Narayanasamy’s ACCESS model (1998).
\r\n\t
\r\n\tEditors hope to build a line of transformative research based on the adaptation of energy and design solutions from natural models to technical models, using methodologies and solutions which will open new areas of work about how to solve efficiency requirements based on natural solutions honed by evolution. This process is based on creativity and forces researchers to think out of their boxes and open new scientific challenges. What drives the research is the urge to find alternative, more efficient solutions to tackle problems. Due to the wide range of possibilities offered by biodiversity’s tested solutions, the methodology prioritize (although not exclude) solution-based approaches.
It is useful to define the culture before discussing the term. According to the definition made by Turkish Language Institution Culture, the culture is described as the sum of all the material and spiritual values created in the process of social development and the tools that are used to create and hand these values down to next generations and show the extent of the man’s authority and control over their natural and social environment [1].
\nAccording to another definition, the culture is the general total of beliefs, attitudes and behaviors, customs and traditions, learned and shared values, and sustains its existence through learning and teaching of attitudes, actions and role models [2].
\nAs it can be understood from these definitions, culture is a non-written link from the past to the present day, bridging the individuals in society. As a phenomenon, The term “culture,” which diversifies in each community and so is experienced differently, also affects the way individuals perceive the phenomena such as health, illness, happiness, sadness and the manner these emotions are experienced [3].
\nCulture is a relative concept that varies according to health cultures as well as affecting the perception of health [4].
\nHealth is determined by biological and environmental factors as well as by cultural practices [5].
\nCulture affects many aspects of human life, such as parental attitudes, child rearing patterns, how to speak, what language to speak, how to dress, believe, treat patients, what to do with and how to feed them and to deal with funerals [6, 7].
\nIndividuals’ health behaviors and health perceptions are regarded inseparable from each other. Communities having endeavored to maintain their cultural characteristics for centuries have passed down this on their health behaviors and strived for finding cures to their health problems in their cultural lives. Types of food, cooking methods, sleeping habits, dressing patterns, forms of treatment of diseases, housing and residence, perception of diseases, modes of acceptance of innovations are characteristics varying from culture to culture and intertwined with culture. It is known that people cannot act independently of the culture they live in [8].
\nCulture is influential at many levels in health, ranging from the formation of new diagnostic groups, to the diagnosis of disease to the determination of what is called a disease or not symptoms and disease cues [6, 7].
\nHowever, in almost all regions of the world, wars, ethnic conflicts, repressive regimes, environmental and economic crises along with globalization have forced many people to abandon their country and migrate in their country or to immigrate other countries as refugees. As a result, multicultural populations comprised of individuals, families and groups from different cultures and subcultures are rapidly emerging all around the world [9, 10, 11].
\nIn order to improve the health behaviors of the community, cultural factors affecting health behavior and health care services need to be clearly recognized [12, 13].
\nThe individuals’ beliefs about health, attitudes and behaviors, past experiences, treatment practices, in short their culture, play a vital role in improving health, preventing and treating diseases [14].
\nCultural variables can be motivational factors in health-disease relationships, [8].
\n\n
Socioeconomic status
Family pattern
Gender roles and responsibilities
Marriage patterns
Sexual behavior
Preventive patterns
Population policy
Pregnancy and birth practices
Body
Nutrition
Dressing/wearing
Personal hygiene
Housing arrangements
General health regulations
Professions
Religion
Habits
Culture-induced stress
Status of immigrants
Substance use
Leisure time habits of
Pets and birds
Self-healing strategies and therapies [8].
Today, health-related cultural traits are under the influence of a medical approach that may be considered as highly conservative almost all around the world. There is an increasing tendency to perceive and evaluate health and disease-related processes explained in medical terms. The rigid medical approach, engaged in extending human life with costly inventions, with a narrow level of knowledge and practices, makes it impossible for individuals to use the potential for qualified living. Modern medicine overwhelms the will of people to experience their own facts and solve their problems. On the other hand, the concept of health should be regarded as a dynamic phenomenon in life and be removed from some patterns of thought. Hence, healthcare should be assessed with a comprehensive understanding of culture in order to promote the art of living healthily among people [15].
\nIndividuals who embrace contemporary public health, evaluate health with a holistic approach, give the other individuals an opportunity to participate in their health care issues, and have the potential to solve problems with appropriate preferences can only be the output of cultural constructs supporting health, values, knowledge, attitudes, behaviors and norms. Health culture is concerned with every individual’s or the society’s patterns of living, celebrating, being happy in life, suffering and dying. It is not enough for the individual to acquire only health-related information, but basic skills such as comprehending health-related values, developing a healthy lifestyle and self-evaluation must be developed. The main purpose of developing health culture is to raise the level of health in the country scale. This can only be ensured by the fact that health education standards be established by well-trained and conscious individuals into practice with the help of their knowledge and skills [15].
\nIt is vital that health services are also appropriate for the target cultures to the extent that they are compatible with contemporary medical understanding. People’s beliefs and practices are part of the culture of the society in which they live. Cultural characteristics should be seen as a dynamic factor of health and disease. In order to be able to provide better health care, it is necessary to at least understand how the group receiving care perceives and responds to disease and health, and what cultural factors lie behind their behaviors [7, 13, 16, 17, 18, 19, 20].
\nUnless health care initiatives are based on cultural values, it will be impossible to achieve the goal and the care provided will be incomplete and fail [2, 21].
\nFor this reason, healthcare providers should try to understand the cultural structure of a society. Health workers must collect cultural data to understand the attitudes of towards coping with illness, health promotion and protection [2, 21].
\nCultural differences and health beliefs have been recognized for many years as prior knowledge in practice. Despite that, cultural health care is unfortunately not part of a routine or common health practice. Knowing cultural beliefs related to health can enable us to build a framework for data collection in health care [2, 22].
\nToday, health policies focus primarily on the prevention of health-related inequalities and discrimination, especially ethnic characteristics. In order for the societies to regulate health care that will meet the needs of different groups in terms of culture, all health team members must be equipped with the necessary knowledge and skills [23, 24].
\nThe term health, with its changing nature and meanings from one culture to another, requires care, including cultural recognition, value and practice. The main element in the transcultural approach in which every health professional has an active role is the individual. The transcultural approach can be applied at all levels of health care institutions; but nurses are in a privileged position in this approach. According to Leininger’s model, only nurses can provide transcultural health services. Because the main aim of nursing is to provide a caring service that respects people’s cultural values and lifestyles. Nurses should offer acceptable, affordable and culturally suitable care to individuals under the conditions of the day [2].
\nKnowing what cultural practices are applied in the societies receiving healthcare services and identifying the cultural barriers to accessing health care services positively affects the caring process [25].
\nThe nursing profession, which plays an important role in the health team, is a cultural phenomenon. The patient’s cultural values, beliefs and practices are an integral part of holistic nursing care [26, 27].
\nThe nurses should explore new ways of providing cultural care in multicultural societies, understand how cultures affect health-disease definitions, and bridge the gap between care for individuals in different cultures [13, 28, 29].
