Transcultural nursing has been incorporated into the nursing discipline and practice due to the increasing diversification of patient populations utilizing wellness programs including hospitals and clinics. Nurses need to be cognizant of the confrontations and differences he/she may face and render nursing care appropriately. Being mindful of the patient’s cultural beliefs and preferences play a critical role in understanding the patient’s view or how he/she will respond to treatment. If the patient’s nursing care plan and therapy options are not within the parameters of his or her cultural values and recovery, progress can be deferred, or condition may worsen. Leininger’s theory rationalizes and anticipates the correlation between a nurse’s ability to understand his or her own cultural beliefs and how to make use of the knowledge to become a better nurse in rendering holistic cultural care. Prudent nurses are receptive and research knowledge and information relevant to the ethnic variations in his/her when conducting assessments to render holistic care.
Madeleine Leininger’s Transcultural Nursing Theory or Culture Care Theory hypothesizes that human care is what makes people mortal, feeling a sense of accomplishment, and feeling healthy. She believes in helping others and “there can be no curing without caring, but caring can exist without curing” (Leininger, 1984; Leininger & McFarland, 2002). Leininger’s theory stresses the culture-based factors and describes how cultural experience may have a candid influence on each person’s perception of health, healing, illness, and death. Her theory explains how the nurse knowing and understanding diverse cultural needs in order to provide effective healing, comprehensive, and holistic nursing care to all ethnic groups. Each individual perceives health and wellness in a different aspect compared to the next. These convictions and practices straightforwardly link to his/her culture. Patients who feel his/her values or beliefs are disregarded or set aside, may decline or postpone care or may hold back important information. Together the nurse and the patient can create or change the plan of care that is directed towards the needs of the patient and avoid labeling an individual based on race or ethnicity. Cultural competence enables nurses to understand beyond the medical conditions and be able to provide high-quality effective care regardless of culture. Often time nurses do not realize the small things can make a big difference in the patient’s care. The purpose of this theory is considered a strength because it describes what is faced with nursing today. Nurses do not always encounter patient’s that have the same insights regarding health and illness. There may be disagreements and sometimes feelings get hurt. However, in nursing setting aside differences, setting mutual goals, and empowering the patient will make working much easier. Both the patient and nurse will be more culturally aware of each other’s cultural view. It never hurts to have more knowledge.
Level of the Theory
The Transcultural theory is a middle-range theory because it focuses on race, ethnicity, and culture. McEwen and Wills (2014) describes middle-range theories that are specific, encompasses a limited number of concepts, and aspect of the real world. Leininger’s sunrise model illustrates the transcultural dimensions of cultural assessments and therapies (McEwen & Wills, 2014, p. 233). Many graduate students and scholars have used Leininger’s theory as a ground for research. One group adopted her theory and examined the health beliefs of Latin subgroups exclusively related to Diabetes Mellitus type 2 (McEwen ; Wills, 2014, p. 233). Other strengths of the theory are clear-cut, and testable hypotheses can be obtained.
The origin of Culture Care Theory blossomed with Leininger’s own interest. She believed God created everyone to be healthy and contribute to love and help others. Her vast clinical professional experiences, intelligence, spiritual awareness, and academic interest are a key component in the development of theory. Is this a strength or a weakness because her theory was developed partly on the basis of spiritual awareness, and she believes God created everyone to be healthy (Leininger & McFarland, 2002). For cultural congruent views and understanding, many people may not believe in God and will argue some other being to be a higher power. Leininger’s theory is strong because providing culturally sensitive care is a positive outcome for patients because it is his/her views and can relate to, rather than the nurse pushing beliefs onto them.
