Author: Buscemi, Charles P
Date published: July 1, 2011
Journal code: JOCD
The state of the science with regards to the concept of acculturation is slowly changing. Acculturation has been originally viewed as a unidimensional process, in which those individuals in contact with a host culture take on the characteristics of the new culture (Flannery Reise, & Yu, 2001). The unidimensional model of acculturation has been described as a linear relationship between an individual's original culture and the host culture (Szapocznik, Kurtines, & Fernandez, 1980). This unidirectional model describes acculturation as the shedding off of an old culture and the taking on of a new culture (Choi, 2001; Flannery, et al., 2001). It was believed that individuals only had two options; either they acculturated or they remained in their own culture (Choi, 2001).
However, as more research was done to understand the concept, a growing belief that acculturation was more than a unidirectional process was evolving (Choi, 2001; Flannery, et al., 2001). The focus on understanding immigrant groups was more on understanding cultural pluralism (Szapocznik, et al., 1980) where a more multidimensional model of acculturation was being accepted. Szapocznik (1980) describes this process with adaptation to a host culture as no longer requiring the rejection of the culture of origin.
This more complex view of acculturation evolved after realizing the limitations of the unidimensional model in capturing the multidimensional aspects of acculturation (Choi, 2001). The belief that the acquisition of some homogeneous or standard form of American culture by immigrant groups failed to capture the cultural change experienced at the individual level (Gibson, 2001).
A movement that describes acculturation as an uneven process that reflects intraethnic and intracultural diversity is growing (Déla Cruz, Padilla, & Augustin, 2000). Acculturation is being describes as a bidirectional process more and more (Choi, 2001; Dela Cruz, et al., 2000; Flannery, et al, 2001). The bidirectional process of acculturation involves the simultaneous acquiring, retaining or relinquishing of the characteristics of both the original and the host cultures (Dela Cruz, et al, 2000). Described as an orthogonal model of acculturation, it proposes biculturalism as the basis of the process (Getting & Beauvais, 1990-91).
The bicultural model assumes that acculturating individuals can maintain two different cultural identities simultaneously (Choi, 2001). Szapocznik (1980) describes the bicultural process as learning communication and negotiation skills in cultural contexts that involve separate sets of rules. The emphasis is now on the individual's ability to negotiate between the two cultural worlds rather than losing connection to the original culture (James, 1997).
Current researchers who are studying acculturation are accepting that it is a broad-ranging concept that includes not only changes in behavior, values, attitudes and identity, but social, economic and political transformations as well (Choi, 2001). The process of acculturative change will be shaped in part by where immigrants settle, the ethnic and social class composition of the communities in which they settle and the presence of co-ethnics within those communities (Gibson, 2001).
Rejection of acculturation as a unidimensional process is evident in the literature (Choi, 2001; Dela Cruz et al., 2000; Flannery et al., 2001; Szapocznik, 1980). Acculturation theories are moving away from describing it as part of in inverse linear relationship (Szapocznik et al., 1980) that does not account for the more complex process it is.
EVOLUTION OF ACCULTURATION THEORY
The study of acculturation has its roots in anthropology and psychology. In the mid 1930s, the Social Science Research Council appointed a subcommittee on acculturation and charged it with the task of analyzing and defining the parameters of acculturation. The results of the subcommittee's work resulted in the formal adoption of acculturation as a legitimate new area of inquiry (Olmedo, 1979). Acculturation was defined as "those phenomena which result when groups of individuals having different cultures come into continuous firsthand contact with subsequent changes in the original cultural patterns of either or both groups" (Redneld, Linton, & Herskovits, 1936, p. 149).
The term was further defined as "the approximation of one social group of people to another in culture or arts by contact; the transfer of cultural elements from one social group of people to another" (Herskovits, 1938).
As the study of acculturation grew, the issue of whether the process was to be conceptualized as an individual process or group process was examined. Earlier work was focused on examining acculturation from a group process (Bogardus, 1949; Herskovits, 1937; Siegel, Vogt, Watson, & Broom, 1953). However, as researchers were realizing that acculturation was influenced more by unevenness of individual ethnicity and cultural diversity (Pachter & Weller, 1993), a growing body of work was focused at the individual level (Olmedo, 1979).
There is general consensus, that acculturation is a learning process (Celano & Tyler, 1990). Earlier theoretical work focused on the normative developmental course of acculturation. Gordon's (1964) model of acculturation reflected an immigrant's acculturation as a temporal function of exposure to new cultural patterns. The model defined acculturation as the length of residence in the host country (Gordon, 1964).
Building on the work of Gordon, Szapocznik, Scopetta, Kurtines, & Aranalde (1978) set out to test a linear model that focused on two dimensions of acculturation, behaviors and values. The acculturation model developed by Szapocznik, et al., (1978) found that a linear process was able to explain behavioral acculturation but not value acculturation.
