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Culture Care Theory Diversity and Universality

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supatha peters

on 5 December 2014

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Transcript of Culture Care Theory Diversity and Universality

Madeleine Leininger
Culture Care Theory: Diversity and Universality
Making quality care universal
Motivation for theory
Purpose and Goal
Main Concepts and definitions
5 Major Assumptions of the Theory
Other Assumptions of the Theory
Usefulness of theory in nursing practice
Examples of Practical Applications
Austin Peay State University
Supatha Peters
Testability of theory
Very useful and practical due to its broad, holistic, culture-specific focus that uncovers meaningful care to different cultures producing better health outcomes and understanding

Used by nurses worldwide and other health-related disciplines and specialties
Assists in creating very strong interpersonal relationships between nurse and person or group
Research findings have provided new teachings, a knowledge base, and protocols that assists in preparing nurses in education and in practice to ensure cultural competence when caring for diverse cultures
Theory has provided new terms and concepts that have and are being used by other nursing theorists

Important Events of 1950's
The Civil Rights Movement begins
and peaks in 1960s
New Technologies (computers, electronic communication, and rapid transportation) and increase in television in every home
Television contributed to a shared experience influencing accepted social patterns
Marilyn Monroe
The years after WWII produced the generation of Baby Boomers
I love Lucy
Madeleine Leininger begins to formulate the Theory of Culture Care in the mid-1950s focusing on care that was cultural-specific

The theory was conceived while studying children in a psychiatric hospital as a clinical nurse and questioned herself on how she can give relevant, meaningful, congruent care unless she understood their cultural background. She noted that there were reoccurring behavior patterns that were derived culturally.

She observed those reasons in nursing (described in previous slide) and named them as factors that also influenced her research

Recognized that nursing care needed cultural knowledge

Important Events in nursing
Care and Culture were two important phenomena that was not valued enough to be studied and was missing in nursing as essential concepts
Nursing was taking care of physicians orders, treatments, and tasks and lacked research-based knowledge in culture
World was becoming more multicultural and nurses were found treating more patients with diverse backgrounds and cultures due to increase in migrants, refugees, and those displaced
More meaningful and sound care involving culture needed to be known and respected
Growing cultural conflicts and ignorance, racism, and ethnocentrism in nursing practice
U.S. moved from isolationism to global functionalism (international relations)
First nurse-anthropologist

Received her PhD in anthropology which was inspired by work with children

Uses concepts and themes derived from nursing and anthropology to develop the Theory of Culture Care
Diversity and Universality also known as the Transcultural Nursing Theory

Mother of transcultural nursing

"Care is the essence and heart of nursing" and has meaning within cultural contexts

Madeleine Leininger
Relationship between concepts
Research generated by theory
Broad and holistic
Allows recognition that caring is a universal concept but varies among cultures
Provides an awareness of cultural sensitivity and decreases ethnocentrism which has no place in nursing/caring
Treats patients as a unique individual
Highly applicable to the nursing practice
Can and has been used by a variety of nurses/nursing theorists and disciplines around the world
Several concepts and terms have come from this theory
Has developed a discipline for nursing
Complex and lengthy theory and can be misunderstood or difficult to use
Theory can be misused by assuming that people can be categorized, rather than recognized by uniqueness and individualized, by virtue of race, culture, and ethnicity
Assume that aspects of certain cultural group are true for every patient who belong to that racial, ethnic, or cultural group (stereotyping and generalizing)
Can be a major cause of error in clinical decision making by misperception of patient values and beliefs

1. Care is the essence of nursing and the distinct, dominant, and unifying focus in nursing
Care - phenomena related to the ways others are helped to improve health, lifeways, or other conditions

Caring - the universal phenomena in which actions and decisions improve health, conditions, or lifeways and varies transculturally

Culture - learned, shared, and generationally transferred values; beliefs; and customs, patterns, and practices (lifeways) that are held by an individual/group that may impact health and illness or disabilities

