MADELEINE LEININGER Culture care diversity and universality model

● Approaches an individual, family, or

● Culture care theory - “that the culture community with the intent to gain
care needs of people in the world will be understanding of the expressions,
met by nurses prepared in transcultural patterns of health, and care
nursing” ● Obtains knowledge about the dynamic
● Transcultural nursing has been defined cultural and social structural dimensions
as a formal area of study and practice influencing health
focused on comparative humans care ● Invites an individual, family, or
differences and similarities of the community to describe their own
beliefs, values, and patterned lifeways experience about health and caring
of cultures to provide culturally ● Documents the description of an
congruent, meaningful, and beneficial individual’s or community’s cultural and
health care to people social structure that influence health
patterns and concern
● Should value diversity for they have the
capacity to perform a cultural
self-assessment
● Should be conscious of the dynamics
inherent when cultures interact and we
should exercise cultural awareness,
being culturally competent is
essential to being an efficient nurse
● CULTURE – set of beliefs held by a
certain group of people, handed down
from generation to generation– it is
learned, shared, and transmitted values
and life way practices of a particular
group that guide thinking, decisions, and
actions in patterned ways
● Nurses have a responsibility to
understand the role of culture in the
health of the patient– not only can a
cultural background influence a patient’s
health, but the patient may be taking
home remedies that can affect his or her
health as well
● Founder of transcultural nursing in the ● Nurses practice according to the
mid-1950s patient’s cultural considerations–help
● Brought nursing and anthropology them be aware of ways in which the
together patient’s culture and faith system
● Established the first caring research provide resources for their experiences,
conference in 1978 with illness, suffering, and even death
● Focused specifically on transcultural ● It helps nurses to be understanding and
nursing- culture care focus respectful of the diversity that is often
● Role of cultural factors in nursing very present in a nurses patient load
practice into the discussion of how to ● It helps strengthen a nurse’s
best attend to those in need of nursing commitment based on nurse-patient
care relationship and emphasizing the whole
 person rather than viewing the patient 6. Cultural care
as simply a set of symptoms or an - Refers to the subjectively and
illness objectively learned and
● Cultural knowledge helps a nurse to be transmitted values, beliefs and
open minded to treatments that can be patterned lifeways that assist,
considered non-traditional, such as support, facilitate, or enable
spiritually based therapies like mediation another individual or group to
and anointing maintain their well being, health
Definition of terms to improve their human
1. Cultural awareness condition and lifeway or to deal
- It is an in-depth self-examination with illness, handicaps or death
of one’s own background, 7. Cultural care diversity
recognizing biases and - Refers to the variability and/or
prejudices and assumption differences in meanings,
about other people patterns, values, lifeways, or
2. Culturological assessment symbols of care within or
- Takes the patient’s cultural between collectivities that are
background into consideration in related to assistive supportive or
assessing the patient and his or enabling human care
her health expressions
- Use to crease a nursing care Ethnohistory
plan that also takes the - Refers to those past facts, events,
patient’s cultural background instances and experiences of individuals
into consideration or groups that are primarily
3. Culturally congruent care people-centered and that describe,
- Care that fits the people’s explain, and interpret human lifeways
valued life patterns and set of within particular cultural contexts and
meanings– which is generated over short or long periods of time
from the people themselves, The generic (folk or lay) care system
rather than based on - Refer to culturally learned and
predetermined criteria transmitted, indigenous, folk knowledge
4. Culturally competent care and skills used to provide assistive,
- Is the ability of the practitioner to supportive, enabling or facilitative
bridge cultural gaps in caring, acts toward or for another individual or
work with cultural differences group with evident or anticipated needs
and enable clients and families to ameliorate or improve a human
to achieve meaningful and lifeway or health condition or to deal
supportive caring with handicaps and death situations
5. Cultural shock The professional care system
- The state of being disoriented - Refers to formally taught, learned, and
or unable to respond to a transmitted professional care, health,
different cultural environment illness, wellness and related knowledge
because of tis sudden and practice skills that prevail in
strangeness, unfamiliarity, and professional institutions usually with
incompatibility to the stranger’s multidisciplinary personnel to serve
perceptions and expectation as consumers
is differentiated from others by
symbolic markers
