According to Andrews (1999), Sir Edward Tylor a British Anthropologist, is credited with defining the term 'culture'

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According to Andrews (1999), Sir Edward Tylor a British Anthropologist, is credited with defining the term 'culture'. Andrews (1999) explains culture as representing a way of perceiving, behaving and evaluating the world. It refers to the complex whole which includes knowledge, belief, arts, morals, law, custom, politics, technologies and any other capabilities or habits acquired by people as members of a society; including those pertaining to health and illness.

The term 'transcultural nursing' was coined by Dr Madeleine M Leininger in the mid 1950s. It was only in the 1970s that the theory began to attract more widespread interest and concept development. It remains a relatively new area of study in the United Kingdom (UK).

Transcultural nursing is a term used to describe a speciality within nursing focussed on the comparative study of different cultures and subcultures, which are examined in respect of their health and illness values, caring behaviour and beliefs. According to Andrews (1999), 'the goal of transcultural nursing is to develop a scientific and humanistic body of knowledge in order to provide 'culture-specific' and 'culture-universal' nursing care practices'. Leininger (1991) defines 'culture-specific' as values, beliefs and behaviours unique to a particular cultural group and 'culture-universal' refers to commonly shared values that are similarly held amongst differing cultures. Whilst Leininger's (1991) sunrise model of cultural diversity and universality is by far the most popular conceptual framework, many others exist.

The importance of transcultural nursing is ever growing due to the diversity, which characterises our national and global populations in relation to ethnicity, national origin, sexual orientation, education, social status and physical ability. Lea (1994) cites a study by Stockwell (1972) who observed interpersonal relationships between nurses and patients, in general hospital wards in the UK. The research revealed that patients with different cultural and religious backgrounds were less popular than patients with the same cultural beliefs as the nurses. It is thought that language barriers, cultural difference in pain response and sick role behaviour may have contributed to these patients being less popular with the nurses. Similar observations have been made in many more recent studies observing communication patterns (Lea 1994).

Practitioners need to be aware of their own ethnocentric tendencies (i.e. making value judgements about other cultural groups using your own belief system) in order to avoid cultural imposition (i.e. trivialising the beliefs of patients which may be different from your own). Lea (1994) adds that nurses need to be aware of their own attitudes towards health and illness in order to react non-judgementally when confronted with lay ideas of health and other cultural systems.

The rather controversial term 'cultural competency' has been used to describe the process of striving to effectively interact with individuals, families or whole communities from a diverse cultural background (Andrews and Boyle, 1999). The term is problematic because it assumes that a 'culturally competent' nurse has a universal understanding of all cultures and it is clearly impossible to know about all the different culturally based beliefs of the patients that may be encountered during one's career. Nevertheless, it is reasonable to suggest that nurses can master the skills of cultural assessment and learn about some of the cultural values of patients where cultural diversity exists (Andrews and Boyle, 1999).

This essay will concentrate on describing the health needs of Gypsies in relation to the way in which they interpret well being and illness and need for the planning of culturally appropriate service planning to accommodate this. In particular, the issues discussed will focus on the specific needs of women in relation to maternity services, family planning and child health.

The terms Gypsy and Traveller will be used interchangeably in this essay. However, the health needs of Gypsies in relation to this discussion will focus on the largest of the Traveller groups in the British Isles known as the English Romanichal Gypsies. The following discourse excludes discussion concerned with health issues relating to New Age Travellers.

There are many definitions of the term's traveller and gypsy. According to Vernon (1994), Traveller is an overarching term used to describe people who lead a nomadic or mobile lifestyle, which includes groups such as Romany Gypsies, Scottish/Irish Tinkers and New Age Travellers.

The ethnonym 'Gypsy' is used to refer to a range of ethnic groups across the world who tend to identify themselves as 'Romani' and speak dialects of the Romani language, which is of Prakritic origin. It is also used to refer to some Traveller groups who deny Romani connections but share aspects of Romani culture and history with Romani-identifying groups (Acton 1974). Furthermore, Gypsies are recognised as a racial group by the Commission for Racial Equality and as such they may not be discriminated against.

McKee (1997), in his account of the history of the Roma people, describes the persecution of Gypsies which includes centuries of slavery, mass extermination in Nazi camps and the institutionalised racism which is still endured today. Many authors (e.g. Acton et al. 1998, Thomas et al. 1997) acknowledge that against this setting of persecution and marginalisation, it is unsurprising that health policy makers and researchers have largely ignored the health needs of Gypsies. Furthermore, current health policy such as the Department of Health's 'Saving lives: our healthier nation' (1998) places particular emphasis on reducing inequalities in health and targeting socially excluded groups. However, it is ironic that the key health policy document 'Reducing health inequalities: an action report' (1999) does not mention the health needs of Gypsies, which is perhaps a reflection of the degree to which they are socially excluded.

McKee (1997) remarked that a search of the literature yielded more research concerning the gypsy variant of the drosophila fruit fly than on the health of Gypsies. Despite much media attention in the last few years relating to the influx of asylum seekers from central and eastern Europe, little new research has been commissioned in the UK to progress our understanding of nomadic groups. In preparation for completing this assignment, searches of Medline and Healthstar using the terms 'Gypsy' and 'Traveller' produced a relevant reading list of less than thirty examples of original research, many of which were conducted in the 1970s and 1980s.
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Many of the studies which are available, suggest that Gypsies have a poorer health status and higher mortality rates than the general population (e.g. Feder 1989, Pahl and Vaile 1986) and the needs of women and children in particular, are frequently discussed in the literature.

A survey by Linthwaite et al (1983) of 265 mothers showed a still birth rate among Travellers 19 times greater than the national average and 12 times that among women in Social Class V. The rate of congenital malformation was 500 per 10,000 live births against a national average of 160.7 per ...

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