There exist many nursing theories, which can be applied in practice and be useful for both healthcare professionals and patients. It is understandable that nursing research is absolutely necessary for effective development of healthcare. It is important to summarize the obtained knowledge and to distribute it following certain criteria. Medical theories serve as individual approaches applied to different patients with the purposes to improve their state of health. These theories provide a holistic framework for practice that has been highly influential and significant in establishing a professional status. One of the most interesting approaches, discussed in this paper, is Madeleine Leininger's theory of culture care diversity and universality in nursing practice. This work includes the following sections:
- importance of the nursing theory in question that tells why Leininger's theory is commonly used in nursing profession;
- summary of the theory with its main concepts;
- application of Leininger's theory to the nurse practitioners activities;
Importance of Leininger's Theory
As it was mentioned in the introduction, the discussed theory is not the only one existing in nursing. However, it is the one, which should be definitely included in a Masters program, because it goes further than describing a framework of the duties, which are to be performed by nurses. It also discusses the importance of interpersonal relationship among the participants of the process and provides deep medical, psychological and social knowledge for nurse practitioners and other healthcare specialists. Thus, Leiningners theory is useful for nursing profession, because it helps nurses, healthcare professionals and researches study transcultural human care phenomena and discover the knowledge nurses need to provide care in an increasingly multicultural world. Though the approach can be applicable in all healthcare professions depending on the needs of a patient, it also helps to distinguish the nursing specialists from all other healthcare working positions. The theory does not only incorporate some anthropological concepts, which physicians necessarily consider, but focuses on human beings as inhabitants of the multicultural world as well. Therefore, nurses spend much more time with the patients in hospital and at home than the physicians do. Applying this approach, they have an opportunity to assist doctors in developing the most effective treatment strategies. The most important concern in application of Leiningners theory is an intercultural conflict, which may arouse between a patient and a nurse, who may belong to different cultures.
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Summary of Leininger's Theory
The exact date of the first publishing of Madeleine Leininger's theory of culture care diversity and universality in nursing is not defined, because the author started to keep track of her first research in the 1950s and issued the first publications in the early 1960s. Nowadays, the approach is still widely discussed and used and its latest editions are dated 2013 2014. Like any other nursing theory, it is based on a number of constructs and concepts. Two most important of them in the approach are emic (insider) and etic (outsider) knowledge, which were introduced by Leininger to differentiate the informants inside knowledge from the researchers outside or professional knowledge. These constructs gave birth to the formation of the main theoretical concepts, mainly domain of inquiry, when a researcher may focus on a domain of inquiry, such as culture care of Mexican family, cultural care and social structure dimensions, cultural care accommodation and preservation and others. Two major tenants of Leininger's theory are culture-specific care, which means identification and adaption of some healthcare practices, which are typical for a certain culture, and culturally congruent care, which is a goal of the approach and represents culturally-based knowledge and actions, which are skillfully used to match the necessities of a patient in the process of providing nursing care.
Terms, typical for all nursing theories, such as a person, health, environment and nursing profession were interpreted in the multicultural context by Leininger. Thus, nursing profession is recognized as a set of learned skills, focused on multicultural care. The environment is formed by a number of factors: technological, religious and philosophical, social, cultural values and beliefs, political, economic and educational. A person is understood as an individual with specific cultural and moral beliefs, which should be taken into consideration in the process of nursing care. Health is addressed as a state of well-being, which is formed by a certain culture. The given constructs and concepts are another reason for choosing this theory for this investigation. It gives a nurse practitioner a chance to see that each patient is an individual, who needs a specific approach in the process of care. A correctly prescribed course of medical treatment and appropriate methods of nursing care will be effective only in case of being based on the cultural and moral beliefs of a patient and not being contradictory with them.
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Application of Leininger's Theory to Nurse Practitioners
Working as a nurse practitioner requires a profound knowledge of medicine, psychology and nursing care. It is not easy to obtain this combination and implement it into practical skills. Moreover, a nurse practitioner should be aware of the factors, which form the individuality of a patient. Leininger's theory can significantly help nursing professionals shift from largely ethnocentric views to multicultural views in order to effectively serve people worldwide. Thus, the considered approach defines that nurse practitioner is a specialist, who helps people on the basis of his or her emic views. McFarland et al. state that nurse practitioners should practice ehtnonursing. The theory explains that an experienced nurse should conduct an ehtnonursing research on the basis of five main principles:
- being an active learner, maintaining an open investigation and active listening in working with informants, avoiding ethnical bias;
- participating together with his or her informants in understanding the meaning of what is seen, heard and prescribed; developing sensitivity to the emic views of the informants;
- keeping track of what is said by the informants in order to implement these principles into a nursing care program;
- attracting an experienced scientist in ethnonursing to carry out the study and organize the data;
- clarifying why the application of ehtnonursing research method with other nursing techniques is needed. Therefore, nurse practitioner in the context of Leininger's theory is a person, who is capable of providing complex, culturally sensitive nursing care, applying a combination of nursing methods.
It is possible to give some examples, illustrating the abovementioned description of a nurse practitioner. When I was working with a patient of Cuban heritage, who was speaking English badly, I understood that Leininger's theory should be the most important approach in guiding me in my actions. I read some sources about the characteristics of Cuban culture and whether this nationality respects traditional medicine in general. I consulted my Hispanic colleague and talked to the physician. I offered a combination of modern medical treatment and herbal remedies because I have learned that Cubans trust traditional medicine more. I established a contact with the patients family, because family values were very important for the patient.
There are many instances of the theory application for nurse practitioners in the literature sources. Thus, McFarland gives an example of a girl, named Debbie, who was diagnosed with a stage II squamous cell carcinoma of the cervix. A nurse practitioner, who had to care for her, followed all five stages, which were described above and, first of all, found that Debbie is an African American who has lived in the small rural area of her Southern state all her life. This fact and more thorough investigation of Debbies background and living conditions gave her nurse practitioner a chance to formulate the most important concepts of health, as they are seen by Debbie, namely the concepts of protection and sharing, which formed a persons well-being. Therefore, the key topics and concepts (religion as an effective mechanism, strong caring by relatives and others), learned and analyzed by Debbies nurse practitioner, became a foundation of developing a nursing care plan.
To conclude, it is worth noting that Leininger's theory of culture care diversity and universality in nursing practice is a favorable topic for investigation. This technique promotes and individual approach to each patient, taking into consideration his or her cultural background. This method is very important for current multicultural societies. Leininger's theory has interpreted the main metaparadigm concepts in the context of transcultural care and demonstrated that a nurse practitioner should not only apply purely professional knowledge, while formulating a care plan, but should examine and analyze the cultural views of the patients with the purpose to give effective nursing help. The most important facts, which were learned in the course of developing this assignment, are a new approach to examining the patients, the necessity of learning more about the culture of a patient with whom a nurse practitioner works as well as the significance of keeping a close contact with the physicians and a family of a patient and discussing some details of the patients perceptions.