This nursing theory paper defines Madeleine M. Leininger’s theory of Transcultural care diversity and universality. She was born in Sutton, Nebraska 1948. Leininger (1978) introduced concept of transcultural nursing and developed culture care theory to explain cultural competency. Her book Culture Care Diversity and Universality: A theory of Nursing was published in 1991. Today nurses are faced with unprecedented cultural diversity because of the increasing number of immigrants and refugees. Culturally competent nursing guides the nurse to provide optimal holistic, culturally based care. Transcultural theory focuses on culture as an important component of human care. The main goal of Leininger theory is to understand the influence of culture on health and illness. This Transcultural theory paper will discuss the cultural dynamics that influence the nurse patient relationship.
Basic concept of Transcultural Theory.
Leininger’s theory of Transcultural care diversity and universality is the theory focusing on transcultural diversity. Nursing is a learned profession focused on care phenomena. His theory is also known as ‘Culture Care theory’. Care is the core of nursing. Culture care theory is the only nursing theory that focuses on culture (Rosenbaum 1997). Increasing number of multicultural population globally has made the nurse to be culturally competent. This can only occur when client’s beliefs and values are thoroughly and skillfully incorporated into nursing plans. Leininger realized that human care was an important aspect of nursing that helped people to maintain health and recover from illness ( Leininger, 1991, p.7). Leininger believes that nursing is essentially a transcultural care phenomenon and lived experience, the uniqueness of which centers on providing human care to people in a way that is meaningful, congruent, and respectful of cultural values and lifestyles.
Description of Nursing Activity.
Before 1950, in nursing two important components were missing, the culture and care.Transcultural nursing is a comparative study of cultures to understand similarities (culture universal) and difference (culture-specific) across human groups (Leininger, 1991). Nurse should be culturally competent in providing holistic care to patient. The sunrise model created by (Leininger, 1997) explains the inter relationships between culture care diversity and universality theory. The sunrise theory includes the enabler which provides guideline map that helps nurses for systemic study of all dimensions of the theory. The sunrise enabler symbolizes the rising of the sun (Care). the main elements in upper half of the sunrise enabler are cultural care world view, cultural and social structure dimensions that influence health care through language, ethno history and environmental factors, these in turn also influence the professional nursing system. The next two halves represent the universe that nurses should respect to appreciate human care. According to Leininger nursing acts like a bridge between generic and professional system.
Culturally Congruent Care
Leininger (1991) identified three major modes to guide nursing decisions, judgments, or actions to provide culturally congruent care to clients.
1. Cultural preservation or maintenance refers to upholding particular group’s values, practices, and beliefs that are learned and shared by client to maintain, improve health condition, and face disability or death.
2. Cultural care accommodation or negotiation refers to those actions and decisions that help people of a designated culture to conform oneself or negotiate with professional care provider for beneficial or satisfying health outcomes.
3. Cultural care repatterning or restructuring refers to professional actions and decisions that help the clients to change or modify their life styles to new environment for more beneficial or healthier life ways than before and still respecting the client’s beliefs and cultural practices.
Acquiring knowledge and understanding of Transcultural model.
The cultural phenomena by (Giger and Davidhizer, 1995) focus on six distinct domains.
1. Communication: Culture greatly influences both verbal and non verbal expression of an individual. Verbal expression like language plays a major role, the nurse should keep in mind the variety of language spoken and respect them. Non verbal interaction such as body posture, use of touch, eye contact, facial expression can change the meaning of communication like in America avoiding eye contact may be viewed as untrustworthy, where as in many Asian culture it is considered as disrespectful. Touch may be viewed as healing in some culture, but may also be believed as serious insult by South East Asians.
2. Space and distance: some individuals tends to maintain space close or far, some feel closeness is expression of care, at same time others feel like taking their space.
3. Time and punctuality: Concept of time can affect the communication of nurse and the patient. In United States (US) culture time and promptness are important. Whereas the Hispanic people consider time in wider frame.
4. Biological variations: the knowledge of growth and development helps the nursing assessment. In some cultures like Indian, Asian, Latino they believe illness is due to imbalance in body. And health can be maintained by correcting this imbalance. Nurse should keep in mind various other factors like the use of herbal supplements, values, beliefs, dietary preferences that influence health and well being.
5. Environmental variations: There are cultures who still believe in folk medicine system. They focus on natural phenomena and body. The western medical system gives importance to health prevention and curative medicine. Health education in non judgmental way by upholding one’s culture is essential.
6. Social organization: Culture is passed on from one generation to another by families, groups and tribal. They provide a platform for individual development. Nurses must provide education and involve the families, multigenerational relatives, adults and children in care of patient.
Importance and uses of Transcultural / Culture care theory.
The main purpose of this theory is to identify cultural based factors that influence health, illness, death and well being of clients and groups.
‘ This theory provides culturally congruent and safe care to clients with diverse culture.
‘ In global research provides knowledge of present and future practices.
‘ Helps to identify patient’s beliefs on health and illness and their values.
‘ Culture care theory is very flexible and globally used, and can be applied in all practical clinical settings.
‘ Helps for self assessment and knowledge build.
‘ Transcultural theory is important for the nurses to follow cultural aspects between the co-workers to continue good inter-personal relationship.
‘ Provides theoretical foundations to all nurses for culturally congruent and competent care to all age groups, families and communities.
‘ Transcultural nursing approach gives holistic care to patient by including physical, social, psychological, spiritual and emotional needs of patient.
Example of dominant care and beliefs. (Indian Culture):
I am an Indian nurse working in United States for past five years. I work in medical surgical and orthopedic unit. I had a Indian patient middle aged man with dehydration and weakness. When I went to patient’s room the patient was upset, depressed with the dinner on the table not touched. In Indian culture the males are dominant and the left hand is believed to be used for toileting purpose. We use right hand for any work, especially while administering food and water. The patient here being male dominant felt insulted when the dietary person delivered the food in left hand. The patient said this food is unclean; I do not want to eat. This may look a small matter of handling, but patient’s cultural beliefs were not respected. I had to reorder food, make him comfortable. Then I addressed this issue to our nurse manager regarding cultural education to all Para medical workers who involve in patient care directly or indirectly. Now in our hospital more focus is given on cultural base during orientation. As a nurse this theory helps me to improve the nurse- patient relationship by understanding their cultural practices and respecting the same.
Increasing number of multicultural population has challenged the nurses to be culturally competent. Religious beliefs and practices greatly influence health and illness. Leininger’s transcultural theory focuses on culture as an important component of health. ‘Clearly nurses without preparation in transcultural nursing would be greatly handicapped when working with people of diverse culture’ (Leininger, 1991). The main concepts of Leininger’s theory are culture, cultural values, cultural diverse, cultural congruence and ethnocentrism. The sunrise model helps the nurse for systematic study of the culture care theory. Transcultural theory is also important for self evaluation and to follow cultural aspects between co-workers to continue good inter personal relationship. Transcultural theory is flexible and can be globally used in any clinical settings to provide optimal holistic and culturally based care.