ intercultural effectiveness levels
were moderate, the problem they experienced most was the language problem
and although many of them had not received adequate training in cultural care,
based on their experiences, they regarded themselves as culturally competent.
Conclusion: Cultural competence is vital in multi-ethnic and multicultural
societies. Cultural competence training should be provided to nurses during
nurse education, or in-service training during their professional life.
Key words: Intercultural effectiveness ■ Cultural effectiveness
■ Cultural competence ■ Cultural approach ■ Paediatric nursing
Medine Yılmaz, Professor, Faculty of Health Science Nursing
Department, I
·
zmir Kâtip Çelebi University, I
·
zmir, Turkey
Hatice Yıldırım Sarı, Professor, University Faculty of Health
Science Nursing Department, I
·
zmir Kâtip Çelebi, I
·
zmir, Turkey,
hatice.yildirimsari@ikc.edu.tr
Meltem Ünlü, Pediatric Nurse, Pediatric Department, Tepecik
Training and Research Hospital, I
·
zmir, Turkey
Perihan Yetim, Pediatric Nurse, Pediatric Department, Tepecik
Training and Research Hospital, I
·
zmir, Turkey
Accepted for publication: September 2019
demographic structure makes the concepts of ethnicity and
culture even more important in health care.
In 2017, Turkey became the largest refugee-hosting country
worldwide, with 3.1 million refugees (United Nations, 2017).
Turkey hosts families from many different cultural backgrounds.
A large number of people migrate to Turkey from Middle
Eastern countries.
Although the decision to migrate is taken by parents, children
are the ones most affected by the migration decision. Migration
leads to serious impoverishment of children. Children may be
separated from their parents due to migration, they may not be
able to attend school, and they face many risks such as social
exclusion, discrimination and even homelessness. Poor living
conditions experienced by migrants can affect children’s health
adversely to varying degrees (UNICEF, 2007).
Migrant children from various cultures are frequently
admitted to children’s clinics and undergo inpatient treatment.
The role nurses play in the provision of holistic care to a child
in the clinical setting is vital. The basic mission of paediatric
nurses is to improve and maintain the physical, mental and
social wellbeing of children, whether they are infants, children
or adolescents, and their families. Provision of truly holistic
care by paediatric nurses is closely related to their respect for
or awareness of cultural/traditional beliefs and having cultural
competence and sensitivity (Berlin et al, 2010; Renzaho et al,
2013; Suk et al, 2015).
Race and ethnicity are often seen as the most important signs
of a person’s culture (Rice and O’Donohue, 2002). However,
other aspects have been identified by the American Academy
of Pediatrics as follows:
‘The term ‘culture’ is used to signify the
full spectrum of values, behaviors, customs,
language, race, ethnicity, gender, sexual
orientation, religious beliefs, socioeconomic
status, and other distinct attributes of
population groups.’
American Academy of Pediatrics, 2004
From this perspective, it is necessary for paediatric nurses
to perform a multidimensional cultural assessment and then
to provide care. In one study of nurses in Taiwan, the ‘cultural
competence’ of the participants was in the low-to-moderate
range, with relatively higher mean scores for the subscales of
‘cultural awareness’ and ‘cultural sensitivity’ and relatively lower
scores for the subscales of ‘cultural knowledge’ and ‘cultural
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skills’. Most of the nurses did not think they had cultural
competence (Lin et al, 2015).
In a study of nurses in four children’s hospitals in the USA,
Hart (1999) reported that paediatric nurses did not routinely
perform cultural assessments of patients and frequently
experienced cultural conflicts. Berlin et al (2006) reported
that 84% of the 270 Swedish paediatric nurses who responded
to a questionnaire had difficulty communicating with patients,
especially with children, born in other countries.
Cultural competence, an important part of patient-
centred care, has been on the nursing agenda for many years
(Heitzler, 2017). To be culturally competent, intercultural
effectiveness is required (Chen and Starosta, 2000). The three
factors contributing to intercultural effectiveness are effective
communication skills, the ability to establish interpersonal
relationships, and the ability to cope with stress (Fisher and
Hartel, 2003). Intercultural effectiveness enables individuals to
achieve communication targets within intercultural interaction
through appropriate and effective performance. Portalla and
Chen (2010) defined five components of interculturally
effective behaviours:
■ Message skills (being able to communicate with patients
from other cultures successfully by understanding and using
verbal and non-verbal behaviours)
■ Interaction management (being able to interact with people
from a variety of backgrounds)
■ Behavioural flexibility (being able to adapt one’s behaviour
to different circumstances)
■ Identity management (being able to accept and respond to
the cultural identity of an individual)
■ Relationship cultivation (being able to form positive
relationships with patients from different cultural backgrounds).
Although there are several studies in the literature investigating
the cultural awareness and sensitivities of paediatric nurses (Berlin
et al, 2010; Hendson et al, 2015; Heitzler, 2017), no researchers
have quantitatively measured the intercultural effectiveness of
paediatric registered nurses. In recent years, nurses in Turkey
have nursed patients from different cultures and provided care
for them. However, the level of intercultural effectiveness of
practising paediatric nurses in Turkey was unknown, and led
to the idea for this study.
Study aim
The aim of this study was to measure the intercultural effectiveness
of paediatric nurses in a Turkish hospital and to explore
relationships between the level of intercultural effectiveness
and some sociodemographic variables in paediatric nurses.
Method
Type
The study had a descriptive and correlational research design.
Setting
The study was conducted at the I·zmir Tepecik Training and
Research Hospital’s children’s clinics in Turkey. The hospital is a
state hospital and serves patients from all socioeconomic groups.
It was chosen because children whose families had migrated
from Syria and other countries were frequently admitted to
this hospital.
Sampling
There were 196 nurses working in the paediatric clinics of the
hospital when the study was carried out. A non-probability sample
of 98 paediatric registered nurses practising at the hospital was
evaluated. The participation rate was 50% because the nurses
worked shifts, and because some of them were on annual leave
or sick leave. There were no specific exclusion criteria.
Ethical approval
Ethical approval was obtained from the administration of the
hospital where the study data were to be collected. The data
were collected between June 2016 and September 2016. After
the nurses were informed about the purpose of the study, their
written consent was obtained.
Procedure
The data were collected during working hours through face-
to-face interviews.
Data collection tools
To collect the study data, two questionnaires and the Intercultural
Effectiveness Scale (IES) were used (Portalla and Chen, 2010).
Table 1. Participants’ sociodemographic characteristics
Sociodemographic characteristic n %
Gender
Female 94 95.9
Male 4 4.1
Marital status
Married 52 53.6
Single 46 47.4
Education
High school 14 14.3
Associate’s degree 19 19.4
Bachelor’s degree 56 57.1
Postgraduate degree 9 9.2
Length of service
0−5 years 48 49.0
6−10 years 24 24.5
11−15 years 12 12.2
16−20 years 13 13.3
Place of residence
District 27 27.6
City 31 31.6
Metropolis 40 40.8
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A sociodemographic characteristics questionnaire was
prepared, including items requesting nurses’ gender, educational
status, marital status, place of residence and length of service.
The Cultural Approach in Nursing Care questionnaire was
prepared by the researchers in light of the pertinent literature
and similar studies (Bayık Temel, 2008; Tanrıverdi et al, 2009;
Bulduk et al, 2011; Tanrıverdi, 2015). The questionnaire was
then reviewed by five experts (three academic nurses and two
clinical nurses). The resulting questionnaire included questions
on whether nurses have taken intercultural nursing courses, their
culture-related thoughts, their self-assessment regarding their
cultural skills, and their knowledge levels of cultural approaches
to nursing interventions and practices. The questionnaire also
included questions related to cultural issues and to practical
applications of cultural care (see Table 2 and Table 3).
Nurses were asked to rate their cultural skills in communication
with children and their parents as ‘very inadequate,’ ‘inadequate’,
‘partially adequate’, ‘adequate’ or ‘very adequate’.
The Turkish version of the Intercultural Effectiveness Scale
(IES), developed by Portalla and Chen (2010) consists of three
subscales and 15 items. The three subscales are:
■ Behavioural flexibility—for example: ‘I am afraid to express
myself when interacting with people from different cultures’
and ‘I find it is easy to get along with people from different
cultures’
■ Interactant relaxation—for example: ‘I always know how to
initiate a conversation when interacting with people from
different cultures’ and ‘I find it is easy to identify with my
culturally different counterparts during our interaction’
■ Interactant respect—for example: ‘I use appropriate eye
contact when interacting with people from different
cultures’ and ‘I always show respect for my culturally different
counterparts during our interaction’.
Items were rated on a 5-point Likert-type scale (ranging
from 1=strongly disagree to 5=strongly agree). The higher the
score, the higher the intercultural effectiveness. The minimum
and maximum possible scores to be obtained from the scale
are 15 and 75 respectively. The Cronbach’s alpha value, which
was 0.79 for the original scale, was 0.74 in the present study.
The results are shown in Table 4.
Data analysis
Statistical analyses were performed using SPSS 20.0. In the
analysis of descriptive data, numbers, percentage distribution
and mean values were used. Because the IES scores showed
normal distribution, the t test and one-way ANOVA (F value)
were used to compare some sociodemographic characteristics
and the IES scores (Portalla and Chen, 2010). P values of <0.05
were accepted as statistically significant at a 95% confidence
interval.
Results
The mean age of the participating paediatric nurses was 29.8 ±
5.8 (20–46) years. Of those, 95.9% were women, 53.6% were
married, 57.1% had an undergraduate degree,and 40.8% had
spent the vast majority of their lives in a large metropolitan area.
Their mean length of service was 6 years (minimum: 6 months,
maximum: 20 years) (Table 1).
Of the participating nurses, 65.3% did not speak any foreign
languages, 74.5% believed that there is a relationship between
their profession and culture, 82.5% thought that the patient’s
culture influences communication and 82.7% thought that the
awareness of the patient’s culture would affect the treatment
and care to be given (Table 2).
In establishing cultural skills in communication with children,
24.5% of participants regarded themselves as adequate, 42.9%
as partially adequate and 11.2% as inadequate (Table 2).
In establishing cultural skills in communication with parents,
50% of them regarded themselves as partially adequate, 22.5%
as adequate and 12.2% as inadequate (Table 2).
Some 27.6% of participants were nursing one in two
patients who were foreigners and/or who did not speak the
same language as the participants; 39.8% were nursing one in
three such patients and 32.7% were nursing one in four such
patients (Table 3).
Table 2. Characteristics related to cultural issues
Characteristics related to cultural issues n %
Can you speak a foreign language?
No 64 65.3
Yes 34 34.7
Do you believe that there is a relationship between your profession and culture?
No 25 25.5
Yes 73 74.5
Do you think that the patient’s culture affects his/her communication? (n=97)
No 17 17.5
Yes 80 82.5
Do you think that understanding your patients’ cultures would be effective in their
treatment and care?
No 17 17.3
Yes 81 82.7
How do you assess your cultural knowledge skills in communicating with children?
Very adequate 17 17.3
Adequate 24 24.5
Partly adequate 42 42.,9
Inadequate 11 11.2
Very inadequate 4 4.1
How do you assess your cultural knowledge skills in communicating with parents?
Very adequate 11 11.2
Adequate 22 22.5
Partly adequate 49 50.0
Inadequate 12 12.2
Very inadequate 4 4.1
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Of the participants, 51% always witnessed parents’ traditional/
cultural practices regarding their children’s care, and 34.7%
observed them sometimes. Some 53.1% always observed that
parents believed that their traditional/cultural practices had
improved their children’s health, and 27.6% observed this
sometimes. An example of a traditional cultural practice would
be a parent swaddling an infant or giving a child an amulet to
wear (in some cultures traditionally believed to ward off evil
or illness).
Of the participants, 54.1% had taken the Intercultural Nursing
Course during their nursing education, and 44.9% had received
in-service training in cultural care during their professional
life; 73.5% wanted to participate in a training programme to
better know the culture of the communities they lived among.
Table 3 shows the most common cultural problems
experienced by nurses: not being able to speak a foreign
language, parents’ low educational level, patients’ age and health
perceptions.
Table 4 shows that the intercultural effectiveness level of
the paediatric nurses is 47.60 ± 4.7, which is moderate. They
obtained the lowest score from the interactant relaxation subscale
(12.04 ± 2.4).
The analysis of the distribution of intercultural effectiveness
scores according to sociodemographic characteristics revealed
that the interactant respect scores of the university graduates
(t=-2.07 P=0.04) and of those living in metropolitan areas
(F =7.48, P=0.001) were found to be at a higher than were
the scores of the nurses of other education levels.
The total intercultural effectiveness scores of the nurses
who believed that nursing and culture were related was higher
than those of the participants who did not (t=-2.54; P=0.01).
Interaction relaxation and total IES scores of the nurses who
thought that the patient’s culture would affect communication
were higher than those of the participants who thought that it
would not (t=-2.53; P=0.013) (t=-2.93; P=0.006). Those who
had taken the intercultural nursing course and received the in-
service training on cultural care had higher interactant respect
scores (t=3.26; P=0.002). Both the total scale scores (F=4.29;
P=0.016) and the behavioural flexibility scores of the participants
who observed the traditional/cultural practices of the parents
were higher than those who did not (F=3.16; P=0.04).
Discussion
To the authors’ knowledge, this is the first study to measure
the level of intercultural effectiveness of paediatric nurses in
Turkey. Intercultural effectiveness is one of the three main
components of the intercultural communication competence
model. Although there have been studies conducted on
cultural sensitivity and cultural awareness, the number of
studies performed on cultural effectiveness is limited. In
order for a nurse to have cultural competence, he or she
should not only be aware of and sensitive to the patient’s
culture but also interculturally effective. In this present study,
the participating paediatric nurses’ intercultural effectiveness
levels were moderate. There is no cut-off score for the IES,
but the analysis found that the university graduate nurses’ IES
scores were higher. Nurses living in a city had lower IES scores.
Several factors have been found to influence nurses’ cultural
competence. The cultural competence assessment levels of
obstetric neonatal nurses in one study were negatively correlated
with age, but positively correlated with their specialty area,
previous training, and self-ranked cultural competence (Heitzler,
2017). Cultural competence has been positively correlated
with number of years of nursing experience, receiving cultural
nursing training,providing care for patients whose culture and
ethnicity were different and providing care for special patient
groups (Lin et al, 2015; Cruz et al, 2016). In Cruz et al’s study
(2017), gender, academic level, clinical exposure, prior diversity
training, the experience of taking care of culturally diverse
patients and patients belonging to special population groups
Table 3. Cultural care—related applications
Applications n %
How often do you meet patients who are foreigners or do not speak the same language
you speak?
One in two patients 27 27.6
One in three patients 39 39.8
One in four patients 32 32.7
Do you observe the parents’ traditional/ethnic practices regarding children’s care?
No 13 13.3
Yes 50 51.0
Sometimes 34 34.7
Do you observe the parents’ traditional/ethnic practices regarding improvements in
children’s health?
No 19 19.4
Yes 52 53.1
Sometimes 27 27.6
Did you take the intercultural nursing course during your nursing education?
No 45 45.9
Yes 53 54.1
Have you ever received in-service training in cultural care?
No 54 55.1
Yes 44 44.9
Would you like to participate in a training programme to better know the culture of the
community you live in?
No 26 26.5
Yes 72 73.5
What are the most common problems/difficulties arising during caregiving?*
Not being able to speak a foreign language 57 58.2
Parents’ low educational level 52 53.1
Patients’ age 32 33.7
Health perception 31 31.6
* Only the percentages of those who answered ‘yes’ are shown.
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were significant factors that were likely to influence cultural
competence.
As is seen in Table 3, the most common problem experienced
by the nurses was that of language. Arabic was the foreign
language most often mentioned by study participants because
most of their foreign patients and their families were Syrian.
Language-related inadequacies are among the factors that reduce
the use of health services by immigrant communities (Pehlivan
et al, 2013). Interactions where what the healthcare provider says
is misinterpreted by the patient will negatively affect not only
that interaction, but also the diagnosis and treatment process
of the disease (Pehlivan et al, 2013).
In a qualitative study conducted in a paediatric stem cell
transplant setting by Calza et al (2016), communication was
seen as a barrier in caring for foreign patients. Hendson et al
(2015) reported that communication problems with immigrant
families of infants admitted to the neonatal intensive care unit
negatively affected the decision-making process at times of
crisis. The language problem can lead to stereotyped behaviours
and lack of intuitive perceptions that nurses use to identify the
needs of families (Hendson et al, 2015).
In the interviews, many nurses indicated that one of the
difficulties they experienced was low educational levels among
Syrian families, which affected their understanding of some
health conditions and treatments, even when an interpreter was
present. However, because no comparison was made between
foreign patients and native patients, such judgements could not
be supported. The correlation between the perception of health
and the level of education is similar in native patients. Yilmaz
et al (2017) categorised the problems experienced by nurses as
language barriers, patients’ education level, health perception
about disease and religious beliefs when providing health care.
The vast majority of the nurses in the present study were
aware of the importance of cultural issues, and only around 11%
considered their cultural competence inadequate. In another
Table 4. Intercultural effectiveness level of the
paediatric nurses in the study
Subscale χ± SS
Behavioural flexibility (7 items) 22.20±3.6
Interactant respect (4 items) 13.30±2.1
Interactant relaxation (4 items) 12.04±2.4
Total 47.60±4.7
Table 5. Distribution of intercultural effectiveness scores by some characteristics of the participants
Behavioural flexibility Interactant respect Interactant relaxation Total
Believing that nursing is related to culture
No 21.4± 3.5 12.6±1.9 11.6± 2.2 45.6±2.7
Yes 22.5±3.6 13.5±2.1 12.2±2.4 48.3±5.0
t, P P>0.05 P>0.05 P>0.05 t=-2.54; P=0.01
Does the patient’s culture affect communication?
