Cultural Nursing Theory

Culture care is grounded within one’s worldview, which is shape by social structure factors such as religion, economics, cultural values, environmental context, ethnohistory, and language (Alligood, 2014; Sitzman & Eichelberger, 2015). Moreover, culture care share similarities and differences related to health and well-being, how individual deal with disability and death, as well as, when to seek relief from illnesses or distress. As culture plays a vital role in health care seeking habits and decision making, it is imperative for nurses to fully understand cultural knowledge. With increase cultural knowledge, nurses are better able to implement care plans that are beneficial to the patient with respect to their beliefs, values, and cultural

practices.
The scope of Leininger’s Culture Care Theory revolves around providing culturally congruent care. For culturally congruent care to be achieved, the patients’ personal needs, values, and beliefs need to be implemented in the care plan. Leininger maintained that culture care practices vary among cultures, therefore nursing care cannot be streamlined from superficial knowledge and limited contact with a cultural group (Alligood, 2014; Sitzman & Eichelberger, 2015). Nursing care should be developed through knowledge from multiple personal interactions with or close examinations of culture social structure factors.
Caring is a phenomena of Leininger's Culture Care Theory. Leininger maintained that care is the principle of nursing and an essential element for survival (Alligood, 2014). Therefore, culture care is a necessary component in nursing care as culture is entwined with the patient. For example, a recent research study was conducted by Duke and Petersen (2015) where they questioned individuals of Chinese, Japanese, and Vietnamese decent in regards to their take on the appropriateness of expressing pain and pain management. They found that although there are some minor differences in how each of these ethnic groups perceive pain, overall, traditional Asians aim to preserve harmony when interacting with others and tend to avoid drawing attention to themselves. Therefore, many remain stoic and reticence to express pain freely, even when asked. It was reported that even though language is sometime a barrier, many individuals tend to not ask for pain medications in avoidance of becoming a burden to health care providers. The study concluded that it is crucial to not stereotype behaviors based on cultural group and to be more observant and knowledgeable of attitudes and perception of pain management to adequately promote patient comfort. For this reason, practicing culture care is a crucial element in patient care as it leads to better health outcomes.
There are many ways in which the tenets will result in improvement in the nursing practice.

To start, integrating the theory will lead the nurse to understand and acknowledge the vast patient population of a multicultural society. This in turn, will result with the nurse individualizing patient care and educational materials to fit personal needs, values, and beliefs of the patient leading to wholistic care of the human being. Overall, incorporating the theory will lead to an improvement in patient outcomes. Sitzman and Eichelberger (2015) wrote that if patients’ experienced nursing care that fails to incorporate their needs, they will develop cultural conflict, noncompliance, and

