Trans-cultural nursing

1. INNOVATION
IN NURSING

2. INNOVATION INVOLVES:
- creative idea
- to make specific differences
- transform systems
- combination of knowledge new
products, process or services.

3. WHY
INNOVATION IN
NURSING ?
 Environment of constant change
 Change in demographics
 Growing demand in health care
services
 Limited economic backup

4. HISTORY OF
INNOVATION
a) Earliest example: Nightingale’s landmark study of maternal morbidity.
b) Dr Linda H Aiken was a pioneer in application of evidence based practice.
c) Dr Frances Hughes raised the profile of nurses by giving them autonomy &
accountability.
d) The Tongan’s Health Society’s Diabetic clinic, NZ offered care in Tongan language in a
cultural setting with native music.
e) In New Zealand, Nurses provided health assistance through smart phones.

5. 1. To improve & maintain quality of
care.
2. To find new information on health &
illness.
3. To find better ways of curing and
caring.
4. To reduce the energy consumption.
5. To compete global workforce
shortage.
6. To meet emerging nursing specialties.

6. AREAS OF
INNOVATION
PRACTICE EDUCATION
CARE MANAGEMENT

7. INNOVATION IN
NURSING PRACTICE
New medical equipment and
technology demands new skills.
Drug based treatment has
changed the scenario of care
giving.
Application of innovative ideas
like motivation of personnel
involved, cultural environment,
etc.

8. HOW TO IMPLEMENT NEW IDEAS?
KNOWLEDGE
PERSUASION INCORPORATION IN
DAILY PRACTICE
DECISION IMPLEMENTATION CONFIRMATION

9. INNOVATION IN NURSING EDUCATION
Computer Assisted Thinking (CAT)
functions:
a) Enhance student’s active thinking
b) Students’ action log is kept in track each time the
students use the program.
c) The analysis of the log reveals the development of
inferential thinking skill in the student.
d) It serve as medical dictionary.

10. INNOVATION IN NURSING EDUCATION
STEPS
• Online survey among faculty regarding their
ideas on innovation in nursing education.
• Faculty meetings and forum of various nursing
programs to discuss innovative programs of
nursing education.
• Development of an electronic community for
Nurse educators to share ongoing innovative
practices.
:
Effective learning of the
students rather than content
of covering.

11. INNOVATION IN
NURSING
EDUCATION
NEWER STRATEGIES
 Creative use of technology like computer assisted instruction, human patient simulators, etc.
 Integration of educational theories.
 Integrative exercise and tests as teaching tools.
 Identification of barriers in innovation implementation.
 Collaboration of multi-dimensional teams.
 Pilot project to assess effectiveness of innovation.
 Tele-teaching, Micro-teaching.
 Nursing informatics and mobile library.

12. INNOVATION IN NURSING CARE
NEWER STRATEGIES
Cost effective nursing practice, hospital at
home care, integrated therapy like DOTS.
Nurses to identify risk factors for disease
prevention.
Nurses to influence positive health status of
population by provide health information like
healthy lifestyles, diet, etc.
CLALLANGES:
 Complex interventions
 Chronically ill
patients
 Shortage of workforce
 Budget constraints

13. INNOVATION IN
NURSING
MANAGEMENT
NEWER STRATEGY
Introduction of NURSE MANAGER
into the senior clinical grades of
nursing.
Key Work: diffuse innovation in daily
practice to improve performance and
competence.
Key Skill: Rigorous awareness and
enthusiasm

14. ROLE OF NURSES AS INNOVATORS
1) Promoting nursing as a profession to create, drive and support innovative steps.
2) Celebrating innovative achievements by nurses.
3) Promote positive environment of collaboration, readiness to change and openness to discuss
innovative ideas.
4) Encouraging inputs ideas from researchers.
5) Providing forum for discussion of innovations.
6) Nurses must keep up the professional conduct during challenges.
7) Nurse are role-model to influence practice of innovative ideas throughout the organization.

15. REASONS FOR FAILURE OF INNOVATIONS
1) Poor leadership and organization.
2) Poor Goal definition and knowledge.
3) Poor communication and participation in
teams.
4) Poor access to information and
monitoring of results.
5) Poor empowerment.