Cultural preservation or maintenance
- Deals on the nursing care aspect with
MARGARET NEWMAN
the goal of helping in the preservation or
maintenance of favorable health and
caring lifestyle ● Health as expanding consciousness
- This entails that in maintaining theory
homeostasis, the nurse or the ● Every person in every situation,
healthcare provider must be sensitive in regardless of how disordered and
the idiosyncrasies and uniques of the hopeless it may seem, is part of the
patient universal process of expanding
Culture care accommodation or negotiation consciousness, which is a process of
- The nurse must be able to adapt or becoming more of oneself, finding
negotiate with the Client by taking into greater meaning in life, and of
account the particular culture the client reaching new dimensions of
belongs to connectedness with other people and
- The nurse must recognize that in order the world
to be effective, he/she must take into
account the possible differences of the ● Metaparadigm: person
client’s beliefs from his/her own, by ○ In this model, the human is
acknowledging this fact the nurse will unitary, he or she cannot be
not come across too strong and will not divided into parts and is
appear as imposing inseparable from the larger
Cultural care repatterning or restructuring unitary field
- Dwells on idea that people are capable ○ People are individuals and
of modifying their lifestyles to human beings are, as a species,
accommodate new healthcare ways or identified by their patterns of
patterns, it further pounds that consciousness, the person
individuals have the capacity to change does not possess
and are open to try new practices as consciousness, instead the
long as they think that the results are person is consciousness
culturally meaningful and satisfying ○ People are centers of
- For the nursing practice, the consciousness with an overall
repatterning aspect of this model is a pattern of expanding
useful tool in trying to bend or flex consciousness
some of the stringent beliefs or ● Metaparadigm: environment
habits of the client by including them ○ The environment is described
in their own healthcare plan as a universe of open systems
- This further implies that considering the ● Metaparadigm: health
cultural background of an individual ○ Health and illness are
does not necessarily mean being certain synthesized as health
practices are better left alone ○ That is the fusion of one state
of being (disease) with its
opposite (non-disease) results
in what can be considered
health
● Metaparadigm: nursing
○ Nursing is the process of
recognizing the patient in
relation to the environment, it
 is the process of the
understanding of consciousness
ELIZABETH LENS & LINDA PUGH
○ The nurse helps patients
understand how to use the
power they have within in ● A middle-range theory of unpleasant
order to develop a higher symptoms (TOUS)
level of consciousness,
therefor it helps to realize the
process of disease, its recover
and its prevention
Six assumptions in Newman’s theory
1. Health encompasses conditions
therefore described as illness or in
medical terms pathology
2. These pathological conditions can be
considered a manifestation of the total
pattern of the individual patient
3. The pattern of the individual patient that
eventually manifests itself as pathology
is primary and exists prior to structural ● Key concepts (1) symptoms, (2),
or functional changes influencing factors, and (3) performance
4. Removal of the pathology in itself will outcomes
not change the pattern of the individual
patient 1. Symptoms
5. If becoming ill is the only way an ● Most but not all symptoms are
individual patient’s pattern can manifest experienced as unpleasant
itself, then that is health for that sensations
individual patient ● The perception-based definition
6. Health is an expansion of the assumes awareness by the
consciousness individual and that the nature of
a symptom can only be truly
Humans are open to the whole energy known and described by the
system of the universe and constantly individual experiencing it
interacting with the energy, with the process of ● Can occur either in
interaction, humans are evolving their individual isolation–one at a time or
patterns of whole → according to newman, the ● In combination and potentially in
pattern of the individual patient is essential, the interaction with other symptoms
expanding consciousness is pattern recognition (in some situations one may
precede and give rise to
Time and space are the temporal pattern of another)
the patient and have a complementary Dimensions of symptoms
relationship, people are constantly changing ● Intensity
through time and space, which is movement ○ Quantifies the degree,
which shows a unique pattern of reality → strength, or severity of
definition of temporal pattern: the unitary the symptom and is the
impression produced by a succession of stimuli most frequently
(as in a melody or rhythm) measure aspect of the
symptom experience
 ● Degree of associated distress treatment related
○ Reflects an affective variables
aspect of the symptom ● (2) Psychological
experience in that it ○ Affective state or mood
refers to the degree to (e.g level of anxiety,
which the individual depression or anger)
experiencing the ○ Cognitive variables (e.g
symptom is bothered by degree of uncertainty,
it level of knowledge and
● Timing meaning of symptom)
