Introduction
The nursing profession has been seen to be directed by diagnostic related groupings, measures of patient acuity, quality statements, and measures of the quality. The profession further has to deal with issues of staffing, cost effectiveness, educational advancement, retention, recruitment, image, professionalism and autonomy (Parker and National League for Nursing, 1990, p.1). Much about nursing practice is done with a lot of emphasis on management and economics to the neglect of the nursing of patients and clients. Using any theory in nursing, suggestion has been made that professionals in the field need to think, question, discuss, study, explore, task risk and through these they will be able to realize the caring and commitment that should be in accordance with nursing principles. In addition, nursing theory presents the practitioners of the nursing field with opportunity to ask various and relevant questions and as a result they become to conceptualize the nursing field more accurately. Therefore, this research work will look at nursing theory and how the nursing theory can provide guidance in many nursing practice situations.
Metaparadigms in nursing
Johnson defines metaparadigm as a concept that is very general and one that functions to give definition to the entire world of thought (Johnson, 2010). Jacqueline Fawcett (1984; cited in Johnson, 2010), in her famous work, “Analysis and Evaluation of Conceptual Models of Nursing” developed four main metaparadigms of nursing and which have come to serve in guiding the larger theoretical universe of the nursing profession (Johnson, 2010). The four metaparadigms are; person, health, environment and nursing.
Person
In nursing the metaparadigm of person is the patient who is subjective and unique not objective, predictable and calculating. The patient at the same time is considered to have distinct human needs which are biophysical, psychophysical, psychosocial and interpersonal (Johnson, 2010). More so, the patient needs to be valued, respected, nurtured, understood and assisted. The person at the same time functions as a whole whereby there is no division among the mind, body and spirit and they are influenced by external environment.
Environment
Environment is seen as a person’s significant others and the physical surroundings together with other settings in which nursing takes place. Environment is vital to the holistic healing that include; mental, physical, social, emotional, spiritual, developmental, protective and supportive environments which become conducive to a patient’s health and wellbeing. Furthermore, environment affects both patients and nurses within a caring-healing interaction. In most cases environment ranges from the patient’s home to the clinical agencies and to society as a whole (Johnson, 2010).
Health
Health can be viewed in holistic terms as the unity that connects physical, social, mental and spiritual self where all parts work interdependently. Health also is influenced by patient’s unique life experiences and in wholeness; health may include patient’s physical, social, aesthetic and moral realms and not only behaviors or physiology (Johnson, 2010).
Nursing
The metaparadigm concept nursing is seen as the actions that are taken by the nurses on behalf of the patient and at the same time the goals or outcomes of nursing actions. Johnson observes that, “it is an intensely ethical and emotional paradigm that goes to the root of nursing as a profession with its own set of rewards” (Johnson, 2010). At the same time nursing actions can be regarded to involve a thorough process of “assessment, labeling, planning, intervention and evaluation” (Songkham et al., 2006).
Cultural Care Theory
In mid-1950s, Madeleine Leininger was working as a child mental health clinical specialist when she discovered cultural differences among children. Caring for the children became a challenge especially considering the fact that the children were from different cultures and their behavior expectations and needs were totally different. To adequately offer help to these children, Madeleine discovered that she had inadequate education concerning cultural factors and to her observation, nursing field lacked adequate education to address the cultural factors influencing caring for children of different cultural backgrounds (Parker, 1993, p.108). Madeleine Leininger (1991) observed that nurses are living in a new age of human care services where they are greatly challenged to know, understand and provide effective care to people of diverse cultures in the world. As a result, Leininger (1991) suggested that nurses need to increase their knowledge and skills as they interact and work with patients from largely unknown cultures (cited in Parker, 1993, p.108). It is during this 21st century that Leininger (1991) noted that nurses need to be prepare to face the great challenges that are associated to intense multiculturalism as patients expects, demand, and protect their human rights derived from their cultural values, beliefs and practices (Parker, 1993). She developed her Culture Care Theory in mid-1950s and her belief was that all theories and practices should include culture with care in nursing.
The Theory’s metaparadigms
Person
The theory postulates that the idea of person should be understood within the culture since person is dependent to culture and this is evident mostly in non-Western countries. In this society a person belongs to family, community, institution and these agencies have a powerful role to influence the individual. Hence linear understanding of culture differentiating the meaning of person has the tendency to limit explanation in nursing.
Environment
The theory appreciates the concept of environment to nursing and uses the context features found in environment that are dictated by culture where each feature found in the environment is given different meaning and implication by different cultures.
Health
The theory postulates that health of an individual is a totality of cultural lifeways with respect to material and non-material cultural care phenomena. At the same time, the health of an individual is influenced by individual’s religion, kinship, political interests, economic views, educational experiences in accordance the individual’s culture.
Nursing
According to this culture care theory, nursing should be carried out within broad and holistic perspective with understanding on the part of the care giver that it is necessary to develop culturally congruent care that is derived from the specific culture the nurse is working in.
