For the past several decades, nursing theory has evolved with considerable considerations towards transcultural care. The concept of culture was derived from anthropology and the concept of care was derived from nursing. When one understands the derivative of nursing knowledge and the basis for cultural sensitivity, one may tailor and provide the best nursing care for diverse groups. Each group may have specific needs that may help or hinder healthcare delivery. Hence, if one fully understands the meanings, patterns, and processes, one can explain and predict health and well-being. Although many nursing theories exist, a closer evaluation will be given to Cultural Care Diversity & Universality and Purnell Model for Cultural Competence.
Cultural Competence & Influence
Cultural competence is deemed as essential component in providing healthcare today. Healthcare professionals in healthcare organizations are addressing multicultural diversity and ethnic disparities in health (Wilson, 2004). To better serve constituents, understanding cultural factors is paramount to providing quality care. Within all cultures are subcultures, ethnic groups, or ethnocultural populations, groups who have experiences different from those of the dominant culture with which they identify; they may be linked by nationality, language, socioeconomic status, education, sexual orientation, or other factors that functionally unify the group and act collectively on each member with a conscious awareness of these differences.
Additionally, subcultures differ from the dominant cultural group and share beliefs according to the primary and secondary characteristics of culture. Culture is largely unconscious and has powerful influences on health and illness (Wilson, 2004). Healthcare providers must recognize, respect, and integrate clients' cultural beliefs and practices into health prescriptions. Thus, the provider must be culturally aware, culturally sensitive, and have some degree of cultural competence to be effective in integrating health beliefs and practices into plans and interventions. Cultural awareness, essentially the objective material culture, has more to do with an appreciation of the external signs of diversity, such as arts, music, dress, and physical characteristics (Wilson, 2004). Cultural sensitivity has more to do with personal attitudes and not saying things that might be offensive to someone from a cultural or ethnic background different from the healthcare providers. Moreover, culturally sensitive, politically correct language changes over time, within ethnic groups, and within the broader cultural group, creating uncertainties for healthcare providers. Cultural competence has several characteristics and includes knowledge and skills as well as the following (Wilson, 2004):
Developing an awareness of one's own culture, existence, sensations, thoughts, and environment without letting them have an undue influence on those from other backgrounds;
Demonstrating knowledge and understanding of the client's culture, health-related needs, and meanings of health and illness;
Accepting and respecting cultural differences;
Not assuming that the healthcare provider's beliefs and values are the same as the client's;
Resisting judgmental attitudes such as "different is not as good;" and Being open to cultural encounters;
Being comfortable with cultural encounters;
Adapting care to be congruent with the client's culture;
Cultural competence is an individualized plan of care that begins with performing an assessment through a cultural lens.
Cultural competence is a process, not an endpoint (Maier-Lorentz, 2008). One progresses (a) from unconscious incompetence (not being aware that one is lacking knowledge about another culture), (b) to conscious incompetence (being aware that one is lacking knowledge about another culture), (c) to conscious competence (learning about the client's culture, verifying generalizations about the client's culture, and providing culturally specific interventions), and finally (d) to unconscious competence (automatically providing culturally congruent care to clients of diverse cultures). Unconscious competence is difficult to accomplish and potentially dangerous because individual differences exist within specific cultural groups. To be even minimally effective, culturally competent care (really an individualized plan of care) must have the assurance of continuation after the original impetus is withdrawn; it must be integrated into and valued by the culture that is to benefit from the interventions.
Each healthcare provider adds a new and unique dimension to the complexity of providing culturally competent care. The way healthcare providers perceive them- selves as competent providers is often reflected in the way they communicate with clients. Thus, it is essential for healthcare professionals to take time to think about them- selves, their behaviors, and their communication styles in relation to their perceptions of culture. Cultural self-awareness is a deliberate and conscious cognitive and emotional process of getting to know yourself: your personality, your values, your beliefs, your professional knowledge standards, your ethics, and the impact of these factors on the various roles played when interacting with individuals who are different from yourself (Maier-Lorentz, 2008). The ability to understand oneself sets the stage for integrating new knowledge related to cultural differences into the professional's knowledge base and perceptions of health interventions. Even then, traces of ethnocentrism may unconsciously pervade one's attitudes and behavior.