No 21.5± 3.6 13.1±1.9 10.7± 1.9 45.4±0.8
Yes 22.4±3.5 13.4 ±2.1 12.3±2.4 48.1±0.5
t, P P>0.05 P>0.05 t=-2.53; P=0.013 t=-2.93, P=0.006
Taking the intercultural nursing course
Yes 22.2± 3.6 14.0±1.5 12.1± 2.6 48.3±4.5
No 22.2±3.5 12.7 ±2.4 12.1±2.2 46.9±4.8
t, P P>0.05 t=3.26; P=0.002 P>0.05 P>0.05
Receiving in-service training in cultural care
Yes 22.6± 3.8 13.7±1.9 11.7± 2.4 48.1±5.2
No 21.7±3.2 12.2 ±2.2 12.4±2.3 46.9±4.0
t, P P>0.05 t=2.32; P=0.02 P>0.05 P>0.05
Observing traditional/ethnic practices
Noa 22.0± 2.5 12.8±2.7 10.7± 1.9 45.4±3.6
Rarelyb 21.4±3.8 13.3±2.1 12.2±2.4 46.9±4.6
Oftenc 23.4±3.3 13.6±1.9 12.3±2.4 49.3±4.7
F, P F=3.16; P=0.04 (b 156 British Journal of Nursing, 2020, Vol 29, No 3
© study, the vast majority of the paediatric nurses who responded Berlin et al (2006) found that most of the paediatric nurses in Although the nurses who participated in the present Limitations Conclusion and recommendations Intercultural competence is an essential skill in nursing. Paediatric nurses working in such societies should perform a As countries become more multicultural and multi-ethnic, Declaration of interest: none
American Academy of Pediatrics Committee on Pediatric Workforce. Bayık Temel A. Transcultural nursing education. Journal of Anatolia Nursing Berlin A, Johansson S-E, Törnkvist L. Working conditions and cultural Berlin A, Nilsson G, Törnkvist L. Cultural competence among Swedish child Bulduk S, Tosun H, Ardıç E. Measurement properties of Turkish intercultural Calza S, Rossi S, Bagnasco A, Sasso L. Exploring factors influencing Campinha-Bacote J. The process of cultural competence in the delivery of Chen GM, Starosta WJ. The development and validation of the intercultural Cruz JP, Estacio JC, Bagtang CE, Colet PC. Predictors of cultural competence Cruz JP, Alquwez N, Cruz CP, Felicilda-Reynaldo RFD, Vitorino LM, Islam Fisher GB, Hartel CEJ. Cross-cultural effectiveness of western expatriate-Thai Hart D. Assessing culture: pediatric nurses’ beliefs and self-reported practices. KEY POINTS ■ This study examined the cultural competence of paediatric nurses in one ■ The study found that the language barrier and parents’ low educational ■ Paediatric nurses working in multicultural/multi-ethnic societies should British Journal of Nursing, 2020, Vol 29, No 3 157
PROFESSIONAL Heitzler ET. Cultural competence of obstetric and neonatal nurses. J Obstet Hendson L, Reis MD, Nicholas DB. Health care providers’ perspectives of Hisama KK. Cultural influence on nursing scholarship and education. Nurs Lin C-N, Mastel-Smith B, Alfred D, Lin Y-H. Cultural competence and related Pehlivan S, YıldırımY, Fadıloğlu Ç. Kanser, Kültür Ve Hemşirelik. [Cancer, Portalla T, Chen GM. The development and validation of the Renzaho AMN, Romios P, Crock C, Sønderlund AL. The effectiveness Rice N, O’Donohue, W. Cultural sensitivity: a critical examination. New Suk MH, Oh WO, Im YJ, Cho HH. Mediating effect of school nurses’ self Tanrıverdi G, Seviğ Ü, Bayat M, Birkök MC. Assessment guide of cultural Tanrıverdi G. Approaches of nurses towards standards of practice for Yilmaz M, Toksoy S, Direk ZD, Bezirgan S, Boylu M. Cultural sensitivity UNICEF. Children and migration. 2007. https://tinyurl.com/t62r9od United Nations. Department of Economic and Social Affairs Population CPD reflective questions
■ When caring for children or adults who speak a different language and/or are from a different culture, think about how ■ What do children and families from different cultures think about the care given to them? How is this assessed in your ■ How could you increase the cultural competencies of nurses in your team?
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158 British Journal of Nursing, 2020, Vol 29, No 3
© Copyright of British Journal of Nursing is the property of Mark Allen Publishing Ltd and its GlobalJournal of Health Science; Vol. 8, No. 7; 2016
ISSN 1916-9736 E-ISSN 1916-9744
Published by Canadian Center of Science and Education
203 Challenges of Transcultural Caring Among Health Workers in Rana Amiri1*, Abbas Heydari2*, Nahid Dehghan-Nayeri3, Abou Ali Vedadhir4,5 & Hosein Kareshki6 Correspondence: Abbas Heydari, School of Nursing and Midwifery, Mashhad University of Medical Sciences, *The first and second authors have equal contributions. Received: July 6, 2015 Accepted: October 10, 2015 Online Published: December 16, 2015
doi:10.5539/gjhs.v8n7p203 URL: http://dx.doi.org/10.5539/gjhs.v8n7p203
Abstract
Background: One of the consequences of migration is cultural diversity in various communities. This has Objectives: The aim of this study is to explore the health care staffs’ experience of caring for Immigrants in Setting: This study is done in Tollab area (wherein most immigrants live) of Mashhad. Clinics and hospitals that Participants: Data were collected through in-depth interviews with medical and nursing staffs. 15 participants Design: This is a qualitative study with content analysis approach. Sampling method was purposive. The Results: The data analysis consisted of four main categories; (1) communication barrier, (2) irregular follow- up, Conclusion: Result revealed that health workers are confronting with some trans- cultural issues in caring of Keywords: health care staffs, immigrants, transcultural caring, cultural competence
1. Background
One of the consequences of migration is cultural diversity in different societies. The cultural diversity, often www.ccsenet.org/gjhs Global Journal of Health Science Vol. 8, No. 7; 2016
204 Medical personnel’s experience of caring for culturally diverse patients are challenging and frustrating. Cultural Transcultural identify as involving, encompassing, or combining component of more than one culture. According Iran is a country with large numbers of immigrants, wherein live at least two million foreign immigrants. 96% of On the other hand, recent studies have shown that immigrants give lower quality care than the resident 1.1 Objective
This qualitative study describes the medical staffs’ experiences of caring for immigrants.
2. Methods
This is a qualitative study, since experiences are subjective; and only through qualitative study we can discover www.ccsenet.org/gjhs Global Journal of Health Science Vol. 8, No. 7; 2016 205 In this study, the purpose of study was initially explained to the personnel and if they were willing or qualified, a Each session may last for 45 minutes to 1 hour in a comfortable and quiet place. Interview was recorded with a In qualitative research, the participants’ selection should be determined based on data needs. Thus, a guiding Ethical consideration: To keep ethical considerations, the ethics committee of Mashhad University of Medical Data analysis: Data analysis was performed simultaneously with data collection. Data were entered to Max QDA 3. Result
Fifteen participants (seven doctors and eight nurses) entered to the study. Among doctors, two were female and
Table 1. Participant’s characteristics
Participants /Field Level of education Experience (year) Age (year) Gender Place of work
P1 Doctor
GP 8 45 Female Sakhteman- clinic
P2 Doctor Ophthalmologist 15 55 Male Khatamol-anbiya-hospital
P3 Doctor Gynaecologist 10 43 Female Golshar – clinic
P4 Doctor GP 12 54 Male Golshar-clinic
P5 Doctor Internal Medicine 5 38 Male Bolvar Tabarsi-office
P6 Doctor GP 20 57 Male Golshar-office
P7 Doctor Internal Medicine 7 43 Male Tabarsi-Office
P8 Nurse
Bachelor 5 32 Female Sakhteman-clinic
P9 Nurse Bachelor 6 35 Female Sakhteman-clinic
P10 Nurse Bachelor 13 40 Male Bolvar Tabarsi-clinic
P11 Nurse Bachelor 10 38 Male Golshar-clinic
P12 Nurse Bachelor 5 31 Female Bolvar Tabarsi-clinic
P13 Nurse Master 10 37 Male Imam Hadi
P14 Nurse Bachelor 15 38 Female Hasheminejad- paediatric ward
P15 Nurse Bachelor 6 29 Female Imam Hossein –OB www.ccsenet.org/gjhs Global Journal of Health Science Vol. 8, No. 7; 2016 206 Table 2. Themes and subthemes
Theme Subtheme
Communication Barriers Different languages
Different Interpretation of signs and symptoms
Irregular Follow- up Residential financial problem
Inadequate information
Lack of trust
More drug, more qualified doctor
Frequent changing doctor
Disregarding staff recommendation
Cultural- personal trait
Low communication skill
Men’s decision role in the treatment of women
Being shy
3.1 Communication Barriers
Participants raised communication barriers in two different types. The first type includes language barriers due to “What was the main problem in dealing with immigrants? When I first started my job here, I had lots of problem The second type of communication problems includes different interpretation of signs and symptoms of the “A patient referred to us several times and asked us that he feels his back is loose and need some information for “I often can understand their language because it is Persian, but I have a little difficulty in describing some of 3.2 Irregular Follow up
Personnel pointed that immigrants have not regular follow-up; therefore the prevalence of chronic disease is The first subcategory is residential- financial problems. Most immigrants live in tragic situations in poverty and One of the doctors explained this reality:
“Immigrants who living in this area and we deal with them are those who are in short financially. Most of these Some doctors and nurses face challenge due to the lack of residential permit in immigrants. Undocumented “A patient referred to me with glaucoma. I prescribed him to do emergency surgery in… hospital as soon as www.ccsenet.org/gjhs Global Journal of Health Science Vol. 8, No. 7; 2016 207 possible. When he referred to the hospital, they didn’t admit him because of illegal resident. He came back to my The second subcategory is inadequate information. One of the reasons for late referring to the doctor in migrants What is interesting about immigrants is that they are careless regarding health. One of my patients has a blood Participants stated that disease could be diagnosed incidentally in some immigrants. It means that they ignore or “I may see here very malignant hypertension, BP 27, the patient may have a high blood pressure for years or may 3.3 Lack of Trust
Another challenge among personnel is mistrust of immigrant toward them. Immigrants show this mistrust in Some immigrants believe that the doctor, who prescribed more medication, has better diagnosed their disease. “One of my concerns regard to immigrants is requesting injectable drugs. They believe that their disease is According to the staff’s statement some immigrants accept education hardly and often resist on training and staff Some immigrants refer to me for blood pressure control. They told me their blood pressure is high. When I check Most medical personnel stressed that migrants pay more attention to neighbors’ advices than them, and this is One of common behavior among immigrants is that they constantly change their doctor. This behavior also One of doctors pointed out to this subject:
“One of concern regarding immigrants is following up the diseases. Patients come to me and receive some drugs 3.4 Cultural-Personal Trait
Some cultural – personal trait of immigrants were considered as challenge to treat and care them. These cultural – • Being shy: One of the barriers to treatment is feeling shy that exists often in genital – urinary diseases or www.ccsenet.org/gjhs Global Journal of Health Science Vol. 8, No. 7; 2016 208 rectal problems. This behavior is more common in women, but men also have this problem and shy to “Once a woman about 60- 70 years referred to me. She just complained of irritation. When I told her go for • Men’s decision role in the treatment of women: Patriarchal in culture of immigrants has caused the I had a patient who had polyp in uterus. I gave her some common medications to stop bleeding and advised her • Low communication skill: Some immigrants don’t have good communication with others. They often 4. Discussion
This study has been done aiming to explore the medical personnel’s experience of caring for immigrants and lead Regarding the first category – communication barrier- many studies stated that one of the biggest problem in Regarding to irregular follow up, health care workers pointed out that immigrant have not suitable follow up www.ccsenet.org/gjhs Global Journal of Health Science Vol. 8, No. 7; 2016 209 cannot communicate with health care properly, cannot understand their language and always feel inferior, which Regarding immigrants’ cultural – personal traits in our study, participants stated to the special cultural features The second and most important challenge is communication and mastering different languages, that in our study, 5. Conclusion
In conclusion we recommend considering the transcultural caring and cultural competency among medical staff This study has implication for research and practice. Despite the large number of immigrants and various This study has some limitations: One of our limitations is that personnel was very busy and had no time for Acknowledgments
This paper was funded by the vice chancellor of the Mashhad University of medical science, thanks for their help. Conflict of Interest
The authors declare that there is no conflict of interests regarding the publication of this paper.
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This is an open-access article distributed under the terms and conditions of the Creative Commons Attribution 9
THE APPLICATION OF TRANSCULTURAL NURSING MODEL IN MOTHER’S BEHAVIOR IN JEMBER
(Penerapan Model Keperawatan Transkultural dalam Perspektif Budaya Madura Awatiful Azza, Cipto Susilo E-mail: awatiful.azza@yahoo.com
ABSTRAK
Pendahuluan: Menyusui merupakan salah satu tugas perkembangan perempuan setelah melahirkan. Banyak faktor yang Key word: transkultural, menyusui, budaya Madura
ABSTRACT
Background and objective : Breastfeeding is one of the development tasks for women after childbirth. Many factors Keywords: transcultural, breastfeeding, Maduranese culture
INTRODUCTION
Breastfeeding is a natural process and is babies but in some women also can interfere 10
Jurnal INJEC Vol. 2 No. 1 Juni 2017: 9– 16
food choices for babies since breastfed infants Nigel and Bandari research results in The data on the health of newborns in the various restrictions, the causal relationship Research objective
I n some t r a d it ional societ ies i n The scope of this research f ield, myths developed in the community about 11
The Application of Transcultural Nursing Model (Awatiful Azza, Cipto Susilo)
2) To develop a model and tested model of 3) To conduct the analysis of cultural Research urgency:
Un it e d Nat ion C h i ld r e n’s Fu nd Low coverage breastfeeding is due to A n t h r o p ol o g i c a l s t u d i e s a b o u t Maternity nurse as a member of the same time can reduce infant mortality due to Models Lininger becomes one of the Review Of Related Literature
Culture is one of the embodiments or Transcult ural nursing is the main 12
Jurnal INJEC Vol. 2 No. 1 Juni 2017: 9–16
A correct understanding of the nurses There are three things to consider nurses Culture care preservation/maintenance, i.e., Culture care accommodation/negotiation, Culture care repatterning/restructuring, When nurses purposively ignore the Culture is one of the embodiments or METHOD
The design used in this research was The research was conducted in Pakusari, 13
The Application of Transcultural Nursing Model (Awatiful Azza, Cipto Susilo) Samples are nursing mothers who have Data were collected by questionnaire, RESULT
Madurese people are very obedient and health, contrary to health. Some Madurese From the data obtained an average Table1. The age distribution of nursing mothers in Suboh, Pakusari 2016
Statistics N Valid 25 25 Mean 27.4000 26.1600 Table 2. Distribution of nursing mothers by giving an education Suboh, Pakusari 2016
Last Education Treatment Group % Control Group % 14
Jurnal INJEC Vol. 2 No. 1 Juni 2017: 9–16 normal distribution of data, it is shown by the Action Breastfeeding is an activity Table 3. Normality test data by Kolmogorov-Smirnov Test in the treatment group and the control
Mother behavior in Mother behavior in N 25 25 Mean 46.1200 46.1200 Most Extreme Absolute .132 .132 Kolmogorov-Smirnov Z 1.002 .659 Table 4. Analysis of application modifi cations of transcultural model based on Maduranese culture Paired Samples Test T df tailed)Mean Deviation
Std. 95% Confi dence Diff erence P a i r Mother Mother -1.79200E1 23.54060 4.70812 -27.63708 -8.20292 -3.806 24 .001
adopted. Model transcultural nursing is an Maintaining culture
Maintaining culture is done when the
patient is not contrary to the culture of b) Culture negotiation
Intervention and implementation of
nursing at this stage to help clients adapt 15
The Application of Transcultural Nursing Model (Awatiful Azza, Cipto Susilo) health. The nurse helps clients to choose and c) Restructuring culture
Cultural restructuring is done when the
culture of adverse health status. Nurses are DISCUSSION
Culture is one of real manifestations This study also shows that there is an Maintaining culture Maintaining culture is done when the Culture negotiation Intervention and implementation of Restructuring culture Cultural restructuring is done when the CONCLUSION
Many cultures did not support exclusive Health professionals need to understand It needs to involve the community and its 16 regulations on infant formula, i.e., Government REFERENCES
A nd rew, M. M., & Boyle, J. S (2008) Arikunto, S., 2002. Prosedur Penelitian Suatu Balitbangkes.RI. (2010). Riset Kesehatan Dinas Kesehatan Kabupaten Jember. (2014). Leininger. M & McFarland. M.R., (2002). Masoara, S. (2013)Manfaat ASI untuk bayi, Nigel & Bandari. (2016) ‘Why invest, and what Nurwidodo. (2006). Pencegahan dan Promosi PDPI, 2011. Pedoman Penatalaksanaan TB Prasetyono DS. (2009) Buku Pintar ASI Pot ter, P. A. & Per r y, A. G. (20 09). Putra JS. (2012) Madura dengan Masalah Rejeki, S., (2014)‘Pengalaman Menyusui Roesli U. (2008) Inisiasi menyusu dini plus Sakha, K, Behbahan. (2005)‘The onset time Study, C.A.Q. et al., 2010. Impact of PRISMA , Tanudyaya, F.K. et al., 2010. Prevalence of Wahyuningsih, S. (2014) ‘Kearifan budaya 959Rev Bras Enferm [Internet]. 2018;71(3):959-66. http://dx.doi.org/10.1590/0034-7167-2017-0105
Alcimar Marcelo do CoutoI, Célia Pereira CaldasII, Edna Aparecida Barbosa de CastroI
I Universidade Federal de Juiz de Fora, School of Nursing. Juiz de Fora, Minas Gerais, Brazil How to cite this article: [Internet]. 2018;71(3):959-66. DOI: http://dx.doi.org/10.1590/0034-7167-2017-0105
Submisison: 04-04-2017 Approval: 05-17-2017
ABSTRACT RESUMO RESUMEN RESEARCH
Family caregiver of older adults and Cultural Care in Nursing care
Cuidador familiar de idosos e o Cuidado Cultural na assistência de Enfermagem
Cuidador familiar de ancianos y el Cuidado Cultural en la asistencia de Enfermería
Alcimar Marcelo do Couto E-mail: alcimar.couto@bol.com.brCORRESPONDING AUTHOR Rev Bras Enferm [Internet]. 2018;71(3):959-66. 960
Family caregiver of older adults and Cultural Care in nursing care INTRODUCTION
The development of a base of knowledge and the recognition Serving as instruments to the various fields of nursing prac- Care is a complex and multidisciplinary concept. Reflecting In the Theory of Culture Care Diversity and Universality, This theory was represented by the Sunrise model. This Composed of factors that relate to each other, interfering in We believe that the process of nursing care of dependent This study is relevant when considering the rapid demograph- incite dependency relationships that interfere in the social inter- Thus, analyzing the care provided by family members Based on this premise, we wondered: how the nursing Caring for dependent older adults might entail negative OBJECTIVE
To present an analysis of nursing care experiences done by METHOD
Ethical aspects 466/2012, of the National Health Council, which regulates Theoretical-methodological framework and type of study method to understand the care process performed by family The Theory of Cultural Care Diversity and Universality of Rev Bras Enferm [Internet]. 2018;71(3):959-66. 961
Family caregiver of older adults and Cultural Care in nursing care environmental context, nursing, culturally congruent nursing Study scenario focused on the Ambulatório de Geriatria e Gerontologia do Data collection and organization dex(13) was used to determine the degree of partial or impor- After identifying the performance overload and emotional Data were collected after signing the Informed Consent Form, The field notes were recorded as topics in a diary during Data analysis proposed by the Grounded Theory method, by open, axial who show work overload and emotional distress.” The con- RESULTS
It was possible to identify the potentialities and frailties de- Potentialities in the context of home care for the depen- process of care, by performing as the caregiver to other family I had taken care of older adults already, bathed, fixed their However, they reported that numerous difficulties were I was getting used to it. […] But this initial phase was very So, if I have to leave, I ask someone to look for her for me. Positive feelings, such as affection, solidarity, appreciation Rev Bras Enferm [Internet]. 2018;71(3):959-66. 962
Family caregiver of older adults and Cultural Care in nursing care of the caregiver, even facing the difficulties resultant from the My feeling is… Of wanting good things for that person, to The existence of stimuli in the everyday life of the care re- So, if I need to leave, they stay here to take care of her. (Emerald)
I have a sister who helps me by paying a person to help me Yes, they financially help me. (Tourmaline)
It was possible to identify through the experiences with the I seek strength, especially on my therapist. I talk a lot with Here I call a neighbor and she helps me, you see? Any time I allow God to take control and He gives me strength and… My support is in God. I touch my rosary and pray. […] Then, Frailties in the context of home care of the dependent was mainly related to the emergence and evolution of chronic The changes caused by these profiles (such as cognitive deficit I am more depressed nowadays […] sometimes I’m hit by We suffer […]. It is a disease [referring to Alzheimer] that Another difficulty reported by the caregivers was the ab- I’d never given a bath, I’d never taken care of someone sick. Today I take care of everything, I change diapers, I go after We observed that the formation of the role of main caregiv- My biggest difficulty is the lack of support within the fam- So, it was very hard. Not having anyone to share the respon- I take care of her every day, weekends, Saturday, Sunday, According to the reports of the participants, the routine ex- Rev Bras Enferm [Internet]. 2018;71(3):959-66. 963
Family caregiver of older adults and Cultural Care in nursing care Daily moments of rest became nonexistent or minimal, in ad- My leisure was fully “pruned,” because I cannot find any- I already sleep very little. […] I’ve been sleeping, but even As the dependency advances, progressive changes in the We are afraid she will get even worse. How are we going to […] I’m scared to death of her getting worse and not being Some repercussions in the dynamics of life arising from the […] To be able to hospitalize her I have the family thinking I cannot fix things right, because who handles sick people We live in the grace of God, because there is no more room We should highlight that the costs of the care fall upon the Implications for Nursing and the experience of caring for dependent older adults in Figure 1 – Conceptual Diagram: the older adult caregiver, cultural care
Adaptation/ Support, assistance and training of the older adult
Preservation/ Maintenance and strengthening of identified in the context of Repatterning/ cultural care Reorganization, swap or aspects (frailties) of the DISCUSSION
Nursing assistance in situations of chronic or irreversible In scenarios in which the cure of pathological processes is Rev Bras Enferm [Internet]. 2018;71(3):959-66. 964
Family caregiver of older adults and Cultural Care in nursing care Professional investment on nurse care according to the cul- Potentialities and frailties that influence the intensity of the The prior experience with the process of nursing care and We also observed that caregivers carry culturally construct- In the search for support and as a form of dealing with the We reinforce that this set of positive aspects found in the nurs- self-esteem of the caregiver. The expected result is the preserva- Feelings of agony, sadness, fear, anger, insecurity and worry The situations experienced in the nursing care process demon- The way each family member performs the daily care de- The noticeable lack of guidelines and support from health The difficulty of the caregiver in obtaining support in the Observing the everyday life of caregivers of older adults al- Family caregivers have shown concern for failing to take Rev Bras Enferm [Internet]. 2018;71(3):959-66. 965
Family caregiver of older adults and Cultural Care in nursing care in accommodating the activities as a caregiver and self-care, Main caregivers need the help of other family members The charges in relation to the main caregiver role, the lack Given this context of negative aspects experienced by the Study limitations ily caregivers who had experienced the overload resulting from from different areas, it is suggested that the issue be investigated Other question that arise and that will require further re- Contributions to the field of Nursing ity of Madeleine Leininger contributed to the reflection about FINAL CONSIDERATIONS
The obtained results enabled us to know and understand We recommend that the potentialities and frailties that stem REFERENCES
1. George JB. Theory of culture care diversity and universality: Madeleine M. Leininger. In: Nursing Theories: the Base for Professional 2. Ramos JLC, Menezes MR. Elderly care with alzheimer disease: a focus on the theory of cultural care. Rev Rene [Internet]. 2012[cited 3. Seima MD, Michel T, Méier MJ, Wall ML, Lenardt MH. Scientific nursing production and Madeleine Leininger’s theory: integrated 4. Leininger MM. Culture care diversity and universality: a theory of nursing. National League for Nursing. New York: Jones Bartlett Rev Bras Enferm [Internet]. 2018;71(3):959-66. 966
Family caregiver of older adults and Cultural Care in nursing care 5. Fortes AFA, Soane AMN, Braga CGB. Teoria do cuidado cultural ou diversidade e universalidade do cuidado cultural – Madeleine 6. Melo LP. The sunrise model: a contribution to the teaching of nursing consultation in collective health. Am J Nurs Res[Internet]. 7. Moraes EM. Atenção à saúde do idoso: aspectos conceituais. Brasília: Organização Pan-Americana da Saúde; 2012.
