Mrs Franklin Jones was admitted from the Emergency Room to Cardiac Intensive Care one week ago with a diagnosis of acute myocardial infarction. She has recovered as expected and is moving to the cardiac step down unit today. She is talking with Nurse Julie Hernandez, as she gets settled in her new room, "I was really surprised when I got that bad pain in my chest! I knew I had high pressure but I just didn't think it was that bad. I try to take my medicine like they told me to in the clinic but sometimes I forget. I guess that I need to study those papers they gave me about what foods I should eat and not eat. I better take care of myself! Momma had bad pressure and it killed her! Who knows—I may even have to learn to cook different than I was taught in Jamaica! I may have to let Tomas do the cooking. He's got more time at home now than I do since he lost his job. There isn't too much time between my shifts at the school cafeteria and my new housecleaning job. You know my sister is coming up from Jamaica to see me. I think she is bringing me some bush tea. That'll set me right!" Using Leininger's Culture Care Model, what factors in the story shared by Mrs. Franklin-Jones should be considered by Nurse Hernandez when planning for the patient's discharge? Why is the theory of Culture Care Diversity important in the delivery of nursing care for all patients? Using Leininger's Theory of Culture Care Diversity and Universality, develop a plan of care for Mrs. Franklin-Jones. Discuss the strengths and limits to Leininger’s Theory. Case Study #2 Claude Jean-Baptiste is recovering from post-hip replacement surgery and has been transferred to the Rehabilitation Institute adjacent to the hospital. When he enters the unit, he sees welcoming signs written in several languages including his own, Creole. Since there are no nurses on that shift that speak Creole, they use a language line to ask for translation services. During this initial nursing assessment, the translator informs Mr. Jean-Baptiste that the nurses invite him to have a relative at his side so that they can be sure to understand and meet his needs. He is asked about Haitian customs and beliefs that they might honor. Mr. Jean-Baptiste is encouraged to bring food and spiritual care items, and to share the warmth of his culture with the nursing staff. Discuss assumptions of the Transpersonal Caring relationship. What is the nurse's role? How is love, as defined by Watson, evident in this caring moment? How can the nurse creatively use self to create a healing environment? Discuss the strengths and limits to Watson’s Theory.

Question

Mrs Franklin Jones was admitted from the Emergency Room to Cardiac Intensive Care one week ago with a diagnosis of acute myocardial infarction. She has recovered as expected and is moving to the cardiac step down unit today. She is talking with Nurse Julie Hernandez, as she gets settled in her new room, "I was really surprised when I got that bad pain in my chest! I knew I had high pressure but I just didn't think it was that bad. I try to take my medicine like they told me to in the clinic but sometimes I forget. I guess that I need to study those papers they gave me about what foods I should eat and not eat. I better take care of myself! Momma had bad pressure and it killed her! Who knows—I may even have to learn to cook different than I was taught in Jamaica! I may have to let Tomas do the cooking. He's got more time at home now than I do since he lost his job. There isn't too much time between my shifts at the school cafeteria and my new housecleaning job. You know my sister is coming up from Jamaica to see me. I think she is bringing me some bush tea. That'll set me right!" Using Leininger's Culture Care Model, what factors in the story shared by Mrs. Franklin-Jones should be considered by Nurse Hernandez when planning for the patient's discharge? Why is the theory of Culture Care Diversity important in the delivery of nursing care for all patients? Using Leininger's Theory of Culture Care Diversity and Universality, develop a plan of care for Mrs. Franklin-Jones. Discuss the strengths and limits to Leininger’s Theory. Case Study #2 Claude Jean-Baptiste is recovering from post-hip replacement surgery and has been transferred to the Rehabilitation Institute adjacent to the hospital. When he enters the unit, he sees welcoming signs written in several languages including his own, Creole. Since there are no nurses on that shift that speak Creole, they use a language line to ask for translation services. During this initial nursing assessment, the translator informs Mr. Jean-Baptiste that the nurses invite him to have a relative at his side so that they can be sure to understand and meet his needs. He is asked about Haitian customs and beliefs that they might honor. Mr. Jean-Baptiste is encouraged to bring food and spiritual care items, and to share the warmth of his culture with the nursing staff. Discuss assumptions of the Transpersonal Caring relationship. What is the nurse's role? How is love, as defined by Watson, evident in this caring moment? How can the nurse creatively use self to create a healing environment? Discuss the strengths and limits to Watson’s Theory.