16. TRANSCULTURAL
NURSING

17. Countries are heterogeneous, multicultural societies.
nurse to understand about culture
 need for respect all human beings
 culturally sensitive
 culturally appropriate
 culturally competent.

18. DEFINITION ‘Transcultural Nursing is a
comparative study of cultures to
understand similarities (culture
universal) and differences
(culture specific) across human
group.’
- Madeleine M Leininger.

19. HISTORY OF TRANSCULTURAL NURSING
• Leininger in 1950 noted cultural differences between patients and
nurses while working with emotionally disturbed child.
• She recognized that health and illness states are strongly influenced
by culture.
• She formulated the theory of Transcultural Nursing and published
‘Culture care diversity and universality- A theory of nursing’ in
1991.
• Her theory has now developed into a discipline in nursing.

20. IMPORTANCE
Marked increase of migration of people worldwide.
Rise in multiculturism identifies among nurses the respect and
understanding for people’s culture and beliefs.
Increased use of health care technology sometimes conflict with
cultural values of the clients.
Increased legal suits resulting from cultural conflict,
negligence, ignorance.
Increased demand for community and culture-based health
care services.

21. THE SUNRISE ENABLER
Culturally congruent nursing care: care based on cultural
values, beliefs & practices.
Cultural Diversity: Variations among different cultures.
Cultural Universality: Similarities of different cultures and its impact on
health and wellbeing.
Generic or Folk Care: Remedies passed down from generation to another
within a particular culture.

23. Illness and wellness are shaped by : perception, coping skills, social level of the
patients.
Cultural competence & cultural knowledge: important component of nursing.
Cultural influences search for relief from disease or distress.
Many cultural influences choose not to seek modern medical treatment as
traditional or alternate models may come into conflict with western models.
Flexible programs, policies and services to meet the need of culturally diverse
population.
Nurse must establish intercultural communications.

24. ESSENTIALS OF PROVIDING CULTURALLY
CONGRUENT CARE:
• Culture Care Preservation: Nurse helps in retainment of values to
bring well-being, recovery from illness or facing handicap or death.
• Culture Care Negotiation: It involves the actions that help people to
adapt to a beneficial health outcome
• Culture care Restructuring: It is used to help clients modify their
health care patterns towards beneficial while still respecting their
cultural pattern and beliefs.

25. Inclusion of cultural values while attaining optimum
level of wellbeing.
The individual cultural value priorities are
respected.
Enhances trust relationship among nurse and
patient.
Meaningful quality care.

26. WEAKNESS OF THE THEORY
• Time consuming
• Requires ongoing research.
• Multiple variations among cultures makes it difficult to
understand a particular authoritative domain in culture.

27. FUTURISTIC NURSING
‘We Must Always Change, Renew, Rejuvenate Ourselves; Otherwise We Harden’
- Johann Wolfgang.

28. DEFINITION
 Nursing is a dynamic profession undergoing change every moment.
 ‘We are in a new place, we are not on the edge of the old place. We are
not pushing the envelope, we are totally a new envelope. So the rule
have changed, ever fundamental premise old way of thinking no longer
applies’
- Sister Elizabeth Davis.

29. VISION OF FUTURE
Porter O’ Grady suggested that nursing will shift
away from dependent, illness fixed and narrowly
defined roles.

30. FUTURE DIRECTIONS
Current Roles Next Century Roles
• Interdependent, Health based &
Flexible application.
• Accountability
• Function- Policy & legislation
maker, team interactive.
• Illness fixed.
• Responsibility – Care &
safety.
• Function- Direct care,
Physician dominated &
policy based.

31. ASSOCIATED FACTORS ASCERTAING
CHANGES
• Demographic changes: Increasing poverty, cultural diversity, continued
urbanization, rising numbers of elderly.
• Environmental Changes: Nuclear plant accidents, tsunami, gradual decrease in
qualities of air, water, etc.
• Flow of Resources: Blocked money flow towards preventive health care,
Political inputs.
• Supply of Manpower and Competition: Shortage of nursing personnel,
competitive & marketing strategies.
• Emerging Bioethical Issues: Prevention of conception, termination of
pregnancy, Gene mapping, Artificial respirators, Heart & lung machines

32. ASSOCIATED FACTORS ASCERTAING
CHANGES
• Public Opinion: Coalitions, Supporters & critics in the society.
• Global Trends: Inter-state problem solving, Disaster Training, participation in political
process.
• Nursing practice & Theory: Continuous research, Evidence based practice, Holistic
nursing.
• Professional Leadership: Dedication, aim & untiring efforts of Nurse leaders.
• Working conditions: Shorter & more convenient hours, Better Accommodations, Better
Salaries.
• Patient’s Bill of Rights: Nurses are accountable & have legal responsibility for
patient’s care.