Level and scope of the theory
Upon its inception the theory has led to intense multiculturalism where different approaches and moral obligations to work with patients from different cultures have been suggested and adopted. Leininger writing about the theory in 1978 and 1990, noted that Culture Care and Diversity Universality theory is one of the major and relevant comprehensive theories in nursing that focuses on discovering human care modalities in different cultures in the world and that the theory has the potential to generate knowledge, insights and practices about many different or similar cultures in the world (Parker, 1993). At the same time the theory has been at forefront in providing the broadest and most holistic perspective to study human caring over time and in different places of the world where the main aim has been to develop culturally congruent care. Leininger also note that Culture Care Theory is much interested in the totality of cultural lifeways with respect to material and non-material culture care phenomena but it is the care derived from the religion, kinship, political interests, economic views, educational experiences that the theory has tried to address (Parker, 1993). Further the scope of Culture Care theory has presented nurses with an opportunity to discover differences and similarities about human care, health, healing, and well being of many of the unknown and known cultures in the world.
Assumptions of the theory
Assumptions of Culture Care theory were formulated within the context and deep commitment that nursing is caring and culture has an impact on care (Parker, 1993). Theoretical assumptions of the theory were derived partly from utilizing ethnonursing and ethnographic qualitative research methods about human care. Leininger postulated that theories were basically available to describe, explain, interpret and provide prediction about phenomena under a particular study.
Basically, Leininger formulated assumptions of this theory that included:
- care is the essence of nursing and a distinct, dominant, central and unifying focus;
- care is essential for well-being, health, healing, growth, survival and for facing handicaps or death;
- culture care is the broadest holistic means to know, explain, interpret and predict nursing care phenomena and in the process guide nursing care practices;
- nursing is a transcultural humanistic and scientific care discipline and profession, the central purpose of which is to serve human beings in the world;
- culture care concepts, meanings, expressions, patterns, processes and structural forms of care are different from and similar to all cultures of the world;
- every human culture has generic care knowledge and practices and usually professional care knowledge and practices which vary transculturally;
- cultural care values, beliefs, and practices are influenced by and tend to be joined in the world view, language, religion, kinship, political, educational, economic, technological, ethnohistorical and environmental context of a particular culture;
- beneficial, healthy, and satisfying culturally based nursing care contributes to the well-being of individuals, families, groups, and communities within their environmental context;
- culturally congruent nursing care can only occur when culture care values, expressions or patterns are known and used appropriately and meaningfully by the nurse with individuals or groups;
- culture care differences and similarities between professional care givers and patients with generic needs exist in human cultures worldwide;
- clients who show signs of cultural conflicts, noncompliance, stresses and ethical or moral concerns need nursing care that is culturally- based; and
- qualitative paradigm with naturalistic inquiry modes provides essential means to discover human care transculturally (Parker, 1993).
Analysis of the theory
Looking at the tradition of nursing field it becomes evident that nursing instruction, practice and research were before the creation of the theory heavily based upon medical diseases, pathologies, symptoms and the treatment of the disease, but this changed in a big way with the focus of human care as major phenomenon of nursing. Using the theory, Leininger worked in New Guinea in early 1960s and found that prevention of illness in this country was based on protective care. Cultural taboos, world views, environmental consideration and many social structure elements of kinship rules, spiritual beliefs and philosophy of life and culture values were seen to be more powerful means to prevent illness and remain well through caring expressions and patterns (Parker, 1993). During the same time, Leininger indicate that in two villages she worked in there were no psychoses, but at best mild expression of depression, sexual problems and intergenerational concerns were dealt with in an effective way through what she called, ‘culturally-based caring model’ (Parker, 1993) and the results were effective.
Evaluation of the theory
Many research studies have found out that culture manifest diversity than universality and as such an understanding of people’s culture is of great importance. Culture Care theory has been applied in many societies around the world, for instance in order to achieve culture congruent care, most nursing actions need to be planned in three modes: culture care safeguarding, culture care accommodation and culture care reorganization. In applying this theory nurses have been content with the fact that caring is common to all cultures and the process of becoming familiar of ones culture is of great importance in order to provide the best nursing care.
Conclusion
Nursing in 21st century is becoming more in acquiring wealth knowledge of care and hence it will become critical especially in teaching and guiding the nursing practice as whole. Culture specific and culture congruent are new terms that are related to culture care theory and which are providing help to nurses and enabling them realize that all cultures can be served with this ideas in mind. In essence, culture care theory has contributed to the discovery of knowledge concerning culture care diversity and universalities and the knowledge in turn has been used to guide, improve, and provide new kinds of nursing care.
References
Johnson, W. J. (2010). Four Basic Metaparadigm Concepts in Nursing. Web.
Parker, M. E. (1993). Patterns of nursing theories in practice. NY, Jones & Bartlett Learning. Web.
Parker, M. E. and National League for Nursing. (1990). Nursing theories in practice. NY, Jones & Bartlett Learning. Web.
Songkham, W. et al. (2006). Occupational Health and Safety Programs for Health Care Workers: An application of an Occupational Health Nursing Model. Occupational Health Nurses Society, Vol. 82, No. 4. Thailand, Chiang Mai University. Web.