NURS 8250 Week 3 Theory Analysis Paper Example

Taking Culture Care Apart: An Analysis of Leininger's Theory Tested on Postpartum Depression Screening for Recently Arrived Immigrant Mothers

Student Name

College of Nursing, Walden University

NURS 8250: Advanced Theoretical and Scientific Perspectives in Nursing

Instructor Name

Month Day, Year

Taking Culture Care Apart: An Analysis of Leininger's Theory Tested on Postpartum Depression Screening for Recently Arrived Immigrant Mothers

Introduction

Describing a theory repeats what it says. Analyzing a theory takes it apart to see how it was built and whether its parts hold together. This paper analyzes the culture care theory Madeleine Leininger developed, known formally by its full title of culture care diversity and universality, in four parts, origins, concepts, relationships and assumptions, following the general approach to theory analysis that Walker and Avant (2019) describe. It then uses the parts to examine one practice situation: screening for postpartum depression among recently arrived immigrant mothers at a composite community health center that serves families from Central America, East Africa and South Asia. The center screens every mother at the two-week and six-week postpartum visits with a standard written questionnaire, and staff notice that many recent arrivals score low yet later present in crisis.

Origins

Leininger was a psychiatric nurse who, working with children in the 1950s, noticed that children from different cultural backgrounds responded to care in different ways, and that nursing had little knowledge to explain those differences. She went on to study anthropology and conducted fieldwork in Papua New Guinea, and she built the theory from two convictions: that caring lies at the heart of what nurses do, and that care takes culturally specific forms (Leininger, 2002). The theory is therefore a product of two disciplines. From anthropology it takes the insider and outsider perspectives on culture and a commitment to ethnographic method; from nursing it takes care as its central concern. McFarland and Wehbe-Alamah (2019) trace its development over several decades and the refinement of the Sunrise Enabler, the visual guide that maps the factors influencing culture care.

Concepts

The theory's central concept is culture care: the values, beliefs and patterned ways of living that help people maintain well-being, face illness or death. Around it sit several related concepts. Worldview is the way a people look out on the world. Cultural and social structure dimensions are the factors that shape care, including religion, kinship, politics, economics, education, technology and cultural values. Ethnohistory is the past of a people as they tell it. The theory distinguishes generic care, the folk and family care learned within a culture, from professional care, the care learned in formal training. Its goal concept is culturally congruent care, care that fits the person's cultural values and lifeways. Finally, it names three modes of nursing decisions and actions: preservation or maintenance, accommodation or negotiation and repatterning or restructuring of care (McFarland & Wehbe-Alamah, 2019).

Relationships

The theory's relationships are stated mainly through the Sunrise Enabler. Worldview and the cultural and social structure dimensions, set within an environmental context, language and ethnohistory, influence care expressions, patterns and practices. Those care patterns shape the health and well-being of individuals, families and groups. Generic and professional care systems both act on the person, and nursing decisions made through the three modes bridge them. The proposed result is culturally congruent care, which the theory holds will support health and well-being.

The central proposition, then, is conditional: care that fits a person's culture will produce better outcomes than care that does not. The theory does not specify how much better, for whom or through what mechanism, which is typical of a broad theory and makes the proposition hard to test directly.

Assumptions

Several assumptions are explicit. Care is the essence of nursing. Culture care has both diversity, variations among cultures, and universality, commonalities across them. Every culture has generic care practices. Culturally congruent care is necessary for well-being. Other assumptions are implicit. The theory assumes that cultures can be identified and described with reasonable stability, that the nurse can learn a person's culture through ethnographic inquiry and that a person's cultural identity is the main lens through which care should be understood. Those implicit assumptions are the most open to challenge, since recently arrived families often live between cultures, and a woman's circumstances, such as immigration status or isolation, may matter as much as her culture.

The Parts Applied: Postpartum Depression Screening

Taking the theory apart makes it more useful for the center's problem than a summary would. Immigrant women have been found to have higher prevalence of postpartum depressive symptoms than nonimmigrant women in a meta-analysis of studies across several countries (Falah-Hassani et al., 2015), so a screening process that misses them is a serious gap.

The concepts identify what the screening tool leaves out. The Edinburgh Postnatal Depression Scale is a brief self-report questionnaire developed in the United Kingdom to detect postnatal depression (Cox et al., 1987). Its items ask about mood, enjoyment, anxiety and self-blame in words that reflect one culture's way of talking about distress. The concept of worldview suggests that some mothers may express distress through the body, such as fatigue or pain, or through relationships, rather than through the feelings the scale asks about. The concept of generic care suggests that families may already have postpartum practices, such as periods of rest supported by female relatives, whose absence after migration could itself be a source of distress the tool does not capture.

The cultural and social structure dimensions widen the assessment. Kinship, for example, points to whether the mother has lost the family network that would have cared for her after birth. Economic and political factors point to work, housing and immigration concerns.

The three modes guide the center's response. Preservation would support the mother's own postpartum practices where they help her. Accommodation might mean using an interpreter who shares her language and adding questions about body and family. Repatterning might mean changing the center's process so that a mother's first postpartum contact is with a community health worker from her community, rather than a written form.

The assumptions mark the theory's limits here. A mother from East Africa who arrived six months ago may not fit a single cultural description, and her distress may be driven more by isolation and legal uncertainty than by culture. An analysis that stays aware of the implicit assumptions avoids turning culture care into stereotypes, which is a risk McFarland and Wehbe-Alamah (2019) also acknowledge in discussing the theory's future.

Conclusion

Analyzed into its parts, Leininger's theory offers the center concepts to see what its screening tool misses, dimensions to widen the assessment and modes to guide its response. Its broad proposition is hard to test, and its implicit assumptions about stable cultural identity fit recently arrived families imperfectly. Those limits do not disqualify the theory for this problem. They tell the center to use its concepts to open the assessment while listening to each mother as an individual.

References

Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150(6), 782-786. https://doi.org/10.1192/bjp.150.6.782

Falah-Hassani, K., Shiri, R., Vigod, S., & Dennis, C.-L. (2015). Prevalence of postpartum depression among immigrant women: A systematic review and meta-analysis. Journal of Psychiatric Research, 70, 67-82. https://doi.org/10.1016/j.jpsychires.2015.08.010

Leininger, M. (2002). Culture care theory: A major contribution to advance transcultural nursing knowledge and practices. Journal of Transcultural Nursing, 13(3), 189-192. https://doi.org/10.1177/10459602013003005

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

Walker, L. O., & Avant, K. C. (2019). Strategies for theory construction in nursing (6th ed.). Pearson.