Madeleine Leiningers Transcultural Nursing Theory - Research Paper Example

? Madeleine Leininger’s Transcultural Nursing Theory Introduction Madeleine was born in July 13 1925 in Sutton, Nebraska in the US. She did her diploma in nursing in Denver, Colorado’s St. Anthony School of Nursing and finished in 1948. She received her B.S. from St. Scholastica’s Benedictine College located in Atchison, Kansas in 1950. Four years later, she earned Masters Degree in Mental and psychiatric health nursing from the Catholic university in Washington D.C. She received her doctorate degree (PhD) in social and cultural anthropology from the University of Washington, Seattle. During her early nursing career, Leininger identified the need and importance of “caring” concept in nursing. She got her motivation from frequent appreciative statements from her patients. This acted as a leeway to her focus on ‘care’ as being an important or central nursing component. She experienced what she termed as a cultural shock during the 1950s while working as a child guide in children’s home. She realized that certain children behavioral patterns appeared to have cultural basis. She also recognized and realized that the missing link to nursing’s comprehension of the several variations necessary in patient care improve and support healing, compliance, as well as, wellness. The insights acted as the beginnings of a phenomenon and construct related to nursing care known as transcultural nursing. Leininger is the founder of the popular transcultural nursing movement in education practice and research. She defined transcultural nursing as a “substantive area of study and practice focused on comparative cultural care values, and practices of individuals or groups of similar or different cultures with the goal of providing culture-specific and universal nursing care practices in promoting health or well-being or to help people face unfavorable human conditions, illness, or death in culturally meaningful ways” (Leininger, 1989). Transcultural nursing handles and addresses the dynamics of culture that affect the client-nurse relationship. Due to its focus in this discrete aspect of nursing, Leininger developed a theory in order to study and explain the results of this kind of nursing care. She named the theory as Theory of Culture Care (Andrews & Boyle, 2008). It emphasizes on the universality and diversity with an aim of providing culturally related and wholistic care (Leininger & McFarland, 2006). The theory is, however, not a grand one since it has certain dimensions to assess for a given picture. It is a comprehensive and wholistic approach, which has given a leeway to a broader and wider nursing than expected with a reductionist and middle-range approach. The theory has a role of providing the required care measures while taking into consideration an individual or patient’s cultural beliefs, values and practices. Leininger came up with and coined the fundamental goal or aim of transcultural practice in nursing. She referred to it as culturally congruent care. It is only possible on the occurrence of the following within the client-nurse relationship: the nurse, together with the client, defines creatively a different or new lifestyle for the well-being or health of the client. This requires the use and application of both professional and generic knowledge and ways in order to fit these diverse and new ideas into nursing practice and goals. Another important and unavoidable aspect of this theory is that knowledge and skills are normally re-patterned for the client’s best interest. This implies that all care modalities and means need co-participation of the client and the nurse. The two have to perform identification, planning, implementation, and evaluation of each mode of caring for culturally congruent or related nursing care. The modes normally stimulate nurses to come up with and design appropriate nursing decisions and actions with the use of the acquired new knowledge, as well as, the culturally based ways to give satisfying and meaningful wholistic care to various individuals, institutions or groups. Gaining more comprehension of the theory requires critical analysis and comprehensions of the assumptions that have been made in the theory (Andrews & Boyle, 2008). Some of these assumptions include: 1).Care is the only essence as well as the fundamental focus in nursing. 2). Culture care is a broad and wholistic to guide or instruct nursing care. 3). the central purpose of nursing is serving human beings in illness, health and in the case of death. 