Introduction
Nursing theories are essential to understanding the role of nurses in care delivery. Depending on their goals and background, various nursing theories focus on different concepts, processes, and relationships in nursing care. Virginia Henderson’s Need Theory is a grand nursing theory that defines the nursing process as a set of activities designed to help patients fulfill their 14 critical needs, including breathing, eating, drinking, elimination, movement, sleep, rest, dress and undress, maintain a healthy body temperature, practice faith, work, and more (McKenna, Pajnkihar, & Murphy, 2014).
Transcultural Nursing Theory, on the other hand, is a middle-range nursing theory developed by Madeleine Leininger to assist nurses in caring for patients from different cultural and religious backgrounds. The theory argues that nurses should provide care in a culturally congruent way, which includes preserving a patient’s culture, making accommodations for a patient’s culture, and restructuring care in a way that suits a patient’s culture (Grace, n.d.). The present paper will aim to compare these two nursing theories and their applications in nursing practice.
Background
The Need Theory was developed by Virginia Henderson based on her experience in nursing and education. According to Alligood (2017), Henderson’s theory was influenced by her work as a rehabilitation nurse. As the primary goal of rehabilitation is to encourage people to be more independent, Henderson proposed that nursing should be a process of helping patients to fulfill their needs independently (Alligood, 2017).
Similarly, Leininger’s theory was prompted by her work in different cultural settings. Leininger found that culture impacted all aspects of health care and disease prevention, from the definition of health to specific processes and practices (Alligood, 2017). The Transcultural Nursing Theory was created to enable nurses to tailor the nursing process in order to achieve culturally congruent care.
Philosophical Underpinnings
The philosophical foundation for the Need Theory is utilitarianism, which is a notion that the morality of people’s actions is judged on their outcomes. Henderson’s theory defines the nursing process as the contribution that helps a patient to fulfill his or her needs independently. Thus, if their health condition prevents a patient from eating normally, a nurse should seek to provide care that would alleviate the symptoms and ensure optimal nourishment until the patient can eat independently. Transcultural Nursing Theory is based on the notion of cultural relativism, which states that morality, beliefs, and customs depend largely on a person’s culture. Therefore, the philosophical foundation of this theory justifies altering the nursing process and its goals to a patient’s cultural and religious beliefs, customs, and practices.
Major Assumptions, Concepts, and Relationships
The major assumption of the Need Theory is that the concept of health is universal and depends on a person’s capacity to fulfill their 14 main needs. In Henderson’s theory, the core concepts are the patient’s needs and independence. The central relationship that is stipulated in the Need Theory is that between a patient and a nurse. Henderson specifies that there are three forms that this relationship can take, depending on the nurse’s role as the patient’s substitution, helper, or partner (Alligood, 2017). The key assumptions of Henderson’s Need Theory include the following:
- Nurses provide care to their patients until the latter can easily care for themselves;
- Patients strive for becoming healthy again;
- Nurses are devoted to their practice day and night and thus are willing to serve their patients’ needs at any time;
- Within the context of nursing practice, mind and body are interrelated and inseparable and thus need to be treated systematically.
Several major concepts should be discussed to further the understanding of Henderson’s Need Theory. The concept of an individual is an important component of the theory and is used to explain that every patient has his or her unique, personal needs. Thus, an individual is a sum of needs outlined in theory. The concept of an environment is not properly explained; however, the theory suggests that in order to meet patients’ needs, nurses should foster a positive and caring environment. Within Henderson’s approach, health is seen as a balance in all aspects of one’s life. The last concept, nursing, is defined as “the unique function of the nurse to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery” (Burggraf, 2012).
Transcultural Nursing Theory, on the contrary, assumes that the idea of health is not universal and that the definition of health largely depends on a person’s cultural values. As a result, the fundamental concepts of this theory are cultural sensitivity, congruence, and patient involvement in decision-making. Transcultural Nursing Theory focuses on the relationship between a patient and a nurse and the relationship between a patient and their culture. In contrast with other theories, Leininger’s approach does not set to explain the concepts of health, nursing, individual, or environment because they are restrictive to the explorations of culturally sensitive care. The theorist proposes three action modalities to provide culturally congruent care, which is the following:
- The preservation and/or maintenance of culture care;
- Accommodation and/or negotiation of culture care;
- Repatterning and/or restructuring of culture care (McFarland & Wehbe-Alamah, 2015).
