Nursing Theorist: Madeleine Leininger - Coursework Example

Nursing theorist: Madeleine Leininger al affiliation There are several nursing theories that have been developed to improve on the nursing profession. They are an organized set of logical concepts, definitions, relationships, that are derived from other fields and models to display a purposive, systematic view of phenomena in nursing. These theories describe and predict the nursing phenomena, and provide a foundation to generate further research. Madeleine Leininger developed the Theory of Culture Care: Diversity and Universality which began in the 1950s with the goal to provide holistic care that is culturally congruent. The development of this cultural theory is to provide nursing care that is culturally congruent through cognitively based assistive, facilitative, supportive or enabling acts or decisions that are made to fit an individual’s , group’s or institution’s cultural values, beliefs and ways. Culture is defined as learned, shared and transmitted values, beliefs, norms and of a specific individual that guide their thoughts and decisions. Diversity in culture care refers to differences in meanings, values and acceptable norms of care within different groups of people, while culture care universality refers to common care that are evident among a variety of cultures. It was developed as a result of nursing experience and creative thinking. The theory was created due to the missing link between in knowledge and practice in nursing. This concept was developed from the anthropological and nursing aspect. Leininger holds that cultural care provides the broadest means to explain, study and predict the nursing knowledge. If nurses understand the meaning of care, patterns, and processes it is possible to predict the health and the wellbeing of a patient which can have effect on the outcome. According to (Leininger, 1995) transcultural nursing is aimed to promote health and well-being of people who face unfavorable human conditions and illnesses that are based on cultural ways. This practice addresses the cultural dynamics that influence the relationship between nurse and client. This theory requires the participation of both the nurse and the patients working together to identify, plan, implement and evaluate each caring mode for congruent nursing care. In order to integrate diverse ideas into nursing care and goals, generic and professional knowledge is required. Knowledge of care and skill are changed for the interest of the care. This theory was developed due to the need to establish culture based care in nursing as a discipline and profession. Care and culture phenomena had been limitedly studied and valued in nursing education and practice. In the world of a rapid multicultural diversification, nurses needed trans-cultural nursing knowledge to function effectively (Leininger, 1995). The theorist had to get nurses to focus on trans-cultural caring as nursing’s unique and distinguished contribution to society by talking and writing about the need for care to be explicated in research and practice. So as to establish a valid and meaningful field of transcultural nursing, a theory related to culture and care had to be developed and used in nursing. In addition, nurses also had to overcome cultural ignorance and racism in their practice (Leininger, 1988). The key components of the theory are basic components towards provision of care that is culturally congruent to meet the healthcare needs of diverse individuals. The key components of culturally congruent care, care diversities, care universalities, social structure, cultural care repositioning, cultural care accommodation, cultural care preservation, and generic and professional care factors. Care diversity and universality is an important principle whereby it is affirmation that caring practices can be unique and specific to a particular culture or shared across many cultures. Care diversities are practices that are practiced in a different way from one cultural group to another and those that are shared among different cultures are referred as care universalities. Therefore caring practices between cultures need to be understood so as to provide appropriate cultural nursing care. In transcultural nursing, the cultural background of a patient is considered by assessing the patient so as to make a nursing care plan based on culture. Taking into account the experiences of care and how they are influenced by a person’s view of the world and the social structures such as language, family, social relations, educational attainment and environmental contexts of cultures within the individual’s life is the second key principle of Leininger’s theory. People’s outlook of life is derived from the cultural experience of an individual of which values, beliefs and behaviors are embedded. Identification of differences in generic or lay approaches to caring and the professional care delivered to patients by nurses is the third key principle. Acquisition of these practices is through learning different cultures and is used to enable and support individuals to resolve health problems. In cultural approach, the practice is not acquired through formal evidence based conceptualizations since patients may be subjected to care that does not acknowledge the importance of caring beliefs, values and practices of which consequences could lead to cultural conflict. The final principle is the modes and actions of trans-cultural care. Three approaches and nursing care are applied so as to assist nurses provide care that is culturally oriented. The mode of nursing care and action concerned with safeguarding and maintaining the core of the patient’s cultural care values, beliefs and expectations within the relationship between the nurse and the patient is referred to as cultural care preservation and maintenance. Culture care re-patterning and restructuring is the mode concerned with facilitating opportunities for patients to change and improve their deteriorating health lifestyle while valuing the cultural beliefs, values and expectations of the patient in relation to care and health. Development of innovative and flexible interventions for nursing assists patients from different cultural backgrounds to adapt to and negotiate their way through the complexities of healthcare delivery and recovery is culture care accommodation. The theorist holds that the theory is not a grand theory because it has particular dimensions to assess for a total picture. Grand theories present concepts