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The Importance of the Utilization of Transcultural Nursing Theory to the Future of Nurse Practitioners

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Transcultural Nursing Theory highlights and is a guide for nurses. The theory highlights those culturally based care factors which may have a direct influence on each individual’s health, well-being, illness, or approach to death. The purpose and goal of the transcultural nursing theory is to provide culturally congruent, safe, and meaningful care to clients of diverse or similar cultures. (Leininger, 2002, p. 190) Leininger has established a theory that studies cultures to understand their differences and similarities. Cultural competence is important within the nursing profession due to differences in each individual’s perception of illness and wellness. The Culture Care Theory establishes an alliance between culture and health care. The alliance is crucial in the establishment of higher level of health awareness and increased well-being for each individual or community. An individual’s health beliefs and practices are directly linked to his/her culture. In determining interventions and appropriate care for an individual or community, the Cultural Care theory, targets cultural beliefs and practices. The theory continues with the belief that nurses need to consider that not all cultures are similar, and there are variations within each culture. The theory consistently focuses on how the individual or community should be treated differently and separately, and personal uniqueness should always be considered. This belief stems from Leininger’s personal belief in “God’s creative and caring ways.” (Leininger, 2002, p. 190)

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Leninger keep building her theory of transcultural nursing on the foundation of her observation and how people from each culture can perceive their nursing care and experiences differently according to their health beliefs and practices. Based on Leninger’s theory of transcultural nursing, the care nurses provide on their patients is derived and shaped from the cultural context in which it is to be provided. Leininger defined in 1978 transcultural as: “a substantive care of study and practice focused on comparative cultural care (caring) values, beliefs, and practices of individuals or groups of similar or different culture with the goals of providing culture-specific and universal nursing care practices in promotion health or wellbeing or to help people to face unfavorable human conditions, illness or death in culturally meaningful ways ” (George, 2002). Leininger defined in 1979 ethonursing as: “the study of nursing care beliefs, values and practices as cognitively perceived and known by a designated culture through theirs direct experience beliefs, and values system” (George, 2002). The theory of Culture Care emphasizes that cultural awareness it is fundamental to develop an excellent discipline in the profession of nurses. Culture is an important aspect to understand society. Leininger studied how individuals of each culture interpret nursing care practices in different ways. Her studies help her construct the concept of trans-cultural theory. In 1991, she stated, “human care is central to nursing as a discipline and as a profession.” With this statement, nursing care was a profound fact that knowledge and care are an important aspect in nursing care practices. She also developed another important cultural concept in her theory that relies on the fact that every culture has both health care practices; she defines one of the practices as the specific culture of the individual and the other as prevailing patterns which are common across cultures. From these concepts are born the terms of Universality and Diversity (George, 2002). World War II brought a complete change into the nursing field. During war time 1939-1945, there was a reemergence of new nurses as the government developed programs to entice women into the nursing profession. The US Cadet Nurses Corps from 1943 to 1948 aim in the recruitment of nurses

