Transcultural care

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The care model of transcultural care is based on the care theory published in 1966 by Madeleine Leininger . In her theory, cultural dimensions of human care , she lays the basis for the model, also known as culture care or intercultural care , which sees every person, both cared for and caregivers, as a holistic being shaped by their culture as well as values ​​and norms of their social environment. It has the need to live, interact and be treated according to these ideas.

Definition

At the beginning of the consideration of the theory of Leininger some terms are clarified for a uniform understanding. In her theory of transcultural nursing, Leininger speaks of transcultural nursing. According to Leininger, culture refers to “[...] learned, shared values, convictions, opinions, norms and lifestyles of a specific group that guide thinking, decisions, actions and structured ways.” Leininger takes this approach from anthropology . According to Domenig, Leininger is based on the classical concept of culture, the culture concept of EB Tylor (1871), who understands culture as a complex whole, knowledge, beliefs of people, art, morality, laws, customs and all other skills and properties that one can as a member of society, includes.

Madeleine Leininger defines care as a humanistic art and science that focuses on personal care behavior. She also focuses on the functions and processes that are aimed at promoting and maintaining healthy behavior or on the recovery from illnesses that have physical, psychocultural and social significance for those who are always helped by a nurse. Nursing is the dominant, specific and unifying characteristic of nursing.

From these definitions she derives a further definition, namely that of culture-specific care, which refers to known values ​​and opinions that help people or enable them to maintain well-being by changing their way of life improve or empower people to cope with death or disability. Professional nurses, the target group of their research, are people who practice a humanistically oriented and scientifically founded profession (professional nursing), the core of which is care. Care - in the sense of helping, supporting and promoting behavior for the benefit of other people who need an improvement in living conditions - should meet the needs of patients and lead to maintaining healthy living conditions, improving harmful lifestyles and with illness, disability or dying to be able to handle better. Leininger describes this care as humanistic care, which consists in "[...] paying unreserved attention to the needs of patients and taking into account their ethical, moral and spiritual-religious ideas as well as their psychophysical needs."

From the point of view of “What is welfare?”, Leininger compiled a list in which she summarized the meaning of the term welfare from the point of view of people from 54 different cultures. Leininger describes health as a "state of well-being [...] that is culturally defined, assessed and practically lived out and which reflects the ability of individuals (or groups) to adapt their everyday role-specific activities to culture-specifically appropriate, positive and structured Way to carry out. "

Madeleine Leininger defines transcultural nursing as follows: “A designated area of ​​study and practice that focuses on a comparative, holistic view of the culture, nursing, health and disease patterns of people; takes into account differences and similarities in their cultural values, beliefs and practices; which aims to provide culturally congruent, sensitive and competent nursing to people from a wide variety of cultural backgrounds. "

Intention for developing the theory

As early as the mid-1940s, Madeleine Leininger became aware of the need for culture-specific care. “ What concerned me most was that the world was moving much more rapidly toward multiculturalism than the profession realized and nurses needed cultural knowledge and a theory to build nursing knowledge to guide nursing practices. However, it was not long before realized that a theory of Culture Care would have limited meaning and would be misunderstood unless there were nurses prepared in transcultural nursing.

It was Leininger's aim to capture the culture-specific in all cultures, for the research of which she founded the method of ethno care (ethnonursing, see section Methods ). Illness in a different cultural area often means being at the mercy of other caregivers, foreign forms of treatment and foreign medicine. These factors influence the healing and recovery process but also the dying process in a positive as well as a negative sense. Carers therefore need a wealth of information on the culture specifics that affect care. Every culture shapes the human conception of body and mind, disease and health, disease diagnosis, therapy and disease processing differently. A child is exposed to cultural imprinting from birth (perhaps even earlier). Taking over central values ​​of culture as a matter of course helps people to integrate into the community and gives them a sense of belonging and self-worth.

Presentation of the theory

Methods

In contrast to traditional theories in nursing, which defines a theory as a sequence of logically related concepts, Leininger describes her theories as a systematic and creative way to get to know something or to explain a limited or vaguely known phenomenon. Culture-specific influences on the patient must be taken into account. If this is not done in sufficient form, the nursing practice could be ineffective, resulting in dissatisfaction with the care provided. Madeleine Leininger studies nursing from an ethnoscientific point of view, since in her opinion ethnoscience is one of the most accurate methods used in anthropology to discover nursing knowledge. According to Leininger, the key to developing and developing the epistemological foundations of nursing awareness lies in the insight into the emic and etic systems of different cultures. Care forms the central core of professional care. Accordingly, care is the prerequisite for well-being, health, healing and for dealing with death. It differs between the different cultures, but there are also similarities. Leininger differentiates between two types of knowledge about care. On the one hand this is the generic (amateur, popular) knowledge, on the other hand the professional care knowledge. Religion, values, opinions and beliefs influence the methods of care. The consideration of these influences on care - from the perspective of the caregiver, but also from the perspective of the patient - is necessary for culturally congruent professional care.

