Community Cultural Approach Using Cultural Care Nursing in Preventing the Transmission of COVID-19 in Ternate City

Cultural values in the community are formed from how they maintain life, this is important for providing health services for nursing professionals. The phenomenon of the COVID-19 virus has become a pandemic problem in society. Indonesia also experiences this problem thoroughly in all regions, and it has become a non-natural national disaster. Prevention eﬀorts continue to be carried out in the community. The Cultural Care approach to nursing is a choice of theoretical ideas to help improve health in society for the better. A total of 40 participants are the people of the city of Ternate and have local cultural values. Data collection was carried out using a questionnaire checklist and interviews. The research ﬁndings were obtained from 30 participants (70%). These ﬁndings provide compatibility of community empowerment methods with the problems, needs, and challenges that exist in the area of the community empowerment activities. These ﬁndings also provide suggestions for empowering people who have regional cultural arrangements and wish to overcome their health problems.


INTRODUCTION
In any society, there are values and cultures used to defend its group of life against the harsh environment.This situation is important to be used by health workers, especially nursing to provide health services and promotion efforts to the community (Kistanto, 2017).
Internationally in general, through the World Health Organization, the phenomenon that occurs due to the COVID-19 virus has become a pandemic problem in the community (WHO, 2020).Indonesia has also experienced this problem thoroughly in all regions and has become a non-natural national disaster.The government then formed a task force to handle and prevent the transmission of COVID-19.Efforts to prevent transmission are currently being developed both by the government and community groups.The health protocol is a way to overcome the transmission of COVID-19, so it is recommended to always maintain health so that a wider spread does not occur.Health protocols for overcoming the transmission of COVID-19 are useful for preventing the spread of COVID-19 in the community (Fitriani, 2021).
The Cultural Care approach to nursing is a choice of theoretical ideas to make health changes in society for the better.As health workers, in carrying out their practice, they must be willing to open themselves to continue to accept and understand the cultural situation in the community.With an approach to the community, all information obtained becomes basic information to prepare for good education.A culture care approach is indeed very supportive and is an option that can be done in conjunction with health promotion efforts because they already know exactly what is going on and how to deal with these health problems (McFarland, 2019).
The Cultural Care Nursing theoretical approach provides direction and thought in accepting, modifying, and educating the public about preventing the transmission of COVID-19.Community groups can use their culture which is a habit that can support the improvement of healthy living.It should be noted that if there are habits that pose a risk of health problems, the theory of cultural care nursing provides steps to improve them (Almeida et al., 2021).
Cultural Care is a field of cultural science in the process of learning and nursing practice that focuses on differences and similarities between cultures by respecting care, health, and disease based on human cultural values, beliefs, and actions, and this knowledge is used to provide nursing care, especially cultural or cultural integrity to humans.
The concept of Leininger's theory comes from the sunrise enabler which is a description of the cultural care approach to nursing.This concept illustrates that humans are integrated with cultural backgrounds and social structures.There are four enablers given by the liner to be used in research, namely the stages through the researcher's function as observers and listeners, fostering a trusting relationship, focusing on the area to be studied, namely cultural care nursing, as cultural coaching that summarizes some of the problems that occur and are not appropriate.to support health promotion.The conceptual model developed by Leininger in explaining nursing care in a cultural context is described in the form of a sunrise (Sunrise Model).Nursing care management is carried out starting from the assessment stage, nursing diagnosis, planning, implementation, and evaluation (Marilyn & Marlaine, 2017).

METHOD
The implementation of this activity utilized the Cultural Care nursing method approach proposed by Marilyn Lineger.
The cultural control system through the Cultural Care nursing solution as an effort to prevent the transmission of COVID-19 is appropriate in nursing care that began with data collection, followed by analysis, implementation, and evaluation.The participants, as many as 40 people, were those who are the people of the city of Central Ternate.The participant criteria were local indigenous people, those who had lived there for more than 10 years in the city, adults, and community leaders.The data were collected using a checklist of questionnaires and interviews.The data were then analyzed according to univariate and bivariate analysis.The results were presented in descriptive form based on the progress obtained in the form of numbers and percentages.Table 1 shown the operational definition of implementation.

