Middle Range Theories on Nursing

Middle range theories focus on a narrow dimension of the nursing reality. There are composed of concepts whose relationships are able to be depicted in a model (Smith and Liehr, 2008). These theories grow and develop with research and practice in order to provide the much needed guidance in scholarly research and everyday practice in the nursing profession (Smith and Liehr, 2008). For a long time some significant aspects of society have not been put under consideration in health care. This is especially to do with diversity of the nation. This is one of the many societal priorities that have a direct impact on the health of the nation. The continued growing in diversity and immigration in the nation are a reality that cannot be ignored. Cultural marginality is a theory advanced by Choi is a bid to increase understanding with individual experiences and the provide care that is relevant to their cultures (Choi, 2001). This health care service being offered to immigrants can only progress with mutual understanding between patients from varied cultural background and the health care providers.

This understanding can be fostered once the concept of across-culture conflict recognition is put into consideration. The concept allows for recognition of contradicting norms, cultures values, behaviors and customs. Conflict always emerges between people with different value systems which push them to compromise their positions and make difficult choices. The recognition of the concept of across culture conflict has much significance in practice and research as it allow for acknowledgment of differences in perceptions among individuals. It recognizes the varied responses and the outcomes of mental health which are directly linked to cultural marginality (Choi, 2001). Apart from the concept of across culture conflict recognition, cultural marginality incorporates other concepts including marginal living and easing cultural tension. As much as the essay will concentrate on the concept of across-culture conflict recognition, these other concepts are also important in addressing the entire theory of cultural marginality. It is a true reflection of the new society whose attitude towards immigrants is dissimilar and contradictory. There is still too much discrimination directed towards immigrants despite the promise of inclusion, tolerance and acceptance by the dominant culture.

Application to Nursing Practice

In the delivery of care it is important to put into consideration the background of the individual. In being able to understand and appreciate an individual’s unique background, it does a lot to influence how the illness is perceived by the professional. In the near future most of the US citizens will self-identify as members of varied ethnic and racial group (Jenko and Moffitt, 2006). In order to improve patient’s outcomes and increase patient’s satisfaction, practitioners are compelled to be culturally competent.

It is possible for conflicts to arise in a number of spheres. In ethics for instance there are a number of principles which are purely Western and may not apply to other ethnic and cultural communities. There are cultures whereby it is considered impolite and disrespectful to share bad news. Some like Asians consider sharing it cruel to share a cancer diagnosis. This too applies to some Europeans who see it as rather inhumane (Jenko and Moffitt, 2006). On the other hand there are Chinese practitioners who observe the ethic of cheng which involves shouldering the patient’s burden as a result of illness and also ensuring they are away from harm. It is also important for the family more so the senior members, that discussions relating to serious illnesses are shunned. In other cultures such as Bosnian, Filipino and Native American the spoken word is perceived with so much reverence. Therefore in times of sickness, the people will endeavor not to speak negatives words. It is important for practitioners to understand that most of the communities actually view sickness as a family affair. In dealing with a patient the practitioners is also indirectly dealing with the entire family.

In almost all cultures there are believes surrounding illness and death or dying. It is important for practitioners to be aware of some of these beliefs which will aid understanding and tolerance of some behavior. For instance there are communities that wear particular garments for spiritual purposes. These may include red ribbons, rosaries, sacred threads etc. Also there are a number of symbolism which accompany dying and illnesses. These cultural and symbolic meanings must be understood in the context which they are being practiced. A practitioner who has been oriented in some of the practices has an advantage compared to the uninitiated one.

It is not possible for any one practitioner to be able to learn all cultures, faith and languages. However, there are important concepts which can be learned and grasped by the practitioners within a short time span. Though death is a universal human experience still there are specific reactions from people of different cultures and faith. The important thing is that they too are human and if the practitioner shows a willingness to learn then it becomes easier for the knowledge to be impacted. The patient and also the family of the patient have certain preferences which they are willing to share if the practitioner shows care and understanding (Jenko and Moffitt, 2006).

Across-culture conflict recognition allows practitioners to perceive individual differences as they offer the much needed care and attention. The response that the nurse awards the patient is important for the recovery process. This is because already the patient faces too much discrimination in the society outside and would be glad to see a difference in health care. The first step for the nurse is to withhold from any feelings that are divisive and typical of discrimination. The client must be recognized as an individual whose recovery depends much on care and the environment in which the care is being offered. The concept is even more pronounced in mental health outcomes. The nurse must be able to engage with the client in a most conducive way, supportive and an open manner. This will guarantee a healthy relationship which is ideal for the recovery process.

