TFN

CULTURE CARE DIVERSITY AND UNIVERSALITY THEORY

MADELEINE LEININGER

MADELEINE LEININGER

developed her theory from a combination of
anthropology and nursing beliefs and
principles

1985

1st published theory in Nursing
Science Quarterly

1988

further explained her theory in the same journal

1991

published her book "Culture Care Diversity and Universality: A Theory of Nursing"

CULTURE CARE DIVERSITY AND UNIVERSALITY THEORY

must take into account the cultural beliefs, caring, behaviors, and values of individuals, families, and groups to provide effective, satisfying, and culturally congruent nursing care

PERSON

● referred to as a human being
● caring and capable of being concerned about
desires, welfare, and continued existence of others

ENVIRONMENT

● environmental framework
→ the totality of an event, situation, or
experience that gives meaning to human expressions, interpretations, and social interactions particularly physical, ecological, and sociopolitical and/or cultural settings
● culture
→ centers on groups and the patterning
of actions, thoughts, and decisions that occurs as the result of “learned, shared, and transmitted values, beliefs, norms, and lifeways”

HEALTH

● viewed as a state of well-being that is culturally defined, valued, and practiced and reflects the ability of individuals or groups to perform their daily roles
● includes health systems, health care practices, health patterns, and health promotion and maintenance

NURSING

● defined as a learned humanistic art and science that focuses on personalized behaviors, functions, and processes to promote and maintain health or recovery from illness
● uses three (3) modes of actions that are culturally-based and thus consistent with the needs and values of the client to deliver care in the manner best suited to a client’s culture
(1) cultural care preservation or maintenance
(2) cultural care accommodation or negotiation
(3) cultural care repatterning or reconstructing

three (3) modes of action (part sa nursing)

(1) cultural care preservation or maintenance
(2) cultural care accommodation or negotiation
(3) cultural care repatterning or reconstructing

CULTURE CARE DIVERSITY AND UNIVERSALITY THEORY

“different cultures perceive, know, and practice care in different ways, yet there are some commonalities about care among all cultures of the world”

TRANSCULTURAL NURSING

⟶ a learned branch of nursing that focuses on the comparative study and analysis of cultures as they apply to nursing and health-illness practices, beliefs, and values

goal of transcultural nursing

to provide care that is congruent with
cultural values, beliefs, and practices

CARE

⟶ refers to assisting, supporting, or enabling behaviors that ease or improve a person’s condition
⟶ essential for a person’s survival, development, and ability to deal with life’s events
⟶ has different meanings in different cultures which can be determined by examining the group’s view of the world, social structure, and language

CARING

⟶ refers to actions and activities directed toward assisting, supporting, or enabling another individual or group with evident or anticipated needs to improve the human condition either to recover or face death

CULTURE

⟶ refers to the learned, shared, and transmitted values, beliefs, norms, and lifeways of a particular group
⟶ guides thinking, decisions, and actions in specific ways
⟶ provides the basis for cultural values, which identify ways of thinking or acting

DIVERSITY

⟶ perceiving, knowing, and practicing care in different ways

UNIVERSALITY

⟶ commonalities of care

CULTURAL CARE

⟶ the subjectively and objectively obtained values, beliefs, and outlines of the lifeways that assist, support, facilitate, or empower another individual or group to maintain well-being, health, and deal with illness, handicaps, or death

cultural care diversity

different meanings, patterns, values,
beliefs or symbols of care within concepts that are related in supporting, assisting human care (such a role of sick person)

cultural care universality

commonalities or similarities in
meanings, patterns, values, beliefs, or cymbals of care that is observed among many cultures and reflect assistive ways to help people

WORLD VIEW

⟶ refers the the outlook of a person or group on the world or their universe to form a picture or a value perception about their life or world around them

SOCIAL STRUCTURE

⟶ organizational factors of a particular culture (e.g. religion, economics, education), and how these factors give meaning and order to the culture