8. Fernandes MGM, Garcia TR. Tension attributes of the Family caregiver of frail older adults. Rev Esc Enferm USP [Internet]. 9. Silva RMFM, Santana RF. Diagnóstico de enfermagem “tensão do papel de cuidador”: revisão integrativa. Rev Bras Geriatr 10. Pedreira LC, Oliveira AMS. Cuidadores de idosos dependentes no domicílio: mudanças nas relações familiares. Rev Bras Enferm 11. Gratão ACM, Vendruscolo TRP, Talmelli LFS, Figueiredo LC, Santos JLF, Rodrigues RAP. Burden and the emotional distress in 12. Strauss A, Corbin J. Pesquisa qualitativa: técnicas e procedimentos para o desenvolvimento de teoria fundamentada. 2. ed. Porto 13. Duarte YAO, Andrade CL, Lebrão ML. O índex de Katz na avaliação da funcionalidade dos idosos. Rev Esc Enferm USP[Internet]. 14. Scazufca M. Brazilian version of the Burden Interview Scale for the assessment of care in careers of people with mental illnesses. 15. Mari JJ, Williams P. A validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of São Paulo. 16. Couto AM, Castro EAB, Caldas CP. Experiences to be a family caregiver of dependent elderly in the home environment. Rev 17. Oliveira DC, D’elboux MJ. Estudos nacionais sobre cuidadores familiares de idosos: revisão integrativa. Rev Bras Enferm [Internet]. 18. Seima MD, Lenardt MH, Caldas CP. Relação no cuidado entre o cuidador familiar e o idoso com Alzheimer. Rev Bras 19. Oliveira BC, Garanhani ML, Garanhani MR. Caregivers of people with stroke: needs, feelings and guidelines provided. Acta Paul 20. Carvalho DP, Toso BRGO, Viera CS, Garanhani ML, Rodrigues RM, Ribeiro LFC. Caregivers and implications for home care. Texto 21. Costa SRD, Castro EAB. Autocuidado do cuidador familiar de adulto ou idoso dependente após a alta hospitalar. Rev Bras 22. Herdman TH, Kamitsuru S. Diagnósticos de enfermagem da NANDA: definições e classificação 2015-2017. Porto Alegre: Artmed; 2015.
23. Loureiro LSN, Pereira MA, Fernandes MGM, Oliveira JS. Percepção de enfermeiras sobre a tensão do papel de cuidador. Rev Copyright of Revista Brasileira de Enfermagem is the property of Associacao Brasileira de 397J. res.: fundam. care. online 2019. 11(n. esp): 397- 403
RESEARCH
DOI: 10.9789/2175-5361.2019.v11i2.397-403 | Oliveira EAR, Da Rocha SS, et al. | The Parents’ Cultural Care…
DOI: 10.9789/2175-531.2019.v11i2.397-403
The Parents’ Cultural Care Towards Promoting Child Development
O Cuidado Cultural dos Pais na Promoção do Desenvolvimento Infantil
Cuidados Culturales de los Padres en la Promoción del Desarrollo Infantil
Edina Araújo Rodrigues Oliveira1*; Silvana Santiago da Rocha2
How to quote this article: ABSTRACT Descriptors: Child Development, Pediatric Nursing, Nursing Care, Culture, Health Promotion.
1 Nursing Graduate, MSc in Nursing by the Postgraduate Program at UFPI, Professor of the Nursing Graduation Course at UFPI. E-mail 2 Nursing Graduate, PhD in Nursing by the Universidade Federal do Rio de Janeiro (UFRJ), Professor of the Nursing Postgraduate Program 398J. res.: fundam. care. online 2019. 11(n. esp): 397-403
ISSN 2175-5361. DOI: 10.9789/2175-5361.2019.v11i2.397-403 398
RESUMO Descritores: Desenvolvimento Infantil, Enfermagem Pediátrica, Cuidados RESUMEN Descriptores: Desarrollo Infantil, Enfermería Pediátrica, Atención de INTRODUCTION the health services to provide care for children, prioritizing Child development begins since the conception, and In order to achieve this development, mothers should five years old — are considered the critical period for the There is also a warning that the adulthood health To be able to understand the health actions developed by Nursing theories allow the establishment of the Thus, when nurses understand that promoting care Therefore, the Madeleine Leininger’s Cultural Care We consider that knowing the family dynamics in the 399J. res.: fundam. care. online 2019. 11(n. esp): 397-403
ISSN 2175-5361. 399
is shown as a possibility for a greater understanding of Hence, this study aims to understand how parents METHODS tive approach, based on the assumptions of the Madeleine The research was carried out from 2012 to 2013 in This age group was selected because it is a risk group The inclusion criteria were: parents who were able to The sample closure was performed by the saturation of There were 16 participants in this study. To ensure the It is important to note that, in this study, the researcher The interview consists of a technique for data collec- And the interview comprises a conversation initiated by The interviews were recorded on an audio media player, For data analysis, we used the content analysis tech- After being recorded and listened comprehensively, the During the material exploration phase, the actual analy- The registration units produced two categories: “daily After the process for obtaining the categories, the dis- This research was approved by the Ethics and Research 400J. res.: fundam. care. online 2019. 11(n. esp): 397-403
ISSN 2175-5361. 400
legal aspects of the Resolution No. 466/12 from the Natio- RESULTS AND DISCUSSION careful analysis of each expression about the parents’ Childcare also involves the monitoring of the various The Tiana’s speech showed that this mother is concerned […] She already looks at everything, notices everything, Regarding the bathing and dressing in children aged […] He does not take a bath alone, even the oldest one He (referring to the one-year-and-11-months-old child) In this study, the mothers of children in the age group of […] He does not let us brush his teeth, he brushes, I’m […] It’s me who gives him a bath, often he takes the little […] The oldest one does not like to brush his teeth, he […] He already wears the underwear on his own, he puts The language development process was also identified […] he often speaks a few words with difficulty, I tell him, The concern about promoting the motor development […] I encourage her to eat alone and of course she eats The active involvement of the mother in the process 401J. res.: fundam. care. online 2019. 11(n. esp): 397-403
ISSN 2175-5361. 401
of child development is evident in this speech, respecting The Brazilian Health Ministr y points out as a Because it is a process, the child development is In the Integrated Management of Childhood Illness The motor development of children aged between three Herein, it is emphasized that the children received In this process of the child development, the act of practice of putting on shoes or slippers, most of the time Another aspect that deserves attention is the Ariel’s According to the information in this manual,18 although In addition to the care for language development, parents Once health professionals are aware of and able to As a mediator and facilitator of the understanding After the speech analysis and with the intention of 402J. res.: fundam. care. online 2019. 11(n. esp): 397-403
ISSN 2175-5361. 402
the children’s health, we used the Leininger’s Cultural By listing these nursing care based on the assumptions The application of the scientific knowledge coordinated CONCLUSIONS children in order to promote the child development reveals The Madeleine Leninger’s Cultural Care Theory has allo- between the family, children, nurses and community, pre- In the development of this research, the proposed objec- Concerning the actions performed by the subjects for This study highlights the necessity for the nurse, as a REFERENCES vigilância do desenvolvimento infantil no contexto da AIDPI. 2. Ribeiro MO; Sigaud CHS; Rezende MA; Veríssimo MLOR. 3. Lopes RCS; Vivian AG; Oliveira DS; Silva C; Piccinini CA. 4. O Enrique; Gilardon A Del Pino M; Di Candia A; Fano V; 5. Moreira MEL; Goldani MZ. A criança é o pai do homem: novos 6. George J. Teorias de enfermagem: os fundamentos à prática 7. Leopardi MT. Teoria e método em assistência de enfermagem. 2 ed. 8. Pagliuca LMF; Maia ER. Competência para prestar cuidado de 9. Soares LC; Klering ST; Schwartz E. Cuidado transcultural a clientes 10. Leininger MM. Culture care diversity and universality: a theory of 403J. res.: fundam. care. online 2019. 11(n. esp): 397-403
ISSN 2175-5361. 11. Leininger MM; Mcfarland M. Culture care diversity and 12. Fontanella BJB; Ricas J; Turato ER. Amostragem por saturação 13. Gil AC. Métodos e técnicas de pesquisa social. 6 ed. São Paulo: 14. Minayo MCS. Pesquisa social: teoria, método e criatividade. 29 ed. 15. Bardin L. Análise de conteúdo. Lisboa: Edições 70, 2011. 466/12. Brasília: Ministério da Saúde, 2012. ed. São Paulo: Martins Fontes, 2003. crescimento e desenvolvimento infantil. Brasília: Ministério da 19. Ministério da Saúde (BR). AIDPI – Atenção Integrada às Doenças 20. Ministério da Saúde (BR). Manual AIDPI neonatal: quadro de 21. Defilipo EC; Frônio JS; Teixeira MTB; Leite ICG; Bastos RR; 22. Andrade AS; Santos DN; Bastos AC; Pedromônico MRM; Almeida- 23. Amorim RCA; Laurentino GEC; Barros KMFT; Ferreira 24. Monteiro MAA; Pestana VLFFG (Coord.) Guias orientadores de 25. Ministério da Saúde (BR). Agenda de compromissos para a saúde Received on: 03/17/2017 Approved on: 04/19/2017 *Corresponding Author: Rua Marcos Parente ,244 E-mail address: edinarasam@yahoo.com.br Zip Code: 64.600-106
The authors claim to have no conflict of interest. Copyright of Revista de Pesquisa: Cuidado e Fundamental is the property of Revista de 9
THE APPLICATION OF TRANSCULTURAL NURSING MODEL IN MOTHER’S BEHAVIOR IN JEMBER
(Penerapan Model Keperawatan Transkultural dalam Perspektif Budaya Madura Awatiful Azza, Cipto Susilo E-mail: awatiful.azza@yahoo.com
ABSTRAK
Pendahuluan: Menyusui merupakan salah satu tugas perkembangan perempuan setelah melahirkan. Banyak faktor yang Key word: transkultural, menyusui, budaya Madura
ABSTRACT
Background and objective : Breastfeeding is one of the development tasks for women after childbirth. Many factors Keywords: transcultural, breastfeeding, Maduranese culture
INTRODUCTION
Breastfeeding is a natural process and is babies but in some women also can interfere 10
Jurnal INJEC Vol. 2 No. 1 Juni 2017: 9– 16
food choices for babies since breastfed infants Nigel and Bandari research results in The data on the health of newborns in the various restrictions, the causal relationship Research objective
I n some t r a d it ional societ ies i n The scope of this research f ield, myths developed in the community about 11
The Application of Transcultural Nursing Model (Awatiful Azza, Cipto Susilo)
2) To develop a model and tested model of 3) To conduct the analysis of cultural Research urgency:
Un it e d Nat ion C h i ld r e n’s Fu nd Low coverage breastfeeding is due to A n t h r o p ol o g i c a l s t u d i e s a b o u t Maternity nurse as a member of the same time can reduce infant mortality due to Models Lininger becomes one of the Review Of Related Literature
Culture is one of the embodiments or Transcult ural nursing is the main 12
Jurnal INJEC Vol. 2 No. 1 Juni 2017: 9–16
A correct understanding of the nurses There are three things to consider nurses Culture care preservation/maintenance, i.e., Culture care accommodation/negotiation, Culture care repatterning/restructuring, When nurses purposively ignore the Culture is one of the embodiments or METHOD
The design used in this research was The research was conducted in Pakusari, 13
The Application of Transcultural Nursing Model (Awatiful Azza, Cipto Susilo) Samples are nursing mothers who have Data were collected by questionnaire, RESULT
Madurese people are very obedient and health, contrary to health. Some Madurese From the data obtained an average Table1. The age distribution of nursing mothers in Suboh, Pakusari 2016
Statistics N Valid 25 25 Mean 27.4000 26.1600 Table 2. Distribution of nursing mothers by giving an education Suboh, Pakusari 2016
Last Education Treatment Group % Control Group % 14
Jurnal INJEC Vol. 2 No. 1 Juni 2017: 9–16 normal distribution of data, it is shown by the Action Breastfeeding is an activity Table 3. Normality test data by Kolmogorov-Smirnov Test in the treatment group and the control
Mother behavior in Mother behavior in N 25 25 Mean 46.1200 46.1200 Most Extreme Absolute .132 .132 Kolmogorov-Smirnov Z 1.002 .659 Table 4. Analysis of application modifi cations of transcultural model based on Maduranese culture Paired Samples Test T df tailed)Mean Deviation
Std. 95% Confi dence Diff erence P a i r Mother Mother -1.79200E1 23.54060 4.70812 -27.63708 -8.20292 -3.806 24 .001
adopted. Model transcultural nursing is an Maintaining culture
Maintaining culture is done when the
patient is not contrary to the culture of b) Culture negotiation
Intervention and implementation of
nursing at this stage to help clients adapt 15
The Application of Transcultural Nursing Model (Awatiful Azza, Cipto Susilo) health. The nurse helps clients to choose and c) Restructuring culture
Cultural restructuring is done when the
culture of adverse health status. Nurses are DISCUSSION
Culture is one of real manifestations This study also shows that there is an Maintaining culture Maintaining culture is done when the Culture negotiation Intervention and implementation of Restructuring culture Cultural restructuring is done when the CONCLUSION
Many cultures did not support exclusive Health professionals need to understand It needs to involve the community and its 16 regulations on infant formula, i.e., Government REFERENCES
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to a questionnaire stated that they did not feel that they were
culturally competent enough (Berlin et al, 2006). In a survey
conducted with student nurses, Cruz et al (2016) found that
although their competence in general cultural communication
skills was high, their competence in health/disease-related
cultural communication skills was low. Nearly half of the nurses
in the present study stated that they had not received any training
in cultural care (Table 5), and 73.5% wanted to have training or
further training. The 27% of nurses who did not want cultural
training may have felt they had gained enough experience of
cultural care during their clinical practice.
their study did not receive formal cultural competence training.
Similarly, Lin et al (2015) stated that nurses identified themselves
as culturally competent, but their cultural skills were found
to be low. In Calza et al’s (2016) study, the nurses stated that
their training and knowledge were not sufficient to provide
care for foreign patients. Providing nurses with training on
cultural competence can provide a self-evaluation opportunity.
According to Campinha-Bacote (2002), achieving competence
is an ongoing process; thus, training programmes aiming to
increase nurses’ cultural competence levels may be useful. Berlin
et al (2010) stated that the cultural knowledge, cultural skills,
cultural encounters and cultural desire levels of paediatric nurses
increased after they received cultural competence training.
study often received interpreter support, they stated that they
frequently had to deal with patients and families with whom
they could not communicate adequately since they did not
speak the same language. However,while half of the nurses
said that they always saw families carry out traditional cultural
practices, the other half said that they only sometimes saw
families carrying out traditional cultural practices. Tanrıverdi
(2015) stated that approximately 65% of the nurses fulfilled
cultural practices. Hisama (2000) found that nurses’ recognition
of the cultures of the individuals for whom they provided care
was positively reflected in nursing care.
A non-probability convenience sample was used. Due to the
difference in gender distribution, the change in the nurses’ IES
scores was not investigated by gender.
In the present study, the participating paediatric nurses’
intercultural effectiveness levels were moderate. The problem
they experienced most was the language barrier and although
half of them did not have adequate training in intercultural care,
based on their experiences, the majority regarded themselves
as culturally competent.
Therefore, nurses should first question their perspectives
on culture and improve their communication skills using
empathy and reflective thinking. Nurses who provide care to
patients in multicultural and multi-ethnic societies should also
learn the cultural characteristics of the groups they care for.
multidimensional cultural assessment in their daily routines.
This is also important in offering family-centred care. Language
is an important problem in providing culturally sensitive care.
cultural competence among nurses has becoming increasingly
important and should be reflected in undergraduate education
and in-service training. Clinical case studies and role playing
may be used in training and education to help improve cultural
awareness. Guidelines on providing culturally appropriate care
are required and should be distributed widely. BJN
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you overcome these barriers. What resources do you use or could you use (such as visual aids)?
area of practice?
