She was almost radical in her approach to healthcare and healing. By radical, I mean that she was the type of individual who aimed to solve matters by getting to the root of the problem. She was more interested in solving the problem and not the symptoms of an underlying issue. She used a systems thinking methodology that made her overall approach to healthcare a faith-based philosophy. Although she used God as a foundation, she was willing to make the effort to conduct scientific research to confirm a basic belief. Consider the fact that nursing focuses on the patient as an adaptive system while medicine on the other hand sees the patient from the perspective of a biological system or more importantly, the patient's disease.

Like Florence Nightingale understood, it is our objective as nurse practitioners to utilize the metaparadigms of nursing to help the patient move along a continuum that begins with health, moves to illness and eventually aims to return to health. The patient is most likely to get well if he or she is comfortable with him or herself, the nurse, to health situation and the environment. It is our goal as nurses to increase a patient's inert adaptation skills in cycles of physiological, self-concept, role function and inter-dependence. We nurses act as external regulatory forces that either modify or adjust any and all stimuli that affect a patient's ability to utilize his or her own adaptation system.

For example; rather than constantly utilizing a verbal analogue scale for assessing whether or not to continues with an I.V. morphine drip, it may be better to allow the patient to have more input from the patient which stimulates his own adaptation process. Does VAS of 4 sit right and is there a level of comfortable to a point where resting is possible or is the breathing good? Florence Nightingale understood that we must allow the patient to adapt to with the metaparadigms of nursing to allow for the adaptation process to promote healing.

Concepts Specific to Labor & Delivery

There has been a debate about the value of looking at culture as a way of understanding aspects of health, for example differences in the health status of ethnic groups." (Royal College of Nursing, 2004) in regard to Labor & Delivery, various cultural beliefs exist. There are various considerations in regard to nursing and cultural labor and delivery philosophies.

The concepts and propositions associated with the Trans-cultural Nursing theory for example opens us up to many shortcomings. Nursing and each individual nurse specifically must be aware of subtle differences in the way people do things. Consider Bennett's Intercultural Sensitivity Model as presented by the Royal College of Nursing:

Denial of Cultural Differences

Defense of One's Own Culture

Minimization of Other Cultures in Order to Protect One's Own Cultural Identity

Cultural Acceptance

Adaptation to Cultural Differences

Integration of Full Cultural Awareness Into Everyday Interactions

Nurses must be cognizant of a woman's cultural differences when it comes to Labor & Delivery. "However, Bennett's model does at least provide a framework for examining our own attitudes towards our culture, how we came to understand our culture and how this fits with our thinking about other cultures. Where each individual nurse lies on the continuum depends on life experiences and the overall aim of the model is to move the nurse towards higher levels of cultural competency through the presentation of specific content and exposure to different cultural experiences." (Royal College of Nursing, 2004)

From the initial stages of the model, it shows how a new or inexperienced nurse practitioner may be unaware that any cultural differences even exist in our society or they may be in a state of denial. We nurses more than many other professions need to understand and promote that there are cultural differences in our environment. A black woman and a white woman may have completely different expectations of the post delivery care for example.

We nurses must also take into consideration our own culture's expectations. "The holistic health perspective of nursing, which integrates all aspects of the health and well-being of individuals and families, can provide especially valuable insight to the assessment, planning, and service delivery processes. Nurses need to not only participate in the planning process during the interdisciplinary planning meetings, but also to contribute their own assessment and recommendations from a nursing perspective." (Mattson Bryan & Wirth, 1995, p. 73)

Life is a bunch of habits that we present as our personality. If our habits are not taken into consideration when we deal with others we tend to risk alienation. "At this stage Bennett suggests that cultural...

During the first stage the individual is unable to see cultural difference, but once awareness is recognized the individual may feel threatened. 'Defense' arises when the individual is only able to perceive their own cultural existence as the norm; anything outside of this is viewed negatively." (Royal College of Nursing, 2004) We nurses are required to promote similarities and appreciate differences.
By minimization of other cultures in order to protect our own, we may inadvertently create expectations or not recognize subtle language and cultural differences. The fact that a Jewish newborn is not circumcised may be a huge problem for a one family and in other Middle Eastern nations other than Israel the concept to circumcise may be thought of as a desecration of the body.

Our own believe patterns may see one, both or neither as unreasonable criticize anyone person for having those beliefs. There are often dynamic and many times very controversial situations affect nursing and health care because of diversity such as the cultural beliefs on birth which also includes prenatal care, pregnancy, labor, delivery, and post-partum care. In case of death there may rites of passage rituals that must be followed in regard to death and dying. Some other considerations include:

Definitions of Illness

Family Roles and Responsibilities for Ill Clients

Nutrition and Diet

Culturally Appropriate Communication,

Culturally Appropriate Diagnoses,

Culturally Appropriate Interventions

Culturally Appropriate Standards of Care

Cultural acceptance and adaptation to cultural differences is where I as a nurse would like to consider myself. I feel as though I have made substantial advances in cultural differences where I may not have had an awareness and understanding of the different meanings of behavior in regard to Labor and Delivery across diverse cultures. Integration of full cultural awareness into everyday interactions is how life should work. "During this stage the individual is able to move between different cultures competently; they are able to draw on their knowledge of different cultural perspectives and frameworks." second nursing theorist that I wish to mention in regard to idea of Labor and Delivery is some of Ernestine Wiedenbach's works. "Wiedenbach believed that there were 4 main elements to clinical nursing. They included: a philosophy, a purpose, a practice and the art. Wiedenbach also believed that there were 3 essential components associated with a nursing philosophy: Reverence for life, Respect for the dignity, worth, autonomy and individuality of each human being and resolution to act on personally and professionally held beliefs." (Wright, 2004) nurse's purpose based on Wiedenbach's works should revolve around what the nurse wants to accomplish as demonstrated by her actions but all of those activities need to focus on achieving results for the patient. Whether the function is Labor and Delivery or any other nursing requirement, nursing actions must be fueled by inert beliefs or feelings about the ability to meet the patient's needs. In order to accomplish this, a nurse like me must therefore have an understanding of a patient's needs and concerns in order for me to develop any viable goals which should be the blueprint for my actions. "The nurses also focuses on prevention of complications related to reoccurrence or development of new concerns." (Wright, 2004) Wiedenbach clearly created terms in her theories for nursing which were not intended to fully define the profession, but were mere attempts to clarify her understanding of many nursing misconceptions and to try to clear up and present clarity.

In the Labor and delivery process, this can be translated into identifying a patient's need for help and if necessary, providing the needed intervention such as implementation of a medical plan of care. For example, the nurse and entire medical team are responsible to be aware of Labor and Delivery issues that may stem from the likes of a premature labor, drug dependent mother or a premature rupture of the membranes. "Providing care, a nurse exercises sound judgment through deliberative, practiced, and educated recognition of symptoms. The patient's perception of the situation is an important consideration to the nurse when providing competent care." (Wright, 2004)

Brief Clinical Example

As a first year nurse I was diligently exploring the nurse's role for meeting the basic and usually more complex physiological needs in various health care settings. Although I touched upon acute care, long-term care and mental health facilities, my biggest eye opening experience in regard to cultural expectations came in an inner city delivery room. My entire perspective of leadership and culture changed as was required to apply the roles I…