Week 13B Theoretical Foundations in Culture Care Theory of Diversity and Universality PDF

CULTURE CARE THEORY OF DIVERSITY AND UNIVERSALITY WEEK 13 (B) Theoretical Foundations in  MADELEINE LEININGER (1925- 2012) “ Care is the heart of nursing; Care is power, Care is essential to healing; Care is curing; Care is the central and dominant focus of nursing and transcultural nu...

CULTURE CARE THEORY OF DIVERSITY AND UNIVERSALITY WEEK 13 (B) Theoretical Foundations in  MADELEINE LEININGER (1925- 2012) “ Care is the heart of nursing; Care is power, Care is essential to healing; Care is curing; Care is the central and dominant focus of nursing and transcultural nursing decisions and actions.” MADELEINE LEININGER (1925-2012)  Madeleine Leininger was born in Sutton, Nebraska.  In 1948, she received her diploma in nursing from St. Anthony’s School of Nursing in Denver, MADELEINE LEININGER (1925-2012)  In 1950, she earned a B.S. from St. Scholastica (Benedictine College) in Atchison, Kansas  1954 earned an M.S. in psychiatric and mental health nursing from the Catholic University of America in Washington, D.C.  1965, she was awarded a Ph.D. in cultural and social anthropology from the Universityof Washington, Seattle (Tomey and Alligood, 2001 MADELEINE LEININGER (1925-2012)  Leininger recognized the importance of the concept of “caring” in nursing. Frequent statements of appreciation from patients for care received prompted Leininger to focus on “care” as being a central component of nursing. MADELEINE LEININGER (1925-2012)  Leininger experienced what she describes as a cultural shock when she realized that recurrent behavioral patterns in children appeared to have a cultural basis. MADELEINE LEININGER (1925-2012)  Leininger identified a lack of cultural and care knowledge as the missing link to nursing’s understanding of the many variations required inpatient care to support compliance, healing, and wellness (George, 2002).These insights were the beginnings (in the 1950s) of a new construct and phenomenon related to nursing care called transcultural nursing METAPARADIGM IN NURSING NURSING  Leininger showed her concern to nurses who do not have sufficient preparation for a transcultural perspective. NURSING 3 TYPES OF NURSING ACTION THAT ARE CULTURALLY-BASED  CULTURE CARE PRESERVATION/MAINTENANCE  CULTURE CARE ACCOMODATION/NEGOTIATION  CULTURE CARE REPATTERNING/RESTRUCTURING  These 3 modes of action can lead to the deliverance of nursing care that best fits with the client’s culture and thus reduce cultural stress and chance for conflict between client and caregiver. PERSON  Humans are universally caring beings who survive in a diversity of cultures through their ability to provide the universality of care in a variety of ways according to differing cultures, PERSON  Leininger (1991) also indicates that nursing as a caring science should focus ahead of traditional nurse-patient interactions to include “families, groups, communities, total cultures, institutions” as well as worldwide health institutions and ways to expand international nursing care policies and practices. HEALTH  She discussed about components of health, specifically: health systems, health care practices, changing health patterns, health promotions and health maintenance. HEALTH  Health is a key concept in transcultural nursing. Because of the weight on the need for nurses to have knowledge that is specific to the culture in which nursing is being practiced, it is acknowledge that health is seen as being universal across cultures but distinct within each culture in a way that represents the beliefs, values and practices of the particular culture. Thus, health is both universal and diverse. ENVIRONMENT  In terms of Environment, Leininger speaks about worldview, social structure, and environmental context. However, environment, if viewed as being signified in culture, is a major principle of Leininger’s theory.  Environment framework is defined as being the totality of an event, situation, or experience.  CULTURE CARE THEORY OF DIVERSITY AND UNIVERSALITY  The concept of culture in Leininger’s theory borrows its meaning from anthropology. Culture is the “learned, shared and transmitted values, beliefs, norms, and lifeways of a particular group that guides their thinking, decisions and actions in patterned ways.  CULTURE CARE THEORY OF DIVERSITY AND UNIVERSALITY  Culture can be seen in the actions, words, rules and standards, symbols and behavior patterns of people and is learned and then handed down from generation to generation.  CULTURE CARE THEORY OF DIVERSITY AND UNIVERSALITY  A key component of Leininger’s theory is that of cultural diversity. This refers to the differences or variations that can be found both between and among different cultures. By recognizing the variations, the nurse can avoid the problem of stereotyping (using general standards) and assuming that all people will react to the same nursing care.  