Feb 23, 2024 Week 6: Culture and Caring Theories
The theory that resonates the most with me relating to NP practice is Kristin Swanson’s theory of caring and healing. The theory of caring and healing integrates the nursing paradigm through the five caring processes it outlines which are: maintaining belief, knowing, being with, doing for, and enabling. Nurse-Clarke, DiCicco-Bloom, & Limbo outline this relation in their 2019 article in the American Journal of Maternal Child Nursing by stating that the nurse must strive to understand what an even means to the life of another person, and under “being with” that the nurse must establish presence with an open mind to listen purposefully, in order to effectively share their feelings (p. 29). I identify with several parts of the theory, especially in regards to trauma processing, but one in particular stands out, enabling. Enabling a patient typically describes a negative context, but in Swanson’s view, enabling includes providing information in digestible amounts in order to not interfere with the grief or trauma process. This resonates with me because I have a tendency to information dump thinking I am being helpful and displaying willingness, when in all reality someone going through a difficult process is extremely prone to sensory overload. McKelvey (2018) outlines a further personal account of the growth opportunity that nurse’s face when going through introductory clinical rotations, facing life, death, illness, and health with their patients for likely the first time all at once (p. 9). I can attest to this shock as I was non-medically trained previous to my education as a nurse, and relied on empathy when treating patients until I learned about the different theories that help guide practice and identify stages of experiences patients are moving through. Swanson’s theory aims at meeting the patient where they are in their journey through a process and supporting them. The CLAS standards outline these very portions that parallel the theory in the sections pertaining to establishing culturally and linguistically appropriate goals for patients. This can be observed in the sections of Swanson’s theory listed as “knowing” where the provider must avoid assumptions and look for cues that the individual is comfortable with engaging in therapeutic communication, this can be facilitated by making culturally appropriate choices in environment and language.
McKelvey MM. Finding Meaning Through Kristen Swanson’s Caring Behaviors: A Cornerstone of Healing for Nursing Education. Creat Nurs. 2018 Feb 1;24(1):6-11. doi: 10.1891/1078-4535.24.1.6. PMID: 29490829.
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Nurse-Clarke, DiCicco-Bloom, B., & Limbo, R. (2019). Application of Caring Theory to Nursing Care of Women Experiencing Stillbirth. MCN, the American Journal of Maternal Child Nursing, 44(1), 27–32. https://doi.
The cultural nursing theory that most resonates with my practice as a future NP is The Purnell Model for Cultural Competence. Similar to other nursing theories, The Purnell Model places focus on the importance of provider understanding of cultural practices and preferences of the patient for optimal treatment outcomes. The Purnell Model is composed of 12 domains which provide an organized framework for the model and include, overview or heritage, communication, family roles and organization, workforce issues, bio-cultural ecology, high-risk behaviors, nutrition, pregnancy, death rituals, spirituality, healthcare practices, and healthcare professionals (Purnell, 2019). By analyzing common health disparities of groups and considering these 12 domains, providers can better understand health care practices, beliefs, cultural norms, and preferences of our patients. According to Purnell (2018), the model provides guidance that urges nurse practitioners to consider their personal and cultural beliefs and values in relation to those we are caring for. By assessing our own attitudes toward cultural practices, we are better able to care for patients, families, communities, and society as a whole. By considering and managing our own thoughts and beliefs, NPs are better able to provide respectful, dignified, care that helps patients to feel comfortable, confident, and recognized in their healthcare.
A nursing paradigm is a fundamental idea that guides development of the practice. According to Deliktas et al. (2019), paradigms that shape the education, research, and practice aspects of a discipline are defined as metaparadigms. Metaparadigms are composed of core issues of a discipline. Jacqueline Fawcettt defined person, health, and environment in nursing as the four main concepts that need to be explored (Nikfarid et al., 2018). The Purnell model is a theory that can be generalized and utilized in all areas of health practice. The Purnell Model of Cultural Competence is significant in the nursing paradigm because it enhances patient care by considering the person as a human being by reflecting on their cultural preferences as a core aspect of the provision of care. The theory has the metaparadigm concepts of global society, community, family, and person; and can be generalized for use in other professions (Purnell, 2019).
I believe I can identify with the Purnell Model because I understand the importance of providing fair, respectful, and dignified health care. I have traveled to many countries and have been fortunate enough to live in and learn about the various cultural beliefs and norms that guide health decision making in those areas. As an example, I lived in Nicaragua where there were high rates of adolescent pregnancies. Through learning about the country’s health disparities and norms, I found that the reason for this was the Machismo culture, beliefs against birth control, and overall, lack of sex education. A primary community effort through the use of international volunteers was sex education and prenatal care. It is crucial that as health care providers, we utilize the Purnell Model to consider communities we treat, their group’s health disparities, and beliefs surrounding health care. I feel that this mutual respect, and knowledge that I have gained has helped me to become a better, more culturally competent and sensitive provider. I also work in an ER that is culturally diverse. By enhancing my knowledge of varying cultures, I can provide better care that best serves the individual.
National Standards for Culturally and Linguistically Appropriate Services (CLAS) were developed in 2000 by the US Department for Health & Human Services Office of Minority Health (OMH) to create systems of care that acknowledge the need to address culture and cross-cultural relationships among individuals, health care providers, and communities (Gomez et al., 2016). The theory focuses directly on improving health care, patient-provider communication, health equity, and cultural competence. When healthcare providers aim to meet CLAS standards, and utilize theory-based practices such as Purnell’s Model, providers are able to implement better healthcare that acknowledges and respects the culture of a patient, and reaches mutual decisions that validates and includes the preferences of the individual. When culturally competent care is provided, patient-provider relations are enhanced, compliance to care plans is met, and health care goals are achieved. As a future NP, I plan to continue to increase my cultural competence through continued education to better serve my patients and their families.
References
Deliktas, A., Korukcu, O., Aydin, R., & Kabukcuoglu, K. (2019). Nursing students’ perceptions of nursing metaparadigms: A phenomenological study. Journal of Nursing Research, 27(5). https://doi.org/10.1097/jnr.0000000000000311 Links to an external site.
Gómez, M. , Charnigo, R. , Harris, T. , Williams, J. & Pfeifle, W. (2016). Assessment of National CLAS Standards in Rural and Urban Local Health Departments in Kentucky. Journal of Public Health Management and Practice, 22 (6), 576-585. doi: 10.1097/PHH.0000000000000410.
Nikfarid, L., Hekmat, N., Vedad, A., & Rajabi, A. (2018). The main nursing metaparadigm concepts in human caring theory and Persian mysticism: a comparative study. Journal of medical ethics and history of medicine, 11, 6.
Purnell, L. (2018). Models and theories focused on culture. In J. B. Butts & K. L. Rich, Philosophies and theories for advanced nursing practice, 3rd ed. (pp. 565-599). Jones & Bartlett
Purnell, L. (2019). Update. Journal of Transcultural Nursing, 30 (2), 98-105. doi: 10.1177/1043659618817587.
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