Question

CASE STUDY: Theresa is a nursing student who recently completed a nursing theory course. Her current course requires clinical rotations at a local hospital on an oncology unit. Her assigned patient is a 40-year-old Hispanic male with inoperable cancer lesions throughout his organs. During her care, she explores the patient's feelings of faith and hope in relation to the medical diagnosis. She spends a lot of her time at the bedside holding the patient's hand, establishing a relationship with him, and meeting his care needs. Theresa asks the patient about his cultural beliefs and how they affect his perception of nursing care.

Describe how Theresa applied aspects of Watson's theory of human caring to her nursing care of her patient.

How would you apply Leininger's culture care theory to the care of Theresa's patient?

Compare Watson's and Leininger's theories in regard to their definitions of person, nurse, health, and environment. What is similar? What is different?

Which type of theory level (grand theory, middle range theory or abstract theory) is Watson’s theory? Which type of theory level is Leninger’s theory?

Answer 1

CULTURE CARE THEORY

Early in her career, Madeleine Leininger recognized the importance of the element of caring in the profession of nursing. Through her observations while working as a nurse, she identified a lack of cultural and care knowledge as the missing component to a nurse’s understanding of the many variations required in patient care to support compliance, healing, and wellness.

Leininger’s Culture Care Theory attempts to provide culturally congruent nursing care through “cognitively based assistive, supportive, facilitative, or enabling acts or decisions that are mostly tailor-made to fit with individual, group’s, or institution’s cultural values, beliefs, and lifeways.” The intent of the care is to fit with or have beneficial meaning and health outcomes for people of different or similar culture backgrounds.

Culturally congruent care is possible when the following occurs in the nurse-patient relationship: “Together the nurse and the client creatively design a new or different care lifestyle for the health or well-being of the client. This mode requires the use of both generic and professional knowledge and ways to fit such diverse ideas into nursing care actions and goals. Care knowledge and skill are often repatterned for the best interest of the clients. Thus all care modalities require coparticipation of the nurse and clients (consumers) working together to identify, plan, implement, and evaluate each caring mode for culturally congruent nursing care. These modes can stimulate nurses to design nursing actions and decisions using new knowledge and culturally based ways to provide meaningful and satisfying wholistic care to individuals, groups or institutions.”

Leininger’s model has developed into a movement in nursing care called transcultural nursing. In 1995, Leininger defined transcultural nursing as “a substantive area of study and practice focused on comparative cultural care (caring) values, beliefs, and practices of individuals or groups of similar or different cultures with the goal of providing culture-specific and universal nursing care practices in promoting health or well-being or to help people to face unfavorable human conditions, illness, or death in culturally meaningful ways.”

Leininger developed new terms for the basic concepts of her theory. The concepts addressed in the model are:

• Care, which assists others with real or anticipated needs in an effort to improve a human condition of concern, or to face death.
• Caring is an action or activity directed towards providing care.
• Culture refers to learned, shared, and transmitted values, beliefs, norms, and lifeways to a specific individual or group that guide their thinking, decisions, actions, and patterned ways of living.
• Culture Care is the multiple aspects of culture that influence and help a person or group to improve their human condition or deal with illness or death.
• Culture Care Diversity refers to the differences in meanings, values, or acceptable forms of care in or between groups of people.
• Culture Care Universality refers to common care or similar meanings that are evident among many cultures.
• Nursing is a learned profession with a disciplined focus on care phenomena.
• Worldview is the way people tend to look at the world or universe in creating a personal view of what life is about.
• Cultural and Social Structure Dimensions include factors related to spirituality, social structure, political concerns, economics, educational patterns, technology, cultural values, and ethnohistory that influence cultural responses of people within a cultural context.
• Health refers to a state of well-being that is culturally defined and valued by a designated culture.
• Cultural Care Preservation or Maintenance refers to nursing care activities that help people from particular cultures to retain and use core cultural care values related to healthcare concerns or conditions.
• Cultural Care Accommodation or Negotiation refers to creative nursing actions that help people of a particular culture adapt or negotiate with others in the healthcare community in an effort to attain the shared goal of an optimal health outcome for patients of a designated culture.
• Cultural Care Re-Patterning or Restructuring refers to therapeutic actions taken by culturally competent nurses. These actions help a patient to modify personal health behaviors towards beneficial outcomes while respecting the patient’s cultural values.

The theory’s culturalogical assessment provides a holistic, comprehensive overview of the client’s background. The assessment addresses the following:

• communication and language
• gender considerations
• sexual orientation
• ability and disability
• occupation
• age
• socioeconomic status
• interpersonal relationships
• appearance
• dress
• use of space
• foods and meal preparation and related lifeways

Leininger proposes that there are three modes for guiding nurses judgments, decisions, or actions in order to provide appropriate, beneficial, and meaningful care: preservation and/or maintenance; accommodation and/or negotiation; and re-patterning and/or restructuring. The modes have greatly influenced the nurse’s ability to provide culturally congruent nursing care, as well as fostering culturally-competent nurses.