In our society today nurses are confronted with a number of conflict-ridden situations (Smith and Liehr, 2008). This is opposed to the narrow and authoritarian models which outlined single minded view on caring. In the class nurses are taught to perceive ‘care’ as a single and the only proper manner in which the issue can be approached. Similarly, nursing in a number of ways has been perceived as a commodity which can be marketed. It is important to involve critical thinking not only in academic but in important decision making situations. However, the extent to which nurses can exercise this authority is limited, since there are rules and policies which govern care. This rules and policies are made by those that do not recognize nursing values. It is therefore common that health care continues to be governed by those that understand little about the whole concept of care.

Nurses need to explore how the concept of care can be carried out in the margins of nursing. In these situations the care is tested severely thus the need for constant innovation. There are scenes which the nurse has to confront requiring providence of care to those perceived as enemies or threat. There are a number of situations like these including famine and disaster, combat situations, correctional settings, care for the homeless, addicts and undocumented immigrants. Many nurses will prefer to avoid such contexts. However, in situations such as these, nurses must rise to the occasion and differentiate between ethics of care and policy. As much as the environment might be impoverished and hostile, the nurse is required not to refrain from giving care. The nurse works alone since the disciplinary values that inform her practices are not recognized by everyone. Since the environment is “non-caring” the nurse has to strategize and take an ethical stand. The fact that the nurse does not agree with everyone on fundamental values such as universal health, ethical conflicts are bound to emerge.

Care situations can only be handled once nurses are secure and have a strong internal philosophy (McEwen and Willis, 2006). They should be able to perceive differences in the world they live in. This is important to avoid the trend in which care is being commodified. The meaning of care is changing fast such that it is used to refer to managed care. This does not embrace the entire concept as viewed by the professions. In order to restore the meaning and to avoid further marginalization of the profession, nurses need to expose these differences. The recognition and understanding of the conflict between differences cultures is one way addressing the problem of care. Professionals do not conform to the dictates of the society but try as much as possible to address the conflict in a caring manner.

Due to profit motive, professionals have undertaken to support dominant groups, health of the wealthy and systems which are do not promote public health. This brings out ethical dilemmas and conflicts in values. It is beyond no doubt that everyone regardless of class, status, background or ethnicity is well deserving of care. They are a number of obstacles on the way of professionals in their bid to ensure impartiality in the awarding of care. This effort can be strengthen if professionals are given enough training which recognizes these disparities. The concept of across-culture conflict recognition is one way to help them cope with the situation.

Fit to Nursing Practice

Care is one of the fundamental concepts in nursing. In fact nursing has been perceived to be synonymous to care. This means there need to be a deeper understanding of care which addresses the individuality of a patient. In order to do this the background of the patient must be taken into account. Sometimes a patient’s illness is related to the environment or context surrounding a patient. To attend to the illness the practitioner must also deal with the background of the patient. It is here that the concept of informs nursing practice. The practitioner aims at gaining confidence and trust from the patient and family. This cannot be achieved without first understanding their cultural, ethnic or racial background.

Nurses too just like anyone else come from a society which is fragmented, politicized and full of discrimination. However, their profession requires of them to rise above the dictates and expectations of cultures, race, religion etc. In brief they have to rise above society. This is not an easy task considering the background which people grew up. The concept that recognizes this background enables the nurse to understand self better. Once the practitioner has understood own culture and appreciates it then it becomes easy to understand that of any other person. The differences do not become an obstacle but something to be understood and enjoyed. This concept brings forth the identity of the nurse in the profession. The practitioner is able to understand herself better as an individual. On the other hand it enables the nurse to celebrate cultural differences that may be encountered in the course of practice.

Cultural marginality is important for professionals in the exploration of individual experiences of the many immigrant groups and marginalized communities. It is important for the promotion of mutual respect, acceptance and tolerance among the professionals. This is achieved through a plan whereby professionals will have to promote acceptance by breaking down boundaries based on status. It is also ideal to ensure they communicate effectively and foster good relationship with those whom they are dedicated to serve.

There are nursing actions that are oppressive and the embrace of the concept can liberate professionals from such actions. For instance professions will more often seek for collaborate with others in leadership (Andersson, 1995). Since they have been made aware of the conflict in society then they will be able to see potential obstacles on the way. These can then be removed or avoided before issues start to emerge. Also instances of reality or cultural shock might be well taken good care of. The education will offer strategies that would enable professionals deal with interpersonal conflicts and violence. This further reduces the instances of isolation, stress and alienation.

The theory provides an avenue for the professionals to celebrate differences. This can be effectively employed to ensure healthcare advantage. It also opens up many opportunities in a sense that professions are not tied or specialized on some factions. Further, the nurses will be well able to enjoy their individual work. This however, does not mean to alienate an individual from the colleagues. In fact the theory will foster collective approach to issues that may seem challenging to an individual nurse.

