Introduction
Madeleine Leininger, a researcher, theorist, certified transcultural Nurse, and author of twenty-seven books, was born in Sutton in July 1925. She experienced cultural surprise in the 1950s while working with home-based child guidance when she observed some forms of behavioral recurrence in children with cultural foundations. She observed and pinpointed a deficit in cultural and care understanding as to the prevailing gap in the awareness of the nurses. The overlooked components depicted disparities in patient care to sustain healing, compliance, and wellness. Subsequently, she framed the concept of the Transcultural Nursing Theory, also known as the Culture Care Theory. The concept offers the idea of nursing care that is consistent with the culture through indulgence of deeds that are compassionate, enabling, and supportive. Besides, it targets the utilization of tailor-made decisions to be congruent with the cultural beliefs, values, and lifestyles of groups, institutions, or individuals. The chief focus of this theory is the inference of constructive significance of nursing care and the health results for individuals with analogous or diverse cultural backgrounds. The correlations of the diversity, culture care, and universality ideas in Leininger’s theory are demonstrated through the Sunrise model’s formulation.
Philosophical Underpinnings
The initiation and development of the Transcultural Nursing theory started during the 1950s (McFarland & Wehbe-Alamah, 2019). Further advancement of the theory was witnessed in 1995 when its inscription appeared in Leininger’s book on Transcultural Nursing. Supplementary explanations of the Culture Care theory were incorporated in the theory-centered study circulated in 2002.
The deployed Sunrise Model ensures logical demonstration of inter-correlations care, culture, universality, and diversity concepts. Besides, the theory has parsimonious nature as the incorporation of the inherent ideas assures its flexible application in diverse backgrounds. Lastly, Leininger’s theory is exceedingly extrapolative and readily acknowledged on the earliest exposure. Consequently, the obtainable affiliations and concepts at a particular abstraction measure facilitate their applications in varied settings.
Main Concepts of the Theory
Health
The term is employed to denote the well-being condition which is culturally esteemed, exercised, and designated to review individual or group capabilities in the performance of daily societal undertakings. Alternatively, it is a culturally defined, specified, and established situation applied by groups or individuals to deal with their everyday activities (McFarland & Wehbe-Alamah, 2019). Noteworthy, the level of education affects the ability of the patient to comprehend and explore the system of health care.
Ethnohistory
The abstraction is delineated as the ancient experiences, evidence, occurrences, and proceedings concerning humankind, species, organizations, and cultures that take place over time in specific perspectives. The context clarifies the historical and present ways of life regarding regulators of culture-care on death, health, and wellness (Wehbe-Alamah et al., 2019). Within the historical-cultural framework, the crucial previous and existing incidences and state of affairs form fundamental caring modalities and practices in providing culture-centered care and understanding transcultural nursing.
Care
The theorist described abstraction as facilitative, supportive, and beneficial ideas and undertakings towards others. Subsequently, caring depicts the deeds, conventions, and viewpoints utilized to aid others in wellbeing and restoration. Care as a construct incorporates general and specialized activities and has been projected to stimulate and unravel health for comparable and varied cultures (Wehbe-Alamah, 2018). Following the recent study outcomes, it has been termed as an invisible and embedded spectacle that often poses challenges on nurses requiring prompt absolute identification and understanding of phenomena. However, most nurses undertake in-depth research in journals and books to be acquainted with knowledge regarding care implications from both the analogous and diversified cultures’ outlooks. Besides, paradigms of culture care have also been established by researchers from the previously unearthed constructs using the earlier studies in ethnonursing. The constructs of care discovered in addition to that include acceptance, equity, exclusion, and reverence to livelihoods.
Culture
The construct, which is adapted from anthropological conceptions, is described as the values, norms, lifestyles, and beliefs of a distinct culture that are pursued and dispensed to guide discernment, resolutions, and measures in a patterned manner. The concept is regarded as the most all-inclusive way to gradually ascertain, elucidate, and project the lifestyles of individuals in diverse geographical localities. Besides, it cuts across kinship and ethnicity interactions, thus serving more than a symbol of ritual and societal connections (Wehbe-Alamah, 2018). Therefore, it indoctrinates the human materialistic and non-materialistic blueprint that can be applied as guidance on decision-making and acting for groups and individuals.
Culture Care
The advancement of the cultural care understanding by transcultural equipped nurses is attained through theoretical bonding of care and culture and eventual ratification via practice and research. Leininger believed that the process of conceptualizing and connecting together culture and care experiences had an immense influence on the elucidation of illness and health (Wehbe-Alamah, 2018). Constituting a phenomenon related to human care, the two aspects involve comprehensive and rigorous examination to establish their embedded correlations. Notably, ethnonursing research deduced additional culture care concepts, namely end-of-life arrangements, permitting presence, and society as a family, which validated family contribution toward care constructs.
