Caring in a changing world: respecting a human being and acknowledging diversity
Dignity is a debated concept, but it is stated as fundamental in Article 1 in The Universal Declaration of Human Rights: ‘All human beings are born free and equal in dignity and rights’ 2. In order to respect dignity, the caregiver has to know the care receiver, the patient, as a person. Swedish nursing researcher Margareta Erlund 3 divides dignity in two parts. Firstly, it is the absolute dignity, which is universal to all human beings, and secondly, it is the relational dignity where dignity is experienced as influenced by the relationship between human beings in society. The absolute dignity is constant and cannot be waived. However, the relational dignity may be insulted or restored. When respecting the person with the person's own values being taken care of, the person as care receiver may experience the caring encounter as dignifying and respectful. This is fundamental part of caring as practice and thus a focus of caring as science.
In clinical work, Ethical guidelines define the values in nursing profession. Accordingly, the nurse encounters her/his patients as valuable human beings and creates a nursing environment, which takes into consideration the values, convictions and traditions of individuals. She/he treats every patient equally well according to the individual needs of the patient irrespective of the illness, sex, age, creed, language, traditions, race, colour, political opinion or social status of the patient 4.
In today's world, immigration is one of the global challenges. One example which refers to that is a study 5 with the topic of empowering and burdening factors of immigrant women during pregnancy and after childbirth. The researchers found that women need social support and also important for them were the roles and power between spouses. Health behaviour was affected by socio‐economic status, cultural habits and beliefs. The importance was also found of support offered by healthcare services and possibilities to benefit from their support.
According to a recent Finnish study 6, the nursing staff's cultural competence has been found to be quite good. The study results pointed out that factors influencing nurses cultural competence were as follows: continuous professional education in immigrant patients care, work experience, multicultural workforce, living abroad, immigrant patients’ meeting frequency and nurse's age. Continuous professional training in immigrant patient care had the most positive effect in nurse's cultural competence. Long work experience also had a positive impact on nurse's cultural competence as did multicultural workforce and living abroad. Nurses reported the material resources in providing cultural sensitive care to be somewhat inadequate. Nurses were quite happy with leadership and human resources. Most of the nurses felt that nursing managers supported good multicultural nursing, but it did not always reflect on workload distribution as increased time or extra personnel when caring for immigrant patients.
To improve nurses’ cultural competence, some theoretical models have been developed. The most famous is Leininger's Theory of Culture Care Diversity and Universality or Sunrise Model, which was developed already in 1970s, but is still used as a framework in research 7 or teaching of nursing 8. The purpose of Kokko's 7 ethnographic study was to describe the development process towards quality transcultural nursing from the Finnish nursing education perspective.