Clinical Problem
Contemporary healthcare systems encounter challenges in addressing the unique health requirements of transgender and gender-diverse youth, impeding their access to comprehensive medical services while upholding principles of sensitivity, respect, and equality. LGBTQ adolescents and young adults in the United States exhibit a higher propensity for experiencing various health issues compared to individuals from other demographic groups. Individuals facing such severe circumstances are at a higher risk of engaging in suicide, contracting HIV, or acquiring STIs. McEwing (2020) posits that the observed disparities could be attributed to a limited comprehension among healthcare professionals regarding the distinct requirements and health challenges this demographic encounters. While Leininger’s Transcultural Nursing Theory does not explicitly address transgender individuals, it is highly applicable to this demographic. The idea is renowned for its adeptness in comprehending and incorporating other cultures in pursuing essential care for individuals. Moreover, the comprehensive and inclusive methodology employed by the organization in comprehending and delivering culturally appropriate healthcare aligns with the specific requirements of the transgender community. By applying this theoretical framework to implementing a training program to enhance cultural competency, healthcare personnel can better understand how to effectively provide care for transgender individuals and enhance their overall competency.
Theory Framework
The Transcultural Nursing Theory was initially introduced in Leininger’s seminal work, Culture Care Diversity and Universality, published in 1991. However, its developmental process may date back to the 1950s. The hypothesis was expanded in her publication Transcultural Nursing, released in 1995 (Pfettscher, 2021). The explanation of theory-based research and the implementation of Transcultural theory is provided in the third edition of Transcultural Nursing, released in 2002. This theory is based on various significant concepts. The concepts are presented in a Sunrise Model, which allows nurses to develop critical and complex thoughts regarding clinical practice. The first concept is transcultural nursing. Transcultural nursing is a specialized area within the nursing profession that centers on examining and evaluating diverse cultures in terms of nursing and the provision of healthcare services. Its primary objective is to offer nursing care that is both meaningful and effective, considering the cultural values and health-related circumstances of the individuals involved.
The second concept is ethnonursing. This field of study examines the cognitive perceptions and knowledge of nursing care beliefs, values, and practices within a specific cultural context based on their firsthand experiences, beliefs, and value systems. Third, nursing is a profession and field that combines humanistic and scientific principles. Its primary objective is to provide care and support to individuals or groups, enabling them to maintain or restore their well-being or health in culturally significant and advantageous ways. Additionally, nursing aims to assist individuals in coping with disabilities or the challenges of death (Pfettscher, 2021). The fourth one is culturally congruent care. Per the theory, culturally congruent care in nursing refers to a set of cognitively based actions or decisions designed to align with individuals, groups, or institutions’ cultural values, beliefs, and lifeways. These actions or decisions aim to provide or support health care or well-being services that are beneficial and satisfying. Fifth, the theory highlights the concepts of emic and etic. Emic refers to knowledge acquired from firsthand experience or from others who have firsthand experience. It refers to general or traditional wisdom, while etic is acquiring knowledge encompassing the professional viewpoint.
The sixth essential concept highlighted in the theory is health. According to Leininger, Health is a condition of optimal physical and mental well-being influenced by cultural norms, values, and behaviors (Pfettscher, 2021). This statement pertains to the capacity of individuals or groups to engage in their daily role activities within culturally expressed, advantageous, and structured lifestyles. On the other hand, as a noun, care refers to abstract and physical actions that involve assisting, supporting, or enabling experiences or behaviors for people with precise or expected needs, aiming to improve or enhance a human condition or way of life. Lastly, culture care universality refers to the shared, comparable, or prevailing uniform care meanings, patterns, values, lifeways, or symbols across multiple cultures. These universal care practices reflect ways to aid, support, facilitate, or enable individuals.
Moreover, the theory emphasizes three main cultural modes. The first approach is to take care of and maintain the culture. Helping members of a specific cultural group is an example of a professional mode encompassing decisions and actions that fall into this category. Their ability to recover from illness, live with a disability, and face death will be enhanced by these choices and acts, which will also help them retain and preserve caring ideals. The second way is culture care accommodation, which includes professional decisions and actions that help people from a specific cultural background adapt to or negotiate with others to benefit their health (McFarland & Wehbe-Alamah, 2019). The last mode is culture care restructuring. This includes all the professional decisions and actions that help clients reorganize their lifestyles to embrace new healthcare patterns that are different and beneficial. The clients’ cultural traditions and beliefs are respected throughout this procedure, which aims to improve their lifestyle compared to before.
