Conceptual framework 26 

Burns and Grove (2007:171) identified that every quantitative research needs a framework to guide the study. The conceptual framework is a brief description of a theory, including those portions of the theory that will be applied or tested in the study (Burns & Grove, 2007:171). A combination of the theory of culture care diversity and universality by Leininger and the humanistic nursing practice model by Paterson and Zderad were applied in this study as conceptual framework due to their focus on care and the influence of values on the nursing care delivered.

Leininger constructed the Theory of Culture Care Diversity and Universality, which identifies the importance of caring in nursing. His theory conceptualizes that care is the essence of nursing and is determined by culture (George, 2002:490; Tjale & De Villiers, 2004:22). This theory predicts that different culture groups identify, know and practice care in different ways, but that some similarities about care do occur amongst cultures (Leiniger, 1985b as cited by George, 2002:491). Leininger indicates the similarities between cultures as universalities and the differences between cultures as diversities (George, 2002:491).

This theory by Leininger conceptualizes that seven cultural and social structure dimensions have a great influence on the care delivered (Tjale & De Villiers, 2004:22). These cultural and

social structure dimensions includes technological factors, religious and philosophical factors, kinship and social factors, political and legal factors, economic factors, educational factors and cultural values and way of life (Tjale & De Villiers, 2004:22). Culture is perceived by Leininger as “learned, shared, and transmitted knowledge of values, beliefs, norms and life ways of a particular group that guides an individual or group in their thinking, decisions, and actions in patterned ways” (Leininger, 1995, as cited by George, 2002: 491).

According to this theory humans are caring beings that are guided by cultural core values, beliefs and practices of the specific culture which function as basis for nursing care (George, 2002:494). Leininger places importance on the values of the nurse as an important part of determining the care delivered in the practice of nursing. This theory establishes that values, beliefs and norms are shaped by the “world view, language, religion, social, political, educational, economical, technological, ethnohistorical and environmental context” of the group. (George, 2002: 491, Tjale & De Villiers, 2004: 22).

Similar to Leininger, the theorists Paterson and Zderad theorized that values play a fundamental role in the level of care delivered in nursing. Paterson and Zderad conceptualize the humanistic nursing practice model which was developed from the experiences of both nurses and patients focusing on the influence of the concept of relationships in nursing (George, 2002:386). The humanistic nursing theory emphasizes that nursing is focused on a nurturing response of the nurse to a client in time of need and is directed towards the development of well-being of the client (George, 2002:387). This theory focuses on the aspect that in delivering this nurturing care the nurses need to know their values, biases, myths and expectations that contribute to the level of nursing they deliver (George, 2002: 386).

Humanistic nursing focuses on the dialogue, community and phenomenological science of nursing (George, 2002: 558). Dialogue is characterized by the interaction between humans, the meeting of people, relations between humans and sharing between individuals (George, 2002: 558). In a community there is a collaborative feeling of belonging (George, 2002:558). Phenomenologic nursology is the preparation of nurses to know each other, having an intuitive response to each other, learning about individuals through science, synthesizing information through using information already known about the individual, and development of a personal and general truth (George, 2002:558). This highlights the focus of humanistic nursing that identifies that nursing occurs in the context of relationship (George, 2002:387). All of these happen in a nurturing environment, by being open and caring (George, 2002:391).

There is a focus by both the theory of culture care diversity and universality, and the humanistic nursing practice model on the care delivered by nurses, thus coinciding with the definition of nursing in South Africa viewing nursing as a caring profession (Act No. 33 of 2005). With Leininger identifying the important role of caring in nursing and conceptualizing that care is the essence of nursing and the humanistic nursing theory emphasizing that nursing is focused on a nurturing response of the nurse to a client in time of need; as combination this formulates the essence of what nursing care in South Africa encompasses. The definition of nursing in South Africa emphasizes the necessity of nurses that “care for and treat a health care user to achieve or maintain health and where this is not possible, care for a health care user so that he or she lives comfortably and with dignity until death" (Act No. 33 of 2005).This sentiment is supported by the humanistic nursing practice model.

The focus of this study is directed by Leininger arguing that values, beliefs and norms are shaped by the “world view, language, religion, social, political, educational, economical, technological, ethnohistorical and environmental context” of the group (George, 2002:491, Tjale & De Villiers, 2004:22). With the humanistic nursing practice model indicating the importance of the nurses’ knowledge of their values, biases, myths and expectations and the strong direction thereof towards the human interaction which is an important part of nursing practice, it guides this study’s focus on the human interaction by nurses (George, 2002:386).