Dan Palmer · Accepted Answer

Mrs. Franklin-Jones tells the nurse that “she needs to study the papers they gave her about what foods she should eat and not eat.” Therefore, the nurse should educate the patient about the foods to eat before discharging her to avoid readmission. The nurse should also factor in the patient’s kinship characteristics. The patient noted that her mother died of HBP, and thus the nurse should provide the interventions that should prevent her from suffering HBP (Busher Betancourt, 2016). The nurse should also consider the patient’s economic factors. Information about the patient’s economy can help the nurse recommend interventions that suit her financial status. Information about economic status can also help the nurse plan care that will not interfere with her job schedule and prevent her from forgetting to take her medications. Importance of the Theory  The theory of Culture Care Diversity is so vital in care delivery. This theory can help a nurse understand the patient’s culture under his or her care and deliver care based on the patient’s values and beliefs. For instance, in the case, the theory has helped Nurse Hernandez identify that Mrs. Franklin-Jones lacks education about the foods to eat and not to eat. As a result, Hernandez effectively plans an intervention to improve the patient’s knowledge. Another importance of this theory is that it can be used to improve the relationship between nurses and patients. When nurses understand patients’ values and beliefs, they will provide care that respects their values, hence improving their relationship (P. Sagar & D. Sagar, 2018). Lastly, the theory is significant because it can improve patients’ satisfaction. Patients who feel that caregivers respect their norms, beliefs, traditions, and values will be highly satisfied with the services (Albougami et al., 2016). A Plan of Care for Mrs. Franklin-Jones The first step of the care plan is health assessment. The health assessment will be done by analyzing the patient’s personal and medical history and physical, sexual, cultural, and emotional factors. Assessment results will be used to provide a diagnosis. The second step is outlining the expected outcomes of the plan. Third, interventions to solve the problem to be highlighted and rationale for interventions provided. Lastly, the plan should be evaluated to find whether it met the proposed outcomes and the improvements to be made where necessary. Overall, the care plan should involve assessing, diagnosing, and outlining expected outcomes, nursing interventions, and evaluation. The Strengths and Limits of Leininger’s Theory The first strength of the theory is that that the Sunrise model was well-developed and has logically demonstrated how the concepts in Universality and Culture Care Diversity interrelate. Second, the theorist organized her concepts clearly and well, and this has made it easy for people to apply the theory in different settings (Albougami et al., 2016). The third strength is that the theory can be generalized and applied in many distinct situations. Lastly, the theory seems hard in terms. However, it can be understood easily upon the first contact. The weakness of the theory is that its terms are not simple. In conclusion, nurses should provide care that considers the patients’ cultural beliefs, values, and practices. Case Study Two - Claude Jean-Baptiste The Transpersonal Caring Relationship is a theory developed by Jean Watson. The theory’s concern in how caregivers provide care to their patients and how they progress care into better plans to restore health by promoting wellness and health and preventing illness. According to the theory, nursing is concerned with preventing diseases, caring for the sick, promoting wellness and health, and restoring people’s health (Tonin et al., 2019). The focus of the theory is health promotion and disease treatment. This part of the assignment uses case study two to apply the theory in nursing care. Assumptions of Transpersonal Caring Relationship Theory  The theory made several assumptions, including the following. First, caring can be demonstrated and practiced effectively through the interpersonal approach only. Second, caring includes the carative elements that can lead to the satisfaction of certain human wants. Third, effective caring promotes family or individual development and health (Pajnkihar et al., 2017). The fourth assumption is that responses to caring accept patients in their current situation and what they will turn out to be after treatment. Fifth, a caring environment is the one that allows the patients to grow and, at the same time, give them opportunities to decide the type of actions they should undergo. The sixth assumption is that the science of curing corresponds with the science of caring. Lastly, the theory assumes that the central practice in the nursing profession is caring (Maniago & Albougami, 2019). From these assumptions, the nurse has the role to provide care to patients by considering the patients’ wants. For instance, in