The essential aspect of developing and delivering healthcare to the patients is to improve the outcomes in terms of efficiency of the process, enhancing the rate of recovery, and improving the quality of life for the patient. Cultural competence is an important aspect of the patients within a given community or society.
However, the major question is “how can a nurse or group of nurses and clinicians deliver patient-centered care to patients with different health beliefs, values, and practices that are in conflict with the guidelines of the medical and nursing care?
To answer the above question, it is important to examine the existing theories that explain how patient-cemented care can be provided to culturally different patients or patient groups. Leininger’s transcultural theory is perhaps the most effective approach to this problem from a cultural perspective. This paper answers the above question by identifying how Leininger’s theory can be used and applied to provide patient-centered care to Hispanic patients in the US.
Summary of the state of science
This section develops a comprehensive review of nursing literature in order to determine the state of science with respect to the multicultural approach of developing patient-centered care in the field of nursing, especially in the management of patients from different cultures in the US. The cumulative index for nursing and allied health (CINAHL) Database was used to identify research articles in the field of nursing, especially those pertaining to the provision of transcultural and patient-centered care to the patients. In particular, the articles focusing on the use of this approach to target and manage Hispanic patients were prioritized. In total, four research articles published between 2009 and 2014 in English were identified using the keywords “transcultural, cultural competence, Hispanic, patient, Madeline Leininger, care improvement’.
CINAHL Database. Woener, Espinosa, Bourne, O’Toole, and Ingersol (2009) carried out a study to examine the improvement of outcomes among Hispanic home care patients using the EXITO project. The researchers aimed at developing the model based on the existing Sunrise Enabler approach, a theory developed by Leininger. The researchers targeted the Hispanic population in a location. The sample population was 125 unduplicated patients receiving home-based care. Since the study was quantitative, statistical inferences were obtained using SPSS tool to determine the relationships between the cultural approach and the outcomes in terms of rates of acute hospitalization and frequency of emergence care visits. The results of the study indicated a negative relationship between the two variables. In addition, the study indicated that customer care, nursing, and patient satisfaction and medical amazement had a direct and positive relationship with the use of the model, which caused these variables to increase with the continued use of the model.
Gordon (2013) conducted research attempting to examine the effectiveness of the nurse’s awareness of Hispanic folk remedies and cultural beliefs about health care. The researcher used a focused group interview. The study was conducted based on an open discussion with the participants. The aim was to determine how the participants view issues such as healthcare, illnesses, and the remedies available to solve these issues. The study sample was comprised of 11 Hispanic women in a focus group. The discussion wanted to answer the question “how do Hispanic beliefs in healthcare affect the outcomes of healthcare practices?”
The researchers used qualitative data analysis to examine the outcomes of the focus group interview. The study had identified different types of 75 symptoms of different diseases as well as the available treatment statements.
The study indicates that a number of remedies are used among the Hispanic communities in home-based treatments.
Howell, Kochar, Saywell, Zollinger, et al (2014) carried out a study to measure the knowledge and use of herbs as medications among the Hispanics in the US. It also sought to determine the experiences of the community in terms of discussing the use of herbs with their physicians or nurses. The study targeted a group of Hispanic patients treating medications in urban healthcare facilities. The researchers worked with a study sample population of 620 individuals. Self-administered questionnaires were sent to the participants and received within three weeks. Statistical analysis was done to examine the awareness and knowledge of the herb used for medical purposes. Over 80% of the participants reported that they had used herbs for medical purposes. Hispanics who used Spanish and those who had been in the US less than 5 years were comfortable herb users. It was shown that more than 60% of the participants used herbs as drugs, but more than 56% were aware that the herbs have the potential to cause harm, especially when taken during pregnancy.
In addition, more than 50% of the participants stated that they had not informed their physicians or nurses about the use of herbs to treat certain diseases or injuries. Moreover, more than 97% of the participants were not able to recognize the English names of 23 out of the 25 types of herbs used in the assessment. The number of participants reporting that their physicians asked about the use of the herbs was only 17%, but only 1.8% thought that their nurses or physicians would appreciate the use of herbs for treating certain illnesses or injuries. Thus, the study concluded that a major role of the nurses or physicians is to find information about the patient’s cultural aspects in order to determine such things as the use of herbs. They are recommended to initiate and encourage effective discussion of the use of herbs among these communities. Therefore, this article shows that a major cultural belief among the Hispanic societies is the use of herbs as drugs for treating various conditions and diseases. In addition, the Hispanic culture of refusing to disclose or discuss the use of traditional interventions with other people, including the care providers.