ENVIRONMENTAL CONTEXT

⟶ refers to the totality of an event, situation, or experience that give meaning to human expressions, interpretations, and social interactions particularly physical, ecological, sociopolitical, and or cultural settings

ETHNOHISTORY

⟶ past facts, events, and experiences of individuals, groups, and various cultures and institutions that are mainly people-centered and that explains, interprets human lifeways within cultural trends

GENERIC (FOLK OR LAY) CARE SYSTEM

⟶ refers to culturally learned and transmitted, indigenous (or traditional) folk (community and home-based) knowledge and skills used to provide assistive, supportive, enabling acts toward another individual, group, or institution with evident needs to improve a human lifeway or health condition (well-being) or to deal with handicaps and death situations

PROFESSIONAL CARE SYSTEM

⟶ refers to formally taught, learned, and transmitted professional care, health, illness, and wellness and related knowledge and practice skills that prevail in professional institutions usually with multidisciplinary personnel to give service to others

3 MODES OF NURSING

CULTURAL CARE PRESERVATION OR MAINTENANCE, CULTURAL CARE ACCOMMODATION OR NEGOTIATION, CULTURAL CARE RESTRUCTURING OR REPATTERNING

CULTURAL CARE PRESERVATION OR MAINTENANCE

→ refers to those assistive, supporting, facilitative or enabling professional actions and decisions that help people of a particular culture to retain and/or preserve relevant care values so that they can maintain their well-being, recover from illness, or face handicaps and/or death

CULTURAL CARE ACCOMMODATION OR NEGOTIATION

→ refers to those assistive, supporting, facilitative or enabling professional actions and decisions that help people of a designated culture to adopt to or to negotiate with others for a beneficial or satisfying health outcome with professional care providers

CULTURAL CARE RESTRUCTURING OR REPATTERNING

→ refers to those assistive, supporting, facilitative or enabling professional actions and decisions that help clients change or greatly modify their lifeways for new, different, and beneficial health care patterns while respecting the client’s cultural values and beliefs and still providing a beneficial or healthier lifeway before the changes were laid out with the clients

ATHERINE KOLCABA

“Comfort is an antidote to the stressors inherent in health care situations today, and when comfort is enhanced, patients and families are strengthened for the task ahead. In addition, nurses feel more satisfied with the care they are giving.”

THE THEORY OF COMFORT

KATHERINE KOLCABA

KATHERINE KOLCABA

● born and educated in Cleveland, Ohio
● 1965
→ received her diploma in nursing and practiced part time for many years in medical surgical nursing, long-term care and home care before returning to school
● graduated gerontology in MSN with
specialty to TAXONOMIC STRUCTURE OF COMFORT
● she represents her own Comfort Line, to assist health agencies implement Comfort Theory on an institutional-wide basis
● local parish nurse program → founder and coordinator
● ANA and Sigma Theta Tau International → member
● University of Akron College of Nursing
→ emeritus associate professor of
nursing

TYPE OF COMFORT

RELIEF, EASE, TRANSCENDENCE

RELIEF

⟶ the state of the patient who has had a specific need met

EASE

⟶ the state of calm or contentment

TRANSCENDENCE

⟶ the state in which one rises above one’s problems or pain

CONTEXT IN WHICH COMFORT OCCURS

PHYSICAL, PSYCHOSPIRITUAL, ENVIRONMENTAL, SOCIAL

PHYSICAL

⟶ pertaining to bodily sensations

PSYCHOSPIRITUAL

⟶ pertaining to internal awareness of self
⟶ including esteem, concept, sexuality and meaning in one’s life; one’s relationship to higher order or being

ENVIRONMENTAL

⟶ pertaining to the external surroundings, conditions, and influences

SOCIAL

⟶ pertaining to interpersonal, family, and societal relationship

MAJOR CONCEPTS AND DEFINITIONS

HEALTH CARE NEEDS, COMFORT INTERVENTIONS, INTERVENING VARIABLES, COMFORT, HEALTH-SEEKING BEHAVIORS, INSTITUTIONAL INTEGRITY, BEST PRACTICES, BEST POLICIES