The key concepts of the model are culture, culture care, culture care diversities, and similarities relevant to transcultural human care (McEwen ; Wills, 2014, p. 233). Other notions are health and illness are perceived differently by all based on individual viewpoints, social class, and ways of handling situations; different approaches to identifying the problem, curing, and care, including folk, and western medical interventions may be required for treatment of illness; and for a nurse to effectively deliver care for a patient of a different background other than their own, effective intercultural connection must take place (Transcultural Nursing, n.d.). For a nurse to provide sensitive culture care, he/she must process and use these concepts. “Cultural competence is defined as a combination of practice viewpoints, congruent behaviors, and guidelines that allows nurses to provide great care in cross-cultural situations” (Leininger ; McFarland, 2002, p. 78). Nurses must evaluate his/her own beliefs and be willing to learn and respect another individual’s moral. These concepts are strengths of this theory because not being aware of cultural health differences can be a major block to helping a patient. Cultural knowledge and experience can assist the nurse to finding the right medium may be the perfect fit for delivering the best treatment.
The major theoretical propositions behind the Culture Care Theory are culture care maintenance, culture care accommodation, and cultural restructuring (McEwen & Wills, 2014, p.233). Culture care maintenance help individuals use cultural core values to view health related issues and supports cultural interventions. Culture care accommodation is adjusting interventions and treatment that can be viewed congruent to the patient’s cultural values and beliefs. Cultural care restructuring is actions taken by culturally competent nurses that support and encourage the patient to transform health behaviors towards beneficial outcomes while respecting his/her cultural values (Leininger ; McFarland, 2002). If patients are able to partake in his/her own care and have a choice in their health-related targets, plans, and interventions, patient’s outcome will improve as a result of their change. That would be considered a strength.
The major theoretical propositions led to a formation of some theoretical assumptions specific to their domain of inquiry in both Western and non-Western cultures listed below (Leininger & McFarland, 2002):
1. “Care is the essence of nursing and a distinct, dominant, central, and unifying focus.” (Leininger, 2002, p. 192)
2. Culture care requires the nurse/researcher to discover and explain, health, illness, treatment, and human conditions.
3. Culture care expressions, meanings, and structural forms are unique but they all have some shared commonalities.
4. Congruent care and interventions are possible if beliefs and practices are explicitly made upfront.
5. Qualitative research methods present essential data to discover the relationships between the domains.
6. Transcultural knowledge practices to provide culturally competent care to all regardless of ethnic background and beliefs.
Leininger’s transcultural nursing theory defines cultural competence as a humanistic and scientific learned profession. As the nurse evaluates his/her own beliefs and customs and not take part in ethnocentrism, he/she will be able to openly view and accept their patient’s views and practices of health and illness. Together the nurse and the patient can create a unique, culturally sensitive plan of care that will facilitate the patient to engage in their health in a meaningful way without disrupting their beliefs. This would be considered a strength of the theory because of both nurse and patient aim toward the same goal for the patient.
Context for Use
The context for use and nursing implications are described to impart culturally compatible nursing care to persons of diverse ethnicities. It is vital for the nurse to understand the patient’s view of illness and his/her focus on distinguishing and understanding the parallels and differences to positively influence nursing care and health. Culture care that is not culturally sensitive has equated to augmented health care expenses and decreased compliance by patients. Individuals tend to be non-compliant if his/her culture needs are ignored or not met. Overall, nursing is aimed at providing cost-effective, high-quality care and Leininger’s Transcultural Nursing Theory play a key role for nurses in any setting who work with patients, families, and groups from a cultural background unlike the nurse’s (McEwen ; Wills, 2014, p.233).
Cultural awareness provides understanding why or how cultural views, beliefs, or rituals impact a patient’s perception of health, illness, suffering, and end of life. This also strengthens a nurse’s role and care to his/her patient’s. Leininger’s theory helps nurses understand a patient’s view in regard to his/her health to create a plan of care culturally sensitive to his or her ethnic background. There is a consistent approach to culturally based care by requiring nurses to exercise cultural knowledge when deciding nursing care. Culture care theory is the groundwork and nurses are the front-runners in providing culturally competent care. Nurses are equipped with Leininger’s tools and directions, all set to meet the forthcoming demands for culturally sensitive care.
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