Leis given to pregnant Hawaiian women should be open at the bottom because a closed lei is believed to have the power to strangle the unborn baby.

Muslims generally do not want women touching them, and during the holy period of Ramadan, they do not want to eat during the day.

Coin rubbing is a common tradition among Vietnamese and results in bruising and red marks on the skin that could be interpreted as abuse, especially when seen on babies and children.

Caucasians are more likely to have a “;touching culture,”; while Asian and other cultures might consider touching dirty and inappropriate, even by a health care professional.

Those examples are cited by ReNel Davis, director of Hawaii Pacific University's Transcultural Nursing Center, as cultural practices that could clash with Western medical practice “;unless they were viewed through the knowledge and understanding of transcultural nursing.”;

Particularly important in Hawaii's multicultural setting, transcultural nursing means being responsive to patients' cultural beliefs and honoring them when possible, Davis has written. Patients who feel more comfortable are more likely to follow medical directions, and it is easier for the nursing staff, she said.

But the taboos are numerous.

“;The first thing we teach students is they will never know all cultures,”; said Jeanine Tweedie, assistant professor of nursing at HPU and education director of transcultural nursing.

“;Transculture education is to learn how to be aware of types of differences so as they talk to their patients, they can elicit what is most important to that patient instead of stereotyping them by their ethnicity,”; she said in an interview. “;For instance, in Hawaii, people may be of more than one ethnicity, and they may adopt cultural practices of more than one ethnicity, so we cannot base our care on their ethnicity, and that is pretty true everywhere.”;

HPU piloted its first transcultural nursing class in 1998 and established the center about five years ago. It is the only university in the nation offering a certificate in transcultural nursing for undergraduates, Tweedie said.

All nursing students are introduced to aspects of transcultural nursing, and the amount of content in the course is being increased, she said. Elective courses also are offered in transcultural nursing, and a certificate is awarded to those who take five specific courses in addition to the regular degree program.

Davis said the transcultural nursing movement began in the 1950s and accelerated as the world became a more global society. Accrediting agencies are requiring that it be taught in nursing colleges and practiced in hospitals and other health care facilities, she said.

She said the mission of HPU's Transcultural Nursing Center “;is to promote the delivery of culturally competent nursing care to diverse populations,”; particularly to reduce health disparities.

HPU has more than 1,600 undergraduate students, and Davis said, “;Our aim is not to have just one class on transcultural nursing, but to have every class reflect an element of cultural sensitivity.”;