\nTranscultural nursing provides effective nursing care to meet the cultural needs of individuals, families and groups [30].
\nThe concept of “Transcultural Nursing” derived from the need to care for individuals in different cultures in nursing was first used by Madeleine Leininger in 1979 [30, 31, 32].
\nIn addition to Leininger, a pioneer model of transcultural nursing, many nurses worked in the field of cultural care. Giger and Davidhazar developed the “Cross-Cultural Diagnosis Model” to assess various variables related to health and illness and provide a practical diagnostic tool for nursing so that culturally competent care could be offered [33].
\nCampinha-Bacote described the cultural competence model [34].
\nCulturally competent nurses are in contact with cultural experiences and aware of their own personality traits and contribute to socio-cultural knowledge in nursing care by providing individualized care [35].
\nNurses who are aware of cultural differences and the effects of these differences on the health of the individual enhance the therapeutic environment by communicating more effectively with the patients [13].
\nThe role and significance of transcultural nursing has been increasingly recognized in the world challenged by cultural diversity. Cultural differences can be seen among ethnic groups as well as within any ethnic group [36].
\nIt has been reported that cultural differences may exist among individuals who live in the same or different regions in Turkey [37].
\nAlthough studies on cross-cultural nursing care in our country are limited, several studies have examined the views of nursing and midwifery students regarding patient care [37, 38, 39].
\nIn a study conducted, the views of nurses working in two different hospitals on the cultural problems they faced in patient care were compared [11, 36].
\nIn recent years, it has been recognized that nurses must explore new ways of providing cultural care in culturally diverse societies, understand how culture affects disease-health definitions, and act as a bridge between the biomedical system and care for individuals in different cultures [2, 40].
\nThe nature and importance of providing culturally sensitive nursing services is multidimensional, including individual and professional aspects. The transcultural approach allows nurses to broaden their horizons and perspectives in addition to making them competent in offering creative care to individuals. Culturally based approaches and knowledge can enhance both the nurse’s and the patient’s self-esteem [2, 41, 42].
\nThe American Nurses Association (ANA) refers to three reciprocal interactions: the culture of the individual (patient), the culture of the nurse, and the culture of the environment in relation to the patient-nurse:
\nCulture of the individual: When nurses understand the specific factors affecting individual health behaviors, they will be more successful in meeting their needs [2].
\nIndividuals’ beliefs about health, culture, past illness/health experiences form a wholistic structure and play a vital role in improving the health of individuals [43].
\nCulture is influential in how people think, speak the language, how to dress, believe, treat their patients and how to feed them and what to do with their funerals etc. Moreover, it plays a significant role in a variety of aspects such as new diagnostic methods, prognosis, symptomatic patterns and determination of whether there is an illness or not [7].
\nCulture of the nurse: The only factor influencing the patient-nurse relationship is not the patient himself/herself. The nurses’ own customs and traditions, beliefs and values are also important in transcultural relationships. The nurse’s self-awareness can be the starting point to understand the patient culturally.
\nCulture of the environment: The last element of the transcultural trio is the culture of the environment. The environment is an integral part of the culture. Individuals as physical, ecological, sociopolitical and cultural beings are continuously interacting with each other. Nurses may have to intervene in the patient and family relationship because of frequent bureaucratic arrangements and procedures. The transcultural approach should be considered in a wide range of subjects, starting from asking if there are any religious practices to be followed or done by the patient during the hospitalization, and writing the signs in the hospital in two different languages [13].
\nIt is essential for nurses to be able to offer appropriate holistic care to patients from different cultures and to know how the transcultural approach is to be put into practice, as it provides guidance on how to behave in the case of these situations.
\nTranscultural nursing is sensitive to the needs of families, groups and individuals who are representatives of groups with different cultures in a community or society. This sensitive approach provides support for the individual in achieving the well-being and happiness [2].
\nCulturally sensitive nursing practices involve the identification of cultural needs, the understanding of cultural links between family and individuals to provide care without affecting the cultural belief system of the family, and the use of emotional strategies for caregivers and patients to reach reciprocal goals. Building therapeutic relationships, offering appropriate and responsive care and treatment can be accomplished through transcultural nursing approach [2].
\nIt is necessary for nurses to recognize individuals in their own cultural patterns, examine them in their own culture, and take these into account in the nursing approach [2, 7, 22].
\nNursing is a developing profession that can continuously adapt to changing situations. Changes in social rules and expectations, the advent of new medical treatments, and improvements in technical systems have helped shape contemporary nursing practices [4, 44, 45].
\nNursing has been significantly influenced by the fact that an increasing number of societies around the world have become multicultural and cultural specific care has been recognized [4].
\nThe concept of cultural competence is a relatively new concept commonly used in the academic disciplines from the beginning of 1989 [4, 46, 47].
\nIn multicultural societies, health care professionals need to be culturally competent, which is expected by the society. Interest in cultural competence has been manifested in the studies conducted on the cultural characteristics of the patients [46].
\nThe nurses’ understanding of the cultures of patient groups is very important for the provision of meaningful effective nursing care [48].
\nThe study performed by Chenowethm et al. titled as the “Cultural Proficiency and Nursing Care: With an Australian Perspective” and Giger and Davidhizar’s study titled as “Culturally Adequate Care: The Afghan, Afghan Origin American and the Importance of Understanding Islamic Cultural and Islamic Religion” can be cited as examples of conducted research on this subject [4, 33, 49].
\nProviding culturally adequate care is an obligation imposed by increased cultural diversity and disclosure of identities, an understanding of home care and inequalities in health care. Cultural competence is a dynamic, variable and continuous process. Although cultural competence is a basic component of nursing practice, this concept has not been clearly explained or analyzed but defined in many ways. At times, various terms such as “transcultural nursing”, “culturally appropriate nursing care” or “culturally sensitive nursing care” were used instead of the term cultural competence [46].
\nThe literature review reveals that there is a common definition of cultural competence the term among researchers and a general consensus on the term. For example, the concepts of “ethnic nursing care”, “cultural care”, “cultural appropriateness” or “culturally appropriate care” are seen as terms close to cultural adequacy [4, 47].
\nCultural competence is the application of knowledge, skills, attitudes, and personal manners anticipated from nurses to provide services and care appropriate to the cultural characteristics of the patients.
\nBaşalan İz ve Bayık Temel reported that Vydelingum [47] made use of Murphy and Macleod-Clark, Bond, Kadron-Edgren and Jones, Spence, Blackford’s findings in his study. In Murphy and Macleod-Clark’s study on ethnocentric views, it was stated by nurses that patients from a minority group were generally regarded as a problem and these patients were perceived as inappropriate for daily routine, and there was lack of holistic care among nurses working to develop a therapeutic relationship with minority groups. Bond, Kadron-Edgren and Jones conducted a study evaluating the knowledge and attitudes of nursing students and professional nurses regarding patients from different cultures. This study has shown that undergraduate and post-graduate nursing programs are partially limited in terms of the knowledge and skills about special cultural groups. Spence, in his study on nurses’ experiences in caring for people from other cultures in New Zealand found that they experienced tension and anxiety when they encountered with an odd case. The subject of cultural well-being and nursing approaches in nursing education was reported in a study carried out by Blackford in Australia. The necessity of care structured under the roof of the white race culture has revealed that it does not consider the health care culture. The lack of cultural adequacy in the care of patients from different cultures has been recognized as an great challenge to all these studies. Cultural conflict has been shown as an output of ethnocentric focus, resulting in a lack of cultural competence, misunderstanding, lack of confidence, communication and obstacles to establishing a positive relationship [4].