HEALTH CARE NEEDS

⟶ needs for comfort arising from stressful health care situations that cannot be met by recipient’s traditional support systems

COMFORT INTERVENTIONS

⟶ nursing actions designed to address specific comfort needs of the recipient
⟶ including physiological, social, cultural,
financial, psychological, spiritual, environmental, and physical interventions

INTERVENING VARIABLES

⟶ interacting forces that influence recipients’ perceptions of total comfort
⟶ consist of past experiences, age, attitude,
emotional state, support system, prognosis, finances, education, cultural background, and the totality of elements in the recipients’ experience

COMFORT

⟶ the state experienced by recipients of comfort interventions

HEALTH-SEEKING BEHAVIORS

⟶ a broad category of outcomes related to the pursuit of health as defined by recipient in consultation with the nurse health-seeking behaviors (HSBs) was synthesized by Schlotfeldt (1975) and proposed to be internal, external, or a peaceful death

INSTITUTIONAL INTEGRITY

⟶ corporations, communities, schools, hospitals, regions, states, and countries that possess qualities of being complete, whole, sound, upright, appealing, ethical, and sincere
⟶ when an institution displays integrity, it produces evidence for best practices and best policies

BEST PRACTICES

⟶ use healthcare interventions based on evidence to produce best possible patient and family outcome

BEST POLICIES

⟶ institutional or regional policies ranging from protocols for procedures and medical conditions to access and delivery of health care

CONCEPTUAL FRAMEWORK

⟶ nurses identify needs of patients and their families which have not been met
⟶ these needs are modified by intervening variables which are factors that nurses cannot change (such as poverty or a diagnosis)
⟶ with these concepts in mind, nurses formulate a comfort care plan, with the goal of enhancing comfort over a measurement of baseline comfort
⟶ when comfort of patients and/or families is enhanced, they can engage more fully, either consciously or subconsciously, in health seeking behaviors (HSBs)
⟶ HSBs are mutually agreed upon goals
⟶ HSBs can be internal (e.g blood work), external (goals in physical therapy), or a
peaceful death
⟶ when patients and families do better, the institution does better, as in measures of patient satisfaction or improved ratings

4 MAJOR THEORETICAL PROPOSITIONS

⟶ comfort is generally state specific
⟶ the outcome of comfort is sensitive to changes over time
⟶ any consistently applied holistic nursing intervention with an established history for effectiveness enhances comfort over time
⟶ total comfort is greater than the sum of its parts

PATIENT

recipients of care may be individuals, families, institutions or communities in need of health care

ENVIRONMENT

any aspect of patient, family, or institutional setting that can be manipulated by nurse, love ones, or the institution to enhance comfort

HEALTH

optimal functioning of a patient, family, health care provider, or community as defined by the patient or group

NURSING

the intentional assessment of comfort needs, the design of comfort interventions to address those needs, and reassessment of comfort levels after implementation compared with a baseline

MAJOR ASSUMPTIONS

⟶ human beings have holistic responses to complex stimuli
⟶ comfort is a desirable holistic outcome that is germane to the discipline of nursing
⟶ comfort is a basic human need which persons strive to meet or have met—it is an active endeavor
⟶ enhanced comfort strengthens patients to engage in health-seeking behaviors
⟶ patients who are empowered to actively engage in health-seeking behaviors are satisfied with their health care
⟶ institutional integrity is based on a value system oriented to the recipients of care—of equal importance is an orientation to a health promoting, holistic setting for families and providers of care