CULTURE CARE THEORY OF DIVERSITY AND UNIVERSALITY  A similar concept is that of cultural universality, the opposite of diversity, which refers to the commonalities or similarities that exists in different cultures. These ideas have led to an important achievement of the theory- that is, “to discover similarities and differences about care and its impact on the health and well-being of groups’ (Leininger,1995) MAJOR IDEAS OF CULTURAL CARE CARE CARING  The conceptual  Behavior directed phenomena related to toward assisting helping, supporting or another individual or empowering group with evident or experiences or behaviors toward anticipated needs to others with evident or improve the human anticipated needs to condition either to improve human recover or to face condition. death. MAJOR IDEAS OF CULTURAL CARE CULTURE CULTURE CARE   The studies, shared The subjectively and objectively obtained and handed values, values, beliefs and outlines beliefs, norms and of the lifeways that assist, lifeways of a certain enable, support, facilitate group that directs or empower another individual or group to their thinking, decision maintain well-being, health and actions in certain and deal with illness, ways. handicaps or death. MAJOR IDEAS OF CULTURAL CARE CULTURAL CARE DIVERSITY WORLDVIEW  The common, general  The method people definitions of care with seem to look out on its patterns, values the world and/or and symbols that is universe to form a observed among many picture of value cultures and reflect perception about their assistive ways to help life or world around people. them.  MAJOR IDEAS OF CULTURAL CARE CULTURAL AND SOCIAL ENVIRONMENTAL STRUCTURE CONTEXT DIMENSION   The changing patterns The summation of an related to the event, situation or arrangement/organization particular experience al factors of a particular that gives meaning to culture (subculture or human expressions, particularly physical, society), which includes ecological, religious, kinship (social), sociopolitical and/or political (and legal), cultural situations. economic, educational, technological and cultural  MAJOR IDEAS OF CULTURAL CARE ETHNOHISTORY EMIC   Past facts, events and Local, experiences of indigenous or individuals, groups and various cultures and the insider's institutions that are views and mainly people-centered values about a (ethnic) and that explains certain and interprets human life phenomenon. ways within particular cultural trends. MAJOR IDEAS OF CULTURAL CARE PROFESSIONAL CARE ETIC SYSTEM  Formally educated, and  Outsider's or instructed professional care, health,illness, more universal wellness and related views and knowledge and practice skills thatexist in values about a professional institutions usually with certain multidisciplinary personnel to give service phenomenon. to clients.  MAJOR IDEAS OF CULTURAL CARE Generic (Folk or Lay) Care System Health  Culturally studied and  The state of well-being given, indigenous(or that defined through traditional), folk cultures values and practiced, and reflects (community and home- the ability of individuals based) knowledge and to perform their daily role skills used to provide activities in culturally another individual, groups expressed, beneficial and or institution with evident pattern styles. or anticipated  (or well-being), or to deal  MAJOR IDEAS OF CULTURAL CARE Cultural Care Cultural Care Preservation or Accommodation or Maintenance  Negotiation  Caring skilled actions The supporting, facilitative or enabling and decisions that specialized actions and decisions that help people of a certain people of designated culture retain culture to adapt to others for a beneficiary important care values or satisfying health outcome with so that they can keep professional care up their well-being, providers recover from illness,  MAJOR IDEAS OF CULTURAL CARE Cultural Care Culturally Competent Repatterning or Nursing Care Restructuring   The assistive, sustaining, The cognitively-based facilitative or enabling assistive, caring, facilitative or professional actions and empowering acts or decisions that help clients decisions that are made greatly change their life to fit with individual, ways for new, different and group or institutional cultural values, beliefs beneficial healthcare and life ways to offer patterns while regarding the meaningful, beneficial client's cultural values and and satisfying beliefs and still giving a healthcare or well-being services.  The following assumptions derived from her work (Leininger and McFarland, 2005) were as follows: 1. Care is the essence and unifying focus of nursing. 2. Culturally based care is essential for well- being, health, growth and survival and to face handicaps or death. 3. Culturally based care is the most comprehensive and holistic means to know explain, interpret and predict nursing care phenomena and to guide nursing decisions and actions.  