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Case 1

Mrs. Franklin-Jones was admitted from the Emergency Room to Cardiac Intensive Care one week ago with a diagnosis of acute myocardial infarction. She has recovered as expected and is moving to the cardiac step down unit today. She is talking with Nurse Julie Hernandez, as she gets settled in her new room, "I was really surprised when I got that bad pain in my chest! I knew I had high pressure but I just didn't think it was that bad. I try to take my medicine like they told me to in the clinic but sometimes I forget. I guess that I need to study those papers they gave me about what foods I should eat and not eat. I better take care of myself! Momma had bad pressure and it killed her! Who knows—I may even have to learn to cook different than I was taught in Jamaica! I may have to let Tomas do the cooking. He's got more time at home now than I do since he lost his job. There isn't too much time between my shifts at the school cafeteria and my new housecleaning job. You know my sister is coming up from Jamaica to see me. I think she is bringing me some bush tea. That'll set me right!"


• Using Leininger's Culture Care Model, what factors in the story shared by Mrs. Franklin-Jones should be considered by Nurse Hernandez when planning for the                 patient's discharge?
• Why is the theory of Culture Care Diversity important in the delivery of nursing care for all patients?
• Using Leininger's Theory of Culture Care Diversity and Universality, develop a plan of care for Mrs. Franklin-Jones.
• Discuss the strengths and limits to Leininger’s Theory.

Claude Jean-Baptiste is recovering from post-hip replacement surgery and has been transferred to the Rehabilitation Institute adjacent to the hospital. When he enters the unit, he sees welcoming signs written in several languages including his own, Creole. Since there are no nurses on that shift that speak Creole, they use a language line to ask for translation services. During this initial nursing assessment, the translator informs Mr. Jean-Baptiste that the nurses invite him to have a relative at his side so that they can be sure to understand and meet his needs. He is asked about Haitian customs and beliefs that they might honor. Mr. Jean-Baptiste is encouraged to bring food and spiritual care items, and to share the warmth of his culture with the nursing staff.


• Discuss assumptions of the Transpersonal Caring relationship. What is the nurse's role?
• How is love, as defined by Watson, evident in this caring moment?
• How can the nurse creatively use self to create a healing environment?
• Discuss the strengths and limits to Watson’s Theory.

Case 1

This paper will focus on both case studies. In Case 1, the essay will discuss on factors to consider when planning for patient’s discharge, benefits of Culture Care Diversity Theory, develop a plan of care for the patient and highlight the strengths and limitations of Leininger’s Transcultural Nursing Theory. In case 2, the essay will focus on assumptions of the Transpersonal Caring relationship and role of the nurse, love in a caring moment, use self in the creation of a healing environment and strengths and limitations of Watson’s Theory.

A discharge plan should involve effective multidisciplinary teamwork which encompasses medical, occupational therapy, nursing, social and physiotherapy services. When discharging the patient, the nurse should consider coping skills, perception and social support of the patient. The nurse should consider providing nutritional education to the patient and consulting a nutritionist to write dietary prescriptions for her based on her health condition and cultural preferences (Almutairi, McCarthy, & Gardner, 2015).

The nurse should consider teaching the patient on important of adhering to medication and the consequences associated with non-compliance.  The nurse should also consider involving the patient’s relatives by educating them on patient’s management strategies and encourage them to remind the patient when to take her medications. Regarding patient’s busy schedule at her two jobs, the nurse should consider encouraging the patient to take a leave from work and relax at home for effective recovery (Butts, & Rich, 2013). 

The theory helps in discovery of healthcare and cultural needs of patients from diverse cultures. It is applied in other healthcare disciplines in the provision of transcultural care to all patients. It helps in the exploration of impacts of culture on patient’s perception and choice of a plan of care and adoption of effective approaches of nursing care based on cultural indications and contraindications of every patient. The theory helps in the establishment of proper and effective patterns of communication when dealing with all patients (Irish, Lundquist, & Nelsen, 2014). 

Acute pain related to occlusion of the coronary artery (tissue ischemia) as evidenced by patient’s reports of chest pain.

