Leininger's Transcultural Theory and the Health Belief Model: A Synthetic Approach to the Problem of Geriatric Care Geriatric care is a challenge in most ERs today because this is where geriatrics expect to receive regular treatment. Making this challenge all the more difficult is the fact that the U.S. population is aging and diversifying. The CDC has reported that over the next 15 years, the U.S. elderly population will consist of more non-Hispanic whites, Asians and non-Hispanic blacks than ever before. Considering that at the same time geriatrics will make up 20% of the population, it is especially important to know how to provide care for elderly persons who are likely to be sensitive to cultural and ethnic cues that have become deep-rooted in their personality over the course of their long life. Thus, for health care providers it is necessary to be culturally aware of attitudes and perceptions that might affect the patient and that could serve as a barrier to the proper palliative care that he or she needs.

The application of Leininger's Transcultural (middle range) theory is helpful in addressing this challenge because it provides the framework for establishing a culturally sensitive approach to treating diverse patients. Leininger's "Culture Care Theory" places culture at the heart of palliative care by pointing out how ethnicity and care expectations are intertwined in the patient and illustrating the need to approach patients with this awareness of how culture and care are related. Care providers who are sensitive to and accommodating of cultural and ethnic beliefs are perceived as more caring, knowledgeable and effective than providers who do not consider ethnic or cultural perspectives (Luna, 1998). While Leininger's theory is helpful for pointing out the need to establish a critical, cultural connection with patients, the Health Belief Model theory can also be applied because it shows that individual perceptions are also a crucial factor in determining their willingness to accept or deny treatment.

The Health Belief Model Theory

Health Belief Model is a borrowed theory that was developed in the mid-20th century in the field of social science. Its purpose was to provide a better understanding of why some people failed to utilize prevention strategies for the spread of disease. What the Health Belief Model identified was the concept that individual beliefs impacted the way in which that person approached treatment. If an individual's beliefs were negative in relation to the threat of disease and the value of treatment, then that individual was less likely to participate in a prevention program. If the individual's beliefs were positively associated with the threat of disease (i.e., the individual believed the threat was real) and with the value of treatment (i.e., viewed treatment as effective and good), that person was more likely to participate in the prevention program (Rosenstock, 1974). Rooted in behavioral theory, the Health Belief Model theory is based on the assessment that an individual will act according to his or her perceptions of what is in his or her best interest. It is appropriate to this particular problem regarding geriatric palliative care because it provides a way to examine the personal beliefs of the individuals and to take them into consideration in a health care environment.

The Health Belief Model has been applied since the 1950s in a number of ways. In 1984, a study was performed in which more than 40 previous studies on the impact of the Health Belief Model were analyzed and the conclusion found that the model is inherently sturdy in terms of predicting perceptions of behavior and outcomes (Janz, Becker, 1984). Carpenter's (2010) study found that there are many variables that the Health Behavior Model does not account for in its prediction method, yet Carpenter's application also showed that the model can be applied as an intervention that promotes education within the nursing environment so that a more health-conscious atmosphere can be effected and the patient-nurse relationship better facilitated. Likewise, the study by Che, Barrett, Velez, Conn, Heinert, and Qiu (2014) used the Health Belief Model theory examine the way in which women view risks to their pregnancy and how that view is demonstrated in their behavior. The study showed that with education, the perception of risk where there is none can be overcome and the Model is helpful in establishing that finding.

How It Would Change the Nursing Practice

The nursing practice would change through the utilization of the Health Belief Model application with regards to the challenge of treating the growing number of diverse geriatric patients with the proper palliative care...

Indeed, the fact that so many elderly patients come to the ER when their ailments are not emergencies indicates something about their personal beliefs -- namely, that they are worried and don't know what to do when something feels wrong, and that they are scare enough to believe it to be an emergency. It also indicates that they want attention right away and do not want to wait because they do not know what will happen if they do wait. Therefore, by applying the Health Belief Model, a better assessment of what geriatric patients of various backgrounds believe about health care and themselves will show nurses what it is that their patients are expecting. This in turn will allow nurses to better prepare for these presentations by prepping ahead of time the right sort of educational material that can be used to address individual patients who meet certain predictive criteria identified by the application of the Health Belief Model.
By incorporating this theory, the practice of treating geriatric patients in the ER would change in the method of approaching the patient. The patient's belief system would be identified by the use of the Health Belief Model, and this identification would allow the nurse to make considerations in approach depending upon expectations, fears, and wants that the patient is likely to have based on this assessment. This would allow for better interaction between patient and nurse as there would be less confusion and the patient would feel more satisfied seeing that the nurse is able to respond in a manner that most pleases the patient. Likewise, the nurse will be able to better educate the patient based on the assessment criteria and this will facilitate the nurse's need to provide adequate palliative care in a manner that keeps the ER from becoming too full and reduces the feeling of everything being an emergency on the geriatric patient's end.

Synthesis

Leininger's Transcultural theory and the Health Belief Model theory can be integrated to form a synthetic solution to the challenge posed by the rise in geriatric presentations of diverse groups in the ER in the coming years. The Transcultural theory will allow the nurse to focus on ethnic backgrounds, traits and expressions so as to be more culturally sensitive to inputs and cues that can be helpful in communicating effectively. The Health Belief Model can support this interaction by simultaneously directing the nurse's attention to the personal beliefs about medicine, personhood, treatment, and expectations when visiting a health care facility that the patient might have. The synthesis of these two theories formulates an approach that is essentially similar to the Transcultural Assessment of Giger and Davidhizar (2002) in which the elements of time, space, communication, environment, biology, and social organization are utilized to help identify the beliefs, needs and values of an ethnically and culturally diverse group of people. In this case that group would be the diversity of geriatric patients in the ER. This synthesis would allow nurses to see that persons of different cultures may have different manners of communicating with health care providers or expectations of how much space to keep between two persons. Nurses could thus be more aware of these differences and how culture can be responsible for them. Especially when dealing with geriatric patients, these subtle nuances can be important in showing respect, dignity and importance. With that awareness in mind, the nurse could cultivate a satisfactory therapeutic intervention plan that would meet the patient's needs, thus creating a healthy relationship between health care providers and the patients. As culturally informed individuals who are also aware of the likelihood of personal beliefs, the nurse is better situated to provide lasting and effective palliative care.

In conclusion, the middle range Transcultural theory and the Health Belief Model borrowed theory can work together to give nurses a more comprehensive sense of where their patients are coming from and how to more successfully approach them in terms of their own unique needs and expectations. These two theories can be synthesized well together particularly in nursing and especially in this area of geriatric challenges because it facilitates the nurse's purpose of providing the best palliative care to patients that is possible at any given moment to any given ethnic or cultural group.