Importance to Nursing

The nursing autonomy will continue to suffer as long as institutional influence prevails. There are situations whereby the nurse is limited in acting morally just because the institution prescribes otherwise. For instance, considering a patient that has been discharged from a hospital at 8 PM. The patient has been given prescriptions which she has to wait until the next day in order to fill, reason being closure of the only pharmacy in the locality. Despite the med chart containing medication for the patient’s evening dose, hospital policy does not allow the nurse to hand over medication. It is even less significant considering that the full medication has already been paid for by the patient. There are similar examples of meaningless policies which must be abided by nurses.

Nursing as a profession has a history of marginalization. Nurses are for instance being marginalized as female profession and also overreliance on medicine (Andersson, 1995). Similarly, the values of the nursing profession continue to be devalued, little understood and for that mater marginalized in the United States and other health contexts. The nursing profession deals on a daily basis with marginalized groups, trying to advocate and defend their interests. This has conflicted in many ways with discourses and ideas meant for profiteering in health care services, locally and internationally. Through nursing practice, narratives from marginalized communities can be collected and their voices amplified such that authorities can understand their plight. Thus is especially so in times of war or similar catastrophes whereby a certain community or group is being targeted. It is important at these circumstances that the principles and values of nursing to prevail despite the pressure from authorities. The concept of care as a universal imperative must be upheld at all times despite pressure from outsides that might not be comfortable with the whole.

The importance of awareness of cultural distinctness can not be overemphasized. In our modern society the need to understand individuals and their need is fundamental to those undertaking the nursing practice. The most apparent use of the concept is in places where one expects to meet a diverse group of people. In institutions of learning for instance it is required of the nurses to be well versed with the different ethnic and cultural backgrounds of the students. School nurses will be better able to avoid conflict if they are made aware of this disparity from the onset. Most of the behaviors of the students can be traced back home or the society in which they grew up. The nurse in attending to individual patients must be able to dig out earlier experiences of the student that are relevant to the current situation. This can only be realized if the practitioner has received sufficient training.

In this era where the United States has been involved in a number of wars and at the same time faced with the threat of terrorist attacks, it is a tricky situation for those offering health care. Just like the society seem to be biased and against certain religious groups or ethnic communities, the practitioners are expected to behave differently. It is inevitable that the society will direct hatred towards a certain racial, ethnic or religious community. These differences can be much pronounced in the society but the same should not penetrate the sphere of healthcare. In the hospitals practitioners deal with individual who need care and assistance. There is no room to compromise on the care given to a patient due to the affiliations that he or she might profess. In some cases it might be the patient that has issues with the practitioner and not the other way round. In such circumstances the practitioner must be aware way in advance how well to handle the situation without affecting the recovery process of the patient.

There are communities which are reluctant to seek healthcare due to cultural believes and practices. Some patients may perceive nurses differently or in manner suggesting distrust. In such cases if the nurse ha the knowledge of the communities then it becomes easy to address the problem. Alternatively if the practitioner fails to address the problem at least it would not affect much of the work. This is to say that the concept of cross-culture conflict recognition makes the nurse be at the top of the game. It enables the understanding of the patient in a way that even the family members will feel and welcome to be part of the healing process.

Conclusion

As many countries including the United States continue to receive immigrants from different parts of the world, it is important for practitioners to recognize conflicts that exist in society. This is to mean that the background of those seeking healthcare is vital for their treatment. The patients must be valued as individuals; their fears, customs, cultural sand ethnic background taken into account on receiving treatment. In some cases the practitioners have to deal with family members who are as important as the patient. In dealing with people’s cultures or customs practitioners must endeavor to exercise caution.

In societies such as schools where one expects people from different cultural, ethnic, religious and racial background; it is important for the nurse to be well versed with the various communities. This will help to make the work easy once the process of healing commences. There are a number of approaches which the student patient will find familiar and comfortable once used by the nurse. Also the knowledge of the cultures of the patients helps to boost confidence and morale which is vital for the healing process.

There are many ways in which communities deal with specific situations such as illness or dying. This can be manifested in a number of ways including the manner of dressing, speech or general behavior. All these must be observed keenly such that the practitioner gains the confidence of family members and the patient. It is important for the practitioner to know that in dealing with a patient he or she is directly getting involved with the family of the patient. For this matter the important of developing trust and confidence should be taken as a priority.

The concept finally promotes cooperation and interdependence among the nursing fraternity. The practitioners are well able to consult and exchange experiences. This is important as it enables them to gain more knowledge and make their career fulfilling. The individual nurse is also empowered such that it eventually becomes easy to understand and deal with a number of situations. The importance skill of multitasking, communication skills and the general practice of care giving are enhanced.