Approved by University Studies Sub-Committee March 17, 2004. A2C2 action pending.

Approved by Faculty Senate April 5, 2004.

WINONA STATE UNIVERSITY

PROPOSAL FOR UNIVERSITY STUDIES COURSES

Department _____Nursing______Date ___2-19-04______

___NURS 325______Transcultural Issues in Health Care ______3______

Course No.Course NameCredits

This proposal is for a(n)___x__ Undergraduate Course (This is an existing course that has been previously approved by A2C2.)

Applies to:__x__ Major______Minor

_____ Required_____ Required

___x_ Elective_____ Elective

University Studies (A course may be approved to satisfy only one set of outcomes.):

Course Requirements:

Basic Skills:Arts & Science Core:Unity and Diversity:

_____ 1. College Reading and Writing_____ 1. Humanities_____ 1. Critical Analysis

_____ 2. Oral Communication_____ 2. Natural Science _____ 2. Science and Social Policy

_____ 3. Mathematics_____ 3. Social Science_____ 3. a. Global Perspectives

_____ 4. Physical Development & Wellness_____ 4. Fine & Performing Arts___x_ b. Multicultural Perspectives

_____ 4. a. Contemporary Citizenship

_____ b. Democratic Institutions

Flagged Courses:_____ 1. Writing

_____ 2. Oral Communication

_____ 3. a. Mathematics/Statistics

_____ b. Critical Analysis

Prerequisites ____none______

Provide the following information (attach materials to this proposal):

University Studies related course requirements are mapped within the attached syllabus.

Attach a University Studies Approval Form.

Department Contact Person for this Proposal:

____Mary ______

Name (please print)Phonee-mail address

WINONA STATE UNIVERSITY

UNIVERSITY STUDIES APPROVAL FORM

Routing form for University Studies Course approval. Course__NURS 325_____

Department Recommendation_____ Approved_____ Disapproved
______
Department Chair Datee-mail address
Dean’s Recommendation_____ Approved_____ Disapproved*
______
Dean of College Date
*In the case of a dean’s recommendation to disapprove a proposal, a written rationale for the recommendation to disapprove shall be provided to the University Studies Subcommittee.
USS Recommendation_____ Approved_____ Disapproved_____ No recommendation
______
University Studies Director Date
A2C2 Recommendation_____ Approved_____ Disapproved
______
Chair of A2C2 Date
Faculty Senate Recommendation_____ Approved_____ Disapproved
______
President of Faculty Senate Date
Academic Vice President Recommendation_____ Approved_____ Disapproved
______
Academic Vice President Date
Decision of President_____ Approved_____ Disapproved
______
President Date
Please forward to Registrar.
Registrar ______Please notify department chair via e-mail that curricular change has been recorded.
Date entered

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Course: N325 Transcultural Issues in Health Care

Placement in the Curriculum: Upper Division Nursing Elective; Multicultural Perspective in Unity and Diversity of University Studies.

Prerequisite: None. The intended learner will have some experience with the health care delivery system or be enrolled in the Nursing major. Other learners may be admitted with permission of the faculty.

Course Credit: 3 semester credits

Course Description: This course explores the importance of transcultural concepts that are present in health care delivery systems. It is designed to assistant learners to increase awareness of all types of human diversity, understand the importance of diversity, and incorporate ways of utilizing this knowledge to deliver culturally competent health care in all settings within the global community.

University Studies: Multicultural Perspectives: The purpose of the Multicultural Perspectives requirement in University Studies is to develop students’ understanding of diversity (gender, ethnicity, race, etc.) within and between societies. This course promotes students’ abilities to:

Multicultural Perspective Criteria / Related NURS 325: Transcultural Issues in Health Care Criteria
a. demonstrate knowledge of diverse patterns and similarities of thought, values, and beliefs as manifest in different cultures; / See Course Outcomes 1 and 2: Define culture and related concepts found in a variety of practice settings and Discuss selected cultural group differences and similarities. Applied in Course Requirements 1: Cultural Assessment Interview and Course Requirements 2: Case Study Analysis where patterns are examined.
b. understand the extent to which cultural differences influence the interpretation and expression of events, ideas and experiences; / See Course Outcome 3:Utilize a cultural framework to assess and analyze health care situations involving multiple cultural values and practices. Applied in Course Requirement 3: Case Study Analysis and 4: Organizational Culture Analysis where real life situations are presented and analyzed.
c. understand the extent to which cultural differences influence the interactions between individuals and/or groups; / See Course Outcome 2: Discuss selected cultural group differences and similarities. Applied in Course Requirement 3: Case Study Analysis and 4: Organizational Culture Analysis where real life situations are presented and analyzed.
d. examine different cultures through their various expressions; and/or / See Course Outcome 2: Discuss selected cultural group differences and similarities. See Course Requirement 5: Annotated Bibliography where literature about various cultural expressions is critiqued.
e. possess the skills necessary for interaction with someone from a different culture or cultural group. / See Course Outcome 5: Articulate an emerging personal philosophy of practice that allows for cultural competence in delivering health care. Applied in Course Requirements 2: Independent Project requiring reflection on personal skills and values in cross-cultural situations.
The classroom discussion and readings present a comprehensive introduction to cultural diversity within societies and between societies with specific consideration in health care. The exams are a measure of student knowledge of this diversity and how to function within such diversity.

Course Focus: The education of health care providers includes the concepts of holism, caring, and culturally competent care for all clients. It is recognized that each person and group functions within a culture. The concept of culture pertains to individuals, groups, communities, and nations. In the complex health care setting of today, health care providers must be able to maintain neutrality in assessments, communicate with clients and other health care team members who speak different languages and come from diverse cultural backgrounds. Health care providers must be able to understand and show compassion for clients they encounter from different cultures, lifestyles, traditions, and expectations. The overall goal is to encourage health care providers to provide optimal care, understanding, and communication to all clients. In addition, health care providers will be challenged to incorporate this knowledge into their personal and professional lives.

Course Outcomes: Upon completion of this course, the student will be able to:

  1. Define culture and related concepts found in a variety of practice settings.
  1. Discuss selected cultural group differences and similarities.
  1. Utilize a cultural framework to assess and analyze health care situations involving multiple cultural values and practices.
  1. Discuss changing conditions occurring within health care delivery systems, including the importance of organizational cultures.
  1. Articulate an emerging personal philosophy of practice that allows for cultural competence in delivering health care.

Course Outline of Major Topics:

Unit I. Historical and Theoretical Foundations of Transcultural Nursing Care

1. Theoretical foundations of transcultural nursing including understanding of diversity, ethnocentrism, Leininger’s theory of culture care diversity and panethic minority groups.

2. Culturally competent nursing care with emphasis on cross-cultural communication, cultural self assessment and sick role behavior.

3. Cultural competence in the health history and physical examination including understanding cultural assessment, biocultural variations and culture bound syndromes.

4. The influence of cultural and health belief systems on health practices with an emphasis on health seeking behaviors.

5. Understand cultural concepts to plan care for families and communities.

Unit II. Transcultural Nursing Across the Lifespan

A wide variety of selected cultures from the global community will be examined with particular attention to:

1. Cultural belief systems and practices related to childbearing.

2. Culture-universal and culture specific childrearing values, attitudes, beliefs and practices.

3. Transcultural perspectives of health and nursing care associated with developmental events in the adult years.

4. Utilize the concepts of cultural variation to plan culturally competent care for older adults.

Unit III. Multicultural Health Care Settings

1. Creating culturally competent organizations.

2. Cultural diversity in the health care work force.

3. Health disparities.

4. Cultural perspectives and mental health nursing with an emphasis on practices of specific cultural groups.

Unit IV. Contemporary Challenges

1. Transcultural aspects of pain including universal aspects of the pain experience and expressions of pain unique to cultures.

2. Cultural competence in ethical decision making and the influence of culture in decision making.

Learning Activities:

1. PowerPoint presentations of foundational concepts

2. Assigned readings

3. Literature review

4. Case studies with research application

5. Audio-visual aids/media offerings

6. Exams

Textbook:

Andrews, M. M. & Boyle, J. S. (2003). Transcultural Concepts in Nursing Care Lippincott: Philadelphia.

References:

Andrews, M.M. & Boyle, J.S. (1995). Transcultural concepts in nursing care. 2nd edition. Philadelphia: J.B. Lippincott Company.

Barnum, B.S. (1996). Spirituality in nursing: From traditional to new age. New York, New York: Springer Publishing Company, Inc..