in general view and give the broadest scope therefore have a limited use for guiding, enlightening and predicting situations in nursing. Some scholars classify this theory as a mid-range nursing theory since it presents concepts and propositions at a lower concept level. It is a wholistic and comprehensive approach which has led to broader application in the nursing practice than what is expected in middle-range approach. Leininger’s theory is also a meta-theory where she suggests that care is the essence of nursing is universal across all network. The theory has helped researchers generate cultural related knowledge. The new ways of learning different ways of trans-culturally is by discovering the epistemic and ontological dimensions by qualitative paradigm. Cultural conflicts, non-compliance, ethical and moral concerns are a result of failed nursing care that is congruent to beliefs and culture. There are several assumptions in relation to the theory. These are care is a distinct and unifying focus, the essence of nursing and essential for wellbeing and health of individuals. The holistic means by which a nurse can know and explain using interpretive means is known as culture care and values and beliefs are influenced in the context of a particular culture. It also assumes that nursing is a scientific transcultural care as professional to serve humanities worldwide. A satisfying culture based care is beneficial and healthy and contributes to the wellbeing of the patients. When community values, beliefs and cultures are known, thats when the culture is congruent. The components of culturally assessment are personal information about the sex, occupation, age, occupation, socioeconomic status, communication and language, relationships between persons, appearance, use of space and dress. Leininger theory is useful to persons with vulnerability to specific conditions or disease particularly immigrants, refugees and temporary residents. Health care among this group of people is complicated by diversity in languages, health practices and food choices. These specific conditions need an individual approach so that the conditions are treated from the patient’s response to life stressors and the effects of the response to the condition. This theory is valuable in nursing care because it is based on the interpersonal relationship between the client and the nurse. It has been proven that communication with patients from diverse linguistic and cultural backgrounds is difficult. It has been recommended that access to appropriate linguistic services should be prioritized, increasing nurses’ understanding of legal issues within patient encounters, providing nurses with support from health care workers, supporting nurses to translate their awareness into acceptance of cultural diversity, and appreciation and commitment to culturally diverse patients and their families (Cioffi, 2003). In the nursing practice, Culture Care theory is recommended to examine the issue of racism as a relevant framework for enhancing cultural competence and diversity especially since the American society has become increasingly diverse while the nursing profession remains static (Lancellotti, 2008). For instance, a study done on a focus group of African-American women showed that adverse birth outcomes were due to experiences of racism. The women were diverse socio-economically and of childbearing age reported experiences throughout their childhood experiences and were having persistent effects. They also reported racism directly in relation to their children, in interpersonal and institutional forms, across different domains of life, with active and passive responses and with pervasive vigilance (Nuru-Jeter, Dominguez, Hammond, Leu, Skaff, Egerter, Jones & Braveman, 2009). The theory has led to inquiry of the existing knowledge of culture based care from disparate studies to find important content and gaps. (Leininger, 1988) realized that culture based care was under researched. Further development could be done by strategies that integrate and preserve theoretical integrity and strengthen research approaches associated with different philosophical perspectives. This could be done through combining findings from diverse research, integrative reviews and mixed methods of studies. Scholarly nurses are urged to consider the benefits and limitations of this theory and the theoretical needs of culture based health care (Weaver and Olson, 2006) Studies show that the limitation of this theory is that most literature focuses on the cognitive aspects of culture and recommends learning the culture of the specific groups which is assumed to apply to everyone which can lead to stereotyping and lead to failure to identify the needs of the individual receiving care. This is when the approach to culture is focused on the values beliefs and traditions of a particular group. It is advisable that to focus on a social position to explain the health status rather than on individual behavior and beliefs so that health care professionals can incorporate culture within a wider, structural framework. It involves recognizing the impact of relationships of indigenous and non-indigenous people on health care (Williamson & Harrison, 2010). In addition, current approaches to cultural education have been embedded in traditional anthropology which are obsolete and fail to acknowledge the global environment that impacts to cultures that are most remote and isolated. Therefore, new transformative approaches to cultural education are need. Despite the increased emphasis on cultural education in nursing, problems that are culturally based still persist as disparities in health, eneven distribution of health care and insufficient knowledge and sensitivity when caring for patients in another culture. In this regard, students should be encouraged to be vulnerable to personal change when interacting with people from other cultures since transformative education is more about personal growth as it about enhanced care of others. The modernized cultural approach should go beyond adaptation care from dominant culture of the health care delivery system to culture of the patient (Duffy, 2002) In nursing education, communication, collaboration, application, reflection and evaluation are key concepts of a clinical model of supervision that will address the pre-existing theory and practice gap in nursing education through an attitude of caring and the utilization of caring behavior based on the Leininger’s theory of culture care. Clinical supervision