Glossary

Definitions of Terms: For every definition that is described here, you should be able to find others that are equally useful and conceptually concise.

Acculturation
Refers to the process of voluntary and willing modification in migrants own culture when they come in contact with another culture. (Purnell & Paulanka, 1998, p.3)

Communication
‘An organised, pattern of behavior that regulates and makes possible all nurse-patient interactions. It is the exchange of messages and the creation of meaning. Because they are acquired simultaneously, communication and culture are integrally linked.’ (Andrews and Boyle, 1999, p.31).

Cultural communication or transcultural communication
Refers to the situational process when people from different or ethnic backgrounds attempt to understand the point of view of the other person from the other’s cultural perspective. (Potter and Perry, 1997, p.352).

Adapting Ruben’s (1977) suggestions, Hofstede (1984) proposes that cross-cultural communication skills should include:

Purnell and Paulanka (1998) see cultural competence as a process, in terms of four characteristics:

Countertransference 
Refers to the process of projecting one’s own feelings and values on to another person. To deal with counter-transference, the individual needs to examine his/her own feelings, attitudes and behaviours.
(Henderson & Primeaux, 1981, p.35).

Culture 
Describes the integrated patterns of human behaviour of an ethnic, religious or social group. The patterned behaviour includes action, assumptions, values and beliefs.

‘Culture is also the sum of beliefs, practises, habits, likes, dislikes, norms, customs, and rituals learned from the family during socialization.’ (Potter & Perry, 1997, p.357)

Other definitions can be found in Giger and Davidhizar (1999, p. 3-4).

Hofstede (1984) sees culture as ‘the collective programming of the mind which distinguishes the members of one human group from another’ (p.21).

Culture is the human-made part of the environment. It has two components. The material components of culture are items produced through creative thinking and technology. The non-material components of culture are made of up of interpretative and symbolic representations. Culture is non-biological, is learned, and is transmitted to each successive generation.

(See also Potter & Perry, 1997, Chapter 21. pp.351-369; Taylor, Lillis & LeMone, 1997, Chapter 3, pp.32-51).

Cultural diversity 
Refers to the representations of a variety of different cultures. It refers to observable differences within and between groups, based on gender, ethnicity, religion, lifestyles, language, food and dietary preferences, dress, disability, sexual orientation, educational and occupational status, family and kinship.

(See Leininger, 1995, p.69).

Culture care 
Refers to knowledge, skills and attitudes that are learned about the values, beliefs and lifeways of people from a cultural perspective that enable caregiving. Another definition following Leininger reads ‘the cognitively learned and transmitted values, beliefs, and patterned lifeways that assist, support, facilitate, or enable another individual or group to maintain their well-being or health, to improve their human condition and lifeways, or to deal with illness, handicaps, or death. (Reynolds & Leininger, 1993, p.19)

Culture care accommodation or negotiation
Yet another concept from Leininger and refers to ‘those assistive, supportive, facilitative, or enabling creative professional actions and decisions that help people of a designated culture to adapt to, or to negotiate with, others for a beneficial or satisfying health outcome with professional care providers’ (Reynolds & Leininger, 1993, p.20).

Cultural care diversity 
Refers to ‘ the variabilities and/or differences in meanings, patterns, values, and lifeways, or symbols of care within or between collectivities that are related to assistive, supportive, or enabling human care expressions’ (Leininger, 1991; See Reynolds & Leininger, 1993, p.19).

Cultural care preservation or maintenance 
Refers to those assistive, supportive, or enabling professional actions and decisions that help people of a particular culture to retain and / or preserve relevant care values so that they can maintain their well-being, recover from illness, or face handicaps and / or death. (Leininger, 1991; Reynolds & Leininger, 1993, p. 19-20).

Culture care repatterning or restructuring 
According to Leininger refers to ‘those assistive, supportive, facilitative, or enabling professional actions and decisions that helps clients reorder, change, or modify their lifeways for new, different, or more beneficial health care patterns while respecting the client’s cultural values and beliefs and providing a better (or healthier) lifeway than before.’ (Reynolds & Leininger, 1993, p.20). 

Cultural Care Universality 
Refers to ‘the common, similar, or dominant uniform care meanings, patterns, values, lifeways, or symbols that are manifest among many cultures and reflect assistive, supportive, facilitative, or enabling ways to help people. (Leininger, 1991; Reynolds & Leininger, 1993, p.19).