Basic assumptions

Leininger defines transcultural nursing as “[...] a main area of ​​nursing that focuses on comparative studies and analyzes of different cultures and subcultures in the world with regard to their nursing behavior, nursing, health-disease values, opinions and behavior patterns, with the aim of a To develop overall scientific and humanistic knowledge in order to create culture-specific nursing practices that are unique to the culture. "

Leininger developed the theory on the basis of basic cultural anthropological assumptions and ethnographic methods. The most important of these basic assumptions are:

  1. Human care is a universal phenomenon , but the terms, processes, structural forms and care patterns are different in cultures.
  2. Nursing acts and processes are essential to human birth, development, growth, survival and peaceful death.
  3. Care is the essence of care and the characteristic, dominant and unifying nature of care.
  4. Nursing has a biophysical, cultural , psychological , social and ecological dimension, and the concept of culture offers the most comprehensive opportunities to learn about and understand care.
  5. Nursing is a transcultural phenomenon in that the nurses interact with clients, staff and other groups and it is necessary for the carers to recognize and apply intercultural factors in the nurse-client relationship and system .
  6. Caregiving behavior, goals and functions of cultures are different, as social structures, worldview and cultural values ​​differ in different cultures.
  7. Self-help activities differ in different cultures.
  8. The identification of universal and non-universal ethnic and professional nursing behaviors, opinions, and actions is important in discovering the epistemological and ontological basis of nursing consciousness.
  9. Nursing is largely culturally derived and requires sound knowledge and skills in order to perform the nursing activities satisfactorily and effectively.
  10. There is no cure without care, but there is care without healing.

The Sunrise model

The model serves as an instrument to fathom the cultural specifics mentioned above and to understand connections that have a strong influence on recovery, healing or the course of death. Leininger has developed the Sunrise model over the course of 30 years and repeatedly adapted it to their new scientific findings.

Sunrise model - overall overview of the various dimensions of cultural maintenance

The Sunrise model enables an overall overview of the various, closely related dimensions of cultural maintenance, which, however, must not be viewed in isolation. The model includes the factors related to human care. The most important aspect here is to understand the cultural world with its different expressions of life and influences on human living conditions. It also offers the opportunity to explore human care from different starting points. When researching culture-specific circumstances, one can begin with the dimension of understanding the world and reality in order to then work towards the lower part of the Sunrise model. However, it is also possible to begin with the examination of the level of professional care in order to then explore the existing understanding of the world and reality or the culture-specific and socio-structural dimensions. In the Sunrise model, different factors are taken into account that have an influence on the care pattern, illness and care, but also whether and what connection these factors have with each other and with one another. These factors are summarized again:

  • technological circumstances,
  • religious and philosophical influences,
  • relational and social factors,
  • political and legal circumstances,
  • economic conditions,
  • educational factors and
  • cultural values ​​and ways of life.

Applying Theory in Practice

With her theory, Leininger creates a generalized, abstract and at the same time practically applicable knowledge that can be implemented in nursing practice. This knowledge is intended to serve generic (amateur) and professional health care. Understanding the difference between generic and professional care is of great importance in terms of avoiding health risks, cultural conflicts, and the cultural pressures that can affect comprehensive care. In doing so, Leininger emphasizes that generic care can gradually transition into a professional form and that it will meet with understanding and respect in practice. The respect in practice is expressed in the fact that the amateur care activities are critically reviewed and (if they withstand this test) are applied by professional nurses. For the decision and implementation of care, Leininger names three modes: the maintenance or preservation function of culture-specific care, the adaptation and understanding function of culture-specific care and the restructuring or pattern change function of culture-specific care. The knowledge of culture-specific care that has been developed with the aid of theory must therefore be implemented in practice within an appropriate framework. In concrete terms, this could mean that patients receive a culture-specific diet as a supplement to the usual hospital food or that they can pursue their religious needs - possibly contrary to the usual procedures in the facility. The involvement of the patient's relatives / caregivers is of great importance, as there can certainly be cuts in the patient's life, which will also determine the time after the stay in the clinic. Habermann emphasizes in this context that the development of intercultural and transcultural skills is essential for the implementation of theory in practice. These competencies to be developed are in detail:

Attitudes and personality traits
  • Motivation and interest in intercultural contact
  • Impartiality; Refrain from negative reviews
  • Positive attitude to a foreign culture; Ability to accept cultural differences
  • Courtesy, kindness, diplomacy
  • Patience and tolerance
Knowledge and skills
  • General knowledge and awareness of cultural differences
  • Knowledge of the peculiarities of a foreign culture (values, norms, conventions)
  • Knowledge of the communication and interaction rules of culture

Communication skills

  • Mastery of strategies to avoid and clarify misunderstandings
  • Ability to initiate and maintain meaningful dialogues with members of another culture
Self-expression and interaction management
  • Ability to negotiate mutually acceptable identities
  • Willingness to take on foreign cultural perspectives and roles
  • Empathy

criticism

Because of the diversity of the concepts of transcultural nursing theory and its high complexity, the theory is certainly not easy to understand. According to Marriner-Tomey, only with a high level of anthropological and transcultural nursing knowledge can the theory be fully and accurately applied by nursing researchers. Other authors criticize the fact that the theory neglects to reflect on one's own point of view in favor of a view of culture, which would prevent viewing of one's own culture. Such an approach leads to the delimitation of cultures from one another. Although Leininger later developed an acculturation grid to include intracultural variations, this grid would ultimately lead to stereotypes. Habermann criticizes the fact that intercultural nursing problems are not adequately depicted and that complex realities are reduced to simple realities, with the result that stereotyping is encouraged. Overall, Habermann describes the Leininger model as too rigid. Schnepp criticizes that social categories such as gender and social class are neglected, and that the culturalization of actually everyday phenomena leads to an unnecessary problematization of these phenomena. According to Uzarewicz and Piechotta, professional care practices are mentioned as influencing factors on culture-specific care, but “[…] their structural relationship to one another within the social system […]” is not processed theoretically, which ultimately has a negative effect on its applicability in practice.

literature

Leininger

  • Nursing and Anthropology. Two Worlds to Blend , New York, 1970.
  • Transcultural Nursing. Concepts, Theories and Practices , New York, 1978.
  • Culture care diversity and universality. A theory of nursing . National League for Nursing Press, New York 1991, ISBN 0-88737-519-7 .
  • Cultural dimensions of human care , Lambertus-Verlag Freiburg / B. 1998, ISBN 3-7841-0823-7 .
  • with Susanna Alban and Cheryl L. Reynolds: Multikulturelle Pflege , Urban and Fischer, Munich Jena 2000, ISBN 3-437-26360-9 .

Other authors

  • Dagmar Domenig: The teaching of transcultural nursing in a clinical context: A tightrope walk. In: Pflege 1999, No. 12, pp. 362–366.
  • Monika Habermann: Aspects of an intercultural organizational development . In: Care Management . 7th year (1999), issue 2
  • Monika Habermann: "A lot of pain" or the "Mamma Mia Syndrome". Reflections on the cultural conflict in the clinical care of foreign patients . In: Care . 1992 issue 5, pp. 34-40
  • Wilfried Schnepp: On the connection between culture and nursing education. In: PflegePädagogik 7 (1997) H 5, pp. 16–32
  • Dagmar Domenig (Ed.): Transcultural Competence. Handbook for Nursing, Health and Social Professions . Hans Huber Verlag, Bern 2007.
  • Dagmar Domenig: Migration, drugs, transcultural competence . Hans Huber Verlag, Bern 2001.
  • Jens Friebe and Michaela Zalucki (eds.): Intercultural education in care . Bertelsmann, Bielefeld 2003, ISBN 3-7639-1886-8 .
  • Monika Habermann: Intercultural Management in Elderly Care. An introduction . German Institute for Adult Education, Bonn (no year).
  • Ann Marriner-Tomey: Nursing Theorists and Their Works . Recom Verlag, Basel 1992, ISBN 3-315-00082-4
  • Charlotte Uzarewicz et al. a. (Ed.): Transkulturelle Pflege , Curara special volume 10, Verlag für Wissenschaft und Bildung Berlin 1997, ISBN 3-86135-564-7 .

Individual evidence

  1. a b c Leininger, M. Madeleine: Cultural dimensions of human care. Lambertus-Verlag, Freiburg im Breisgau 1998.
  2. Leininger 1995
  3. Leininger, M. Madeleine: Culture Care Diversity & Universality: A Theory of Nursing. National League for Nursing Press, New York 1991.
  4. Marriner-Tomey, Ann: Nursing theorists and their works. Recom Verlag, Basel 1992.
  5. Uzarewicz, Piechotta, 1997, p. 112.
  6. ^ German Institute for Adult Education Jens Friebe and Michaela Zalucki (eds.): Intercultural education in care . Download PDF 946 kB