1. Nursing Faculty Care Expressions, Patterns, and Practices Related to Teaching Culture Care
Open with how I started this dissertation idea….
Working with student diversity to address diversity in the nursing workforce AND teaching transcultural nursing. Noticed that one cannot make progress with culturally diverse nursing students and the workforce if not taught culture care. I predicted /thought that Creating a culture (environmental context) and learning to valuing similarities and differences is essential for successfully addressing diversity in the workforce AND teaching culture care…
Sandra J. Mixer, PhD, RN
Assistant Professor of Nursing
The University of Tennessee-Knoxville
SNRS 2009

2. Purpose and Goal
Purpose is to discover, describe, and systematically analyze the care expressions, patterns, and practices of nursing faculty related to teaching culture care
Goal is to discover faculty care that facilitates teaching students learning how to provide culturally congruent nursing care

3. Domain of Inquiry
Nursing faculty care expressions, patterns, and practices related to teaching culture care within the environmental context of baccalaureate nursing programs in urban and rural universities in the Southeastern United States
Study context was NURSING FACULTY
Environmental context: BSN
URBAN & RURAL
SE United States

4. Method
Grounded in culture care theory and ethnonursing qualitative research method
Purposive sampling – 27 nursing faculty
Leininger’s ethnonursing data analysis and qualitative criteria
Open-ended interviews until saturation
Informants confirmed themes & patterns
27 nursing faculty: tenured/tenure-track and clinical track. Representing urban and rural contexts

5. Leininger’s Sunrise Enabler to Discover Culture Care
Cultural & Social Structure Dimensions
Cultural Values, Beliefs & Lifeways
Influences
Care Expressions Patterns & Practices
Holistic Health / Illness / Death
Focus: Individuals, Families, Groups, Communities or Institutions in Diverse Life Contexts of
Generic (Folk)
Care
Nursing Care Practices
Professional Care–Cure Practices
Transcultural Care Decisions & Actions
Culture Care Preservation/Maintenance
Culture Care Accommodation/Negotiation Culture Care Repatterning/Restructuring
Religious & Philosophical Factors
Technological Factors
Economic Factors
Educational Factors
Environmental Context, Language & Ethnohistory
Worldview
Kinship & Social Factors
Political & Legal Factors
© M. Leininger 2004
Leininger’s Sunrise Enabler to Discover Culture Care
Sunrise Enabler cognitive map of the theory - Depicts an integrated holistic view of the influencing dimensions and major concepts of the theory –.
The CC Theory provides a holistic means to understand the range of factors that influence nursing faculty teaching culture care.
Theory traditionally used to look at different patient cultural groups, I’ve used it to look at nursing education and specifically how faculty teach culture.
Culturally Congruent Care for Health, Well-being or Dying

6. Leininger’s 4 phases of ethnonursing analysis for qualitative data:
Data Analysis
Leininger’s 4 phases of ethnonursing analysis for qualitative data:
Collecting, describing, and documenting raw data
Identification and categorization of descriptors and components
Pattern and contextual analysis
Major themes, research findings, theoretical formulations, and recommendations
Ethnonursing method Developed by Leininger to study transcultural human care phenomena using the CCT
Importance of people as knowers about human care and professional nurses’ way of knowing
These phases while Similar to other qualitative methods, are specific to the ethnonursing research method
(FYI) During the first phase, data analysis began on the initial day of research and continued throughout the study. Informants’ interviews were transcribed in Microsoft word and excel. The researcher was fully immersed in the data and personally transcribed most of the audio recordings. Listening to informant voices and expressions brought forth important contextual data, passion, tone, and emphasis of data.
In the second phase of ethnonursing qualitative analysis, data was studied for similarities and differences and meanings were sought from recurrent components in the data. In the third phase, patterns and ideas related to teaching culture care were identified. The fourth phase involved synthesis and interpretation of data, abstracting themes from the findings. Finally, themes confirmed were used to identify nursing decisions and actions in teaching culture care. As data was analyzed, informants were contacted for additional data and clarification. Informants confirmed findings related to themes and patterns and provided valuable feedback about the accuracy of discoveries made. In all phases of analysis, findings were traced back to the raw data which was essential for an audit trail and to meet the five qualitative criteria for ethnonursing studies; credibility, confirmability, meaning-in-context, recurrent patterning, and saturation (Leininger, 2006a).

