Nursing Theory Analysis Paper
Many researchers globally have researched on the discipline of nursing and developed some theories aimed at explaining some health care phenomenon. Theories of nursing play a critical role in influencing the outcome of different areas of practice including research, education, administration, and nursing informatics. Nursing theories fall under the mid-range theory or grand theory classifications. The analysis below discusses the theory of Transcultural Nursing by Madeleine Leininger that falls under the mid-range category of nursing theories.
Analysis of the Transcultural Nursing Theory
Background
Leininger is well-recognized psychiatric and mental health professionals of the 1950s. Earned her first diploma in nursing in 1948, advanced to a B.S. in 1950 and later continue her higher learning education in psychiatric and mental health masters in 1965 and a Ph.D. in cultural and social anthropology. According to Sitzman & Eichelberger (2011), Leininger worked in a child guidance home where she realized the importance of promoting care across diverse populations. She experienced a cultural shock during her services as child guidance upon realizing that culture influenced most children's behavioral patterns. The experienced led her to observe the world from the cultural perspective and realized the need for embracing cultural diversity in delivering health care to the modern society to support healing, wellness, and compliance (Sitzman & Eichelberger, 2011).
The analysis of children’s behavioral patterns revealed the lack of care and cultural knowledge among nurses providing care to the children. Leininger discovered three factors that support patient care, namely; wellness, healing, and compliance. She used these factors to establish culturally competent nursing education aimed at expanding nurses’ understanding and knowledge of diverse cultures to enhance patient well-being and patient care through the Transcultural Theory of Nursing. The theory plays a critical role in improving the nurse-patient relationship expectations in a diverse population (Busher Betancourt, 2015).
The education, knowledge, and nursing experience of Leininger impacted the development of the Transcultural Nursing Theory. As a psychiatric and mental health expert, Leininger could understand different behavioral patterns of the children she guided and related them to the child’s cultural background. Moreover, she had a Ph.D. in culture and anthropology that gave her the ability to understand the relationship between care, culture, and behaviors. According to Busher Betancourt (2015), nurses are good models for promoting patients’ cultural needs calling for the experts in the nursing practice to implement the Transcultural Theory of Nursing as the tool for teaching cultural competency.
Crucial references for the original /current work of the theorist and other authors about the theory
A lot of authors have made reference to the Leininger's Transcultural Nursing Theory. The knowledge and understanding of the theory help in promoting a culturally-oriented care leading to a universal accessibility and improved patient well-being across the different health continuum. Douglas, Pierce, Rosenkoetter, et al. (2011) references Leininger's Theory of Transcultural Nursing in their study that aimed at describing universally acceptable standards of practice that promote cultural competence in the practice of nursing. The work of Leininger played a critical role in the analysis because authors argued that a nurse may not understand attributes of every culture, but the application of a cultural assessment model would help create more knowledge. According to Douglas, Pierce, Rosenkoetter, et al. (2011), the body of literature from the transcultural nursing practice helps in providing specialized knowledge to nurses on how to practice culturally competent nursing care.
On the other hand, Mixer (2011) referred to Leininger’s Theory of Transcultural Nursing during the study on “Use of the Culture Care Theory to Discover Nursing Faculty Care Expressions, Patterns and Practices Related to Teaching Culture Care.” The author aimed at discovering practices in the nursing faculty care that support education for students that promote culturally congruent care. Leininger’s Theory of Transcultural Nursing played a primary role in supporting the study by identifying various aspects of culture that influence the nursing care and development of educational models capable of improving students’ outcome. The literature led to the discovery of more than 150 cultural constructs that help nurses understand needs of patients from diverse cultures and improve care (Mixer, 2011).
Finally, the theory helps in developing nursing philosophies that help nurses in delivering compassionate and patient-centred care. Butts and Rich (2015) made reference to Leininger’s Theory of Transcultural Nursing while analyzing how theories promote the evidence-based advanced nursing practice. According to Butt and Rich (2015), empirical, socio-political, and aesthetic theories provide researchers with the evidence needed to recognize and account for the patient's values, needs, and preferences. The authors expounded on the importance of applying theories in research and identified Leininger's Transcultural Nursing Theory as one of the well-known empirical theories that help advance the practice of nursing.
Phenomenon of concern/problems addressed by the theorist
Leininger's approach to care through the Transcultural Nursing Theory demonstrates the role of theory and practice in guiding the practice of nursing. The discipline of nursing has a historical consideration as the most underdetermined, complex and varied among all other disciplines. Understanding elements of care that will influence the health outcome of a person requires a lot of research and analysis. Leininger's primary concern was the future of the people globally after realizing that many providers did not have adequate skills and knowledge on health values and beliefs of diverse populations. The theory addresses the process of discovering and providing culturally congruent care to diverse populations. According to Leininger (2007), attaining cultural competency through education, learning, and practice promotes the well-being of individuals, healing, and health.