All cultures are not alike and all individuals that fall within a cultures is not alike. Each person is unique and is an individual. All cultures have practices related to care.
6. All cultures have generic (lay, folk, or indigenous) care knowledge and some have professional care practices that varies
7. Culture care values, beliefs, and practices are influenced by and tend to be embedded in worldviews, languages, philosophy, religion (and spirituality), kinship, social, political, legal, educational, economic, technological, ethnohistorical, and environmental context of cultures and are essential in providing cultural congruent care.
8. Nursing requires knowledge of different cultures to provide culturally congruent care

Focuses on comparative aspect of caring by acknowledging similarities (universalities) and differences (diversalities) amongst different cultures and the way they relate to health, well being, illness, and death

"The goal is to provide culturally congruent care using one of three modes of nursing care actions/decisions that will contribute to the health and well being of people, or help face death or disabilities" (Leininger, 1997a)
Case Study
I have used this theory in my nursing practice and will continue to use it in my advanced practice because providing care that is culturally competent or congruent is respecting the patient and caring for them holistically in their totality. The Cultural Care Theory is broad and uses a qualitative approach making it comprehensive in scope. It is applicable in all care settings.

Being mindful of and combining patient's life ways, beliefs, and values with professional nursing care is what caring is all about
Culture care meanings of African American parents related to infant morality and health care by Coleman (2009)
Puerto Rican women's perceptions of heart disease risk by Lange, Evans-Bernard, Cooper, Fahey, Kalapos, and Tice (2009)
Leininger proposes that there are three modes to be considered and used to guide nursing care decisions and actions to provide culturally congruent care that is culturally sensitive, beneficial, meaningful, respectful and tailored to the care recipient
Cultural preservation/maintenance
The Sunrise Model/Enabler
Three modes of action/decision that guides nurses to meet care needs
Health systems that help discover different types of care/care patterns in culture
arrows means they influence each other
Leininger did not support the four nursing metaparadigm concepts of person, environment, health, and nursing stating the terms are limited and culture bound, can not explain a term by the same phenomenon and they are not distinct to nursing (Leininger, 1997).

"A learned humanistic profession and discipline that is focused on cultural care, holistic knowledge, and competencies to assist individuals or groups to maintain or regain their health (well-being) or to deal with life/death in meaningful ways" that are congruent with values, beliefs, and lifeways
(Leininger, 1997)
Her thoughts on the four nursing metaparadigm
Nurse practice that helps retain/preserve relevant care values held by certain cultures to maintain well being, recover from illness, or face handicaps and/or death
Culture Care Accommodation or Negotiation
Nursing actions that adapt to accommodate culture or negotiates care with others for a beneficial or satisfying health outcome with providers
Excluding pork or pork derivatives such a gelatin from a person who is Muslim's tray
Alter medication schedule so patient can fast or providing interpreters for non-English speaking clients or Native American wishing to incorporate tribal healer's rituals into care
Explaining harmful effects of smoking water pipes or cigarettes to those who practice this tradition or using lemon drops to whiten eyes
Culture Care Repatterning or Restructuring
Nursing practice that help a client to change cultural practices to more healthier and beneficial patterns while respecting values and beliefs
Provide foods that are "hot" for illnesses which are considered "cold" for someone with Chinese background
Three Theoretical Modes
Hundreds of studies developed
Used to...
Study cultural implications of different health problems
Identify cultural groups' characteristics that influence health
Provide cultural awareness in nursing education (non-research)
Study Using Culture Care Theory
Long, Sowell, Bairan, Holtz, Curtis, & Fogarty (2012) studied type 2 diabetes in four different Latino subgroups using focus group methodology to find insights into each group's cultural health beliefs. Using questionnaires and focus group sessions, they were able to find similarities, but more differences between the groups of Colombians, Mexicans, Puerto Ricans, and Mayan. By using Leininger's Culture Care Diversity and Universality theory to guide their research, they were able to obtain data that allowed them to deduct that shorter educational material that were preferably in their language would be more beneficial to these groups as well as an interpreter. An optimal provider would be one that respects and understands their culture and would promote their adherance to treatment.