Integrative Care
The therapeutic field describes the conception as the anticipated results of specialized and generic care when utilized expressively and properly. Leininger further explicated the concept as the innovative, consistent, and secure manner of combining generic, skilled, and holistic care conventions and information for the valuable well-being experience of the client (Wehbe-Alamah, 2018). Through the holistic care characteristic of culture congruence, integrative care merges generic and professional approaches, thus eliminating the usage of the expression “nursing care practices”.
Emic and Etic
Emic denotes the indigenous or local knowledge of culture and interpretation of particular scenarios, while etic talks about the opinions and cultural institutional understandings about culture care by expatriates or outsiders. Formulation of these terms helped in the detection of divergent phenomena of culture care (McFarland & Wehbe-Alamah, 2019). Leininger sought to distinguish the universal and diverse cultures as well as to knowledge care between the insiders and the professional outsiders. Over the years, emic and etic constructs have evinced their immense significance in the clarification of the resemblances and dissimilarities in awareness and cultural-snitch practices in comparison to the habits of certified nurses.
Culturally Congruent Care
The concept denotes clients’ cultural decisions, engagements and care thought utilized subtly to implicitly align with the cultural norms, morals, and livelihoods for their wellbeing, or disabilities, ailment, and bereavement prevention. The fundamental goal of nursing since its initiation has been to assist caregivers in offering culturally compatible care. Remarkably, the understanding of nurses on the cultural practices and beliefs of the Mexican-American women during their postnatal period was important in offering them culture-centered care (Bhakta & Mani, 2019). The discovered preferences for this group included the aspiration for cultural heritage conservation and upholding prayers and religion as the essentials to healthy living.
Culture Care Diversity
The ideology integrates the differences in values, codes, patterns, lifestyles, and implications of cultural care amongst human creatures or other traits correlated with the provision of valuable culture-specific care to users. The assertion of the concept was overtly highlighted by the exploration outcomes of culture care research undertaken on the immigrant refugees from Somalia in Minnesota (Wehbe-Alamah, 2018). The study found numerous dissimilarities in preferences for care between the dual genders.
Culture Care Universality
The scheme postulates an occurrence in which groups or individuals have similar or collective culture care. The sensation is often manifested with intermittent ideas, values, intentions, lifestyles, or secret languages that offer caregivers guidance to accord supportive, enabling and facilitative care for healthy results. The investigation on nurturing African-American offsprings suffering from autism led to the inference of two themes in both the collective and diverse care settings (Burkett et al., 2017). The former topic yielded faith and respect, while the latter narrowed to paternal care versus maternal care.
Worldview
The concept illustrates the inclination of individuals on universe perception in depicting their stand on the importance of life and the surrounding world. The notion offers a wider impression on the alignment of someone to life or persons that impact decisions, care, and curing reactions. Notably, it directs the lifestyle actions and resolutions such as caregiving, wellbeing, care receiving, and health of the people. A study by WehbeAlamah (2018) on the individual care dogmas showed that the worldviews are entrenched in a particular religion and distinctive cultural practices and beliefs. The universal societal impressions are also encrypted in generic phonological expressions. However, the traditional denotations of such lexes are only available to members of that particular community because those terminologies were acknowledged as intricate kinship ties that figuratively persuaded the community’s fate in pleasing the ancestors.
Environmental Context
The term defines wholly the experience, circumstances, or activities that provide significance to elucidations, expressions, and collective collaboration of individuals surrounded by specific ecological, sociopolitical, geophysical, and technologic features in particular cultural backgrounds. Research has delineated how the ecological context served as an obstruction and enabler to effective care results for some infections (Ulrich et al., 2019). The identified issues comprised the physical environment and setting, care alternatives understanding, initial use of customary care, and deployment of distinct disease protection kits. Additionally, rehabilitation nurses can advance cultural co-existence via a five-phased introspective passage (Steefel, 2018). This consideration was established through the screening of the environmental-related concerns, cultural opinions, and needs of the inmates.
The Model
The theory of Madeleine Leininger employs the Sunrise Model since it assists nurses in the development of complex and critical opinions in the nursing profession. The developed views in every particular context ought to take into account and assimilate the psychological, biological, social, and cultural aspects utilized in nursing care (McFarland & Wehbe-Alamah, 2019). The Sunrise Model used in describing the universality and diversity of cultural care dimensions appears as illustrated below.