4). Curing cannot be there without issuing and receiving of care. 5). the concept of culture care involves both similar and different aspects among all the cultures of the entire globe. The above assumptions and the defining terms synthesized, a broad description of a culturally competent nurse emerges. Such a nurse has the ability to consciously address the fact that client-nurse exchanges are affected by cultural effects. A culturally competent nurse also has clarity and compassion. She has the ability to enquire from clients about their cultural practices, as well as, their preferences. The nurse also incorporates the personal, environmental, cultural, and social needs and beliefs into a care plan when possible and necessary. Lastly, a culturally competent nurse respects cultural diversity of different clients. Leininger also proposed three modes that guide nurses as they try to practice the theory at the workplace. These are negation and or/ accommodation, restructuring and or/ re-patterning and maintenance and or/ preservation (Leininger, 1989). How the theory can be applied in professional nursing practice As mentioned earlier, Leininger’s theory is very crucial, especially in the nursing training field. Incorporation of knowledge among nursing students in various matriculation institutions is a necessity as it ensures that the future client-nurse relationship is maintained to the best level possible. Just like other health sciences, training of the theory among nursing students takes five important steps (Leininger, 1989): 1) assessment, 2). Diagnosis, 3). Planning, 4). Implementation and 5). Evaluation. These steps are described below: 1. Assessment Assessment or testing of this theory requires a high level of professionalism among nurses in different hospitals and other health centers. Individualized care is done and a detailed assessment of the patient is done immediately. Information is obtained from the patient in a direct and structured means. The information is acquired through interviews, observations, and examinations. In certain cases, especially when the patient is very hill and cannot take part in the interview, the behavior he or she exhibits is recorded. Reports from close family members of the patient are also taken into considerations. The behaviors may be reactions of the patient towards the nurses, for instance, a Muslim patient would be hesitant to remove her clothes during treatment. Other cultural based behaviors of the patient would be his or her observable reactions towards medicinal drugs or injections or x-ray machines. The client’s health history is also taken into considerations. Such historical information includes previous hospitalization, family history, and socio-cultural practices and behaviors. From this, the nurse will come up with both subjective and objective data based on the patient’s observation. An example of subjective information is the perception of the client on the current cultural behaviors. This focuses on a client’s understanding or judgment on certain cultural behaviors. Objective behaviors include the patient’s response to a new cultural environment. In case of interview, the nurse should select a private place, which give the patient enough time and confidence to give all the required details. Nursing Diagnosis This is the continuous or the ongoing nurse phase for the nursing process. As observed from the above, nursing care is always a dynamic process that involves the change in a patient’s health status over a time and it normally leads to the necessity of a new data, modification, and different diagnosis in the care plan. After data collection, the nurse does a comparison on the information received and analyzes the data to come up with an appropriate nursing diagnosis. This is a special nursing problem, which normally includes both the maladaptive and adaptive health responses. Nursing diagnosis of a patient suffering or affected by cultural issues may be of an actual or a potential health problems. One of the mostly used standards in measuring or coming up with the diagnosis is that of NANDA (North American Nursing Diagnosis Association). Nursing diagnostic statement has three parts: 1). the health problems, 2). Contributing factors, and 3). Defining characteristics (Lundy & Janes, 2009). The defining characteristics are important as they provide the necessary indicators for the evaluation of the behavioral outcome. An example is a patient may make a statement like “I will better die than eat such food.” Such a statement implies that the patient is from a cultural background where taking of the food type is not common. Outcome identification of the diagnosis should be done. During the process, the patient should be undergoing treatment and his or her response recorded accurately. The nurse has to view the patient’s problems and the reasons behind them. There are two possible factors that may affect the patient’s unhealthiness; someone else’s behavior or personal feelings. Clarification of goals in behavioral terms is done. The goals should be clear stating what the nurse is planning to attain within a given time span (Sagar, 2011). The result should be distinctive outlining the outcome solution to the problem. Planning After identification of the patient’s problem, diagnosis made, planning care is done with an aim of setting goals, determining priorities, selecting nursing actions and developing or writing the necessary nursing plan (Sagar, 2011).Using analysis, the nurse determines which problems are to be addressed first. The goals are of two distinct categories; long term or short-term goals. For instance, a short-term goal for a patient would be to make him or her talk to or interact with other people from other