Madeleine Leininger’s Transcultural Nursing Theory

The evaluation of whether nursing is a science, an art, or both has been at the centre of discussions of the nursing theories. For instance, one perspective considers nursing to be a basic science that consists of the nursing knowledge, which nurses practice to better human life (Barrett, 2002). A different perspective is that nursing is an art, which encompasses the practice of the nursing discipline (Barrett, 2002). The nature of nursing, as summed up from Madeleine Leininger’s concepts in transcultural nursing theory, is that nursing is a science.

Leininger’s transcultural nursing theory takes cognizance of the role of cultural differences in determining the efficacy of nursing. According to the theory, also known as cultural care theory, culture is “the learned shared, and transmitted values, beliefs, norms, and life practices of a particular group that guides thinking, decisions, and actions in patterned ways”, it determines the care that individuals desire from professional carers (Leininger, 1988, p. 156). Using her anthropology background, Leininger embarked on the study of how diversity in culture may affect the patients’ evaluation of care. This led to the clamour for nurses to be culturally competent in providing care to their patients. As such, based on Leininger’s work, nursing is a science since it fits a description of science as articulated by Parse. That is, science is “the theoretical explanation of the subject of inquiry and the methodological process of attaining knowledge in a discipline; thus, science is both product and process” (Parse as cited in Barrett, 2002, p. 51).

Surrogate Decision Makers

  1. Individuals are eligible to act as surrogate decision makers in the State of Texas.

Chapter 597, section 041, subsection (a) of the Texas Health and Safety Code provides for individuals who should act as surrogate decision-makers, in case an individual lacks the capacity to make a decision concerning ones treatment. In order of descending priority, the surrogate decision-maker should be:

    1. a spouse actively involved in the life of the patient,
    2. an adult child actively involved in the life of the patient and who has been approved to act as a sole decision-maker by all other adult actively involved in the patient’s life,
    3. a parent or stepparent who is actively involved in the patient’s life,
    4. an adult sibling who is actively involved with the patient’s life and has the approval to act as a sole decision-maker by all other adult siblings actively involved in the patient’s life,
    5. any other adult relative actively involved in the patient’s life and with approval to act as sole decision-maker of all other adult relatives actively involved in the patient’s life.
  1. Resolution of disputes concerning a party’s right to act as a surrogate decision-maker

Subsection (d) highlights the resolution process for disputes concerning a party’s right to act as a surrogate decision-maker. Such disputes are to be resolved only “by a court of record under Chapter V, Texas Probate Code” (Tex. Health and Safety Code § 597.041(d), 2005).

  1. Limitations of consent for the surrogate decision-maker in the State of Texas.

Limitations of consent to the surrogate decision-maker can only be applicable if the patient makes decision on his or her own. According to the subsection (c), “consent given by the surrogate decision-maker is valid and competent to the same extent as if the client had the capacity to consent and had consented” (Tex. Health and Safety Code § 597.041(c), 2005).

Informed consent

The American Nurses Association (ANA) provides guidelines in a formal code of ethics to help nurses make appropriate decisions when they face ethical dilemmas. In Fred’s case, provision 1, 2 and 3 guide a nurse’s decision. Provision 1 expects nurses to be compassionate and respect their client’s dignity, worth and uniqueness, irrespective of client’s social, health, economic or personal status (ANA, 2001). In Fred’s case, the particular guidance would be “respect for human dignity and the right to self-determination” (ANA, 2001, n.p). Since Fred has expressed his wish to discontinue therapy on the research drug, I would disrespect his right to self-determination and hence his dignity, as such I will continue providing him with such a therapy, for him to avoid disappointing his family and his doctor (Masters, 2009, p. 93).

Provision 2 establishes that the “nurse’s primary commitment is to the patient” (ANA, 2001, n.p.). In such commitment, the nurse, as per item 1 of the provision, needs to put the client’s interest above all other interests. In Fred’s case, his wish is to discontinue the therapy on the chemotherapeutic drug. As such, failure to honour such a wish could subject him to undesirable consequences that negate his interests. Accordingly, the interests of Fred would be served better by discontinuing the therapy and providing supportive therapy that would relieve his suffering.

Provision 3 expects the nurse to advocate for the patient’s rights, safety and health (ANA, 2001). In item 3 of this provision, nurses ought to protect their patients, when such patients participate in research (ANA, 2001). Since Fred desires to discontinue his participation in research, I would facilitate his leaving to protect him from the negative outcomes that have made him desire to leave the research (Butts & Rich, 2005, p. 42).

References

American Nurses Association (ANA). (2001). Washington, DC: American Nurses publishing. Web.

Barrett, E. A. M. (2002). What is nursing science? Nursing Science Quarterly, 15(1), 51-60, Web.

Butts, J. B., & Rich, K. (2005). Nursing ethics: Across the curriculum and into practice. London: Jones & Bartlett Learning.

Leininger, M. M. (1988). Leininger’s theory of nursing: Cultural care diversity and universality. Nursing Science Quarterly, 1(4), 152-160, Web.

Masters, K. (2009). Role development in professional nursing practice (2nd. ed.). London: Jones & Bartlett Publishers.

Tex. Health and Safety Code § 597.041 (2005).

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