1. Transcultural Care Dr Tina Harris, Lead Midwife for Education Adapted from a presentation originally developed by Maggi Brimson 1

2. Transcultural issues and care – What is transcultural care? – The importance of culture in midwife practice – What is Culture? – Differences between culture, ethnicity and race. – The population of Leicester and Leicestershire – Meeting clients’ needs – Stereotyping and prejudice 2

3. What is transcultural care The goals of transcultural care are to, – “... give culturally congruent nursing care, and to provide culture specific and universal nursing care practices for the health and well-being of people or to aid them in facing adverse human conditions, illness or death in culturally meaningful ways.” http://en.wikipedia.org/wiki/Transcultural_nursing 3

4. Why do we need to know about transcultural care? Meeting needs of population we serve – Needs of the local pop we serve are important and that is why we look at the society around us when considering the care they need. Particularly relates to needs assessment of minority ethnic groups. Regulatory requirement – NMC (safeguarding the public) The code Standards for pre-registration midwifery education 4

5. Cultural competence Cultural competence refers to an ability to interact effectively with people of different cultures, particularly in the context of human resources, non profit organisations and government agencies whose employees work with persons from different cultural/ethnic backgrounds. ]] http://en.wikipedia.org/wiki/Cultural_competencehttp://en.wikipedia.org/wiki/Cultural_competence 5

6. What is culture Culture is the learned and transmitted knowledge about a particular culture with its values, beliefs, rules of behaviour and lifestyle practices that guides a designated group in their thinking and actions in patterned ways. (Leininger, 1978) 6

7. Culture may be:- Knowledge Values Beliefs Rules of behaviour Lifestyle practices Guidelines Attitudes 7

8. Culture can be transmitted by; Symbols Language Art Ritual 8

9. What is your own culture Values Beliefs Rules Attitudes Lifestyle practices 9

10. How is your culture transmitted Symbols Language Art Rituals 10

11. What about cultures within healthcare? Loros Maternity services – Home birth service – Midwifery led units – Large maternity unit managing complex cases 11

12. How are these different? Culture Race Ethnicity Religion 12

13. Health Beliefs Individual but influenced by culture Fundamental for holistic practice Midwives bring in their own health beliefs and and expres the culture of midwifery practice as a professional group 13

14. Types of Health Belief Biomedicine Personalistic (magico-religious) Naturalistic (holistic) 14

15. Check list for midwifery care Care of women and their families needs to be both appropriate to the individual/group and also to take into account their cultural and religious beliefs. 15

16. Checklist for midwifery care Midwives need to ensure that they undertake an assessment which takes into account the cultural and religious background of the person they are offering care to. 16

17. Checklist for midwifery care Although midwives do not need to be cultural experts they need awareness of the possible effects cultural differences can have on all aspects of care. 17

18. Ways of describing ethnic origin White: British White: Irish White: Other White Mixed: White and Black Caribbean Mixed: White & Black African Mixed: White and Asian Mixed: Other Mixed 18

19. Ways of describing ethnic origin Asian or Asian British: Indian Asian or Asian British: Pakistani Asian or British Asian: Bangladeshi Asian or British Asian: Other Asian 19

20. Ways of describing ethnic origin Black or Black British: Caribbean Black or Black British: African Black or Black British: Other Black Chinese Other Ethnic Groups 20

21. Leicester City population (304,000) Census 2011 183,000 (60%)white British 3200 (1%)White Irish 9100 White other 3100 (1%)white/black Caribbean 900 white/black African 2900 white/Asian 1900 Mixed other 56900 (19%)Indian Asian 14000 (5%)Pakistani 2800 (1%)Bangladeshi 5800 (2%)Asian other 4800 black Caribbean 5800 (2%)black African 1000 black other 6500 (2%)Chinese 3000 (1%)other 21

22. Cultural issues in delivering care to pregnant women and their families Can you think of how culture may impact on the care women will want and the care we will give? 22

23. Religion: Census 2001 Leicester Christian 44.72% Buddhist 0.23% Hindu 14.74% Jewish 0.15 Muslim 11.03% Sikh 4.21 England & Wales Christian 71.75% Buddhist 0.28% Hindu 1.06% Jewish 0.5% Muslim 2.97% Sikh 0.63% 23

24. Religion: Census 2001 Leicester Other religions 0.42% No religion 17.43% Religion not stated 7.07% England & Wales Other religions 0.29% No religion 14.81% Religion not stated 7.71% 24

25. Sources of information – http:www.bbc.co.uk/religion (accessed 4/10/12) – http:www.statistics.gov.uk/census (accessed 4/10/12) – Holland K, Hogg C, (2001) Cultural Awareness in Nursing and Health Care, (Arnold: London) – Watt S, Norton D (2004) Culture, ethnicity, race: what’s the difference? Paediatric Nursing.16, 8, 37-42. 25

26. Further reading Andrews M and Boy J S (2012) Transcultural concepts in nursing care. 6 th ed. London:Lippincott Williams and Wilkins. Kotsapas et al (2009) Transcultural considerations in obstetrics and gynaecology: what the clinician needs to know. Journal of Obstetrics and Gynecology. April 29(3) pp175-180 Lewallen L P (2011) The importance of culture in childbearing. JOGNN. 40(1) pp4-8 Papadopoulos I et al (2006) Transcultural health and social care: development of culturally competent practitioners. Edinburgh:Elsevier Sookhoo D (2009) Race ethnicity and childbirth in C Squire (Ed) Social context of birth. Abingdon:Radcliffe Publishing pp85-99 26