Applying Leininger’s Middle-Range Theory of Culture Care Diversity and Universality
In our modern society, health reports indicate that 1 in every six adult citizens in the United States is diagnosed with high blood pressure, sometimes referred to as hypertension. High blood pressure is among adults’ leading causes of early death (William, 2020). This paper includes a case of a forty-one-year-old young African American male patient with a long history of high blood pressure (Cooper, 2019).
The patient reports not responding well to his recommended treatment medications. This has made it challenging to control the patient’s hypertension properly. The patient’s history indicates he experiences blood pressure that goes as high as 240/180 (Cooper, 2019). The patient experiences side effects from various high blood pressure medications that interfere with his sexual functions, like hydrochlorothiazide, while beta blockers make the patients feel mentally lazy. This has resulted in the patient ignoring his hypertension medication and other recommendations from his health physicians, such as a change of lifestyle choices and better healthy eating habits (Cooper, 2019). Other barriers such as inadequate healthcare, racial disparities, and poor interactions with his health caregivers also limit the patient’s high blood pressure control.
Various treatment plans and approaches can be prescribed for African American patients with high blood pressure. One of the treatment plans is the application of Leininger’s Middle Range theory of cultural diversity care. This theory will provide caregivers with the appropriate cultural compatibility to enable them effectively provide the African American patient with high blood pressure adequate nursing care. It offers nurses cognitive-based assistance and support and facilitates informed decision-making that is specifically tailored to fit the patient (William, 2020).
This paper will examine Leininger’s Middle Range Theory of cultural care and its literature reviews. In addition, the paper will describe high blood pressure among the African American population and apply Leininger’s Middle Range Theory of cultural care Diversity and Universality in treating young African American male patients with high blood pressure. The patient’s compliance problem will be evaluated using Cultural care Diversity and Universality. The patient’s treatment interventions will be identified, and an assessment of his treatment outcomes will be explained. Finally, the paper will provide an alternative theory that can be used in the treatment of high blood pressure in African Americans and a conclusion to the paper.
Description of Theory: Leininger’s Theory of Culture Care Diversity and Universality
Madeleine Leininger developed the Middle Range Theory of cultural care early on in her nursing career. She realized the importance and effectiveness of implementing care in nursing practices (Gonzalo, 2021). She identified this essential aspect of nursing practice while working as a practicing nurse. She noticed that there needed to be sufficient cultural and patient care knowledge. She viewed cultural and patient care knowledge as a significant component that would enable nurses to understand better the patient needs that were missing in patient care (Gonzalo, 2021). Understanding them would enhance patient compliance, healing, and recovery process.
Leininger developed the theory to help nurses understand culturally congruent patient care. It would enable nurses to make rational, supportive, and effective decisions that fit patients’ cultural beliefs, values, and lifestyles (Gonzalo, 2021). Its significance is to provide patient care that better fits, benefits, and improves the health outcomes of patients from similar and different cultural backgrounds. The theory can successfully be implemented if nurses and patients collaborate and work together.
By working together, the nurses and their patients can creatively formulate a better treatment care plan schedule that fits their lifestyle, improves their health, and enhances their healthy habits (Gonzalo, 2021). Applying the theory model necessitates applying both generic and professional nursing knowledge and techniques to enable the combinations of these diverse concepts into practical nursing care actions and goals. It re-patterns nursing care knowledge and professional nursing skills to fit its patients’ health interests and needs. This is why the theory emphasizes the collaboration of nurses and their patients to enable them to recognize, plan, implement, and analyze specific patients’ caring approaches for culturally compatible patient care.
Leininger develops various basic concepts within the theory that enable its understanding and implementation. These concepts include; care, which is defined as helping patients with their required and anticipated needs to enhance and improve their health conditions (Gonzalo, 2021). Caring is defined as the action directed toward offering care to patients. Culture is defined as the shared, learned, and communicated beliefs, norms, values, and lifestyles of different individuals from similar or different population groups. The theory defines Cultural Care as a combination of different aspects of cultures that impact and enable patients to improve their health conditions or deal with their health illness or death. Cultural Care Diversity is described as the various values, meanings, and accepted techniques of patient care within similar and different ethnic groups (Gonzalo, 2021). Cultural Care Universality is defined as the common nursing care that can be identified from the different ethnic groups’ cultures.