ACCEPTANCE BY THE NURSING COMMUNITY

PRACTICE, EDUCATION, RESEARCH

PRACTICE

⟶ students and nurse researchers have frequently selected this theory as a guiding framework for their studies in areas such as nurse midwifery, hospice care, perioperative nursing, long-term care, stressed college students, dementia patients, and palliative care
⟶ when nurses ask patients or family members to rate their comfort from 0 to 10 before and after an intervention or at regular intervals, they produce documented evidence that significant comfort work is being done
⟶ a verbal rating scale is sensitive to changes in comfort over time
⟶ a list of effective comforting interventions for each patient/family member is readily available and communicated
⟶ perianesthesia nurses have incorporated the Theory of Comfort into their clinical practice guidelines for management of patient comfort
⬦ in this setting, comfort management specifies
(1) assessing patients’ comfort needs related to current surgery, chronic pain issues, and comorbidities;
(2) creating a comfort contract with patients prior to surgery that specifies effective comfort interventions, understandable and efficient comfort measurement, and the type of postsurgical analgesia preferred;
(3) facilitating comfortable positioning, body temperature, and other factors related to comfort during surgery; and
(4) continuing with comfort management and measurement in the postsurgical period

EDUCATION

⟶ the theory proved to be easy for faculty to understand and apply and provided an effective method to role-model a supportive learning partnership with the students
⟶ the theory is appropriate for students to use in any clinical setting, and its application can be facilitated by use of comfort care plans available on Kolcaba’s website
⟶ the taxonomic structure and conceptual framework guided ways of being a comforting faculty member
⟶ the theory provided ways for students to obtain relief from their heavy course work by facilitating questions to their clinical problems, maintaining ease with their curriculum through trusting their faculty members, and achieving transcendence from their stressors with use of self-comforting techniques
⟶ the authors anticipate “that this adaptation may assist students to transform into professional nurses who are comfortable and comforting in their roles and who are committed to the goal of lifelong learning”

RESEARCH

⟶ nurses can provide evidence to influence decision making at institutional, community, and legislative levels through studies that demonstrate the effectiveness of comforting care
⟶ using the taxonomic structure of comfort as a guide, Kolcaba developed the General Comfort Questionnaire to measure holistic comfort in a sample of hospital and community participants
⬦ positive and negative items were generated for each cell in the taxonomic structure grid
⬦ twenty-four positive items and twenty-four negative items were compiled with a Likert-type format ranging from strongly agree to strongly disagree, with higher scores indicating higher comfort
⬦ at the end of the instrumentation study with 206 one-time participants from all types of units in 2 hospitals and 50 participants from the community, the general comfort questionnaire demonstrated a Cronbach alpha of 0.88
⟶ researchers are welcome to generate comfort questionnaires specific to their areas of research
⬦ the verbal rating scales and other
traditionally formatted questionnaires may be downloaded from Kolcaba’s website, where she also responds to inquiries in an effort to enhance the use of her theory

RETIREMENT AND ROLE DISCONTINUITIES THEORY

SISTER LETTY KUAN

SISTER LETTY KUAN

● born on November 19, 1936 in Katipunan-Dipolog, Zamboanga del Norte
● Master Degree in Nursing and Guidance and Counseling
● Doctoral Degree in Education
● University of the Philippines College of
Nursing Faculty and Academic
→ vast contribution to achievements
● Professor Emeritus
→ a title awarded only to a few who met the strict criteria

RETIREMENT AND ROLE DISCONTINUITY THEORY

● states that is another phase in a person’s life that would require some adjustments
● there are some roles that the person has already learned to play for many years
● now that the role has to be discontinued, there is a period of adjustment for this too so that the person can adjust to yet again, another new role in his/her life
● there are different things that can make the role discontinuity and retirement become positive in people’s lives

PHYSIOLOGICAL AGE

⟶ endurance of cells and tissues to withstand the wear-and-tear phenomenon of the human body
⟶ some individuals are gifted with strong genetic affinity to stay young for a long time

ROLE

⟶ set of shared expectations focused upon a particular position
⟶ may include beliefs about what goals or values the position incumbent is to pursue and the norms that will govern his behavior
⟶ set of shared expectations from the retiree’s socialization experiences and the values internalized while preparing for the position as well as the adaptations to the expectations socially defined for the position itself
⟶ for every social role, there is complementary set of roles in the social structure among which interaction constantly occurs

