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How Can I Think Differently? Nursing Theories Applied to Practice

Kayla Van Laeken

3647520

Faculty of Health Disciplines Athabasca University

Nursing 608: Philosophical Foundations of Nursing

Professor Margaret Scaia

March 5th, 2024

How Can I Think Differently? Nursing Theories Applied to Practice

Theories provide fundamental knowledge for nursing concepts and create a basis for

nursing care today (Leininger,1988). A theory is defined as “a set of concepts, definitions,

relationships and assumptions or propositions derived from nursing models” (Jacobson, 2017,

p.13). Nursing-specific theories begin with the discovery of ontological and epistemological

sources of nursing knowledge (Leininger, 1988). Theory-guided nursing care can be utilized to

improve patient care and create positive health outcomes for individuals, families, and

communities. This paper will explore my epistemological stance on nursing knowledge and a

description of the contemporary Cultural Care Theory by Madeleine Leininger. Finally, I will

describe the connection of the Cultural Care Theory to my practice in pediatric surgery.

My Epistemological Nursing Stance

Epistemology is “the study of the nature of knowledge and truth, and is focused on what

is considered justified knowledge” (Nursing Epistemology, 2021). In nursing, epistemology

refers to the patterns of knowing and epistemological views (Nursing Epistemology, 2021). The

study of epistemology is essential in nursing to ensure nurses understand the benefits of

knowledge in practice and know what they know versus what they need to learn.

Nursing knowledge is developed specifically for nursing practice and includes organized

information supported by evidence and facts, that have been tested and applied (Carper, 1978 &

Truncellito, n.d). This knowledge encompasses but also goes beyond intuition, wisdom, and

sensitivity to create an evidence-based, care plan targeted to provide wholesome care for

individuals (Kim, 2015). My epistemological view of nursing knowledge resonates with Barbara

Carper’s Fundamental Patterns of Knowing in Nursing. According to Carper (1978), there are

four fundamental patterns of knowing. These include empirics, esthetics, ethics, and personal
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knowledge (Carper, 1978). They demonstrate the diversity and complexity of nursing knowledge

and portray the importance of utilizing all four patterns simultaneously in caring for an

individual (Carper, 1978).

Patterns of Knowing

Empirics or the science of nursing is described as “empirical knowledge specific to

nursing” (Carper, 1978, p. 14). It emphasizes explanations that are systematic and controlled by

evidence (Carper, 1978). Esthetics, the art of nursing, according to Carper (1978), is founded on

perception and empathy. It looks at the unique perceptions of human experience and goes

beyond science to encompass a humanistic approach to care (Thorne, 2020). Ethical knowing is

the moral component, which goes beyond the ethical codes and looks at voluntary and deliberate

actions and right and wrong (Carper, 1978). Finally, personal knowledge is described as

knowledge needed to engage in interpersonal relationships authentically and is achieved

“through reflection, synthesis of perceptions and connecting with what is known” (Thorne, 2020,

p. 4). These four patterns of knowing are singular but interdependent when providing high-

quality patient-centered care.

Nursing according to Madeleine Leininger’s Cultural Care Theory utilizes both a

scientific and humanistic approach to care that goes beyond the individual to incorporate

families, communities, and cultural groups (Rosenbaum, 1986). One can also argue that ethical

knowing and personal knowledge are incorporated into her approach to care as she includes

culturally sensitive care in practice acknowledging right and wrong, with a focus on

interpersonal relationships (Rosenbaum 1986). The Cultural Care theory, which will be

expanded on throughout the paper, encompasses Carper’s various patterns of knowing and

supports my practice in various ways.

Leininger’s Cultural Care Theory

Madeleine Leininger began her career as a nurse in the 1940s when she wrote a personal

conviction mentioning that caring is a core concept of nursing (Nelson, 2006). It wasn’t until the

1950s when she was working as a psychiatric nurse, that she noted the inclusion of culturally

sensitive care was missing in her practice (Nelson, 2006). This led Leininger, to pursue a

master’s degree in anthropology which in turn resulted in the creation of the Cultural Care

Theory (Nelson, 2006).

