Leininger Theory

Application of Leininger Theory of Culture Care Diversity and Universality Gurpreet Mand Student ID #200858728 Memorial University of Newfoundland and Labrador

NURS-2700-081 (Nursing Theories - 40985) Dr. Suzan Banoub-Baddour October 19th, 2010

Application of Leininger Theory of Culture Care Diversity and Universality The increasing cultural diversity of Canada demands the complex cultural specific or culturally congruent nursing care. Culture is a critical component that affects the attitudes and actions of people about their health and disease (George, 2010, P. 414). Each culture has different practices related to caring for sick people based upon their values, beliefs, and traditions. These practices among cultures with respect to care, health, and illness are extremely challenging for nurses to provide effective nursing care. Therefore, the understanding of different cultures is becoming extremely crucial for Canadian nurses. Dr. Madeline Leninger, a nurse and theorist, recognized the importance of an understanding and knowledge of culture for both the nurse’s and the patient’s. She developed a theory known as "Culture Care Diversity and Universality” which was the beginning of transcultural nursing (Course Notes, George 2010). Leininger described common practices across cultures as culture care universalities, and specific practices to a given culture as culture care diversities. For Leininger, the essence of nursing is caring. However, she emphasized to provide care from cultural perspectives. She elaborated that the patient can experience feelings of discomfort and helplessness if cultural care is not practiced (George 2010, 413). Therefore, nurses must embrace the concept of culturally congruent care for this increasingly diversified nation to promote effective nursing care. This paper focused on the development process of nursing care plan to provide culturally congruent care to a young Muslim mother. Mrs. H. is 28 years old, born in Pakistan, who migrated to Canada three years ago. She has diagnosed with gestational diabetes in the first trimester of her pregnancy and started on insulin. She would discharge from hospital after she will receive primary teaching of blood glucose monitoring. CLSC nurses will follow her up at home for next six weeks. Leininger’s Sunrise “Enabler” is a conceptual model to guide nursing judgments and activities to provide culturally congruent care. Nurses can utilize Leniniger`s concepts for holistic assessments of the patient to collect data for her physical, psychological, social and spiritual needs. According to Leininger, it is necessary to talk to patient about their beliefs and values of life. Nurses should do some research about patient`s culture. They will be able to relate influencing factors with patient`s health practices and concerns after knowing more about patient`s culture. They should not assume and stereotype that people migrate from the same country needs specific culture care. Nurses must discuss with the patient their current expectation from the staff and their past experiences with health care. Nurse must begin to collect relevant information to determine patient cultural specific needs from the beginning. Nurses must be able to perform nursing tasks while continuing to observe client behavior. Dennis and Small suggest that the following questions and techniques will assist a nurse to focus on culturological assessment:
• How does the one identify oneself?

• Who answers nurse 's questions? (The client or by a family member)

• Language of communication with nurses and between themself.

• An interpreter or family member responds to interview questions.

• How client and family show respect, how they address nurse and how they prefer to address them?

• Maintenance of eye contact, If not, Why?

• What are the food choices of the client? Client is eating hospital food or family bringing the food.

• Identify gender issues, for example, Males may not allow to be present during the interview or treatment of a female patient.
• Nurses should practice nonjudgmental responses. These can open or close lines of communication.

• What is religion of the patient, if any? What are religious needs or requirements?

• In Leininger 's theory, worldview is person perspective to see and interpret the world. The Leininger model is a broad approach to achieve cultural understanding. Although all nurses assess their clients, only practice in culturalogical assessment can help them to acquire expertise. Leininger`s culturalogical assessment guide is the best developed tool to achieve culture-specific assessment (George2010, 417). By using this tool, nurse was able to obtain all required information to develop cultural specific care plan for the client. When nurse arrived for an initial meeting with the client, she identified herself as native Punjabi from Pakistan. She was wearing her traditional dress and head covered with hijab. Her husband and sister in law were also there. She was able to understand English and respond in single phrases. Husband could speak English fluently. Husband was answering most of the questions. He talked to client in their native language before responding for most questions and then interpreted for nurse. However, everyone addressed nurse as “sister. Client was making eye contact with nurse during conversation. Sister in law was talking sitting quietly and was not making eye contact with man at all. Husband left the room when nurse started physical assessment of the client. Patient cooperated with nurse for physical assessment. She explored her own experiences with health care. She informed the nurse that she would allow only woman health professional to perform a physical examination. Both women started to communicate openly after husband has left the room. They were making eye contact with the nurse to answer questions. Client has passed high school from Pakistan. She could not work due to her language barrier. She likes watch T.V. program in her own language. She stated that she and her baby suffered because she could not fast during the month of Ramadan due his pregnancy. She was wondering eating more sweet can cause diabetes. In Leininger 's theory, worldview is person perspective to see and interpret the world. Individual`s worldview has influence of cultural and social structure dimensions includes technological, religious, social, political, legal, economic, cultural values and educational factors (George, 2010, p. 411). Lenininger expected nurses to be fully aware of their own culture and how it may affect their nursing care practice. According to her, nurse should apply worldview and social structure knowledge to the situation to identify culture care diversities and universalities. Nurses should see their patients in the context of their culture and must develop cultural competence to provide quality care to patients of different cultures. Nurse reflected her own worldview to avoid the situation of cultural shock and cultural imposition ( Course notes ; George2010) . Nurse did research about Pakistan and Muslim religion before the interview.
According to Leininger`s theory nurse was able to relate following factor to Mrs. H`s health practices and concerns.