CHANGE OF LIFE

⟶ period between near retirement and post retirement years
⟶ in medico-physiologic terms, this equates with the climacteric period of adjustment and readjustment to another tempo of life occurs

RETIREE

⟶ an individual who has left the position occupied for the past years of productive life because he/she has reached the prescribed retirement age or has completed the required years of service

ROLE DISCONTINUITY

⟶ interruption in the line of status enjoyed or role performed
⟶ the interruption may be brought about by an accident, emergency, and change of position or retirement

COPING APPROACHES

⟶ interventions or measures applied to solve a problematic situation or state in order to restore or maintain equilibrium and normal functioning

DETERMINANTS OF POSITIVE PERCEPTIONS IN RETIREMENT AND POSITIVE REACTIONS TOWARD ROLE DISCONTINUITIES

HEALTH STATUS, INCOME, WORK STATUS, FAMILY CONSTELLATION, SELF-PREPARATION

HEALTH STATUS

⟶ physiological and mental state of the respondents
⟶ classified as either sickly or healthy

INCOME (ECONOMIC LEVEL)

⟶ financial affluence of the respondent
⟶ classified as poor, moderate, or rich

WORK STATUS

⟶ status of the individual according to his/her work

FAMILY CONSTELLATION

⟶ means family composition
⬦ close knit or extended family
→ where three more generations of family members live under one roof
⬦ distanced family
→ whose member
dwelling units
live in
separate
⬦ nuclear family
→ where only husband, wife and children
live together

SELF-PREPARATION

⟶ preparing of self to the possible outcome in life

HEALTH STATUS

⟶ dictates the capacities and the type of role one takes both for the present and future
⟶ fits for everyone to maintain and promote health at all ages because only proper care of the mind and body is needed to maintain health in old age

FAMILY CONSTELLATION

⟶ a positive index regarding retirement positively and also in reacting to role discontinuities
⟶ in the Philippines, the family undoubtedly stands as the security or trusting bank where all members, young and old can always run to and get help
⟶ when one retires, the shock of the role discontinuities is softened because the family not only cushions the impact, but also offers gainful substitutes, as in providing monetary support, absorbing emotional strains that often times with discontinuities and other forms of surrogating

INCOME

⟶ has a high correlation with both the perception of retirement and reaction towards role discontinuities
⟶ since income is one of the factors that secure the outlook of an individual, efforts must be exerted to save and spend money wisely while still actively earning in order to have some reserved when one grows old
⟶ also implies that retirement pensions should be adjusted to meet the demands of the elderly
⟶ this should be done in order to have a more relevant and realistic pension and benefits adjustment

WORK STATUS

⟶ goes hand and hand with economic security that generates decent compensation
⟶ for the retired, it implies that retirement should not be conceptualized as a period of no work because capabilities to function get sharpened and refined as they practice it on a regular basis
⟶ work enhances the aspects of self-esteem and contributes to the feeling of wellness even and old age

SELF-PREPARATION

⟶ said to be both therapeutic and recreational in essence pays its worth in old age
⟶ this does not only account professionalism or expertise but also benevolent work as in charitable actions with the colleagues
⟶ self-preparation is investing not in monetary benefits but in something that gives them dignity and enhance their fe

TO COPE WITH THE CHANGES BROUGHT BY RETIREMENT

⟶ one must cultivate interest in recreational
activities to channel feelings of depression or isolation and facing realities through confrontation with some issues

TO PERCEIVE RETIREMENT POSITIVELY

⟶ requires early socialization of the various roles we take in life
⟶ the best place to start is at home extending to schools, neighborhoods, the community and society in general
⟶ in retirement, their fellow retirees are their own best advocates
⟶ to facilitate this, barriers to full participation in the areas where important decisions are rich should be eliminated in order to give recognition and appreciation of the knowledge, wisdom, experience, and values which are the social assets that make the retired age and the custodians’ folk wisdom

