untitled

residents received help from their spouses and/
or adult children. In contrast with the Anglo
American findings, African American spouses, chil-
dren, extended family members, and nonkin who
were considered family reflected the care pattern of
families helping elderly residents. Grandchildren,
great grandchildren, nieces, nephews, grandnieces,
and grandnephews, as well as church members or
friends who were considered family and were re-
ferred to as brothers, sisters, or daughters, were in-
volved in caring for African American elders. The
nursing staff recognized the importance of family
involvement in the care of residents and practiced
culture care preservation to maintain culture spe-
cific family care practices for residents from each
cultural group.
The care pattern of protection was important to
African American residents but not to Anglo
American residents. Most African American resi-
dents had left homes that were in unsafe neighbor-
hoods and had moved into the facility partly for
that reason. African American nursing staff recog-
nized the importance of protective care and often
accompanied African American residents when
they wanted to go outside. The nursing staff made
efforts to practice culture care accommodation by
negotiating to take the residents outside to sit on
the small grass strip around the perimeter of the
parking lot of the home.
McFarland (1997) also discovered that the nurs-
ing care and the lifeways of elderly residents in the
nursing home setting were less satisfying than in
the apartment setting within the retirement home
context. Professional nurses need to be more ac-
tively involved in culture care repatterning as co-
participants with elders to restructure lifeway
practices, care routines, and the environmental
context of nursing homes (including room designs
and privacy considerations). Culture care restruc-
turing of these care-related concerns can only be
accomplished when nurses assume an advocacy
role for the elderly residents and work with govern-
mental and private agencies that provide the fund-
ing and make the rules and regulations that affect
long-term care. The culture care theory, with the
ethnonursing method, assisted the researcher in
this study in the discovery of action and decision
modes that were culturally specific for Anglo and
African American elders residing in a long-term
care institution.

CULTURE CARE OF GERMAN AMERICANS

In 2000, McFarland & Zehnder (in press) con-

ducted a two-year ethnonursing study of the cul-

ture care of German American elders living in a

nursing home in a small Midwestern city in the

United States. Their findings, which confirmed

many of McFarland’s (1997) earlier findings, in-

cluded many care beliefs and practices that required

culture care preservation. German American elder

care practices included caring for fellow residents

by assisting confused residents to find their assigned

seat in the dining room or making items for the an-

nual bazaar to raise money to buy flowers for the

nursing home courtyard garden, thereby benefit-

ting all of the residents. The finding of the impor-

tant care of doing for others versus an emphasis on

self-care was previously discovered in McFarland’s

earlier study in 1997 with Anglo American and

African American elders and was confirmed in this

German American study.

German American elders received spiritual care

from the local German American church and pas-

tor. The pastor conducted a worship service and a

Bible class in German each week. Spiritual religious

care, provided by connections with the Lutheran

Church, was essential to German American elders

in maintaining their traditional lifeways and health

in the nursing home setting. This finding had also

been discovered with Anglo American elders in

McFarland’s (1997) previous study and was con-

firmed with German American elders.

McFarland is currently conducting a compara-

tive synthesis of culture care findings related to

ethnonursing studies of elder care conducted by

transcultural nurses with diverse cultures world-

wide. This will hopefully lead to the discovery of

universal and diverse care meanings, beliefs, and

practices to meet the needs of the increasing num-

bers of elders worldwide who value generic culture-

specific care to reaffirm their cultural identities in

the latter phase of their lives.

The purpose of the culture care theory (along

with the ethnonursing method) has been to

discover culture care with the goal of using

the knowledge to combine generic and

CHAPTER 20 Application of Leininger’s Theory of Culture Care Diversity and Universality 331