What is are the importance of culture care theory in the nursing profession?

13. The ethnonursing qualitative research method provides an important means to accurately discover and interpret emic and etic embedded, complex, and diverse Culture Care data (Leininger, 1991b, pp. 44-45).

Because within every cultural group there is a wide range of beliefs, traditions, and even healing practices, it is important to “bridge” generic and professional nursing care in order to provide “culturally congruent” care (Sagar, 2011, pg. 10). With that being said, it is important for nurses to evaluate their own values, beliefs and traditions and become aware that others may share different values, beliefs and traditions. As Sagar indicates, Leininger’s model provides three action modes nurses can use to help bridge care and provide care to someone with respect to their individual beliefs, cultural background, and values.  These modes are used in a variety of clinical settings:

·        Preservation and Maintenance Approach: this refers to the choices that would “maintain and preserve desirable and helprul values and beliefs” (Sagar, 2011, pg. 4). An example would be to encourage direct care such as bathing, feeding, and other activities of daily living by family members who may be interested in actively contributing in the care of a loved one (Sagar, 2011, pg. 11).

·        Negotiation and Accommodation: this is helpful in “adaptation and transaction for care that is fitting for the culture of the individual, families or groups” (Sagar, 2011, pg. 4). An example would be when a nurse teaches a Filipino American patient that although garlic may lower his blood pressure, he still needs to take the antihypertensive medications that are prescribed (Sagar, 2011, pg. 11).

·        Repatterning or Restructuring: this involves working with the individual in a “mutual decision-making process as the nurse modifies or changes the nursing action to achieve better health outcomes” (Sagar, 2011, pg. 4). The nurse sets mutual decisions with the patient to use change or modification in the care plan to achieve improved health outcomes. An example is when there is a patient who does not believe that they need an advance directive because “death is up to God.” The nurse can educate her about having her wishes followed when she can no longer make decisions or speak for herself.  Explaining that by creating advance directives, her wishes will be followed (Sagar, 2011, pg. 11).

Each of these modes can be seen on a daily basis in nursing care as nurses become more and more in tune with the numerous cultural differences that exist in the world. Nurses are learning that taking a holistic approach and not just focusing on the one illness or injury, but also how the patient perceives the illness or injury, their beliefs about the healing process, their environments and support systems in place they can provide enhanced and more patient centered care.

 

From Victoria's Perspective:

I have worked in many different roles since becoming a nurse, from working in an Emergency Room, Occupational Health, Assisted Living, and now in managed care working as a telephonic case manager for an insurance company in High Point, NC.  In all of my experiences, assessing for cultural beliefs and needs has always been an integral part of my role. As a case manager, I now talk with people all over the United States, from many different cultural backgrounds and beliefs and it is vital that as a nurse, I assess for those pieces so that I can best meet my patients where they are.  With every new person I contact, a brief cultural assessment is always a part of my initial assessment. We ask if there are any religious or cultural beliefs that may affect their care. Sometimes I may have to explain the question, but once in a while, I have come across people who have beliefs that do affect their overall health. I wanted to share one example because it was really rewarding for me, although I did not know that I had made an impact until a few weeks after I had transitioned her to another case manager. This particular patient had become sick and was hospitalized and needed IV antibiotics. I received her once she admitted to a skilled nursing facility and began working with her. Her family was from Trinidad and they have strong beliefs in voodoo. She was not in a good position with her family and believed that they had used voodoo to make her sick. She became very depressed and sobbed to me on the phone one day talking about how sick she was and that she did not know how she would get better. In using motivational interviewing and reflective listening, I worked with her one on one and encouraged her to continue with the IV antibiotics. During that time, I was using what Leininger calls “accommodation and/or negotiation” although I was not aware at the time that was what I was doing.  Unfortunately, she had to go back into the acute hospital for something else and I transitioned her back to a complex case manager. Several weeks later, her behavioral health case manager approached me and told me that my patient had wanted her to tell me how much she appreciated everything I had done for her, mostly just listening. To me, I cannot imagine not providing culturally competent care, because it has always been instilled in me. However, if I had not been culturally sensitive to my patient, I could have easily said she was wrong and that voodoo did not make her sick. But I would not have had the same relationship with her and I would not have helped her to continue to take the antibiotics that eventually did make her well enough to return home. 

From Meagan's Perspective:

I work in the Surgical Trauma ICU at a hospital in Charlotte, NC.  Charlotte is a melting pot of cultures and ethnicities and our hospital deals with this on a daily basis. Elements of the transcultural nursing model are easily observed on a daily basis.  Upon admission, the nurse goes through an admission history with either the patient or the patient’s family.  Part of this initial assessment includes assessing the patient’s religious preferences.  Along with this, the patient is offered to have someone from pastoral care come by during their stay.  Our pastoral care is made up of a diverse group of pastors, priests, rabbis, and spiritual leaders from many different religions.  Someone from pastoral care is always in the hospital to be available at any given time.  However, arrangements can easily be made to have someone from the patient’s specific belief system come to visit.  Another way that transcultural care is observed is through certified-interpreters.  We have interpreters in house 24 hours a day.  Often we have patients who speak English as a second language or speak little to no English.  Having interpreters in the building or available by telephone conference allows the patient to have the opportunity to have their plan of care or procedures explained to them in their own language.  The hospital that I work at also thrives on family-centered care.  We take into account that certain cultures depend on the care of their family members during times of illness.  We allow the family to be as involved in the day to day care of the patient as is possible.  It is also encouraged for them to bring in things of significance to decorate the patient’s room, in order to make the patient feel like they are in a more familiar setting.  Transcultural nursing really depends on more than just the nursing team in the clinical setting.  However, the nurse is the one who interacts with the patient and family the most and must have an open mind about those that are different from themselves in order to provide the best care for the patient.

What is the goal of Leininger's theory of cultural care?

What is a culture of caring in nursing?

Why is it important to consider culture in healthcare?

What is transcultural nursing and why is it important?