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Global Perspectives - Global Models
Transcript of Global Perspectives - Global Models
"What people need most to grow, remain well, avoid illnesses and survive or to face death is human caring." (Leininger, 1991)
For Leininger, what influenced her research work the most were the comments her patients fed back to her such as:
"It is you nurses that are helping me to get well."
"Nurses who give good
care really can make
the difference of how I
feel and whether I get
well or die."
"You give good care
talking to me, it helps
me get well."
"I could never have left this hospital without your good nurisng care."
Our rapidly growing multicultural world makes it imperative that nurses understand different cultures to work and function effectively with people having different values, beliefs and ideas about nursing, health, caring, wellness, illness, death and disabilities.
Leininger's Sunrise Model was born out of her love of anthropology - the discipline that focuses on human cultures worldwide.
The idea of linking care to culture was to many a strange idea in nursing.
Leininger realised that nurses relied too heavily on biophysical and psychological explanations for care, with virtually no awareness of how culture could influence both nursing and care.
She became convinced of the close relation between nursing and anthropology.
Out of this link she developed the field of "transcultural nursing".
Transcultural Nursing enables holistic, meaningful therapeutic quality care to be delivered within the framework of culturally aware nursing practice.
Nightingale's ideas (1859) on health, the individual and physical environment, were important to support theoretical perspectives but were not developed as formal nursing theory.
Hildegard Peplau was the first published nursing theorist since Florence Nightingale, she wrote extensively on interpersonal relationships in psychiatric Nursing.
Others such as: Virginia Henderson
None of these ever really emphasised the importance of culture care or transcultural nursing - this was left to the work of Madeliene Leininger (1925 - 2012)
In order to develop her theory of Culture Care she derived her ideas from a holistic nursing and anrthropological perspective of human beings living in different places and different ways for nurses to understand and work with people in the world.
Leininger predicted that nursing would become intensely multicultural in the 21st century because of the world wide changes that would bring people closer to each other.
For Leininger nursing needed to move from its long dependency on medicine and the medical model and come into its own as a recognised and legitimate discipline with a unique body of knowledge.
Nurses needed not only a holistic "biopscyhosociocultural" view but also a comparative view of cultural differences and similarities as they worked with people in different environmental contexts and this idea was included in Leininger's theory.
For Leininger care was the essence of nursing and the central dominant and unifying focus of the discipline.
She felt that we could care better for people if we had an understanding of their cultural context and if nurses were prepared to be challenged to recognise and make appropriate changes in order to provide culturally congruent care
Anthropology - the science of humanity
The work of Boas and Malinowski in the late 19th and early 20th centuries, and more recently the work of Margaret Mead on gender equality and sexual liberation has put anthropology on the map and has been distinguished from other social sciences by its emphasis on in-depth examination of context, cross-cultural comparisons, and the importance it places on participant-observation, or long-term, experiential immersion in the area of research.
Margaret Mead quotes:
"Sister is probably the most competitive relationship within the family, but once the sisters are grown, it becomes the strongest relationship." (Mead M.)
Nobody has ever before asked the nuclear family to live all by itself in a box the way we do. With no relatives, no support, we've put it in an impossible situation.
Prayer does not use up artificial energy, doesn't burn up any fossil fuel, doesn't pollute. Neither does song, neither does love, neither does the dance.
Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.
The "Civilised" world has much to learn from the "Primitive" world.(Mead, M.)
Transcultural nursing is an essential aspect of healthcare today. The ever-increasing multicultural populations pose a significant challenge to nurses providing individualized and holistic care to their patients. This requires nurses to recognize and appreciate cultural differences in healthcare values, beliefs, and customs. Nurses must acquire the necessary knowledge and skills in cultural competency. Culturally competent nursing care helps ensure patient satisfaction and positive outcomes. (Maier-Lorentz, 2008)
Leininger wanted to bring the best of both worlds together - the folk, indigenous lay care system with the professional care system of the day so that people could seek and receive culturally congruent care.
If this did not happen she saw culture conflicts, noncompliance behaviours, cultural stresses, imposition practices and a host of other nursing care problems occuring.
If nurses had transcultural knowledge of many cultures, it would be possible to teach and provide care that was congruent with the people's lifeways, rather than use care by imposition or culture bound professional practices.
Some examples of culture care accommodation:
A chinese patient might express the need for herbal tea to ease a "nervous stomach"
Arab-Muslim families value total family participation when assisting a sick family member. For a sick Muslim child in hospital the mother is obliged and responsible to stay with him / her
In conceptualising the theory Leininger had three major phases:
1. Culture Care Preservation or Maintenance
2. Culture Care Accommodation and / or Negotiation
3. Cultural Care Repatterning or Restructuring.
Leininger, M.M., (1991)(Ed), Culture Care Diversity & Universality: A Theory of Nursing, National League for Nursing Press, New York.
John Bul Dau has experienced challenges in his life that most people never imagine. Born in war-torn Sudan, Dau is one of 27,000 "Lost Boys of Sudan," driven from their villages when the northern Arab government attacked the ethnic minority population of Southern Sudan in 1987. For the next five years, John Bul Dau led groups of displaced boys across Sudan for hundreds of miles facing starvation, disease, and violence.
What can we use to focus our attention to the detail of caring?
A conceptual model is a model made of the composition of concepts, which are used to help people know, understand, or simulate a subject the model represents.
Some Common Conceptual Models
"Success and Struggle is a package, a package that
can never ever be separated." (John Bul Dau)