Nursing has evolved into a science. Like other scientific disciplines, the practice of nursing is guided by nursing theories. According to Julia George, “practice is based on the theories of the discipline that are validated through research” (George, 2011, p. 7). The major shift in theoretical thinking in nursing is said to occur in the 1960s when the focus in nursing shifted from simple problem/need and functional role, to the relationship between nurse and patient (George, 2011, p. 10). The aim of this paper is two-fold: First, I will compare and analyze the concept definition of care (caring) across Dorothea Orem’s self-care theory and Madeleine Leininger’s theory of culture care theory.
Second, I will present the concept statement, metaparadigms, philosophies, and conceptual model of Dorothy Orem’s self-care theory and discuss where and how Orem’s self-care theory can be applied to nursing. I will explore the major concepts and assumptions of Dorothea Orem’s self-care theory and Madeleine Leininger’s culture care theory, and compare and analyze the two theories in terms of the similarities and differences. The concept of care (caring) is a core concept common to many nursing theories. Boykin and Schoenhofer in presenting their theory of Nursing as Caring maintain that caring is the moral imperative for nursing (see George, 2011, p. 11).
Dorothea Orem’s self-care theory and Madeleine Leininger’s culture care theory both focus on patient care. I can easily identify with both theories. As a practicing nurse, my personal philosophy is that nursing is about caring; this apart, Orem’s and Leininger’s theories are not as abstract as some of the theories. Both theories can therefore be still be used by the nurses who are not in academia to guide and improve their practice. Orem’s theory focuses on the key concept of self-care. According to Orem’s theory, every individual adult has the capacity for self-care. “Self-care implies that when they are able, individuals care for themselves. When the person is unable to care for himself, the nurse provides the assistance needed. For children nursing care is needed when the parents or guardians are unable to provide the amount and quality of care needed” (George, 2011, p. 114).
I find Orem’s theory to be logical. There are certain situations when one is ill and does not require a nurse. For example, most people do not immediately go to the hospital with the common cold. In this case they take care of themselves. When a health problem arises for which “self-care” is insufficient to take care of the situation, one has to seek the attention of the “nurse” who compensates for this deficit. According to Orem, a nurse is needed when someone needs nursing care because of inability to care for oneself. The environment is to foster and maintain nurse therapeutic relationship between nurses and patients, to determine when someone needs help or assistance, attention to patient response, giving direct aid to individuals and families and collaboration with other health professionals. The “nurse” according to Orem can be a parent or another human, family or community, not necessarily a health care nurse.
As outlined in her theory, there are three interrelated actions or measures used to provide self-care. The first is the Universal self-care requisites; this is self-care that is holistic and includes the need oxygen, water, food, elimination, activity, and rest, to prevent trauma and other necessities of life. The second type is the developmental self-care requisites; this is self-care that should be undertaken in accordance with human growth and development. The third type is the health deviation self-care requisites; this self-care carried out because of health problem or disease prevention and health promotion (George, 2011, p. 116).
Orem’s concept of “self-care” theory seems to have a universal appeal. In a sense one can say that Orem is not just referring to individuals who are sick. For example, new-born babies need nursing care not necessarily because they are sick but because they are unable to “self-care” for themselves and the parents typically might not be able to provide the quality of specialized care needed at birth; nursing care is therefore needed for the first couple of days and then the parents can take over the care until the child becomes a self-caring individual. Orem defines nursing as “the provision of self-care which is therapeutic in sustaining life and health, in recovering from disease or injury, or coping with their effects” http://www.faculty.ucc.edu/nursing-gervase/orem.
Madeleine Leininger, like Orem, sees the importance of the element of caring in the profession of nursing. As Leininger puts it, “care (caring) is essential to curing and healing, for there can be no curing without caring” http://www.Madeleine-leininger.com. The term ”transcultural nursing” is used to refer to humanistic and scientific knowledge and practices that focus on assisting individuals, families and communities to maintain or regain health and to deal with disability, dying or other human conditions in a culturally respectful and beneficial manner
http://www.Madeleine-leininger.com. Leininger’s theory of transcultural care theory is derived from the disciplines of (cultural) anthropology. Key concepts in this theory include cultural diversity (the differences between and among the various cultures) and cultural universality (the common elements or similarities found in various cultures). While she was working as a nurse, in a child guidance home Leininger observed recurrent behavioral differences and eventually concluded that the differences had a cultural base (George, 2011, p. 405).