○ The length of time that a ● (3) Situational
symptom ○ Physical and social
continue–duration environment
○ Or rapidity with which ○ Access to resources
symptoms ● Performance outcome
occur–frequency ○ The experience of
○ Recurrence and how it symptoms can have an
varies over a period of impact on the
time–pattern individual’s ability to
● Quality function or perform:
○ The nature of the physically, cognitively
symptom or the way in and socially defined
which it is manifested or roles
experienced, that is, ● (1) Physical
what it feels like to have ○ Pain, depression, and
the symptom–each has fatigue had a strong
unique characteristics relationship to physical
functioning of patients
The measurement of the symptoms would be ● (2) Cognitive
more descriptive when all four characteristics ○ Memory,
are included– However, measuring one, two, or comprehension,
three characteristics is valid and informative for learning, concentration,
healthcare providers in managing the and problem solving
symptom(s). ● (3) Role performance
2. Influencing factors ○ The ability to carry out
● There are 3 interrelated personal care and
categories of factors (1) social roles including
physiological, (2) psychological, activities of daily living
and (3) situational and employment-related
● Influence predisposition to and roles
manifestation of a given A given symptom or set of symptoms–may
symptom or multiple symptoms generate a number of different performance
and the nature of the symptom outcomes that may occur simultaneously but
experience also can be time ordered
● (1) Physiological Performance outcomes that are proximal in
○ anatomical/structural, time to the symptom experiences–can
physiological genetic, influence more distal outcomes, particularly if
illness-related, and the symptom is sustained for a period of time
 to the patient or nurse and is highly
JOSEPHINE PATERSON
subjective– “where I feel belong or am”
● Space and time coincide within the
Humanistic nursing theory nursing experience; patient begins to
Person feel at home the longer the stay
● Humans are viewed as open fields with Nursing
special life experiences, as energy ● Lived experience between human
fields, they are greater than and different beings, it is an evolving, affecting, and
from the sum of their parts and cannot helping relationship in which the patient
be predicted from knowledge of their and nurse engage in a dialogue, the
parts emphasize the importance of the nurse
● Human beings are viewed as being being aware of herself and of the client
holistic in nature, are special, as unique human beings, and of
dynamic, aware, and understanding the individual perspective
multidimensional, capable of abstract and needs of each patient, the nurse
thought creativity, capable of taking must therefore modify their responside
responsibility, language, empathy, in offering a genuine presence
caring, and other abstract patterns of ● Reciprocal call and response;
communication are aspects of an achieved through an awareness of the
individually high level of complexity and nurse’s own worldview, values,
diversity and enable one to increase understanding, and responses, through
knowledge of self and environment understanding the self and the other, the
● Persons are to be valued, to be nurse can engage in an authentic
respected, nurtured, and understood therapeutic exchange of experience,
with the right to make informed understanding, and of being
choices regarding their health and ● It is an interhuman, transactional,
may include families and communities interconnected dialogue of helping in
Health a way that recognizes and expresses
● Valued as necessary for survival and one's own genuine humanness and
is often proposed as the goal of responds to the unique human-ness
nursing of the patient; implies the valuing of
● Many instances of nursing that could be some human potential beyond the
described as “health narrow concept of health taken as
restoring/sustaining/promoting” absence of disease; not merely with a
● Nurses engage in “health person’s well being but with this
teaching/supervision” more-being with helping him become
● Narrowest meaning is freedom from more as humanly possible
disease (not seen as an attainable;
terminal/chronic illnesses)
Environment
● As the time and space in which the KATHARINE KOLCABA
nursing experience takes place
● From the existential perspective, it is the Theory of comfort
time and space as lived by the ● Diploma in nursing from St. luke’s
nurse/patient hospital of nursing in 1965
● Space is the lived perception of the ● Comfort is an immediate desirable
world around the nurse and patient outcome of nursing care
● Place is another component of space,
but it is more personalized, it belongs
● Person how they can affect the patient’s
○ Individuals, families, institutions, health
or communities in need of ● Comfort exists in three forms
health care ○ If specific comfort needs of a
● Environment patient are met, the patient
○ Any aspect of the patient, family, experiences comfort in the
or institutional surroundings that sense of relief–e.g patient who
can be manipulated by a nurse, receives pain medication
or loved one to enhance comfort ○ Ease addresses comfort in a
● Health state of contentment; anxieties
○ Considered to be optimal are calmed
functioning, as defined by the ○ Transcendence is described as