Cultural competence 
Is conceptualised as a conscious process by Purnell and Paulanka (1998) who define it in terms of four characteristics:

Development of one’s awareness of one’s existence without allowing it to have an undue influence on people from other backgrounds; demonstration of knowledge and understanding of the other person’s culture; acceptance and respect of cultural differences ; adaptation of care to be congruent with the client’s culture. (Purnell and Paulanka, 1998, p.2)

‘Cultural competence is a dynamic, fluid, continuous process whereby an individual, system, or health care agency finds meaningful and useful delivery strategies based on knowledge of cultural heritage, beliefs, attitudes and behaviours of those to whom they render care’ (Giger & Davidhizar, 1999, p.8.)

Cultural competence has also been defined as a set of congruent behaviours, attitudes, structures and policies that are affected in intercultural situations. Cultural competence involves individuals and organisations.
(See Giger & Davidhizar, 1999, p.7-9).

Cultural congruent care 
Refers to ‘those cognitively based assistive, supportive, facilitative, or enabling acts or decisions that are tailor-made to fit with an individual’s, group’s, or institution’s cultural values, beliefs, and lifeways in order to provide meaningful, beneficial, and satisfying health care, or well-being services’ (See Leininger, 1991, p.46-47; Reynolds & Leininger, 1993, p.19-20). Care that is in keeping with the cultural norms of the patient/client, and does not give rise to conflict.

Cultural imposition 
Describes the tendency of one group or individual to impose their ideas, values, beliefs and practices upon another group or individual because of the belief that theirs is superior. 
( See Leininger, 1995, p.180).

Cultural sensitivity 
Refers to the capacity to identify, relate to and empathise with the values, beliefs and feelings of others. (See Henderson & Primeaux, 1981, p.50).

Culture specific 
Refers to values, beliefs, and patterning of behavior that tend to be specific or unique to a group and which do not tend to be shared with members of other cultures’. (Andrews & Boyle, 1999, p.4).

Culture universal 
Refers to shared values, beliefs and patterning of behaviours across cultures. (See Leininger, 1995, p.69).

Diversity 
Refers to differences of any kind such as class, gender, ethnicity, physical ability, and sexual preferences. There are many spectrums of diversity. Valuing diversity recognises diversity in all its dimensions. (See Andrews & Boyle, 1999, p.14-15).

Environmental context 
Refers to ‘the totality of an event, situation, or particular experiences that give meaning to human expressions, interpretations, and social interactions in particular physical, ecological, sociopolitical and/or cultural settings’ (Leininger, 1991, p.48 cited in Rosenbaum, 1997, p.26-27). 

Ethnicity 
Refers to a characteristic which may ‘identify’ a person to others. (See Bhugra & Bahl, 1999, p.1). 

‘Ethnicity is the sense of identification of a collective cultural group, largely based on the group’s common heritage’. (Taylor, Lillis & LeMone, 1997, p.33).

Ethnic group 
Refers to the group a person belongs to as a result of shared characteristics including ancestral and geographical origins, social and cultural traditions, religion and languages. 

‘The characteristics of an ethnic group include common language and dialect, migratory status, … and religious faith and practices…traditions, values, symbols, literature, folklore, music, and food preferences…have a sense of uniqueness’ (Potter & Perry, 1997, p.354). 

Ethnocentrism 
Refers to ‘a universal tendency of human beings to think that their ways of thinking, acting, and believing are the only right, proper, and natural ways. This can be a major barrier to providing culturally conscious care’ (Purnell and Paulanka, 1998, p.3).

Ethnocentrism has been defined by Drever (1952, p.6) as ‘an exaggerated tendency to think the characteristics of one’s own group or race are superior to those of other groups or race’ (cited in Hofstede, 1984, p. 25).

Ethnohistory 
Yet another concept in Leininger’s model and refers to’ those past facts , events, instances, and experiences of individuals, groups, cultures, and institutions that are primarily people-centred (ethno) and that describe, explain, and interpret human lifeways within particular cultural contexts and space-time referents’. (Reynolds & Leininger, 1993, p. 20-21).

Ethnoscience 
Refers to the systematic study of the way of life of a particular cultural group. Its purpose is to obtain an accurate account of the group’s thinking, beliefs, values, and perceptions and interpretations of their world. (See Leininger, 1995, p.159).

Folkways 
The normal, habitual ways ethnic groups do things. Mores are those folkways that must be followed because they are believed to be beneficial for group survival. (See Henderson & Primeaux, 1981, p.1).