Bennett, M.J. (1998). Basic concepts of intercultural communication: Selected readings. Yarmouth, Maine: Intercultural Press, Inc..

Gardenswartz, L & Rowe, A. (19980. Managing diversity in health care. San Francisco: Josyey-Bass Publishers, inc..

Galanti, G.A. (1997). Caring for patients from different cultures: Case studies from american hospitals. 2nd edition. Philadelphia: University of Pennsylvania Press.

Gochenour, T. (1990). Considering filipinos. Yarmouth, Maine: Intercultural Press, Inc..

Hall, E.T. ( 1959). The silent language. New York, New York: Doubleday (Anchor Books).

______( 1966), The hidden dimension. New York, New York: Doubleday (Anchor Books).

______(1976). Beyond culture. New York, New York: Doubleday (Anchor Books).

______(1983). The dance of life. New York, New York: Doubleday (Anchor Books).

Kritek, P.B. (1994). Negotiating at an uneven table:A practical approach to working with difference and diversity. San Francisco: Jossey-Bass Publishers.

Leininger, M. (1995). Transcultural nursing: Concepts, theories, research & practices, 2nd edition. New York, New York: Mcgraw-Hill , Inc.

Luckman, J. (1999). Transcultural communication in nursing. Albany, New York: Delmar Publishers.

Morrison, T, Conaway, W.A., & Borden, G.A. (1994). Kiss, bow, or shake hands: How to do business in sixty countries. Holbrook, Massachusetts: Adams Media Corporation

Nydell, M.K. (1996). Understanding arabs: A guide for westerners. Revised edition. Yarmouth, Maine: Intercultural Press, Inc.

Osland, J.S. (1995). The adventure of working abroad: Hero tales from the global frontier. San Francisco: Jossey-Bass Publishers.

Potter, P.A. & Perry, A. G. (1997). Fundamentals of nursing: Concepts, process, and practice. 4th edition. St. Louis: Mosby.

Richmond, Y & Gestrin, P. (1998). Into africa: Intercultural insights. Yarmouth, Maine: Intercultural Press, Inc..

Seelye, H. N. & Deelye-James, A. (1996) Culture clash: Managing in a multicultural world. Lincolnwood, Illinois: NTC Publishing Group.

Seelye, H.N. (1997). Teaching culture: Strategies for intercultural communication. Lincolnwood, Illinois: NTC Publishing Group.

Singer, M.R. (1998). Perception & identity in intercultural communication. (Abridged version). Yarmouth, Maine: Intercultural Press, inc..

Triandis, H.C. (1995). Individualism & collectivism. San Francisco: Westview Press.

Trickett, E. J., Watts, R. J. & Birman, D, eds. (1994). Human diversity: Perspectives on people in context. San Francisco: Jossey-Bass Publishers.

COURSE Requirements:

1. Cultural Assessment Interview: 25% of total grade

Cultural Assessment Tool Guidelines

This tool is based on the Purnell Model for Cultural Competence.

  1. OVERVIEW, INHABITED LOCALITIES, AND TOPOGRAPHY
  1. What is the person’s country of origin?
  2. Reason for migration (economic and political factors)
  3. Educational Status and Occupation at “home” and at present (value placed on education and past and present occupation)
  1. COMMUNICATION
  1. Dominant language
  2. Tone of voice and willingness to share feelings and ideas
  3. Personal space and eye contact (inquire, do not assume)
  4. Greeting customs and meaning of nonverbal communication
  5. Importance of time and past-, present- or future-orientation
  6. Format for names in their culture
  1. FAMILY ROLES AND ORGANIZATION
  1. Identify the head of household
  2. Describe gender roles
  3. Prescriptive, restrictive, and taboo behaviors of family and group members
  4. Discuss family roles and priorities (elderly, caste system or status cultural members, etc.)
  5. Describe how alternate lifestyles found in the U.S. “fit” with this culture.

IV. WORKFORCE ISSUES

  1. Identify specific workplace issues
  2. Describe any special considerations important to members of this culture when working with other diverse groups (adjustment issues included)
  3. Are there issues related to workplace autonomy, in superior-inferior positions, with regard to religious practices, and gender issues in the work setting?
  4. Identify language and interpretations barriers.