Handbook Online
The essential guide to product selection
at your fi ngertips?
to product selection and is the only website of its kind,
listing every wound care product currently available in
the UK in the convenience of one easily accessible place.
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Mashhad-Iran: A Qualitative Study
1 School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
2 Evidence-Based Care Research Center, Department of Medical-Surgical Nursing, School of Nursing and
Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
3 School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Tehran University of
Medical Sciences, Tehran, Iran
4 Department of Anthropology, Faculty of Social Sciences, University of Tehran
5 Honorary Research Associate (HRA), UCL Department of Science and Technology Studies (STS), University
College London, Gower Street, London, WC1E 6BT, United Kingdom
6 Educational Science and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
Mashhad, Iran. Tel: 98-513-845-8884. Fax: 98-513-859-7313. E-mail: heidarya@mums.ac.ir
created challenges for healthcare systems.
Mashhad- Iran.
immigrants had more referral were selected.
(7 Doctors and 8 Nurses) who worked in the more referred immigrants’ clinics and hospitals were entered to the
study.
accuracy and consistency of data were confirmed. Interviews were conducted until no new data were emerged.
Data were analyzed by using latent qualitative content analysis.
(3) lack of trust, (4) cultural- personal trait.
immigrants. Some of these issues are related to immigration status and some related to cultural difference
between health workers and immigrants. These issues indicate that there is transcultural care challenges in care
of immigrants among health workers. Due to the fact that Iran is the context of various cultures, it is necessary to
consider the transcultural care in medical staffs. The study indicates that training and development in the area of
cultural competence is necessary.
caused by immigrants, has created challenges for health care systems (Kirkham, 1998). Studies have shown that
knowledge and understanding of medical staff about patients’ culture is a crucial factor in providing effective
care (Ciofi, 2005). Erlen has recommended the health professionals must initially understand the patients’ culture,
and set aside any prejudice that may affect their performance (Erlen, 1998). To offer the proper treatment, it is
necessary to make the health care personnel familiar with transcultural caring (Vydelingum, 2006).
to Madeleine Leininger, the pioneer of transcultural nursing, transcultural nursing is a substantive area of study
and practice that focuses on the comparative cultural values of caring, the beliefs and practices of individuals or
groups of similar or different cultures. Transcultural nursing is an area of expertise in nursing that responds to the
need for developing global perspective within nursing practice in a world of interdependent nations and people
(Maler-Lorentz, 2008). However health staff face with many challenges and difficulties to provide treatment and
care appropriate to the culture. One of the greatest challenges in transcultural communication is when medical
personnel and clients speak different languages (Ciofi, 2003).
these immigrants are Afghan (1,453, 513 people), 3% Iraqi (50.000 people) and 1% Pakistani (about 15-17
thousand people) (Statistical book year, 2011). Meantime, Mashhad, due to being coterminous with Afghanistan
and Pakistan and being pilgrimage, has the maximum amount of immigrants (Statistical book year, 2011). The
majorities of Immigrants who live in Iran are Shia and because of their religion have immigrated to Iran. There
are two groups of immigrants in Iran; those who have legal residency and those who live illegally. These two
groups are different regarding right of working, education and refer to health Centre. Immigrants who live
legally have right to access to the health care, but they don’t have insurance and the cost of treatment is very high.
They have right to work but they must do low-level jobs. Illegal Immigrants have not right to work and hospitals,
especially public ones, do not accept and admit them. Most of immigrants cannot refer to hospitals because of
the cost of treatment, so prevalence of chronic disease is high among them (Otoukesh et al., 2012; Koepke, 2011;
Squire & Gerami, 1998; Olszewska, 1982).
population (Cioffi, 2005; Nelson, 2002; Dias, Severo, & Barros, 2008). Several studies have pointed out that
immigrants have often less access to the health system than settlement (Adamson, Chaturvedi, & Donovan 2003;
Dyhr, Andersen, & Engholm, 2007; Smaje, 1997; Hjern, Persson, & Rosen, 2001). Neglect, abuse and
marginalization are parts of day-to-day experiences of the immigrants (Oddone, Wienberger, Freedman, &
Kressin, 2002). Literature review showed that there are some qualitative studies about nurses and midwives’
experiences of caring immigrant and minority patients (Kirkham, 1998; Boi, 2000; Cioffi, 2004; Khanyile, 1999;
McKinley, & Blackford, 2001; Murphy, & Clark, 1993; Dias, Gama, Cargaleiro, & Martins, 2012; Zwane, &
Poggenpoel, 2000). Studies on the health care staffs’ attitudes towards immigrants are almost quantitative and
examined the health cares’ views through a questionnaire (Dias, Severo, & Barros, 2008; Michaelsen, Krasnik,
Nielsen, Norredam, & Torres, 2004; Nielsen, Krasnik, Michaelsen, Norredam, & Torres, 2008). There are few
qualitative studies on medical personnel’s experience and views to immigrants (Abbott, & Riga, 2007; Priebe et
al., 2011). Considering to different cultural background and large number of immigrants in Iran, it is essential to
pay attention to transcultural caring in this society. Also, no study has been done on this issue in Iran; therefore,
in this study we aimed to examine the medical personnel’s experiences, doctors and nurses, of caring from
immigrant patients.
real feeling and attitudes of people in that context. In terms of qualitative research, the researchers have used
content analysis approach. This study has been done in Mashhad-Iran in 2013. Mashhad was chosen as place of
study, since many immigrants live there due to its coterminous with Afghanistan and Pakistan and being
pilgrimage. The most referred immigrants’ hospitals such as Hasheminejad, Imam Hossein and Imam Hadi were
selected. Fifteen health workers who met the inclusion criteria: work in the most refer immigrants’ hospital and
clinic, having a bachelor degree or higher, five years or more experience working with immigrant in that clinics
or hospitals and volunteered to join, entered to the study. Exclusion criteria were unintended to participation and
having work experience less than 5 years. To understand the factors influencing the experience of medical
personnel, purposive sampling was used.
written consent would be obtained from them. Then, the time and place of interview was determined according
to the participants’ will. To collect data, semi-structured interview was used. Participants were free to express
their feelings and experiences. First, an open question was asked of participants like “what is your experience of
caring from immigrant patients”. The researcher without directing the question, tried to obtain their experiences
through in-depth dialogue.
digital recorder. In addition to recording, face and body gestures (body language), pauses and non-verbal
gestures was noted by the researcher.
principle for choosing participants is data saturation. In this study, interviews with health staffs have continued
until the data saturation was obtained. Sample selection process has continued until no new data was appeared
during data collection.
Sciences has approved the study. The researchers explained the goal of study to the participants; although their
right to refuse participation at any time during the study was also stressed. In addition, the patients who
consented to participate in the study were asked to sign a consent form. Permission to use an audio tape recorder
during the interview sessions was obtained from health workers.
software. For data analysis, the latent qualitative content analysis by Graneheim and Lundman was used. Data
were classified and united. Uniting data includes raw coding and giving units meaning and classification
includes grouping units of meaning or logic to large classes and the main category based on the similarity
(Graneheim & Lundman, 2004). To increase reliability and validity of data, different methods such as allocating
sufficient time, in-depth interviews with participants, explaining the objectives of the study and returning codes
to participants to verify their accuracy were used.
five male and had experience ranging from 5 to 20 years. Five nurses were female and three were male and they
had experience ranging from 5 to 15 (see in Table 1). Each interview lasted approximately 45 to 60 minutes. The
results were in the main named as challenge in transcultural caring and were presented at four categories of
“communication barriers,” “irregular follow up,” “lack trust” and “cultural – personal trait”. The main core,
categories, and subcategories are presented in Table 2. Each category has been discussed in some detail.
different languages or dialects. Most personnel were not able to understand what immigrants said and vice versa.
As indicated by GP:
with the language of immigrants. Some of them even couldn’t understand me. It was a great challenge because I
had to give some information to my patients, but it was interrupted in this way and I was not happy (general
practitioner, participants 1)”.
disease between staff and patients. Immigrants were confusing personnel with different expression of signs and
symptoms. Health workers indicate this problem as follows:
this problem. We did not understand what he meant. He didn’t explain more, as he was embarrassed. After a few
sessions, we finally realized that he means his libido was low (nurse, participant 7).
their sign and symptom. For example, they say I get hot hot and it is difficult unless the doctor understands what
they culturally mean (general practitioner, participant 4)”.
common among them. Health workers indicated to two reasons for irregular follow up; consisting of residential-
financial problems and inadequate information.
they could not afford cost of treatment. Cost of treatment in Iran is very expensive for immigrant, because most
of them have not insurance. These financial problems in immigrants have created some challenges for disease
follow up.
immigrants do self-treatment and they would refer for treatment if they get worse. That’s why chronic diseases
are prevalent among them. I had a couple of cases referred to me and they need more Para-clinical examination
and follow-up, but they cannot, which is mostly due to financial issues (Internal medicine, participant 5)”.
immigrants don’t have right to admit in the public hospitals; even if they are in an emergency situation. These
situations create some problems for doctors, because they are not able to refer for further treatment. One of
doctors indicated it such as:
office and asked help me. I admitted him in the hospital on my own responsibility, but it must be legally bad for
me. We don’t know what to do in this situation; we have to do something because we have a commitment
(ophthalmologist, participant 2)”.
was lack of information about health and health seeking. Because of inadequate information, they do not worry
about their illness and are careless about themselves. The GP is pointed to this reality:
pressure above 20, but it does not matter too much for him. I told him your pressure is very high, you may have a
heart attack, it is dangerous, but it is not so important for him, He is so carefree. (GP, participants 6).
tolerate the problem until it is accidently diagnosed. The GP said that:
come for another problem. For example, a patient came to the clinic a couple of weeks ago with a blood pressure
26.5; I do not remember its diastole well. When I checked his blood pressure I even doubt, and checked it again.
Then I wanted another barometer, but the result was the same. The patient was immigrant that he came for
another problem, he couldn’t believe as well. They don’t refer for their health. I had a patient that was first
diagnosed with diabetes with blood sugar more than 300 (GP, participant 4).
form of some beliefs and behaviors such as; more drugs more qualified doctors, frequent changing doctor and
disregarding staff recommendations.
Next belief, which is common among immigrants, especially in those with low education, is belief to the
injections. They think that injection is more useful than other drugs for diseases, and when they refer for
treatment, they just ask for injections. As explained by one of our participant:
treated only with injections. It’s highly prevalent among immigrants, that Afghans called it Pichkari. When they
come here, they asked me Pichkari, if I don’t prescribe injection they leave office unsatisfied (general
practitioner, participants 1)”.
talks. They are convinced very hard, because they do not trust health workers. Most personnel complain about
the fact that immigrants don’t pay attention to the recommendations. A nurse indicated it:
their pressure I see its ok. But they don’t accept it and they ask to retake. I retake and ensure them that they are
well, but they don’t accept me (nurse, participant 11).
one of the major problems to seek treatment. Participants declared that immigrants are often distrustful, they do
not trust the staff, so they do not accept the teachings.
emerged from mistrust to physician. In fact, it is believed that if the doctor is good, they should feel better with
one or two doses of drug and if they don’t, they conclude that their illness is not diagnosed properly and they
change the doctor. They refer several doctors for a disease and each time they don’t complete the treatment.
and not completing them, they refer to another doctor and then another and another and a small problem will be
converted to a complicated issue (internal medicine, participant 5)”.
personal trait are including:
expressing their disease. Also, due to the religious beliefs, they often prefer to be examined by a same
sex doctor. Some women, especially elderly, prevent from gynecological examination. One of our
participants pointed out to this issue:
internal examination, she blamed me that shame on you, you are as old as my daughter, I had 9 pregnancy and
childbirth and no one have seen me. I insisted more and she went on bed for gynecological examination. I
realized she had complete prolapse of the uterus that half of the uterus was out of vagina. I asked her if she felt
something out of her, she said yes I did. I asked why you didn’t say it. She told I shied to tell my daughter and
granddaughters (Gynecologists, participant 3)”.
major role of decision-making in the family to be the responsibility of men. Participants stressed that in
some families, the authority is to the extent that women cannot follow up their disease if their husband
was unsatisfied. Of course, especially if the disease is related to the uterus and reproductive system, the
men decision-makers are more pronounced. As indicated by a doctor:
for emergency surgery. After a while, she came back and said: “my husband did not let me for surgery, he told
me if I operates my uterine he would divorce me or remarry (Gynecologists, participant 3).
isolated and are not sociable. Staff stated that immigrants often cannot communicate and we have to pin
them down. They are often convinced, shy and unexpected. Inabilities to communication harm their
health and prevent health workers to easily understand their problems.
to the formation of four categories: communication barrier, irregular follow up, lack of trust and personal –
cultural traits. It was indicated that there are transcultural challenges regarding the care of immigrants among
health care workers. Due to the large number of immigrants and different cultures in Iran, paying attention to this
subject is necessary. So this study provides unique and innovative result for improving quality of health care in
Iran.
proper care for people with diverse culture and language is communication barrier (Scheppers, Dekker, Geertzen,
& Dekke, 2006). Several possible reasons have been proposed for communication barrier, including different
interpretations of signs by immigrants and health workers, different language in two groups and different health
needs (Adamson, Chaturvedi, & Donovan, 2003). Furthermore, our study revealed that there are two kinds of
language barrier; firstly different language and secondly different interpretations of the signs and symptoms of
disease. On the other hand according to Steeger and Lipson, the effective trans-cultural communication includes
emotional, cognitive and behavioral strategies. Emotional strategy includes respect, appreciate and feel
comfortable with the cultural differences, learning through cultural exchange, ability to have unprejudiced
behavior and awareness of cultural values. Cognitive strategy involves acquiring knowledge about different
cultures and ability to understand the culture. Behavioral strategies include flexibility in verbal and non-verbal
communication, ability to speak calmly and without accent. These strategies show that language is only small
part of the communication process and cultural resources and realities of the patients should also be considered
(31). Therefore, in our study the problem is low communication skills and familiarity with the transcultural care
among health care workers. Unfortunately there is no proper training for medical student and staff in Iran for
transcultural communication and cultural competency. In this regard, it is recommended to provide proper
transcultural communication training for health care workers, to enable them to communicate effectively despite
the language and culture difference.
because of financial-residential problem and low information. Different studies pointed out the residential-
financial problems of immigrants as barrier for health care seeking (Scheppers, Dekker, Geertzen, & Dekke,
2006). On the other hand, low knowledge and information about disease among immigrants is one of the
problems that have indicated by different studies (Lipson & Omidian, 1997; Refuges watch, 2000). Lack of trust
was another category in our study, which was confirmed by other research. Studies have indicated that mistrust
toward health care system is more common among immigrants because of their situation and condition. They
result in mistrust. In addition other studies in Iran showed that patients had lack of trust to personnel because of
unequal and superior-inferior relation between the staff and patients (Vaseli, Dehghan-Nayeri, Borim-Nezhad, &
Vedadhir, 2015). Ignoring and not meeting the emotional and psychological needs of the patient was evidence of
non-interactional communication in Iran. This unfair relation resulted in patient’ distrust toward the staff.
that could limit their treatment and care. Individual cultural behaviors are varies from person to person and
society to society. By recognizing these cultural behaviors, substantial steps can be taken to resolve the defects.
Meyer and colleagues provided four major challenges for cultural competency in health caregivers. First, there is
a different understanding of disease in different areas; for example, some patients according to their culture do
not want to talk about sexual problems. If we respect culture, won’t we ignore the sexual problems? (Meyer,
2012). In our study, there was also this challenge for health care staff. Patients disagree with discussing or
examining the sexual issues and even prevent from doing so. Here, a challenge is created for the staff whether
they should respect their cultural restrictions or do the treatment. Men power in decision-making for women’s
health care had created problems for staff, because entering the family environment was considered as annoying
action. On the other hand, if no intervention has been done, the person may die due to the disease.
the challenge existed somehow. The next challenge is race, if a group has a higher education level, we should
respect them or due to cultures, we must try avoiding the culture of dominating and the fourth is trust which is
obtained hardly because of different cultures (Meyer, 2012). In our study, most personnel have indicated that
immigrant mistrust health care workers and this caused they not pay attention to their recommendation.
due to the fact that Iran is a ground for different cultures and also due to the pilgrimage of Mashhad and having
large numbers of pilgrims annually from neighboring countries. Considering domestic and foreign cultures can
improve the quality of healthcare services provided.
cultures in Iran, it is the first study that works on transcultural caring. It is very important subject in health area
that should be considered by scholars and further research about this topic is necessary. Furthermore, for practice
it has some implication; pay attention to needs of immigrants and especially their cost of treatment should be
considered by UN, also holding some training course to enhance health information of immigrants is
recommended. As well as holding transcultural caring course is needed for health care workers.
interview. They didn’t like to interview beyond their job and in job environment (hospital, clinics or office), they
were very busy. So we asked 10 nurse and 10 doctors to participate, but some of them did not accept our request.
Next limitation is that in our study we consider health workers as nurse and doctors and did not consider other
groups of health workers. Finally, in addition to interview, using other data gathering strategies such as
observation helped strengthening the data.
The authors thank all participants for participating in the study.
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PERSPECTIVE OF MADURA CULTURE IMPROVING BREASTFEEDING
Meningkatkan Perilaku Ibu Menyusui di Jember)
Faculty of Health Sciences University of Muhammadiyah Jember
dapat mempengaruhi keberhasilan ibu dalam memberikan ASI secara ekslusif, diantaranya adalah dukungan keluarga
maupun pengaruh budaya lokal. Tujuan Penelitian ini untuk menerapkan model keperawatan transkultural dalam
perspektif budaya Madura pada ibu menyusui. Metode : Penelitian ini dilakukan di desa Suboh wilayah kerja Puskesmas
Pakusari, pengumpulan data menggunakan kuesioner, dan fokus group diskusi. Desain penelitian quasi eksperimen
post test design with control dengan analisis Paired Samples Test. Selain itu, peneliti juga melakukan analisis kualitatif
untuk mengeksplorasi budaya Madura. Sampel yang digunakan adalah ibu menyusui yang mempunyai bayi usia 1-6
bulan sebanyak 50 sampel dan dibagi menjadi 2, yaitu kelompok perlakuan dan kontrol. Selain itu sumberdata lain yang
digunakan adalah tenaga kesehatan. Hasil: Hasil penelitian didapatkan bahwa rentang usia ibu antara 15 – 34 tahun, dengan
rata-rata berusia 27 tahun, selain itu rata-rata pendidikan responden tidak tamat SD sebanyak 60%, baik pada kelompok
perlakuan maupun kontrol. Hasil analisis tentang modifi kasi budaya didapatkan P value 0,001 yang artinya ada pengaruh
penerapan model transcultural nursing dalam Meningkatkan perilaku ibu menyusui. Diskusi: Aplikasi modifi kasi budaya
yang dilakukan mampu meningkatkan produksi ASI. Perlu kerjasama yang baik bagi semua komponen masyarakat dalam
mensuport ibu menyusui dengan memodifi kasi budaya lokal yang kurang menguntungkan bagi kesehatan.
can aff ect mother’s success in breastfeeding exclusively, such as family support as well as local cultural infl uences.
This research aims to apply the transcultural nursing model in Madura cultural perspective in breastfeeding mothers.
Method: This research was conducted in Public Health Centre of Pakusari Suboh Jember. The data were collected using
questionnaires, and focus group discusses. The research design was question-experimental research of post test design
with control by using Paired Samples Test analysis. In addition, the researchers also performed a qualitative analysis
to explore the Maduranese culture. The samples were breastfeeding mothers who had infants aged 1-6 months, and 50
samples were then divided into two, i.e., treatment and control groups. Also, another data source were health professionals.
