Nursing could be considered as both art and science; hence, it requires a framework that incorporates the values of these spheres in order to provide quality care. The focus of care should be on individuals, their family, and friends, the community of the population as they form the patient in a patient-nurses relationship (Garrett, 2018a). Therefore, the theoretical framework used is expected to be in support of this relationship and be readily understandable by patients to allow apprehension of the theory’s value in practice (Garrett, 2018a). The research in nursing aims towards the development of new and safe standards for practices. Therefore, there is a need for each theory to be examined to determine its effect and supervise the emergence of positive changes in practice. There is also a need to identify the political, social, environmental impact of the theory because negative effects or lack of social responsibility will render it not valuable for nursing (Garrett, 2018b). In this paper, empirical indicators for Leininger’s transcultural nursing care will be defined, and testable hypotheses will be used to determine its value in practice. In addition, an existing framework in the form of activities of the daily living model where such indicators are implemented will be discussed.
Middle-range theories, in comparison to grand theories, could be considered as narrower and more defined because they consist of a limited number of relatively concrete and specific propositions and concepts. Consequently, theories involve conceptual models that are specified by a number of middle-range theories as the theories encompass a limited aspect of the total reality (Smith & Liehr, 2018). The definition of an empirical indicator is – an instrument, procedure, experimental condition that acts as a concrete and specific practical proxy or substitute for the middle-range theoretical concept. The information obtained from empirical indicators is typically called data. Empirical indicators function as the tool to generate and test middle-range theories. The collected data is calculated as quantitative scores or sorted into qualitative categories.
On the other hand, the definition for transcultural nursing differs conceptually as some perceptions consider the theory as a process while others as abilities. However, the consensus is met on the inclusion of cultural sensitivity, awareness, knowledge, skills, and safety. Thus, Leininger’s theory of transcultural nursing is concerned with the provision of culturally sensitive care to “the needs of the individuals, families, and groups who represent a diverse cultural population within a society” (Okeya, 2021, p. 31). In the context of health care, the perceptual framework of illness, well-being, and accepted treatment modalities are influenced by cultural heritage. As a result, it should be noted that cultural values cannot be separated from the concepts of health because the ethical aspect of nursing depends on it. For people in the nursing profession, it is essential to be aware of the value systems of their patients along with family expectations about the roles and relationships. The discontent in this relationship between the nurses and patients might transform into serious ethical dilemmas with drastic results.
The goal of transcultural nursing is to provide effective, culturally adequate healthcare.
Consequently, the competence of the nurse in this aspect would be bound to recognition of the fact that cultural differences emerge across all levels of diversity (Im & Lee, 2018). For example, the primary levels such as physical ability, sexuality, age, gender, and language, and secondary such as geographical location, education, religion, and socio-economic background. Hence, the purpose of transcultural nursing lies in the search for and application of specific ways to attend to the needs of patients from “Asian, African, Caribbean, Eastern European and other cultures and subcultures” (Okeya, 2021, p. 31).
In accordance with transcultural nursing theory, from the patient and nurse relationship, the researchers may gather data from the patients’ responses to culturally sensitive questions. These questions may include patients’ backgrounds, language, religion, and family norms (Okeya, 2021). The data is collected in the form of answers from the patients, which can be used as empirical data to provide a score. Consequently, it could provide an insight on the approaches to take in tackling the cultural issues in practice which would form protocols or scripts to direct actions in a precise manner (Okeya, 2021). The correlation of the theoretical nursing model and practice demonstrates the way four entities such as individual, family, community, and healthcare organization are influenced by the revolving and cooperative four factors practice, research, management, and education (Roy, 2018). A similar approach could be used to represent the data for transcultural nursing theories where the data for primary and secondary levels of diversity is used. This model could be used for meaningful data gathering and, depending on the purpose of the study, contribute to various scientific studies.
Numerous methods to assess patient’s health and nursing needs with consideration of mental and social factors have been developed. They demonstrate various degrees of advantages and disadvantages, but during implementation across varying contexts, a simple framework gives more flexibility (Garrett, 2018b). Consequently, some degree of duplication is inevitable within any assessment framework; hence it is essential to demonstrate comprehensive qualities in the assessment, rather than being pedantic in the categorization of health issues (Garrett, 2018b). In addition, it is necessary to be aware that depending on the context, some aspects are more relevant than others. In the research of Garrett (2018b), the activities of daily living (ADL) model, which builds upon Roper, Logan, and Tierney’s research, was proposed. This model uses the categories of physical, psychological, socio-cultural, environmental, and economic needs. The empirical indicators for this model correspond with the aspects of transcultural nursing.
The model implies the usage of transcultural nursing in the assessment of a patient’s current condition and ability to execute daily living activities. Psychological considerations involve such factors as language and communication, self-worth or image, expressing sexuality or gender, and existential or religious beliefs. Socio-cultural considerations incorporate such indicators as a life partner(s), family and friends, significant others and pets, cultural customs/traditions/way of life, employment/work, education, organization/group/team membership. They help to address concerns with health, healing, and the ability to function independently. Environmental factors consider how a person’s environment impacts health, healing, and well-being. Financial considerations include aspects of how access to personal funds and access to public and private healthcare programs and insurances work to accomplish health and well-being goals.
These empirical indicators could be asked before and after the nursing care in the form of direct questioning or survey completion. Some of the information is publicly available or could be disclosed by the patients with their consent. This implementation of empirical indicators from transcultural nursing is essential in modern-day health assessment practices. This way, it is possible to identify the extent of the culture’s influence on care effectiveness and patient’s healing. Furthermore, it would simplify and diversify the statistical data collected to conduct further research.
In conclusion, transcultural nursing involves the application of cultural characteristics in healthcare. The empirical indicator is an instrument used as a practical proxy for middle-range theoretical concepts. In regard to transcultural nursing, such information as sexuality, age, gender, language, location, religion, and socio-economic background acts as empirical indicators. They could be used in the activities of the daily living model to address the questions on the patients’ well-being and various scientific studies. Furthermore, this data is used to identify specific ways to attend to the needs of patients from diverse cultural backgrounds.
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