Culture Care Theory 文化照護理論 Madeleine Leininger Culture Care Diversity and Universality Theory

New knowledge and practices are essential for nurses to function in a rapidly changing multicultural world. Nurses needed in-depth knowledge of cultures with an anthropological view and in-depth, culturally based care phenomena. The cultural care theory provides some entirely new teaching content ways to care for immigrants and refugees of many different and neglected cultures.

Culturally Congruent Care 文化融合性的照護 Culturally congruent care refers to culturally based care 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 wellbeing, or to prevent illness, disabilities, or death. 文化融合性的照護是依據文化照護(cultural nursing) 的理念,提供與個人或群體的文化價值觀、信仰及生活方式互相融合的護理措施,以促進個人或群體的健康狀態.

Cultural Nursing:文化照護 以主觀(emic)和客觀(etic)立場得到的價值觀、信仰及表達方式, 以協助人們維持幸福和健康,或協助他們去克服疾病、殘障以及死亡. emic有圈(局)內人、主(本)位研究觀點的意思；而etic則可翻成圈(局)外人、客位研究觀點的意思。 所謂的主位研究(emic)，亦即，研究者不憑自己的主觀認識，盡可能的從當地人的視角去理解文化，通過聽取當地提供情況的人(即報導人)所反映的當地人對事物的認識和觀點，進行整理和分析的研究方法。也就是說，主位研究要求研究者對研究對象有深入的瞭解，熟悉他們的知識體系、分類系統，明瞭他們的概念、話語及意義，通過深入的參與觀察，儘量像本地人那樣去思考和行動。 客位研究(etic)是研究者以文化外來觀察者的角度來理解文化，以科學家的標準對其行為的原因和結果進行解釋，用「比較的」和「歷史的」觀點看待民族誌提供的材料。

Culture Care (文化照顧) Refers to the values & beliefs that assist, support, or enable another person or group to maintain well-being, improve personal condition, or face death or disability Is universal, but the actions, expressions, patterns, lifestyles, and meanings of care may be different Knowledge of cultural diversity is essential for nursing to provide appropriate care to clients, families, and communities

Culture care is divided into general care and professional care 是人類一種天性的具體體現，它存在於日常生活中。 專業照顧 (professional care)： 是一種有目的、有意義的專業活動，是一種工作而 不是一種屬性。 專業照顧是那些幫助性、支援性、關心性的專業行為，從而改善人類的生存條件或生活條件，以利於人類社會的生存及發展。 專業照顧與普通照顧在意義及表達方式上有很大的區別

Culture Care Diversity 文化照護的差異性 It refers to the differences or variabilities among human beings with respect to culture care meanings, patterns, values, lifeways, symbols or other features related to providing beneficial care to clients of a designated. 不同文化狀況裡,對於協助、支持或增進他人健康、幸福、生活及面對殘廢或死亡有不同的價值觀、 信仰及方式。

Culture Care Universality 文化照顧的同通性 It refers to the commonly shared or similar culture care phenomena features of human beings or a group with recurrent meanings, patterns, values, lifeways, or symbols that serve as a guide for care givers to provide assistive, supportive, facilitative, or enabling people care for healthy outcomes. 在不同文化狀況下,對於協助、支持或增進他人 健康、幸福、生活及面對殘廢或死亡有相同的 價值觀、 信仰及方式。

Transcultural Nursing 汎文化護理 It is a discipline with a body of knowledge and practices to attain and maintain the goal of culturally congruent care for health and wellbeing. http://www.culturediversity.org/basic.htm

The Sunrise Enabler The theory includes an enabler ( Dr.Leininger prefers it not be called a model), serves as a conceptual guide or cognitive map to guide nurses in the systematic study of all dimensions of the theory. This map or guide is called the Sunrise Enabler.

