Cultural Care Diversity and Universality Theory and Model
Leininger’s cultural care diversity and universality theory and the sunrise model that depicts her theory are perhaps the most well known in nursing literature on culture and health (Leininger & McFarland, 2006). The theory draws from anthropological observations and studies of culture and cultural values, beliefs, and practices. The theory of transcultural nursing promotes understanding of both the universally held and common understandings of care among humans and the culture-specific caring beliefs and behaviors that define any particular caring context or interaction. According to Leininger, this theory is intended to be holistic: Culture is the specific pattern of behavior that distinguishes any society from others and gives meaning to human expressions of care (Leininger, 2002).
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The theory of cultural care diversity and universality is heavily used in education and research. It incorporates the following assumptions about care and caring as they relate to cultural competency (Leininger, 2002): Cultural Care Diversity and Universality Theory and Model
• Care (caring) is essential to curing and healing, for there can be no curing without caring.
• Every human culture has generic, folk, or indigenous care knowledge and practices and usually some professional care knowledge and practices that vary transculturally.
• Culture care values, beliefs, and practices are influenced by and tend to be embedded in the worldview, language, philosophy, religion and spirituality, kinship, social, political, legal, educational, economic, technological, ethno-historical, and environmental contexts of cultures.
• A client who experiences nursing care that fails to be reasonably congruent with his or her beliefs, values, and caring life ways will show signs of cultural conflict, noncompliance, stress, and ethical or moral concern.
• Within a cultural care diversity and universality framework, nurses may take any or all of three culturally congruent action modes: (1) cultural preservation/maintenance, (2) cultural care accommodation/negotiation, and (3) cultural care repatterning/restructuring.
According to Leininger, cultural care preservation/maintenance refers to assistive, supportive, facilitative, or enabling professional actions and decisions that help individuals, families, and communities of a particular culture retain and preserve care values so that they can maintain well-being, recover from illness, or face possible handicap or death. Cultural care accommodation/negotiation refers to assistive, supportive, facilitative, or enabling professional actions and potential decisions that help individuals, families, and communities of a particular culture adapt to or negotiate with others for satisfying healthcare outcomes with professional caregivers. Cultural care repatterning/restructuring refers to the assistive, supportive, facilitative, and enabling roles filled by nurses and other healthcare providers to promote actions and decisions that may help the person, family, or community change or modify behaviors affecting their life ways, thereby achieving a new and different health pattern (Leininger & McFarland, 2006). These three action modes are sometimes used with other cultural theories and models.
Leininger recognized the comparative aspects of caring within and between cultures—hence the theory’s acknowledgment of similarities as much as differences in caring in diverse cultures. Her transcultural model has implications for how nurses assess, plan, implement, and evaluate care of people from diverse cultural backgrounds. The sunrise model and theory have clarity, but they are complex. The model has generality for nursing, empirical precision, and derivable consequences. The sunrise model can be found on the Transcultural Nursing Society’s website (http://tcns.org/Theories).
The Roy Adaptation Model
The History
Sister Callista Roy recalled that the origins of her adaptation model date back to 1964, when she was a master’s-level student at Mount St. Mary’s College in Los Angeles. In 1970, she published the basic ideas of her conceptual model in an article titled “Adaptation: A Conceptual Framework for Nursing” in Nursing Outlook. In 1971 and 1973, the model was further explained in a chapter of Riehl and Roy’s (1974) book, Conceptual Models for Nursing Practice. A more comprehensive explanation of the model can be found in Roy’s (1976) book, Introduction to Nursing: An Adaptation Model. Further refinements of the model were published in the second edition of that book (Roy, 1984). Roy’s clinical experiences in pediatric nursing and neurological nursing were important influences in the development of her model (Roy, 2009).
The primary influencers for defining the key aspects of Roy’s adaptation model included the systems theory described by von Bertalanffy (1968) and the work of physiological psychologist Harry Helson (1964), who developed adaptation-level theory. Helson proposed that adaptation involves both psychological and physical processes when an individual faces environmental stimuli. He described three kinds of stimuli—focal, contextual, and residual—that come together and result in a pooled effect. Based on those principles, Roy described how adaptation could help people conserve the energy needed to heal and to cope with new life experiences (Roy & Whetsell, personal communication, 2005) Cultural Care Diversity and Universality Theory and Model.