Result: The result showed that the maternal age range between 15-34 years with an average age of 27 years. Besides,
the average of the respondents’ education background was that 60% of them did not pass elementary school, both in
treatment group and control group. The results of the analysis on cultural modifi cations were p-value of 0.001, which
means that there are the eff ects of applying the transcultural nursing model in improving mother behavior. Conclusion:
An application of cultural modifi cations that is able to increase milk production. Therefore, it needs a good cooperation
for all the components of society in supporting breastfeeding mothers by modifying less the local culture that becomes
favorable for health.
one of the tasks in the health care of children
(babies), but in reality, not all mothers can
carry out these tasks well, not successfully
breastfeed or stop breastfeeding early. This
condition does not only affect the health of the
with the self-concept as a mother since it
cannot be an optimal role in health care to her
babies (Study et al. 2010). Breastfeeding plays
an important role to maintain the health and
survival of infants because breast milk is the
best food for babies. Breast milk is the right
will make babies rarely suffer from diseases
and avoid malnutrition compared to infants fed
other milk (Study et al. 2010) (Some research
shows that even though a breastfeeding mother
in a state of malnutrition, the breast milk
still has enough quality. The differences in
maternal nutrition affect only the quantity of
breast milk and not on the quality of breast
milk. Exclusive breastfeeding in Indonesia
is still very alarming, and it needs a lot of
attention from all sides. Mother awareness to
exclusively breastfeed their babies is still very
poor and shows a decline from year to year. In
2008, coverage of exclusive breastfeeding was
only 24.3%, in 2009 was 34.3%, in 2010 was
only 15.3%, while the target to be achieved
should be 80%. The low number of exclusive
breastfeeding triggers the low nutritional status
of infants and toddlers and can be an indirect
cause of infant mortality (Study et al. 2010).
2016, which was published in the bulletin
Lancet reveals breastfeeding can reduce infant
mortality by 13 percent, a variety of adverse
effects can occur in infants if they do not get
breast milk (Study et al. 2010) Other data on
lactation research notes that the IQ of premature
babies group who were breastfed is 8.5 points
higher than those are given formulated milk.
While the research conducted in Guatemala
argues that the delay of lactation onset became
a significant greater risk of doing short-term
breastfeeding (Study et al. 2010).
Jember district is not much different from
some places in Indonesia. The data from the
Department of Health Jember 2014 shows that
infant mortality rate (IMR) increased from the
previous year into a range of 398 439 cases each
year. Based on the data that there are several
causes of infant mortality is 48 per cent due to
malnutrition, 15 per cent because of shortness
of breath, and 15 percent of other cases (Study
et al. 2010). It becomes interesting to study
because of Jember as one of the districts in
East Java with Madura ethnic population is
greatest. Knowingly or not, the factors of trust
and cultural knowledge as conceptions about
between food and health-illness conditions,
habits and ignorance, have brought both
positive and negative impacts on the health of
mothers and children. Breastfeeding success
also greatly influenced by many factors both
from within his own mother as well as from the
surrounding environment. One powerful factor
is of social, cultural and environmental factors
in the community where they are located. A
culture is a form of human adaptation to the
environment. Adaptation in the broad sense
includes all the behavior and habits and set
forth in the mind, knowledge, attitudes, and
practices; all intended as a form of reaction
to the environment (and amendments thereto)
both internally and externally (Nurwidodo.
2006) . Model transcultural nursing is a
formula that can be developed to bridge the
local culture in order to become a culture
which is positive for the health of mothers and
babies, and in this case is a nursing mother.
Indonesia, we can see the conception of culture
embodied in the daily behavior related to the
culture different of postpartum mothers with
modern health conception. Socio-culture
factors have an important role in understanding
the attitudes and behaviors responded to birth
and breastfeeding. Most cultural views on
these matters have been handed down in the
culture of the community. Therefore, even
though health officials might find a form of
behavior or attitude that proved to be less
beneficial for health, but it is often not easy for
health professionals to make changes on it, due
to having been embedded beliefs underlying
attitudes and behaviors in depth in the local
culture.
especially nursing mothers maternity, building
on the development of local culture to be able
to support successful breastfeeding. The aims
of this study are as follows:
1) To analyze the Maduranese culture and
breastfeeding through transcultural model
approach.
transcultural in Maduranese culture among
nursing mothers.
modifi cation through the implementation
of the transcultural model to be a positive
culture for nursing mothers both in treatment
group and control group.
(UNICEF) claims that there are 30,000 infants
deaths in Indonesia and 10 million deaths of
children under five in the world each year. It
could be prevented by breastfeeding (breast
milk) exclusively for six months after birth,
without providing food or beverage additives in
infants. UNICEF also states that infants fed by
formula milk are likely to die during the first
month of his birth, and the opportunity was 25
times higher than babies who are breastfed by
mothers exclusively (Nigel & Bandari, 2016).
several factors, such as lack of knowledge,
awareness, motivation and low maternal
attitudes to breastfeeding, in addition to
the strong cultural inf luence also provide
a substantial contribution to the failure of
exclusive breastfeeding.
pregnancy and birth for women with all good
and bad consequences on the health of these
need to be considered for health professionals
in Indonesia in an effort to increase the success
of health care services they apply for both
mother and baby.
health team has a very big role in helping
improve the health status of the community,
especially the health of mothers and children.
Maternity nurses should be able to mobilize
community participation in particular, with
regard to maternal health, maternity, nursing
mothers, newborns, teenagers and the elderly.
Community involvement in order to care
for his health can be implemented; then the
health professionals should be able to find the
approach to society that the program launched
by the government can be successful and at the
malnutrition.
references to develop the potential of people
with a culture of Madura in Jember. The
number of cultural rules in society, as well
as the myths that developed Jember related
nursing mothers, is very detrimental to mother
and baby. It has an impact on the high infant
mortality rate (IMR) is one of the reasons is the
poor nutrition due to poor feeding behavior.
forms of real interaction as human beings and
social creatures. Culture, in the form of norms,
becomes a reference of human behavior in
life one others. The pattern of life that lasts
long in one place, which is always repeated,
makes human beings tied up in the process.
The sustainability to constantly live a life and
last long are the process of internalization
of the values that influence the formation of
character, thought patterns, the interaction
patterns of behavior all of which will have an
influence on nursing intervention approaches
(cultural nursing approach). Culture has broad
influences in lives of an individual. Therefore,
it is important for nurses to know the cultural
background of the patients (Andrew, M. &
Boyle, J. S, 2008). Local wisdom can be
formed from a way of thinking and behavior of
the community when responding to problems
that arise around it (Wahyuningsih, S. 2014).
((PDPI 2011)
direction in nursing which focuses on study
and comparative analysis of cultures and
sub-cultures in the world and appreciate the
behavior of caring, nursing services, values,
beliefs about healthy sick, as well as patterns
of behavior aimed at developing knowledge
the body of scientific and humanistic nursing
practice in order to make room for the
particular culture and universal culture (Potter,
PA & Perry, AG 2009). The transcultural
nursing theory emphasizes the importance of
the role of nurses in understanding the client’s
culture.
themselves about the culture of clients, whether
individuals, families, groups, and communities
can prevent imposition.Cultural culture shock
and culture shock occurs when an outside
party (nurses) are trying to learn or adapt
effectively to specific cultural groups (clients)
whereas culture imposition is the tendency of
health professionals (nurses), either secretly
or blatantly imposing cultural values, beliefs,
and habits/behavior on individuals, families,
or groups from other cultures because they
believe that their culture higher than in the
other group’s culture (Leininger M and MC
Farlan MR, 2002).
in performing transcultural nursing models,
namely:
the principles of aid, facilitate, or pay attention
to the cultural phenomena in order to form the
individual determines the health and lifestyle
desired.
i.e., the principles of aid, facilitate, or pay
attention to the cultural phenomenon, refl ecting
the ways to adapt or negotiate or consider the
health and lifestyle of the individual or client.
i.e.,the principle of reconstruction or change
the design to help improve health conditions
and lifestyle towards better client (Leininger
M and MC Farlan MR, 2002).
theoretical basis of nursing practice based on
cultural or transcultural nursing, they will
undergo a cultural shock. It will be undergone
by the client in a condition where nurses are not
able to adapt to differences in cultural values
and beliefs. this may lead to the emergence
of a sense of discomfort, powerlessness, and
some will be disoriented. It is important
for nurses to understand their own culture
before understanding transcultural nursing.
In applying transcultural nursing, not only
culture that must be considered, but also keeps
in mind the nursing paradigm that can be
applied in transcultural nursing.
forms of real interaction as human beings and
social creatures. Culture in the form of norms,
customs become a reference human behavior
in life with others. Madura community is
known to have a distinct culture, unique, and,
it is considered as the cultural identity of the
individual ethnic identity of Madura in behavior
and Bohemian society. In the Maduranese
culture, women were ‘reserved’ husband is
fully under his control. The absolute leadership
is in the hands of the husband (male). Men
who have a right to determine what is allowed
and what should not be done by women for
women is hers. Because women are at the
center of self-esteem of men, then women
are being protected, controlled and owned by
men (Putra, J.S. 2012). The weak bargaining
position of women seems to have consequences
far greater, that women do not have access to
health care, even when they are pregnant.
Besides the many myths that developed in the
Maduranese community about breastfeeding,
also contribute to the low achievement of the
target of exclusive breastfeeding. Breastfeeding
is a natural process and is one of the tasks in
the health care of children (babies), but in
reality; not all mothers can carry out these
tasks well, not successfully breastfeed or
stopping breastfeeding early (Rejeki, S. 2014).
Breastfeeding mothers need a strong support in
order to provide their exclusive breastfeeding
for 6 months. Collaborative culture and the
latest methods of breastfeeding can increase the
overall successful coverage lactation. Hence,
the application of the transcultural model
is the most appropriate way for Indonesian
people who are still highly affected by local
cultural.
quantitative with the question-experimental
approach of post-test design with control. As
for the exploration of the culture of Madura,
the researchers also conducted a qualitative
approach.
Jember district, especially in Suboh village.
children aged 1-6 months, with the Madurese
people in 4 districts Suboh village Posyandu
Pakusari with purposive sampling approach
in 50 samples. In addition, researchers also
obtained data from couples and families
mothers as participants, validate the data on
Community Leaders, and Jember District
Health Office.
in-depth interview and FGD (focus group
discussion). Quantitative data analysis is
done by using the data homogeneity test
Kolmogorov Smirnov and continued with the
analysis Paired Samples Test, while data FGD
results presented in qualitative terms.
submissive to some information given by the
community leaders or scholars. The myth that
developed in the community about pregnancy,
childbirth and postpartum may be inhibiting
the achievement of the health program to
reduce maternal and child mortality rate.
Some cultures are found in pregnant women,
childbirth and breastfeeding are very unique,
there is positive support also exists negative
women have birth to a shaman, to reduce
pain during labor the mother’s body smeared
with hot ash, to reduce the swelling of the
vagina after giving birth mothers are given
the herb ginger mixed with salt to compress.
Other cultures are related to breastfeeding
infants were given coconut if the milk has not
come out, do a breast care on the river with
sand, mothers should not eat fish because
milk will be fishy and only recommended
to eat vegetables. Some characteristics of
nursing mothers in the village Suboh have
been identified include:
age of nursing mothers in the control group
is 26 years old with a minimum age of 16
years while the maximum is 34 years old
and the average age in the group treated with
the 27-year minimum age 15 years, while
the maximum was 34 years old. Data shows
that most respondents did not complete
primary school either the treatment group
or control of 60% and 64%. Breastfeeding
mothers’ behavior to find out the behavior of
lactating mothers in the treatment group or
the control group then performed Normality
Test Data. The results of the analysis using the
Kolmogorov Smirnov test: indicates that the
The age of treatment group The age of control group
Missing 0 0
Median 28.0000 26.0000
Mode 32.00 18.00a
Std. Deviation 5.37742 5.79281
Variance 28.917 33.557
Minimum 15.00 16.00
Maximum 34.00 34.00
a. Multiple modes exist. The smallest value is shown
Elementary school/no school 15 60.0 16 64.0
Junior High School 9 36.0 8 32.0
Senior High School 9 4.0 1 4,0
TOTAL 25 100.0 25 100.0
P value in the control group and the treatment
group 1.002 0.659 greater than 0.05 The test
results obtained using Paired Samples Test P
value 0,001 <0,05 so that it can be concluded
there is the influence of culture through the
modification of the Transcultural nursing
model in improving milk production
that is always carried out by mothers in this
village, apart from exclusive breastfeeding
or not. Nowadays with the advancement of
information and the active region midwives,
nurses and volunteers have much to change
the culture and myths. Model Transcultural
nursing is an effort to help people understand
their health, through a cultural perspective
treatment group
control group
Normal
Parametersa
Std. Deviation 17.98685 17.98685
Diff erences
Positive .132 .132
Negative -.073 -.073
Asymp. Sig. (2-tailed) .268 .778
a. Test distribution is Normal.
perspective in treatment group and control group.
Paired Diff erences
Sig.
(2-
Std.
Error
Mean
Interval of the
Lower Upper
1
behavior of
treatment
group
beavior
of control
group
effort to help people understand their health
but does not eliminate the existing culture.
According to Leininger, 2002, the strategy used
in applications such transcultural nursing
a)
health. Perencanaan and implementation
of nursing provided in accordance with the
relevant values which have been owned by
the client so that the client can improve or
maintain their health status.
to a particular culture more favorable to
determine other cultures that favor health
improvement.
working to restructure the client’s lifestyle.
The pattern of life plan selected is usually
more profi table and in accordance with the
beliefs held.
or forms of interaction as a social human
being. Madurese community is known to
have a specific culture, unique, and, cultural
identity is considered as the individual
identity of ethnic Madurese in behaving and
in the community (Wulansari , S, Sadewo,
dan Raf lizal. 2014). The results of research
on Madurese community about breastfeeding
are breastfeeding is an activity that is always
carried out by mothers in this village, apart
from exclusive breastfeeding or not. Nowadays
with the advancement of information and the
active region midwives, nurses and volunteers
have much to change the culture and myths.
effect of cultural modification through the
transcultural nursing model in increasing milk
production Model Transcultural nursing is an
effort to help people understand their health,
through a cultural perspective adopted. Model
transcultural nursing is an effort to help people
understand their health but does not eliminate
the existing culture. According to Leininger,
2002, the strategy used in applications such
transcultural nursing
patient is not contrary to the culture of health.
Perencanaan and implementation of nursing
provided in accordance with the relevant
values which have been owned by the client
so that the client can improve or maintain their
health status.
nursing at this stage to help clients adapt to a
particular culture more favorable to health. The
nurse helps clients to choose and determine
other cultures that favor health improvement.
culture of adverse health status. Nurses are
working to restructure the client’s lifestyle.
The pattern of life plan selected is usually
more profitable and in accordance with the
beliefs held.
breastfeeding among Madurese people. An
application in the form of cultural modifications
as made through a trial model of transcultural
in Maduranese culture was to allow an
education on lactation management using the
existing culture, demonstration by developing
a culture that is to be adapted to modern
techniques associated with the treatment of
breast and massage oxytocin. There was the
inf luence of cultural modifications to the
successful breastfeeding in Suboh, Pakusari,
Jember district.
the local culture in the community about
health. There were three attempts related to
culture in the community to support the health
of which is to preserve the culture, to negotiate
culture and to reconstruct culture.
figures in providing health education related to
local culture so that the results can be achieved
well. It needs to establish a breastfeeding
counselor at health services, both in clinics and
health centers with a hope to improve public
knowledge regarding exclusive breastfeeding.
It needs to improve socialization of exclusive
breastfeeding for the implementation so that it
can be maximized and perceived by the public.
It takes the government’s courage in enforcing
Jurnal INJEC Vol. 2 No. 1 Juni 2017: 9–16
Regulation of the Republic of Indonesia No.
39 of 2013 on infant formula, in all maternal
and child health services. Community figures
among Maduresecommunity become a figure
and role model in daily lives. Thus, it needs a
good cooperation between health officials and
local community figures to actively participate
in helping the surrounding community in
modifying a negative culture into a positive
culture for public health.
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emotional distress, using the Theory of Culture Care. Method: Qualitative study with nine caregivers of home care dependent older
adults, based on Grounded Theory. Results: The fi ndings allowed the identifi cation of potentialities and frailties in the context of
family home care and subsidizing the construction of a theoretical scheme resulting from the analysis of possibilities of the nursing
care practice according to the culture, through the three modes of action: maintenance, adjustment and repatterning of cultural
care. Final considerations: Respecting the cultural values and family beliefs, the nurse can help to institute mutually established
changes, promoting a better quality in the nursing care relationship and a relief to the strain of the role of the caregiver.
Descriptors: Caregivers; Family; Older Adult; Nursing Theory; Culture.
Objetivo: Analisar as experiências de cuidadores familiares de idosos dependentes, que apresentam sobrecarga e desconforto
emocional, à luz da Teoria do Cuidado Cultural. Método: Estudo qualitativo, fundamentado na Grounded Theory, com nove
cuidadores de idosos dependentes de cuidados no domicílio. Resultados: Os achados possibilitaram identifi car potencialidades
e fragilidades no contexto familiar de cuidado domiciliar e subsidiaram a construção de um esquema teórico decorrente da
análise das possibilidades de atuação da enfermagem mediante um cuidado congruente com a cultura, através dos três modos
de ação: manutenção, ajustamento e repadronização do cuidado cultural. Considerações fi nais: Respeitando os valores culturais
e as crenças da família, o enfermeiro pode ajudar a instituir mudanças, coestabelecidas com os cuidadores, que promovam uma
melhor qualidade na relação de cuidar e aliviem a tensão do papel de cuidador.
Descritores: Cuidadores; Família; Idoso; Teoria de Enfermagem; Cultura.
Objetivo: Analizar las experiencias de los cuidadores familiares de los ancianos dependientes, que presentan sobrecarga e incomodidad
emocional, a la luz de la Teoría del Cuidado Cultural. Método: Estudio cualitativo, fundamentado en la Grounded Theory, con nueve
cuidadores de ancianos dependientes de cuidados en el domicilio. Resultados: Los hallazgos posibilitaron identifi car potencialidades
y fragilidades en el contexto familiar de cuidado domiciliar y subvencionaron la construcción de un esquema teórico decurrente del
análisis de las posibilidades de actuación de la enfermería por medio de un cuidado congruente con la cultura, a través de los tres
modos de acción: el mantenimiento, el ajuste y la re-estandarización del cuidado cultural. Consideraciones fi nales: Respetando los
valores culturales y las creencias de la familia, el enfermero puede ayudar a instituir cambios, coestablecidas con los cuidadores, que
promuevan una mejor cualidad en la relación de cuidar y alivien la tensión del papel de cuidador.
Descriptores: Cuidadores; Familia; Anciano; Teoría de Enfermaría; Cultura.
Couto AM, Caldas CP, Castro EAB.
and definition of means to communicate it are requirements for
a profession. Thus, any nursing practice needs theoretical foun-
dations. The theory can offer a systematic way to view facts and
events, and provide contribution to the research process, diag-
nosis, planning, implementation and evaluation of nursing(1-2).
tice, the theories should guide research, teaching, manage-
ment and care assistance. By developing theories and studying
their applications in professional practice the status of science
is enforced and the specific field of knowledge is widened(3).
on the specificity of the concept, there are different existing
definitions that explore various perspectives and complement
each other. This study adopted the definition of Madeleine Le-
ininger, who defines care as the actions and activities directed
to the assistance, support or training of another individual or
group with clear or anticipated needs, to improve the human
condition, way of life or to face death(1,4).