Many women were offered books, tuition, housing, and stipends if they decided to embark in a nursing career and assist during war. From this point on, we can appreciate how in the nursing discipline became important cultural knowledge. More than 59,000 American Nurses served during war. Nurses worked close to the front lines and served under fire in field hospitals and during evacuations. They also served on hospital trains, ships, and as flight nurses on medical transport (Bellafaire, 1998). Army nurses experience on the field gave them self-confidence and the desires to grow professionally. When they returned to the United States, many opportunities to pursue career and further education were given to nurses. War World II forever changed the nursing profession, as society was ready to accept nurses as professionals in the medical field and as members of the health care system (Bellafaire, 1998). During war, nursing was acknowledge as profession and as result nursing studies began to grow. Also, educational programs were not as limit as before. Before war nursing programs were not available in every university, the first nursing masters programs was offered by Yale University in 1923 and the first doctoral program was offered by the University of Columbia in 1929. After war ended, a research trend in nursing began to sprout. In 1950’s the American Association (ANA) begun a 5-year study on nursing functions and activities. The study developed functions, standards and set the qualifications for professional nurses in 1959 (Burns & Grove, 2005). After the war ended, the baby boomers era stated during 1946 to 1964 more than 75 million babies were born. Health care was needed for the emergent population. The demand for nurses increased and many women nurses decided to get married and stay home with their family leading to a shortage of nurses. Also, during the 1960’s government created Medicare and Medicaid increasing the possibilities of people receiving health care leading to the overall demand of nurses in the United States (Bellafaire, 1998). The high demand for nurses created the need of developing studies that determined the most effective educational preparation for registered nurses. These studies were conducted during the 1950s and the 1960s by Mildred Montag, a nurse educator who developed and evaluated a 2-year associate degree. In 1953, an Institute for Research and Service in nursing was created at Columbia University; the program was aimed to provide research and learning experiences in doctoral students. Later in 1957, The Walter Reed Army Institute of Research established a department of nursing research. This was the first nursing entity that carried out clinical research (Burns & Grove, 2005). Between 1950’s and 1960’s we can find numerous clinical studies that focused on the quality of care and how nurses can developed a criteria to measure nurse-patient intervention success. During this time nurses were acknowledge as part of the health care system and the increasing demand of nurses created advance study programs for professionals leading to more clinical research and encouraging nurses to find ways to improve patient care (Burns & Grove, 2005). Leninger’s theory of Cultural Care, Diversity and Universality, can be apply to everyone as a group or individual since we all form part of a cultural group. The theory can help recognized when a nurse can experience a cultural shock and how can correctly approached cultural differences to deliver the best care. This theory requires critical thinking from the nurse as involves collecting and using data to support overall decisions on patient care (George, 2002). This theory is universal and can be found in any place where nursing care is delivered. Leninger’s theory has been study by many other researchers who have used the theory as a guide and today is the frame of many nursing organizations. Not only on research and organizations Cultural Care theory has been spread, the education of nurses around the world has also been impacted with Leninger’s framework (George, 2002). Dr. Leninger is considered an international scholar and worldwide founder and pioneering of the field of transcultural nursing. Leninger has spread her word in over 220 articles and 28 books around the world. Among her most important works we can include; the significance of culture in nursing (1967), Nursing and anthropology: two worlds to blend (1970), and Transcultural nursing concepts, theories, research and practice (1978) (Akram, 2001). Research on cultural diverse care has been detail in studies from many other researchers including; American Gypsies (Bodnar & Leininger, 1992, 1995); Anglo and African American elders in long-term care (McFarland, 1997); Culture and Pain (Villarruel, 1995); the Gadsup of New Guinea (Leninger, 1991, 1995); Muscogee Creek Indians (Wing & Thompson, 1996); Old Order Amish (Wenger, 1991, 1995); etc (George, 2002). Some organizations found today that share Leninger’s values and beliefs are; Cultural Diversity a non-profit organization dedicated to increase cultural awareness among nurses and propose solutions when problems of bias conflict arise. The organization is run by Victor Fernandez RN BSN and Kathy Fernandez RN BSN. The organization is aim to promote workshops, guest speaker appearances focused to teach student nurses increase awareness of cultural diversity they also offer a web-based center that promotes interactive teaching and learning content about transcultural nursing (Fernandez, V. & Fernandez, K. 2008).

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To sum up, the United States has one of the most diverse populations in the world. In 2008, the U.S. Census Bureau predicted that the nation will further increase in racial and ethnic diversity throughout the midcentury. There is widening disparity in health care quality and access among minority populations (Agency for Healthcare Research and Quality [AHRQ], 2008) especially among African Americans, Hispanic Americans, and American Indians (Sullivan Commission, 2004). Healthy People 2020 (U.S. Department of Health and Human Services [USDHHS], 2011) has as one of its goals the elimination of these disparities. While accounting for 33% in 2000, racial or ethnic minority groups will comprise almost half of the U.S. population by the middle of this century (AHRQ, 2008; U.S. Census Bureau, 2008). Recognizing that barriers exist for diverse populations, the USDHHS Offi ce of Minority Health developed national standards for culturally and linguistically appropriate services (CLAS) (OMH, 2001; USDHHS, 2001). Sagar_07480_PTR_Ch 01_22-07-11_1-20.indd 9 agar_07480_PTR_Ch 01_22-07-11_1-20.indd 9 7/22/2011 9:17:59 PM /22/2011 9:17:59 PM Along with CLAS and other guidelines, the Leininger’s CCDU offers a structured approach to promoting culturally congruent care. Leininger (1995b, 2002b, 2006b) warned about cultural imposition, the tendency of health care workers to impose their own belief system and values to other people or groups because of notions of superiority

This imposition may happen while providing care here in the United States or when working with developing countries in partnerships and collaborations. People have deeply ingrained cultural values and beliefs; the success of educational outreach or technological support may depend on the “applicability or fi t” (Sagar, 2000) in a particular country. Leininger’s CCDU (1995a, 2002a, 2006a) and sunrise model’s depiction of nurses bridging generic folk practices and professional nursing is truly telling of the immense role of nurses. Furthermore, nurses are with patients 24 hours a day, 7 days a week, creating that potential for rendering culturally congruent care that enhances health care outcomes. For this reason, it is of utmost importance to promote cultural competence among all nurses (Bomar & Glenn, 2004).

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Agency for Healthcare Research and Quality. (February, 2008).

U.S. Department of Health and Human Services. 2007 National healthcare disparities report. Rockville, MD: Author. American Association of Colleges of Nursing. (1998).

The essentials of baccalaureate education for professional nursing practice. Washington, DC: Author. American Association of Colleges of Nursing. (1999).

Nursing education’s agenda for the 21st century. Washington, DC: Author American Association of Colleges of Nursing. (2008).

Cultural competency in baccalaureate nursing education. Washington, DC: Author

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