Cardiovascular disease in the Amish: An exploratory study of knowledge, beliefs, and health care practices by Gillum, Staffileno, Schwartz, Coke, Fogg, & Reiling (2011)
Native Hawaiian attitudes of culturally sensitive healthcare provider traits and behaviors by Vogler, Altmann, and Zoucha (2010)
In this multicultural world, nurses provide care to a number of patients with diverse backgrounds, values, beliefs, and cultures. Madeleine Leininger's Cultural Care Theory can be tested and used on every patient the nurse encounters as well as use it as a framework for research.
"The purpose is to discover, document, interpret,and explain the predicted and multiple factors influencing and explaining care from a cultural holistic perspective" (Leininger, 1997a)
(All other professionals)
Refers to individuals, families, groups, total cultures and communities/institutions

Whichever is appropriate within cultural context
A conceptual guide used to systemically study dimensions of the theory to identify beliefs, values, and behaviors and is a useful tool in practice
The relationship and structure between the concepts in the culture care theory is presented in Leininger’s sunrise model/enabler

Leininger, 2002, p. 192
2 types of care systems all cultures have:

1. Folk (lay/generic/traditional/indigenous) oldest modes of caring in the world
2. Professional system-school or evidence-based knowledge
Both care systems together create nursing and molded with nursing care can produce beneficial and meaningful care to different cultures
The nurse and individual/group partner up to identify, plan, and implement each caring mode for culturally congruent care
Instead she held that care (considered in culture context) is central and unique to nursing and explains it

She does however define nursing, health, person, and environment
2. Culture care is the broadest, holistic means to know, explain, interpret, and predict beneficial nursing care and guide decisions and actions
3. Culture based care is essential for the well being, health, growth, and survival of individuals and for facing death or disabilities
4. Curing and healing needs to have culturally based caring--there is no curing without caring but you can have caring without curing
5. Culture care concepts, meanings, expressions, patterns, processes, and structural forms vary transculturally with diversities (differences) and some universalities (commonalties)
Crusade against communism:The Cold War & TheRed Scare
Leininger observed....
Leininger uses "environmental context" which refers to an event or life experience in a environmental setting (physical, social, political, etc) including their attached meanings and interpretations that guide decisions and behaviors
the state of well being that is defined, valued, or practiced culturally by individuals or groups
well being, illness, disability, handicap
An individuals worldview and culture is influenced or made up of social structure, technological factors, religion, kinship/social, political, economics, education, ethnohistory.

All of these are factors that influence environmental context and language

In turn, environmental context and language influences health and well being
If nurses can understand patterns, meanings, and processes of individuals or groups, one can predict health/wellbeing
A 36 year old Muslim woman is staying in the hospital and does not speak English. This was her first day. At shift change, the day shift nurse reports that the patient had not touched any of her food trays all day and figured she just did not feel like eating her breakfast and lunch tray. Upon entering the room, the nurse notices her dinner tray was left untouched also. The nurse pushes the tray towards the women and tells her that it is important that she eats it in order to heal. The patient pushes the whole table away. The nurse begins to question why the patient will not eat.
Looking at the tray, the nurse realizes that there was a grilled pork chop. Realizing that Muslim's do not eat non Halal foods, or foods that are not allowed or prepared/killed a certain way the nurse removes the tray. The nurse would use cultural preservation/maintenance to preserve her cultural beliefs and would use cultural accommodation to allow a family member to bring in Halal prepared foods or call the kitchen to make other arrangements.
Initiating and sustaining breastfeeding in African-American women by Lewallen & Street (2010)
(for knowledge)
(to provide care)

Care/Caring is what should describe nursing
Culture care- culturally influenced actions that guide nursing practice/interventions that improve health or well being or assist in dealing with death or disabilities

Culture care diversity- differences in cultural-based meanings, patterns, values, or lifeways

Culture care universality-similarities or commonalities in cultural-based meanings, patterns, values, or lifeways

Culturally congruent care- Tailored nursing interventions (actions/decisions) related to 3 modes of care: preservation/maintenance, accommodation/negotiation, and/or repatterning/restructuring
Main Concepts and definitions
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retrieved from youtube
Full transcript