\nThe nurse experiencing cultural conflict must first recognize his/her subconscious cultural behaviors in order to understand the reason for the cultural conflict [13].
\nIn a cultural conflict, the nurse can respond negatively from the cultural perspective in the following ways:
Ethnocentrism: It refers the individual’s interpretation of other cultures in terms of their own culture based on their own cultural heritage.
Stereotyping: The acceptance of the same characteristics of individuals or group members without considering individual differences.
Cultural blindness: A symptom of not paying attention to expressing cultural diversity.
Cultural imposition: The situation emerges at a time when the nurse expects the patient to comply with his/her cultural norms or the norms of the health institution. The nurse may think, “You have to follow my hospital’s rule and comply with our procedures here.”
Cultural conflict: When a nurse, patient and family have different values, exhibit different behaviors, conflicts may arise in the case of differences in beliefs and traditions. However, the expected professional attitude from the nurse is cultural relativism. Cultural relativism means recognizing and understanding the individual’s culture in its own structure, without referring to other norms and judgments. The nurse approaching the patient with cultural relativism has a clear view of the characteristics of cultures, diversity of beliefs and practices in different environments resulting from different social needs [2].
\n
The individual/patient’s own perspective and cultural beliefs must be respected and recognized.
The nurse should be competent and authorized to carry out professional actions and make decisions.
The nurse should help the individual to develop new patterns to lead a satisfying and healthy life in the case of harmful behaviors [50].
The nursing care plan must be individual, holistic and contemporary. Interpreters or religious leaders may need to be included in the caring plan if there are any linguistic problems. The patient’s view on the cause of his or her illness is also a key element in planning the care [49].
\nIn preparing the nursing care plan, basic principles related to culturally sensitive nursing practices can be followed.
\n\n
The importance and influence of the culture should be considered,
Cultural differences should be valued and respected,
Cultural influences in the manners of individuals should be understood,
An empathic approach should be put into action towards individuals with cultural diversity,
Individuals’ cultures should be respected,
Health professionals should be patient with individuals in cultural issues,
Individuals’ behaviors should be thoroughly analyzed,
Cultural knowledge should be increased and enhanced,
Adaptation and orientation programs about cultural diversity should be offered [2, 7, 22].
The scope of cultural nursing practice can be:
identification of cultural needs
understanding the cultural connections of the individual and the
using emotional strategies for the caregivers and the patients to reach the reciprocal goals
Thus, the cultural approach will guide the nurses in planning nursing interventions. In this case, nursing care can be provided without harming the cultural belief system of the family [13, 51].
\nThis short review provides the basis for a deeper cultural assessment that the nurse can do in the future. The nurse has the opportunity to communicate effectively with the individual through brief cultural assessment data collected [7, 13, 22, 52].
\nNurses should make cultural evaluations when they first communicate with individuals. This evaluation may be in-depth, or a brief review that will form the basis for an in-depth assessment to be done later. In a brief review, several questions about health practices, diet, religious preference, ethnic background and family can be asked to the individual. This short review provides the basis for a deeper cultural assessment to be done by the nurse in the future. Thıs, the nurse has a chance to communicate effectively with the individual through brief cultural data [7, 13, 22, 52].
\n\n
Demographic data
Regional population density
Population density entering the region
Age distribution of the residents in the region
Distribution of demographics such as education, job, income etc.
The national origin of the population living in the region
Traditional health beliefs
Definition of illness
Definition of health
Health-related behaviors
Reasons for your illness
Poor eating habits/nutrition
Bad eating arrangements
Viruses, bacteria and other organisms
A punishment/curse from Allah (the God)
Being affected by the evil eyes
Magic, charm, spell or jealousy
Witchcraft
Environmental changes
Sorrow or loss
Excessive or little labor
Methods for maintaining health
Health protection methods
Methods of restoring health-home treatments/household recipes
Utilization of health care resources and visitations
Traditional healers favored by sick people
Health beliefs and practices related to childbirth
Health beliefs and practices related to raising children
Traditional practices and ceremonies arranged for dying individuals and related to death
In addition to recognizing the cultural characteristics of the community, by depending on these data, nurses should recognize traditional medicines, places of worship and sacredness, and other such organizations and, if possible, should visit and observe such places in order to identify the service group.
\n\n
The nurses should be knowledgeable about the community receiving care services provided by themselves.
The nurses should identify the social gathering environments such as schools, hospitals, places of worship of the community they serve care.
The nurses should define the specific areas they want to focus on prior to cultural evaluation.
The nurses should determine the strategies that can help them collect data about cultural values.
The nurses should define the items that may act as bridges between the cultures.
The nurses should be able to ask appropriate questions without hurting the individuals.
The nurses should cooperate with colleagues and other health workers.
The nurses should discuss with the community leaders, whether official or non-official, about cultural characteristics deemed important in the lifestyle of the society.
The nurses should not resort to unethical traps to make an early generalization based on the cultural data of the society.
The nurses should be honest, open and sincere towards the individuals and the self.
The nurses should obtain both objective and subjective data and verify them to be correct before implementing nursing care [7, 13].
Additionally, the nurses should at least learn some relevant vocabulary and common phrases used in caregiving that will facilitate communication [7, 13].
\n\n
Nurses are transcultural care personnel.
An individual is considered as a cultural asset and cannot be separated from his/her own cultural heritage and background.
Environment is a structure or framework
Transcultural care is a sensitive nursing care service addressing to the needs of individuals from different cultural groups [18].
A manual of guidelines has been prepared by International Nurses Association (ICN), American Nursing Academy, Transcultural Nursing Association, with the aim of creating a common language for nursing practice all over the world and providing a holistic and cultural content care that respects social equality, justice and individual differences. There are 12 items in the manual given in the following:
Social Justice and Equality
Critical Perspective
Cultural Awareness
Cultural Based Care
Cultural Based Health Care Systems and Organizations
Patient Advocacy and Empowerment
Multicultural Workforce
Cultural Based Care in Education and Training
Intercultural Communication
Intercultural Leadership
Policy Development
The foundations of transcultural nursing were laid in the mid-1950s. In nursing, Peplau first mentioned in 1950 that the cultures were an important variable affecting mental health. The growing interest in Leininger’s transcultural nursing model has begun with population changes and migration. Leininger tried to promote transcultural nursing movements. Much more attention was paid to the care of individuals from different cultures in the 1960s. Since 1960s, nurses have been carrying out studies aimed at providing particularly cultural care to people from all communities/cultures. In 1962, King stated that psychopathological behaviors differ from culture to culture. In 1969, the International Council of Nursing (ICN) began using cultural content in nursing. The Transcultural Nursing Society (TCNS) was established in 1974 to train nurses in this area.
