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LEININGER'S CULTURE CARE THEORY EXEMPLAR

Leininger's Culture Care Theory Exemplar

Tammy Ransom Liberty University NURS 502 Dr. Crawford December 13, 2020

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LEININGER'S CULTURE CARE THEORY EXEMPLAR

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Leininger's Culture Care Theory Exemplar Nursing theory refers to practices that enable the nurse to clarify their values and beliefs about human health and process and pursuing an understanding of patient care approaches— allowing nurses to discern and evaluate their essential role in the healthcare setting. These theories serve as a tool for personal knowledge, reflection, reasoning, critical thinking, and effective decision making (Younas & Quennell, 2019). Nursing theories have proven valuable for guiding nursing practice and research across various cultures and nursing settings. An exemplar can be described as a model, ideal, or pattern that represents an example and is designed to increase understanding of particular content. Applying nursing theory and exemplar will entail reflecting on an important story of nurse-patient interaction in a clinical practice setting that reflects the nursing theory's important aspects. This paper aims to examine how a clinical experience in nursing practice reflects how Leininger’s Culture Care Theory addresses patient-centered and culture-specific care and highlights a nurse's journey in understanding the significance of culture on health and healing (McEwen & Willis, 2019). Overview of Leininger's Culture Care Theory With the advancement of travel, nursing has become a global profession, crossing several continents and encountering diverse cultures. Global health issues continue to transcend national boundaries. Global health issues require cooperation in response, planning, prevention, preparedness, and care that reflects health equity issues among nations. Global health issues force a broader understanding of how we are connected in today's world (Edmonson et al., 2017). Advances in science, technology, and social media have a powerful effect on individuals and society. As diversity in population has steadily increased, so have the challenges facing healthcare providers and healthcare consumers. Culture is defined as the values, beliefs,

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customs, traditions, and patterns of individual populations (Young & Guo, 2020). Learned behaviors and perceptions are passed down from generations. Not all those within the same ethnic groups may share the same cultural customs or religious beliefs. Diversity and linguistic challenges have become increasingly complex. Attempting to elicit a health history is vitally important but may be difficult due to linguistics. Leininger defined cultural diversity as a variable in care beliefs, meanings, patterns, values, symbols, and lifeways (Young & Guo, 2020). This array of variables increases the likelihood of miscommunication between patients and providers. Nurses should be sensitive and understand the patient's worldview, religion, economic status, political view, education, language, and health beliefs (Li et al., 2016). Healthcare providers need to acquire and enhance the ability to acknowledge and embrace cultural diversity. Leininger recognized in the 1950s that culture and care were two significant phenomena that nursing had not formally studied. Leininger's theory remains one of the oldest nursing theories and is the only theory explicitly focused on the close interrelationship of culture and care on well-being, health, and illness (Leininger, 2002). Leininger provided the first formal definition of transcultural nursing as an area of nursing that focuses on the comparative study and analysis of different cultures and subcultures concerning nursing and health-illness practices, beliefs, and values. Leininger's study has been used to generate scientific and humanistic knowledge to provide culturally specific care. Leininger had a vision that by the 21st century, there would be a transcultural nursing theory to guide nurses in the care of patients. The purpose of Leininger's theory is to help clinicians discover the interdependence of care and culture while noting the similarities between and among cultures (McFarland & WehbeAlamah, 2019). Leininger's theory is known for a holistic yet culture-specific focus to provide care to diverse cultures (Leininger, 2002). The goal of the theory is to direct nursing in providing

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culturally competent care that will contribute to the individual's well-being. Cultural and social structure factors are significant forces affecting care and influencing wellness decisions and patterns (McFarland & Wehbe-Alamah, 2019). The theory intends to produce knowledge regarding nursing care of individuals who place importance on their cultural heritage (McEwen & Willis, 2019). The key concepts discussed in Leininger's theory are culture, culture care diversities, and universalities related to culturally congruent care (McFarland & Wehbe-Alamah, 2019). Worldview and social factors greatly influence cultural care, meaning that knowing these factors is necessary to provide meaningful care. Other significant concepts are care, caring, emic view, etic view, culture care models, and worldview (McFarland & Wehbe-Alamah, 2019). Leininger's Culture Care Theory has four major tenants that are the undergirding of the theory. The first tenant is that culture-based care has diversities (difference or variables) and some universal (common) features (McFarland & Wehbe-Alamah, 2019). The second theoretical tenant is a worldview, and social structure factors influence cultural meaning, expression, and patterns in a different culture (McFarland & Wehbe-Alamah, 2019). Social structure factors include religion, economics, education, technology politics, emic and etic knowledge, and environment. The third theoretical tenant is that both generic (emic or insiders' view) and professional (etic) health factors in diverse environmental contexts greatly influence health and health outcomes (McFarland & Wehbe-Alamah, 2019). The fourth tenant is the conceptualization of the three major culture care decisions and action modes used to plan culturally congruent care for patients' health and well-being or help them face disabilities. This includes first assessing the social structure factors of the individual, family, or group. The