Leininger’s model makes the following assumptions:

1. Care is the essence of nursing and a distinct, dominant, and unifying focus.
2. Caring is essential for well-being, health, healing, growth, and to face death.
3. Culture care is the broadest holistic means by which a nurse can know, explain, interpret, and predict nursing care phenomena to guide nursing care practices.
4. Nursing is a transcultural, humanistic, and scientific care discipline and profession with the central purpose to serve human beings worldwide.
5. Caring is essential to curing and healing. There can be no curing without caring.
6. Culture care concepts, meanings, expressions, patterns, processes, and structural forms of care are different and similar among all cultures of the world.
7. Every human culture has lay care knowledge and practices and usually some professional care knowledge and practices which vary transculturally.
8. Culture care values, beliefs, and practices are influenced in the context of a particular culture. They tend to be embedded in such things as worldview, language, spirituality, kinship, politics and economics, education, technology, and environment.
9. Beneficial, healthy, and satisfying culturally-based nursing care contributes to the well-being of individuals, families, and communities within their environmental context.
10. Culturally congruent nursing care can only happen when the patient, family, or community values, expressions, or patterns are known and used appropriately, and in meaningful ways by the nurse with the people.
11. Culture care differences and similarities between the nurse and patient exist in any human culture worldwide.
12. Clients who experience nursing care that fails to be reasonably congruent with their beliefs, values, and caring lifeways will show signs of cultural conflicts, noncompliance, stresses and ethical or moral concerns.
13. The qualitative paradigm provides new ways of knowing and different ways to discover the epistemic and ontological dimensions of human care.

The Culture Care Theory defines nursing as a learned scientific and humanistic profession that focuses on human care phenomena and caring activities in order to help, support, facilitate, or enable patients to maintain or regain health in culturally meaningful ways, or to help them face handicaps or death.

JEAN WATSON’S THEORY OF HUMAN CARING

Nursing is defined by caring. At Redlands Community Hospital, nursing has embraced the theory of Jean Watson’s Caring Science. Caring Science helps us to embrace the positive energy that flows from an integrated mind, body and spirit and is mutually rewarding to both the patient and the nurse. Forged by the vision of Florence Nightingale who asserted that the “role of a nurse is to put her patient in the best position to be able to self-heal”, nurses are optimally positioned to be the heart of healing. By actively engaging in caring through authentic presence and intentionality, the nurse is able to optimize her patient’s ability to heal from within.

How do we as nurses maintain emotional sensitivity and caring attitudes in an over-stressed and demanding workplace? Jean Watson contends that caring regenerates life energies and potentiates our capabilities. The benefits are immeasurable and promote self-actualization on both a personal and professional level. Caring is a mutually beneficial experience for both the patient and the nurse, as well as between all health team members. In addition, it is important to remember that Watson emphasizes that we must care for ourselves to be able to care for others; self-healing is a necessary process for rejuvenating our energy reserves and replenishing our spiritual bank.

Be the difference that makes the difference. It’s what you say and do, and how you say and do it. Caring, safeguards and affirms our humanity. It unveils our true thoughts, feelings, and attitudes and allows us to live more authentically in our relationships. Caring improves patient outcomes and customer satisfaction. It is contagious and infuses caring-energy into others. It invokes awareness and intuition. It is positive and inspirational. It is the wonder-glue of enduring relationships and human connectedness. Caring is what makes Redlands Community Hospital a special place!

- Excerpt from 2011 Nurses’ Day Celebration
Lauren Spilsbury, RN, MSN

Nurses at Redlands Community Hospital have selected Jean Watson’s Theory of Human Caring (Theory of Transpersonal Caring) as the foundation for their nursing practice.

According to Watson (1997), the core of the Theory of Caring is that “humans cannot be treated as objects and that humans cannot be separated from self, other, nature, and the larger workforce.” Her theory encompasses the whole world of nursing; with the emphasis placed on the interpersonal process between the care giver and care recipient. The theory is focused on “the centrality of human caring and on the caring-to-caring transpersonal relationship and its healing potential for both the one who is caring and the one who is being cared for” (Watson, 1996).

The structure for the science of caring is built upon ten carative factors. These are:

1. Embrace: Altruistic Values and Practice Loving Kindness with Self and Others
2. Inspire: Faith and Hope and Honor Others
3. Trust: Self and Others by Nurturing Individual Beliefs, Personal Growth and Practices
4. Nurture: Helping, Trusting, Caring Relationships
5. Forgive: and Accept Positive and Negative Feelings – Authentically Listen to Another’s Story
6. Deepen: Scientific Problem Solving Methods for Caring Decision Making
7. Balance: Teaching and Learning to Address the Individual Needs, Readiness and Learning Styles
8. Co-Create: a Healing Environment for the Physical and Spiritual Self which Respects Human Dignity
9. Minister: To Basic Physical, Emotional and Spiritual Human Needs
10. Open: to Mystery and Allow Miracles to Enter