\nThis organization aims to provide the nurses and other health care professionals with the basic knowledge necessary to develop cultural skills in culturally sensitive practice, education, research and management [2].
\nSince 1989, “Journal of Transcultural Nursing” has been published, aiming to train nurses about transcultural care and improve their practice. Evidence-based studies have been conducted in this area. Today, there are about 25 books and over 800 articles covering research, theory and applications related to transcultural nursing [2].
\nThis is a promising field of study with which Turkish nurses have recently started to be familiar. Now that globalization is inevitable, studies on transcultural care practices will broaden the horizons of Turkish nurses and the others all around the world.
\nIn addition to Leininger, a pioneer model of transcultural nursing, many nurses worked in the field of cultural care including Boyle, Campinha-Bacote, Yahle Langenkamp, Giger and Davidhizar, Juntunen, Leuning, Swiggum et al., Purnell, Ryan, Carlton and Ali.
\nAmong these, there are researchers arguing that the models and theories of two modelists (Giger and Davidhizar and Purnell) who do myriads of studies on cultural care are extremely simple, comprehensible and suitable for use in many different fields and cultures [5].
\n\n
Burchum JLR; Cultural competence: Evolutionary dimension.
Campinha-Bacote J; Cultural competence in providing health care services: Culturally adequate care model.
Cross T., Bazron B; Dennis K., Isaacs M.; Towards a culturally adequate care process: Effective services for minority children with emotionally serious illness.
Kim-Godwin YS; Clarke PN & Barton L.; Providing culturally adequate public care model.
Leininger MM; The differences in cultural care and the theory of universality.
Leininger M; Cultural care theory and ethnocentric research method.
Leininger M; Evaluation of culture care for appropriate and adequate practices.
Orque M.; Orque’s ethnic/cultural system: Conceptual framework for ethnic nursing care.
Pacquiao DF; Cultural competence in ethical decision making.
Papadopoulos I. & Lees S; Training culturally competent researchers.
Purnell LD. & Amp; Paulanka BJ; Ppur model for cultural competence.
Suh EE; Cultural competence model through evolutionary concept analysis.
Wells M; Beyond cultural competence: a model for individual and institutional cultural development [4, 46].
\n
Giger JN. & Davidhizar RE; Transcultural nursing; Evaluation and intervention
Spector RE; Cultural difference in health and disease.
\n
Andrews MM; Culturally adequate nursing care.
Andrews MM; History of health and cultural competence in physical examination.
Bloch B; Bloch’s assessment guide for ethnic/cultural diversity.
Boyle JS & Andrews MM; Andrews/Boyle assessment guide.
Spector RE; Cultural care: guidelines for inheritance, assessment and health traditions [4, 46].
The conceptualization of the cultural competence model in nursing has emerged after 1989. Leininger, Campinha-Bacote, Giger and Davidhizar, Orque, Purnell and Paulanka, Spector, Andrews and Boyle are regarded as the pioneers contributing to the accumulation of the relevant data. Orque is a leading figure in developing a cultural model for nursing with “the conceptual framework of the ethnic system”. The use of nursing theories and models in nursing researches offers unparalleled contribution to the health care system through the practices of the nurse as a professional. Cultural competence models developed by nurse researchers can be transferred not only to nursing but also to other disciplines.
\nLeininger describes transcultural nursing as a branch of nursing or nursing school based on comparative research and analysis of different cultures which provides cultural universalism and cultural independence in nursing care and focuses on comparative studies and analyzing differences in cultures around the world in a respectful manner in view of health, illness, care, beliefs and values [3, 5, 13].
\nThe aims of transcultural nursing are to provide sensitive and effective nursing care to meet the cultural needs of individuals, families and groups, to integrate transcultural concepts, theories and practices into nursing education, research and clinical applications, to improve transcultural nursing knowledge, and to incorporate this knowledge into nursing practice.
\nThe International Nurses Association (ICN) invited the nurses from the World Health Organization (WHO) member countries to work on adaptable models to their communities at the 1989 Seoul Conference. The studies conducted in Turkey show that the nurses need to have classification lists and guidelines to be used in care, and thus a more systematic care will be provided in less time for individual patients and more data will be collected. In Turkey internationally developed models and classification systems in nursing care are translated into Turkish, or new guidelines specific to clinics are developed and used. These include NANDA’s diagnosis, Gordon’s Functional Health Patterns, NIC, NOC and Daily Living Activities and the OMAHA system [55].
\nThe use of transcultural nursing models, classification systems and guidelines is becoming widespread. These models focus on the relationship of nursing to concepts and theories related to life, health, disease and society, facilitate organizing their thoughts, and provide a common language among professional members.
\nWhile there has been an increased awareness of the importance of cultural care and collecting cultural data in recent years in Turkey, no models or guides have been developed in Turkey [55].
\nThe “Culture Care Diversity and Universality” theory developed by Leininger in 1960, the first nurse who made the first work in this field and received the title of anthropologist, is the first theory developed in the field of transcultural nursing and still used worldwide. This theory focuses on exploring different and universal cultures and providing comparative care. It adopts a multi-factorial approach affecting health and care such as environmental conditions, ethnography, language, gender, class, racism, social structuring, belief, politics, economics, kinship, technology, culture and philosophy. This model includes technological, religious and philosophical, kinship and social factors, cultural values and lifestyle, political and legal, economic and social factors [50], which have been used in many studies in the west and in other countries since 1960 (Figure 1).
\nLeininger’s sunrise model. Reference: [2].
Narayanasamy described the model in 1998 with the letters ACCESS (Assessment, Communication, Cultural negotiations and Compromise, Establishing respect, Sensitivity and Safety) to form the framework of cultural care practices [42] (Table 1).
\nTranskültürel Hemşirelik | \n|
---|---|
Assessment | \nCulturally focusing on the patient’s life style, beliefs and practices related to health | \n
Communication | \nAwareness of the variety of verbal and nonverbal reactions | \n
Cultural Negotiation and Compromise | \nBecoming more aware of the other people’s cultures and exploring their problems as well as understanding the patient’s opinion, | \n
Respect | \nDescribing therapeutic relationship relevant to the patient’s cultural beliefs and consensus values | \n
Sensitivity | \nApplying the sensitive care model to culturally different groups | \n
Safety | \nMaking the patient feel safe in the culturally sensitive care | \n
The model developed in 1988 was first published in 1990. This model is a tool developed to assess cultural values and their effects on health and disease behavior [33] (Figure 2).
\nGiger and Davidhizar’s transcultural assessment model. Reference: [33].
This ethnographic model created to promote cultural understanding of people’s status in the context of health promotion and illness is based on ethical perspectives of individual, family and community. It can be used in primary, secondary and tertiary protection stages [56] (Figure 3).
\nPurnell’ s model for cultural competence. A care preparation that is accepted as appropriate from a cultural perspective requires that the nurse personally develops, perfects and uses specific skills. Reference: [55].
