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Introduction
Nursing theories form a crucial foundation for nursing practice and education as they review the key nursing concepts and provide tools to improve patient care. Today, there are many nursing theories available to practitioners, so that each person can practice by a nursing theory that suits his or her beliefs, goals, and views. There are nursing theories composed back in the 19th century, such as the Environmental Theory, and theories that address contemporary issues in nursing care. Studying nursing theories is important, as it helps nurses to find an appropriate framework to practice by and to develop their own viewpoints on nursing, health, and recovery.
Grand nursing theories focus on the overall definitions of nursing and seek to provide a comprehensive approach to patient care. The Need Theory was developed by Virginia Henderson in the mid-20th century and presents an example of a grand nursing theory that stipulated 14 major nursing concepts based on patients needs (McEwen & Wills, 2018). The theory has been popular in a variety of settings because it sets a useful framework for nurses to assist them in addressing patients needs.
Middle-range nursing theories, on the other hand, serve to address a specific nursing problem or practice issue that is faced by nurses on a regular basis. Instead of providing an overview of the nursing process and defining the core principles of nursing, middle-range theories seek to provide a solution to the problem, which would help to improve the nursing process and promote patient care. The Transcultural Nursing Theory, proposed by Madeleine Leininger, is an example of a middle-range theory, as it focuses on the specific issue of caring for culturally diverse patients (McEwen & Wills, 2018). The theory is particularly useful in the contemporary setting, as nurses face the need to provide culturally-sensitive care to patients every day.
Both of the chosen theories are useful for nurses working in various settings, as they assist in structuring the nursing process and offer a solution for everyday issues. Comparing the theories can help to outline their strengths and application considerations, as well as stipulate potential limitations. The present paper will seek to compare the two theories based on their foundations, assumptions, and application to nursing practice.
Background
In order to better understand the two chosen theories, it is essential to review their background. Virginia Henderson grew up in Kansas City, Missouri. Her interest in nursing sparked during World War 1 when she volunteered to become a military nurse (Masters, 2014). Henderson obtained her diploma from the Army School of Nursing after the end of the war and began working as a nurse at a visiting nurse service in New York (Masters, 2014). However, similarly to many other nursing theories, Henderson was also interested in teaching nursing to prospective health practitioners, which is why she later completed a degree in nursing education. Her teaching career highlighted the importance of nursing theory in building an adequate vision of patient care. In 1955, Henderson introduced her theory of nursing in the second edition of her book, Textbook of the Principles and Practice of Nursing (Masters, 2014). She continued her career in nursing education and released many writings in support of her nursing theory.
Madeleine Leininger was born in the town of Sutton, Nebraska, in 1925. She received comprehensive nursing instruction after first entering the Cadet Nurse Corps in 1945, and took particular interest in psychiatric nursing (Wayne, 2014). This enabled her to work in a child guidance home in the 1950s with children from diverse cultural backgrounds; the experience allowed her to understand the importance of culturally-sensitive nursing care. According to McFarland and Wehbe-Alamah (2015), it was during this time she saw challenges and noncaring actions in the care of children and realized that only limited research had been conducted in relation to care within specific cultures and in health institutions (p. 2).
Leininger believed that the individual differences between patients that stem from their cultural background should be reflected in the nurses approach to patient care. In her career as an educator, Leininger sought to promote the concept of transcultural nursing in order to fill in the gaps in cultural knowledge that was evident in the nursing community of the time. However, for many years, her efforts were ignored. Alligood (2018) states that up until the 1990s, articles on transcultural nursing were mostly rejected by journals and publishers because the relevance of cultural knowledge to nursing care was widely underrated. Due to this fact, Leininger established the Journal of Transcultural Nursing to spread her experience and knowledge across the nursing community. Many of her publications contributed to the development of the Transcultural Nursing Theory, which was finally published in 1995.
