Nursing Theory Analysis Presentation (1)
-
Upload
juliann-trumpower -
Category
Documents
-
view
96 -
download
1
Transcript of Nursing Theory Analysis Presentation (1)
{Madeleine Leininger’s
Culture Care TheoryClemson University
Nursing TheoryJuliann Trumpower
Background
• She is the founder of the theory of Culture Care/Transcultural Theory.
• She was the first nurse researcher to study the importance of culture in regards to individual health and caring behaviors.
• In her Sunrise Model the theoretical framework is depicted.
• The roots of her theory come from her extensive research and clinical practices with multiple different cultural groups.
• This theory has now developed as a discipline in nursing.
1948-Diploma in Nursing from St. Anthony’s School of Nursing
1950-BS in Biological Science from Benedictine College 1953-MSN from Catholic University, Washington D.C 1965-Ph.D in Anthropology from University of Seattle 1966-The first course of transcultural nursing was
available for nursing students at the University of Colorado.
Nominated for Nobel Peace Prize Author of 30 books and over 220 publicationsAfter 50 years of of study and research it is recognized as a major, relevant and dominant theory in nursing
Timeline of Madeline Leininger
In the mid 1940s she began to realize that the concept of care was an important aspect of nursing.
After WWII, She began to see increased immigration and began to notice behavioral differences and how this affected care.
She believed that a nurse’s inability to culturally understand their patient led to a significant decrease in the quality of care provided. Her theory states that providing care measures that are in harmony with an individual or groups culture, beliefs, practices and values are necessary for providing quality care.
Central purpose was to discover, document and explain diverse and universal culturally based care factors influencing health, well-being, illness or death.
Purpose of culture care theory
Framework is used to help nurses avoid ethnocentric assessments
Leininger used frameworks from anthropology as well as care constructs from a nursing approach.
Purpose was to improve the quality of nursing care by creating the first ever transcultural nursing theory based on research of both universal and diverse cultural phenomena.
Sunrise Model
Theoretical foundations
Care is the central focus of nursing Care is essential for health and well-being, illness
and dying Every culture’s health practices and behaviors can
vary and are to be valued. Care is the best way to describe role of a nurse.
Culture care is the best way to approach this role. Nursing care must include examination of cultural
and social structure, world view, values/beliefs, language, and environmental contexts (per sunrise model)
Culturally congruent care improves the health and well being
Theory and assumptions
“Im black, white, asian, fat, female and fury AND everyone loves me”
Culture and Care are two major constructs of Theory Care- those aiding, encouraging, and enabling acts or thoughts toward others with
obvious or anticipated needs which help improve life or lessen illness/distress.
Culture-learned, shared and transmitted values, beliefs, norms of a group that influence behaviors. It defines health, illness and the search for relief from disease or distress. Guides human decisions and actions
Culture Care- aspects of culture that influence or enable person to deal with illness/death. Culturally based care is essential for well-being, health, growth, survival or facing hardships and death.
Transcultural Care- practice focused on cultural care values, beliefs and practices of individuals or groups of similar or different cultures with goal of providing culture specific practices in order to promote health and wellness or deal with death and or illness.
Culture Care diversity and universality Differences in meanings, values or care of different groups of people common care or similarities among culture
Concept Definitions
Nursing- learned profession with a disciplined focus on care phenomenon
Worldview- personal view of meaning of life Health- state of well-being that is culturally defined and valued Emic- refers to an insider’s views of knowledge of the culture Etic- the outsider’s viewpoints of the culture and reflects more on
the professional angles of nursing Generic care- learned or passed down indigenous, traditional, or
folk knowledge and practices provided to improve well-being or help with illness, death or other human conditions,
Professional care-formal, cognitive knowledge and practices generally learned through educational instititutions.
Early nurse theorists focused on the four metaparadigms of person, environment, health and nursing. Dr. Leininger found these concepts limited, inappropriate, and inadequate to fully explain nursing and was greatly concerned with the fact that care and culture were not included in these metaparadigms.
Concept Definitions
{
{Culture Care Preservation and Maintenance
Culture Care Accomodation/Negotiation
Culture Care Repatterning and Restructuring
{States with laws mandating culture competence in healthcare
Despite advances in science, technology and pharmaceuticals, there remain great healthcare disparities amongst culturally diverse populations.
Estimated 33% of U.S. population made up of cultural minorities.
Research has shown that provider-patient communication is linked to satisfaction, ADHERANCE to medical instructions, and health outcomes
Culture competence improves outcomes and quality of care while reducing health care disparities
Changes in healthcare laws have changed the traditional “fee for service”, to reimbursement based on outcomes and quality.
Comprehensive, holistic and culturally sensitive care develops trust
Application to Nursing
Many cultures studied in depth over last 50 years using Leininger’s theory.
More Research needed to determine how culturally competent care affects outcomes and disparities. Need for empirical data.
National Institute of Health (NIH) and Agency for Healthcare Research and Quality (AHRQ) and other groups have increased funding for cultural education and research
New areas of research importance Lesbian, Gay, Bisexual and Transgender- huge disparities
in healthcare and unique healthcare needs that go unaddressed
Adolescent culture- Active listening, use of peers Refugee- influx of refugees, many with PTSD as rape and
torture common war tactic
Research
“have you decided on a birth control method for after the baby is born”
Doctor refused to treat daughter of lesbian couple, while unethical- it is
NOT illegal!
Research indicates nursing faculty not adequately prepared to teach culture care or mentor in cultural sensitivity
Need for broad holistic approaches and teaching strategies to promote student education and application to their nursing practice
Researchers agree transcultural nursing should be integrated throughout curriculum.
Transcultural education limited and varied between institutions..
2002 Laison Committee on Medical Education required culture competence integration into curriculum for accredidation of medical schools. As of yet, not required of nursing programs.
Need for unified conceptual teaching framework Immersion programs had best training outcomes
Education
Affordable Care Act- move from fee for service to reimbursement based on outcomes.
Hospitals and healthcare systems and practices can no longer survive without improving quality and outcomes which has necessitated addressing healthcare disparities amongst diverse groups and cultures
Private insurers such as Aetna, Blue Cross Blue Shield and Kaiser have developed initiatives toward culture competence in recognition of its relationship to improved quality and outcomes and decreased disparities
Federal government developed Health Disparities Coalition focused on addressing health disparities in community health clinics
Accrediting agencies such as the Joint Commission on Accredidation of Healthcare Organizations (JCAHO) exploring opportunities to track disparities and cultural competence
Administration