Running head: TRANSCULTURAL NURSING

Theory Evaluation: Leiningers Culture Care Theory of Diversity NURS !"# Theoreti$al %oundations for the &ra$ti$e of Nursing Linda Nga'eduru Co((in State University

Universality

)elen %uld S$hool of Nursing *anuary "#+ "#,-.

TRANSCULTURAL NURSING " Theory Des$ri(tion /adeleine Leininger re$ogni0es the i'(ortan$e of understanding of diverse $ulture for nurses and $lients in relation to (atients $are initiated a trans1$ultural nursing theoreti$al fra'e2or3. The (ur(ose of the theory is to en$ourage the (rovision of $ulturally $o'(ati4le nursing $are of fol3s of varied $ultures+ and the vital (rin$i(le is that it is i'(erative for nurses to 4e a2are of the diverse individuals vie2s of illness 5Alligood To'ey+ "#,#6. In this era of

$ultural and ethni$ diversity+ nurses are re7uired to ad8ust their thin3ing strategies and ada(t to the ra(id $ultural $hanges. This $ould 4e a$$o'(lish through intera$tions 2ith their (atients and in$or(oration of their (atients 4eliefs+ and then deter'ine for a((ro(riate intervention for 4etter out$o'e. The theory also des$ri4es that stresses+ non$o'(lian$e+ $ultural $onfli$ts+ and ethi$al or 'oral $on$erns are seen 2ith (atients do not re$eive nursing $are that is reasona4ly $ongruent 2ith their 4eliefs+ values and 2ay of life. Trans1$ultural nursing and $aring nursing $on$e(ts are ai'ed to2ard $aring+ and the $o'(onents of a $ulture $are theory+ diversity+ universality+ 2orldvie2+ and ethno1history are essential to the four $on$e(ts 5Care+ $aring+ health+ and nursing6. Care+ $ulture+ $ulture $are+ $ulture $are diversity and $ulture $are universality are the 'ain $on$e(ts 5Alligood To'ey+

"#,#6. The $on$e(t of $are is the funda'ental nature of nursing. Culturally 4ased $are as a holisti$ a((roa$h and $ulture $are $on$e(ts of $o''onality and universality should 4e given attention due to our 'ulti$ultural environ'ent and its de'and. Cultural $are is a different 2ay an entity or $o''unity ada(t or learn+ a$7uire to use for i'(rove'ent and fa$ing their daily 2ay of life+ health+ si$3ness+ and even fa$ing death+ should 4e understood in their $are delivery. Caring as having or dis(laying 2ar'th or feeling of $on$ern and e'(athy for others 2as re$ogni0ed as the funda'ental nature of nursing and e9$lusive to nursing 4y Leininger in the 'id ,:;#s and is

TRANSCULTURAL NURSING truly a signifi$ant $on$e(t in nursing (ra$ti$es 5Leininger+ "##!6. She develo(ed this theory to use in the nursing field as a guide for nurses in the future. The $on$e(t re'ained the sa'e throughout the histori$al develo('ent+ and Leininger re(orted that the theory 2as refined for 'any years and resear$h 2as $ondu$ted on 'ore than ,# $ultural grou(s and her 4oo3 listed $ultural values and $ultural $are 'eanings in the'. Culturally Congruent Care $an 4e delivered through three 'odes na'ely: A$$o''odation or negotiation+ (reservation or 'aintenan$e+ and re1(atterning or restru$turing 5Alligood To'ey+ "#,#6. The 'ain (rin$i(le of the theory is to en$ourage nurses to 4e a2are

of a (ersons vie2 of illness. /any s$hools of nursing use Culture Care Diversity and the Universality theory in guiding their 2or3 and resear$h (ro8e$ts. To fa$ilitate $o''uni$ation in delivery of health $are+ it is essential to in$or(orating $ultural sensitive 2hen 7uestioning $lients fro' a diverse grou( a4out their 4eliefs and (ra$ti$es. A su48e$tive res(onse fro' (atients indi$ates that $ulture $are theory is $onsidered dedu$tive 4e$ause $ulturally diverse (atients understand further as regards to ho2 $are hel(ed the' than nurses. The theory illustrates the i'(ortan$e of $aring in the nursing (rofession. The theorys o48e$tive is to (rovide $ulturally har'onious nursing $are of fol3s of differen$e $ultures 5Alligood To'ey+ "#,#6.

