Middle Range Theory Evaluation

Theoretical and Scientific Foundations for Nursing Practice; Middle Range Theory Evaluation

Middle Range Theory Evaluation

Ingenious words articulated by the Hmong people are as follows: “when crossing a river,

remove your sandals; when crossing a border, remove your crown (Lor, Xiong, Park, Schwei, &

Jacobs, 2017, p. 408).” This proverb is inspiratory pertinent to the objectives of this author in

pursuit of nursing excellence. What wisdom may be translated from this Hmong aphorism and

found useful to the nursing discipline? The elucidation here of Hmong insight is as if they

desired to paint a picture for the conscious efforts vital to the achievement of cultural humility.

How does this relate to middle range theory?

Cultural congruency, requisite of humility, is imperative to optimal outcomes in the

nurse-patient relationship (Elminowski, 2015). The practice of humility by the nurse in settings

of diversity of culture promotes understanding and circumvention of cultural impositioning

(Isaacson, 2014). The misperception of capacity to practice cultural competency facilitates

hierarchical care, power imbalances, social injustices, and health disparities (Foronda, Baptiste,

Reindholdt, & Ousman, 2015). In the vast multicultural modern realm, continuing a remiss quest

for cultural competency gravely hinders patient care outcomes, whereas, upholding a vision of a

preferred future of universality of care exempt from bias is the pathway to nursing excellence.

Critical to this conquest is the augmentation of pertinent nursing knowledge; the evaluation of

theory is elementary to the propositioned developments. The purpose of this paper is to evaluate

the Culture Care: Diversity and Universality Theory and the Interpersonal Relations in Nursing

Theory from the context of a petition for cultural humility as the alternative to the solecism of

cultural competency.


Theory of Culture Care: Diversity and Universality


Madeleine Leininger contributed to the progression of nursing with her innovative

conceptual framework and theoretical development of cultural awareness. Leininger’s research

resulted in the birth of transcultural nursing with a focus on improvements in nurse-client

relationship outcomes when culturally congruent holistic care is present (Sitzman &

Eichelberger, 2015). Her explicit theory is one of middle range upper level with the basic tenets

offered as care being the essence of nursing as well as a direct action and cultural care and

sensitivity as the understanding and incorporation of values and beliefs of the patient to

positively influence health or illness. Further tenets presented are diversity as respect for

practices within cultures and universality as acceptable practices across cultures (McEwen &

Wills, 2014). Leininger accentuated the cultural awareness of the nurse combined with co-

participation in decision making with the client as necessary for delivery of meaningful and well-

received care (Sitzman & Eichelberger, 2015). Although implicit, she thoroughly presented the

detrimental impact of cultural impositioning to nursing.


Theory of Interpersonal Relations in Nursing


The aftereffect of order change within the discipline of nursing cultivated by Hildegard

Peplau in 1952 has had substantial impact on the nurse-client relationship (D’Antonio, Beeber,

Sills, & Naegle, 2013). Prior to Peplau, nursing was focused on what nurses did to their patients;

Peplau transformed this emphasis to what nurses did with their patients (Sitzman & Eichelberger,

2015). Peplau propositioned the core of nursing to emanate from achievement of mutualistic

relationships cognizant of individual traits of clients and self-awareness of nurses. Thus, implicit

in her model may have been the most primitive attempt to embrace cultural diversity and

encourage humility through construct of collaborative relationships in trade for authoritative.

Peplau’s theory is middle range descriptive with influences from Henry Stack Sullivan and

Abraham Maslow (McEwen & Wills, 2014).


The Theory of Culture Care:


It is the long-term ambition of this author to alter the delivery of nursing care to that

which is congruent with the process of cultural humility; courage to remove one’s crown

becomes an expectation of the healthcare professional. Perceptions of hierarchy and pretense no

longer exist in a preferred future of nursing excellence. Values, beliefs, and practices of all

patients are explored and embraced with tender of egoless tactics. Advanced practice nurses are

stellar advocates of cultural humility recognizing its exercise as not only duty but privilege.

Paternalistic behaviors are shunned practices of the past. In their shoes, respect, equality, social

justice, and elimination of health disparities walk freely.


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