Leininger conceives the existence of social and cultural forces
that exert important influences on human beings and, conse-
quently, on the process of care. Considering this, health profes-
sionals should give more attention to the resulting attributes of
culture. In the nursing field, the disregard for these factors in
care practices, the looseness from the cultural reality of the per-
son, the incongruity between the act of caring and their values
and beliefs may result in the appearance of cultural conflicts,
frustrations, stress and even moral and ethical concerns(3-5).
model facilitates the understanding of the triad individual-
family-group when facing their cultural values and ways of life,
being relevant to the nursing care by allowing the construc-
tion of complex and critical thinking about the dimensions of
the cultural and social structures in each specific context(2,5-6).
the process of nursing care, the model is divided in four levels:
1 – it leads to the study of nature, significance and attributes of
nursing care; 2 – it provides knowledge about the individuals,
families, groups and institutions, in various health systems; 3 –
it focuses on the popular system, the professional system and,
in it, nursing; 4 – it is the level of the decisions and actions of
nursing care, which involves the cultural preservation/main-
tenance of care, cultural accommodation/negotiation of care
and the cultural repatterning/restoration of care(2,5-6).
older adults at home by a family member has its own character-
istics in different contexts, despite being an universal phenome-
non observed in multiple nationalities and cultures. Having this
as basis, the nursing care must be based on the theory of cultur-
al care, being adequate to every individual or group, respecting
their characteristics and using actions that are consistent with
the values and the needs identified in each situation(2,5).
ic and epidemiological transition in Brazil, which contributes to
action processes of older adults and create the need for family
care(7).
to older adults in need of assistance in Brazil, becomes ex-
tremely important to meet the needs and demands of this
population. Through the cultural dimension of nursing care,
the nurse avoids the nursing care practice as just empirical
or technical, and performs a practice rooted in scientific and
theoretical models. In the context of family caregivers of de-
pendent older adults, the nurse needs to perform nursing care
using family experiences, the sociocultural context of the fam-
ily, considering nursing experiences from the culture in which
the binomial older adult-caregiver is inserted(2).
theory of Culture Care Diversity and Universality could pro-
voke reflections on the phenomenon “the life context and the
experience of caring for dependent older adults in the home
environment by family caregivers who show performance
overload and emotional distress”?
aspects to the relative, such as changes in physical and emo-
tional state, imbalance between activity and rest, as well as
compromised individual coping. These are the attributes of
the strain placed on the caregiver, this is a significant aspect of
our cultural care reality(8-11). Given the context of performance
overload and emotional distress of the family caregiver, know-
ing their psychosocial responses allows the understanding of
how to plan for home care.
overloaded and emotionally distressed family caregivers of de-
pendent older adults at home, pointing to the implications for
the practice of Nursing with the use of the Theory of Culture
Care Diversity and Universality.
The project met the recommendations of Resolution no.
research involving human beings in Brazil. The survey was
conducted with approval by the Research Ethics Committee
of the University Hospital of UFJF. This study used precious
and semi-precious stones as codenames for the participants to
guarantee their anonymity.
This is a qualitative study using Grounded Theory(12) as the
members with different sociocultural patterns.
Madeleine Leininger provided subsidies for this analysis through
these concepts and assumptions: culture, cultural care, diversity
of cultural care, universality of cultural care, vision of the world,
Couto AM, Caldas CP, Castro EAB.
care, maintenance of cultural care, adjustment of cultural care
and repatterning of cultural care(4-5).
The research took place in two scenarios. It was initially
Hospital Universitário da Universidade Federal de Juiz de
Fora [Geriatrics and Gerontology Clinic of the University Hos-
pital of the Federal University of Juiz de Fora], Minas Gerais
– Brazil, serving as the place to identify older adults depen-
dent of others for their Basic Activities of Daily Life (BADL)
and their main caregivers during nursing appointments. The
home of the binomial dependent older adult-family caregiver
became the second scenario. The strategy adopted to collect
data were home visits as a form of getting closer to, knowing
and characterizing the caregivers as well as observing their
work overload and emotional distress.
A total of 78 older adults were evaluated, the Katz in-
tant dependency on the BADLs. Of these, 27 older adults
were identified. The main family caregiver of the dependent
older adult was identified and evaluated for the presence of
performance overload on the caregiver role, using the Zarit
scale for assessing caregiver burden (Burden Interview)(14)
and for detecting emotional distress (Self Reporting Ques-
tionnaire – SRQ-20)(15).
distress levels of the relatives, those who presented moder-
ate, or moderate to severe performance overload and scores
above the cutoff point for emotional distress in the SRQ-20
scale were selected to participate in the qualitative phase of
the study, which occurred between August 2012 and March
2013, period in which this article was written. Twelve (12)
caregivers met the inclusion criteria. Semi-structured inter-
views and participant observation were done during the home
visits, field journals were made for nine of these caregivers,
noting the theoretical saturation.
in one or two meetings, by appointment and prior consent.
the observation period and later expanded in the form of
memos. The transcripts of the interviews and the pre-analysis
were done after expanding the notes and before the next in-
terview, starting the processes of open, axial and selective en-
coding, as pointed by the methodology(12).
The emerging content were transcribed and analyzed as
and selective encoding. Through this process a group of codes
in subcategories were obtained and then, categories accord-
ing to concepts that led to the reflection of the phenomenon
“the life context and the experience of caring for dependent
older adults in the home environment by family caregivers
text-focused intervening conditions allowed the further analy-
sis through the Theory of Culture Care Diversity and Univer-
sality of Madeleine Leiniger.
scribed in the four categories formed to explain the phenom-
ena through the observation in the homes of families who
live and care for a dependent older adult and through the
interviews conducted with the main caregivers. The four cat-
egories are: becoming a caregiver; the experiences of being a
caregiver for a dependent older adult; demands resulting from
the process of nursing care for a dependent older adult by a
family member; and search for support and training.
dent older adult
An identified potentiality was the prior experience with the
members or even volunteer work. This characteristic outstood as
a facilitating aspect for the adaptation to the routine of care that
needs to be provided to the current dependent family member.
hair, helped them with dressing, made the bed, did laundry.
They were known, […] it was voluntary. That helped me a
lot. (Ruby)
faced in the initial phase of the caregiver role – fear, insecurity
and inexperience were frequent. Over time, the relatives expe-
rienced relief of those feelings and scenarios, the emergence
of adapting to their new life condition was noted, which facili-
tated their perception and identification of resources to over-
come the obstacles. The caregivers, through their continuous
care experiences, consolidated the experience and gradually
adapted to the needs and routines of the older adult required
by nursing care. This led to the adaptation and establishment
of an empirical process of care. Thus, strategies were created
such as delegating responsibilities to other family members to
minimize the overload and emotional distress feelings as well
as avoiding suffering.
[emphasis] difficult. (Jade)
I’m actually delegating now. […] I didn’t do that before. It
was all me. (Sapphire)
of their actions, in addition to moments of harmonious inter-
action between the caregiver and the older adult, emerge from
the continuous caring experiences, which can be identified
on the reports given by the caregivers. We comprehend these
feelings as fundamental to the maintenance of the self-esteem
Couto AM, Caldas CP, Castro EAB.
commitment to the health condition of the relative.
see what I can do to help, and if I can help I’ll be happy.
And for my limitations, what I can do makes me happy, it’s
not even for taking care of an older adult, it’s the possibil-
ity that I’m dodging my own disease, and that by helping
someone else I am helping myself. (Crystal)
lationship is also identified such as the support of secondary
caregivers and the possibility of delegating some activities to
other family members. The existence of support, especially
financial, was identified as well as the direct collaboration in
the care for the older adult.
take care of her during the day. (Agate)
caregivers in nursing appointments and the home visit followed
by interview for this study, movements of support and profes-
sional support seeking the forming of a social support network,
the start or increase in frequency of the search of religiousness/
spirituality as major strategies to keep performing the task of car-
ing. These actions were aimed at the minimization of the nega-
tive effects caused by the stress in the role of caregiver.
her, especially. (Crystal)
that I come here in the fence […] I call a neighbor they are
willing to help me. (Crystal)
Then, the support I seek in God, because my support is in
Him. Fully in God. (Emerald)
I talk to my saints that help. When I am sad and facing dif-
ficulties I pray. (Ruby)
older adult
The loss of autonomy and independence of older adults
diseases. Dementia profiles were diagnosed in six of the nine
dependent older adults cared by the participants of this study.
and the loss of memory and identity), on the perception of the
surveyed caregivers, is that they make them feel anguish, pain,
sadness, anger and even depression, showing a difficulty in ac-
cepting the process of family dependency of the older adult.
revolt, then, when I see, I start crying. (Tourmaline)
I’m going to tell you, I’ve got a chance to talk to a person,
this disease is worse than cancer, because it takes even the
dignity and the identity of the person. […] it’s sad, taking the
identity of the person, right? (Sapphire)
sence of prior experience with the process of care. When
caregivers became aware of the responsibility that was
dropped into them, when all the basic and instrumental daily
care needs of the relative became their responsibility, they
felt threatened by lack of knowledge or skills, especially to
perform some activities such as bathing, diaper change and
administration of medications.
(Jade)
medical prescriptions so I can buy less expensive diapers
using the government program, you see. […] In this part,
to care of hospital, of doctor, of medicine, of bath, of food,
everything, I’m the one doing it, but at the beginning it was
very difficult. (Emerald)
er was accompanied by impacts on various aspects of life and
health, causing a series of limitations and difficulties for their
lives. According to the participants, the higher risks of getting
ill, self-negligence, performance overload and emotional dis-
tress are caused in part by the uncertainties and the dilemmas
in the family relations, and for the most part, the absence of
an established support network of family members. The lack
of days or moments off and the absence of relay of the care
activities between family members are examples.
ily. (Crystal)
sibility. (Jade)
holiday, there are no breaks or days to rest. (Tourmaline)
perience of nursing care of dependent older adults can be
understood as the set of changes that happened in their lives
from the moment when the need to take such care took place.
In the initial context, caregivers reported that the love life start-
ed to occupy a secondary plan, they had to leave work to take
care of the family member, in addition to the loss of commit-
ment with social activities such as leisure activities and chang-
es in their health conditions. Changes in the health conditions
include changes in the usual pattern of sleep, with a reduc-
tion of time and quality, because of the constant interruptions.
Couto AM, Caldas CP, Castro EAB.
dition to the coexistence with negative feelings.
one to be with her. […] I don’t have freedom to take a walk
or to have an hour for lunch. So, I abandoned entirely my
leisure, for her. (Crystal)
with the littlest movement I’m awake. I watch her at night,
if she is breathing and everything, I already have it, this
fear. (Pearl)
daily lives of families happen, especially in the course of life
of the main caregiver. The routine of care was shown to be
pervaded by diverse and contradictory feelings such as fear,
sadness, insecurity, concern, conflicts and tensions. Fear was
a very common sentiment and it was related to several factors,
being evidenced by the fear of “the degree of dependence” of
the older adult getting worse and this representing an increase
in the already high demand for care given by the caregiver.
do? It’s going to be even more difficult. (Pearl)
able to handle it. (Jade)
process of caring for the dependent older adult were highlighted
by the participants: the family conflict permeated by disputes
and accusations; the lack of time for self-care and maintenance
or involvement in social activities; and those of economic na-
ture, with suppression of spending with themselves, given the
increase in expenses with the older family member.
badly of me. Half the family dislikes me, because I fought to
go with her to the hospital. (Crystal)
cannot handle everything […] I lack time to do everything, I
can only take care of him. There is no time to think of me.
(Ruby)
on my budget. […] But then we get through very tight. […]
The number of diapers has increased, the number of rem-
edies that are purchased […] So there is a financial burden
and I think that also wears me […]. (Sapphire)
family, especially those with low income and that live with
dementia, wounds or any other injury that requires therapy
and specific technologies, not always available at the health
system. In addition to the social and emotional costs, the fi-
nancial cost consumes the resources that the caregivers used
to invest in themselves. This factor requires further study to
detail the costs of family caring for dependent older adults.
The in-depth study of the phenomenon “the life context
the home environment by family caregivers who show perfor-
mance overload and emotional distress” from the theoretical
framework of Culture Care Diversity and Universality of Lei-
niger made the construction of a theoretical scheme possible.
Derived from the analysis of possibilities of culturally congru-
ent nursing care, through the three modes of action: adjust-
ment (adaptation/negotiation), preservation/maintenance and
repatterning/restructuring of culture care.
nursing and
negotiation of
cultural care
of the family caregiver
maintenance of
cultural care
the positive aspects (potentialities)
nursing care
Restructuring of
modification of the negative
process of nursing care
dependency, comprehended using the Theory of Cultural
Care Diversity and Universality, brings attributes that the pro-
fessional should prioritize instead of chasing the cure, which
is not always possible, focusing on care, which is an essential
human need. Through cultural care, the nurse adopt in these
cases one of the assumptions of the theory: “cure is impos-
sible without care, but there may be care even with no pos-
sibility of cure”(1,4).
impossible, as in the cases of dementia or the reversal of the
dependency, it is up to nursing and the family caregiver to
provide the required care so the older adult, in its limitations,
is taken care of. The development of coping strategies to over-
come the negative feelings can be stimulated. These feelings
might be originated from a cultural way of relating to living
together and having to take care of a dependent older adult
and in need of home care from the family(2,4).
Couto AM, Caldas CP, Castro EAB.
tural dimension becomes relevant to change the scenario of
suffering that is established through the continuous life of the
caregivers, who take high loads of activities resulting from the
dependency process of the older relative(2).
overload and emotional distress levels of the family caregivers
were identified along the studied sociocultural context of the
formation of the caregiver role. The formation period seems to
be a moment in which the families need monitoring and sup-
port from health professionals and from a support network,
this would enforce the positive aspects while minimizing or
eliminating the negative aspects identified(16).
the support from secondary caregivers who contribute sharing
the daily activities are some of the potentialities identified.
Prior experience in other care situations contributes to the
change of posture and attitude as the main caregiver facing the
new nursing care relationship, since some relatives realize the
need for the division of responsibilities and the need to allow
the involvement of other family members. Strategies of coping
or support should be identified or stimulated and supported,
in such a way caregivers can periodically relieve themselves
of the responsibilities and requirements inherent to the care
process(10). Actions in this sense contribute to eliminate or re-
duce the emergence of morbidities and comorbidities in the
binomial dependent older adult-family caregiver.
ed values and habits related to family roles, once they start
caring for a sick or dependent family member. In addition to
the bonds and interaction between the caregiver and the de-
pendent older adult acting as positive stimuli that facilitates
the performance of nursing care and contributing to relieve
the tension of the caregiver, another important factor is the
ability to maintain the self-esteem of the caregiver and the
support and family bonding, even when facing series of dif-
ficulties and limitations in daily life of caring(10,17).
negative aspects of the nursing care relation, religiousness/
spirituality were pointed as an important strategy adopted by
caregivers. Faith, spirituality and religious practices were cited
and identified, also being used by families assessed by other
studies, which consider them as very effective coping strate-
gies to deal with stress, anguish, depression and overload re-
sultant from the nursing care process. We understand that the
caregivers seek help through the expressions of religioiusness/
spirituality to obtain the strengthening of hope, comfort and
relief of suffering, establishing itself as a protective factor(17-18).
ing care relationship established in family environments needs to
be recognized, respected and valued by the nurses during the pro-
posed guidance and support activities. By assuming this theoreti-
cal thought as part of the nursing practice the nurse could possibly
adopt the principle of preservation/maintenance of cultural care(4-
5) to help maintain and strengthen: positive feelings, prior experi-
ence of the caregiver, adaptation to a cultural process of nursing
care, interaction in the caring relationship and maintenance of the
tion of the health conditions of the caregiver, the ability to perform
its role and thus, the promotion of mutual well-being.
experienced routinely and long term can contribute to the wear
on the caregiver role(18). Thus, families need professional support
in these situations, in such a way they can organize and establish
a care routine involving the greatest possible number of family
members or even friends and neighbors. This support helps the
main caregivers to maintain their social activities, self-care, lei-
sure and rest, without feeling guilty or insecure with the ability
to care of the other subjects involved in the process(2,17).
strate the lack of skills and appropriate training to perform the role.
Additionally, they point to the need of support actions for family
caregivers and even health education to provide better conditions
of nursing care for the dependent older adult population, meeting
the specific knowledge and skills necessary for the family caregiv-
ers to perform the actions delegated to them(19). Preparing and ac-
companying the relative in the performance of the new caregiver
role is needed, helping them to overcome difficulties and to pro-
vide quality nursing care that meets all the identified needs and
that is congruent with the cultural context of the family group(3).
pends on the acquired and practiced knowledge, it can be
said that the nursing care actions reflect the culture of the
caregiver, its family and their context. Therefore, culture de-
termines the patterns and lifestyles, influencing the decisions
made, which determines that the nurse performs care based
on the culture of the subjects(2,5).
services were identified as a contributing factor to the emer-
gence of overload and emotional distress feelings by the care-
giver. Considering the increased demand of time and the inse-
curities when facing difficulties in nursing care activities without
the necessary knowledge for each scenario experienced(2).
share of nursing care tasks is related to insertion into reduced
family size or because other family members work, but also
due to the lack of involvement of other relatives in the depen-
dency situation of the older adult, health problems and even
the difficulty of the main caregiver in trusting in the ability of
other family members to perform the function. The impossibil-
ity of sharing the nursing care activities with other relatives is
a determining factor for the definition and often, for the lonely
maintenance of the main caregiver(2,10,20).
lowed us to note that nursing care is a demanding task that causes
many changes in their lives after taking the role, such changes
include the abandonment of work and the economic impact on
family dynamics, the lack of time for social activities (mainly lei-
sure activities) and effects on physical and mental health condi-
tions, with frequent reports of changes in the sleep pattern(16-17,20).
Not sleeping well or sleeping too little reflects on the performance
of everyday activities, on behavior and on the well-being feeling(2).
proper care of their health conditions and reported difficulty
Couto AM, Caldas CP, Castro EAB.
the greater difficulty is the lack of family support and of social
and health support networks. Sometimes the family members
realize that they are living on the limits of their physical and
emotional reserves, but have no one to help. In other cases,
the involvement in the nursing care process is so deep that they
do not realize that the limits of their conditions to provide care
have been reached, sometimes exceeding these limits(18,20-21).
and to set days and times for each to assume part of the care
processes and responsibilities. This partnership allows them
to have time available to take care of themselves, to have lei-
sure periods and to recover the energy spent when taking care
of the other, minimizing the strain on the performed role.
of understanding and support from other family members and
family disputes, in addition to to the economic repercussions
caused by low income families, the abandonment of work to
be devoted entirely to the caregiver role and the increase in
expenditure because of the demands of the nursing care pro-
cess of the older adult, are contributing factors to the nursing
diagnosis stress in the role of caregiver(8-9,22-23).
family caregiver, which cares for the dependent older adult in
the home environment, the nurse can adopt the accommoda-
tion/negotiation and repatterning/restructuring of cultural care
methods. The first involves actions directed at the forms or ways
to negotiate, adapt and adjust the identified adverse conditions,
the second refers to nursing actions that seek to assist the care-
giver of older adults in the modification process of the nega-
tive patterns(1,4), such as the abandonment of work to nurse care,
leisure, love life being in the background, negative feelings in
the care process, compromising of their health conditions and
changes in sleep and rest patterns to patterns that are beneficial
to the family caregiver and the relationship of care.