The Cultural Care Theory is an empirically grounded contemporary model of care

founded on the belief that cultural care is the essence of nursing and should be central to nursing

metaparadigms (Leininger, 1988 & Rosenbaum, 1986). Leininger believes nursing to be a

profession that emphasizes care and caring and states that care “is essential to human health and

is the unique and major feature that distinguishes nursing from other disciplines” (Rosenbaum,

1986, p.414). Care is a universal human phenomenon that goes beyond the individual to include

communities, families, and cultural groups (Rosenbaum, 1986).

Key Elements of the Cultural Care Theory

According to Leininger (1988), three nursing actions aid to support culturally congruent

care. They include “cultural preservation or maintenance, cultural care accommodation or

negotiation and cultural care repatterning or restructuring” (Madeleine Leininger-Nursing

Theorist, n.d). Culture is defined as “a set of beliefs held by a certain group of people, handed

down from generation to generation” (Madeleine Leininger-Nursing Theorist, n.d). When caring

for a patient as a nurse it is important to include a self-assessment, to address one’s personal

biases, and determine how they may affect the care of the patient with diverse cultural

backgrounds (Madeleine Leininger-Nursing Theorist, n.d). When a patient is receiving care, the
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diagnosis should incorporate any problems that may arise in the environment and cultural

background (Madeleine Leininger-Nursing Theorist, n.d). Lastly, the care plan should involve

aspects of the individual’s cultural background, when possible, to preserve their cultural beliefs.

Being sensitive to other’s cultural beliefs can allow for better outcomes, as culture can be an

integral part of people’s lives and impact their decisions on treatments and care (Madeleine

Leininger-Nursing Theorist, n.d).

The theory can also be applied to the Sunrise Model by Madeleine Leininger. It is a

conceptual framework used in the Cultural Care Theory to guide nursing care. It depicts how

components of the theory influence the care and health of individuals, families, and groups with

a focus on a holistic approach (Leininger, 1988). The visual model begins with a person’s

worldview and how different influences and decisions impact health and well-being (Leininger,

1988).

What Nursing Settings does this Theory fit into?

Cultural care refers to care that supports the values, and beliefs of individuals, families,

and groups to maintain, and improve one’s well-being throughout life or to face death

(Leininger, 1988). Practicing care that supports one’s beliefs will enrich the care provided and

create positive outcomes, and meaningful and trusting relationships between health care worker

and patient. This theory can be applied to all settings in nursing, as caring is a crucial concept to

promote health. The application of the Cultural Care Theory can be used to transform the future

of nursing to elicit care that is supportive of one’s specific and unique care goals and needs

(Lancellotti, 2008).

Strengths and Limitations

Madeleine Leininger’s cultural care theory emphasizes the importance of incorporating

cultural factors into nursing care, resulting in culturally sensitive care (Leininger, 1988). The

theory provides a comprehensive framework for grasping and addressing cultural elements in

nursing. It promotes a holistic approach to care that regards physical, emotional, social, and

spiritual well-being (Lancellotti, 2008; Leininger, 1988). When used appropriately, it can

provide a framework to guide nursing and “influence global health in a multicultural society”

(Lancellotti, 2008, p. 182).

Although there are many strengths to the Cultural Care Theory, there are also limitations

to its use in practice. It can be criticized for assuming cultures are rigid and categorized and not

fully account for diversity within cultures and unique cultural experiences (Lancellotti, 2008).

Without confirming beliefs with patients, it can result in applying generalizations to a whole

cultural or religious group, and the use of stereotypes and prejudice within nursing care

(Lancellotti, 2008). Nurses need to recognize this potential risk of the impacts of making

assumptions about one’s cultural and health beliefs, and treat everyone individually,

remembering that cultures are fluid and everchanging amongst individuals.

How is this Theory Helpful in Practice?