The three modes outlined above are considered essential for caring and should be used in combination with specific care information discovered from Transcultural Nursing Theory. Therefore, Leininger challenges nurses as practitioners to discover holistic care tools used by the representatives of different cultures and apply them to practice if the context warrants their use.
Clinical Applications
The two theories vary greatly in terms of their usefulness in extending nursing science testability. Henderson’s Need Theory is applicable to clinical research, as it provides a specific framework for measuring the outcomes of nursing processes. For example, it can be applied to studying the management of chronic pain, as the goals of treatment are to improve the patient’s independence, mobility, and quality of life. Transcultural Nursing Theory does not add particular value to nursing science testability. Nevertheless, it can still be used in qualitative nursing research to study culturally sensitive nursing practices and develop new frameworks for providing culturally congruent care. Thus, both theories have unique clinical applications depending on the area of interest.
Application to Nursing Practice
The approach to nursing practice within the Need Theory is both visionary and revolutionary because it increases the status of nursing as a healthcare field, granting professionals more responsibility and authority. Thus, when applying the theory to nursing practice, they should fulfill their unique functions of meeting the fourteen fundamental needs of their patients. However, in order to successfully reach the established objectives of meeting patients’, nurses should be self-determined and self-reliant. This points to the fact that the Need Theory views nursing as an independent profession rather than a support mechanism.
Henderson’s Need Theory can be used to guide nursing practice and achieve optimal patient outcomes. First of all, it offers a framework for evaluating a person’s current health and determining the patient’s fundamental needs. Secondly, this theory can help nurse practitioners to set health goals for patients and to measure the progress of treatment (Ahtisham & Jacoline, 2015). If a patient’s health condition impairs their mobility, the treatment should seek to reduce pain and promote mobility, thus assisting the patient in fulfilling their needs.
Transcultural Nursing Theory can also be applied to nursing practice to aid nurses in caring for patients from diverse cultural and religious backgrounds. As noted by Busher Betancourt (2015), due to the globalization of healthcare, the nursing practice now involves rendering services to patients from other countries, cultures, and ethnicities. With the help of the theory, nurses begin to understand the importance of a transcultural approach, especially when it comes to professionals who come to work from other countries.
As a result, Transcultural Nursing Theory should be used to define a patient’s beliefs about health and their primary health goals. It can also help to tailor the nursing process to the needs of a particular patient, thus ensuring cultural congruence (Grace, n.d.). Finally, Leininger’s theory can be utilized by nurse practitioners to overcome cultural barriers and establish a trusting relationship with patients from different backgrounds. In an environment characterized by the public’s increased cultural awareness and rising health care costs, the demand for holistic and transcultural care is on the continuous increase to ensure that improper client care does not occur.
Application to My Practice
My clinical setting is a primary care clinic, and thus both theories can be successfully applied to my work. Primary care nurses work with patients with varied medical conditions. Due to the increased life expectancy and the aging of the general population, I often provide care to people with chronic diseases and disabilities that impair their quality of life and prevent them from engaging in their normal daily activities.
The Need Theory is particularly useful in these cases, as it can help to identify the gaps that need to be addressed in order to improve a person’s quality of life. For example, if obesity prevents a patient from being physically active and spending time with their family, nursing care should seek to help the patient to lose weight and develop healthy habits. However, if a patient suffers from depression and is thus unable to fulfill their communication, learning, and work needs, the appropriate nursing intervention would be to refer them to a specialist.
Meeting the goal of fulfilling patients’ needs as outlined in the Need Theory can be a useful framework to enhance my effectiveness within nursing practice. Since the needs of patients can range from spiritual to psychosocial, the theory can be applied to further the understanding of clients’ demands and thus to improve care quality. Relationships with patients can be of special importance because if they are positive, I, as a nursing professional, will have more leverage and authority to recommend appropriate treatments without having to overcome communicational barriers.
Another important trend that affects my nursing practice is increased diversity. The local community is characterized by the plurality of cultures, religions, and ethnicities, which means that I often need to provide care to patients whose values and beliefs are different from mine. Transcultural Nursing Theory is particularly helpful in this case, as it assists in determining cultural differences and tailoring the process of care accordingly.