RESULT AND DISCUSSION
The first implementation was a survey on the needs and problems related to preventing the transmission of the COVID-19 virus using the local culture of the targeted community.From this survey, the community service team had found the needs and problems that could then help in COVID-19 prevention in the community including the efforts made through the approach of science and nursing practice.The results of the initial survey showed that there were some behaviors to prevent the spread of COVID-19 that still needed to be strengthened.The results itself can be seen in the Table 2.
Information about the behavior of the local people there was already known.Some of them did not want to support this effort (25%).The implementation of the education that the team prepared must be done to strengthen the community in maintaining their health, and the most important thing was how to facilitate them to comprehensively understand all the materials and knowledge.
An assessment of the knowledge and behavior of the community towards efforts to prevent the transmission of COVID-19 is very important for health workers to know.The transmission prevention strategy must utilize the involvement of the local community.This is the approach strategy that was deemed suitable for the culture of the community that is of concern (Hosen et al., 2021).
The COVID-19 pandemic had been affecting the community for a while, and during this time they had been looking for important steps to be taken to prevent the transmission of the virus.There had been victims of COVID-19, and this made the community anxious.They had asked their local government to help them.They asked the government to give them some assistance and knowledge of how to avoid the disease (Yıldırım et al., 2021).
The participants' cultural behaviors that were identified were then analyzed in order to discover the problems and their causes, which is shown in the Table 3.The results of the analysis were then determined to be the priority of the COVID-19 transmission prevention activity in this targeted community.
The following assessment was carried out using the transcultural care assessment format, and the team was able to identify several problems comprising nursing problems, high risk of infection related to lack of knowledge about the dangers of COVID-19 transmission, noncompliance with health protocols related to the philosophy of individual and cultural values, beliefs, and spiritual distress related to lifestyle changes by following health protocols.Starting from the implementation of activities, it was necessary to take a harmonious approach with the community group (Bruns et al., 2020).It was also necessary to organize activities to foster trusting relationships with the community group.These activities were discussion forums with the community group (participants) to design what was required to prevent the transmission of COVID-19 and create messages through print and electronic media about preventing the transmission of COVID-19 by prioritizing local wisdom and culture.The implementation of community service activities is showcased in Table 4. • Social activities (praying together, thanksgiving, social gathering) that involve many people.

Knowledge deficit Infection risk
• Some expressed disbelief about the existence of COVID-19 in the community.2 • The belief that calamities are determined by God.

Philosophy of individual and cultural values
Noncompliance with health protocols • People rarely wear masks in crowded areas.3 • Changes in congregational prayer activities (keep your distance and use masks).

Changes in environmental lifestyle
Spiritual Distress • Changes in doing spiritual and cultural activities due to crowding.Merging each of them into Groups on Social Media; monitor, advocate, and provide information and education on an ongoing basis.
All activities were carried out based on an agreement between the team and the local community.The community was given logistics in the form of food and important articles for them to comply with the COVID-19 health protocol.In the activity, participants were given a reword in the form of snacks, lunch and a set of health protocols in preventing COVID-19.Participants were gathered in a meeting room in the hall of the local sub-district office.Every activity prepare the COVID-19 prevention protocol.
The stigma about COVID-19 in society affected the prevention and handling efforts.For better understanding during counseling sessions, the team used electronic and print media.These included booklets, leaflets, and posters that were made as attractive as possible and in accordance with local culture.The relationship of mutual trust between the relevant agencies and the local community can provide even better achievements in preventing the transmission of the COVID-19 disease (Jauhar et al., 2021).
Through this cultural care nursing approach, the education turned out to be effective and acceptable to the families and the local cultural community.The final assessment of this community activity showed that there was an optimal acceptance of behavior change to be even healthier.The participants had more understanding and desire to always make efforts to prevent the transmission of COVID-19 as shown in Table 5.
The community service team found significant changes through the assessment of new normal behavior in preventing the transmission of COVID-19.The Cultural Care Nursing theoretical approach has provided directions and ways to accept, modify, and educate the public about preventing the transmission of COVID-19.

CONCLUSION
The problems found were a high risk of infection, noncompliance with health protocols and spiritual distress.The implementation began with counseling about information and knowledge about health protocols in preventing the transmission of COVID-19.The next activity is displaying posters that adapt to local wisdom.With an inherent approach using culture and local wisdom, this method can have a good effect on efforts to prevent the transmission of COVID-19.Related parties need to consider the cultural of the community in carrying out efforts to overcome health problems that occur in the community.

Table 1 .
Operational definition of implementation A culture that can support/less favorable/contrary to health efforts checklist instrument; ordinal 2 Implementation Action Problem-solving through nursing interventions as an effort to prevent the transmission of COVID-19 Likert scale ordinal 3 Evaluation Assessment of attitudes and behavior after giving action/education checklist observation

Table 2 .
The results of a survey of community behavior in preventing the transmission of COVID-19

Table 3 .
Problem analysis

Table 4 .
Implementation of community service activities

Table 5 .
Assessment of new normal behavior in preventing the transmission of COVID-19