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clinician draws upon these findings and the patients' etic and emic health practices to develop a care plan. Leininger's theory offers an anthropological view that provides the following concepts: the close relationship between culture care across the continuum, emic and etic knowledge, comparative method, the historical perspectives of cultural groups, and cultures impact on patients' lives. Leininger's model requires that providers know patients' understanding of their culture, and there is a need for awareness of the provider's outsider understanding (Botelho & Lima, 2020). Exemplar My Encounter with O.M. Knowledge of immigrants' mental health care beliefs and practices is needed to help mental health nurses, and providers understand the population to provide culturally congruent mental health care (Wolf et al., 2014). During my career as a psychiatric nurse, I have provided care for patients of many different cultures. There is a stigma associated with mental illness across most cultures. Many cultures rarely acknowledge that psychiatric problems and common treatments have been ineffective. After spending many months on a burn unit, my first encounter with O.M. occurred after she was admitted to the behavioral health unit. O.M. had suffered 3rd-degree burns over the majority of her body after attempting suicide. O.M. had placed a chemical on her body, lit a match, and had been on fire when bystanders intervened. The burns had resulted in the disfiguration of her body. She had lost her fingers and ears. During her stay on the burn unit, she had multiple skin grafts. O.M. had suffered from auditory hallucinations for years and was later diagnosed with schizophrenia. O.M. had not received any prior treatment before her admission. Over the next few months, O.M will be admitted involuntary several times. Over the months of

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caring for her, I realized that she has very little social or family support because of the cultural views on mental illness. O.M.'s cultural heritage is Muslim. During the care of this Muslim patient, I was made aware of the belief that mental illness is an infliction caused by supernatural entities such as Jinn (demons), "black magic," or "evil eye." The Muslim belief is that mental illness, hallucinations, delusions, or disorganized thought processes are caused by devil possession. Supernatural causes of mental illness are caused by black magic, the evil eye, and envy, all of which invoke negative consequences, and in order to ward off these evil spirits, charms, markings, jewelry, and rituals are used to distract jealousy and envy. Also, during this Muslim patient's care, I became aware that mental illness stigmatization affects their treatment and personal family relationships. Families are often rejected and isolated for having an association with a mentally ill person, having addiction issues, or suicide attempt. The Islamic religion strictly forbids suicide. The stigma associated with mental illness leads to prejudice and discrimination regarding marriage, employment opportunities, education, healthcare, and housing. Due to the stigmatization, many Muslims will not seek treatment or delay treatment. Muslims often delay voluntary treatment, and treatment is not sought until it is critical or involuntary treatment. There is a fear that mental health professionals will impose their beliefs in Muslim culture and undermine Islamic beliefs. There is a strong emphasis on religious interventions such as reciting the Qur'an to cure emotional disturbance. To provide culturally competent care for my patient, I had to be aware of her beliefs and attempt to integrate the patient's culture into Western medicine to help her have a better outcome. Western medicine relies upon more diagnosis of mental illness and providing medication. Most Muslims do not believe that medication can cure mental illness.

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Culture care preservation and/or maintenance, culture care accommodations and /or negotiations, culture care repatterning and/or restructuring are three action decision care models unique to the culture care theory (Wolf et al., 2014). While receiving care, O.M. was given time for prayer, access to the Qur'an, and the patient was allowed time to assess concerns over Jinn or evil spirits (culture care preservation). Caring for a Muslim culture patient requires restructuring the behavioral health unit schedule to accommodate the patient's religious belief. This includes being aware of the patient's fasting culture from sunup to sundown during Ramadan, affecting meal distribution and medication administration times. Also, consulting with the pharmacy to be aware of any medication that may have pork derivatives would influence the patient's adherence to the medication regimen. Reading the Qur'an is not harmful to the patient and has the possibility of improved outcomes. These interventions were included in the patient's plan of care (negotiation and accommodation). It took time to build trust and respect with the patient to present education regarding mental illness and treatment options for improved patient outcomes (repatterning/restructuring). Application of Leininger's Theory Every culture has a wide range of beliefs, traditions, and even healing practices. Nurses need to bridge the gap between generic and professional nursing care to provide culturally congruent care. Nurses must also address their beliefs and traditions and be aware that others may share different values, beliefs, and traditions. Nurses must be aware of their own biases. Leininger's model provides three action modes that nurses can use to bridge care and provide care that respects a person's culture and beliefs. The preservation and maintenance approach refers to maintaining and preserving desirable and helpful values and beliefs. Many nurses in western culture focus on interventions