Language 
A factor that identifies an ethnic group. Language shapes the ethnic group’s philosophy of life, plays an important role in the development of cognitive skills, and in the formation of the self-concept. Language helps people define their world. People speak different languages to express their worldviews in different ways. People who are bilingual may show preferences for speaking in one language over the other in different situations, and when communicating with people from other ethnic groups. Sub-cultures can be bilingual or multilingual.

Mores 
(See Folkways above)

Power Distance 
A term used to refer to human inequality in a variety of areas within society, such as prestige, wealth, power, laws, rules, rights and privileges (see Hofstede, 1984, p.65-68). Power distance is noted within groups and between groups. Interpersonal power can manifest itself in the relationship between patient and health care providers.

Race 
Refers to the biological classification of people who have the same physical characteristics. ( See Billington, Hockey & Strawbridge, 1998, p.27-28).

Spirituality 
Concerned with essence of life, the quest to find meaning, and it is more than religion, and ‘includes behaviours that give meaning to life and strength to the individual.’ (Purnell & Paulanka, 1998, p,39)

‘Spirituality is born out of each person’s unique life experience and his or her personal effort to find purpose and meaning in life’ (Andrew & Boyle, 1999, p. 381).

It relates to the soul, and involves hope, love, trust, forgiveness.
See: Goddard N (1995); Narayanasamy, A. (1999a); Narayanasamy, A. (1999b).

Values 
Attributes that determine our subjective reasoning and conceptions of what is desirable within ourselves and society. 

‘Values are principles and standards that have meaning and worth to an individual, family, group, or community.’ (Purnell & Paulanka, 1998, p.3).

‘Cultural values’ are ‘the powerful, persistent, and directive forces that give meaning, order, and direction to the individual’s, group’s, family’s, or community’s actions, decisions, and lifeways, usually over a span of time’. (Andrews and Boyle, 1999, p.24, citing Leininger, 1995). 

References used in this glossary

Andrews, M. M. & Boyle, J S. (1999) Transcultural concepts in nursing care. 3rd ed. Philadelphia: Lippincott.

Bhugra D. and Bahl V. (Eds) (1999) Ethnicity: An agenda for mental health. London, Department of Health / Gaskell.

Billington R., Hockey J. and Strawbridge S. (1998) Exploring self and society. London, Macmillan

Drever J. (1952). A Dictionary of Psychology. Baltimore: Penguin Books Ltd.

Giger, J. N. & Davidhizar, R. E. (1999) Transcultural Nursing. Assessment and Intervention. 3rd ed. St. Louis: Mosby.

Goddard, N. (1995) ‘Spirituality as integrative energy’: a philosophical analysis as requisite precursor to holistic nursing practice. Journal of Advanced Nursing, 22 (4), pp 808-815.

Henderson G. and Primeaux M. (1981) Transcultural health care. Menlo Park, CA: Addison-Wesley Publishing Company.

Hofstede, G. (1980, 1984) Culture’s consequences: International Differences in Work-Related Values. Newbury Park, CA: Sage Publications.

Hofstede, G. (1984) Culture's consequences. London: Sage Publications.

Leininger M. (1991) Culture care diversity and universality: A theory of nursing, New York, NY: National League for Nursing.

Leininger, M. M. (1995) Transcultural nursing: concepts, theories, research and practices. 2nd ed. New York: McGraw-Hill.

Narayanasamy, A. (1999a) Learning spiritual dimensions of care from a historical perspective. Nurse Education Today, 19 (5), 386-395.

Narayanasamy, A. (1999b) A review of spirituality as applied to nursing. International Journal of Nursing Studies, 36 (2), 117-125.

Potter, P. A. & Perry, A. G. (1997) Fundamentals of Nursing: concepts, process, and practice. 4th ed. St. Louis: Mosby.

Purnell, L. D. & Paulanka, B. J. (1998) Transcultural Health Care. A Culturally Competent Approach. Philadelphia: F. A. Davis Company.

Reynolds, C. L. & Leininger, M. (1993) Culture care diversity and universality theory. Newbury Park: Sage Publications.

Rosenbaum, J. N. (1997) Leininger’s theory of culture carer diversity and universality: Transcultural critique. The Journal of Multicultural Nursing & Health, 3 (3), 24-29, 36.

Ruben, B.D. (1977). Guidelines for cross-cultural communication effectiveness. Group and Organization Studies, 2, 470-479).

Taylor, C., Lillis, C. & LeMone, P. (1997) Fundamentals of Nursing. The Art & Science of Nursing Care. 3rd ed. Philadelphia: Stanley Thornes Publishers and Lippincott.