33. • Emphasis to be given to improve the following
aspects of students:
 communication with interdisciplinary colleagues.
 Advance nursing practice skills of students.
 Health maintenance skills, community-based
skills of students.
 Critical thinking ,Accountability & assertiveness.
 Cost effectiveness of care, practice teaching &
research.
 Decision making, Client teaching.
 e-nursing education, use of simulators, virtual
reality, etc.

34. Change in nurses’ role due to :
 demand for quality care
 tele-medicine, longer life-expectancies, organ
donation, palliative care, pain management,
spirituality assessment, grief counselling, etc.
 health teacher
 Decreasing knowledge gap between physician &
nurse will bring better collaboration.
 scientific approach of problem solving & research
orientation
 solo practitioner

35. FUTURE OF NURSING ADMINISTRATION
• Role in Planning: Leadership & responsibility
in planning health care.
• Transition of Illness to Health: Nurse will
focus on preventing illness, bringing lifestyle
changes, bringing health promotion.

36. EMERGING ROLES OF A NURSE
 CLINICAL NURSE SPECIALIST: Advance practice nurse with expertise in specialized
clinical set-up, possess qualities like clinical judgement, moral agency, collaboration, etc.
 NURSE PRACTITIONER: Provides health care in out-patient or community-based
setting by holistic approach. Possess legal authority to implement patient management,
orders diagnostic tests, prescribes medications.
 ADULT NURSE PRACTITIONER: Provides primary ambulatory care to adults. Roles
includes Case management, Leadership, Education, Research, Policy development.
 FAMILY NURSE PRACTITIONER: Provides primary ambulatory care for families in
collaboration with family physician. Meets family’s health care needs, guides & counsels
family.

37. EMERGING ROLES OF A NURSE
 ACUTE CARE NURSE PRACTITIONER: Registered nurse with advanced nursing skill, provides
direct services to critically ill adult patients in a hospital.
 GERIATRIC NURSE PRACTITIONER: Trained to meet specialized needs of ageing adults, with
emphasis on health promotion & maintenance.
 PEDIATRIC NURSE PRACTITIONER: Provides specialty care for children from birth to 21 years
of age. Practices in hospitals, physician’s office or in emergency care.
 CERTIFIED NURSE MIDWIFE: Expertise in prenatal care, management of labour, postpartum
care, family planning, etc. Provides medical consultation, collaborative management & referral.
 CERTIFIED REGISTERED NURSE ANESTHETIST: Delivers anesthesia to clients in various
settings like surgical centers, birthing centers taking care of patient’s needs before, during, after
surgery & follow up.

38. SPECIALIZED AREAS OF NURSING SERVICES
• MOBILE NURSING: Provides home-teaching & care for patients with various needs like discharged
patients, ventilator dependent patient, patients needing assistance in self-care, etc.
• SPACE NURSING: Space nursing Society (SNS) was established in 1991 with 400 worldwide members.
It evaluates emergency plans, medications used in space, telemedicine opportunities, performing surgery
in space, etc.
• FORENSIC NURSING: Nurse have specialized training in forensic evidence collection, criminal
procedures, legal testimony expertise. It is the liaison between medical profession & criminal justice
system.
• DISASTER NURSING: Readiness in responding to immediate community needs during & after a
catastrophic event.
• HOSPICE NURSING: Observing & assessing symptoms for terminally ill patients.

39. SPECIALIZED AREAS OF NURSING SERVICES
• RESEARCH: Research is aim towards provision of high quality of educational program
to prepare workforce of nurse scientist, develop a sound research infrastructure and
research funding in future.
• EDIDENCE BASED PRACTICE: It is directed towards achievement of cost-effective,
high quality patient care based on scientific inquiry and not on opinions.
• ROBOTIC NURSING: Recent trends indicate development of robotic technology in
delivery of primary health care. nurse in various treatment procedures.