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Submitted in Accordance with the Requirement for the Degree of in the Department of Atthe TOWARDS CULTURE CARE NURSING EDUCATION: A STUDY OF T.G. MASHABA'S TRANSCULTURAL THEMES BY THOKOZANIP.MHLONGO submitted in accordance with the requirement for the degree of DOCTOR OF LITERATURE AND PHILOSOPHY in the Department of ADVANCED NURSING SCIENCES atthe UNIVERSITY OF SOUTH AFRICA PROMOTER: PROFESSOR HIL BRINK JOINT-PROMOTER: PROFESSOR JB HLONGWANE JUNE 1998 ii DECLARATION I declare that TOWARDS CULTURE CARE NURSING EDUCATION: A STUDY OF T.G. MASHABA'S TRANSCULTURAL THEMES is my work and all the sources that I have used or quoted have been indicated and acknowledged by means of complete references. Thokozani P. Mh iii ACKNOWLEDGEMENTS I am eternally grateful to the Almighty God for giving me life and the ability to pursue my academic dream. I wish to extend my sincere gratitude and appreciation to Professors HIL Brink and JB Hlongwane, my promoters, for their wise guidance and consistent encouragement. If it was not for their help, this thesis would still have been in the form of notes. Nikhule nize nikhokhobe! I am greatly indebted to my beloved relatives for sustaining my zeal and to my beloved family - [bonke oMakhedama nabo bonke abaNtwana - abaseZulwini (Odidini), kwaPhindangene, naseNkombabantu] -for their love, understanding and support. All my friends - at UNISA:Doctor, Rua, Professors CT and DBZ, Ursula, Olive, Nita, Dirk, Sonya, Mavis, Anneli, Margo, Susan, Sarie, Kathy, Laetitia, Olga; UNIZUL: ~ursing Department staff, especially Dr Zungu and Mrs Mhlongo; UNITRA: Sizwe, Sokhela, Thembeka; KZN Nursing Department staff: Lulu, Mrs. Memela, Hlongwane, Nxumalo, Moleko, Cele; and IOWA, USA: Paula, Meridean, Toni, Pat, Mary, Kathleen, Keela, Fran, Colleen, Marita, and Pam - have been more than I expected. My thanks to them are deep and sincere. Ukwanda kwa/iwa ngumthakathi! iv Prof. RV, Umama, Chief Director: Health Resource Planning of the Department of Health, has helped me in many ways. I sincerely thank her. To Mrs Mtshali and her adopted kids (Nono, Thabsile, Phangisile, Mpo, Pinky, Smangele, Neli, Makhos1, 1-..coKozo, uKho, and Sheila) for their encouragement and inspiration during the early stages of nursing practice. To Mrs MG Cele who recruited me to the nursing profession. Umnwele o/ude. I wish to thank Valerie Ehlers, Senior Lecturer: UNISA for her help and encouragement throughout this project. I can still hear her voice - on our way from Nelspruit - saying"/ am sure you will make it Thokozani." Conducting of this research was possible because of the permission and cooperation received from Prof. Mashaba's family, especially Sibusiso and Mrs. Koloti; Ngwelezana Hospital authorities and staff; the Department of Health (Nursing Section) of KwaZulu-Natal Government; and Prof. Mashaba's contemporaries. I wish to place on record my sincere gratitude to these individuals. The staff of the UNISA library were very helpful. I thank them sincerely. I also felt welcome at the UNIZUL library. I wish to thank the staff of this library for their help. v DEDICATION This thesis is dedicated to: my father: Joachim Mandlenkosi Mhlongo my mother: Witness Bahlekisile Zulu my father in New York (USA): James Barringer my God family: KwaSibiya (Emzini kaMakhuzwayo): kuMagule, Ephraim (lnsizwa), Sangi, Oris, Tito, Sibongile, neBhubesi (Sifanele). my other God family: EmaMbatheni (Emzini KaShandu): kuMama, IKhomu, MaJazi, iNdlunkulu yakwaMsibi, Thoko, lndlovu (MC), lnkosi YasoNdini (Chris), Ben, Fikile, Mbonozi, noKhulekani. my brothers: Bongani (Gilbert), Derrick and Joe (lmbazo) my grand parents: Ugogo wakwaSibiya - "lnzalasizwe": OkaMathentamo wase Nsukazi, uNtNana oMkhulu (uPetros) wasoDidini noNdlunkulu, Umama (u-Agnet) wasemaMbatheni, uNdlunkulu wakwaMuziwomuntu, noMama waseThekwini (Thembile). AbaNtwana: umNtwana (MG) wakwa-Phindangene, uMntwana (VT) wase-Nkombabantu, nabaNtwana oSam, Jakobe, uDingane (Joseph), Ntethelelo, Ntuthuko (Zuzi), Jotham, Phesheya, Nelisa, Naftali, Stanela, uFudu, Velemseni, nabaNtwana bakwaBhekizwe. Abamantombazane: oNonhlanhla, Cebisile, Phumzile, Mandisa, Emelda, Nokuthula, Nono, noNikeziwe. my dear friends: L. Sacks, EW Niedermeier, S.Hentges, Z. Mthuli and W. Khuzwayo. vi ABSTRACT In this study an attempt has been made to reflect upon T.G. Mashaba's transcultural themes. For the purpose of this study, the researcher had to differentiate between traditional and professional cultural themes. All of these were mirrored in some of Mashaba's works through the employment of descriptive devices in a manner that enables one to picture her philosophy of transcultural nursing care, her ideas and ideals, conceptions, opinions and beliefs. The chief aim of this study was to survey the significance and contribution of Mashaba transcultural themes