When Cultures Collide

holistic-careInherent to the practice of nursing is the exposure to caring for a large variety of people. The astute nurse utilizes the ability to tailor care to the needs of the patient which includes the consideration of culture. A starting point in this contemplation is the transcultural nursing research offered by Madeleine Leininger. Her culture care theory and the Sunrise Model provide direction for the APN in the treatment of heterogeneous populations since they acknowledge patterns that are both collective and also limited to certain cultures. Primary attributes of her theory are care and caring. Her goals were to allow different cultural groups to sustain or reclaim their health. She recognized that beliefs and manifestations regarding caring may vary greatly among cultural groups. Though there may be differences, caring is the core of nursing and also an amalgamating focal point (Joel, 2013, p. 355).

A desire for holistic care can be cultural in nature. Holistic nursing is founded on “a philosophy, a body of knowledge, and an advanced set of nursing skills applied to practice that recognize the totality of the human being, the interconnectedness of body, mind, spirit, energy, social/cultural relationship context, and environment. Philosophically, it is a world view and not a modality” (Mariano, 2007, p. 166).

Holistic care can include a belief in natural remedies and healing practices rooted in Eastern philosophy. An expansive term for this provision of health care is complementary alternative medicine (CAM) or integrative care. Complementary and alternative medicine includes “various medical and health-care systems and practices, and products that are not presently considered to be part of conventional medicine” (Joel, 2013, p. 304). Complementary therapies are “not necessarily proven therapies that are used in conjunction with conventional medicine/nursing” (Joel, 2013, p. 304).

In Western cultures the usual differences are observed between traditional and alternative medicine. Traditional medicine is considered orthodox medicine that is “practiced by doctors who have undergone training in medical schools that are approved by medical associations” (Kola, 2007). Alternative medicine is an all-inclusive term used to describe approaches to corrective treatments differing from the accepted orthodox medicine. Many times alternative medicine practices clash with Western or orthodox medicine practices. “Ethical problems can result when a physician and a patient adhere to different paradigms of medicine” (Kola, 2007).

Those who were found to use CAM were “women, people with higher education, people who have been hospitalized in the last year, and former smokers” (Joel, 2013, p. 310). Many problems drew the usage of CAM techniques such as “back, neck, and joint pain; colds; anxiety and depression; insomnia; and gastrointestinal problems” (Joel, 2013, p. 310). One such therapy is acupuncture.

The healing art of acupuncture is believed to have originated in China and is imbued in ancient Chinese culture. The word acupuncture is derived from Latin with the meaning of needle prick (Geng et al, 2011). It is described by biochemist and historian Joseph Needham to be “a system of channels for transporting energy and fundamentally circulatory in nature to all tissues round the body” (Lu & Needham, 1980). It is a medical practice that has existed for 3000 years but has been used in the West earnestly only for the past 30 years (Stux et al, 2003). In order for this culturally practiced modality to become science, experiments which are observable, reproducible and conformable to currently accepted physiology and cell biology would have to be conducted (Geng et al, 2011).

The acupuncture procedure consists of needle insertion (Shi et al, 2012), along a system of tracks called meridians by the practitioners that are invisible anatomically (Geng et al, 2011). It has been extensively used for various conditions but remains controversial in effectiveness. “Apart from needle insertion, issues such as needling sensation, psychological factors, acupoint specificity, acupuncture manipulation, and needle duration also have relevant influences on the therapeutic effects of acupuncture. Acupuncture is a complex intervention of both specific and non-specific factors associated with therapeutic benefit” (Shi et al, 2012). It would then stand to reason that the particular practitioner of acupuncture has influence on the therapeutic benefit. The consideration of these influences would affect the interpretation of clinical trials to assess the efficacy of acupuncture.

“The role of the APN is to support patients in their choice of holistic-integrative practices, make recommendations, and deliver safe and effective complementary therapies when appropriate” (Joel, 2013, p. 311). It is also important that the APN be knowledgeable about various CAM modalities and provide pertinent advice to patients as to their safety and potential effectiveness. Many patients do not seek medical advice before trying alternative medicine treatments nor report their use to their health care providers. Some felt that their use was not important for the health care provider to know, that the provider just did not ask about use, or simply believed that it was none of their business (Joel, 2013, p. 311).

The APN will need to assess the use of integrative medicine as well as orthodox medicine in her patient respecting cultural differences and preferences.

Geng, L., Jie-Ming, L., Pei-Wen, L., Xiaoqiang, Y., Peter, Z., Wei, L., …Edward, Y. (2011). Physiology and cell biology of acupuncture observed in calcium signaling activated by acoustic shear wave. Pflugers Archive-European Journal of Physiology, 462, 587-597.
Guang-Xia, S., Xiao-Min, Y., Cun-Zhi, L. & Lin-Peng, W. (2012). Factors contributing to therapeutic effects evaluated in acupuncture clinical trials. Retrieved from http://www.trialsjournal.com/content/13/1/42
Joel, L. (2013). Advanced practice nursing: Essentials for role development. (3rd edition). Philadelphia, PA.: F.A. Davis Company.’
Kola, A. (2007). Medicine and culture: Transcultural needs in modern Western societies. The AvMa Medical & Legal Journal 13 (3).
Lu, G., Needham, J. (1980). Celestial lancets: A history and rationale of acupuncture and moxibustion. Cambridge University Press: Cambridge, UK.
Mariano, C. (2007). Holistic nursing as a specialty: Holistic nursing-Scope and standards of practice. Nursing Clinics of North America, 41(2), 165-188.
Stux, G., Berman, B., Pomeranz, B. (2003). Basics of acupuncture. Springer, Berlin.


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