Letters
Marilyn M McFarland
School of Nursing, University of Michigan, Flint MI, United States of America
Marilyn K Eipperle
Kaleva MI, United States of America
PP: 93 - 94
Article Text
Letter to Authors
October 11, 2008
Dear Dr McFarland and Ms Eipperle,
I am a graduate student at Towson University in Baltimore, Maryland. I am in my last class which is Theoretical Foundations of Nursing Practice. Recently I read your article in the Contemporary Nurse (2008) 28(1-2): 48-63 titled 'Culture Care Theory: A proposed practice theory guide for nurse practitioners in primary care settings'. I enjoyed reading this article since the provision of culturally congruent care to our patients is of great interest to me. I also wanted to find out if this theory can be applied to all nurses and not just the advanced practice ones.
I have previously read some of Dr Madeleine Leininger's work about transcultural nursing. Leininger's Theory of Culture Care Diversity and Universality, as described in your article, appears to be one that can be applied to various nursing settings including the acute care hospitals. I particularly like the aspect of caring in nursing as this concept has been linked to increased patient satisfaction. Patient satisfaction has been in the forefront of nursing and hospital administrators as they strive to provide the safest and the highest quality patient care possible.
Caring in nursing is not a new concept, dating back as far as Florence Nightingale. Caring in nursing has also been discussed by many and has been incorporated into various nursing care models. There are many caring theories. The most notable is Dr Jean Watson's Caring Theory. The concept of transcultural nursing also dates back to the 1950s and 1960s when Dr Leininger first noticed that nurses were not sensitive to the patients' cultural needs when caring for them. To further support the need for nurses to provide culturally congruent care, in the 1990s, the Joint Commission amended its standards to require a cultural assessment be a part of the basic nursing assessment.
Nurses are afraid of the word 'theory' and 'evidence based practice'. I believe it is due to lack of knowledge. The baby boomer nurses were not educated about theory in their basic nursing degrees; and Generation Y nurses, even though they have had the education, do not know how to apply the theories to practice. As nurses become busier with innovations, technology, electronic documentation, sicker patients, and more educated patients, there is little time left for them to 'care' for the patients. I firmly believe that provision of culturally congruent care in any setting is essential, as well as the right thing to do.
Your article discusses using Leininger's Theory of Culture Care Diversity and Universality in the advanced practice nursing curriculum. This needs to be taken a step further and such theories also need to be included in basic nursing programs to provide the continuity of care by all nurses. Then it is up to the nursing administrators and the nursing educators, in collaboration with bedside nurses, to create sound, theory-based models for patient care. We must give the bedside nurses the opportunities to use theory and make its application easy. Excellence in nursing as defined by the Magnet designation, and all the changes that occur as a result, are because it is the right thing to do for our patients and our nurses.
In conclusion, I wanted to comment on your description of the three modes of care in the Culture Care Theory. You summarize these modes as: caring with respect for the client's beliefs, values, and expressions...; to advocate for the client...; and in partnership with the client. I believe that these concepts on how we provide care can be used in any setting where nurses practice.
Thank you for a well written, informative and thought provoking article.
Blanka McClammer MSc, MA, RN, NEA, BC
Graduate Student, Towson University, Baltimore, MD
Director of Clinical Education, Howard County General Hospital, Columbia, MD
Authors' Reply
August 1, 2009
Dear Ms McClammer,
Thank you for your letter expressing your interest in our article in Contemporary Nurse (April 2008) 28(1-2): 48-63 entitled 'Culture Care Theory: A proposed practice theory guide for nurse practitioners in primary care settings'.
As stated in the opening paragraphs, our intention in writing the article was to provide a response to the question posed by Fawcett, Newman, and McAllister in their article (Nursing Science Quarterly 2004) addressing the fate of nursing theory in advanced practice nursing by proposing the use and applicability of Leininger's theory for nurse practitioners in primary care settings.
Having read some of Dr Leininger's work, as you stated, it has therefore in all likelihood provided you with an introduction to the basic tenets, assumptions, and premises of her theory which was developed for use by all nurses from all levels of practice, education, and research, as well as by other health disciplines.
While it is true that there are other theories of caring in nursing, Leininger's theory of Culture Care Diversity and Universality is among the very first, and is the most comprehensive and holistic as it encompasses practice, education, and research through the use of both the theory and the ethnonursing research method.
Leininger (2006) states that 'care is the essence and the central, dominant, distinct, and unifying focus of nursing' and that 'care/caring are essential to curing or healing for there can be no curing without caring' (p.18). Dr Leininger has written about many cultures including the cultures of nursing, and most importantly, the imperative need for overall healthcare reform to incorporate caring, culturally congruent care, and culture care competence throughout not only the nursing profession but the entire healthcare system nationally and globally.
In addition, many transcultural nurse authors and researchers have published extensive book chapters and peer-reviewed articles based on transcultural studies guided by Leininger's theory of cultures and nursing care set in homes, clinics, offices, hospitals, schools, universities, classrooms, and long-term care facilities that serve as guideposts for the caregiving professional nurse in providing hands on nursing care, education, research, and clinical practice to an diverse and similar peoples and populations.
We refer you to the content found in the long list of articles and books by the theorist, specifically Leininger (1991) and Leininger & McFarland (2002 & 2006), and the seminal article by Dr Leininger in the Journal of Transcultural Nursing (1995) for more in-depth reading and study.
Thank you again for sharing your thoughts regarding our article. We wish you success as you begin to move forward in your new career.
Sincerely,
Marilyn R McFarland PhD, RN, FNP-BC, CTN
Marilyn K Eipperle MSN, RN, FNP-BC
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