V. BIOCULTURAL ECOLOGY

a. Describe skin color and physical variations for members

of this cultural group.

b. Identify any biological variations that must be

considered.

c. Are there risk factors related to environment and

climate?

  1. Identify common hereditary or genetic diseases or

Conditions

  1. Identify variability in metabolism and risk factors

With this group

  1. HIGH-RISK BEHAVIORS
  1. What are high-risk behaviors common to this group?
  2. Identify typical health-seeking behaviors and health promotion activities
  3. Are safety measures used or considered commonly?
  1. NUTRITION
  1. Explore the meaning of food and dietary practices
  2. What are specific food rituals?
  3. Are there foods used to promote health or treat illnesses?
  4. Identify significant nutritional deficiencies or intolerances (personal or cultural) that might be expected.
  1. PREGNANCY AND CHILDBEARING PRACTICES
  1. Explore use of birth control and fertility practices
  2. Describe views regarding pregnancy and child raising
  3. Are there prescriptive, restrictive, or taboo behaviors related to sexual intercourse and pregnancy
  4. Describe any practices of caring for the neonate?
  1. DEATH RITUALS
  1. Describe culturally specific death rituals and mourning

practices

  1. Describe burial practices
  2. Explore the meaning of death, dying, and the afterlife
  1. SPIRITUALITY
  1. What is the religion or usual spiritual practices of this person?
  2. How does this practice give meaning to life?
  3. How does it affect health practices?
  4. Are there conflicts between religious beliefs and the traditional health care delivery system?
  1. HEALTH-CARE PRACTICES

a. Identify predominant beliefs about health status that

influences health practices

  1. Describe values for health promotion and illness

Prevention

  1. Identify any folklore or tribal customs
  2. Are there any culturally significant beliefs or practices?

(See this section on table on page 46 in text)

X. HEALTH-CARE PRACTITIONERS

  1. Explore the status of who gives health care and the

status of health care deliverers.

Additional Questions:

I. What possible transcultural issues do you assess with this interviewee and the cultural group from which they come?

II. .How would these differences affect the plans of care-giving and health care delivered?

III. Describe your value for considering transcultural differences/diversity within the health care delivery system. Please use analysis and thought with this. Have you changed any ways of thinking and acting? Have you opened up to new ways of thinking? Is this important in the delivery of health care and how much energy should be given to it?

Criteria:

The learner is expected to thoughtfully gather all pertinent information for the categories of the Purnell Model. A careful interview well documented will receive 80 points.

Questions I. And II. Will be each worth 5 points.

Question III. Is important in articulating a personal framework for the inclusion of transcultural concepts in planning client care. This compromises 10 points or 10% of the total score.

A professional paper will be granted 100 points.

2. Independent Project: 20% of total grade

For this activity there is an element of choice so that you can do application of learning in a less formal way. It is important that you begin to take note of differences and similarities in all settings and in anything that you do. This includes professional and personal life experiences. You may chose a movie, TV presentation, personal observation, read a book/literature, or be very creative to assess and consciously analyze. Please choose a human or depicted human interaction of persons or groups of persons from different nationalities, religions, ways of life, economics level or in some way have developed to this point in time from different circumstances. You have the freedom to choose a racial issue or something as common as a family interaction with members who have married into an established group or have chosen to join an established group.

There is culture all around us and each of us represents a subculture of our own. When we speak of organizational culture this will be a factor in how organizational cultures become reality.

This assignment is meant to get at your personal values and feelings and to better understand your response to the world around you.

  1. Describe the situation and your observations. (Any inclusion of feelings and personal values is encouraged.)
  1. Describe to the best of your ability the differences and similarities in the experience.
  1. What behaviors resulted and how was it resolved or not resolved?
  1. Using the knowledge you have gained or affirmed, assess the results and give an analysis of it as far as:

Could it have been handled in a different way?

Suggest alternative ways of interacting or why it “worked”

  1. How has this experience changed your ways of thinking and viewing human behaviors?

3. Case Study Analysis: 10% of total grade

4. Organizational Culture Analysis: 10% of total grade

5. Annotated Bibliographies: 10% of total grade

6. Two Exams and Final: 25% total grade

Grading Scale:

100-92% A

91-83% B

82- 74% C

For Pass/No credit option 74% needed.

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