this case, the nurses should provide Claude Jean-Baptiste with the care that comprises his Haitian customs and beliefs. Evidence of Love in the Case According to Maniago and Albougami (2019), Watson defined love as the practice of providing care in a respectful, nurturing, and understanding manner. A nurse can show love by valuing the patient as a whole. The following are ways to love, as defined by Watson, evident in this caring moment. First, love can be seen where the nurses have welcomed Claude Jean-Baptiste with signs written in different languages, including Creole, his own language. The action shows that the unit values the patient’s presence in the hospital. Second, love has been shown by the nurses when they provide the patient with a translator. The nurses have accepted the patient by providing him with a translator, which is a sign of love. Third, respect is one of the elements of love, as described by Watson (Pajnkihar et al., 2017). The nurses have respected the patient’s culture by allowing him to bring food and spiritual care items. Lastly, leadership has been shown when the nurses allowed the patient to be accompanied by a family member. Using the Sub-concept to Self to Create a Healing Environment  The concept of “self” comprises of the perceptions of the features of the “ME” or “I” the perspectives of the connection of “ME” and “I” to various aspects of life and others. In other words, “Self” is a concept that highlights how one views herself or himself (Pajnkihar et al., 2017). Nurses can use this concept to create a healing environment in the following ways. First, the nurse can make the patient environment as quiet as possible. Lastly, the nurses can use the Self-concept to take the patients outside the room after ambulating them. The Strengths and Limits of Watson’s Theory The first strength of this theory is that it is easy to understand and can guide and improve nursing practices in a healthcare organization. Second, the language used was not sophisticated; rather, it is evolutionary and fluid. Third, the concepts of the theory have been clearly and comprehensively. Another strength is that the theory’s assumptions are logical and can be effectively applied in the healthcare environment (Tonin et al., 2019). Lastly, the theory’s scope comprises the majority of aspects of the phenomena of health and illness. The weakness of the theory is that it has not clearly highlighted the direction nurses should take to achieve authentic healing and caring relationships. Nurses who need concrete guidelines may feel insecure using this they alone. Conclusion Watson’s theory can help nurses make caring the center peace of nursing practice. Through this theory nurses can create a healing environment. References Albougami, A. S., Pounds, K. G., & Alotaibi, J. S. (2016). Comparison of four cultural competence models in transcultural nursing: A discussion paper. International Archives of Nursing and Health Care, 2(3), 1-5. https://pdfs.semanticscholar.org/f1b7/48b664e1236fc0841a6c33259403e3f4f5e9.pdf Busher Betancourt, D. A. (2016). Madeleine Leininger and the transcultural theory of nursing. The Downtown Review, 2(1), 1. https://engagedscholarship.csuohio.edu/tdr/vol2/iss1/1/ Maniago, J. D., & Albougami, A. (2019). A national survey of transpersonal caring competency among emergency room nurses in Saudi Arabia. https://doi.org/10.21833/ijaas.2020.01.015 Pajnkihar, M., McKenna, H. P., Štiglic, G., & Vrbnjak, D. (2017). Fit for practice: Analysis and evaluation of Watson’s theory of human caring. Nursing science quarterly, 30(3), 243-252. https://doi.org/10.1177%2F0894318417708409 Sagar, P. L., & Sagar, D. Y. (2018). Current State of Transcultural Nursing Theories, Models, and Approaches. Annual review of nursing research, 37(1), 25-41. https://connect.springerpub.com/content/sgrarnr/37/1/25 Tonin, L., Lacerda, M. R., Favero, L., Nascimento, J. D., Rocha, P. K., & MO, N. (2019). Transpersonal caring model in home-Care nursing for children with special care needs. Journal of Nursing Education and Practice, 9(1). URL: https://doi.org/10.5430/jnep.v9n1p105 Alternative Expert Answer Nursing Culture Care Model Nursing care is often improved by the presence of various theories to guide the nurses through the individual processes that help in achieving maximal results. An example of these theories is Leininger’s Culture Care Theory, which aims at providing care that is culturally congruent through cognitive based facilitative, assistive, enabling, or supporting acts that are tailor-made for the best convenience of the individual (Wehbe-Alamah, 2018). The theory appreciates the values of the individual, his institution, group’s or cultural beliefs and values in the care process. Its primary emphasis is that culture and care are crucial concepts for a successful nursing process. Jean Watson’s theory of human caring, on the other hand, contends that caring is meant to regenerate the energies of patients in life and to promote self-actualization both at personal and professional levels (Alharbi & Baker, 2020). The practitioner and the patient need to have a transpersonal relationship of caring to achieve the unitary consciousness. This essay involves an explanation of two case studies in which the two theories are used to provide solutions to patients who require nurse attention to manage and improve their condition. Case Study #1 Mrs. Franklin-Jones, a patient admitted to the emergency room with MI diagnosis has recovered and is expected to move comfortably with the cardiac step. She expresses her relief to the Nurse in charge, telling her that she never thought her condition was supposed to be that serious but she is happy that she recovered, and is willing to take up any steps necessary to increase her safety. Factors to Consider when arranging the Discharge There are several factors in the story of Mrs. Franklin James that should be addressed when the nurse is planning for the discharge. Through Leininger’s culture care theory, the nurse would identify some of the things in the patient that would enable them to give the patient a culturally congruent nursing care (McFarland & Wehbe-Alamah, 2017). For example, the fact that the patient realized that she had been eating unhealthy foods and that she is willing to change for the better should be used to show the patient how she can have a meal plan that would at least be helpful for her condition. Also, the patient seems to be a little too occupied with her jobs, and hopes that her son, who just lost her job, will be of great help in helping her to prepare the recommended meals. Whereas this idea is somewhat faulty, the nurse should include a discharge plan that would ensure that the nurse is not overworked and also increases her independence with regards to things that help her in her daily living. Importance of the Culture Care Diversity Theory The theory of is important in delivering nursing care for all patients as the collaboration between nurses and patients in achieving culturally congruent care helps in promoting the best interest of clients while indirectly applying professional care. It encourages co-participation between the nurse and the clients in the plans of treatments and efficient decision making in providing holistic care to patients in groups, individuals and institutions (Del Grosso, 2019). Also, the theory of Culture Care Diversity helps in enabling comparative cultural care values as a primary element of transcultural nursing and as a major way of achieving wellness in patients using culturally meaningful ways. It helps the patients to appreciate the procedures that are set for them in the care process. Plan of Care for the Patient using Culture Care Diversity theory and Universality The plan of Care of Mrs. Franklin-Jones involves the following steps. First, the assisting nurse is required to understand her fears and strengths before starting the care plan. It is clear that the recent admission had inflicted a lot of pain in the patient, and she is willing to do anything it takes not to get in a similar situation. The fact that she wants to increase her knowledge in healthy eating and healthy living habits also makes it easy to achieve a perfect plan of care. The nurse should also understand her cultural preferences, including cultural foods and music as this would help get rid of the anxiety that could otherwise prevent her effective recovery process. The fact that Mrs. Franklin-Jones is in a busy schedule is also a useful tool in care as it helps the nurse to engage her for different care protocols in her free time, which she is likely to value even more. In the plan of care, the ability to be independent through things such as monitoring her symptoms and calling the relevant care personnel in case of extreme presentations should also be fostered in the patient. Most importantly, the patient should not lose her ability to perform the activities of her daily living. Limits and Strengths to Leininger’s Theory Among the strengths of the theory is the fact that it provides a holistic and comprehensive view of the patient’s background and seeks to improve it in the care process. For instance, during the assessment, the patient is checked for their communications, gender orientation, interpersonal relationship, occupation, and other personal attributes. These features help in fine-tuning the care protocol to meet the client needs in the best way possible. In the example above of Mrs. Franklin-Jones, it is this kind of assessment that proves to deliver competent care and provide high hopes for her recovery. The limits to the theory include but is not limited to the fact that the theory makes several assumptions that make it sometimes not applicable in certain circumstances in the real world. For instance, the theory assumes that curing cannot happen without caring. However, sometimes the natural self-care operations of the body could be enough to provide healing. Nevertheless, the theory is relatively efficient in delivering transcultural care. Case Study #2 Claude Jean-Baptiste, a Post-hip