stress.
Culture Care Theory can be used in collaboration with other professionals to improve health care. Nurses can collaborate with Registered Dietitian to make appropriate meal plans for patients. For example, patients on dialysis have to watch their potassium intake as they cannot excrete potassium on their own accord. However, boil greens or pumpkins are the stable in dietary intake in the elderly Hmong population. Since these food choices are high in potassium the dietitian can educate the patient on appropriate dietary needs, where as the nurse can reinforce the importance of reducing potassium in their diet. Nurses can also work with the social worker to meet patient need physically, financially, and mentally. On the whole, integrating the theory along with working as an interdisciplinary team can significantly improve patient outcomes.
Evaluation of Practice Tool
Practice tools can help nurses achieve their goals of providing safe and effective patient care. Cultural skill is a necessary tool needed to gather relevant data from patients’ regarding their cultural needs, values, and beliefs (Campinha-Bacote, 2011). The goal of a cultural assessment is to compile accurate cultural data that comes directly from the patient and their family, to successfully create a culturally relevant treatment plan.
Summary of Practice Tool
There are many practice tools that can be utilized by nurses to perform cultural assessments and get the patients’ perception of their illness. One such cultural assessment tool is the mnemonic, LEARN (Campinha-Bacote, 2011). LEARN is a framework that stands for Listen, Explain, Acknowledge, Recommend, and Negotiate. The framework can assist with overcoming communication and cultural barriers, leading to successful patient care. In using this framework, the nurse must first listen to the patient’s perception of the problem, whether it is physiological, psychological, spiritual, and/or cultural. Next, the nurse explains his or her perception of the patient’s problem. After the nurse explain his/her perception, he/she would then acknowledge the similarities and differences between the two perceptions. In the fourth step, the nurse gives his/her recommendations for treatment of the illness or presenting problem. Finally, the nurse and the patient can negotiate a treatment plan that would fit the patient’s personal needs, cultural beliefs, and values.
Connections Between the LEARN Model and Leininger’s Theory
There is a clear link between the LEARN model and Leininger’s Culture Care Theory. Both the LEARN model and the theory focuses on the patient as a whole, taking into consideration their values, beliefs, and personal needs. The primary goal of these two concepts, is to provide safe, effective, and culturally competent patient care. More importantly, the framework is a practice example of Leininger’s Theory. The framework was created by Berlin and Fowkes due to an increase in diversity among the patient population and the differences found within the health and disease belief systems (Berlin & Fowkes, 1983). As with Leininger’s Theory, the framework was designed to bridge cultural sensitivities between patients’ beliefs and the biomedical model.
Application to Nursing Clinical Area and Personal Practice
The LEARN model is an effective tool that is beneficial and relevant to the nursing practice. Utilizing the framework will not only improve the nurse-patient relationship, it will also allow the nurse to better understand the patients’ perspectives. Essentially, applying the framework into practice will aid in patient compliance and patient satisfaction with their health care.
Integrating the LEARN Model into Practice
The LEARN model is a simple tool that can easily be implemented into the nursing practice to assess patient understanding of their health and wellness.

To start implementing this framework, one need to understand and acknowledge that every patient is not only different from one another, but a unique individual. Assumptions and stereotypes about a specific cultural group must be avoided, along with personal biases (Murphy, 2011). Furthermore, actively listening and fully engaging patients’ can improve nurse-patient communication and enhance patient outcome. Integrating the framework will enable nurses to become culturally competent health care providers. First and foremost, the framework permit patients’ the opportunity to express their concerns and perception of their problem (Campinha-Bacote, 2011). Additionally, it focuses on incorporating the patients beliefs, values, and needs into the plan of care. The framework further give nurses an opportunity to better understand and evaluate their patients’ concerns. Campinha-Bacote (2011) reported that continuous encounters with culturally diverse backgrounds will lead nurses to validate, refine, or modify what they know of existing values, beliefs, and practices of a cultural group. This in turn, will develop into cultural desire, cultural awareness, and cultural knowledge. With the end result, being cultural

competence.
There should be no ethical, legal, or regulatory considerations that would be applicable in integrating the LEARN model into practice. The framework is simply a guide that assists health care practitioners in improving communication with patients in regard to cultural differences. More than anything, the framework aid the nurse to becoming more sensitive to cultural differences and being more culturally knowledgeable. All in all, it will lead to improve patient care and patient satisfaction.
Conclusion
Culture is a crucial factor in health care. Culture guide and shape people through values, beliefs, and practices that are learned, shared, and transmitted from generation to generation (Alligood, 2015; Sitzman & Eichelberger, 2015). Leininger maintained that culture is the defining factor of health, illness and the search for relief from disease or distress (Alligood, 2014). In light of that, nurses need to fully understand cultural knowledge. With increase cultural knowledge, nurses are better prepared to implement effective care plans that will fit the patients desire needs and cultural practices. To assist nurses in gaining cultural knowledge, there are practice tools such as the LEARN model (Campinha-Bacote, 2011). The LEARN model can be easily utilized by nurses to perform cultural assessments in order to make effective care plans. By integrating the framework into ones’ nursing practice they are essentially increasing their cultural encounter and in doing so, they are developing cultural desire, cultural awareness, and cultural knowledge. In the end, the nurse will develop cultural competence.
In this day and age, cultural competence is a vital factor in providing safe and effective patient care. A culturally competent nurse is one who integrates cultural desire, cultural awareness, cultural knowledge, cultural skills, and cultural encounters into their nursing practice (Capinha-Bacote, 2011). Review of multiple articles indicates that integrating culture care into one’s nursing practice is a necessity in providing culturally congruent patient care