For instance, many Hispanic patients rely on traditional methods of treatment and feel more comfortable with herbal remedies than with conventional medical therapy. Transcultural Nursing Theory can help to bridge the two approaches by supplementing medical treatment with traditional medications. This would ensure that patients are comfortable with the prescribed treatment, thus improving their adherence to the plan of care and achieving better patient outcomes.
Since many healthcare workers may have a tendency to impose their own cultural beliefs on patients, Transcultural Nursing Theory is a valuable contributor to practice. It will ensure that twenty-four hours a day and seven days a week, healthcare providers work on enhancing the potential and the quality of services through eliminating cultural barriers that limit care implementation. Because of this, the promotion of cultural competence among all nurses is important for rendering culturally congruent care.
Parsimony
The Need Theory is significantly simpler than the Transcultural Nursing Theory due to the differences in their focus and goal. The Need theory considers the entire nursing process and seeks to simplify it in order to provide a specific practice framework. Hence, Henderson describes a distinctive set of needs and defines the various types of relationships between nurses and patients (Alligood, 2017). These needs are clearly communicated to nurses so that they understand the distinction between them and can rank patients’ needs from most to least important. However, there is a lack of a conceptual framework to show how the needs interconnect in order to further nurses’ understanding.
Transcultural Nursing Theory, on the other hand, targets the complex notion of culturally sensitive nursing care, which involves a variety of considerations depending on the cultures, practices, and processes involved (Grace, n.d.). In contrast to the Needs Theory that puts people at the forefront of successful nursing care, Leininger’s approach focuses on culturally appropriate care as a core aspect of nursing (Busher Betancourt, 2015). Despite this approach being criticized for the lack of attention to treatment, the relationships built on the basis of the Transcultural Nursing Theory can be enough to ensure that patients receive the highest quality of care.
Conclusion
All in all, the comparison shows that despite the differences between the two theories, they can both be used to enhance nursing practice and achieve optimal patient outcomes. Transcultural Nursing Theory is particularly helpful for nurses who provide care to culturally diverse patient populations, whereas the Need Theory assists in goal-setting and patient assessment. Thus, both theories can be successfully used in my practice to help me in developing care plans that are goal-oriented, culturally sensitive, and realistic.
Leininger’s Theory of Transcultural Nursing requires professionals to exhibit effective communication skills through incorporating beliefs, values, and background of patients in every stage of the nursing process. In the case where a nurse has an opportunity to make patients more comfortable with the help of an appropriate care style, he or she should pursue a positive environment and understand the needs of their patients without bias or judgment. Thus, Transcultural Nursing Theory is an important tool to promote cultural competence among care specialists in the context of a nation with ample historical past.
Henderson’s Need Theory can be useful within multiple clinical settings as a framework used for recognizing patients’ needs and delivering appropriate care based on those needs. Also, the theory can help nurses collect information about patients’ health status for enhancing the quality of services they deliver to patients. Since Henderson linked patients’ needs to Maslow’s hierarchy, the theory can be applied to the nursing practice for setting goals based on those needs.
References
Ahtisham, Y., & Jacoline, S. (2015). Integrating nursing theory and process into practice: Virginia’s Henderson Need Theory. International Journal of Caring Sciences, 8(2), 443-450.
Alligood, M. R. (2017). Nursing theorists and their work (8th ed.). St Louis, MO: Elsevier.
Burggraf, V. (2012). Overview and summary: The new millennium: Evolving and emerging nursing roles. OJIN: The Online Journal of Issues in Nursing, 17(2), 1-2.
Busher Betancourt, D. A. (2015). Madeleine Leininger and the transcultural theory of nursing. The Downtown Review, 2(1), 1-8.
Grace, R. (n.d.). Transcultural Nursing Theory. Web.
McFarland M., R., & Wehbe-Alamah, H. B. (2015). Leininger’s culture care diversity and universality (3rd ed.). Burlington, MA: Jones & Bartlett Learning.
McKenna, H., Pajnkihar, M., & Murphy, F. (2014). Fundamentals of nursing models, theories and practice (2nd ed.). Hoboken, NJ: John Wiley & Sons.