The theory provides various comprehensive, holistic assessments of patients’ backgrounds. It assesses the patients; communicative background and their language, gender considerations, sexual orientations, job occupation, age, dress code, appearance, social-economic status, use of personal space, interpersonal relationships, and the food products that they prepare, eat and relate to their cultural lifestyle. This will help the nurses to provide specific patients with appropriate, beneficial, and effective patient care.
Leininger implements various assumptions with the Middle Range Theory. The theory assumes that patient care is the primary element of the nursing profession. It is the distinctive, governing, and unifying focus on nursing practices (Gonzalo, 2021). Caring is important because it improves patients’ well-being, recovery, and health. The theory offers nurses the means to explain, understand, and forecast different cultural nursing care approaches that help direct nursing care practices. It assumes that caring is important because it leads to better patients’ health conditions, healing, and their health illnesses being cured; hence the theory states that curing patients is impossible without caring (Gonzalo, 2021).
The theory only adopts helpful, healthy, and adequate transcultural nursing care that positively impacts the well-being of patients, families, and communities within the patients’ environment (Gonzalo, 2021). Only when patients, families, and communities’ cultural beliefs, values, and patterns have been identified and implemented in the patients’ care appropriately and in effective ways by their nurses can cultural nursing care be successful. The theory offers nurses new means of knowing and differentiating the different cultural dimensions of patient care.
Literature Review: Use of Leininger’s Theory of Culture Care Diversity and Universality in Nursing Research and/or Practice
Lingerer’s middle-range theory of Cultural Care Diversity and Universal Care was used as a framework for a medical research study to improve self-care behavior in patients with heart failure (Jaarsma et al., 2018). The theory was used to identify and evaluate essential self-care interventions for patients diagnosed with heart failure (Jaarsma et al., 2018). The research article identified that nursing experiences and abilities, patients’ cultural beliefs and values, nurses’ cognitive abilities, confidence, and patient support are important aspects of the theory that can be adopted to improve the self-care of patients with heart failures.
Pickett et al. (2019) adopted Lingerer’s middle-range theory of Cultural Care Diversity and Universal Care in a study to manage the weight of patients. The theory was used to examine various patients’ behaviors, including their culture, their living environment, and the psychological factors that may result in the patients failing to manage their weight properly. The article’s findings show that the theory predicted various weight management issues, including poor health and lifestyles choice (Pickett et al., 2019). These predictions are the primary cause of health risks such as obesity in patients.
Medical researchers adopted Lingerer’s middle-range theory of Cultural Care Diversity and Universal Care in healthcare studies to improve home-based care for individual patients living with dementia. The reason for the study was that most patients with dementia receive healthcare treatment from their homes (Köhler et al., 2021). The health researcher aimed to develop efficient patient care for patients with dementia. The findings indicated that the patient care arrangement needed to concentrate more on patient needs, caregiver roles, and their interrelationship (Köhler et al., 2021). The study recommended that the aspects revealed by the theory needed to be improved in order to enhance the stability of home-based care arrangements for patients with dementia.
The article “Nurses- puerperal mothers’ interaction: searching for cultural care” is a medical study that adopted Lingerer’s theory to identify the significance of cultural patient care between nurses and mothers (Coutinho et al., 2019). The study utilized twenty-one nurses and fifteen mothers who had just given birth. The Middle Range theory of Cultural Care Diversity and Universal Care revealed that nurses’ attitude was essential in order to offer mothers quality healthcare in the study. The nurses’ cultural competence and the interactive language they use when associating with the mother influence the kind of patient care nurses provide (Coutinho et al., 2019). The study recommended that nurses improve on this aspect in order to offer mothers who have just given birth effective care.
In a study by James & Jessicah, (2020), the Middle Range Theory of Cultural Care Diversity and Universal Care was adopted in a study to improve evidence-based nursing care practices in treating patients affected by trauma (James & Jessicah, 2020). The theory evaluated various behaviors and attitudes of nursing as they provided patients with nursing care. From the study, the theory was able to provide patient-centered care effectively; it was trauma-informed and evidence-based, making its validity and practicality more accepted and applicable (James & Jessicah, 2020). This was after nurses adopted various patients’ transcultural practices in their nursing care.
Im et al., (2018) used the frameworks of Lingerer’s middle-range theory of Cultural Care Diversity and Universal Care to assess the symptoms of patients with chronic illness so as to improve self-care practices for patients with chronic illness. The theoretical parts of the theory were used to assess and improve the efficiency of self-care practices for the patients. This is because the theory is usually adopted in various self-care treatments since it was first developed for patients with chronic illness; hence, the need to improve its efficiency. From the results obtained in the study, it was determined that the self-care monitoring for patients with chronic illness needed to be improved. Nurses need to improve patient symptom monitoring as it influences patients’ recovery rate.