This study was limited to the experiences of a group of fam-
the care of a dependent older adult relative. A limitation of this
research, inherent to the method, refers to the fact that data anal-
ysis has not been done independently by two researchers. Be-
ing a current and relevant theme to the daily practice of nurses
through other methods that allow a greater generalization.
search through different methods relate to the sleeping pattern
of the family caregiver, religiousness/spirituality as therapeutic
support, the expenses of the family with the home care of
dependent older adults and how the nurse is present in home
care teams, adopting the culturally congruent nursing care.
The use of Theory of Culture Care Diversity and Universal-
the possibilities of nursing performance on the context expe-
rienced by family caregivers of dependent older adults. From
the perspective of cultural care, the nurse could contribute
to these families using the three modes of action proposed
by Leininger –preservation/maintenance, adjustment/ nego-
tiation and repatterning/restructuring of culture care –, thus
providing nursing care better suited to the culture of the older
adult/caregiver/family.
the experiences when taking care of dependent older adults
at home by a family caregiver who presented performance
overload and emotional distress in the role. The methodologi-
cal approach used contributed to better approach the socio-
cultural reality of each family, to observe the daily life of the
main caregiver and to establish trust, which enabled dialogue
marked by emotions and relief, and reports that expressed
their difficulties, limitations, needs and potentialities.
from the process of home care of dependent older adults are
recognized, picking up the values and the beliefs of the fam-
ily and the sociocultural context of the family caregiver. This
would enable the structuring of interventions and care plans,
designed from the nursing consultations, home visits and ed-
ucational activities such as groups of older adult caregivers
congruently with the cultural attributes. These are possibilities
that help to institute mutually established changes with care-
givers, promoting better quality of family relationships of care
and relieving the strain of the caregiver role.
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Oliveira EAR, Da Rocha SS, et al. The Parents’ Cultural Care Towards Promoting Child Development. Rev
Fund Care Online.2019.11(n. esp):397-403. DOI: http://dx.doi.org/10.9789/2175-5361.2019.v11i2.397-403
Objective: The study’s purpose has been to further understand how parents promote child development in
children below five years old upon the family context, then establishing the nursing care according to the
Madeleine Leininger’s Theory. Methods: It is a descriptive-exploratory study with a qualitative approach that
was carried out with parents of children below five years old, who were registered in a healthcare service from
Picos city, Piauí State, Brazil. The research complied with the ethical principles of the Resolution No. 466/12.
Results: The parents, who are the first educators having contact with the children’s universe, showed a concern
regarding the motor development care, also language and mental development process. It is emphasized
the need for a safe guidance by the nursing professionals, and also respecting their cultural contribution.
Conclusion: Nurses are expected to explore even more the probable performance according to each child’s age
and considering the child development stage, moreover, respecting the cultural care provided by their parents.
address: edinarasam@yahoo.com.br, Universidade Federal do Piauí (UFPI), Brazil.
at UFPI. E-mail address: silvanasantiago27@gmail.com, Universidade Federal do Piauí (UFPI), Brazil.
Oliveira EAR, Da Rocha SS, et al.
The Parents’ Cultural Care…
Objetivo: Compreender como os pais promovem o desenvolvimento infantil
às crianças menores de cinco anos no contexto familiar, estabelecendo
cuidados de enfermagem à luz da teoria de Madeleine Leininger. Métodos:
Estudo de natureza descritiva exploratória, qualitativa, desenvolvida com
mães ou pais de crianças menores de cinco anos de idade, cadastradas na
estratégia Saúde da Família de Picos – Piauí. A investigação cumpriu os
princípios éticos da Resolução nº 466/12. Resultados: Os pais como os
primeiros educadores a ter contato com o universo infantil, demonstraram
preocupação no cuidado com o processo de desenvolvimento motor, da
linguagem e mental, destaca-se a necessidade de orientações seguras dos
profissionais enfermeiros, respeitando sua contribuição cultural. Conclusão:
Percebe-se que dever ser mais explorado pelos enfermeiros o desempenho
esperado para cada idade da criança no que se refere aos marcos do
desenvolvimento infantil, respeitando o cuidado cultural dos genitores.
de Enfermagem, Cultura, Promoção da Saúde.
Objetivo: Comprender cómo los padres promueven el desarrollo infantil
para niños menores de cinco años en el contexto familiar, el establecimiento
de cuidados de enfermería a la luz de la teoría de Madeleine Leininger.
Métodos: Estudio descriptivo, exploratorio cualitativo, desarrollado con
madres o padres de niños menores de cinco años de edad, inscritos en los
picos de la familia de la Estrategia de Salud – Piauí. La investigación cumplió
con los principios éticos de la Resolución N ° 466/12. Resultados: Los
padres como los primeros educadores que tienen contacto con el universo
del niño, expresado preocupación en el cuidado del proceso de desarrollo de
la motricidad, el lenguaje y mental, existe la necesidad de una guía segura de
las enfermeras, respetando su aporte cultural. Conclusión: Es evidente que
debería estudiarse más a fondo por las enfermeras rendimiento esperado
para cada edad del niño en relación con los hitos del desarrollo del niño,
respetando el cuidado cultural de los padres.
Enfermería, Cultura, Promoción de la Salud.
The health policies in Brazil are expanding the capacity of
basic actions for them, including the monitoring of the
child development.
covers aspects such as physical growth and neurological,
behavioral, cognitive, social and affective maturation of the
child. Thus, it provides the child with the capacity to respond
to their needs and those of their environment, considering
their life context.1 Furthermore, it is unique process for
each child, influenced by family, cultural standards, values,
and beliefs.2
understand that children need to have opportunities to
show their intellectual and motor skills, alternating the
dependence and independence periods of the mother-
child relationship, which requires emotional maturity from
the mothers,3 since the early stages of childhood — up to
formation of the individual’s subjectivity, with the presence
of another being to understand him, then also participating
in this process.4
problems may have their origin in the childhood due to the
absence or failure of the care during the child development
process, and should be strictly observed and identified by
the family and health professionals.5
nursing professionals, it is necessary to explain scientifically
how they were proposed and clarify their training principles.
In general, nursing is concerned with four main concepts: the
person, the health, the environment, and the nursing. These
concepts are used for developing theories.6 In turn, a theory
is a sequence of logical steps that allow an understanding
of something to be investigated and explored by the author
based on a central concept.7
professional practice based on a scientific approach,
qualifying the nursing to promote human care in a holistic
and human way, practicing it with the individual, family and
community. It is also highlighted that the main objective
of a theory is to unveil and clarify how nursing care can
be applied to the individual, family or groups, from the
knowledge of all factors that cause illness and/or changes in
the health process, including the biological to the cultural
ones.8
for the individual also includes identifying and knowing
their cultural differences, life experiences and family,
the planning, implementation and evaluation of nursing
care achieves success in their care actions, favoring an
approximation and congruence between the practices of
the popular and professional care, which transcend to an
authentic care.9
Theory shows that nursing must possess the cultural
knowledge of the individual to better promote care in the
different thinking ways, knowledge and health practices,
and that each culture influences the existence of the
care, but without losing the essence of love and affection
in these care actions. So, this theory aims to direct the
nursing care practices by means of a harmonious and
productive association between care and culture. Thus,
Leininger proposes that the nursing decisions must involve
the preservation/maintenance of the cultural care, the
accommodation/negotiation of cultural care and the re-
standardization/restructuring of the care culture.10
care for the children’s growth and development, which is
shaped by the parents’ culture, based on the beliefs and
values of this group of society, allied to the knowledge of
transcultural nursing according to Madeleine Leininger,
Oliveira EAR, Da Rocha SS, et al.
DOI: 10.9789/2175-5361.2019.v11i2.397-403
The Parents’ Cultural Care…
these processes.11
promote child development in children below five years old
upon the family context, establishing nursing care according
to the Madeleine Leininger’s Theory.
This is a descriptive-exploratory study with a qualita-
Leininger’s Cultural Care Theory, considering that this is
a viable and feasible way to uncover this care during the
child development.
Picos city, Piauí State, Brazil, which belongs to the Vale
do Rio Guaribas territory. The study population consisted
parents of children below five years old residing in the
territorial area of the São Vicente family health care team,
because it is the pioneer in the implementation of the
child care program.
in Brazil that demands specific government policies, usually
composed of children who have high morbidity and mor-
tality rates and need higher indicators for both the mor-
bidity of diarrheal diseases, respiratory diseases and its
consequences, as for neonatal and infant mortality.
participate in the study, registered in the Saúde da Famí-
lia [Family Health] Strategy Project of the municipality
of Picos, Piauí State, Brazil, and had children below five
years old.
responses. The inclusion of new subjects in the research is
suspended when the researcher identifies and analyzes the
repetition of contents in the speech, and it is unnecessary
to continue the collection of new data.12
anonymity, they were identified by the names of characters
of children stories. The mothers’ participation was greater
because they were more present in the residences during
the visits, since the fathers were present only at lunch or
at night because they worked in another place.
also observed the neighborhood where they live, neighbors,
home and the relationship between parents and children,
while observing the customs, habits and values, which
provided the affinity and understanding of the contribution
of culture to the care for the growth and development of
children offered by their parents. During the observation
phase, semi-structured interviews were carried out by
addressing the following question: “What do you do to
promote the development of your child?” Nevertheless, as
needed, the researcher included other questions to com-
plement the ideas expressed by the interviewees.
tion capable of providing social interaction, allowing the
construction of a conversation between the researcher and
the interviewee, who is his data source, with the possi-
bility of extracting information about human behavior.13
the researcher in order to collect facts about the subjects
required to what one wants to find out in a research.14 The
interviews were carried out in a quiet location, generally
inside of the interviewees’ own residence, with no noise,
usually in a room with only the presence of the intervie-
wer and interviewee to maintain the quality of the sound
and speech, according to the availability of the subjects,
and only started when the children or other people were
already absent from the place.
for the ease of storing and reproducing the interviews on
the computer, facilitating repeated listening and transcrip-
tion of the speeches in full.
nique proposed by Bardin, which comprises three steps:
pre-analysis, material exploration, result treatment, infe-
rence, and interpretation.15
interviews were transcribed in full, thus allowing a more
fluent reading and, later, the highlighting of the griffins
and the numbering of the cuts. Once the data transcrip-
tion phase was completed, the organizational phase began,
consisting of a period of intuitions, in which the initial
ideas for the conduct of the analysis process were opera-
tionalized and systematized.15
sis occurred, which consists essentially of coding opera-
tions, which involves transforming the raw data through
clipping into recording units and then describing them.
activities in child care” and “promotion of the growth
and development of the child”. In the presentation of the
selected speech in the categories, we used the following
standardization: the ellipse within brackets ([…]) indicated
cutouts within the same speech, and the information con-
tained within parentheses sketched interesting observations,
which complemented the speech or expressed non-verbal
behaviors expressed by the interviewees.
courses were then interpreted by using the Madeleine Lei-
ninger’s Cultural Care Theory and according to the criteria
found in the vast knowledge about the theme, generating
an understanding of the cultural care of the parents to
promote the growth and development of their children
bellow five years old in the home context.
Committee from the Universidade Federal do Piauí under
the Legal Opinion No. 246.306, respecting the ethical and
Oliveira EAR, Da Rocha SS, et al.
DOI: 10.9789/2175-5361.2019.v11i2.397-403
The Parents’ Cultural Care…
nal Health Council.16
By obtaining the subjects’ speech followed by the
care for children below five years old, permeated by the
cultural values, it was possible to elaborate five categories,
being presented in this article only one of them: “child
development”.
phases and areas of its development. As parents are the first
educators to have contact with the child universe, children
put unlimited confidence in them, albeit unconsciously,
to build together the advances in the process of motor,
language and mental development.
about observing what the child already does and promoting
some stimuli:
turns her neck, you talk on her side and she turns her neck
to look at who is talking, already holds things, already gets
things, already stands on the lap, when you put her on
their feet, she already stands there, she holds your neck,
looks and turn her neck to one side and the other, makes
a few sounds, keeps talking, holds some things, keeps
smiling at everyone, she keeps smiling at everyone who
arrives, and talking, and so when I talk to her when she is
in someone else’s lap, she gets agitated, wanting me to get
her, she’s smart, very smart. When I put her on the bed,
she’s already wanting to turn around, she moves on the
whole bed pushing her feet, then she moves on the whole
bed, besides I do not even leave her in bed a lot, I prefer to
put her in the crib, because I’m afraid of her movements,
she’s very restless, I’m afraid of her movements and she
ends up sliding […]
(Tiana)/Child’s age: three months old
from 18 to 21 months, occasionally there may be short
periods of resistance to bathing, whose cause is difficult to
determine.17 At this age, babies begin to show interest in
dressing and, in general, they are quite cooperative, being
able to try to put on their shoes, although they show more
skill to undress themselves then to dress. At 21 months,
the child is able to undress himself completely until the
shirt and sometimes he removes it if this is possible. We
emphasize the Fiona’s speech:
(the six-year-old child), I give him a bath. Giving a bath,
wearing clothes, brushing the hair… Only I do all this!
wears the underwear by himself, use the perfume, asks for
the shorts and the shirt, but only wears the underpants
puts the slipper on, walks normal, talks about almost
everything, I brush his teeth every day, I even brush the
other’s teeth (the six-year-old child) […]
(Fiona)/Child’s age: one year and nine months old
two to three years showed enthusiasm when expressing daily
activities such as personal hygiene and dressing developed
by the small children, as transcribed below:
telling how to do it, but he does not brush them right,
only the front ones more…
(Snow White)/Child’s age: two years and nine months
bucket, but he doesn’t know how to take a bath, It’s me
who takes care of him, he knows how to wear his shorts
and underwear, he just can’t wear the shirt […]
(Ariel)/Child’s age: two years and ten months old
brushes them for adventure because they are going to
brush their teeth, he has a “Cocoricó” brush, we have to
create a story for him to brush his teeth […]
(Bela)/Child’s age: two years and ten months old
the slippers on, I have to watch him carefully when he’s
putting some cologne on, or else he spills it all over himself
[…]
(Pocahontas)/Child’s age: two years and six months old
in the mothers’ speech:
if he says a word that is not right one, I tell him, then he
says “mama”, I don’t know, then he tries to speak, but it
doesn’t work […]
(Ariel)/Child’s age: five years old
was present in Margarida’s care for her child:
a little […] I finish giving her the food, but first I let her
eat there alone to encourage her to learn to eat with her
hands […]
(Margarida)/Child’s age: two years old
Oliveira EAR, Da Rocha SS, et al.
DOI: 10.9789/2175-5361.2019.v11i2.397-403
The Parents’ Cultural Care…
its phases.
developmental framework for children aged from zero to
four months: they pay attention to and follow objects in
their visual field; when they are in the face down position,
they raise your head shortly; they smile spontaneously and
begin to distinguish the day from the night.18 The caregiver
must stay alert because the child can fall, since he is no
longer stay quiet, as stated by the Tiana’s speech.
continuous and dynamic, involving the participation of
several actors, primarily the family members. The protocols
from the Health Ministry for monitoring the child’s health
indicate that the stimulus for child development must happen
gradually, steadily, and cautiously, given that the fact that
a child is educated in a pleasant environment, surrounded
by affection and attention, will influence constructively the
achievement of a healthy life in the adulthood.19
(IMCI) protocols, when verifying the recommendations
for cases in which children are classified with a normal
development, parents are encouraged to constantly stimulate
their child and monitor their growth in the Basic Health
Unit.20
and 18 months was the subject of a survey in a city of Minas
Gerais State, Brazil. The results suggest that the children
of parents with a stable relationship, better socioeconomic
pattern, and better education degree, have a more favorable
environment to the promotion of child development with
a probability of more opportunities for this purpose, from
which we conclude, based on these arguments, that the
environment interferes both in health promotion and in
the development of diseases.21 It is also emphasized that a
better maternal education, availability of educational games
and materials at home, increased emotional and verbal
interaction of the mother with the child and the presence
of the husband are contributing factors for a healthy child
cognitive development.
care mostly by the mother, although they could also share
their life with the grandparents or other relatives. The
strong presence of the mother at home was identified as a
predisposing factor to the promotion of motor development,
as well as the application of simple neurological tests for
the evaluation of children to obtain an early diagnosis of
deviations in child development, suggesting the acceptance
of these practical measures by the professionals of the Family
Health Strategy project.23
dressing begins to be developed in child with an age of
two years or more, being appreciated by him when the
adult assists him in this task.19 Nonetheless, regarding the
exchanging them, they hardly do this action correctly, as
stated by the guide of the Portuguese Nurses Order, which
also emphasizes children’s participation in small tasks, in
activities that allow them to express their thoughts and
emotions, besides stimulating the word pronunciation, but
always preserving the limits.24
speech about promoting healthy and promising stimuli
for the development of the child’s language, encouraging
her to continue the speech progress with the vocabulary
expansion. According to the child’s health manual provided
by the Health Ministry, language acquisition consists of the
persistent conversation between mother and child, which
are started by simple sounds, sometimes incomprehensible,
but repeated with pleasure until the appearance of small
phrases emitted by the children, followed by the design of
their own features, drive and choices. It is highlighted that
procedures such as these build advances in the child’s mental
health and encourage him to speak, thus consolidating the
transmission of community’s cultural values.18
parents are not always prepared to accept the free expression
of their children’s thinking, they need to understand the
power that the association of motor functions and language
has in the evolution and acquisition of new knowledge
by the child as well as in stimulating their freedom and
socialization.
have also shown attention and zeal with the development
of motor coordination with the two-year-old son, so the
behavior adopted by Margarida is in accordance with the
guidelines provided by the Health Ministry and the guide
provided by the Portuguese Nurses Order, in which it is
emphasized that the children aged two years or more must
carry the food to the mouth and eat well with his own hands,
using the spoon.18,24
identify the motor, social, psychological and linguistic
components that promote the child development process,
attention must be paid to any and all warning signs that
cause changes.25
of these family relationships, the active presence of the
primary care nurse or the Family Health unit arise, which
should transmit its orientations, particularly during
prenatal and child care consultations, home visits or in
any other opportunity to intensify the connection between
this professional and the individuals, the family, and the
home and community environment, thus allowing the
construction of a knowledge based on the reality of each
one as well as the promotion of an environment favorable
to a healthy child development.
guiding nurses to the development of care practices for
Oliveira EAR, Da Rocha SS, et al.
DOI: 10.9789/2175-5361.2019.v11i2.397-403
The Parents’ Cultural Care…
Care Theory to propose the following nursing care for this
category considering the child development promotion.
of the Leininger’s Theory, we propose that nurses develop in
children the practice of a congruent, cultural care based on
the different cultural values and lifestyles of each individual
or group, with the purpose of maintaining, negotiating, or
standardizing once again the behaviors in order to avoid
cultural shock and thus provide health and well-being for
the assisted community.10
by the primary care nurse with the families’ cultural
knowledge will provide a formulation of a promising
and healthy assistance regarding the child growth and
development, through educational and assistance actions
built in a consolidated partnership between professional
nurses, parents and children.
