Transcultural nursing: facing the challenges of advocacy and diversity/universality

This paper is in response to an invitation to address the topic of advocacy and diversity from the perspective of past and present transcultural nursing. With origins in nursing, with its philosophy of active intervention, and in anthropology, where relativism proposes merit in diverse (including non-interventive) approaches to health and illness, transcultural nursing grapples with potential epistemological conflict as it helps shape health care in highly industrialized, multicultural societies and even more varied global contexts. As a developing subdiscipline, transcultural nursing continuously reexamines dialectical relationships between change and preservation and between health care needs and the risk of imposition. Whereas advocacy is viewed as a moral imperative in nursing, diversity (which can be used to argue against acknowledgement of differences and to promote the pretense that everything is the same for everyone) remains better developed conceptually than operationally, while universality too often falls prey to misuse as an argument against acknowledgement of diversity. Within a framework constructed from the juxtaposition of advocacy with diversity/universality (Leininger, 1988c, 1991), this article appraises the accomplishments and challenges of transcultural nursing as it moves into its second quarter century. It is proposed that the future of transcultural nursing should emphasize development of realistic nursing roles that include a confluence of advocacy and diversity/universality and negotiation of responsible social conceptualizations of cultural issues such as "race" and diversity.