\n
Having the ability to understand complex cultural dimensions,
Assuming a holistic approach to care instead of biophysical approach,
Showing efforts to reach rapidly increasing cultural beliefs and activities that are unique to distinct groups and individuals
Being able to change the idea of believing that individuals’ own race is superior to others,
Being able to make cultural evaluations,
Developing communicative and scientific language skills,
Being able to deal with cultural differences in real terms and make interpretations,
Being able to use appropriate cultural teaching techniques
Compromising cultural beliefs and studies with the general state of provision of health care,
Respecting for the sociocultural diversity of women, newborn babies and their families [8, 57].
The ability of nurses to change their current and future nursing practices through transcultural nursing care approach in the nursing care system can be achieved through cultural specific transcultural nursing education programs [22, 58].
\nRegardless of their ethnic characteristics, nursing educators have great responsibilities to develop positive attitudes towards intercultural nursing care as a role model for their students [29, 58].
\nIn addition, registered nurses should be aware of these issues and develop their knowledge and competence. Educators and administrators need to know, understand and believe in the importance of intercultural nursing care in order to be role models for students. The first step in the development and implementation of intercultural nursing education programs in nursing institutions is to evaluate the curriculum. It is recommended that the review in nursing schools be started with an examination of the mission statement. It should be examined whether the significance of cultural differences, care and education are explained in the mission statement [58, 59].
\nThe multicultural education approach and educational program should replace the dominant cultures in nursing schools. With the help of this approach, school administrators and academics should observe whether content issues are appropriate and adequate in terms of multicultural education in current educational programs [58].
\nIn terms of multiculturalism, important main subjects, concepts, theories should be defined and integrated into the curriculum [59].
\nThe terms such as cultural competence, multiculturalism, cultural diversity, cultural awareness, cultural safety should be intertwined with other professional subjects into the curriculum.
\nAn educational environment should be created in which racial differences are accepted and respected in nursing education. Within the scope of the program, generalizations and conceptualizations specific to different cultural groups should be introduced in theoretical and practical courses. During the courses social problems, experiences brought about by different racetracks such as racism, prejudicial discrimination, language problems, communicative difficulties, lack of obtaining information, health services that do not meet the needs, lack of recognition or determination of diagnosis, and incorrect nursing diagnosis should be discussed [58, 59, 60, 61].
\nStudents can examine and evaluate their racial characteristics in the communication and skills lab. In addition, similarities and differences between ethnic groups should be emphasized in all lectures [58, 59].
\nIn intercultural nursing education, the students’ ethnocentric worldview “just like me” should be replaced by the view “not like me”. It is stated in the nursing education that it is very useful for the student to assume some duties and responsibilities in community services and health education programs to develop cultural competence [58].
\nIn addition, it has been shown that the exchange of national and international students and teaching staff in nursing schools is a very useful way to build cultural awareness and sensitivity by experiencing, working, and living in another culture, in order for students to find intercultural opportunities in different cultural settings [58, 62, 63].
\nIt is stated that it is a useful teaching method for nurses to teach nursing diagnoses with case studies involving different cultural items in education programs. In nursing programs focusing on intercultural education, nursing educators use methods and tools such as critical reflection, discussion groups, role playing, observations, simulation exercises, clinical scenarios as well as written materials, videos, film monitoring and audio tapes [58].
\nAlthough transcultural nursing has an important role in the holistic approach, it is criticized at some points and is also mentioned in opposing views.
\nIn the case of launching nationalist initiatives in intercultural care, it has been stated that stereotyped images may emerge, and that particular attention may be paid to certain cultural individuals in the caring process. Given the presence of some 3000 cultures around the world, it is impossible for healthcare professionals to have knowledge of all cultures. It also requires the specialization of health personnel in order to provide qualified, culturally specific care. Despite the desire to create multicultural societies in the world in which there are liberal immigrant policies, it cannot be argued that there is an accepted standard in health care, in terms of the socioeconomic status, ethnic characteristics, sexual behavior and lifestyle preferences. There is a cultural crisis in health care services. Individualized intercultural care is a nurse’s responsibility as both a human and a professional. However, it is noted that nurses may be ethnocentric with cultural knowledge, understanding, awareness, education, cultural competence and lack of faith [58].
\nIt is argued that extraordinary endeavors in cultural sensitivity can result in the classification of cultures, thereby leading to stereotyped behaviors in certain cultures, races and religions. Another criticism is that paying particular attention to the patient of a particular culture, and focusing on that side can cause limitations in care. It is emphasized that the patient may feel “special”, “needing protection” or “patronized”. In addition, it has been pointed out that concerns about transcultural care in the field of health will only lead to formation of specialization in transcultural care that could increase responsibilities for nurses, which in turn will put a burden on them [2].
\nThe authors declare that they have no conflict of interest.
No outside funding was received for this study.
Classic smart home, internet of things, cloud computing and rule-based event processing, are the building blocks of our proposed advanced smart home integrated compound. Each component contributes its core attributes and technologies to the proposed composition. IoT contributes the internet connection and remote management of mobile appliances, incorporated with a variety of sensors. Sensors may be attached to home related appliances, such as air-conditioning, lights and other environmental devices. And so, it embeds computer intelligence into home devices to provide ways to measure home conditions and monitor home appliances’ functionality. Cloud computing provides scalable computing power, storage space and applications, for developing, maintaining, running home services, and accessing home devices anywhere at anytime. The rule-based event processing system provides the control and orchestration of the entire advanced smart home composition.
Combining technologies in order to generate a best of breed product, already appear in recent literature in various ways. Christos Stergioua et al. [1] merge cloud computing and IoT to show how the cloud computing technology improves the functionality of the IoT. Majid Al-Kuwari [2] focus on embedded IoT for using analyzed data to remotely execute commands of home appliances in a smart home. Trisha Datta et al. [3] propose a privacy-preserving library to embed traffic shaping in home appliances. Jian Mao et al. [4] enhance machine learning algorithms to play a role in the security in a smart home ecosystem. Faisal Saeed et al. [5] propose using sensors to sense and provide in real-time, fire detection with high accuracy.
In this chapter we explain the integration of classic smart home, IoT and cloud computing. Starting by analyzing the basics of smart home, IoT, cloud computing and event processing systems. We discuss their complementarity and synergy, detailing what is currently driving to their integration. We also discuss what is already available in terms of platforms, and projects implementing the smart home, cloud and IoT paradigm. From the connectivity perspective, the added IoT appliances and the cloud, are connected to the internet and in this context also to the home local area network. These connections complement the overall setup to a complete unified and interconnected composition with extended processing power, powerful 3rd party tools, comprehensive applications and an extensive storage space.
In the rest of this chapter we elaborate on each of the four components. In Section 1, we describe the classic smart home, in Section 2, we introduce the internet of things [IoT], in Section 3, we outline cloud computing and in Section 4, we present the event processing module. In Section 5, we describe the composition of an advanced smart home, incorporating these four components. In Section 6, we provide some practical information and relevant selection considerations, for building a practical advanced smart home implementation. In Section 7, we describe our experiment introducing three examples presenting the essence of our integrated proposal. Finally, we identify open issues and future directions in the future of advanced smart home components and applications.
