Module 6 Case Studies

The Culture Care Theory

The culture care theory was developed by Madeleine Leininger in early 1950, informed by challenges and non-caring actions facing children from certain cultures in healthcare institutions. Leininger identified culture and care as missing dimensions in nursing and the delivery of quality care. According to McFarland and Wehbe-Alamah (2015), understanding and responding appropriately to patients from different cultures is critically important in the delivery of care and improved patient outcomes. Applied to the nursing profession, the theory believes that nursing can be integrated with individual cultures to deliver supportive, enabling, and facilitative care designed to meet the specific needs of the individual. The theory is focused on providing care and improving health outcomes for patients from different cultural backgrounds. The nurse works collaboratively with the patient to design a new care model that fits the patient needs. Consistent with the case study and drawing upon the principles of the culture care model, we analyze factors that Nurse Hernandez can consider when planning Mrs. Franklin-Jones discharge. We also evaluate and present the importance of the Culture Care Diversity theory in the delivery of nursing care. Using Leininger’s theory, we develop a care plan for Mrs. Franklin-Jones. Lastly, we discuss the strengths and limitations of the Leininger’s theory.

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Applying Leininger’s Theory to Planning Mrs. Franklin-Jones Discharge

Every cultural group has a wide range of traditions and beliefs that affect their daily lives. Nurses must be able to evaluate and understand the patient’s beliefs, values, and traditions and design plan of care to meet the individual needs. There are various factors Nurse Hernandez should consider when planning Mrs. Franklin-Jones discharge. The first element to consider is culture care accommodation and negation as guided by the culture care model (Russell, Brunero, & Lamont, 2014). This will involve enabling or offering assistive acts designed to help Mrs. Franklin-Jones to deal with her health and enable her to adopt health and effective practices for her health. Mrs. Franklin-Jones admitted that she does not understand her illness and was surprised when she had a bad pain in the chest. She told nurse Julie Hernandez that she did not think that her high blood pressure was that bad. She also expressed her fears about blood pressure killing her momma, and admitted that she must be able to take care of herself. Unfortunately, as she narrated to nurse Hernandez, she does not understand what was written in the papers, including changes to her diet. In light of this, the nurse should educate Mrs. Franklin-Jones about her illness, her medications, and diet. The aim is to give Mrs. Franklin-Jones a better understanding of her illness, help her understand her medications, and ensure she understands the importance of taking her drugs without missing before discharge. Educating Mrs. Franklin-Jones about her illness will clear her misconception that she might die just like her mother. Discussing Mrs. Franklin-Jones’s diet change will empower her to make better decisions about her diet and help her take care of herself after discharge. 

The other factor to consider is culture care restructuring to enable acts or help Mrs. Franklin-Jones make the necessary changes in her diet life for better healthcare outcomes. Mrs. Franklin-Jones narrated to nurse Hernandez that she is afraid she may have to cook differently than she used to in Jamaica. She even expressed about letting her husband do the cooking because he has more time than her. Mrs. Franklin-Jones also mentioned that her sister was coming from Jamaica and bringing bush tea, which as she says might set her right. The nurse should first understand the food traditions of Mrs. Franklin-Jones, which will enable her to engage the patient empathetically. The nurse should educate the patient about the diet and ways to prepare it. Mrs. Franklin-Jones seems excited about the bush tea her sister is bringing; the nurse should first understand the ingredients of the bush tea and assess if they are suitable for the patient. If not, she should explain to the patient in a way that will not offend the patient about her cultures. 

Importance of Culture Care Model in Delivery of Care

The issue of multicultural population poses various challenges to the United States healthcare industry. Nurses are required to recognize and appreciate cultural differences when delivering patient care. Leininger’s culture care theory introduces the element of transcultural nursing and provides a guiding principle for nurses to deliver holistic transcultural care.  The theory provides nurses with guidance to provide care that is in harmony with the patient’s cultural beliefs, values, traditions, and practices. It allows the design of patient care that is culturally competent and centered on the patient. 

Plan of Care for Mrs. Franklin-Jones using Culture Care Model

AssessmentNursing DiagnosisPatient Cultural Beliefs, values and traditionsPatient OutcomesInterventions
Admitted with a diagnosis of acute myocardial infarctionBad pain in the chestDiagnosed with high blood pressurePatient forgets taking her medicinePatient has difficulties understanding her diet changeThe patient is worried about her blood pressure because it killed her motherThe patient does not know how to cookThe patient does not want to give up her traditional food habitsMrs. Franklin-Jones is used to Jamaican foodsThe patient believes the bush tea is going to make her feel betterThe patient is afraid of her condition because her mother died of blood pressurePatient understand her illness and eliminates her fear of deathPatient understands her medication, diet change, and learns to cook differently from the way she learned in Jamaica.Patient stops eating traditional foods that may be dangerous to her health. Utilize culture care model to:Explain to the patient about her illness, help her understand her medication and dietHelp the patient understand her diet and assist her with ways to prepare the new dietUnderstand the ingredients of the bush tea and explain to the patient the implications of eating traditional foods that might escalate her condition

Strengths and Limits to Leininger’s Theory

The strength of Leininger’s theory is that it recognizes the importance of culture and its influence in the delivery of care. Unfortunately, its weakness lies in the fact that it can be a source of error in making clinical decisions based on a misperception of patient cultural values. Additionally, there is limited applicability of cultural framework delivery of care, which can raise problems when integrating cultures into patient care.  