is a vital component of nursing education therefore providing students with an opportunity to develop personal identity, knowledge base and the ability to transfer classroom knowledge to a clinical setting (Baxter, 2007). Through Leininger’s theory, as practitioner, I can be able to provide a culturally congruent holistic care to patients from different cultural backgrounds. In this manner, I can be able to assist, facilitate, support and make decisions that can fit different cultures. I will be able to promote health and the wellbeing of patients who suffer unfavorable conditions based on their cultural ways. This theory will improve my relationship with clients so as to identify, plan and implement every caring mode. This theory has enables me overcome a cultural ignorance and to develop an open mind towards cultural diversity and ensure health care suitable to every one of them. The theory will enable me to aware of how the patient’s culture provides resources on health and illness. It has helped me to understand and respect diversity. This theory has shed light to care diversity and universality whereby some caring practices can be unique and specific to particular culture or shared among different cultures. People’s outlook that are derived from cultural experience also have an impact to the health care of an individual. With this theory, I have come to learn different cultures so that I can be able to support clients and resolve health problems. The modes of transcultural care, that is Culture preservation and maintenance, culture care re-patterning, and culture care accommodation will assist me provide culturally oriented care. This theory will enable me provide individual care to people who are vulnerable to certain conditions such as immigrants, refugees and temporary residents. The theory has enabled me strengthen my commitment in nursing on the foundation of emphasis on a person and my relationship with the patient instead of the symptoms and illness. There is still need to conduct further research in culture based care. Additional nursing research is required to promote trans-cultural nursing. Leininger provided a basis for further research in trans-cultural care not only in nursing but other disciplines of health care. I am motivated to create awareness among other health care professionals on the need of culture based care so as to improve the patients health. The knowledge acquired will enable nurses appreciate differences in cultural differences in values, beliefs and customs. This theory is applicable to me since I have been able to adapt to different environment while having interactions with people in various forms of media in terms of being open minded to meditation which is a form of treatment in some ethnic groups. Basics and advanced research studies are being globally researched and done by and tested. There is an elevated increase in clients who are funding to continue research in culture based care. Trans-cultural nursing will enhance theoretical development that will recognize constructs that are specific to culture and universal. Knowledge of the cultural background of the patient will enable me heighten the awareness with own beliefs, morals and prejudice. This will help me develop an understanding and appreciate diversity of the values and beliefs of the patient. It will help me strengthen my commitment to nursing that is centered around creating relationship with the client emphasizing care on the person. However, this theory can lead to cause of error in making clinical decisions due to misinterpretation and stereotyping of the patient’s culture. There will also be signs of nursing care practices that are less efficacious if the nurse does not recognize the culture of the patients and therefore will result to poor health outcomes. Adapting and integrating the theory in a practical model will also be difficult since some nurses may experience cultural shock. Moreover, the framework is also limited to few applications and inappropriateness could result from healthcare strategies based on cultural framework could be developed. In conclusion, identifying the difference in cultural beliefs, values and traditions will strengthen the commitment to relationship centered medicine that emphasizes care of the suffering person. It is important that nurses should be sensitive to the cultural background of their patients in the current healthcare system. This is because culture is an essential part of an individual therefore affecting health, in addition to their response to treatment and care. Nurses can therefore create a nursing plan that will contribute to a faster healing process after looking at how a patient’s cultural background is related to their health. Reference Baxter, P., (2007). The CCARE model of clinical supervision: Bridging the theory-practice gap. Nurse Education in Practice. 7 (2); 103-111. Cioffi, R. N. J. (2003). Communicating with culturally and linguistically diverse patients in an acute care setting: nurses’ experiences. International Journal of Nursing Studies. 40 (3); 299-306. Duffy, M.E. (2002). A critique of cultural education in nursing. Journal of Advanced Nursing. 36 (4); 487-495. Lancellotti, K., (2008). Culture Care Theory: A framework for Expanding Awareness of Diversity and Racism in Nursing Education. Journal of Professional Nursing, 24 (3); 179-183. Leininger, M., (1988). Leininger’s Theory of Nursing: Cultural Care Diversity and Universality. Nursing Science Quarterly, 1(4); 152-160. Leininger, M. (1996). Culture Care Theory, Research, and Practice. Nursing Science Quarterly, 9(2); 71-78. Leininger, M. (1997). Overview of the Theory of Culture Care with the Ethnonursing Research Method. Journal of Transcultural Nursing, 8(2): 32-52. Leininger, M. M., & National League for Nursing. (2001). Culture care diversity and universality: A theory of nursing. Boston: Jones and Bartlett Publishers. Nuru-Jeter, A., Dominguez, T. P., Hammond, W. P., Leu, J., Skaff, M., Egerter, S., Jones, C. P., Braveman, P. (2008). “It’s The Skin You’re In”: African-American Women Talk About Their Experinces of Racism. An Exploratory Study to Develop Measures of Racism for Birth Outcome Studies. Maternal and Child Health Journal, 13(1): 29-39. Weaver, K., & Olson, J. K. (2006). Understanding paradigms used for nursing research. Journal of Advanced Nursing, 53(4); 459-69. Williamson, M., Harrison, L., (2010). Providing culturally appropriate care: A literature review. International Journal of Nursing Studies, 47(6); 761-69. Read More