The Sunrise Enabler 「日出模式」主要項目有世界觀 (worldview) 及文化和社會結構因素 (cultural & social structure dimensions)；文化和社會結構因素又包括文化價值觀及生活方式 (cultural values & lifeways)，宗教、哲學或靈性因素 (religious & philosophical factors)，科技因素 (technological factors)，親戚和社會因素 (kinship & social factors)，經濟因素 (economic factors)，教育因素 (educational factors) 及政治和法律因素 (political & legal factors)。這些因素會影響到個案的整體性健康。

3 Modes of Nursing Action Culture care preservation or maintenance Culture care accommodation or negotiation Culture care restructuring or repatterning

The Sunrise Enabler Leininger 提出三種文化照護的型態來引導護理措施，即 文化照護的保存： Preservation / Maintenance 協助個人或群體保留及運用與文化有關的照護行為，以維護個人或群體的健康狀態。 文化照護的調整：Accommodation / Negotiation 協助某特定文化的個人或群體去適應及協調的活動，使個人或群體有一個滿意的健康狀態。 文化照護的再造： Repatterning / Restructuring 依據個人或群體的文化價值觀和理念，協助改變、調整、修正他們的收活方式，使得健康狀態比未改變前更好 (達到文化融合性照護)。

Theory’s Purpose & Goal to explicate transcultural nursing knowledge and practice Goal: to identify ways to provide culturally congruent nursing care to people of diverse or similar cultures

Culture and nursing The influence of cultural background upon nursing Leininger’s Transcultural nursing theory The principles of cultural nursing The strategies of cultural nursing

The influence of cultural background upon nursing Cultural background influences the reasons of producing diseases. value concept, attitude or life style in culture may influence the occurrence of some diseases

(2) Cultural background influences patients’ reaction to diseases. 1) Gender 2) Educational background 3) Family’s support

(3) Cultural background influences patients’ manner of seeing a physician 1）Religious conception 2) Economic condition

(4) Culture influences a person’s cognition to death 1）Chinese traditional culture of emotional state on death 2）Chinese traditional behavioral culture on death

Transcultural nursing theory Leininger’s Transcultural nursing theory (1) The formation of the theory (2) Basic content of the theory (3) Goal of the theory

Basic content of the theory (1) Cultural care is a necessary qualification to the survival of human being (2) The nationalities with different culture in the world have the universality (commonness) and speciality of culture care. (3) Culture care is divided into general care and professional care.

Goal of the theory To provide the nursing care corresponding to culture for the health of individual, family and colony.

The principles of cultural nursing (1)principle of comprehension (2)principle of education (3) principle of mobilization

(4) Principle of giving suggestions (5)Principle of wholeness

4) To seek supportive system 5) To pay attention to the diversity on value conception 6) To follow the principles of cultural nursing

Strategies of cultural nursing The nursing strategies of meeting patients’ cultural needs The nursing strategies that help patients to adapt hospital’s cultural environment.

Strategies of meeting patients’ cultural needs 1)To understand patients’ behavior of seeing a physician 2)To identify patients’ reaction to disease. 3) To establish a nurse-patient relationship adapted to cultural phenomena

strategies that help patients to adapt hospital’s cultural environment To help patients to be familiar with the environment of hospital as soon as possible To establish a good relationship between nurse and patient.

b. Special taboo c. National convention 3) To respect patients’ habits and customs a. Diet b. Special taboo c. National convention

泛文化護理模式 日出模式示意图 世界觀 社會文化結構 血統 社会 政治 法律 環境背景語言 经濟 影響 教育 科技 護理系統 專業醫療系统 文化價值信仰生活方式 血統 社会 政治 法律 日出模式示意图 環境背景語言 宗教 哲学 经濟 影響 護理表現範例與常規 教育 科技 整體健康/生病/死亡 不同健康系统中的個人、家庭、團体和社区或機構前後不同健康關係 民俗醫療 系统 護理系統 專業醫療系统 照護型式和決定 文化保留與維護 個人或團體有更好的健康、幸福安寧 面對殘障死亡 文化的調式與協議 文化的再造

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