To ensure patient verbalizes pain relieve/control.

Obtaining a full history of pain.

Monitoring and documenting the nature and characteristics of pain including both verbal and non-verbal cues (Fawcett, & Desanto-Madeya, 2012). 

Pain is usually subjective, and its good when its communicated by the patient.

Variation in patient’s behaviour and appearance poses challenges in assessment (Irish et al, 2014). 

Patient verbalizes relieved chest pain.

Knowledge deficit related to unfamiliarity with resources, emotional state and limited exposure as evidenced by an inaccurate following of instructions, forgetting and asking questions regarding her diet.

To ensure that the patient demonstrates a proper understanding of medication regimen and dietary requirements after discharge.

Providing the patient with thorough, clear and understandable demonstrations and explanations to the patient regarding her diet and medications (Irish et al, 2014). 

Proper understanding promotes adherence, coping and healing (Irish et al, 2014). 

Patient understands her dietary requirements and the importance of adhering to her medications.

The main focus of this theory is on the concept of culture in the provision of nursing care to all patients. The theory helps the nurse to be culturally competent and sensitive. The nurses are expected to be conscious when handling patients from different cultural diversities so that they can adequately respond to the of all patients with different cultural norms and values. In comparison to other theories whose focus is on health, people, nursing, and environment, Leininger highlights patient care as the cornerstone of nursing (Karakus, Babadag, Abay, Akyar, & Celik, 2013).

Planning for Patient’s discharge

This can be considered as the principal cause of errors in clinical decision-making such as misperception of patients’ values on outcomes.  Data collected regarding patient’s cultural norms, values and customs will not always be accurate, consistent and applicable to all patients in nursing practice. Failure of nursing practice to recognize the cultural aspects of patients’ needs may lead to signs of ineffective and less efficacious practices of nursing care. Additionally, this may lead to patient dissatisfaction with nursing services provided (Swanson, 2012).

Nursing care should be holistic, but the theory focuses on culture only. It does not seem to give attention to medical conditions and illnesses and their manifestations. There can occur some technicalities in adoption or integration of one’s culture which can turn out to be a cultural shock on the other side of nurses. Leaning about culture does not guarantee a relation to them. This is entirely different from the actual integration and incorporation of culture into practice (McFarland, & Wehbe-Alamah, 2014). 

Watson’s Transpersonal Caring model has seven assumptions:(1) Caring is composed of various curative factors that are associated with satisfaction of particular human requirements and needs. (2) The concept of caring can be adequately and effectively practiced and demonstrated interpersonally. (3) Effective caring enhances health and family or individual growth. (4) The responses provided in caring show acceptance of the patient at his or her current and future state. (5) The science of caring complements the science of curing. (6) Caring practice is the centre of nursing. (7) A caring environment provides development of patient’s potential hence allowing him or to her make best choices of action at a particular time (Swanson, 2012).

The nurse has various roles such as instilling hope and faith to the patient, promotion of expression of patient feelings, creation of a healing environment, cultivation of sensitivity to self and the patient and establishing therapeutic relationships with the patient. The nurse has a role in patient assessment, planning, implementing interventions and evaluating patient care (Purnell, 2012). 

Love is regarded as a healing experience that impacts on the life of every patient. Love involves instilling faith, hope, and honor to other people and having a personal sensitivity to self and others. In love, interactions between the nurse and the patient have a great potential of creating a transcendence moment. In a caring moment, the nurse and the patient have an equal opportunity to decide on the choice of actions to take in their relationship. When there is love, both parties develop a spiritual connection that transcends space, time and physicality (McFarland, Mixer, Webhe-Alamah, & Burk, 2012).  

Importance of Culture Care Diversity Theory

As far as patient care is concerned, the nurse is a very crucial tool. The nurse can creatively use self by maintaining patient’s privacy and dignity, avoiding taking control, working to maintain patient comfort and showing sincere concern for the well-being of the patient. He or she must demonstrate a high level of respect for the patient (Suliman, Welmann, Omer, & Thomas, 2009).

