Case Study 1 and 2 on Application of Nursing Theories

Madeleine Leininger transcultural nursing theory involves understanding and knowing different cultures with respect to health-illness and nursing caring practices, values and beliefs with the goal to provide efficacious and meaningful nursing care services to individuals according to their health-illness and cultural values context (Mixer, 2011). It puts its focus on that different cultures have dissimilar caring behaviors and different health and illness patterns of behaviors, beliefs and values. Betancourt (2015) explains that Leininger Culture Care Theory provides a culturally congruent nursing care cognitive based facilitative, supportive, assistive or enabling acts that are tailor-made to fit with an institution’s, groups or individuals cultural life ways, beliefs and values.

Factors to Be Considered By Hernandez

According to the first case study, during the discharge of Mrs. Franklin-Jones, Julie Hernandez should consider different aspects. Mrs. Frankline-Jones has a forgetful mind where she sometimes forgets to take her medications. She fears that her illness may kill her as “bad pressure killed her mom”. This belief may be used positively by the nurse in pointing the advantages of following her medication, resting and eating habit to the last letter. She knows how to cook but she is afraid that her cooking may not be up to the requirements.

She is living on a strict schedule where she does not have extra time for cooking. This is a factor to be considered because with her condition of acute myocardial infarction, she requires times to relax and time to prepare her meals. Tomas should be considered in planning her meals as he is the family who will stay with her. While planning her eating habits, her origin which is Jamaica should be considered in deciding on the best dishes for her. To her, family is everything and they should be included in her recovery process. The nurse should research more on her originality to understand her norms, values and beliefs.

Importance of the Theory of Culture Care Diversity

Culture care diversity add clarity, depth and meaning to the overall focus at arriving at culturally nursing care component. It refers to the differences in acceptable, values or meanings forms of care in between groups of people (Betancourt, 2015). It focuses on predicting, explaining and describing nursing differences and similarities focused primarily in caring in human cultures and human care. It provides a holistic and comprehensive view of culture care influences by use of language, social structure, generic, worldview, professional system and environmental context.

Plan of Care for Mrs. Frankline Jones

Nursing Care Plans for Myocardial Infarction

1. Nursing diagnosis: Acute, Pain
2. May be  related to: coronary artery occlusion (Tissue ischemia)
3. Possibly evidenced by:
4. Changes in pulse, BP
5. Restlessness, changes in level of consciousness
6. Facial grimacing
7. Reports of chest pain with/without radiation
8. Evaluation criteria/desired outcome- patient will
9. Pain Level (NOC
10. Display ease of movement, relaxed manner, reduced tension
11. Verbalize relief/control of chest pain within administered medications appropriate time frame
12. Pain Control (NOC)
13. Demonstrate use of relaxation techniques.

Nursing Interventions	Rationale
Pain management Independent Document or monitor pain characteristics noting non-verbal cues (diaphoresis, crying, restlessness, rapid breathing, clutching chest, moaning), verbal reports and hemodynamic response (heart rate changes/BP)	Variation of behavior and appearance of patients with pain may challenge the assessment. Deeper investigation and verbal history of precipitating factors to be postponed until after relieving the pain.
Review history of previous MI pain, angina equivalent or angina. Discuss family history	Differentiates current pains preexisting patterns. It also identifies complications like pericarditis, pulmonary embolus, or extension of infarction
Provides a quite environment, comfort measure or calm activities. This should be achieved by approaching the patient calmly and confidently.	Decreases external stimuli, which aggravate cardiac strain and anxiety, limits coping abilities while adjusting to current situations.
Independent Instruct/assist in relaxation techniques like distraction behaviors, deep/slow breathing, guided imagery, visualization.	Helpful in decreasing response or perception to pain providing a sense of having some control a circumstance, increase in positive attitude.
Check vital signs before and after narcotic medication.	Respiratory depression/hypotension occurs as a result of narcotic administration. The problems increase due to myocardial damage increase in presence of ventricular insufficiency.

Strengths and Limits to Leininger’s Theory

Strengths

One of the strength of Leininger theory is its flexibility to be used with communities, groups, families, individuals and institutions in diverse health system. Leininger’s theory provides a visual schematic representation of the interrelationships and theory of its key components among its parts. Due to the increasing multicultural nature of nursing practice, it has increased the relevance of the theory.