Philosophical Foundations
Both theories have certain philosophical foundations that affect their content and teachings. For example, the Need Theory can be placed within the field of epistemology, as it establishes solid principles for nurses to follow and is based on the knowledge of patients needs. The key provision of Hendersons theory is that the nursing process should be focused on addressing the patients needs or teaching them how to fulfill those needs independently (McEwen & Wills, 2018). The needs established by Henderson are based on the knowledge of human physiology and prior research on the impact of lifestyle and environment on health.
The theory of Transcultural Nursing, however, falls into a different field of philosophy. It concerns nursing decision-making and communication between the nurse and the patient and is thus relevant to ethics. In particular, Transcultural Nursing emphasizes the importance of providing care that does not conflict with patients beliefs or customs, which is one of the major ethical dilemmas in nursing today (McEwen & Wills, 2018). Transcultural Nursing Theory seeks to maximize patient health benefits while at the same time ensuring that his or her spiritual or cultural needs are met, which makes this theory particularly relevant to the utilitarianist perspective on ethics. Therefore, although the two theories both have strong philosophical foundations, they consider different fields of philosophy.
Assumptions, Concepts, and Relationships
The Need Theory
There are four central assumptions that are generally recognized in the Need Theory that also aid in defining the key relationships and concepts evident in the theory. The first assumption is that the goal of nursing care is to assist the patient in fulfilling his or her needs and achieve a maximum degree of independence (Masters, 2014). This also defines the relationship between the patient and the nurse as centered around the patients needs and desire to live an independent life. Another assumption is that the needs established by the Need Theory cover all of the aspects of patients health and well-being, both physical and emotional. This assumption stems from the concept of health that is presented in the theory. Henderson views health as a state in which the patient is capable of fulfilling all of the 14 needs independently. The third assumption made by the theory is that external factors, such as working conditions, communication with others, and recreational activities, all contribute to patient health. Finally, the Need Theory assumes that nurses are willing to help patients to achieve a maximum degree of independence (Masters, 2015). This assumption also highlights the important aspect of the relationship between the nurse and the patient. According to Hendersons theory, in the nursing process, nurses and patients act as partners with a shared goal of fulfilling patients needs.
Transcultural Nursing
Farland and Wehbe-Alamah (2015) provide a list of assumptions that form the basis of the theory of Transcultural Nursing. Similarly, these assumptions help in defining other aspects of the theory, including key concepts and relationships. The first assumption made by the theory is that cultural background affects patients health-related behavior and thus impacts their wellbeing. The concept of health thus includes not only the physical manifestations of wellness but also behaviors and practices that influence patients health. Leininger also defines the relationship between the patient and his or her culture as relevant to the nursing care. The second assumption is that providing culturally-sensitive care can help nurses to improve patient outcomes (Farland & Wehbe-Alamah, 2015). Therefore, the concept of care by Leininger stretches beyond required procedures for improving health and includes the understanding and knowledge of the patients culture. The relationship between the nurse and the patient is also affected by this assumption. In Transcultural Nursing, the relationship between nurses and patients should be focused on the nurses commitment to respect and value patients culture. Finally, another important assumption is that full recovery cannot be achieved without care (Farland & Wehbe-Alamah, 2015). The concept of nursing provided in the theory combines all of the above assumptions; in Leiningers theory, nursing is the process of assisting the person in achieving ideal health with the help of culturally-sensitive care.
Application to Nursing
Both theories are rather versatile in their application to nursing practice. However, there are some settings in which applying these theories could provide more benefits for patients and nurses alike. For instance, the Need Theory provides a useful framework for chronic disease care, rehabilitation care, and geriatric care. In all of these areas of nursing, practitioners work with patients whose ability to meet their needs independently is impaired. Moreover, the goal of care provision in this areas is to enable the person to live as independently as possible, which complies with the principles of Hendersons Need Theory. Leiningers theory, on the other hand, would help to achieve maximum benefits if applied in practice areas where the patients come from various cultural backgrounds. For example, Transcultural Nursing would be especially useful in providing health services to disadvantaged populations, as there is a larger share of ethnic and racial minorities in this patient population.