The nurse can use self to earn patient’s trust through positive interactions in the clinical area. The nurse should encourage the patient on participation in her care. The nurse can creatively use self in recognition of triggers/aggravating or relieving factors of a patient’s condition for implementation of appropriate measures of mitigation. The nurse should figure out what led to the occurrence of the manifestations. The nurse should not establish any financial relationships with the client or share personal contacts instead he or she should share office contact information (Lachman, 2012).

Although few people find this theory a bit complex, it is straightforward to understand. The theory can be practical in guidance and improvement of practices by equipping healthcare personnel with highly satisfying and effective aspects of clinical practice. It also ensures the provision of holistic patient care.  Watson chose to use non-technical, fluid, sophisticated and evolutionary language to describe and elaborate more on her concepts in an artful manner. Some of the concepts she described in her theory are caring-love, cartas, and carative factors. Paradoxically, abstract and straightforward concepts like caring-love are quite challenging to integrate into practice, yet experiencing and practicing the concepts results to greater and sophisticated understanding (Suliman et al, 2009).

The theory is considered to be logical since the carative factors are described based on the assumptions that give them a supportive framework. Logically, the carative factors are derived from the assumptions and connected the hierarchy of human needs. It also focuses on aspects of prevention of diseases and illnesses, health promotion and experience of peaceful patient death hence it increases its generality. The carative factors highlighted in Watson’s model gives guidelines for interactions between the nurse and the patient which is a very crucial component of patient care (Watson, & Woodward, 2010).

Watson’s model does not provide explicit direction to be taken for the achievement of authentic caring-healing nurse-patient relationships. The nurse requires concrete guidelines; therefore, he or she may not feel comfortable and secure incorporating the theory into practice alone. Some people take a lot of time to integrate and implement the carative and caritas factors into practice (Watson, & Woodward, 2010).

Conclusion

Both theories apply to nursing care. Both have strengths and weaknesses like any other theory. Every theory addresses various concepts which are essential in the care of patients from diverse cultures.

References

Almutairi, A. F., McCarthy, A., & Gardner, G. E. (2015). Understanding cultural competence in a multicultural nursing workforce: Registered nurses’ experience in Saudi Arabia. Journal of Transcultural Nursing, 26(1), 16-23.

Butts, J. B., & Rich, K. L. (2013). Philosophies and theories for advanced nursing practice. Jones & Bartlett Publishers.

Fawcett, J., & Desanto-Madeya, S. (2012). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories. FA Davis.

Irish, D. P., Lundquist, K. F., & Nelsen, V. J. (2014). Ethnic variations in dying, death and grief: Diversity in universality. Taylor & Francis.

Karakus, Z., Babadag, B., Abay, H., Akyar, I., & Celik, S. S. (2013). Nurses’ views related to transcultural nursing in Turkey. International Journal of Caring Sciences, 6(2), 201-207.

Lachman, V. D. (2012). Applying the ethics of care to your nursing practice. Medsurg Nursing, 21(2), 112.

 McFarland, M. R., & Wehbe-Alamah, H. B. (2014). Leininger's culture care diversity and universality. Jones & Bartlett Publishers.

McFarland, M. R., Mixer, S. J., Webhe-Alamah, H.B, & Burk, R. (2012). Ethnonursing: a qualitative research method for studying culturally competent care across disciplines. International Journal of Qualitative Methods, 11(3), 259-279.

Purnell, L. D. (2012). Transcultural health care: A culturally competent approach. FA Davis.

Suliman, W. A., Welmann, E., Omer, T., & Thomas, L. (2009). Applying Watson's nursing theory to assess patient perceptions of being cared for in a multicultural environment. Journal of Nursing Research, 17(4), 293-300.

Swanson, K. M. (2012). Empirical development of a middle range theory of caring. Caring in Nursing Classics: An Essential Resource, 211.

Watson, J., & Woodward, T. K. (2010). Jean Watson’s theory of human caring. Nursing theories and nursing practice, 3, 351-369.

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