cultural backgrounds. The long-term goal would be making the patient get used to different cultural practices. Culture shock should be avoided completely in this stage. This is an example of nursing action selection. Recording or writing of nursing goals, actions, and problems is a nursing care plan. Health teaching is also done here to ensure that the client get used to the nurse and is free to reveal to him or her something about his or her health conditions. This is one of the main goals of transcultural theory. Implementation Implementation phase of nursing refers to the actual initiation of the nursing cultural care plan. The patient’s outcome or goals are attained through the nursing intervention performance. The nurse assesses the patient and determines if interventions are efficient and effective. The intervention may be self-care activities and counseling. In order to implement the actions, nurses should have intellectual, technical, or personal skills. The nursing actions are of two types; dependent and independent nursing action. Dependent actions are those that are derived from a counselor or a psychiatrist such as issuance of medicine to the client. Independent action, on the other hand, is mainly based on the nursing diagnosis actions and care plans. It pursues the patient to attend to personal hygiene (Sagar, 2011). Evaluation At this phase, the nurse reviews all the previous nursing process phases in order to determine whether the expected results are achieved or not. In this case, the nurse should determine whether the culture-related problems in the patients were solved. Certain questions may help the nurse in understanding or evaluating her performance. For instance, the nurse should ask herself a question like, have I done everything for my patient? Evaluation also indicates the patient’s problems that have been solved (Sagar, 2011). It needs to be assessed repeatedly, replanted, implemented, and re-evaluated. This way, the patient’s solution would have been solved and any further or future occurrences of the problem prevented. Conclusion As a nursing student, application of this theory requires nurses to have a responsibility to comprehend the role that culture plays in patients’ health. There are several reasons why transcultural theory is a special aspect or unit among nursing students. It is always beneficial for the nurse to use patients’ cultural knowledge to treat them. To begin with, it is necessary in helping strength the commitment of nurse to nursing based on patient-nurse relationships. Besides, the theory also asserts in viewing and studying the whole person rather than viewing the patient in a simple manner using a set of symptoms or illness. Applying cultural knowledge also helps a nurse become open-minded to the treatments that maybe or are normally considered non-traditional in nature. Such treatments include various spirituality-based therapies such as anointing and meditation. Knowledge of one’s cultural background is very necessary, as it enables the nurses understand well the various diversity of cultural practices among the patients. Most health institutions received clients from a range of cultural backgrounds; therefore, the knowledge of the existence and practices of these cultural backgrounds is important among the nursing staff. In addition to the above, not all patients admitted or treated in hospitals suffer from physical complications there are quite a number of patients who have mental problems as the cause of their admission into the institutions. Such patients can be handled professionally by nurses who have detailed comprehension of their cultural backgrounds. The theory, therefore, forms a fundamental part of nursing faculty in all the institutions that offer nursing as a course. All health institutions should be aware of this theory, as well as, its importance in the nursing field. To all students, application of Junelle Hiponia quote is very important to provide a leeway to quality delivery of nursing services. “We must not only rely too heavily on the biophysical explanations but also be virtually aware of how culture can influence nursing and our nursing care” (Lundy & Janes, 2009). Also to note is that the theory when utilized well will enable nurses discover large scale phenomena in a global view, social and cultural dimensions of several cultures. It is thus a challenge to nurses to learn, as well as, adapt with a variety of customers or patients. References Andrews, M. & Boyle, J. (2008).Transcultural concepts in nursing care. Philadelphia: Lippincott williams & wilkins. Leininger, M. (1989). Care, discovery and uses in clinical and community nursing. Detroit: Wayne State University Press. Leininger, M. & McFarland, M. (2006).Culture care diversity and universality: a worldwide nursing theory. New York, NY: Jones & Bartlett Learning. Lundy, K. & Janes, S. (2009). Community health nursing: caring for the public's health. New York, NY: Jones & Barlett Learning. Sagar, P. (2011). Transcultural Nursing Theory and Models: Application in Nursing Education, Practice, and Administration. New York, NY: Springer Publishing Company. Read More