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that make changes with the belief that care should be based on professional nursing knowledge (McFarland & Wehbe-Alamah, 2019). Nurses need to be guided by caring models to consider what caring actions should be maintained or preserved. These generic caring practices should be maintained, supported, and even integrated into the plan of care. During the care of O.M., there were several cultural considerations to take into account. As we talk to the patients in behavioral health, we try to maintain eye contact to show active listening. During O.M's care, there was a need to consider the Muslim culture of not making direct eye contact. When making patient assignments, the attempt was made to avoid assigning a male nurse to care for the patient. Also, in the Muslim culture, the right hand is considered a clean hand, so administering medications or passing food trays, the right hand should be utilized. Culture care accommodations or negotiations refer to the nursing care actions that help the patient from particular cultures negotiate with others in the healthcare setting to attain the shared goal of optimal health outcomes. As a nurse, it is essential to acknowledge a patient's unique cultural beliefs regarding health and emphasize the importance of accommodating new health behaviors to improve recovery. Acceptance of mental health care can help decrease stigma and give patients a better sense of belonging, promoting better patient outcomes. On a behavioral health unit, many personal items are not allowed due to safety considerations. When caring for O.M. to help maintain her cultural heritage, some exceptions were made. This included allowing O.M. to have her hijab so that she could cover her head. Also, considerations were given to personal clothing in order to help O.M. maintain modesty. Also, male staff and physicians were asked to knock before entering the room to allow the patient time to ensure modesty.

LEININGER'S CULTURE CARE THEORY EXEMPLAR Culture care repatterning or restructuring refers to therapeutic actions that are taken by culturally competent nurses. These actions help a patient modify personal health behaviors toward beneficial outcomes while respecting its own culture. Nurses' understanding of the cultural background and their attitude toward western medicine and mental health is vital in delivering mental health care. During the care of O.M., it was important to help her understand her illness and the importance of taking medications. Unfortunately, with O.M., she did not always adhere to her medication regimen once discharged, which has led to multiple readmissions. There has been attempts to involve the family in her care, but with the stigma of mental illness in the Muslim culture, her family has decided not to contact the patient. Despite multiple attempts, there remain obstacles in repatterning or restructuring her lifeways for a more beneficial health pattern. Conclusion Madeline Leininger's culture care theory, with the central focus being on communication and care demonstrated by the nurse, actively synthesized and incorporate the patient's cultural beliefs, values, and backgrounds in every step of the nursing process. It is a holistic, compassionate care theory in nursing that has a lasting impact on the nursing practice and is valued worldwide. It influences nursing care practice by considering cultural differences, resulting in cultural sensitivity, cultural awareness, and cultural competence. The theory reflects nursing values and helps nurses gain fresh insights about care, health, and well-being in a culturally appropriate manner. Ignoring unique individual cultural interpretation, beliefs, and practices of diverse health related issues prevent providing culturally competent care. Incorporating emic care beliefs and practices in etic plan of care facilitates the delivery of care that addresses professional standards while tending to the patient's cultural-specific needs of

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LEININGER'S CULTURE CARE THEORY EXEMPLAR diverse cultural backgrounds. Bridging emic and etic care beliefs and practices through Leininger's Culture Care Theory promotes culturally congruent care and leads to increased patient satisfaction, improved patient cooperation, and a faster recovery.

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References Botelho, M., & Lima, C. A. (2020). From cultural competence to cultural respect: A critical review of six models. Journal of Nursing Education, 59(6), 311–318. https://doi.org/10.3928/01484834-20200520-03 Edmonson, C., McCarthy, C., Trent-Adams, S., McCain, C., & Marshall, J. (2017). Emerging global health issues: a nurse's role. Online Journal of Issues in Nursing, 22(1). https://doi.org/10.3912/OJIN.Vol22NO01Man02 Leininger, M. (2002). Culture care theory: A major contribution to advance transcultural nursing knowledge and practices. Journal of Transcultural Nursing, 13(3), 189–192. https://doi.org/10.1177/10459602013003005 Li, J., He, Z., Luo, Y., & Zhang, R. (2016). Perceived transcultural self-efficacy of nurses in general hospitals in guangzhou, china. Nursing Research, 65(5), 371–379. https://doi.org/10.1097/nnr.0000000000000174 McEwen, M., & Willis, E. M. (2019). Theoretical basis for nursing-with access (5th ed.). Philadelphia, PA: Lippincott-Raven Publishers. McFarland, M. R., & Wehbe-Alamah, H. B. (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. https://doi.org/10.1177/1043659619867134 Wehbe-Alamah, H., & McFarland, M. (2020). Leininger's ethnonursing research method: Historical retrospective and overview. Journal of Transcultural Nursing, 31(4), 337–349. https://doi.org/10.1177/1043659620912308

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Wolf, K. M., Zoucha, R., McFarland, M., Salman, K., Dagne, A., & Hashi, N. (2014). Somali immigrant perceptions of mental health and illness. Journal of Transcultural Nursing, 27(4), 349–358. https://doi.org/10.1177/1043659614550487 Younas, A., & Quennell, S. (2019). Usefulness of nursing theory‐ guided practice: An integrative review. Scandinavian Journal of Caring Sciences, 33(3), 540–555. https://doi.org/10.1111/scs.12670 Young, S., & Guo, K. (2020). Cultural diversity training: the necessity of cultural competence for health care providers and in nursing practice. The Health Care Manager, 39(2), 100–108. https://doi.org/10.1097/HCM.000000000000294...