|Professional and lay care in the Tanzanian village of Ilembula|
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The structure of this study is based on Leininger’s Culture Care Theory (1991, 1995a, 1995b, 1997). Leininger (1991, 1995a) underlines the meaning and importance of culture in explaining an individual’s health and caring behaviour, and her Culture Care Theory is the only nursing theory that focuses on culture. (Rosenbaum 1997.) The roots of the theory are in clinical nursing practice: Leininger discovered that patients from diverse cultures valued care more than the nurses did. Gradually, Leininger became convinced about the need for a theoretical framework to discover, explain, and predict dimensions of care, and developed the Culture Care Theory as the outcome of studies performed in numerous Western and non-Western cultures. (Leininger 1997.)
In her Culture Care Theory, Leininger states that caring is the essence of nursing and unique to nursing. (Leininger 1978, 1981, 1984, 1988, 1991, 1995a,b, Reynolds 1995.) Leininger (1997) actually criticizes the four nursing metaparadigm concepts of person, environment, health and nursing (Fawcett 1989.) First, Leininger considers nursing a discipline and a profession, and the term ‘nursing’ thus cannot explain the phenomenon of nursing. Instead, care has the greatest epistemic and ontologic explanatory power to explain nursing. Leininger (1995a) views ‘caring’ as the verb counterpart to the noun ‘care’ and refers it to a feeling of compassion, interest and concern for people (Leininger 1970, Morse et al. 1990, Reynolds 1995, McCance et al. 1997). When Leininger’s definition of care is compared to other transcultural scholars’ definitions, it appears that her view of care is wider than, for example, that of Orque et al. (1983), who describe care as goal-oriented nursing activities, in which the nurses recognise the patients’ ethnic and cultural features and integrate them into the nursing process. Second, the term ‘person’ is too limited and culture-bound to explain nursing, as the concept of ‘person’ does not exist in every culture. Leininger (1997) argues that nurses sometimes use ‘person’ to refer to families, groups, communities and collectivities, although each of the concepts is different in meaning from the term ‘person’. Third, the concept of ‘health’ is not distinct to nursing as many disciplines use the term. (Leininger 1997.) Fourth, instead of ‘environment’ Leininger uses the concept ‘environmental context’, which includes events with meanings and interpretations given to them in particular physical, ecological, sociopolitical and/or cultural settings. (Leininger 1991, 1995a,b, 1997.)
Care always occurs in a cultural context. Culture is viewed as a framework people use to solve human problems. (Orque et al. 1983, Leininger 1991.) In that sense, culture is universal. It is also diverse, as Leininger (1991, 1995a, 1995b, 1997) refers culture to the specific pattern of behaviour which distinguishes any society from others. Transcultural scholars define culture by stressing behavioural aspects as an explicit form of it. Leininger (1997, 38) states that culture refers to “the lifeways of an individual or a group with reference to values, beliefs, norms, patterns, and practices” and agrees that culture is learnt by group members and transmitted to other group members or intergenerationally. Leininger (1991, 1995a) distinguishes between emic and etic perspectives of culture. Emic refers to a insider’s views and knowledge of the culture, while etic means the outsider’s viewpoints of the culture and reflects more on the professional angles of nursing. Apart from culture and environmental context, ethnohistory is also meaningful when examining care from the cultural perspective. (Leininger 1995a.) The environmental context, which includes physical, ecological, sociopolitical and cultural settings, gives meaning to human expressions of care. Ethnohistory refers to the past events and experiences of individuals or groups, which explain human lifeways within particular cultural contexts over short or long periods.
Leininger (1991, 1995a, 1995b, 1997) has formulated several theoretical assumptions and orientational definitions to guide nurses in their discovery of culture care phenomena. The assumptions and definitions are derived from the theoretical conceptualizations and philosophical positions of the Culture Care Theory, and they are used as guides to systematic study of the theory. Strictly constructed theoretical formulations would be incongruent with the purposes of the qualitative paradigm. The following assumptions concerning care/caring were significant when planning the study:
care (caring) is essential to curing and healing, for there can be no curing without caring
every human culture has lay (generic, folk or indigenous) care knowledge and practices and usually some professional care knowledge and practices, which 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 ethnohistorical, and environmental contexts of cultures
a client who expreriences nursing care that fails to be reasonably congruent with his/her beliefs, values, and caring lifeways will show signs of cultural conflict, noncompliance, stress and ethical or moral concern
the qualitative paradigm provides ways of knowing and discovering the epistemic and ontological dimensions of human care transculturally
Leininger (1997) states that orientational definitions are more appropriate in the qualitative research paradigm than the rigid operational definitions typical of quantitative studies. Orientational definitions are used as guides for studying the domain related to the theory. The following orientational definitions (Leininger 1995a, 1995b) structure this study:
cultural and social structure dimensions refer to the dynamic, holistic, and interrelated features of culture (or subculture) related to religion or spirituality, kinship (social), political (and legal), economic, education, technology, cultural values, language and ethnohistorical factors of different cultures
professional care systems refer to formally taught, learnt and transmitted professional care, health, illness, wellness and related knowledge and practical skills that prevail in professional institutions
lay care systems refer to culturally learnt and transmitted knowledge and skills used to provide assistive, supportive, enabling or facilitative acts towards or for another individual or group to improve a human lifeway, health condition or to deal with handicaps and death.
Leininger has presented the Sunrise Model (Fig. 2) to visualise the different dimensions of her Culture Care Theory. It is designated to depict a total view of the different, but very closely related dimensions of the theory. I use the Sunrise Model in this study as a cognitive map to orient and depict the different dimensions of the theory. Leininger (1991, 1997) has included in the Sunrise Model the modes of cultural care preservation/ maintenance, culture care accommodation/negotiation and culture care repatterning/restructing, which I have excluded from my study. My aim is to demonstrate how care is integral to socio-cultural issues in the context of Ilembula village rather than create a model of culturally congruent care of the Bena in Ilembula.