Further study led Szapocznik & Kurtines. (1980) to modify the original assumptions regarding a unidimensional linear process associated with acculturation. Biculturalism, as discussed earlier, is an important outgrowth of original acculturation theory (Szapocznik et al., 1980). This theory postulated that biculturalism is normative for immigrants living in bicultural communities (Szapocznik & Kurtines, 1980) whereas underacculturation or overacculturation is associated with maladjustment. However, the concept of time in the theory remained, as time moves forward immigrants become more acculturated.
Berry's (1986) model states that acculturation follows several courses that depend on characteristics of the immigrant groups and those of the host society. The theory states that an immigrant gradually adopts cultural patterns of the host in a given cultural domain such as language, until a conflict point is reached (Berry, 1986). At which point the immigrant makes an adaptation to reduce the conflict between patterns of the host culture and those of the culture of origin (Berry, 1986). Berry identified the following four types of adaptation immigrant use to reduce the conflict: 1. assimilation-continuous move toward the dominant culture, 2. integration-synthesis of the two cultures, 3. rejection-reaffirmation of the traditional culture, and 4. marginalization-alienation from both cultures.
Work previously done with acculturation has led to other concepts being studied. Today, concepts such as acculturative stress (Vega, Gil, & Wagner, 1998) and cultural marginality (Choi, 2001) are being examined as outgrowths of acculturation. Acculturative stress is exposure to social situations and environments that challenge an individual's ability to make adjustments in their behaviors or way of thinking about themselves (Vega, et al., 1998). Whereas cultural marginality is defined as "situations and feelings of passive betweeness when people exist between two different cultures and do not perceive themselves as centrally belonging to either one" (Choi, 2001, p.198).
ACCULTURATION AND NURSING THEORY
Although no nursing theory directly related to acculturation in nursing was located after an exhaustive search, most work with the concept at a theoretical level has incorporated acculturation. Leininger (2002) describes five concepts adapted from anthropology that are essential in transcultural nursing. They are described as the five basic interactional phenomena that nurses need to know in order to understand transcultural contexts: culture encounter, enculturation, acculturation, socialization, and assimilation. To better elucidate the concepts, and because they are intertwined, an explanation of each is presented.
Culture encounter refers to situations in which a person from one culture meets or interacts with a person from another culture. These encounters offer individuals brief opportunities for exchange in ideas, but do not offer opportunities for exchange in values, beliefs, or lifeways. The second concept is enculturation. Similar to acculturation, it involves the process of how one learns to live by a particular culture with its specific values, beliefs, and practices. To illustrate the concept, Leininger uses how a child who is becoming enculturated learns how to be part of a particular group (i.e. Italians, Anglo-American, Hispanic). By learning the acceptable behavior, values, beliefs, and actions, the child is becoming enculturated.
Thirdly Leininger (2002) defines acculturation as "the process by which an individual or group from culture A learns how to take on many (but not all) values, behaviors, norms, and lifeways". Leininger further explains that acculturated individuals reflect that they have adopted the values and lifeways of another culture by their expressions and actions. However, an individual may still retain, and use traditional beliefs and values from the old culture that will not interfere with taking on new cultural norms (Leininger, 2002).
The final two concepts are socialization and assimilation. Socialization is describes as how an individual or group learns how to function within the culture of the larger society and learns how to interact with others, how to survive, work and live in harmony. Assimilation refers, to the way individuals or groups from one culture selectively choose certain features of another culture without taking o many of the attributes of liefways that would declare one to be acculturated (Leininger, 2002).
Based on the acculturation component of the five interactional phenomena, Leininger (1991) developed the Acculturation Enabler Guide. The enabler was developed as part of an ethnonursing research method to assess the extent to which individuals or groups of a particular culture are more traditionally or nontraditionally oriented. It was developed to work with components of the Culture Care Theory in order to assess cultural variabilities of a particular culture along lines of differentiating experiences.
To meet the needs of a multicultural society Purnell (2000; 2002) developed a model for cultural competence. Purnell defines cultural competence as the adaptation of care in a manner that is consistent with the culture of the patient. A culturally competent nurse develops an awareness of his or her existence, sensations, thoughts, and environment without letting these factors have an undue effect on those receiving care.
The model is based on 16 assumptions, one that involves acculturation. Purnell (2002, p.193) list the following assumption: "to be effective, health care must reflect the unique understanding of the values, beliefs, attitudes, lifeways, and worldview of diverse populations and individual acculturation pattern".
Another model in transcultural nursing is The Process of Cultural Competence in the Delivery of Healthcare Services model (Campinha-Bacote, 2002). This model is based on the premise that cultural competence is an ongoing process in which nurses continually strive to achieve the ability to effectively work within the cultural context of the patient (Campinha-Bacote, 2002). The model, which is largely based on Leininger 's transcultural nursing work, involves the integration of the following constructs: cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire. The model's author points out that all five constructs have an interdependent relationship. It is further explained that no matter when a nurse enters the process of providing culturally competent care, all five constructs must be addressed and /or experienced.