The worldview of cultural care delves into the understanding of groups, institutions, societies, families, and individuals in dynamic systems of healthcare. The acquaintance offers cultural health and care that have explicit expressions and significance (McFarland & Wehbe-Alamah, 2019). After that, the model draws attention to information regarding the definite care characteristics of nursing care, specialized care, and universal systems. Data plays a key role in the establishment of multiplicity, predominance, dissimilarities, and correspondences of cultural care. The deliverance of nursing care is ultimately accomplished by focusing on deeds and decisions that entail the conservation of societal protection. Additionally, it is attained through restructuring, negotiation, or compromising ethnic safeguarding.
Heuristic Value of the Theory
The theory is essential in the description of the desired nurse-patient relation because the nurse is responsible for care implementation, while the patient offers his or her time in care-receiving. Additionally, the concept guides the nurses while engaging themselves in cultural-related training as well as the execution of homologous care approaches that the patients consider to meet their cultural beliefs. Furthermore, it addresses the fulfillment of the cultural prerequisites of the patients through the assessment and application of nursing strategies and interventions that are congruent to the cultural background. Finally, immense transformations have been observed in the caregivers who were less acquainted with diversity amongst patients. Consequently, a tremendous decline in patient-nurse conflicts has been recorded, thus having enhanced the healing of the victim.
Analysis
The theory postulates the significance of aiding the patients and nurses in the enhancement of their wellbeing condition. Conversely, it assists the nurses in inculcating fresh concepts in diversified cultures without bringing up unpleasant schemes to the members. Notably, it is an integration of a set of resilient customs that are augmented across generations that make its penetration challenging. The process of nurses getting fully assimilated to a different societal setting is cumbersome as they have to familiarize themselves with the ensuing new practices and credence. Besides, the entire undertaking would turn out to be expensive.
The diminished engagement of nurses with this type of nursing model can be attributed to the indistinct manner of financial compensation and fiscal constrictions. Due to its indiscreet characteristic, the nurse may be meted with insecurity issues due to the emergence of conflict with the members, particularly in societies with countless taboos. Leininger is exceedingly lauded for the formulation of the culturally diverse and care-centered theory. However, the theory failed to give a comprehensive discourse of the roles, responsibilities, and functions of the nurses as it gave extensive emphasis on the cultural impression. The concept did not quantify how the clients would acquire the assistance, sustenance, or facilitation themselves to enhanced livelihood.
Conclusion
Transcultural nursing delineates the provision of care corresponding to the societal practices, principles, and tenets as the role of nursing care. Cultural awareness assists nurses in being conversant with the patient’s conviction and cultural system in dealing with suffering, demise, and illnesses. Additionally, the knowledge makes the nurses be respectful and understanding of the nurse-patient diversity as well as being open-minded to spiritually-based treatments and therapies such as anointing. When crafting the nursing plan, nurses are obligated to be intuitive to the cultural settings of their patients. With the awareness of incongruity, the practice of designing culture-specific nursing involvements is important as the culture defines how numerous persons influence their health and response to care and therapeutics. Through the deployment of Leininger’s theory, nurses are able to interject the relationship between the health of the patient and his or her cultural background. The acquired knowledge is utilized in generating a nursing program that encourages patients to quickly recover while maintaining insight into their social context.
References
Bhakta, A., & Mani, S. (2019). Cultural, social, religious beliefs and practices during postpartum period among post natal women in selected rural and urban health care settings. Indonesian Journal of Global Health Research, 1(1), 1-12.
Burkett, K., Morris, E., Anthony, J., Shambley-Ebron, D., & Manning-Courtney, P. (2017). Parenting African American children with autism: The influence of respect and faith in mother, father, single-, and two-parent care. Journal of Transcultural Nursing, 28(5), 496-504.
McFarland, M., & Wehbe-Alamah, H. (2019). Leininger’s Theory of Culture Care Diversity and Universality: An overview with a historical retrospective and a view toward the future. Journal of Transcultural Nursing, 30(6), 540-557.
Ulrich, B., Barden, C., Cassidy, L., & Varn-Davis, N. (2019). Critical care nurse work environments 2018: Findings and implications. Critical Care Nurse, 39(2), 67-84.
Wehbe-Alamah, H. (2018). Leininger’s Culture Care Diversity and Universality Theory: Classic and new contributions. Annual Review of Nursing Research, 37(1), 1-23.
Wehbe-Alamah, H., McFarland, M., Andrews, M., & Lograsso, S. (2019). An ethnohistory of the transcultural nursing scholars and their contributions to the field. Journal of Transcultural Nursing, 1.