• Technological; Lack of understanding of diabetes. Unable to use glucose monitor.

• Religious; Client and her family see diabetes as a curse resulted for not fasting during Ramadan. Women can not followed by male health professional. There is no female endocrinologist in that area.
• Kinship and social: Women should cover their face when they go out, as they are not allowed to expose themselves by Islam. “Hijab” is the covering of the body except the face and hands.
• Cultural Values: Unable to attend support group because of her cultural values.

• Education; Client did not have a high level of education. Knowledge and comprehension on diabetes and other health practices is low.
• Economics; Financial situation is not very strong.

Nurses should develop a culturally congruent care plan by involving patients with the goal of improving their comfort and response to care. Culturally congruent care is “care that is beneficial and meaningful to the people being served” (Andrews & Boyle, 2003, p. 6). The nurse must recognize and respect the health beliefs of the patient’s culture prior to planning nursing care. Nurse must pay particular attention to patient`s health related belief for nursing care plan to be accepted and successful. A nursing care plan developed for Mrs. H. based on data collected from the assessment including religious beliefs, family relationships and prior hospital experiences. A special session with a dietician arranged for her as she has recently diagnosed with diabetes and she has some cultural dietary practices and preferences. Nurse assessed patient’s emotional response to illness and readiness to learn before developing the care plan. According to Dennis and Small nurses can use following steps to develop cultural specific care planning:
• Identify client 's care preferences including religion, cultural demands and culturally generated feelings.

• Accommodate cultural preferences wherever possible to reduce frustration and resistance. For example, a female Muslim client will not allow the male nurse to take care of her the care plan should assure that a female nurse is available to care for this client.
• Recognize language barriers, the extent of language difficulty and possible arrangements for an interpreter and document in the care plan.
• Include family and significant others. Specify their roles in the care plan. Who will care for the client after discharge? Should teaching include certain family members?
• Recognize decision conflicts. The client 's actions may be at variance with nursing or other health care goals but consistent with cultural values.
• Identify obstacles to the implementation of the plan and find alternatives. According to Leininger the three modes nursing care and action are cultural care preservation/maintenance, cultural care accommodation/negotiation, and cultural care repatterning/restructuring. These three modes of nursing care are culturally based. Nurses` knowledge and research about patient`s cultural specific aspects will help them to establish the three modes of nursing care decisions and actions. However, the three modes of nursing care do not indicate specific nursing interventions. Leininger suggests that finding cultural beliefs and values of the client and utilizing three modes for this cultural congruent care is required for the well-being of the clients (Course notes; George, 2010). Leininger`s theory recognizes the importance of culture and its influence on everyone. In her theory, the nurse and client are participants and both have the influence of their culture. Leininger`s theory help nurses to identify differences and similarities among cultures. This guide them how to collect and use knowledge to provide cultural specific or culturally congruent nursing care to people based upon the people 's cultural values, beliefs, and practices (George, 2010). Leininger’s theory is flexible and widely useful. Nurses can utilize it with individuals, families, groups, communities and institution in diverse health systems (Andrews & Boyle, 2003, p. 6). Leiinger `s theory allows patients to express intense emotions as a response to illness. It also provides them opportunity to explore their health beliefs. However, it does not provide specific guidance for nursing care (George, 2010). Her theory focuses more on the nurse’s approach to care rather than focusing on medical symptoms, disease, or treatment. Cultural congruent care for clients, families, and groups of diverse cultures is becoming a prominent practice in health care system of Canada. Leininger 's Theory of Cultural Care Diversity and Universality plays a pivotal role to provide cultural congruent care to patients. Her Sunrise Model provides guidance to nurses to make crucial decisions and actions for patients who have different cultural beliefs and values. The three major modes of action in her theory assist them to develop cultural specific care plan for patients. Patients can achieve a greater level of wellness by receiving care with their cultural preferences. Therefore, Leininger emphasized that the nurses must recognize and respect the health beliefs of the patient’s culture when planning nursing care (George, 2010).