Secondly, Leininger’s Transcultural Theory addresses the problems and nurse-patient interaction. Nurse-patient relationship influences the health outcome of the patient, family, group, and community. The theory helps overcome the problem of poor nurse-patient relationship that has the potential of disintegrating the future of health care organizations. Leininger aimed at developing transcultural nurses capable of discovering patients' needs and preferences by analyzing their cultures. A transcultural nurse identifies the close relationship of care by relating culture to health and well-being of the patient (Leininger, 2007).
Application of deductive/inductive/reproductive reasoning
Theorists make use of the existing knowledge to make conclusions, predictions, and explanations to represent a problem or concept addressed in theory. The knowledge happens through deductive, inductive, or reproductive reasoning. The theory largely depends on the inductive reasoning to highlight, describe, analyze, and interpret the meaning of culturally congruent care to the people. The inductive reasoning approach develops a general knowledge of an event or a phenomenon after a thorough observation and analysis. The approach starts from particular to general (Bradford, 2015). Leininger's approach to transcultural nursing follows the inductive reasoning. Leininger first made an observation on behavioral patterns of children, which represents the particular concept of concern, and discovered the lack of culturally congruent care as the course of the problem, the general (Leininger, 2007). The inductive reasoning gives a chance for a failure but evidence gathered from different authors and theorists show that Leininger's reasoning was based on facts.
Major concepts of the theory
The knowledge about people, families, communities, institutions, and groups in diverse health care systems helps in promoting cultural care. Leininger tries to increase such knowledge through her Theory of Transcultural Nursing. Health care providers that understand the meaning of cultural care have special meaning and demonstrate unique expressions to their patients and the profession. The theorist made it possible for nurses across the globe to understand the meaning and application of the Transcultural Nursing Theory through an explanation of some concepts that define the transcultural care. The major concepts used by Leininger are:
Nursing: A humanistic and scientific profession acquired through learning that assists and supports individuals to live a healthy lifestyle (Leininger, 2007).
Ethnonursing: A study of values, beliefs, and practices largely known by a specific culture and their impact on nursing care (Leininger, 2007).
Culture: Learned, shared, and transferred beliefs, values, ways of life, and norms of a certain group that guides how they think, make decisions, and act (Leininger, 2007).
Culture Care: learned values and patterns of living that help in creating a supportive and enabling environment to allow people maintain health and well-being (Leininger, 2007).
Culture Care Universality: Uniform, dominant, common, or similar care patterns, values, and meanings manifested among different cultures to reflect supportive ways of assisting people (Leininger, 2007).
Transcultural nursing: A field of nursing that focuses on the study and analysis of cultures putting more emphasize on health-illness caring practices, values, and beliefs, and nursing.
Professional Nursing Care (Caring): Knowledge and skills obtained by a nurse in a learning institution and used to provide a supportive, enabling, assistive, and facilitative environment for improving human health and well-being (Leininger, 2007).
Cultural Congruent: Cognitive-based supportive, assistive, and enabling activities tailored to fit with a specific person, group, community, or institutional, cultural practices, values, and beliefs with the objective of offering a beneficial, meaningful, and overwhelming health care (Leininger, 2007).
Human beings: The theory describes human beings as elements that provide care and have concerns for the needs, well-being, and health of others (Leininger, 2007).
Health: A state of life that gives human beings the ability to perform daily activities in a culturally valued, defined, and practiced manner (Leininger, 2007).
Relationships between major concepts
Leininger explained major concepts of the theory using an explicit approach leaving the reader with no uncertainties. The concepts of the Theory have a common goal of making the readers understand the transcultural nursing care. Leininger defined each of the major concepts with the element of care, belief, values, and practices in them. On the other hand, the major concepts focus on the professional care systems that every health care organization should practice irrespective of the location. The concepts explain characteristics and main features making up a professional health care system that implements cultural care. Finally, the theory’s major concepts explain nursing care decisions involving culture capable of influencing the outcome of care. Cultural-specific concepts call for the preservation and conservation of the cultural care by restructuring health organizations and nurses to adopt culturally competent care.
Explicit and implicit assumptions made by the theorist
According to Butts and Rich (2015), theories consist of concepts and propositions explaining a certain phenomenon. Theories operate under philosophical assumptions identified implicitly or explicitly. Leininger's Transcultural Nursing Theory operates on some implicit and explicit assumptions. First, Leininger makes an implicit assumption that different cultures have different ways of practicing and perceiving their cultural values and beliefs. However, some cultures share common values, beliefs, and practices creating uncertainty on the assumption. The second implicit assumption made by the theorist is that diverse expressions, patterns, lifestyles, and meanings demonstrate care despite the view of human care as a universal concept.