In my current position as a perioperative nurse, I provide care to all pediatric patients

requiring surgery in Manitoba. Culturally competent care is essential when working with many

patients with different ethnicities and cultural backgrounds. Being active listeners, open to

understanding, and accepting others’ beliefs and cultural values, can support individuals and

families in a time of stress, and overwhelming fear that accompanies surgery. An example of a

time when the Cultural Care Theory can be utilized and is helpful in practice is when we are

removing body parts. It is important to ask and take into consideration religious beliefs as some
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cultures believe in the burial of the body as a whole. When this occurs, several important

processes need to be put in place to ensure that the family can keep the area being removed. It

requires an organizational team, to ensure the amputated part is acquired, analyzed, preserved,

and given back to the family for the future. To promote a culturally safe space, care that is

congruent with one’s beliefs is essential to support a positive relationship between the nurse

patient, and family.

How Might this Theory Not be Helpful in Practice?

There are times in surgery when applying the Cultural Care Theory to practice can be

difficult. The Cultural Care Theory is based on providing culturally congruent care, that is

individualized, specific and beneficial to the client (Leininger, 1988). In life-threatening

surgeries, such as craniotomies, bowel resections, and blunt and penetrating traumas, applying

the Cultural Care Theory does not always occur. As a surgical team, we are working as fast as

we can to get an operating room prepared, while simultaneously speaking to the family and

taking the child into the operating room. It can be a hectic and overwhelming time for staff,

families, and patients, but the quicker we start surgery the better the overall outcomes typically

are. This results in a very brief interaction with family, and therefore missing key components of

culturally sensitive care. We provide the best care possible in the emergent time frame provided.

In the future, when trying to create a culturally safe space in emergency surgery as nurses

we could focus on spending a few crucial minutes asking the legal guardian and patient about

care preferences. This can include incorporating the Interpersonal Relations Theory by Hildegard

Peplau. She is the founder of the Theory of Interpersonal Relations, which focuses on attempting

to meet individuals’ needs (Purdy & Popan, 2022). It focuses on the unique aspects of individual

care needs to improve the patient-nurse relationship (Purdy & Popan, 2022). In the operating
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room, this can include keeping a religious item near the patient in surgery or keeping a head

covering on when possible. It is important as nurses, to recognize that even when we think we

may not be providing culturally supportive care, the time we do spend with the family, even

though short can still create a positive impact on the family and ease a bit of the stress and

innerving emotions that result from a loved one requiring emergency surgery. Utilizing the

Cultural Care Theory, simultaneously with the Interpersonal Relations Theory can allow for

further consideration of the unique cultural care needs of individuals, families and groups and

foster a healthy, trusting relationship that improves overall care.

Conclusion

The use of theories in nursing is used to guide nurses in practice and allow for the

discovery of new perspectives about care (Leininger, 1988). The application of theories to

practice can improve patient outcomes and provides nurses with a framework to assist them with

care decisions and providing quality care. Understanding the contemporary Cultural Care Theory

created by Madeleine Leininger and its nursing application can be linked to my practice in the

operating room. The vast differences in population, require a culturally supportive approach to

care that enables all members to feel safe and comfortable when receiving surgery. Nurses are

responsible for understanding the role of culture within the context of health promotion,

maintenance or death and dying (Madeleine Leininger-Nursing Theorist, n.d).

References

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1(1), 13–24.

Jacobson, S. (2017). Building bridges from theory to practice: Nursing theory for clinical nurses.

Med-Surg Matters, 26(3), 1-15.

Kim, H. S., (2015). The essence of nursing practice: Philosophy and Perspective. NY, NY:

Springer.

Lancellotti, K. (2008). Culture Care Theory: A Framework for Expanding Awareness of Diversity

and Racism in Nursing Education. Journal of Professional Nursing, 24(3), 179-183.

Leininger, M.M., (1988). Leininger’s Theory of Nursing: Cultural Care Diversity and

Universality. Nursing Science Quarterly, 1(4), 152-160.

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