Ryan and Twibell (2009) attempted to test the relationship between the nurses’ level of knowledge or awareness of cultural factors of the patients and the level of the patient outcomes in a hospital setting. The researchers used a quantitative study design with transcultural Nursing Immersion Experience Questionnaires (TNIEQ) to examine the relationship between the two variables in a sample population of 29 nurses in the US. The first section of the questionnaires examined the nurses’ knowledge of the dimensions of cultural aspects as indicated in the TNIEQ system. The second part had open-ended questions asking the participants to describe how the transcultural immersion experience changed them personally and professionally.
A multivariate analysis of the results indicated that nurses who are aware of the transcultural factors and how they are applied in practice had the highest degree of professional and personal change that related to better nurse-patient relationships and improved overall outcomes. This study is rated high in terms of its ability to test an already existing theory. It has tested the Leinginer’s transcultural theory of nursing and shown that the theory applies in practice.
Madeleine Leininger’s Transcultural theory of Nursing
Developed by Madeliene Leininger in the mid-20th century, the transcultural theory uses culture to understand the patient behavior. It is based on the observation that cultures differ significantly from each other (Leininger & McFarland, 2006). In addition, it states that cultures have a profound influence on all spheres of life. In healthcare, cultures define human health, diseases, illness and the process of searching for remedies to these problems. According to the theory, each cultural difference should be respected when providing healthcare. The theory further emphasizes on the need for cultural competence. Knowledge of the factors, attitudes and behaviors of a group of people allows nurses and practitioners to work in different cultures effectively and produce the required outcomes.
It affects the perceptions and attitudes towards diseases, care services and the overall outcomes of a healthcare delivery process. The essential feature of patient-centered care and cultural completeness is the importance of seeing each patient as a unique individual (Leininger, 2008). Cultural competence is an expansion of the patient-centered delivery of healthcare services. It refers to the set of necessary skills that clinicians and nurses must attain in order to provide effective and quality healthcare services.
The theory assumes that care is the central focus or the spirit of nursing. It also assumes that care is necessary for achieving the desired well-being of an individual.
Applying Leininger’s theory to improve patient outcomes among the Hispanics
An important aspect of the Hispanics in the US is the tendency to live as communities in urban areas, where they maintain their culture after immigration. Moreover, as indicated above, the belief in herbs as effective remedies is rampant among these communities, especially those from South America and Mexican rural areas. The individuals tend to believe that using natural herbs from the wild is an effective way of treating diseases and injuries. However, they tend to seek medical interventions once the conditions fail to heal after applying the herbs.
In applying Leininger’s theory, the nurse must note that the belief in herbs among the Hispanic and Latinos is a cultural factor that is rooted in their traditions. Nevertheless, it should be respected. To understand its influence on the outcomes of the healthcare services provided, the nurse must develop a close relationship with the patients. The nurse must exemplify knowledge and appreciation of the use of herbs among the community. The nurse must be open to discussion with the patients in order to learn more about the herb traditions and beliefs. When adequate knowledge is developed, the nurse must develop a model for intervention. For example, the nurse should inform the patients that medical interventions and drugs should not be used concurrently with the herbs because there is a high likelihood of reactions and possible harm to the body (Andrews & Boyle, 2012). In addition, the nurse must ensure that the information is also provided to the family members. The patients and their families must be made aware of the need to seek professional advice before using herbs. In this way, it is possible to discourage the use of herbs among the Hispanic patients.
Andrews, M. M., & Boyle, J. S. (2012). Transcultural concepts in nursing care. Journal of Transcultural Nursing, 13(3), 178-180.
Gordon, S. M. (2009). Hispanic cultural health beliefs and folk remedies. Journal of Holistic Nursing, 12(3), 307-322.
Howell, L., Kochhar, K., Saywell, R., Zollinger, T., Koehler, J., Mandzuk, C., & Allen, D. (2014). Use of herbal remedies by Hispanic patients: do they inform their physician?. The Journal of the American Board of Family Medicine, 19(6), 566-578.
Leininger, M. M. (2008). Leininger’s theory of nursing: Cultural care diversity and universality. Nursing Science Quarterly, 1(4), 152-160.
Leininger, M. M., & McFarland, M. R. (2006). Culture care diversity and universality: A worldwide nursing theory. New York: Jones & Bartlett Learning.
Ryan, M., & Twibell, R. S. (2009). Outcomes of a transcultural nursing immersion experience: Confirmation of a dimensional matrix. Journal of Transcultural Nursing, 13(1), 30-39.
Woerner, L., Espinosa, J., Bourne, S., O’Toole, M., & Ingersoll, G. L. (2009). Project (inverted exclamation mark) EXITO!: success through diversity and universality for outcomes improvement among Hispanic home care patients. Nurs Outlook, 57(5), 266-73.