GOVERNMENT AGENCY

⟶ to construct holistic pre-retirement preparation program which will take care of the retiree’s finances, psychological, emotional, and social needs

RETIREMENT

⟶ should be recognized as the fulfillment of every individual’s birthright and must be lived meaningfully

TECHNOLOGICAL COMPETENCY AS CARING IN NURSING

ROZZANO LOCSIN

ROZZANO LOCSIN

● born in 1954
● a native of Dumaguete City, Philippines
● Tokushima University, Tokushima Japan
→ resides and practices his nursing profession as Professor of Nursing
● Florida Atlantic University, Boca Raton, Florida, United States of America
→ Professor Emeritus
● 1988, University of the Philippines
→ earned his degree in Doctor of
Philosophy in Nursing
● Silliman University
→ 1976 – Bachelor of Science in Nursing → 1978 – Master of Arts in Nursing

TECHNOLOGICAL COMPETENCY AS CARING IN NURSING

⟶ a middle range theory grounded in nursing as caring
⟶ it is illustrated in the practice of nursing grounded in the harmonious coexistence between technology and caring in nursing

ASSUMPTIONS OF TECHNOLOGICAL COMPETENCY AS CARING IN NURSING

⟶ persons are caring by virtue of their humanness
⟶ persons are whole or complete in the moment
⟶ knowing persons is a process of nursing that allows for continuous appreciation of persons moment to moment
⟶ technology is used to know wholeness of persons moment to moment
⟶ nursing is a discipline and a professional practice

DIMENSIONS OF TECHNOLOGICAL VALUE IN THE THEORY

⟶ technology as completing human beings to reformulate the ideal human being such as in replacement parts, both mechanical (prostheses) or organic (transplantation of organs)
⟶ technology as machine technologies, for example, computers and gadgets, enhancing nursing activities to provide quality patient care
⟶ technologies that mimic human beings and human activities to meet the demands of nursing care practices, for example, cyborgs (cybernetic organisms) or anthropomorphic machines and robots such as ‘nursebots’

THE PROCESS OF NURSING

KNOWING, DESIGNING, VERIFYING KNOWLEDGE, PARTICIPATION IN APPRECIATION

KNOWING

⟶ the process of knowing person is guided by technological knowing in which persons are appreciated as participants in their care rather than as objects of care
⟶ the nurse enters the world of the other. In this process, technology is used to magnify the aspect of the person that requires revealing—a representation of the real person
⟶ the person’s state change moment to moment—person is dynamic, living, and cannot be predicted

DESIGNING

⟶ both the nurse and the one nursed (patient) plan a mutual care process from which the nurse can organize a rewarding nursing practice that is responsive to the patient’s desire for care

VERIFYING KNOWLEDGE

⟶ the continuous, circular process demonstrates the ever-changing, dynamic nature of knowing in nursing
⟶ knowledge about the person that is derived from knowing, designing, and implementing further informs the nurse and the one nursed

PARTICIPATION IN APPRECIATION

⟶ the simultaneous practice of conjoined activities which are crucial to knowing persons
⟶ in this stage of the process is the alternating rhythm of implementation and evaluation
⟶ the evidence of continuous knowing, implementation and participation is reflective of the cyclical process of knowing persons

PREPARE ME THEORY

CARMENCITA M. ABAQUIN

CARMENCITA M. ABAQUIN

● University of the Philippines College of Nursing
→ nurse with Master’s and Doctoral Degree in Nursing
→ served as faculty
→ held the position as Secretary of the
College of Nursing
● an expert of Medical Surgical Nursing
● with subspecialty in Oncologic Nursing
● Chairman of the Board of Nursing
→ her latest appointment speaks of her competence and integrity in the field she has chosen
● developed the theory “PREPARE ME: Interventions and Quality of Life of Advance Progressive Cancer Patients”