Smart home is the residential extension of building automation and involves the control and automation of all its embedded technology. It defines a residence that has appliances, lighting, heating, air conditioning, TVs, computers, entertainment systems, big home appliances such as washers/dryers and refrigerators/freezers, security and camera systems capable of communicating with each other and being controlled remotely by a time schedule, phone, mobile or internet. These systems consist of switches and sensors connected to a central hub controlled by the home resident using wall-mounted terminal or mobile unit connected to internet cloud services.
Smart home provides, security, energy efficiency, low operating costs and convenience. Installation of smart products provide convenience and savings of time, money and energy. Such systems are adaptive and adjustable to meet the ongoing changing needs of the home residents. In most cases its infrastructure is flexible enough to integrate with a wide range of devices from different providers and standards.
The basic architecture enables measuring home conditions, process instrumented data, utilizing microcontroller-enabled sensors for measuring home conditions and actuators for monitoring home embedded devices.
The popularity and penetration of the smart home concept is growing in a good pace, as it became part of the modernization and reduction of cost trends. This is achieved by embedding the capability to maintain a centralized event log, execute machine learning processes to provide main cost elements, saving recommendations and other useful reports.
A typical smart home is equipped with a set of sensors for measuring home conditions, such as: temperature, humidity, light and proximity. Each sensor is dedicated to capture one or more measurement. Temperature and humidity may be measured by one sensor, other sensors calculate the light ratio for a given area and the distance from it to each object exposed to it. All sensors allow storing the data and visualizing it so that the user can view it anywhere and anytime. To do so, it includes a signal processer, a communication interface and a host on a cloud infrastructure.
Creates the cloud service for managing home appliances which will be hosted on a cloud infrastructure. The managing service allows the user, controlling the outputs of smart actuators associated with home appliances, such as such as lamps and fans. Smart actuators are devices, such as valves and switches, which perform actions such as turning things on or off or adjusting an operational system. Actuators provides a variety of functionalities, such as on/off valve service, positioning to percentage open, modulating to control changes on flow conditions, emergency shutdown (ESD). To activate an actuator, a digital write command is issued to the actuator.
Home access technologies are commonly used for public access doors. A common system uses a database with the identification attributes of authorized people. When a person is approaching the access control system, the person’s identification attributes are collected instantly and compared to the database. If it matches the database data, the access is allowed, otherwise, the access is denied. For a wide distributed institute, we may employ cloud services for centrally collecting persons’ data and processing it. Some use magnetic or proximity identification cards, other use face recognition systems, finger print and RFID.
In an example implementation, an RFID card and an RFID reader have been used. Every authorized person has an RFID card. The person scanned the card via RFID reader located near the door. The scanned ID has been sent via the internet to the cloud system. The system posted the ID to the controlling service which compares the scanned ID against the authorized IDs in the database.
To enable all of the above described activities and data management, the system is composed of the following components, as described in Figure 1.
Sensors to collect internal and external home data and measure home conditions. These sensors are connected to the home itself and to the attached-to-home devices. These sensors are not internet of things sensors, which are attached to home appliances. The sensors’ data is collected and continually transferred via the local network, to the smart home server.
Processors for performing local and integrated actions. It may also be connected to the cloud for applications requiring extended resources. The sensors’ data is then processed by the local server processes.
A collection of software components wrapped as APIs, allowing external applications execute it, given it follows the pre-defined parameters format. Such an API can process sensors data or manage necessary actions.
Actuators to provision and execute commands in the server or other control devices. It translates the required activity to the command syntax; the device can execute. During processing the received sensors’ data, the task checks if any rule became true. In such case the system may launch a command to the proper device processor.
Database to store the processed data collected from the sensors [and cloud services]. It will also be used for data analysis, data presentation and visualization. The processed data is saved in the attached database for future use.
Smart home paradigm with optional cloud connectivity.
The internet of things (IoT) paradigm refers to devices connected to the internet. Devices are objects such as sensors and actuators, equipped with a telecommunication interface, a processing unit, limited storage and software applications. It enables the integration of objects into the internet, establishing the interaction between people and devices among devices. The key technology of IoT includes radio frequency identification (RFID), sensor technology and intelligence technology. RFID is the foundation and networking core of the construction of IoT. Its processing and communication capabilities along with unique algorithms allows the integration of a variety of elements to operate as an integrated unit but at the same time allow easy addition and removal of components with minimum impact, making IoT robust but flexible to absorb changes in the environment and user preferences. To minimize bandwidth usage, it is using JSON, a lightweight version of XML, for inter components and external messaging.
Cloud computing is a shared pool of computing resources ready to provide a variety of computing services in different levels, from basic infrastructure to most sophisticated application services, easily allocated and released with minimal efforts or service provider interaction [6, 7]. In practice, it manages computing, storage, and communication resources that are shared by multiple users in a virtualized and isolated environment. Figure 2 depicts the overall cloud paradigm.
Cloud computing paradigm.
IoT and smart home can benefit from the wide resources and functionalities of cloud to compensate its limitation in storage, processing, communication, support in pick demand, backup and recovery. For example, cloud can support IoT service management and fulfillment and execute complementary applications using the data produced by it. Smart home can be condensed and focus just on the basic and critical functions and so minimize the local home resources and rely on the cloud capabilities and resources. Smart home and IoT will focus on data collection, basic processing, and transmission to the cloud for further processing. To cope with security challenges, cloud may be private for highly secured data and public for the rest.
IoT, smart home and cloud computing are not just a merge of technologies. But rather, a balance between local and central computing along with optimization of resources consumption. A computing task can be either executed on the IoT and smart home devices or outsourced to the cloud. Where to compute depends on the overhead tradeoffs, data availability, data dependency, amount of data transportation, communications dependency and security considerations. On the one hand, the triple computing model involving the cloud, IoT and smart home, should minimize the entire system cost, usually with more focus on reducing resource consumptions at home. On the other hand, an IoT and smart home computing service model, should improve IoT users to fulfill their demand when using cloud applications and address complex problems arising from the new IoT, smart home and cloud service model.
Some examples of healthcare services provided by cloud and IoT integration: properly managing information, sharing electronic healthcare records enable high-quality medical services, managing healthcare sensor data, makes mobile devices suited for health data delivery, security, privacy, and reliability, by enhancing medical data security and service availability and redundancy and assisted-living services in real-time, and cloud execution of multimedia-based health services.
Smart home and IoT are rich with sensors, which generate massive data flows in the form of messages or events. Processing this data is above the capacity of a human being’s capabilities [8, 9, 10]. Hence, event processing systems have been developed and used to respond faster to classified events. In this section, we focus on rule management systems which can sense and evaluate events to respond to changes in values or interrupts. The user can define event-triggered rule and to control the proper delivery of services. A rule is composed of event conditions, event pattern and correlation-related information which can be combined for modeling complex situations. It was implemented in a typical smart home and proved its suitability for a service-oriented system.