The following assumptions derived from her work (Leininger and McFarland, 2005) were as follows: 4.Transcultural nursing is a humanistic and scientific care discipline and profession with the central purpose to serve clients. 5. Culturally based caring is essential to curing and healing, for there can be no curing without caring, but caring can exist without curing.  The following assumptions derived from her work (Leininger and McFarland, 2005) were as follows: 6. Culture care concepts, meanings, expressions, patterns, processes and structural forms of care vary transculturally with diversities and some universalities. 7. Every human culture has generic care knowledge and practices and usually professional care knowledge and practices, which vary transculturally and individually.  The following assumptions derived from her work (Leininger and McFarland, 2005) were as follows: 8. Culture care values, beliefs and practices are influenced by and tend to be legal, educational, economic, technological, ethnohitorical and environmental context of cultures. 9.Beneficial,healthy and satisfying culturally based care enhances the well-being of clients.  The following assumptions derived from her work (Leininger and McFarland, 2005) were as follows: 10. Culturally congruent and beneficial nursing care can occur when care values, expressions or patterns are known and used explicitly for appropriate, safe and meaningful care. 11.Culture care differences and similarities exist between professional and client- generic care in human cultures worldwide.  The following assumptions derived from her work (Leininger and McFarland, 2005) were as follows: 12. Clients who experience nursing care that fails to be reasonable congruent with the client's cultural beliefs and values will show signs of stress, cultural conflict, noncompliance and ethico-moral concerns. 13. The complex and diverse data of culture care can be discovered and interpreted through ethnonursing qualitative research method. ACCEPTANCE BY THE NURSING COMMUNITY ACCEPTANCE BY THE NURSING COMMUNITY Practice Practice  As our world becomes more culturally varied, nurses will find the pressing need to be conflict and clashes as they move from one place to another like from rural to urban communities without Transcultural Nursing preparation.  As cultural differences arises, families are less satisfied with nursing and medical services. Nurses who travel and seek employment in foreign lands are experiencing immigrant status. Transcultural nursing education has become crucial for all nurses nationwide. Research  A lot of nurses today are using Leininger’s Culture Theory worldwide. The theory is the only one in nursing focused purposely on culture care and with a research technique(ethnonursing) to examine the theory. Education  With the sensitive public awareness of healthcare cost, different cultures, and human rghts, there is a much superior demand for comprehensive, holistic, and transcultural people who are trained to safeguard quality-based care and to prevent legal suits related to improper client care. THEORY ANALYSIS CLARITY  Leininger's theory is a holistic and comprehensive perspective of individuals, groups and institution although it presented broad concepts and does not give special attention to disease and symptom. SIMPLICITY  Culture Care Theory is really a wide and holistic standpoint of human populations. Leininger’s Culture Care Theory is applicable worldwide to help direct nurse researchers in comprehensive in conceptualizing the theory and research advances and to conduct practice. GENERALITY  Transcultural Nursing theory addresses nursing care from a multicultural and worldwide perspective. It is useful and applicable to both groups and individuals with the goal of rendering culture-specific nursing care. The theory is most helpful as a guide for the study of any cultures and for the comparative study of several cultures. Accessibility  Ongoing and future research will lead to additional care and health findings and implications for ethnonursing practices and education to fit specific cultures and universal features. Clearly, a body of Transcultural Nursing knowledge has been established over the past decade that has a great impact on nursing and many healthcare systems. IMPORTANCE  This theory could be the means to establish a sound and defensible discipline and profession, guiding practice to meet a multicultural world because it has a broad and multicultural focus.  THEORY OF HEALTH AS EXPANDING CONSCIOUSNESS MARGARET NEWMAN (1933- 2018) “We have to embrace a new vision of health. Our caring must be linked with a concept of health that encompasses and goes beyond disease. The theory of health as expanding consciousness provides that perspective.”  Margaret A. Newman was born on October 10, 1933, in Memphis, Tennessee.  