Casey (2022) employs Transcultural Nursing Theory to guide the implementation of an evidence-based educational program aimed at enhancing the proficiency of emergency department (ED) providers in providing care for the LGBTQ community within the ED. This study involved nursing students whose cultural competency was tested before the educational simulation intervention was implemented. Once measured, they were asked to work with an LGBTQ patient, a modified version of the National League of Nursing (NLN), using a standardized patient scenario. After the educational simulation intervention, all of the students filled out the same cultural competency scale so that their results could be used to measure their cultural competence. When comparing scores from before and after the educational exercise intervention, the clinical questions showed that it raised scores on cultural competence. Higher scores on cultural competency were linked to lower results on therapeutic communication. Thus, this study proves that applying the Transcultural Nursing Theory can help guide an intervention’s implementation and ensure it is a success.
Approach to Using the Theory
The distinctiveness of Leininger’s Transcultural Nursing Theory lies in its integration of several social structures, including politics, kinship, religion, economics, life span values, philosophy of living, geo-environmental elements, and cultural history, collectively shaping the provision of cultural care. Culturally competent care can promote healing, well-being, and overall health (Casey, 2022). The theory adopts a holistic approach by prioritizing the humanistic aspect of an individual, as opposed to emphasizing symptoms, disease, pathology, and curative interventions. By adhering to the transcultural nursing theory, the implementation of cultural competency can mitigate the occurrence of illnesses and impairments among the transgender population. This is achieved through the provision of inclusive and well-informed care, which helps minimize the likelihood of healthcare disparities and challenges transgender individuals face.
Another essential aspect of Leininger’s theory that applies to transgender individuals is that they have a right to get healthcare that aligns with their unique life experiences and cultural beliefs. This aspect is mainly supported by the three primary modes of culture, including culture preservation, accommodation, and restructuring. By using the Sunrise Model developed by Leininger (refer to Appendix A), the project will help ensure healthcare providers embrace critical thinking in their practice to effectively incorporate cultural and social frameworks that promote quality care for transgender people (McFarland & Wehbe-Alamah, 2019). Also, in this project, Leininger’s approach will be employed to illustrate the necessity of education in providing culturally competent care for transgender individuals. These practices will ensure that healthcare providers are competent to deliver safe and therapeutic care in every cultural context.
Furthermore, this theory can prove effective for transgender individuals because it will ensure the project adopts a holistic approach by considering the individual’s sexuality and gender. In formulating this theory, Leininger aimed to advance and sustain every population’s welfare and physical condition. This goal also aligns with the objectives of this project because enhancing the proficiency of healthcare practitioners in comprehending and addressing the health requirements and providing treatment for the transgender community is crucial. Besides, Leininger’s philosophy centers on understanding emic and etic facets of care. In this case, culturally congruent care methods are based on emic and etic care ideals, can optimize health and well-being, mitigate cultural burdens, and enhance the overall quality of life (Pfettscher, 2021). Hence, healthcare providers can acquire external information by utilizing transgender resources, participating in training, and gaining firsthand experience in caring for this population.
References
Casey, K. (2022). Improving LGBTQ Provider Competency in the Emergency Department: Guided by Leininger’s Theory of Transcultural Nursing. https://scholarworks.umass.edu/cgi/viewcontent.cgi?article=1321&context=nursing_dnp_capstone
McEwing, E. (2020). Delivering culturally competent care to the lesbian, gay, bisexual, and transgender (LGBT) population: Education for nursing students. Nurse Education Today, p. 94, 104573. https://doi.org/10.1016/j.nedt.2020.104573
McFarland, M. R., & Wehbe-Alamah, H. B. (2019). Leininger’s theory of culture care diversity and universality: An overview with a historical retrospective and a view toward the future. Journal of Transcultural Nursing, 30(6), 540–557. https://doi.org/10.1177/1043659619867134
Pfettscher, S. A. (2021). Florence Nightingale: Modern nursing. Alligood, MR Nursing theorists, and their work, 52-70.
Appendix A
Figure 1: Sunrise Model of Madeleine Leininger’s Theory