Culture Care Theory: A Proposed Practice Theory Guide for Nurse Practitioners in Primary Care Settings
McFarland, Marilyn M., Eipperle, Marilyn K., Contemporary Nurse : a Journal for the Australian Nursing Profession
'The fate of nursing conceptual models and theories in the contemporary climate of advanced practice nursing' is a question we have pondered since reading an article by Fawcett, Newman, and McAllister (2004: 136). In their scholarly dialogue, Fawcett et al explored the development and function of advanced practice nursing within the current health care system of the United States and discussed nursing theory in relation to the preparation for and application within the advanced practice role. It is our proposal that Leininger's Theory of Culture Care Diversity and Universality addresses this question by providing an appropriate and useful theoretical framework/conceptual model of nursing for nurse practitioners that informs advanced practice nursing, particularly the nurse practitioner role, to provide culturally congruent care to diverse and similar clients in primary care practice contexts. 'A framework of advanced practice nursing could guide the development of advanced practice curriculums, shape role descriptions and practice agreements, inform policy development related to provider roles in healthcare, and provide direction for research agendas' (Brown 1998: 157). More specifically, as discussed by Newman and McAllister as above, we are offering the special contributions this theory has been making to the collective knowledge base of advanced practice nursing theory. As Anderson (1987: 7) has stated,'We need to use a framework for nursing care that allows us to examine the multiple determinants which shape people's experiences.' Advanced practice nursing, as defined by Hanson & Hamric (2003: 205) is 'the application of an expanded range of practical, theoretical, and research-based therapeutics to phenomena experienced by [clients] within a specialised clinical area of the larger discipline of nursing' with further clarification that the core competency of each role is 'direct clinical practice' and that a nurse practitioner is therefore an advanced practice nurse.
The focus of this article is to address what has been done toward integrating Leininger's Theory of Culture Care Diversity and Universality into the practice of advanced practice nursing in the role of the family nurse practitioner (FNP) in primary care contexts; and what, in our view, needs to be done now and in the future to expand the potential role of this theory in nurse practitioner practice. Given that culture care is a core competency domain for family nurse practitioners (United States Department Health and Human Services [DHHS] 2002), it is our view that nurse practitioners need to recognise the need, validity, and missing component of culture care in nursing. Leininger (2006a: 16) refers to culturally congruent care as 'knowledge, acts, and decisions used in sensitive and knowledgeable ways to appropriately and meaningfully fit the cultural values, beliefs, and lifeways of clients for their health and well-being, or to prevent illness, disabilities, or death To provide culturally congruent care and safe care has been the major goal of the Culture Care Theory.'The major premise of the Culture Care Theory is that there are differences (diversities) and universalities (commonalities or similarities) in transcultural care knowledge and practices that have awaited discovery (and have been discovered) to establish a growing body of relevant transcultural nursing knowledge as the new guide to nursing practices (Leininger 2002b: 79; Omeri 2003: 181). Culture is the history or learned symbolic human and structural organisation and action that make humans human (Keesing 1981 cited in Ray 1999: 178); culture 'refers to patterned lifeways, values, beliefs, norms, symbols, and practices of individuals, groups, or institutions that are learned, shared, and usually transmitted intergenerationally over time' (Leininger 2002b: 83).
Leininger (2006a: 12) has defined care as 'those assistive, supportive, and enabling experiences or ideas towards others with evident or anticipated needs to ameliorate or improve a human condition or lifeway . …