References
Andrews, M.M. & Boyle, J.S. (2003). Transcultural concepts in nursing care (4th ed.). Lippincott: Philadelphia. George, J. (2010). Nursing Theories, the Base for Professional Nursing Practice 6th ed. Norwalk, Connecticut: Appleton & Lange. P 404--424 www.madeleine-leininger.com Dennis Betty P., Small Ernestine B. Incorporating cultural diversity in nursing care: an action plan ABNF Journal, The, Jan-Feb, 2003 retrieved from http://findarticles.com/p/articles/mi_m0MJT/is_1_14/ai_98250419/pg_3/?tag=content;

http://www.cmp-cpm.forces.gc.ca/pub/rc/rel/islam-eng.asp

Appendix

Nurse used different sources to complete foolowing research about Pakistan and Muslims religions Cultural and religious beliefs and values.
LIFE AND TRENDS OF MUSLIMS;
1. Testimony of faith (Shahada): There is no god except God and Muhammad is the messenger of God. Prayer (Salat): Five times a day
2. Fasting (Sawm): Every Muslim should fast during the month of Ramadan except sick, children and elderly
3. Almsgiving (Zakat): 2.5% of annual savings should be distributed among poor.
4. Pilgrimage (Hajj): Once in a lifetime for those able to perform the pilgrimage 5. Muslim men must wear a beard with or without a moustache. They must keep their beard and mustache clean and cropped.
6. Women’s dress in Islam is based on a principle of female modesty. They should cover their face when they go out as they are not allowed to expose themselves by Islam. “Hijab” is the covering of the body except the face and hands. It has been seen by some as oppressive and as a symbol of a Muslim woman 's subservience to men and as a symbol of an Islamic identity. Some Muslim women wear the veil to cover all their body except the hands and eyes. Some women wear a loose-fitting garment called burka to cover from head to foot including their eyes. Only a net cloth over the eyes is permitted to see.
DIETARY REQUIREMENTS;
• Muslim only eat halal meat, slaughtered following religious guidelines.
• Muslim do not eat pork and other swine products as forbidden by Islam.
• Fish and eggs only cooked near halal food can be consumed.
• Alcohol and drugs are prohibited.
• Muslims can have food that is offered in the name of Allah only.
• Patient may wish to fast between sunrise and sunset during Ramadan. Sick person, who must follow a prescribed course of medical treatment can be excused from fasting during Ramadan. Patient’s wishes should be followed.
MEDICAL AND HEALTH REQUIREMENTS;
• Muslim patient should recite the Islamic creed during his last breath from other Muslims.

• Female patient should attend by only female doctors, nurses and aides. In an emergency, the order of preference is (1) a female Muslim doctor, (2) a female non- Muslim doctor, (3) a male Muslim doctor, and, if none of these is available, (4) a male non-Muslim doctor.

• Organ transplantation is not forbidden in Islam, however, Some people may object to it.

• Abortion allowed only if there is a threat to the life of the mother.

• Islam does not oppose the blood transfusion.

• Women may deny an internal examination before marriage and childbirth.

• Women should wear clothes including hospital gowns that cover the legs and arms.

• Muslim woman can share a hospital room with another female patient.

• Woman will expose only her body part for medical treatment.

• Male babies are usually circumcised shortly after birth.

DEATH AND BURIAL

Upon death, the eyes of the deceased should be closed. A bandage can be used to close the mouth. Arms and legs must be straightened.

The body should be washed before shrouded in white cloth. Women can wash only women’s bodies and men can wash men’s bodies. A husband or wife may wash their spouse’s body.

Funeral is always held in the mosque with prayers for the deceased.

Burial should take place soon after death. Body should be buried on its right side.

Cremation is forbidden in Islam.

OTHER

• The Shari’ah is a Islamic law derived from the Qur’an. It is a comprehensive system of laws to address religious, moral and social issues.
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SOURCES OF INFORMATION

http://www.cmp-cpm.forces.gc.ca/pub/rc/rel/islam-eng.asp

http://www.islamcanada.com — Canadian website providing information about Islam.

http://www.muslim-canada.org/ — website of the Canadian Society of Muslims. MUN Student ; Gurpreet Mand_ DEPARTMENT OF NURSING Date; Oct.19 2010 Instructor; Dr. Banddour

NURSING CARE PLAN Clients initials; Mrs. H. Age ; 54years Sex; Female
Nursing Diagnosis 1: Knowledge deficit related to new diagnosis of diabetes mellitus.

MUN Student ; Gurpreet Mand_ DEPARTMENT OF NURSING Date; Oct.19 2010 Instructor; Dr. Banddour

NURSING CARE PLAN Clients initials; Mrs. H. Age ; 54years Sex; female

Nursing Diagnosis 2: impaired verbal communication related to language barrier and cultural difference.

References: Andrews, M.M. & Boyle, J.S. (2003). Transcultural concepts in nursing care (4th ed.). Lippincott: Philadelphia. George, J. (2010). Nursing Theories, the Base for Professional Nursing Practice 6th ed. Norwalk, Connecticut: Appleton & Lange. P 404--424 www.madeleine-leininger.com