Assumptions of Transpersonal Caring Relationship

The theory of human caring was developed by Jean Watson and is widely used in nursing practice. According to Ajimol (2011), the theory views nursing as a caring science with philosophical and ethical implications. The model is divided into four elements, which include, the Caritas process, transpersonal caring relationship, caring moment, and caring healing modalities. Consistently, we discuss the assumptions of the transpersonal caring relationship and identify the role of the nurse in this model. Drawing upon the case study, we identify how love, as defined by Jean Watson, is evident in the caring moment. We then analyze ways in which the nurse can use self to create a healing environment. Finally, we analyze and present the strengths and limits of Jean Watson’s human caring theory. 

Assumptions of Transpersonal Caring Relationship

The transpersonal caring relationship is the second element of Jean Watson’s theory of human caring. According to Fitzpatrick and McCarthy (2014), transpersonal caring relationship believes that the conscious intention of care is to promote healing and wholeness in patients. As Caruso, Cisar, and Pipe (2008) further elaborate, the theory assumes that the ongoing personal and spiritual growth help the nurse in providing a deeper level of professional healing. The nurse provides care based on their life history, previous experience, feelings towards the specific issue. The nurse is responsible for protecting the human dignity and her own. The caring consciousness of the nurse is communicated to the patient to preserve their dignity and honor their spirit. The model assumes that nursing is designed to help patients attain harmony with their mind, body, and soul. 

Evidence of Love in the Caring Moment

According to Jean Watson theory of human caring, when nurses treat patients as individuals and provide them with the necessary assistance, they are able to meet their needs. In return, the patients feel appreciated, recognized, and loved. In case study #2, love is displayed in several ways. For instance, when Claude Jean Baptiste arrived at the Rehabilitation Institute adjacent to the hospital, welcoming signs written in several languages including his language met him. When the facility recognized there were no nurses that speak Creole in that shift, they requested for translation services. During the first nursing assessment, the facility allowed a relative to be by Claude’s side so that they can also understand his needs. By doing this, the facility displayed concern and love for the patient. Claude was also encouraged to honor his Haitian customs and beliefs and even bring food and spiritual items and share his culture with the staff. Virtually, this was a clear indication that the facility understood the patient’s needs, appreciated, and recognized them, which was translated into the love they have for their patients. 

Using Self to Create a Healing Environment

Drawing upon Jean Watson’s theory of human caring, healing involves the restoration of wholeness. Healing, in this case, does not only involve treatment to eliminate the disease, rather it is a process that transcends the physical wellness, to include emotional, mental, and spiritual wholeness. The environment has the ability to inhibit or motivate healing. Nurses can create a healing environment using self by applying the ten Caritas process. For instance, nurses should show love and kindness to patients, be present to enable and sustain the faith and hope of the patients. Nurses can also promote healing by nurturing and maintaining caring and trusting relationships with the patients. The other way nurses can promote healing is by supporting patients in their negative and positive expressions, educate patients about the meaning of wholeness and support them through the process. Additionally, nurses can also assist patients with basic needs such as administering human care, to help in the mind-body-spirit alignment and wholeness.

Strengths and Limits to Watson’s Theory

In its application to the nursing practice, the theory of human caring has both strengths and weaknesses. For instance, one of its strengths lies in its ability to enhance the relationship between the nurse and the patient and improve patient outcomes. The strength lies in the principle of placing the patient in the context of family, community, and their culture. The theory allows the delivery of care to be personalized to the individual levels and enhances meeting the patient needs. On the other hand, some of the limitations associated with Jean Watson’s theory include the fact that, the theory ignores the biophysical needs and gives special attention to psychosocial needs. By doing this, the theory ignores the physiological component of the individual’s health. Additionally, the theory is open to interpretation, which is likely to result in ambiguities and result in difficulties when applying the theory to the nursing practice. 

References

Ajimol, L. (2011). Developing a Practice Model for Watson’s Theory of Caring. Nursing Science Quarterly, 24(1), 27-30.

Caruso, E. M., Cisar, N., & Pipe, T. (2008). Creating a Healing Environment: An Innovative Educational Approach for Adopting Jean Watson’s Theory of Human Caring. Nursing Administration Quarterly, 32(2), 126-132.

Fitzpatrick, J. J., & McCarthy, G. (2014). Theories guiding nursing research and practice: Making nursing knowledge development explicit. New York: Springer Publishing Company, LLC.

McFarland, M. R., & Wehbe-Alamah, H. B. (2015). Leininger’s culture care diversity and universality: A worldwide nursing theory. Burlington, Massachusetts: Jones & Bartlett Learning.Russell, R., Brunero, A., & Lamont, S. (2014). Reflecting on Transcultural Care; Culture Care Theory and Mental Health Nursing. Austin Journal of Nursing Health Care, 1(2), 1-4.

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