patient, group, family, or a state of comfort in which
community patients are able to rise above
● Nursing their challenges
● Process of assessing the ● The four contexts in which patient
patient’s comfort needs, comfort can occur are
developing and implementing ○ Physical
appropriate nursing ○ Psychospiritual
interventions, and evaluating ○ Environmental
patient comfort ○ sociocultural
● Intentional assessment of
comfort needs, the design of
comfort measures to address
those needs, and the
reassessment of comfort levels
after implementation
● Assessment may be either
objective, such as in the
observation of wound healing,
or subjective, such as by asking
if the patient is comfortable

● Comfort is the product of holistic

nursing
○ Holistic nursing is a practice that
focuses on healing the whole
person, this practice recognizes Key elements in the theory
that a person is not simply his or ● Health care needs are defined as those
her illness needs identified by the patient or family
○ Holistic healing addresses the in particular nursing practice setting
interconnectedness of the mind, ● Intervening variables are factors that are
body, spirit, social/cultural, not likely to change, and over which
emotions, relationships, context health care providers have little control;
and environment prognosis, financial, social support
○ All of these aspects combine to ● Health-seeking behaviors are the
create the person, so in order to behaviors of a patient in an effort to find
heal the person, the holistic heath
nurse looks at all aspects and
 ● Institutional integrity is the value, ● Experience of comfort
financial stability, and wholeness of ○ Relief from discomfort, the state
health care organizations at the local, of ease and peaceful
regional levels contentment, and whatever
makes life easy or pleasurable
● Experience of dignity and respect
○ Incorporates the idea of
CORNELIA RULAND AND SHIRLEY
MOORE personal worth, as expressed by
the ethical principle of autonomy
of respect for persons
Middle range theory; peaceful end-of-life theory ● Being at peace
Cornelia M. Ruland ○ Feeling of calmness, harmony,
- Focuses on aspects of and tools for and contentment, (free of)
shared decision making in clinically anxiety, restlessness, worries
challenging situations: ● Closeness to significant others
- For patients confronted with difficult ○ The feeling of connectedness to
treatment or screening decisions other human beings who care
- Preference-adjusted management of
chronic/serious long term illness over Major assumptions
time
Shirley M. Moore Person and nursing
- Has taught nursing theory and nursing ● The occurrences and feelings at the
sciences to all levels of nursing students end-of-life experiences are personal and
and conducts a program of research individualized
and theory development that addresses ● Nurses assess and interpret cues that
recovery after cardiac events reflect the person’s end-to-life
- Considered theory construction as experience and intervene appropriately
essential skill for doctoral students to attain or maintain a peaceful
experience, even when the dying person
Sources cannot communicate verbally
● Family, a term that includes all
● General system theory is an indicator significant others is an important part of
of its usefulness in explaining the end-of-life care
complexity of healthcare interactions ● The goal in end-of-life care is to
and organization maximize treatment which is the best
● Preference theory the good life is possible care will be provided through
defined as getting what ones wants, an the judicious use of technology and
approach that seems particularly comfort measures, in order to enhance
appropriate in end of life care quality of life and achieve a peaceful
death
Concepts
Relational statements
● Not being in pain 1. Monitoring and administering pain
○ Being free of the suffering or relief
symptom distress is the central ● And apply pharmacologic and
part of many patients’ end-of-life nonpharmacologic interventions
experience contribute to the patient’s
experience of not being in pain
2. Preventing, monitoring, and relieving
physical discomfort
● Including facilitating rest,
relaxation, and contentment,
and preventing complications
contribute to the patient’s
experience of comfort
3. Including the patient and significant
others in decision making
● Regarding patient care, treating
the patient with dignity, empathy
and respect, and being attentive
to the patient’s expressed
needs, wishes and preferences
contribute to the patient’
experience of dignity and
respect
4. Providing emotional support,
monitoring and meeting the patient’s
expressed needs
● For anti anxiety medications,
inspiring trust, providing patient
with guidance in practical issues
and providing physical presence
of another caring person to
contribute to the patient's
experience of being at peace
5. Facilitating participation of
significant others in patient care
● Attending to significant others
grief, worries and questions and
facilitating opportunities for
family closeness contribute to
the patient’s experience of
closeness to significant others
or persons who care
6. The patient’s experiences of not
being in bain
● Including comfort, dignity, and
respect, being at peace, and
closeness to significant others
or persons who care contribute
to the peaceufl end of life