Leininger’s cultural care theory aims to provide culturally congruent nursing care through “cognitively based assistive, supportive, facilitative, or enabling acts or decisions that are mostly tailor-made to fit with individual’s, group’s, or institution’s cultural values, beliefs, and lifeways” (Leininger, M. (1995). Transcultural nursing: Concepts, theories, research and Practices. New York: McGraw Hill, Inc., p. 75). Leininger uses the four nursing metaparadigm differently in her theory. For example, she uses the concept to refer to families and groups or communities; health is not limited to nursing. Leininger’s Culture Care Theory views nursing as a transcultural, humanistic and scientific care discipline and profession with the central purpose to serve human beings worldwide.
“Whereas it is important to look at a patient as a whole person from a physiological, psychological, spiritual, and social perspective, it is also important to take a patient’s culture and cultural background into consideration when deciding how to care for that patient. For example there should be no when attending to people from other minority cultures such as gay, lesbians, and trans-gender individuals. Nurses, when using this theory, can recognize and understand cultural similarities and differences to influence the person’s health status. In essence the theory assumes that nurses who understand, value, and practice culturally competent nursing care are more effective and capable of achieving positive outcomes in the healthcare of their patients.
The theory assumes that culturally nursing care will occur when the patient’s beliefs and value systems are carefully incorporated the patient’s nursing care plan. From the above outline of Madeleine Leininger’s culture care theory and Dorothea Orem’s self-care theory one can see that both theories see (patient) care as the central focus of nursing. Both theories are very practical; one can even describe them as “empirical.” The two theories do differ in one very important focus: Leininger focuses on culture to influence health, whereas Orem focuses on the self (self-care) to keep the body healthy and functioning. It is evident that both theories have undergone some significant revisions over time.
In this section, I will shift the focus of the discussion of where and how Leininger’s cultural care theory may be best applied to nursing practice. The Transcultural theory considers the component of culture as an important factor that needs to be included when planning the care of the patient. For family assessment, the theory can serve as basis and guide in evaluating the different factors that need to be assessed in the family. In application of transcultural theory in family assessment there are three points that need to be considered.
First, the nursing care should incorporate the cultural backgrounds of the family by appropriately doing culture and background interview to the family Second, the family nurse should incorporate the inquiry on health beliefs, heath patterns, and practiced superstitions and beliefs that propose significance to the health condition of the family. Finally, the nurse needs to incorporate the most suited interventions that called for by the clients for care modalities and health care interventions (e.g. hospital, clinician, family, herbalist, etc.
The use of transcultural theory in family assessment further enhances the nursing care being administered to the patient http://www.Madeleine-leininger.com. In terms of application, one can see certainly where exercising cultural sensitivity as advocated by the culture care theory would lead to better rendering of healthcare and faster recovery.
The theory raises a number of serious questions. For example, how does one handle emergency situations? Giving the current nurse-patient ratios in hospitals and the vast array of cultures that nurses are likely to encounter, especially in a county hospital like the one in which I work? This apart, communication and language is a hallmark of any culture; does Leininger culture care theory implies that nurses should begin to attempt to render service to patients in the patient’s native language?
These are questions that we might not have answers for at this point. Here is where philanthropic organizations like Sigma Theta Tau International (STTI) and the Joanna Briggs Institute can continue to support further research into nursing theory and health education that would help bridge the gap between nursing research and clinical practice.
Leininger M. (1991). Culture care diversity and universality: A theory of nursing. New York: National League for Nursing Press. George, Julia B. (2011). Nursing theories: The base of professional nursing practice 6th edition. Pearson Education, Inc. Leninger M, McFarland M. Transcultural Nursing: Concepts, Theory, Research, and Practice; 3rd ed., McGraw-Hill Professional; New York, 2002.