The assu'(tions underlying the theory are: Caring is vital to $urative and healing. Caring is the $ore of nursing and the 'a8or+ 2hole fo$al (oint. Caring is vital for develo('ent+ 2elfare+ healthiness+ $ontinued e9isten$e and fa$ing diffi$ulties or death. Nursing is a trans1$ultural hu'anisti$ and syste'i$ $are vo$ation 2ith the (rin$i(le of hel(ing (ersons+ $o''unities+ grou(s+ or institutions glo4al. Culturally fo$used $are is the e9tensive holisti$ resour$es that identify+ $larify+ inter(ret+ and envisage nursing $are (heno'ena+ dire$t nursing de$isions+ and a$tions. Cultural $are $on$e(ts+ e9(ressions+ 'eaning+ (ro$esses+ (atterns+ and stru$tural for's

TRANSCULTURAL NURSING < of $are vary trans1$ulturally 2ith dissi'ilarities and $o''on features. The 2orldvie2+ language+ attitude+ thin3ing+ religion+ s(irituality+ 3inshi(+ the (oliti$al+ so$ial+ legal+ e$ono'i$al+ edu$ational+ environ'ental+ and te$hnologi$al situations of $ultures influen$es $ulture $are 4eliefs+ values and (ra$ti$es. Every $ulture has general $are 3no2ledge and (ra$ti$es 2hi$h vary trans1$ulturally. &ositive+ strong and gratifying $ulturally14ased $are influen$es the health and health of (ersons+ grou(s+ fa'ilies+ and $o''unities inside their e$ologi$al (ers(e$tive. Culturally har'onious nursing $are $an si'(ly o$$ur 2hen an individual+ fa'ily+ a grou(+ and $o''unity language or (atterns are re$ogni0ed and utili0ed o(enly in suita4le and signifi$ant 2ays. Culture $are dissi'ilarity and si'ilarity a'ong health (rofessions+ and $lients e9ist in all individual $ultures 5Alligood To'ey+ "#,#6. Theory Analysis Cultural Care Diversity and Universality theory is used as a theoreti$al stru$ture for resear$h studies+ is un2ra((ed for utili0ation in nursing (ra$ti$e and e9(loration and $an 4e the 'ethodi$al finish (rodu$t that sho2s nursing 3no2ledge. Theories+ (rin$i(les+ $on$e(ts+ and so'e resear$h fa'iliarity of $ultures are 2ith us as in this diverse 2orld. In order to (rovide $o'(rehensive+ holisti$+ and effe$tive interventions dealing 2ith these diversities+ nurses should rely on sound theoreti$al do$trine to $onstru$t and i'(le'ent their (lan of $are. The theory o4viously fo$uses on the $lose relationshi(s of $ulture and $are on health+ 2ell14eing+ illness+ and death. The area of $on$ern in this theory Cultural Care Diversity and Universality is that health and illness are not for'ally defined sin$e there are no universally a$$e(ted definitions for these $on$e(ts. =hat is $onsidered an illness in a $ulture 'ight 4e different for another $ulture+ and the sa'e a((lies in $aring. The usefulness and effe$tiveness of using $are is the essential thesis in

TRANSCULTURAL NURSING ; nursing+ re7uire'ents 'ore resear$h validation. Different $ultures vie2 $are differently+ su$h as ho2 a$u(un$ture 'ar3s on a Ca'4odian or >ietna'ese 'ay 4e inter(reted as a4use in A'eri$an $ulture. The theory did not give any thought to the disease sy'(to's. Studying $ulture does not 'ean 2e $an lin3 to the'? there is a differen$e 4et2een a$tual e9(erien$e and studying $ulture. Culture sho$3 o$$urs in nursing as a dile''a in in$or(orating and ada(ting the $ulture of others. The 'odel has t2o 'a8or signifi$ant $on$e(ts in nursing+ na'ely $ulture and $are+ 2hi$h are easily understood. )er diagra' $learly re(resents the relationshi(s 4et2een the 'any fa$tors involved in individuals+ fa'ilies+ grou(s+ $o''unities+ and institutions 2hi$h are ne$essary for $ulturally $ongruent $are. Leininger has defined the differen$es 4et2een $are+ $ulture and $ulture $are as the 4eliefs and values that allo2 an individual to u(hold 2ell14eing and the su((orting 4ehaviors that i'(rove a $lients $ondition+ 4ut the a$tions+ lifestyles+ languages+ and the i'(li$ation of $are 'ay 4e unusual to different (erson or grou(s+ and 3no2ledge of $ultural diversity is essential to a health (rofessional in order to give suita4le $are to (atients+ fa'ilies and $o''unities. Theory Evaluation Caring as the essen$e of nursing+ as des$ri4ed 4y so'e theorists li3e Leininger+ =atson and @oy3in+ has o$$u(ied an i'(ortant (la$e in nursing literature. The Theory of Culture Care Diversity and Universality has gras(ed the nurses thin3ing as the 'a8or trans1$ultural theory i'(le'ent glo4ally and is dee(ly in$reasing fro' 'ainly one $ultural to a 'ulti$ultural holisti$ and relative (ers(e$tive. Caring is $ru$ial to re'edial and $urative+ for there $annot 4e $uring 2ithout $aring. In order for a $lient to 4e $oo(erative+ $o'(liant and satisfied 2ith nursing $are+ the (rofessional has to listen to the $lient to dis$over and study a4out the $lients 4eliefs of 2ellness and disease. The (rovision of language line or a language inter(reter to a (atient 2ith a

