Guest Contributor: Carolina Ferreira Marcelino
Master’s student in Child and Pediatric Health Nursing
Catholic University of Portugal (Lisbon)
The migratory phenomenon has reached historic levels in recent months. It is expected to continue to increase, either to search for better socioeconomic conditions or to run away from violence, conflicts, and natural disasters. According to the United Nations High Commissioner for Refugees (UNHCR), in the first months of 2022, the number of people forced to flee their country was around 100 million, 32.1 million of which had been granted refugee status, and about half of them were children (UNHCR, 2022).
Children are a particularly vulnerable population and thus deserve special protection since the effect of displacements can have a devastating impact on their health (UNHCR, 2020).In June 2023, in the pediatric inpatient service of a Portuguese district hospital, there were two siblings hospitalized, coming from Guinea, for symptomatic control of a genetic disease. They were brought by their mother, who left her three other children in their home country, with the aim of finding answers for different healthcare methods that would relieve the pain and suffering of the two sick children.
The critical symptoms were under control, and everything was ready for discharge. However, their social situation did not allow such a thing to happen. For three months, there was no answer from social services for the children and the mom to be included and integrated into society, and with that, the hospital became their home. As time went by, children’s behavioral regression was noticeable. The youngest increasingly communicated less, exhibited more childish behaviors, and lost control of his sphincters. The older one began to exhibit aggressive and challenging behaviors towards the health professionals.
In this specific situation, it felt that the nursing care was standard, without great theoretical support and a culturally congruent approach to the values, beliefs, and culture of the family. The nursing team, of which I’m a part, responded individually. Each professional managed the everyday according to their experience and with what they thought was “right”.
The search for the cultural knowledge of that family could be the solution for us to understand certain attitudes of both the children and the mother, deemed “bad” by the nursing team.
I sought to deepen my knowledge on this subject since I felt the need to prepare myself for the future, which I can do by having theoretical support that can allow me to act in a culturally competent manne
In 1991, Madeleine Leininger created the “Theory of Culture Care Diversity and Universality“, which is used to guide people through the world by considering “care” as the essence of nursing.
Culture is defined by Leininger as a set of patterns of actions and thoughts that arise from values, beliefs, and ways of life transmitted and shared by a group of people (Leininger, 1988). Therefore, Leininger argues that nursing, as a subject, science, and profession focused on caring for the human being, should assist in transitions, empowering individuals or families to maintain or recover their health or well-being through culturally significant and beneficial interventions (George, 2014). For this, nurses must know the meanings, cultural values, beliefs, and specific health care of a particular culture in order to guide people’s decisions and our nursing interventions.
For that reason, the nurse, to provide culturally congruent nursing care, should initially observe and listen to the client regarding their cultural values, beliefs, and practices related to health management. Subsequently, they must identify and document recurring patterns and its meaning (heard or experienced). All of this information has to be synthesized and registered for further situations.
Finally, the nurse should develop a plan of nurse-client care based on culture and with the client’s co-participation in decisions and actions to provide culturally congruent care. During the care plan, the nurse should establish diagnoses, plan interventions, and define expected outcomes (George, 2014).
For nursing interventions to be culturally congruent with the needs and values of the client, they must include preservation or maintenance, accommodation or negotiation, and re-patterning or restructuring. The development of these actions by the nursing team will lead to a decrease in cultural stress and, consequently, a reduction in the risk of conflict between the nurse and the client (George, 2014).
Preservation or maintenance is characterized by a health professional’s support so that the person maintains their health and well-being (George, 2014). Accommodation or negotiation is characterized by the assistance of health professionals by negotiating and assisting in health care, leading to a better outcome. (George, 2014). Finally, there-patterning or restoration of care culturally aims to modify or restructure their ways of life for better standards and outcomes in health. This requires a broad knowledge of the client’s cultural background, and the client’s lifestyle should be viewed as a priority (George, 2014). Through these three methods, it is possible to help clients from various cultures, as the nurse conveys information that will lead to better health outcomes while aligning with the cultural values, beliefs, and lifestyle of the client (George, 2014).
In summary, I consider that adequate education and training would be crucial for culturally congruent care so that it is possible to provide health care through this perspective.
References
George, J. (2014). Nursing Theories: The Base for Professional Nursing Practice (6th ed.). England; Pearson. Leininger, M. (1988). Leininger’s Theory of Nursing: Cultural Care Diversity and Universality. Nursing Science Quarterly, 1(4), 152-160. doi:10.1177/089431848800100408
United Nations High Commissioner for Refugees. (2020).Children represent about half of the number of refugees in the world. Retrieved from https://www.acnur.org/portugues/2020/10/12/criancas- represent about half of the number of refugees in the world/
United Nations High Commissioner for Refugees. (2022). Refugee data finder. Retrieved from https://www.unhcr.org/refugee-statistics/insights/explainers/100-million-forcibly-displaced.html.
Serrano, N. (2024, junho 18). Embracing Cultural Diversity in Nursing: A Personal Journey and Reflection on Leininger’s Theory. Nursology. https://nursology.net/2024/06/18/embracing-cultural-diversity-in-nursing-a-personal-journey-and-reflection-on-leiningers-theory/
About Carolina Ferreira Marcelino
I have been a nurse since 2021, and my experience has been in paediatric care.
My area of interest is culturally congruent care for migrant children and families, so they can achieve wellbeing and satisfaction with health care. This post was created as part of the Nursing Theories course, under the pedagogical supervision of Professor Zaida Charepe (PhD, Associate Professor).