Comparison of Theories in Nursing Practice
As mentioned above, the two practices differ a lot in their approach to nursing practice. Whereas the Need Theory provides a comprehensive framework for nursing practice, the theory of Transcultural Nursing focuses on the importance of culturally-sensitive nursing practice. Thus, the Need Theory can be used to create a plan for patient care in all areas of nursing practice. The plan would include an assessment of patients needs, which would help to highlight any gaps that need to be addressed (Athisham & Jacoline, 2015). After the initial assessment, the nurse would develop a treatment plan that would aid in filling these gaps by improving the patients ability to meet his or her needs independently.
Transcultural Nursing, on the other hand, can be used by nurses when caring for patients from a different cultural background. When applying this theory to practice, nurses should seek to define and understand health behaviors that are influenced by the patients culture and to negotiate ways of correcting unwanted behaviors or promoting healthy practices in a way that would not conflict with the patients culture and beliefs. Therefore, Leiningers theory focuses on approaching the patient and developing a partnership between the patient and the care provider rather than offering a structured framework for treatment.
Examples in Clinical Setting
An example of the use of the Need Theory in my clinical setting would be chronic disease management. Patients with chronic diseases that are admitted to my place of practice often fail to fulfill some of their needs independently. For instance, chronic pain could prevent the person from working or participating in recreational activities. By applying the Need Theory, the nurse can outline the unmet needs and find a useful treatment that would help the patient to live a more fulfilling life. In the case of chronic pain, pain-reducing medication could assist the patient in becoming more independent.
Transcultural Nursing can be used when caring for a patient from a different culture. In particular, the theory can be applied to instances when damaging behaviors stem from the patients culture. For example, if a patient from a different cultural background suffers from obesity, his or her unhealthy eating could be influenced by cultural customs, such as celebrations or food traditions in the family. In this case, Transcultural Nursing can help to improve the nurses understanding of the patients culture in order to find a way of addressing the patients culturally-influenced eating behaviors in the treatment plan.
Parsimony
Parsimony is an essential criterion in theory assessment, as it concerns the clarity and conciseness of a theory (McEwen & Wills, 2018). A parsimonious theory is a theory that can be explained in a clear and concise way without causing misunderstanding. Here, both theories appear to be relatively parsimonious. The Need Theory can be explained as a nursing theory that establishes a set of 14 critical patient needs and defines the nurses role in helping the person to fulfill these needs. The Need Theory does not include a lot of concepts, and all of its provisions can be easily explained in a few sentences. Similarly, the Transcultural Nursing Theory can be defined as a theory that highlights the importance of culturally-sensitive care in promoting patient outcomes and advises nurses to use their knowledge and understanding of the patients culture to develop an appropriate treatment plan. Leiningers theory is rather concise and can be explained clearly and concisely to nursing students and practitioners.
Conclusion
Overall, both theories are relevant and useful when applied to a variety of practice settings. The analysis of the two theories shows that they can be used together, as they specify the nurses role and the critical relationships in nursing care in a similar way. Correct application of these theories in nursing practice could help nurses to improve patient health outcomes, allowing patients to live a fulfilling life.
References
Ahtisham, Y., & Jacoline, S. (2015). Integrating nursing theory and process into practice: Virginias Henderson Need Theory. International Journal of Caring Sciences, 8(2), 443-450.
Alligood, M. R. (2018). Nursing theorists and their work (9th ed.). Oxford, UK: Elsevier Health Sciences.
Masters, K. (2014). Nursing theories: A framework for professional practice (2nd ed.). Burlington, MA: Jones & Bartlett Publishers.
McEwen, M., & Wills, E. M. (2018). Theoretical basis for nursing (5th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
McFarland, M. R., & Wehbe-Alamah, H. B. (2014). Leiningers culture care diversity and universality (3rd ed.). Burlington, MA: Jones & Bartlett Publishers.
Wayne, G. (2014). Madeleine M. Leininger The founder of Transcultural Nursing. Web.
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