Understanding the care provided by parents for their
many challenges. Understanding how the cultural contribu-
tion is present in each family and how it can influence the
health promotion in children, especially in these aged up
to five years old, allows to expand the child care practices,
respecting the primordial holistic vision in nursing science.
wed us to expand the possibilities of foreseeing this dynamic
family scenario, making us realize that it is totally feasible to
construct a systematized nursing care with the cooperation
serving the cultural contributions of each group.
tive was achieved by showing the care provided by the parents
to their children aged up to five years old, with the opportunity
to understand how they developed actions to promote the
child development. From the speech analysis, it was possible
to develop nursing care actions for children, considering the
parents’ cultural values.
the promotion of care for the development of children, we
noticed the mothers’ enthusiasm in accompanying the phases
of the motor and linguistic development, besides stimulating,
although timidly, the improvement of these functions at each
age. Therefore, we highlight that the expected performance
for each child’s age need to be more explored by nurses con-
sidering the child development milestones.
primary care professional concerned with the health promo-
tion, to be aware of the fact that the cultural influence still
remains in the various manifestations of child care, and that
the harmonious coexistence between scientific and cultural
knowledge is completely possible.
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Required Reviews: None
Published on: 01/15/2019
Edina Araújo Rodrigues Oliveira
Centro, Picos, Piauí, Brazil
Telephone number: +55 89 99978-8282 / 89 99406-6095
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However, users may print, download, or email articles for individual use.
PERSPECTIVE OF MADURA CULTURE IMPROVING BREASTFEEDING
Meningkatkan Perilaku Ibu Menyusui di Jember)
Faculty of Health Sciences University of Muhammadiyah Jember
dapat mempengaruhi keberhasilan ibu dalam memberikan ASI secara ekslusif, diantaranya adalah dukungan keluarga
maupun pengaruh budaya lokal. Tujuan Penelitian ini untuk menerapkan model keperawatan transkultural dalam
perspektif budaya Madura pada ibu menyusui. Metode : Penelitian ini dilakukan di desa Suboh wilayah kerja Puskesmas
Pakusari, pengumpulan data menggunakan kuesioner, dan fokus group diskusi. Desain penelitian quasi eksperimen
post test design with control dengan analisis Paired Samples Test. Selain itu, peneliti juga melakukan analisis kualitatif
untuk mengeksplorasi budaya Madura. Sampel yang digunakan adalah ibu menyusui yang mempunyai bayi usia 1-6
bulan sebanyak 50 sampel dan dibagi menjadi 2, yaitu kelompok perlakuan dan kontrol. Selain itu sumberdata lain yang
digunakan adalah tenaga kesehatan. Hasil: Hasil penelitian didapatkan bahwa rentang usia ibu antara 15 – 34 tahun, dengan
rata-rata berusia 27 tahun, selain itu rata-rata pendidikan responden tidak tamat SD sebanyak 60%, baik pada kelompok
perlakuan maupun kontrol. Hasil analisis tentang modifi kasi budaya didapatkan P value 0,001 yang artinya ada pengaruh
penerapan model transcultural nursing dalam Meningkatkan perilaku ibu menyusui. Diskusi: Aplikasi modifi kasi budaya
yang dilakukan mampu meningkatkan produksi ASI. Perlu kerjasama yang baik bagi semua komponen masyarakat dalam
mensuport ibu menyusui dengan memodifi kasi budaya lokal yang kurang menguntungkan bagi kesehatan.
can aff ect mother’s success in breastfeeding exclusively, such as family support as well as local cultural infl uences.
This research aims to apply the transcultural nursing model in Madura cultural perspective in breastfeeding mothers.
Method: This research was conducted in Public Health Centre of Pakusari Suboh Jember. The data were collected using
questionnaires, and focus group discusses. The research design was question-experimental research of post test design
with control by using Paired Samples Test analysis. In addition, the researchers also performed a qualitative analysis
to explore the Maduranese culture. The samples were breastfeeding mothers who had infants aged 1-6 months, and 50
samples were then divided into two, i.e., treatment and control groups. Also, another data source were health professionals.
Result: The result showed that the maternal age range between 15-34 years with an average age of 27 years. Besides,
the average of the respondents’ education background was that 60% of them did not pass elementary school, both in
treatment group and control group. The results of the analysis on cultural modifi cations were p-value of 0.001, which
means that there are the eff ects of applying the transcultural nursing model in improving mother behavior. Conclusion:
An application of cultural modifi cations that is able to increase milk production. Therefore, it needs a good cooperation
for all the components of society in supporting breastfeeding mothers by modifying less the local culture that becomes
favorable for health.
one of the tasks in the health care of children
(babies), but in reality, not all mothers can
carry out these tasks well, not successfully
breastfeed or stop breastfeeding early. This
condition does not only affect the health of the
with the self-concept as a mother since it
cannot be an optimal role in health care to her
babies (Study et al. 2010). Breastfeeding plays
an important role to maintain the health and
survival of infants because breast milk is the
best food for babies. Breast milk is the right
will make babies rarely suffer from diseases
and avoid malnutrition compared to infants fed
other milk (Study et al. 2010) (Some research
shows that even though a breastfeeding mother
in a state of malnutrition, the breast milk
still has enough quality. The differences in
maternal nutrition affect only the quantity of
breast milk and not on the quality of breast
milk. Exclusive breastfeeding in Indonesia
is still very alarming, and it needs a lot of
attention from all sides. Mother awareness to
exclusively breastfeed their babies is still very
poor and shows a decline from year to year. In
2008, coverage of exclusive breastfeeding was
only 24.3%, in 2009 was 34.3%, in 2010 was
only 15.3%, while the target to be achieved
should be 80%. The low number of exclusive
breastfeeding triggers the low nutritional status
of infants and toddlers and can be an indirect
cause of infant mortality (Study et al. 2010).
2016, which was published in the bulletin
Lancet reveals breastfeeding can reduce infant
mortality by 13 percent, a variety of adverse
effects can occur in infants if they do not get
breast milk (Study et al. 2010) Other data on
lactation research notes that the IQ of premature
babies group who were breastfed is 8.5 points
higher than those are given formulated milk.
While the research conducted in Guatemala
argues that the delay of lactation onset became
a significant greater risk of doing short-term
breastfeeding (Study et al. 2010).
Jember district is not much different from
some places in Indonesia. The data from the
Department of Health Jember 2014 shows that
infant mortality rate (IMR) increased from the
previous year into a range of 398 439 cases each
year. Based on the data that there are several
causes of infant mortality is 48 per cent due to
malnutrition, 15 per cent because of shortness
of breath, and 15 percent of other cases (Study
et al. 2010). It becomes interesting to study
because of Jember as one of the districts in
East Java with Madura ethnic population is
greatest. Knowingly or not, the factors of trust
and cultural knowledge as conceptions about
between food and health-illness conditions,
habits and ignorance, have brought both
positive and negative impacts on the health of
mothers and children. Breastfeeding success
also greatly influenced by many factors both
from within his own mother as well as from the
surrounding environment. One powerful factor
is of social, cultural and environmental factors
in the community where they are located. A
culture is a form of human adaptation to the
environment. Adaptation in the broad sense
includes all the behavior and habits and set
forth in the mind, knowledge, attitudes, and
practices; all intended as a form of reaction
to the environment (and amendments thereto)
both internally and externally (Nurwidodo.
2006) . Model transcultural nursing is a
formula that can be developed to bridge the
local culture in order to become a culture
which is positive for the health of mothers and
babies, and in this case is a nursing mother.
Indonesia, we can see the conception of culture
embodied in the daily behavior related to the
culture different of postpartum mothers with
modern health conception. Socio-culture
factors have an important role in understanding
the attitudes and behaviors responded to birth
and breastfeeding. Most cultural views on
these matters have been handed down in the
culture of the community. Therefore, even
though health officials might find a form of
behavior or attitude that proved to be less
beneficial for health, but it is often not easy for
health professionals to make changes on it, due
to having been embedded beliefs underlying
attitudes and behaviors in depth in the local
culture.
especially nursing mothers maternity, building
on the development of local culture to be able
to support successful breastfeeding. The aims
of this study are as follows:
1) To analyze the Maduranese culture and
breastfeeding through transcultural model
approach.
transcultural in Maduranese culture among
nursing mothers.
modifi cation through the implementation
of the transcultural model to be a positive
culture for nursing mothers both in treatment
group and control group.
(UNICEF) claims that there are 30,000 infants
deaths in Indonesia and 10 million deaths of
children under five in the world each year. It
could be prevented by breastfeeding (breast
milk) exclusively for six months after birth,
without providing food or beverage additives in
infants. UNICEF also states that infants fed by
formula milk are likely to die during the first
month of his birth, and the opportunity was 25
times higher than babies who are breastfed by
mothers exclusively (Nigel & Bandari, 2016).
several factors, such as lack of knowledge,
awareness, motivation and low maternal
attitudes to breastfeeding, in addition to
the strong cultural inf luence also provide
a substantial contribution to the failure of
exclusive breastfeeding.
pregnancy and birth for women with all good
and bad consequences on the health of these
need to be considered for health professionals
in Indonesia in an effort to increase the success
of health care services they apply for both
mother and baby.
health team has a very big role in helping
improve the health status of the community,
especially the health of mothers and children.
Maternity nurses should be able to mobilize
community participation in particular, with
regard to maternal health, maternity, nursing
mothers, newborns, teenagers and the elderly.
Community involvement in order to care
for his health can be implemented; then the
health professionals should be able to find the
approach to society that the program launched
by the government can be successful and at the
malnutrition.
references to develop the potential of people
with a culture of Madura in Jember. The
number of cultural rules in society, as well
as the myths that developed Jember related
nursing mothers, is very detrimental to mother
and baby. It has an impact on the high infant
mortality rate (IMR) is one of the reasons is the
poor nutrition due to poor feeding behavior.
forms of real interaction as human beings and
social creatures. Culture, in the form of norms,
becomes a reference of human behavior in
life one others. The pattern of life that lasts
long in one place, which is always repeated,
makes human beings tied up in the process.
The sustainability to constantly live a life and
last long are the process of internalization
of the values that influence the formation of
character, thought patterns, the interaction
patterns of behavior all of which will have an
influence on nursing intervention approaches
(cultural nursing approach). Culture has broad
influences in lives of an individual. Therefore,
it is important for nurses to know the cultural
background of the patients (Andrew, M. &
Boyle, J. S, 2008). Local wisdom can be
formed from a way of thinking and behavior of
the community when responding to problems
that arise around it (Wahyuningsih, S. 2014).
((PDPI 2011)
direction in nursing which focuses on study
and comparative analysis of cultures and
sub-cultures in the world and appreciate the
behavior of caring, nursing services, values,
beliefs about healthy sick, as well as patterns
of behavior aimed at developing knowledge
the body of scientific and humanistic nursing
practice in order to make room for the
particular culture and universal culture (Potter,
PA & Perry, AG 2009). The transcultural
nursing theory emphasizes the importance of
the role of nurses in understanding the client’s
culture.
themselves about the culture of clients, whether
individuals, families, groups, and communities
can prevent imposition.Cultural culture shock
and culture shock occurs when an outside
party (nurses) are trying to learn or adapt
effectively to specific cultural groups (clients)
whereas culture imposition is the tendency of
health professionals (nurses), either secretly
or blatantly imposing cultural values, beliefs,
and habits/behavior on individuals, families,
or groups from other cultures because they
believe that their culture higher than in the
other group’s culture (Leininger M and MC
Farlan MR, 2002).
in performing transcultural nursing models,
namely:
the principles of aid, facilitate, or pay attention
to the cultural phenomena in order to form the
individual determines the health and lifestyle
desired.
i.e., the principles of aid, facilitate, or pay
attention to the cultural phenomenon, refl ecting
the ways to adapt or negotiate or consider the
health and lifestyle of the individual or client.
i.e.,the principle of reconstruction or change
the design to help improve health conditions
and lifestyle towards better client (Leininger
M and MC Farlan MR, 2002).
theoretical basis of nursing practice based on
cultural or transcultural nursing, they will
undergo a cultural shock. It will be undergone
by the client in a condition where nurses are not
able to adapt to differences in cultural values
and beliefs. this may lead to the emergence
of a sense of discomfort, powerlessness, and
some will be disoriented. It is important
for nurses to understand their own culture
before understanding transcultural nursing.
In applying transcultural nursing, not only
culture that must be considered, but also keeps
in mind the nursing paradigm that can be
applied in transcultural nursing.
forms of real interaction as human beings and
social creatures. Culture in the form of norms,
customs become a reference human behavior
in life with others. Madura community is
known to have a distinct culture, unique, and,
it is considered as the cultural identity of the
individual ethnic identity of Madura in behavior
and Bohemian society. In the Maduranese
culture, women were ‘reserved’ husband is
fully under his control. The absolute leadership
is in the hands of the husband (male). Men
who have a right to determine what is allowed
and what should not be done by women for
women is hers. Because women are at the
center of self-esteem of men, then women
are being protected, controlled and owned by
men (Putra, J.S. 2012). The weak bargaining
position of women seems to have consequences
far greater, that women do not have access to
health care, even when they are pregnant.
Besides the many myths that developed in the
Maduranese community about breastfeeding,
also contribute to the low achievement of the
target of exclusive breastfeeding. Breastfeeding
is a natural process and is one of the tasks in
the health care of children (babies), but in
reality; not all mothers can carry out these
tasks well, not successfully breastfeed or
stopping breastfeeding early (Rejeki, S. 2014).
Breastfeeding mothers need a strong support in
order to provide their exclusive breastfeeding
for 6 months. Collaborative culture and the
latest methods of breastfeeding can increase the
overall successful coverage lactation. Hence,
the application of the transcultural model
is the most appropriate way for Indonesian
people who are still highly affected by local
cultural.
quantitative with the question-experimental
approach of post-test design with control. As
for the exploration of the culture of Madura,
the researchers also conducted a qualitative
approach.
Jember district, especially in Suboh village.
children aged 1-6 months, with the Madurese
people in 4 districts Suboh village Posyandu
Pakusari with purposive sampling approach
in 50 samples. In addition, researchers also
obtained data from couples and families
mothers as participants, validate the data on
Community Leaders, and Jember District
Health Office.
in-depth interview and FGD (focus group
discussion). Quantitative data analysis is
done by using the data homogeneity test
Kolmogorov Smirnov and continued with the
analysis Paired Samples Test, while data FGD
results presented in qualitative terms.
submissive to some information given by the
community leaders or scholars. The myth that
developed in the community about pregnancy,
childbirth and postpartum may be inhibiting
the achievement of the health program to
reduce maternal and child mortality rate.
Some cultures are found in pregnant women,
childbirth and breastfeeding are very unique,
there is positive support also exists negative
women have birth to a shaman, to reduce
pain during labor the mother’s body smeared
with hot ash, to reduce the swelling of the
vagina after giving birth mothers are given
the herb ginger mixed with salt to compress.
Other cultures are related to breastfeeding
infants were given coconut if the milk has not
come out, do a breast care on the river with
sand, mothers should not eat fish because
milk will be fishy and only recommended
to eat vegetables. Some characteristics of
nursing mothers in the village Suboh have
been identified include:
age of nursing mothers in the control group
is 26 years old with a minimum age of 16
years while the maximum is 34 years old
and the average age in the group treated with
the 27-year minimum age 15 years, while
the maximum was 34 years old. Data shows
that most respondents did not complete
primary school either the treatment group
or control of 60% and 64%. Breastfeeding
mothers’ behavior to find out the behavior of
lactating mothers in the treatment group or
the control group then performed Normality
Test Data. The results of the analysis using the
Kolmogorov Smirnov test: indicates that the
The age of treatment group The age of control group
Missing 0 0
Median 28.0000 26.0000
Mode 32.00 18.00a
Std. Deviation 5.37742 5.79281
Variance 28.917 33.557
Minimum 15.00 16.00
Maximum 34.00 34.00
a. Multiple modes exist. The smallest value is shown
Elementary school/no school 15 60.0 16 64.0
Junior High School 9 36.0 8 32.0
Senior High School 9 4.0 1 4,0
TOTAL 25 100.0 25 100.0
P value in the control group and the treatment
group 1.002 0.659 greater than 0.05 The test
results obtained using Paired Samples Test P
value 0,001 <0,05 so that it can be concluded
there is the influence of culture through the
modification of the Transcultural nursing
model in improving milk production
that is always carried out by mothers in this
village, apart from exclusive breastfeeding
or not. Nowadays with the advancement of
information and the active region midwives,
nurses and volunteers have much to change
the culture and myths. Model Transcultural
nursing is an effort to help people understand
their health, through a cultural perspective
treatment group
control group
Normal
Parametersa
Std. Deviation 17.98685 17.98685
Diff erences
Positive .132 .132
Negative -.073 -.073
Asymp. Sig. (2-tailed) .268 .778
a. Test distribution is Normal.
perspective in treatment group and control group.
Paired Diff erences
Sig.
(2-
Std.
Error
Mean
Interval of the
Lower Upper
1
behavior of
treatment
group
beavior
of control
group
effort to help people understand their health
but does not eliminate the existing culture.
According to Leininger, 2002, the strategy used
in applications such transcultural nursing
a)
health. Perencanaan and implementation
of nursing provided in accordance with the
relevant values which have been owned by
the client so that the client can improve or
maintain their health status.
to a particular culture more favorable to
determine other cultures that favor health
improvement.
working to restructure the client’s lifestyle.
The pattern of life plan selected is usually
more profi table and in accordance with the
beliefs held.
or forms of interaction as a social human
being. Madurese community is known to
have a specific culture, unique, and, cultural
identity is considered as the individual
identity of ethnic Madurese in behaving and
in the community (Wulansari , S, Sadewo,
dan Raf lizal. 2014). The results of research
on Madurese community about breastfeeding
are breastfeeding is an activity that is always
carried out by mothers in this village, apart
from exclusive breastfeeding or not. Nowadays
with the advancement of information and the
active region midwives, nurses and volunteers
have much to change the culture and myths.
effect of cultural modification through the
transcultural nursing model in increasing milk
production Model Transcultural nursing is an
effort to help people understand their health,
through a cultural perspective adopted. Model
transcultural nursing is an effort to help people
understand their health but does not eliminate
the existing culture. According to Leininger,
2002, the strategy used in applications such
transcultural nursing
patient is not contrary to the culture of health.
Perencanaan and implementation of nursing
provided in accordance with the relevant
values which have been owned by the client
so that the client can improve or maintain their
health status.
nursing at this stage to help clients adapt to a
particular culture more favorable to health. The
nurse helps clients to choose and determine
other cultures that favor health improvement.
culture of adverse health status. Nurses are
working to restructure the client’s lifestyle.
The pattern of life plan selected is usually
more profitable and in accordance with the
beliefs held.
breastfeeding among Madurese people. An
application in the form of cultural modifications
as made through a trial model of transcultural
in Maduranese culture was to allow an
education on lactation management using the
existing culture, demonstration by developing
a culture that is to be adapted to modern
techniques associated with the treatment of
breast and massage oxytocin. There was the
inf luence of cultural modifications to the
successful breastfeeding in Suboh, Pakusari,
Jember district.
the local culture in the community about
health. There were three attempts related to
culture in the community to support the health
of which is to preserve the culture, to negotiate
culture and to reconstruct culture.
figures in providing health education related to
local culture so that the results can be achieved
well. It needs to establish a breastfeeding
counselor at health services, both in clinics and
health centers with a hope to improve public
knowledge regarding exclusive breastfeeding.
It needs to improve socialization of exclusive
breastfeeding for the implementation so that it
can be maximized and perceived by the public.
It takes the government’s courage in enforcing
Jurnal INJEC Vol. 2 No. 1 Juni 2017: 9–16
Regulation of the Republic of Indonesia No.
39 of 2013 on infant formula, in all maternal
and child health services. Community figures
among Maduresecommunity become a figure
and role model in daily lives. Thus, it needs a
good cooperation between health officials and
local community figures to actively participate
in helping the surrounding community in
modifying a negative culture into a positive
culture for public health.
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