The system can process large amounts of events, execute functions to monitor, navigate and optimize processes in real-time. It discovers and analyzes anomalies or exceptions and creates reactive/proactive responses, such as warnings and preventing damage actions. Situations are modeled by a user-friendly modeling interface for event-triggered rules. When required, it breaks them down into simple, understandable elements. The proposed model can be seamlessly integrated into the distributed and service-oriented event processing platform.
The evaluation process is triggered by events delivering the most recent state and information from the relevant environment. The outcome is a decision graph representing the rule. It can break down complex situations to simple conditions, and combine them with each other, composing complex conditions. The output is a response event raised when a rule fires. The fired events may be used as input for other rules for further evaluation. Event patterns are discovered when multiple events occur and match a pre-defined pattern. Due to the graphical model and modular approach for constructing rules, rules can be easily adapted to domain changes. New event conditions or event patterns can be added or removed from the rule model. Rules are executed by event services, which supply the rule engine with events and process the evaluation result. To ensure the availability of suitable processing resources, the system can run in a distributed mode, on multiple machines and facilitate the integration with external systems, as well. The definition of relationships and dependencies among events that are relevant for the rule processing, are performed using sequence sets, generated by the rule engine. The rule engine constructs sequences of events relevant to a specific rule condition to allow associating events by their context data. Rules automatically perform actions in response when stated conditions hold. Actions generate response events, which trigger response activities. Event patterns can match temporal event sequences, allowing the description of home situations where the occurrences of events are relevant. For example, when the door is kept open too long.
The following challenges are known with this model: structure for the processed events and data, configuration of services and adapters for processing steps, including their input and output parameters, interfaces to external systems for sensing data and for responding by executing transactions, structure for the processed events and data, data transformations, data analysis and persistence. It allows to model which events should be processed by the rule service and how the response events should be forwarded to other event services. The process is simple: data is collected and received from adapters which forward events to event services that consume them. Initially the events are enriched to prepare the event data for the rule processing. For example, the response events are sent to a service for sending notifications to a call agent, or to services which transmit event delay notifications and event updates back to the event management system.
Event processing is concerned with real-time capturing and managing pre-defined events. It starts from managing the receptors of events right from the event occurrence, even identification, data collection, process association and activation of the response action. To allow rapid and flexible event handling, an event processing language is used, which allows fast configuration of the resources required to handle the expected sequence of activities per event type. It is composed of two modules, ESP and CEP. ESP efficiently handles the event, analyzes it and selects the appropriate occurrence. CEP handles aggregated events. Event languages describe complex event-types applied over the event log.
In some cases, rules relate to discrepancies in a sequence of events in a workflow. In such cases, it is mandatory to precisely understand the workflow and its associated events. To overcome this, we propose a reverse engineering process to automatically rediscover the workflows from the events log collected over time, assuming these events are ordered, and each event refers to one task being executed for a single case. The rediscovering process can be used to validate workflow sequences by measuring the discrepancies between prescriptive models and actual process executions. The rediscovery process consists of the following three steps: (1) construction of the dependency/frequency table. (2) Induction of dependency/frequency graphs. (3) Generating WF-nets from D/F-graphs.
In this section, we focus on the integration of smart home, IoT and cloud computing to define a new computing paradigm. We can find in the literature section [11, 12, 13, 14] surveys and research work on smart home, IoT and cloud computing separately, emphasizing their unique properties, features, technologies, and drawbacks. However, our approach is the opposite. We are looking at the synergy among these three concepts and searching for ways to integrate them into a new comprehensive paradigm, utilizing its common underlying concepts as well as its unique attributes, to allow the execution of new processes, which could not be processed otherwise.
Figure 3 depicts the advanced smart-home main components and their inter-connectivity. On the left block, the smart home environment, we can see the typical devices connected to a local area network [LAN]. This enables the communication among the devices and outside of it. Connected to the LAN is a server and its database. The server controls the devices, logs its activities, provides reports, answers queries and executes the appropriate commands. For more comprehensive or common tasks, the smart home server, transfers data to the cloud and remotely activate tasks in it using APIs, application programming interface processes. In addition, IoT home appliances are connected to the internet and to the LAN, and so expands smart home to include IoT. The connection to the internet allows the end user, resident, to communicate with the smart home to get current information and remotely activate tasks.
Advanced smart home—integrating smart home, IoT and cloud computing.
To demonstrate the benefits of the advanced smart home, we use RSA, a robust asymmetric cryptography algorithm, which generates a public and private key and encrypts/decrypts messages. Using the public key, everyone can encrypt a message, but only these who hold the private key can decrypt the sent message. Generating the keys and encrypting/decrypting messages, involves extensive calculations, which require considerable memory space and processing power. Therefore, it is usually processed on powerful computers built to cope with the required resources. However, due to its limited resources, running RSA in an IoT device is almost impossible, and so, it opens a security gap in the Internet, where attackers may easily utilize. To cope with it, we combine the power of the local smart home processors to compute some RSA calculations and forward more complicated computing tasks to be processed in the cloud. The results will then be transferred back to the IoT sensor to be compiled and assembled together, to generate the RSA encryption/decryption code, and so close the mentioned IoT security gap. This example demonstrates the data flow among the advanced smart home components. Where, each component performs its own stack of operations to generate its unique output. However, in case of complicated and long tasks it will split the task to sub tasks to be executed by more powerful components. Referring to the RSA example, the IoT device initiates the need to generate an encryption key and so, sends a request message to the RSA application, running in the smart home computer. The smart home computer then asks the “prime numbers generation” application running on cloud, to provide p and q prime numbers. Once p and q are accepted, the encryption code is generated. In a later stage, an IoT device issues a request to the smart home computer to encrypt a message, using the recent generated RSA encryption key. The encrypted message is then transferred back to the IoT device for further execution. A similar scenario may be in the opposite direction, when an IoT device gets a message it may request the smart home to decrypt it.
To summarize, the RSA scenarios depict the utilization of the strength of the cloud computing power, the smart home secured computing capabilities and at the end the limited power of the IoT device. It proves that without this automatic cooperation, RSA would not be able to be executed at the IoT level.
A more practical example is where several detached appliances, such as an oven, a slow cooker and a pan on the gas stove top, are active in fulfilling the resident request. The resident is getting an urgent phone call and leaves home immediately, without shutting off the active appliances. In case the relevant IoTs have been tuned to automatically shut down based on a predefined rule, it will be taken care at the IoT level. Otherwise, the smart home realizes the resident has left home [the home door has been opened and then locked, the garage has been opened, the resident’s car left, the main gate was opened and then closed, no one was at home] and will shut down all active devices classified as risk in case of absence. It will send an appropriate message to the mailing list defined for such an occasion.
Smart home has three components: hardware, software and communication protocols. It has a wide variety of applications for the digital consumer. Some of the areas of home automation led IoT enabled connectivity, such as: lighting control, gardening, safety and security, air quality, water-quality monitoring, voice assistants, switches, locks, energy and water meters.