replacement surgery patient is transferred to a rehabilitation institute adjacent to the facility. Upon entering the unit, he realizes that the welcoming signs are written in his own language. With the help of a translator, the nurses try to assess the needs of Jean-Baptiste, and they recommend that a family member should be invited to help in fully addressing his needs. He is also interested in knowing the customs and beliefs of his community that the hospital honors, and is excited to share aspects of his culture with the nursing staff. Transpersonal Caring Relationship Assumptions & the Role of the Nurse There are several assumptions of transpersonal caring relationship and the role of the nurse in achieving care. According to Jean Watson, caring is one of the things that regenerates life energies and builds the capabilities of the patient. The assumption is that after caring, there are numerous automated benefits that people receive and both the professional and personal levels. On the contrary, sometimes care does not automatically generate wellness in the patients. The healthcare giver may follow all the precautions necessary but still experience a situation of no recovery in the patient. On the other hand, the patient can recover even without extensive action of the care giver. How Love is Evident in the described caring environment as explained by Watson There are several indicators that show that love is evident in the care environment of the patient as described by Watson. One of the dominant elements is the fact that the healthcare givers in the rehabilitation unit recognize the fact that the patient only understands cleore language, and so they put a welcome note that he can understand. In situations where the patient is not shown such an amount of love, it is possible that they may not make much considerations to the fact that an elderly patient needs to understand where they are and that they need to embrace change in a positive way (Willis & DM, 2017). Another way in which love is evident is the respect for autonomy of the patient, where he is allowed to freely interact with the healthcare givers, and even talk with them about other non-health topics such as their cultural ways of life. Creating a Healing Environment The nurse can creatively use self to generate a healing environment by helping the patient to realize their potentials as well as to express their needs and feelings in an open way. Self-actualization is achieved by encouraging the patient to take the necessary steps for him to improve his life and rejuvenate his energy reserves (Clark, 2016). Watson emphasizes that it is crucial to work for self in order to achieve the state of the ability to care for others, which includes the creation of a healing environment. Limitations and Strengths to Watson’s Theory Among the strengths of Watson’s theory is the fact that it enables the client to be comfortable in the context of the community, the culture, and the family. The theory recognizes that the healthcare giver is with the patient for only a short period of time, and hence there is need to prepare the patient for the longer period where he will be interacting with their family and community. A limitation of the theory is the fact that some of the biophysical needs of the patient are given too little attention at the expense of the psychosocial needs, and this, at times, would undermine the speed of recovery. Conclusion Leininger’s Culture Care Model and Transpersonal Caring Relationship are perfect examples of theories that can be applied when conducting care to individuals who have chronic conditions. Both theories help to increase the independence of the patients in their regular activities by improving their understanding of their condition as well as the self-management protocols. The theories also help in improving patient care through increasing their understanding of the environment that surrounds them. References Alharbi, M. K. N., & Baker, D. O. G. (2020). Jean Watson’s Middle Range Theory of Human Caring: A Critique. International Journal of Advanced Multidisciplinary Scientific Research (IJAMSR) ISSN: 2581-4281, 3 (1), 1-14. Clark, C. S. (2016). Watson’s human caring theory: Pertinent transpersonal and humanities concepts for educators. Humanities, 5(2), 21. Del Grosso, A. (2019). Application of Leininger’s Culture Care Theory in Family Medical History. McFarland, M. R., & Wehbe-Alamah, H. B. (2017). Theory of culture care diversity and universality. Nursing Theorists and Their Work-E-Book, 339. Wehbe-Alamah, H. B. (2018). Leininger’s Culture Care Diversity and Universality Theory. Annual Review of Nursing Research, Volume 37: Transcultural and Social Research, 1. Willis, D. G., & DM, L. S. (2017). Watson’s philosophy and theory of transpersonal caring. Nursing Theorists and Their Work-E-Book, 66.

Mrs Franklin Jones was admitted from the Emergency Room to Cardiac Intensive Care one week ago with a diagnosis of acute myocardial infarction

Written By: Dan Palmer, RN

Edited By: Ethan Green, MSN-FNP