7. Data Analysis
Ethnonursing Qualitative Criteria of credibility, confirmability, meaning-in-context, recurrent patterning, saturation, and transferability
Research mentor – expert in theory and method
Faculty were interviewed until saturation occurred.
Since informants were faculty; directly ed patterns and themes. Excited to receive their confirmation. Congruent with the method.
Mentor facilitated theory guiding the study from beginning to end.

8. Ethnodemographic Data
Age range: 25-71
Ethnicity: 26% Black 74% Caucasian
Teaching experience: new - 40 years
Nursing experience: years
11/27 doctoral degrees (2 in nursing)
All limited transcultural nursing education
“Black” term faculty used to describe themselves

9. Major Research Findings
Theme I
Faculty care is embedded in Christian religious values, beliefs, and practices within the context of the southern United States
Strong beliefs enhance faculty ability to care for students and pts/families with similar and diverse religious backgrounds
Intentional about teaching students to avoid cultural imposition

10. Described faith was integral to their being and basis of caring/teaching culture care
“absolutely influences every aspect of my life… God the Father, Jesus the Son, and Holy Spirit the comforter…to do what I do every day”
“I recognize we all have weaknesses and we all have forgiveness that we must ask for. The whole Christian belief. And through that I see acceptance more because as you know in nursing we see a lot, hear a lot and you see people sometimes during their best and sometimes during their worst parts of their life. And there are times you see a lot of weaknesses in human kind as well as strengths and just recognition of all that. And that’s why I try to take each person as an individual and where they’re at now and try not to judge.”
Influence of faith on teaching;
(Share with 1st quote) One faculty described that she comes into her teaching un-biased, “even though God is the center of my world, all students may not have similar beliefs.” She gives them the chance to explore their spirituality “whatever that might be; from whence their energy comes.”
(Share with 2nd quote) Shared this sense of grace with her students as she assisted them to examine their values and beliefs toward the patients and families they cared for.

11. Taught students to be respectful in attending to religious/spiritual care. Nonjudgmental.
“Students are very spiritual when they come to us…Religiosity is big in their lives and it takes a while for students to understand that they don’t have to embrace the culture or religion of the patient, yet certainly must talk to them on their journey.”
“treat every patient the same, no matter how they got to be in our care and whether we agree with their lifestyle or habits.” She further articulated, “You can’t let personal feelings get into your nursing. You just can’t.”

12. Major Research Findings
Theme II
Faculty taught students culture care without an organizing conceptual framework and with differences among classroom, on-line, and clinical contexts
Faculty explicitly taught culture care in clinical contexts through modeling
Focused heavily on rich experiences and less so on scholarly work in TCN
Assigned culturally diverse patients and families AND in both urban and rural contexts
Teaching students to treat all people with respect and to address individual needs: “I’m hoping it is my example more than me telling them what to do”

13. Major Research Findings
Theme III
Faculty provided generic and professional care to nursing students to maintain and promote healthy and beneficial lifeways
Respect for students
Mentoring
Surveillance care
Respect for similarities and differences
Faculty were mentored and in turn valued mentoring their students
Surveillance care:
“listening” (including the online environment)
“checking in” with students in class, via , discussion board
being “approachable” – socializing/visiting with students.

14. Major Research Findings
Theme IV
Care is essential for faculty health and well-being to teach culture care within the environmental context of the school of nursing / university

15. Theme IV - Patterns IVA Caring as leadership Collective caring
Respect – Love, forgiveness, and valuing family
Balance tripartite faculty role
Reciprocal caring
Faculty mentoring of one another (co-mentoring)
Each faculty member contributes to creating a health community
Caring for oneself to be enabled to care about others
Leadership was personal leadership as well as formal/administrative leadership
Respect “we all have a unique contribution and all respect each other”
Love & Forgiveness – needed to work out conflict and move forward
Balancing tripartite role – laughed out loud
Mentoring had a significant impact on faculty lives throughout their careers
Sleep, nutrition, exercise -> role modeling to students

16. Theme IV - Patterns IVB Noncare was expressed as cultural conflict
Lack of leadership support
Impact of meeting faculty tripartite role on health
Tenure process
Not assisting new faculty
Collegial conflict
Overt and covert racism
Racism was expressed by both white and black faculty - Among one another white-black/black-white; black-black; and white-white