Advanced smart home components include: IoT sensors, gateways, protocols, firmware, cloud computing, databases, middleware and gateways. IoT cloud can be divided into a platform-as-a-service (PaaS) and infrastructure-as-a-service (IaaS). Figure 4 demonstrates the main components of the proposed advanced smart home and the connection and data flow among its components.
Advanced smart home composition.
The smart home application updates the home database in the cloud to allow remote people access it and get the latest status of the home. A typical IoT platform contains: device security and authentication, message brokers and message queuing, device administration, protocols, data collection, visualization, analysis capabilities, integration with other web services, scalability, APIs for real-time information flow and open source libraries. IoT sensors for home automation are known by their sensing capabilities, such as: temperature, lux, water level, air composition, surveillance video cameras, voice/sound, pressure, humidity, accelerometers, infrared, vibrations and ultrasonic. Some of the most commonly used smart home sensors are temperature sensors, most are digital sensors, but some are analog and can be extremely accurate. Lux sensors measure the luminosity. Water level ultrasonic sensors.
Float level sensors offer a more precise measurement capability to IoT developers. Air composition sensors are used by developers to measure specific components in the air: CO monitoring, hydrogen gas levels measuring, nitrogen oxide measure, hazardous gas levels. Most of them have a heating time, which means that it requires a certain time before presenting accurate values. It relies on detecting gas components on a surface only after the surface is heated enough, values start to show up. Video cameras for surveillance and analytics. A range of cameras, with a high-speed connection. Using Raspberry Pi processor is recommended as its camera module is very efficient due to its flex connector, connected directly to the board.
Sound detectors are widely used for monitoring purposes, detecting sounds and acting accordingly. Some can even detect ultra-low levels of noise, and fine tune among various noise levels.
Humidity sensors sense the humidity levels in the air for smart homes. Its accuracy and precision depend on the sensor design and placement. Certain sensors like the DHT22, built for rapid prototyping, will always perform poorly when compared to high-quality sensors like HIH6100. For open spaces, the distribution around the sensor is expected to be uniform requiring fewer corrective actions for the right calibration.
Smart home communication protocols: bluetooth, Wi-Fi, or GSM. Bluetooth smart or low energy wireless protocols with mesh capabilities and data encryption algorithms. Zigbee is mesh networked, low power radio frequency-based protocol for IoT. X10 protocol that utilizes powerline wiring for signaling and control. Insteon, wireless and wireline communication. Z-wave specializes in secured home automation. UPB, uses existing power lines. Thread, a royalty-free protocol for smart home automation. ANT, an ultra-low-power protocol for building low-powered sensors with a mesh distribution capability. The preferred protocols are bluetooth low energy, Z-wave, Zigbee, and thread. Considerations for incorporating a gateway may include: cloud connectivity, supported protocols, customization complexity and prototyping support. Home control is composed of the following: state machine, event bus, service log and timer.
Modularity: enables the bundle concept, runtime dynamics, software components can be managed at runtime, service orientation, manage dependencies among bundles, life cycle layer: controls the life cycle of the bundles, service layers: defines a dynamic model of communication between various modules, actual services: this is the application layer. Security layer: optional, leverages Java 2 security architecture and manages permissions from different modules.
OpenHAB is a framework, combining home automation and IoT gateway for smart homes. Its features: rules engine, logging mechanism and UI abstraction. Automation rules that focus on time, mood, or ambiance, easy configuration, common supported hardware:
Domoticz architecture: very few people know about the architecture of Domoticz, making it extremely difficult to build applications on it without taking unnecessary risks in building the product itself. For example, the entire design of general architecture feels a little weird when you look at the concept of a sensor to control to an actuator. Building advanced applications with Domoticz can be done using OO based languages.
Deployment of blockchain into home networks can easily be done with Raspberry Pi. A blockchain secured layer between devices and gateways can be implemented without a massive revamp of the existing code base. Blockchain is a technology that will play a role in the future to reassure them with revolutionary and new business models like dynamic renting for Airbnb.
We can find in the literature and practical reports, many implementations of various integrations among part of the main three building blocks, smart home, IoT and cloud computing. For example, refer to [12–14]. In this section we outline three implementations, which clearly demonstrate the need and the benefits of interconnecting or integrating all three components, as illustrated in Figure 5. Each component is numbered, 1–6. In the left side, we describe for each implementation, the sequence of messages/commands among components, from left to right and from bottom up. Take for example the third implementation, a control task constantly runing at the home server (2) discovers the fact that all residents left home and automatically, initiates actuators to shut down all IoT appliances (3), then it issues messages to the relevant users/residents, updating them about the situation and the applied actions it took (6).
Advanced smart home implementations chart.
The use of (i) in the implementations explanation, corresponds to the circled numbers in Figure 5.
First step is deploying water sensors under every reasonable potential leak source and an automated master water valve sensor for the whole house, which now means the house is considered as an IoT.
In case the water sensor detects a leak of water (3), it sends an event to the hub (2), which triggers the “turn valve off” application. The home control application then sends a “turn off” command to all IoT (3) appliances defined as sensitive to water stopping and then sends the “turn off” command to the main water valve (1). An update message is sent via the messaging system to these appearing in the notification list (6). This setup helps defending against scenarios where the source of the water is from the house plumbing. The underlying configuration assumes an integration via messages and commands between the smart home and the IoT control system. It demonstrates the dependency and the resulting benefits of combining smart home and IoT.
Most houses already have the typical collection of smoke detectors (1), but there is no bridge to send data from the sensor to a smart home hub. Connecting these sensors to a smart home app (2), enables a comprehensive smoke detection system. It is further expanded to notify the elevator sensor to block the use of it due to fire condition (1), and so, it is even further expanded to any IoT sensor (3), who may be activated due to the detected smoke alert.
In [5] they designed a wireless sensor network for early detection of house fires. They simulated a fire in a smart home using the fire dynamics simulator and a language program. The simulation results showed that the system detects fire early.
Consider the scenario where you leave home while some of the appliances are still on. In case your absence is long enough, some of the appliances may over heat and are about to blowout. To avoid such situations, we connect all IoT appliances’ sensors to the home application (2), so that when all leave home it will automatically adjust all the appliances’ sensors accordingly (3), to avoid damages. Note that the indication of an empty home is generated by the Smart Home application, while the “on” indication of the appliance, is generated by IoT. Hence, this scenario is possible due to the integration between smart home and IoT systems.
In this chapter we described the integration of three loosely coupled components, smart home, Iot, and cloud computing. To orchestrate and timely manage the vast data flow in an efficient and balanced way, utilizing the strengths of each component we propose a centralized real time event processing application.
We describe the advantages and benefits of each standalone component and its possible complements, which may be achieved by integrating it with the other components providing new benefits raised from the whole compound system. Since these components are still at its development stage, the integration among them may change and provide a robust paradigm that generates a new generation of infrastructure and applications.
As we follow-up on the progress of each component and its corresponding impact on the integrated compound, we will constantly consider additional components to be added, resulting with new service models and applications.
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