TRANSCULTURAL NURSING ! language 4arrier+ in order to understand and in$or(orate the $lients values or 4eliefs a4out their $are+ 2ill 'a3e the (atient $o'(ly 2ith their treat'ent (lans+ as they 2ill (er$eive their $are (rovider as $aring. The ter'inology and definitions are $onsistent throughout the 'odel 2ith the $ulturally $ongruent $are 4eing the goal. All the $on$e(ts in the theory either dire$tly or indire$tly is 2ithin the $lini$al nursing (ra$ti$es of various $ultures+ and the overall goal re'ains $lear. Leininger did not su((ort all of the four 'eta1(aradig' $on$e(ts of environ'ent+ health+ (erson+ and nursing. She e9(lained the ter' A(ersonB as too li'ited+ in that the $on$e(t of a (erson is not (resent in all $ulture. She e9(lained that so'e nurses use A(ersonB to refer to fa'ilies+ grou(s+ and $o''unities+ 4e$ause 2hen nurses $are for fa'ilies+ it is rather dissi'ilar fro' $aring for an individual. In the $ase of health+ Leininger e9(lains that the $on$e(t of AhealthB has the (otential of e9(laining nursing+ 4ut it is not se(arate fro' nursing 4e$ause various dis$i(lines use this sa'e ter'+ AhealthB 5Leininger+ "##!6. The Aenviron'entB $on$e(t she des$ri4ed as environ'ental $ir$u'stan$es+ 2hi$h in$lude 'eaningful events and e9(lanations offered to the' e9a$tly so$io(oliti$al+ (hysi$al+ environ'ental+ and $ultural settings 5Leininger+ "##!6. Studies have sho2n that Culture Care Diversity and Universality theory has 4een the 'ain i'(ortant advan$e in the nursing and health field in the "#th $entury and in the future 5Leininger+ "##!6. A des$ri(tive non1resear$h e9a'(le is the health $are of a *ehovahs =itness $lient 2ho does not re$eive a 4lood transfusion. The $lients religious o4servan$e has to 4e res(e$ted and in$or(orated into their $are+ and it is i'(erative that the $lients $are (rovider has the 3no2ledge of 2ays to a$7uire su$h infor'ation fro' the $lient? this has to start during initial $onta$t 2ith $lients.

TRANSCULTURAL NURSING C The A((li$ation of Theory Cultural Care Diversity and Universality e'(hasi0es 'ore on the different individuals $ultural 4a$3grounds and des$ri4es ho2 $ulture 4e$o'es an i'(ortant (art of a (ersons health a$tivities. It 4e$o'es a signifi$ant theory to 4e in$luded in a (atient $are (lanning. %or fa'ily assess'ent+ the theory serves as a guide and 4asis in evaluating the different fa$tors that need to 4e assessed in the fa'ily. The nurse should in$or(orate fa'ily $ultural 4a$3grounds 4y doing $ultural and 4a$3ground intervie2s of the fa'ily+ in$or(orate fa'ily health 4eliefs+ health (atterns and (ra$ti$es and deter'ine a((ro(riate health $are intervention for the (atient. It is only 2hen the health $are (rofessional listens to the (atients fa'ily that he or she 2ill o4tain vital infor'ation a4out the 4eliefs+ and health $are (ra$ti$es of a (atient 2ho is una4le to s(ea3 or suffering fro' de'entia. An e9a'(le is in the $are of an Ethio(ian (atient 2ith ter'inal illness? the health $are (rofessional has to tal3 to the (atients fa'ily s(o3es(erson a4out the illness and not dire$tly to the (atient. =ith res(e$t to $o''unity health+ the gro2ing need for (ra$ti$al a((li$ation $an 4e a((lied in hos(itals+ $lini$s or $o''unity $enters. Dne e9a'(le is gay (arents? their o(inions should 4e res(e$ted+ and they should 4e addressed a((ro(riately. A((li$ation of good thera(euti$ $o''uni$ation is vital 2hen $aring for the $hildE$hildren or fa'ily 'e'4ers of gay (arents? a((ro(riately addressing their roles is vital in their $are. /any s$hools of nursing+ graduate students+ and s$holars have used the 'odel as a 4asis for resear$h and to guide their 2or3. The develo('ent of the sunrise 'odel and the ethno1 nursing resear$h 'ethod designed to fit the theory has 4een used to dis$over lots of ne2 $ultural $are data 5Alligood To'ey+ "#,#6. The theory 'ay involve $urrent or future resear$h ideas.

The first theory that $on$entrated on e'i$+ eti$ $ulture $are+ and fa$ts lin3ed to 2orldvie2

TRANSCULTURAL NURSING F $o''on stru$tural features and (eo(le $ulture in diverse environ'ental $onte9ts. The theory has three 'odes for delivering $ulturally $ongruent $are. The theory has (rovided nurses 2ith a sense of dire$tion+ ho(e+ and $onfiden$e and 'ade nurses to refle$t a4out the 'ost $o'(ound and hard (heno'ena of individual $ultural $aring.

TRANSCULTURAL NURSING : Referen$es Alligood+ /. R.+ To'ey+ A. /. 5"#,#6. Nursing theorists and their work 5Cth ed.6. /aryland

)eights+ /issouri: /os4yEElseiver In$. Leininger+ /. /.+ /$%arland+ /. R 5Eds6. 5"##!6. Culture care diversity and universality: a @artlett.

worldwide theory of nursing 5"nd ed.6. Sud4ury+ /A: *ones