to nursing. ---- . -- - In identifying the two systems, Mashaba was attempting not only to help nurses to become aware of these systems, but to consider ways to make reciprocal interfaces with the two systems. Marked caring differences among health care systems exist as well as similar features. Efforts were made - by Mashaba - to explicate these caring aspects in order to provide a sound rationale and therapeutic nursing care. vii The design used in this study was purely descriptive, investigative, interpretive and analytic with the specific aim of elucidating Mashaba's ideas, ideals and thoughts. This approach helped in bringing to light the value of the themes while at the same time focusing attention on their transcultural nature. Leininger's Cultural Theoretical Model was applied - as a conceptual Model - for the analysis of transcultural themes. This research study gives us a picture of a gifted and hardworking woman. She was ambitious and had set definite goals for herself. Her sense of cultural observation and imaginativeness elevate her as- a spokesperson for the underprivileged, not only of her race, but of any nationality. In her efforts, she was a moderate who believed that engagement in a dialogue would bring better and more lasting solutions than war. This gives her work the universal relevance and appeal. Key terms: Culture, Cross-cultural health, Traditional health care, Cultural health care, Transcultural nursing, Indigenous healing, Folk Medicine, Health care themes, Ethnoscience, Psychocultural therapy. viii TABLE OF CONTENTS Declaration ii Acknowledgement iii Dedication v Abstract vi Table of content viii CHAPTER ONE INTRODUCTION Statement of the problem 4 Purpose of the study 5 Significance of the study 6 Study assumptions 8 Research questions 10 Organization of the study 11 ix CHAPTER TWO LITERATURE REVIEW AND DEFINITION OF TERMS Introduction 16 The term "CULTURE" 17 The significance of culture to nursing 20 Social significance 20 Ethical significance 21 Ethnographic significance 23 The term "CULTURE CARE" 24 The term "TRANSCULTURAL NURSING" 25 The term "TRANSCULTURAL THEMES" 27 Traditional health care system 28 Professional health care system 29 Culture Care Diversity 29 Culture Care Universality 30 Thematic research: An Empirical and Conceptual Review 30 The Rationale for thematic research 30 Discovering Cultural Themes 31 Thematic Research Studies 33 Thematic research: Implications for the research design 38 x Combining Ethnography and Biography 38 Ethnographic research approach 39 Defining Ethnography 39 Ethnographic Approach Applied to Nursing Practice 40 A Review of Different Types of Ethnographies 42 Biographic research approach 43 Defining Biography 43 Biography Approach Applied to Nursing Practice 44 A Review of Different Types of Biographies 44 Towards the Thematic framework 46 Conceptual framework 48 CHAPTER THREE METHODOLOGY Introduction 49 Research approach and delimitation of research 50 Research design 50 Data collection 51 Fieldwork 52 Interviews 54 Data analysis 55 xi Ethical consideration 57 Validity and reliability 57 Consent and confidentiality 58 CHAPTER FOUR A SKETCH OF MASHABA'S LIFE HISTORY Introduction 60 Formative years 60 The family background 61 The socio-economic status 61 The education background 63 The Christian-Zulu upbringing 64 Preliminary stages of the nursing career 65 Entrance into the nursing profession 65 Entrance into nursing education 67 The nursing (practice) experiences 67 Advanced stages of the nursing career 68 Becoming a matron 68 Preparation to start a new hospital 69 Taking charge of Ngwelezana hospital 70 Ngwelezana becomes an--independent hospital '71 xii The KwaZulu Government 71 The department of health 72 She is promoted to principal matron position 73 Becoming a University of Lu1u1a11~ t..:mployee 75 Starting a new University Department 75 The Department of Nursing Science 76 She is promoted to nursing professor position 78 The person in Mashaba 81 The physical features 81 The working Zulu woman 83 Combining Western life and African lives 84 The Nursing Scholar 85 Commitment to continuing education 85 Contacts with other scholars 86 Learning from the role models 88 The philosophy of life through her activities 89 xiii CHAPTER FIVE THEMES ON TRADITIONAL HEALTH CARE SYSTEM Introduction 96 Zulus in Zululand 97 Traditional (Zulu) Health Care System 98 Mashaba: A Zulu nurse 103 Themes on traditional health care 105 Recognition of Traditional (Zulu) culture 105 Recognition of Traditional (Zulu) language 108 Recognition of native nurses' history 110 Thematic illustrations of cultural differences 113 Characteristics of a good transcultural nurse: The influences of Zulu (African) culture. 119 Incorporating the Ubuntu element 119 Native context for native students 122 Understanding of culture
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