Case Study Analysis

The case study involves a patient, Mrs. Franklin-Jones, who was admitted from the Emergency Room to Cardiac Intensive Care after being diagnosed with myocardial infarction. Her conversation with Nurse Julie Hernandez, reveal the situation leading to the condition where she stated it started as a pain in the chest. Her family had a history of high blood pressure. She admitted that she was not following the drug schedule nor adhering to the dietary recommendation. She has a tight schedule as she has two jobs thereby limited time to relax.

Leininger’s Theory

Discharge of the Patient

The Leininger’s Culture Care Theory seeks to offer a culturally congruent care plan that fits as supportive, facilitative and within the parameters of cultural values, beliefs, and lifeways. The application of the theory is through collaborative efforts between the nurse and client to collaborate in coming up with a care lifestyle that will ensure the good health of the client. The theory takes into account the generic and professional knowledge. This theory may offer good guidance to the case of Mrs. Franklin Jones.

One of the main factors that the theory points out to the need of addressing a socioeconomic status of the patient. In this case study, the patient has pressure from work as she has two jobs, serving in the school cafeteria and as a housecleaner. This situation leaves little time for her to carry out activities for health living such as proper dieting, taking drugs and working out. The situation is more complicated because she is the main breadwinner as Tomas lost his job which piles up more pressure on her to achieve more for the family.

The other key factor to be considered in this case is the interpersonal relationship of the Mrs. Jones. Mrs. Franklin as the detail point out has a good relationship with those close to her. Her connection and collaboration with Tomas point out to a positive relationship. The partners seemingly work together as a team as she indicates that she is contemplating to have Tomas prepare meals for her. She also doesn’t have a problem with being the breadwinner after Tomas lost his Job. Mrs. Jones can also be said to be in good terms with her sister who is visiting all the way from Jamaica and even bringing her bush tea which she considers great for her health.  Family members are great caregivers and need to be integrated into the care plan.

The dietary issue is another factor that needs to be addressed during the planning of the patient’s discharge. The patients’ medical history of high blood pressure puts her at a higher risk of getting heart diseases. The patient indicated that she had been offered a recommendation on the best dietary plan to follow but admits that she is unable to follow it to the latter. Having been brought up in Jamaica, she is more conversant with the Jamaican cooking styles which she admits is limiting the options she has and indicates the need to increase her knowledge in more cooking style. The patient further holds a cultural value to the traditional bush tea which she highly regards due to its medicinal value.

Importance of Theory of Cultural Care Diversity to Offering Nursing Care

The theory of Culture Care Diversity is an essential resource to inform on the nursing care being offered to patients. This is because it offers guidelines that are important in the enhancing the good health and well-being of a patient. The theory notes indicate that care is central to the nursing practice and required for attaining health, well-being, healing, recovering, proper growth and continued survival of the patient (George, 2011). The theory identifies that there are differences in the remedies, knowledge, and care practice brought about by differences in culture. The theory points out to the need for nurses collaborating with the patient to develop a care plan that is aware of the cultural factors.

According to the theory, the patient is an integral part of the system. Patients are largely affected by factors such as language, religion, social, political, economic, technology, historical and environmental factors (Leininger’s, 2008). The health status of the patient should be considered in the result of the interaction of these factors as they affect the manner in which the patient recovers.

The theory proposes guidelines that the nurses need to follow and requires them to know the traits of different ethnic groups. Nurses should strive to offer individualized care to their respective patients. The healthcare system should be considered as interlinked to cultural factors. With the knowledge from this theory, nurses are equipped with the necessary skill to help them in their planning and implementing the care plans within the constraints of the culture. The care plan should also be adapted to the diverse sociocultural background (Leininger, 2002).

Mrs. Franklin-Jones Plan of Care

Cultural Maintenance

The first element to consider is the food and diet that the patient takes. The patient does not have to take learn new tactics of cooking. The recommended food can be prepared within the Jamaican cooking style that the patient is conversant with. Recommendations will be given to have the patient take bush tea that she that has traditionally be considered to have medicinal effects.

Culture care accommodation/ Negotiation

The needs of the patient require following the given prescriptions given by the product even if she works on a tight schedule. Great emphasis will be taken to ensure that the patient is well aware of the effects of different food which may cause high blood pressure. The family members need to be enlightened on the need of helping out the patient in various roles. They are also supposed to do a follow up on the recommended prescription and dietary requirement.

The patient needs to consider restructuring her economic way of life. This will require the patient to take time to rest. This is meant to help the patient to offload the excess burden due to pressure placed on her due to double shift.

Strengths of Leininger’s Theory

The theory is very important in that it highlights the need of every patient to be within the constraints of a given culture. The cultural factors have great influence on patient’s actions and behavior that affects the how healing, recovery, and well-being. The theory proposes the action that the nurses should take in developing a plan that is within means of the culture. This ensures that the care plan is accepted by the patient who will make efforts to adhere to the prescriptions and suggested an action (Leininger, 2008).

