An Overview of Theoretical Works in Transcultural Nursing
From the early stage of transcultural nursing, theories have been an essential part of transcultural nursing. Under heavy influences of anthropology and psychology, theorists began to determine the theoretical basis of transcultural nursing and to define culture and nursing care, nursing environments, nursing intervention, and nurses' roles [10, 11, 12, 13, 14]. As mentioned previously, the central concepts in transcultural nursing were culture, nursing, and environment.
During the time, several theories related to culture have been adopted from other disciplines and used in nursing with some modifications and refinements of the major and subconcepts of existing theories from other disciplines. During the 1950s, 1960s, and early 1970s, several theorists have developed theories that could uniquely explain the concepts related to transcultural nursing to provide an independent conceptual framework for nursing education, practice, and research in transcultural nursing [10, 12, 20].
During the late 1960s and 1970s, when metatheoretical discussions were made by nursing theorists [11, 16], grand theories including transcultural nursing theories were criticized for their lack of explicated propositions and empirical testing [21]. Then, in the mid 1970 to the 1980s, theorists began to discuss the necessity of substantive theories in nursing and began to discuss the central concepts in nursing [16]. From the 1980s and 2000s, all concept analysis and concept development methods were suggested and used [22]. During these periods, nursing scholars in transcultural nursing also focused on their theoretical works on concept analyses and concept development of central concepts related to transcultural nursing [23, 24, 25, 26, 27, 28, 29].
From the 1990s, two new types of nursing theories were introduced: middle-range theories and situation-specific theories [17]. With the emerging middle-range theories in nursing in general, several middle-range theories related to transcultural nursing were proposed [16, 30]. Also, a number of situation-specific theories related to transcultural nursing were proposed during the same period [31, 32, 33, 34, 35, 36, 37, 38].
In recent years, with drastic advances in nursing research, transcultural nursing scholars began to search for the theoretical bases that could be easily operationalized into research in transcultural nursing as in nursing in general [17]. At the same time, with globalization and advances in nursing practice, transcultural nursing also needs to find the theoretical bases that could be easily translated into transcultural nursing practice. In the current stage of nursing theories that is characterized as “diversity in thought” [39], an increasing number of theories are suggested in many different areas in nursing, including acute care, oncology, women's health, pediatric, occupation health, community health, and so forth. [40, 41]. However, there has been no exploration on the current trends in theoretical works related to transcultural nursing in recent years.
Discussion
This integrated literature review provided an overview of the current trends in theoretical works related to transcultural nursing. The theoretical works related to transcultural nursing obviously had purposes of exploring, defining and clarifying, and reflecting nursing phenomenon related to transcultural nursing. The theorizing process of the theoretical work related to transcultural nursing also involved various theorizing methods and multiple sources for theorizing. The theoretical works clearly provided implications for future research and practice.
These trends in the theoretical works in transcultural nursing are consistent with those observed in nursing theories in general [70]. Im and Chang (2012) indicated that the current theoretical works in nursing tended to develop and refine specific concepts, develop middle-range theories that focused on specific concepts, and develop instruments to specifically target individual concepts of theories and connect theories to specific areas of nursing practice. They also indicated the coexistence of all types of theoretical works, the close linkages to nursing research, and international collaborative efforts made for the development of the theoretical works. In general, the findings of this review agree with the previously reported trends in nursing theories in general. However, the interpretation of these findings needs to be carefully made because only the articles published in refereed journals during the last 10 years were reviewed. Subsequently, theoretical works that have been published in the forms other than refereed journal articles were missing in this review/analysis. Also, as noted, the criteria for the review were limited to the components of theorizing suggested by Im (2005).
This article suggests the following implications for future theoretical development in transcultural nursing based on the findings of the review/analysis. First of all, the theoretical works in transcultural nursing need to continuously aim at multiple purposes as noted in this review. Nursing phenomena in transcultural nursing are evolving with advances in technologies, transportation, and communication. Subsequently, many nursing phenomena that were taken for granted have changed by time and place as well as by culture. Thus, the theoretical works in transcultural nursing need to reflect these changes by exploring, defining and clarifying, and adequately reflecting the changing phenomena.
Second, as noted previously, only few articles clearly described the level of theory/model/concept that was presented in the articles. Only the articles that presented theories from grounded theory approaches or the findings from concept analyses clearly described the methods used for theorizing in their works. Among 68 articles that were reviewed, more than a half of the articles did not provide information on the methods used for their theorizing process. Most of the 21 articles actually presented a theory/model/concept that was developed using a concept analysis or grounded theory approach. For future theoretical works related to transcultural nursing, the methods used for theorizing need to be specified and described in detail to provide a concrete ground for the theoretical works.
Third, most of the theories/models/concepts presented in the reviewed articles were developed from a single source of secondary data, such as a literature review. For a comprehensive and balanced understanding of nursing phenomena, the use of multiple sources for theorizing has been highly recommended [71]. Only two articles in this review indicated the use of two sources for theorizing [54, 68]. Moreover, the theoretical works that were developed based on literature reviews tend to use a wide range of numbers of articles in their analysis and synthesis; some even did not report the number of articles that they reviewed. Also, the inclusion and exclusion criteria for selection of articles were rarely reported. For future theoretical works in transcultural nursing, multiple sources of theorizing need to be used while providing further details on the sources of theorizing.
Finally, the trials to link the theoretical works in transcultural nursing to nursing practice and research need to be continued. As mentioned, with changes in nursing phenomena involved in transcultural nursing, the theoretical works need to provide directions for nursing practice and research that appropriately and adequately reflect the changes in nursing phenomena. Subsequently, the efforts to link the theoretical works to nursing practice and research as well as those to link the changes in nursing phenomenon to the theoretical works need to be continued.
Conclusion
This integrated literature review explored the current trends in theoretical works related to transcultural nursing published in the past 10 years. The findings suggest that the trends were generally consistent with the previously reported trends in nursing theories in general. The theoretical works related to transcultural nursing clearly defined the purposes of theorizing; used various theorizing methods; used different theorizing sources, mostly secondary data; and clearly explained the linkages to nursing practice, research, hospital policy, health organizations, and education. Based on the findings, four implications for future theoretical development in transcultural nursing were suggested: (a) the need to continuously aim at multiple purposes of theorizing, (b) the need to clearly describe the level of theory/model/concept in the study, (c) the need to use multiple sources for theorizing, and (d) the need to continuously describe the linkage of theoretical works to nursing practice and research.
Considering its definition and history, transcultural nursing has always been on the front line of dealing with global changes in nursing phenomena. Transcultural nursing is “a specialty created to answer the need for developing a global perspective in the practice of nursing in a world of interdependent nations and people.” [72]Efforts must be continuously made to further develop the theoretical works related to transcultural nursing to reflect the changes in this ever-evolving nursing world and to provide culturally sensitive and competent nursing care.
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