She earned a bachelor's degree in nursing from the University of Tennessee in Memphis.  She finished her master’s degree in medical- surgical nursing and teaching from the University of Califomia, San Francisco and earned her Doctor of Philosophy in nursing science and rehabilitation nursing in 1971 from New York University.  After holding academic positions at the University of Tennessee, New York University, and Pennsylvania State University, Newman was a Professor at the University of Minnesota in Minneapolis until her retirement in 1996, where she is Professor Emeritus.  During her nursing education career, she was Director of Nursing for the Clinical Research Center at the University of Tennessee, Acting Director of the PhD Program in the Division of Nursing at New York University, and Professor in- Charge of the Graduate Program and Research in Nursing at Pennsylvania State University. METAPARADIGM IN NURSING Nursing  Newman emphasizes the primacy of relationships as a focus of nuring, both nurse-client relationships and relationships within clients’ lives.  The emphasis of this process of expanding consciousness and as facilitator, the nurse helps an individual, family or community to focus on patterns of relating pattern recognition, considered the nursing process. Person  Persons as individuals are identified by their individual patterns of consciousness and defined as centers of consciousness within an overall pattern of expanding consciousness. The definition of persons includes family and community. Environment  Newman identifies interaction between person and environment as a key process that creates unique configurations for each individual. THEORY OF HEALTH AS EXPANDING CONSCIOUSNESS  Newman's Health as Expanding Consciousness arose from Rogers' Theory of Unitary Human Beings. The model has progressed to include the health of all people, regardless of the presence or absence of disease. This is a process of becoming more of oneself, of finding greater meaning in life, and of reaching new dimensions of connectedness with other people, as well as the world.  According to Newman, understanding the patient's pattern is essential. The pattern recognition is the expanding consciousness. The manifestation of disease depends on the pattern of the patient, so the pathology of the diseases exists before the symptoms begin to appear.  Newman also explains the interrelatedness of time, space, and movement. Time and space are the temporal pattern of the patient, and they have a complementary relationship. People are constantly changing through time and space, and it shows a unique pattern of reality.  The theory states that health and illness are synthesized as health. That is, the fusion of one state of being (disease) with its opposite (non- disease) results in what can be considered health. In this model, the human is unitary. He or she cannot be divided into parts, and is inseparable from the larger unitary field. People are individuals, and human beings are, consciousness. Instead, the person is consciousness. MAJOR CONCEPTS Health  Health is the "pattern of the whole" of a person and includes disease as a manifestation of the pattern of the whole, based on the premise that life is an ongoing process of expanding consciousness.  Health is a transformative process to more inclusive consciousness. Health  Newman explained that disease fuses with its opposite, non-disease or absence of disease, to create a new concept of health that is relational and is "patterned, emergent, unpredictable, unitary, intuitive, and innovative," rather than a traditional linear view that is “causal, predictive, dichotomous, rational, and controlling." Health  Health and the evolving pattern of consciousness are the same. The essence of the emerging paradigm of health is recognition of pattern. Newman sees the life process as progression toward higher levels of consciousness. Pattern  Pattern is information that depicts the whole and understanding of the meaning of all of the relationships at once. It identifies an individual as a particular person. Example of explicit manifestations of the pattern of a person are the genetic pattern that contains information that directs becoming, the voice pattern, and the movement pattern. Pattern  According to Newman, whatever manifests itself in a person's life is the explication of the underlying implicate pattern, the phenomenon we call health is the manifestation of that evolving pattern. Consciousness  Consciousness is both the informational capacity of the system and the ability of the system to interact with its environment. Consciousness includes not only cognitive and affective awareness, but also the interconnectedness of the entire living system which includes physicochemical maintenance and growth processes as well as the immune system. Consciousness  Newman explained that individuals came into being from a state of consciousness, and that they were bound in time, found their identity in space, and, through movement, learned the "law" of the way that things worked; they then made choices that ultimately took them beyond space and time to a state of absolute consciousness. Parallel between Newman’s Theory of Expanding Consciousness and Young’s Stage of Human Evolution Newman developed the following assumptions: 1. Health encompasses conditions heretofore described as illness or, in medical terms pathology. 