17. Leininger’s Sunrise Enabler to Discover Culture Care
Worldview
Cultural & Social Structure Dimensions
Cultural Values, Beliefs & Lifeways
Kinship & Social Factors
Political & Legal Factors
Environmental Context, Language & Ethnohistory
Religious & Philosophical Factors
Economic Factors
Influences
Care Expressions Patterns & Practices
Educational Factors
Technological Factors
Holistic Health / Illness / Death
Focus: Individuals, Families, Groups, Communities or Institutions in Diverse Life Contexts of
Generic (Folk)
Care
Nursing Care Practices
Professional Care–Cure Practices
The modes are the way we use this data….As teachers how is this useful to us in the real world?
Transcultural Care Decisions & Actions
Culture Care Preservation/Maintenance
Culture Care Accommodation/Negotiation Culture Care Repatterning/Restructuring
Culture Care Preservation/Maintenance
Culture Care Accommodation/Negotiation
Culture Care Repatterning/Restructuring
Culturally Congruent Care for Health, Well-being or Dying
© M. Leininger 2004

18. Culture Care Preservation/Maintenance
Maintain efforts to assist students to care for culturally diverse clients in the clinical setting
Preserve faculty collective/reciprocal care for students and one another
Faculty value teaching culture care and are doing so in the clinical setting

19. Culture Care Accommodation/Negotiation
Negotiate integrating culture care content into established nursing courses throughout the curriculum
Introduce required and elective courses on culture care
Negotiate for culturally congruent strategies to promote healthy faculty lifeways
Assistance and support for balancing the faculty tripartite role
INTENTIONALLY integrated

20. Culture Care Repatterning/Restructuring
Use an organizing framework for teaching culture care
I recommend the culture care theory – holistic, universalities and diversities (sim/diff)

21. Care Constructs
Five Decades TCN research – discovery of 175 Care Constructs from 58 cultures
Care Constructs further substantiated in this study:
RESPECT
Praying with
Listening
Reciprocal care
Collective care
Surveillance care
Over five decades of transcultural nursing research using the ethnonursing research method has led to the discovery of 175 care constructs from 58 cultures (Leininger, 2006_).
These care constructs contribute to nurses understanding the meaning of care to people. Further study of care constructs facilitates discovering the epistemic roots of caring and health phenomena (Leininger, 2006-chpt 10).
Care constructs discovered/listed by Leininger and further substantiated in this study.
Faculty identified RESPECT as essential in teaching and modeling culturally congruent care.
Leininger, 2006

22. New Care Construct Discovered
Mentoring / Co-mentoring
Mentoring/co-mentoring – caring sustained over a period of time and involved faculty members making a significant impact on one another’s professional career.
Faculty identified as essential in teaching and modeling culturally congruent care.

23. New Care Construct Discovered
Christian Care
Informants described that within the context of their expressed Christian values and beliefs:
the need to love and accept persons where they are at and facilitate movement forward.
Not judge one another and forgive one another without knowing or understanding another’s circumstances.
Although related to spiritual care, Christian care is a distinct care construct because informants described it as being specifically related to and evolving from their Christian values and beliefs which were taught from childhood.
Faculty identified as essential in teaching and modeling culturally congruent care.

24. Nursing Implications
Despite 50 years of TCN knowledge development through theory, research, and practice; there remains a lack of formal, integrated culture education in nursing
The need to prepare a culturally competent workforce – challenge if faculty are not formally prepared in transcultural nursing
Findings Congruent with the literature
FYI:
Only 8/27 = 30% of ALL informants had had ANY TCN education. And for KEY Informants – the tenured faculty usually most responsible for influencing curricular decisions only 2/10 (20%)
2/5 Urban and NO rural informants received any TCN education or workshop
Scholarship…. Role modeling and experience is honoring generic care.

25. Significance of the Study
Further substantiated Leininger’s work
Contributed to Practice of Nursing – understanding complex nature of teaching culture care
Contributed to Discipline of Nursing – building the body of transcultural nursing education knowledge

26. Future Study Extending dissertation research
Interview - how you teach nursing students about caring and culture
If you would like to be a participant, contact:
Dr. Sandy Mixer
extends previous research conducted with faculty in baccalaureate programs representing a small area of the southeastern United States (Mixer, 2008). This research seeks to broaden the participant pool and environmental context (e.g. diversity of faculty; geographic location; baccalaureate and graduate programs; private as well as public universities) to further explicate data essential to nursing faculty as they prepare a culturally competent workforce.