Cultural knowledge, it is the process of seeking and obtaining sound education knowledge about cultural and ethnic groups. It involves obtaining knowledge of client's worldviews about health related beliefs and values. The model sets forth in clarifying that in obtaining cultural knowledge, no individual is a stereotype of one's culture of origin, but a unique combination of life experiences, and the process of acculturation to other cultures (Campinha-Bacote, 2002).
Further development of the model has resulted in an instrument that measures cultural competence among health care professionals (Campinha-Bacote, 2002). The Inventory For Assessing The Process of Cultural Competence Among Healthcare Professionals (IAPCC) is a 20-item instrument that is based on four the models constructs: cultural awareness, cultural knowledge, cultural skills, and cultural encounter. It is noted, however, that the instrument does not measure the construct of cultural desire, and that further work in this are is forthcoming (Campinha-Bacote, 2002).
Another model concerns cultural diversity in health and illness (Spector, 2002). The purpose of the model is to increase nurse awareness of the dimensions and complexities of delivering nursing care to people from different cultural backgrounds (Spector, 2002). The model is based on three concepts of culture care: heritage consistency, health traditions, and cultural phenomena.
Heritage consistency involves the degree to which one's lifestyle reflects his or her respective traditional culture (Estes & Zitzow, 1980). Heritage consistency exists on a continuum; an individual may possess value characteristics of both a traditional heritage and an acculturated /modern heritage. An assumption is that a person who holds on deeply to more traditional beliefs will be more likely to follow more traditional methods of health /illness practices and beliefs.
The final two concepts of the model are health traditions and cultural phenomena. Health traditions are described as the interrelated balance of the body, mind, and spirit, (Giger & Davidhizar, 1995; Spector, 2002). It describes what people do from a traditional perspective to maintain health, protect health or prevent illness and restore health.
Cultural phenomena describe six phenomena that vary among cultural groups and affect health care (Giger & Davidhizar, 1995) The six phenomena are: environmental control, biological variations, social organizations, communication, space, and time orientation. The six phenomena serve to illustrate the diversity that exists between cultural groups.
The model consists of internal and functional structures and it is here where acculturation plays a role. On of the assumptions of the internal structure of the model is that there is a relationship between an individual's cultural identity. Health beliefs and practices can be analyzed either by one's heritage or at the level at which one has acculturated to the dominant culture. With regards to functional structure, a balance between one's heritages needs to exist. This balance involves a harmonious relationship between traditional ethnocultural heritage and an individual's acculturated belief system.
Many nursing theorists have stated that assessment of acculturation needs to be included when providing culturally competent nursing care (Leininger, 2002; Purnell, 2002, 2000; Capinha-Bacota, 2002). Purnell defines cultural competence as the adaptation of care in a manner that is consistent with the culture of the patient. A culturally competent nurse develops an awareness of his or her existence, sensations, thoughts, and environment without letting these factors have an undue effect on those receiving care (Purnell, 2000; 2002). Purnell further states that to be effective, nursing care must reflect the unique understanding of the values, beliefs, attitudes of diverse populations and individual acculturation pattern.
Nurses in the practice setting can begin to develop an understanding of how acculturation is associated with health related issues. Nurses can use the acculturation instruments at the bedside to better assess the patient's level of acculturation.
Also, culture and cultural issues are being examined by accrediting bodies. For example, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) (2001), states issues related to culture need to be addressed when assessing pain. The JCAHO encourages health care organizations to develop cultural competency programs. Nurses can establish healthscreening programs, health promotion activities and provide health information in a culturally competent manner considering acculturation.
DEGREE OF ATTENTION OF ACCULTURATION
Acculturation has been traditionally studied within psychology, anthropology and sociology. Nursing has studied acculturation, but in relation to other variables. According to Peragallo (2000) acculturation has received relatively scant scholarly attention.
Building on the initial theories found in psychology and anthropology, nursing has incorporated acculturation into many of the current transcultural theories. However, it is evident that no single theory of acculturation in nursing was found in literature reviews.
Further work, form a nursing perspective, in understanding the underpinnings of acculturation is needed. Transcultural nursing is an important component of the care nurse proved to clients. The goal of providing culturally competent care is pervasive and ongoing. Researchers, theorists, and practitioners must continue to view provision of cultural specific care as important work.
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CHARLES P. BUSCEMI, PHD, ARNP, FNP-BC
Charles P. Buscemi, PhD, ARNP, FNP-BC, is an Assistant Professor at Florida International University, College of Nursing and Health Sciences located in Miami, FL. Dr. Buscemi may be reached at: firstname.lastname@example.org.