Angela & Rivera, (2021) conducted a medical study of providing adequate transgender nursing care to patients by using Lingerer’s middle-range theory of Cultural Care Diversity and Universal Care. The study identified a gap within transgender care. It revealed that various aspects of the domain of transgender care and nurses’ sensitive care were missing (Angela & Rivera, 2021). The study revealed that nurses could identify their personal implicit and explicit prejudice through self-reflection and observing various internal nursing growth techniques. This will help them change and be able to develop better gender nursing care practices (Angela & Rivera, 2021).
The Middle range theory was used by (Riegel et al., 2019) in a study to evaluate cultural values and attitudes that impact women nurse leaders from regions with western cultures. The theory identified two domains which include leadership frames and leadership contexts. These domains are essential in enabling nurses to understand nursing leadership in western cultural regions (Riegel et al., 2019). It will enable them to be culturally sensitive while dealing with patients with similar and different cultural beliefs and values in western regions. This would help them guide nurses working under their supervision to adopt transcultural healthcare practices when treating patients.
Description of problem/situation: High Blood Pressure in African American Men
High blood pressure is very common in the United States, especially in older adults. One out of every six adults is diagnosed with High blood pressure. It increases individuals’ chances of developing various heart disorder conditions, strokes, and kidney diseases (William, 2020). It was identified from the National Health reports that high blood pressure is very common among African Americans, affecting 56% of male adults within the ethnic groups. The white population only reported 46% of its male having high blood pressure, while the Hispanic and non-Hispanic recorded 37% and 38% of males with high blood pressure (William, 2020).
High blood pressure has also been frequently diagnosed among younger African American male youth than other ethnic groups within the United States. It leads to various health complications that African American men, such as dementia, strokes, blindness, and heart failure, commonly report (William, 2020). Various factors have been identified to cause high blood pressure in African American men. These factors include:
African American genetic factors. The genetic makeup of the African American descendants is linked to the high rate of high blood pressure among male African Americans. This can be associated with African American men responding differently to high blood pressure medication treatment than other ethnic groups (William, 2020). Health reports on African American men also indicate that they are more sensitive to salt, which is commonly known to result in high blood pressure in individuals.
Another significant factor known to result in more African American men developing high blood pressure is the environmental factor. Study researchers have indicated that the high blood pressure cases in African Americans are because of the various issues that are distinctive to their experiences (William, 2020). The different experiences the ethnic group faces, such as cultural segregation and stress, result in more hypertension cases in African American men than in other ethnic groups. This was also observed when reports of African American men in the United States were compared with African. It was observed that 54% of African American men were reported to have high blood pressure, while only 43% of the African ethnic group indicated having high blood pressure (William, 2020). Medical researchers and experts have also highlighted various social and economic factors, such as African American man discrimination and economic inequality, resulting in them developing high blood pressure more frequently.
Applying Leininger’s Theory of Culture Care Diversity and Universality to Nursing Practice: In a Case Study to Managing High Blood Pressure in an African American Male Patient
Nurses can use the Middle-Range Theory of cultural care diversity and universal care to study and assess high blood pressure risk factors of the forty-one-year-old African American male patient. The nurses can collaborate with the patient to identify family genetic makeups that act as risk factors and result in the development of hypertension in the forty-one-year-old patient (Cooper, 2019). The caregivers can adapt the theory to help them study the patient’s health behavior that instigates the development of high levels of high blood pressure of 240/180 that the African American patient records.
This will enable the nurses to formulate effective treatment plans that favor patients (Cooper, 2019). By assessing a patient’s healthy habits using the Middle Range Nursing Theory, nurses can prescribe appropriate dietary approaches to reduce and manage high blood pressure levels (Gonzalo, 2021). The theory will also enable the patient’s physicians to examine the patient’s hereditary gene makeup.
It will enable them to acquire the essential information on the kind of specific medication to prescribe to the African American male patient since most of the high blood pressure drugs are unreactive and cause various side effects to the patient (Gonzalo, 2021). The physicians will be able to identify specific calcium channel blockers, alpha-blockers, Beta-blockers, and ACE inhibitors medications that are highly effective in treating male patients. The theory will also help nurses identify the health disparities that the patient has constantly been exposed to, affecting his high blood pressure management and treatment.