2. These “pathological” conditions can be considered a manifestation of the total pattern of the individual. 3. The pattern of the individual that eventually manifests itself as pathology is primary and exists prior to structural or functional changes. Newman developed the following assumptions:  4. Removal of the pathology in itself will not change the pattern of the individual.  5. If becoming "ill" is the only way an individual's pattern can manifest itself then that is health for that person.  Newman developed the following assumptions:  Newman's implicit assumptions about human nature include being unitary, an open system, in continuous interconnectedness with the open system of the universe, and continuously engaged in an evolving pattern of the whole. ACCEPTANCE BY THE NURSING COMMUNITY Practice  In Newman's view, the responsibility of professional nurses is to establish a primary relationship with the client for the purpose of identifying meaningful patterns and facilitating the client's action potential and decision-making ability. Practice  Newman believes that the goal of nursing is not to make people well, or to prevent their getting sick, but to assist people to utilize the power that is within them as they evolve toward higher levels of consciousness.  Newman's theory of health was useful in the practice of nursing because it contained the concepts of movement and time that are used by the nursing profession and intrinsic to nursing interventions such as range of motion and ambulation. Education  Newman suggested that nursing education revolve around pattern as a concept, substance, process, and method. Education by this method would enable nursing to be an important resource for the continued development of health care. Education  Examining the pragmatic adequacy of Newman's theory in relation to nursing education reveals that teaching the research method associated with the theory also teaches student to experience transformation through pattern recognition. Education  Teaching the theory of health as expanding consciousness necessitates a shift in thinking from a dichotomous view of health to synthesized view that accepts disease as a manifestation of health. Research  Newman observed that her research not only assisted clients who participated, but she and fellow researchers also gained a better understanding of self as a nurse researcher. Newman stated that research should center on investigations that are participatory in which client-subjects are partners and co-researchers in the search for health patterns. Research  This method of inquiry is called cooperative inquiry or interactive, integrative participation. Numerous nurse practitioners and scientists have used the theory to incorporate the concepts into their nursing practice or to elaborate the theory through research. THEORY ANALYSIS Clarity  Newman presented the dimensions, definitions and descriptions of the concepts of the theory in a clear and consistent manner. Simplicity  The deeper meaning of the theory of health as expanding consciousness is complex. As Newman advocated in the 1994 edition of her book, Health as Expanding Consciousness, the holistic approach of the hermeneutic dialectic method is consistent with the theory and requires a high level of understanding of the theory on the part of the researcher to extend the theory in praxis research. Generality  The concepts in Newman's theory are broad in scope because they all relate to health. The theory has been applied in many cultures and is applicable across the spectrum of nursing care situations. Application of the theory is universal in nature. The broad scope provides a focus for middle-range theory development. Accessibility  In the early stages of development, aspects of the theory were tested with the traditional scientific mode. However, quantitative methods are inadequate to capture the dynamic, changing nature of this theory. A hermeneutic dialectic approach was developed and has been used extensively for full explication of its meaning and application. Importance  The focus of Newman's theory of health as expanding consciousness provides an evolving guide for all health-related disciplines. In the quest for understanding the phenomenon of health, this unique view of health challenges nurses to make a difference in nursing practice by the application of this theory.