Leininger's Cultural Care Diversity & Universality
Caring as a central concept within nursing has led to the development of several caring theories, Madeleine Leininger's Theory of Culture Care, which was formulated in the 1970s (Nelson, 2006). Madeleine interesting cultural dimensions of humane care and caring led to the development of her theory of cultural care. She subscribed to the central tenet that care is the essence of nursing and the central, dominant, and unifying focus of nursing. Hence, the unique focus of this theory effect care is linked with culture. She defines culture as the learned, shared, and transmitted values, beliefs, norms, and likewise of the particular crew that guides their thinking, decisions, and actions in patterned ways (Nelson, 2006). The basic premise of this theory is to discover human care diversities in relation to worldview and social structure. Discover ways to provide culturally congruent care to people of different or similar cultures in order to maintain or regain their well-being, health, or facing death in a culturally appropriate way.
Providing care which is acceptable culturally and is beneficial and useful to the client, family or culture groups health beliefs refers to cultural care universality as the common, similar, or dominant uniform care (Maier-Lorentz, 2008). Seemingly, this involves patterns, values, lifestyle, or symbols of care. However, caring and nursing are central concepts and theory. To improve and provide care, which is culturally acceptable and is beneficial and useful to the client and family, is the key. For example, a group of refugees who fled to the United States of America to seek refuge from political unrest persecution, and extreme poverty will need culturally sensitive nursing care. Providing culturally congruent nursing care to this group of people proved difficult with the language being a major barrier. Hence, this led to the lifeways of this group remaining unknown. Gaining knowledge of this culture includes healthcare beliefs, concept of held, caring behaviors, and their barriers to healthcare. Moreover, making a direct correlation between social factors, economic factors, educational factors, political factors, religious factors, cultural values and belief factors, traditional healthcare factors, and professional healthcare factors enables culturally sensitive nursing care to occur.
The complexity of Leininger's theory is evident when reviewing the numerous concepts considered central to her work (Nelson, 2006). Many purport that the theory is not simple and requires knowledge and appreciation of transcultural and anthropological insights. Others maintained that it is neither simple nor easily understood, especially upon first reading. However, she stresses that once the interrelationships between concepts are grasped, simplicity is more apparent. Supporting this, Leininger asserts that once her undergraduate and postgraduate nursing students have conceptualized the theory, they find it highly practical, relevant, and more simple than complex (Nelson, 2006). Furthermore, Leininger sees many benefits of using the theory to develop and provide culture-specific care and care that is meaningful to clients who are culturally different.
Purnell Model for Cultural Competence
The Purnell Model of Cultural Competence is an organizing framework to guide cultural competence among healthcare professionals (Kim-Godwin, et al., 2001). The stress on culture and diversity is good because cultural competence improves the health of its citizens. However, culture is an extremely demanding and complex concept, requiring providers to look at themselves, their patients, their communities, and their colleagues from multiple perspectives. Increasing one's consciousness of cultural diversity improves the possibilities for healthcare practitioners to provide culturally competent care, and therefore improved care. Cultural competence is a conscious process and not necessarily linear. To add to the complexity of learning culture, no standardization of terminology related to culture and ethnicity exists. The definition of cultural sensitivity presented by one person or group is the same definition that another person or group defines as cultural competence or awareness.
In 1991, Larry Purnell was teaching undergraduate students in which he discovered the need for both students and staff to have a framework for learning about their cultures and the cultures of their patients and families. Unfortunately, ethnocentric behavior, lack of cultural awareness, lack of cultural sensitivity, and a lack of cultural competence existed (Kim-Godwin, et al., 2001). Insomuch, his model is designed as a holistic framework that can be used across disciplines and practices. Understanding clients' ethnocultural beliefs enables effective communication and…