On the other hand, Leininger made some explicit assumptions that other theorists find hard to change. She assumed that care occurs as a distinct concept that unifies, dominates, and forms the central focus of nursing. Care occurs without the cure, but it is impossible for the cure to occur without care. Leininger made another explicit assumption that the central purpose of the concept of nursing is to serve people in every corner of the world.
Description of four basic nursing metaparadigm
Leininger's theory is the unique among other nursing theories because it does not rely on the four basic nursing metaparadigm. The four basic metaparadigm of nursing are nursing, person, environment, and health. The use of these concepts would restrict the discovery of the aspect of care and culture that are the most relevant elements of the theory. The concept of care had more relevant in the theory because Leininger claimed that care is the basic necessity of nursing. The four metaparadigm, person, health, nursing, and the environment represent an avenue for the delivering of care to the population. According to Leininger (2007), care represents the dominant domain of nursing. The application of the element of care helps in understanding necessary qualities and skills required of a nurse in the practice of nursing that promotes a congruent cultural care. On the other hand, Leininger used the element of culture to describe a person, health, and environment. The analysis of culture helps in understanding the person's environment, hence; discovering the type of health approach to utilizing to improve the outcome of care.
Clarity of the theory
The theory of Transcultural Nursing demonstrates both lucidness and consistency. Leininger used simple vocabularies to explain her reasoning. The elements and concepts used to define a transcultural nursing practice have open meanings allowing readers and researchers to gain the positive attitude towards the theory. Butts and Rich (2015) claimed that empirical indicators connect concepts that make up theories to make theory more clear and valid. Leininger used simple empirical indicators to explain her concepts to come up with the most comprehensive theoretical model.
The role of the theory in guiding nursing actions
The theory plays a major role in guiding nursing actions through the improvement of health and the practice of nursing. The theory calls for the implementation of a new nursing curriculum that ensures all graduates from institutions of medicine and nursing have the high cultural competency to enable them to serve patients from a global perspective. The theory helps to guide nursing actions by creating a culturally competent nursing care that promotes positive nurse-patient relationship made possible through the easier understanding of individual beliefs, norms, values, and practices. Also, the theory guides nursing actions through the application of three theoretical models that influence action and decisions of nurses. The three models are culture care repatterning and restructuring; culture care preservation; and culture care accommodation. The application of these models influences actions of nurses by making them offer highly safe, beneficial, and therapeutic care (Leininger, 2007).
Conclusion
The Leininger’s Theory of Transcultural Nursing has helped transform the health care system and the practice of nursing by ensuring providers deliver care to every person irrespective of the individual cultural background. The theory remains significant to date and finds more application in different areas of nursing practice.
Application of the theory in the area of nursing
Practice: The theory helps in changing the practice of nursing by calling for the implementation of a culturally diverse nursing practice. Nurses now base their activities and decisions on culture to help care for people from diverse backgrounds and improve patient outcome today and in the future.
Education: Nursing institutions use the theory as a teaching tool to help students understand the aspect of culture and relate to its care. Moreover, students use Leininger’s theoretical framework to test their variables during research.
Informatics/Administration: The health care management units face significant administrative challenges especially when dealing with staff members from different cultural and social backgrounds. The theory of Transcultural Nursing helps solve administrative problems by allowing managers to develop programs aimed at teaching the staff cultural knowledge and competency.
References
Bradford, A. (2015, March 23). Deductive reasoning vs. inductive reasoning. Live Science.
Retrieved Jan. 24, 2017, from http://www.livescience.com/21569-deduction-vs-induction.html
Busher, Betancourt, D. A. (2015). Madeleine Leininger and the Transcultural Theory of Nursing. The Downtown Review, 2(1), 1-8.
Butts, J. B., & Rich, K. L. (2015). Philosophies and theories for advanced nursing practice.
Burlington, Massachusetts: Jones & Bartlett Learning.
Douglas, M. K., Pierce, J. U., Rosenkoetter, M. Purnell, L. (2011). Standards of practice for Culturally competent nursing care: 2011 Update. Journal of Transcultural Nursing, 22(4), 317-333.
Leininger, M. (2007). Theoretical questions and concerns: response from the theory of culture Care diversity and universality perspective. Nursing Science Quarterly (20)1, 9-13.
Mixer, S. (2011). Use of the Culture Care Theory to Discover Nursing Faculty Care Expressions, Patterns and Practices Related to Teaching Culture Care. The Online Journal of Cultural Competence in Nursing and Healthcare, 1(1), 3-14.
Sitzman, K., & Eichelberger, L. W. (2011). Madeleine Leininger’s Culture Care: Diversity and Universality Theory, In Understanding the work of nurse theorists: A creative beginning. Sudbury, Mass: Jones and Bartlett Publishers.