Limitations

The use of the Leininger’s Theory can lead to errors in developing clinical decisions based on a misperception of outcomes and values that the patients based on the outcome. A scenario where the nurse is unable to identify the cultural aspect of human needs, there is a possibility of leading to dissatisfaction with the care given (Andrews & Boyle, 2008). There is a limit on the applicability of different strategies based on the cultural framework. The theory does not identify the power relations that exist between groups and may negatively affect the response of a patient to a care plan.

Case 2

The case involves a patient, Claude Jean-Baptiste is in recovery process from post-hip replacement surgery. He has been transferred to the Rehabilitation Institute that is just next to the hospital. The signage in the unit is in several languages including his own, Creole. The unit has no nurses that speak his language and has to communicate through a translator. On the issues asked by the  nurses are the Haitian customs and beliefs that might be honored.

Assumptions of the Transpersonal Caring Relationship

In this case, the patient has the right to care about the moral and ethics. The nurses also ought to be professional on how they establish the nurse-patient relationship. The nurse and patient need be mutual and with concern on the welfare of each other. Nursing is thereby considered as an important profession that accords care to patients and grants transpersonal care concept.

The transpersonal caring concept has four main parts; intersubjectivity, self, the actual caring occasion of the patient and nurse and phenomenal field (Watson, 2002). In the case under consideration, Jean-Baptiste was from a different culture and required a lot of care and transpersonal understanding to ensure a flourishing relationship.

Love as Defined by Watson

According to Watson, love needs to be unconditional and altruistic. It involves the consideration of the patient’s needs rituals, wishes, beliefs, and routine. In the case being considered, the patient received a lot of love from the nursing community in the Rehabilitation Institute where he undergoes recovery. In the facility, the signage is even in his language which is an evidence of care and appreciation of his culture. Despite the language differences, the facility can access a translator to ease the communication process that is important to the nursing process. In the center, the patient is given an option of having a relative within the facility. The nurses are also concerned with understanding the patient’s culture by making inquiries on what customs and beliefs they need to understand.

Use of Self in Creating a Healing Environment

According to Venes (2013), self-implies the perception of “I” and me to other people and the interaction of different aspects of life in togetherness. In the era of evidence-driven nursing practice that requires the nurses to be considered as a finest of the fine arts. The nurses can adopt a unifying nursing model, and have health practice that promotes patient safety. The Theory of Human Caring was proposed by Jean Watson. The nurse needs to practice of having loving and kindness by building a caring consciousness. In creating a healing environment, the nurse needs to ensure that they are authentically present and develop a deep belief system. As a nurse, one needs to cultivate personal spiritual practice and transpersonal self. They should work to develop and sustain a helping-trust which is essential for an authentic caring relationship (Lukose, 2013). The nurse can further engage in the artistry of caring-healing practices. They are needed for the nurse to help create an environment of healing that takes into account wholeness, beauty, comfort, dignity, and peace (Caruso, Cisar, & Pipe, 2008).

Strengths of Watson’s Theory

The theory takes an approach that was not previously explored within the nursing profession. The theory meant to ensure that the nurse is well knowledgeable about the art of caring and how the power of caring is acknowledged. The theory considers the simplicity as an important aspect. This implies the relationships of care are considered as a transpersonal relationship where the nurse and the patient need to understand each other. The theory is readily available thereby making it easy to learn and apply in actual practice by the nursing professions. The theory covers the dimension that aims to improve the dynamic human world. The theory can be modified for all possible nursing conditions that the nurses can apply in their practice.

Weaknesses

The theory makes an assumption of very critical biophysical needs of patients and instead emphasizes psychosocial needs. Despite the fact that nursing includes psychological components, biophysical needs of patients go beyond their psychology.

References

Andrews, M., & Boyle, J. (2008). Transcultural Concepts in Nursing Care. New York: Wolters Kluwer Health.

Caruso, E., Cisar, N., & Pipe, T. (2008). Creating a Healing Environment; An Innovative Educational Approach for Adopting Jean Watson’s Theory of Human Caring . Nurse Admin Quartely, 126-132.

George, J. (2011). Nursing theories: the base for professional nursing practice (6th edition). Saddle River, NJ: Pearson Education, Inc. 

Leininger M. Culture Care Theory: A Major Contribution to Advance Transcultural Nursing Knowledge and Practices Journal of Transcultural Nursing, Vol. 13 No. 3, July 2002 189-192.

Leininger, M. (2008). Overview of Leininger’s Theory of Culture Care Diversity and Universality. Retrieved from http://www.madeleine-leininger.com/cc/overview.pdf

Lukose, A. (2011). Developing a practice model for Watson’s theory of caring. Nursing Science Quarterly, 24(1), 27-30.

Venes, D. (2013). Taber’s cyclopedia medical dictionary. FA Davis.

Watson, J. (2002). Intentionality and caring‐healing consciousness: A practice of transpersonal nursing. Holistic nursing practice, 16(4), 12-19.