Criticisms/Weakness

Betancourt (2015) explains that one of the major weaknesses of the theory is that it contains ambiguous terminology lacking clarity while describing key concepts. This is because nurses struggle in achieving clarity in concepts like cultural congruence, cultural competence, cultural sensitivity and cultural awareness. Another criticism of this theory is its failure to recognize the relationship between power, knowledge and their inattention to the complexities associated with racism, discrimination and prejudice. It is limiting nurses from incorporating the social, political and economic policy agendas in their plan. The other weakness is its failure in recognizing the power relations existing between groups. For example, when a group of people behaves as unexpected, it is represented as noncompliant.

Case study 2

Moral and Ethical Concerns In Relation To Transpersonal Caring Relationship

According to Caruso, Cisar, and Pipe (2008)The human caring theory of Jean Watson contributes to the nursing existential side meaning the caring of the patient’s body, mind and spirit to continue the healing process at optimal level. Watson explains the transpersonal caring relationship to “move beyond ego self and radiate to spiritual, even cosmic, concerns and connections that tap into healing possibilities and potentials”. The nurses are morally committed enhance and protect human dignity. They are also looking for authentic presence by asking the patient to include a relative for a better understanding of his condition and recovery. Families’ supports a patient in their recovery journey.          

They are respecting the patient’s beliefs by requesting him on information about Haitian customs and beliefs that they should honor. In the spirit and body aspect, they are encouraging Mr. Jean-Baptiste to bring spiritual care items and food. They are also sharing their love by welcoming him with his native language the Creole. The nurses while caring for Mr. Jean-Baptiste, are seeking to recognize. Connect and accurately detect the inner spirit condition by genuine presence and being centered in the caring moment; the energy field, thought, senses, words, actions, thought, intuition, feelings, body language, cognition and behaviors.

Love in the Caring Moment

Love/Heart-Centered Caring practice / is one aspect covering all the 10 Watson’s carative factors (Caruso, Cisar, & Pipe, 2008). One way that the nurse’s shows love is by cultivating one’s own transpersonal self and spiritual practices that goes beyond ego self by requesting them to carry spiritual care items. Another way they showed love is by developing and sustaining an authentic, helping-trusting relationship where they asked the client to bring a relative with them. The relative will assist them in understanding and meeting their needs. They are also sharing their love by welcoming him with his native language the Creole.

Using Self to Create a Healing Environment

According to Bacon (2014), while creating a healing environment a client should look for ways to reduce stress in the environment. The study of psychoneuroimmunology shows how emotional stress impacts on an individual’s body in a variety of ways. This happens due to an individual’s brain and immune, endocrine and nervous system constantly interacting with each other. One system’s reverberation impacts all the others. Human are a social and relational being with capacity to respond and create self, others, environment and the supernatural power.

According to Leininger, care is a powerful humanizing force incorporating the patient’s cultural knowledge and his or her community in the care they are receiving (Bacon, 2014). This includes environmental, economic, political and religious context constituting an individual’s and his or her understandings and perceptions of life and its surroundings.

Strengths and Weakness of Watson Theory

Strength

The strength of this theory is that it places clients in the family context, the culture and community. It also places the client as a focus of the nursing practice rather than technology. Another significant feature of the theory is personal growth potential by nurses while engaging transpersonal caring relationships.

Limitations

The ten carative factors of Watson primarily delineate a person’s psychosocial needs. This theory requires more research in applying the practice. Biophysical needs of an individual are given less value. Although Watson claims allegiance to the perspective of human science, her distinction between the experience of a person’s world and the world it actually is.

References

Bacon, J. (2014). Creating Healing Environment : Strategies Christian Nurse Use (1st ed.). Loma Linda University. Retrieved from http://scholarsrepository.llu.edu/cgi/viewcontent.cgi?article=1184&context=etd

Betancourt, D. (2015). Madeleine Leininger and the Transcultural Theory of Nursing (1st ed.). Cleveland State University. Retrieved from http://engagedscholarship.csuohio.edu/cgi/viewcontent.cgi?article=1020&context=tdr

Caruso, E., Cisar, N., & Pipe, T. (2008). Creating a Healing Environment (2nd ed., pp. 126-132). Lippincot Williams & Wilkins: Nurs Admin Q. Retrieved from http://www.watsoncaringscience.org/images/features/library/HealingEnviron_2008%20MayoAZ.pdf

Mixer,. (2011). Use of the Culture Care Theory to Discover Nursing Faculty Care Expressions, Patterns, and Practices Related to Teaching Culture Care. The Online Journal Of Cultural Competence In Nursing And Healthcare, 1(1). Retrieved from http://www.ojccnh.org/pdf/v1n1a1.pdf