Alternative Theory for Management of High Blood Pressure in African American Male Patient
Orem’s Self-Care Theory is an alternative nursing theory that can also be highly effective in treating African American male patients with high blood pressure (Manzini & Simonetti, 2019). The theory acts as a guiding care tool for patients with high blood pressure. The theory could help the patient develop self-care treatment schedules with the help of his nursing caregiver. His caregiver can conduct interviews, nursing diagnoses, and physical evaluations to understand the patient cultural care practices (Manzini & Simonetti, 2019). This will enable the caregivers to identify self-care deficits related to the African American male patient’s lack of blood pressure control, such as reasons for not responding well to his recommended treatment and why certain medications affect the patient’s sexual function and mental stability. Orem’s Self-Care model will help the caregiver assess these risk factors and formulate the best treatment plans for the young African American male patient (Manzini & Simonetti, 2019).
Conclusion
High blood pressure is categorized among the highest health issues affecting millions of United States residents’ especially African American men. This is mostly because of the unique risk factors that can be identified among the African American men group. These unique risk factors have increased the number of high blood pressure cases within this particular ethnic group. An example can be observed in the case of the forty-one-year-old African American male patient who has been struggling to manage his high blood pressure. His genetic makeup has made it hard for the patient to adhere to various recommended treatments. The medications affect the patient’s sexual function and also make him feel mentally lazy. Various health disparities and poor interactions have also contributed a lot to the patient’s slow reaction to treatment. To effectively manage African American male patient hypertension, physicians can adopt Leininger’s Middle-Range Theory of cultural care diversity and universal care. The theory was developed to accommodate patients’ cultural norms, values, and beliefs in their healthcare. This enables healthcare physicians to be able to assess patients’ genetic makeup and their social, economic, and environmental factors that make them prone to developing high blood pressure. The theory can facilitate physicians to analyze these unique factors because they affect how patients react to various treatment regimens. Leininger’s Middle-Range Theory of cultural care diversity and universal care can be used to assess and develop effective treatment plans by nurses for African American male patients. The theory has also been adopted in various studies to improve self-care for patients with chronic illnesses such as heart failure. It can also help nurses improve their transcultural patient care services in order to enhance their nursing care practices. In the case of the forty-one-year-old patient, Leininger’s Middle-Range Theory of cultural care diversity and universal care was used to identify specific calcium channel blockers, alpha-blockers, Beta-blockers, and ACE inhibitors medication that are highly effective in treating African American men since. Nurses can also adopt the use of Orem’s Self-Care Theory to help them evaluate and provide essential self-care treatment plans for the African American patient as an alternative treatment plan.
References
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Gonzalo, A. (2021, August 19). Madeleine Leininger: Transcultural nursing theory. Nurseslabs. https://nurseslabs.com/madeleine-leininger-transcultural-nursing-theory/
James, H., & Jessicah, E. (2020, October). Evolution of forensic nursing theory——Introduction of the constructed theory of forensic nursing care: A middle-range theory. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678647/
Manzini, F. C., & Simonetti, J. P. (2019). Nursing consultation applied to hypertensive clients: Application of Orem’s self-care theory. Revista Latino-Americana de Enfermagem, 17(1), 113-119. https://doi.org/10.1590/s0104-11692009000100018
William, H. (2020, March 1). High blood pressure in African Americans. WebMD. https://www.webmd.com/hypertension-high-blood-pressure/guide/hypertension-in-african-americans
Im, E., Broome, M. E., Inouye, J., Kunaviktikul, W., Oh, E. G., Sakashita, R., Yi, M., Huang, L., Tsai, H., & Wang, H. (2018). An emerging integrated middle-range theory on Asian women’s leadership in nursing. Journal of Transcultural Nursing, 29(4), 318-325. https://doi.org/10.1177/1043659618760397
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Coutinho, E., Amaral, S., Parreira, M. V., Chaves, C. B., Amaral, O., & Nelas, P. (2019). Nurses- puerperal mothers’ interaction: Searching for cultural care. Revista Brasileira de Enfermagem, 72(4), 910-917. https://doi.org/10.1590/0034-7167-2018-0216
Jaarsma, T., Cameron, J., Riegel, B., & Stromberg, A. (2018). Factors related to self-care in heart failure patients according to the Lingerer’s middle-range theory of Cultural Care Diversity and Universal Care: A literature update. Current Heart Failure Reports, 14(2), 71-77. https://doi.org/10.1007/s11897-017-0324-1
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