Which of the culture and caring theories most resonates with you for your practice as an NP? How does the theory integrate the nursing paradigm?  What parts of the theory do you identify with? How does the theory help to meet CLAS standards to advance health equity?

Week 6: Cultural Theories

Table of Contents

Introduction

Cultural beliefs may influence how an individual, family, or community chooses to address health issues. Cultural competence is necessary to bring together providers and patients from diverse backgrounds in order to achieve positive health outcomes. Nurses need to understand how to function in cross-cultural situations. This requires an understanding of culture, how it influences a person’s healthcare decisions, and the ways in which nurses can adapt communication and interventions with patients and families.
It is essential that nurse practitioners have a clear understanding of cultural competence to provide quality care. Understanding various theories and models can assist with establishing culturally sensitive practice.

Leininger’s Cultural Care Diversity Theory

The purpose of Leininger’s theory is to enhance knowledge related to the uniqueness of nursing care of each patient as well as to value the cultural heritage of human care. Major components of the model are culture, culture care, and culture-care similarities and differences pertaining to transcultural human care. Other major components are care and caring, emic view (language expressions), etic view (beliefs and practices), professional system of healthcare, and culturally congruent nursing care (McEwen & Wills, 2014). 

Leinenger’s theory includes elements of care as a major part of cultural competence. Health professionals are charged with the following actions to enhance culturally competent care:

• Preservation and maintenance: helping patients and families to preserve values important to their health
• Accommodations and negotiation: helping patients and families interact with other health professionals in order to preserve or improve health
• Repatterning and restructuring: helping patients, families, and communities with lifestyle and behavioral changes to improve health outcomes

(Purnell, 2018).

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Campinha-Bacote Model

Campinha-Bacote stressed that in order for nurses or others to act with cultural competence, they must first be motivated to do so. Five concepts guide practitioners in establishing cultural competence:

• Cultural awareness: Understanding and deliberately identifying one’s own values and biases.
• Cultural knowledge: Learning about the values and worldviews of others.
• Cultural skill: Assessing physical and psychosocial needs in relation to culture.
• Cultural encounter: Interacting with culturally diverse people and groups
• Cultural desire: Interest in engaging in culturally competent behavior

(Campinha-Bacote, 2002)

Practitioners can engage in the process starting at any of the five stages, but must complete all stages in order to practice culturally competent care.

The Purnell Model for Cultural Competence

The Purnell Model for Cultural Competence originated with the clear idea that in order to better care for and assess patients, it is important to understand cultural practices of the patient or group. The model permits nurse practitioners to evaluate their own cultural beliefs and values and how these relate to caring for patients, families, communities, and the global society (Purnell, 2018).

The organizing framework for the Purnell Model for Cultural Competence includes 12 domains (Purnell, 2018). The domains may be used to assess the ethnocultural attributes of an individual, family, or group. These 12 domains include the following:

Cultural Competence

Click on the interactive to learn more about cultural competence.

Cultural Competence (Links to an external site.)

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Health Disparity

Health disparities are differences in “the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates in a population as compared to the health status of the general population” (National Institutes of Health, n.d.). Disparities relate to preventable differences in health care outcomes, such as infant mortality rates, and populations can be defined by a number of characteristics, including race, ethnicity, socioeconomic status, gender, or age (Baker, 2018).

Nurse practitioners must be aware of health disparities in their community, and seek methods to promote health equity among all. The National Culturally and Linguistically Appropriate Services (CLAS) standards are guidelines to help ensure health equity among populations. There are standards in the areas of governance, leadership and workforce; communication and language assistance; and engagement, continuous improvement, and accountability. CLAS standards help to ensure that practitioners account for cultural health beliefs, preferred language, health literacy levels, and communication needs when providing care to patients (Office of Minority Health, n.d.).

Reflection

Health disparity impacts all communities. What are the most important health disparities in your community? Review the Healthy People website to help gain a better understanding of disparities that exist and consider how you will make a difference in promoting health equity within your community