THEORY OF
TRANSCULTURAL
NURSING
Madeleine M. Leininger, PhD, RN, CTN, LHD, DS, PhDNSc, FAAN

Shelley Bonner BSN, BPsySc
Un...
Biography
• Born in Sutton, Nebraska & lived on a farm with 4 brothers and sisters.
• In 1948, graduated from St. Anthony‟...
Biography
• From 1955-58, she pursued further graduate studies and

directed the Child Psychiatric Nursing Program as Asso...
Career
• 1954 Associate Professor of Nursing at the University of Cincinnati.
• 1966-1969 Held a joint appointment in the ...
Honors
• Fellow of the American Academy of Nursing

• Distinguished Fellow of the Royal College of

Nursing, Australia
• L...
Beginnings of Theory
• In mid 1940‟s, working with med-surg patients she began to realize

how the concept of human care w...
Definitions
• Caring – action or activity towards providing care.

• Care – assist others with real or anticipated needs t...
Definitions
• Nursing – learned profession with a disciplined focus on care

phenomenon.
• Worldview – personal view of me...
Definitions
• Dr. Leininger distinguishes between emic & etic

perspectives of culture.
• Emic refers to an insider‟s view...
Transcultural Theory Concepts
• Uses culture to understand behavior.
• All cultures are not alike.
• Culture influences al...
Transcultural Theory Concepts
• She criticizes the nursing metaparadigm concepts of person,

environment, health, and nurs...
Definitions
• Apart from culture and environmental context,

ethnohistory is also meaningful when examining care
from the ...
Underlying Assumptions
• Care is the essence and central focus of nursing..
• Caring is essential for health and well-bein...
Synthesizing the assumptions
• “Care” has the greatest epistemic and ontologic explanatory

power to explain nursing.
• A ...
Primary Themes and Sunrise Model
• The concept of culture was derived from anthropology and the concept of

•
•
•

•

•

c...
Sunrise Model
Cognitive Map for nurses
– different influences that
explain care.

(Sagar, 2012)
Care Modalities
• Dr. Leininger does not use the term nursing intervention

because it communicates the ideas of cultural ...
Three Modalities
• There are three modes/modalities for guiding nursing care

judgments, decisions, or actions to provide ...
Cultural Preservation or Maintenance
• Professional actions and decisions that help people of a

particular culture to ret...
Cultural Care Accommodation or
Negotiation
• Professional actions and decisions that help people of a

designated culture ...
Cultural Care Repatterning/Restructuring
• Professional actions and decisions that help clients reorder,

change, or great...
Dr. Leininger initiated the establishment of
the:
• Committee on Nursing and Anthropology
• In 1988, the International Ass...
Clinical Case Scenario
• A 45 y/o man of Asian descent who is less than 24 hours post-

surgical exploratory laparotomy is...
Online resources to assist in
implementing cultural competence:
• University of Washington Medical Center‟s Culture Clues
...
References
• Cameron, C. & Luna, L. (2005). Leininger‟s transcultural nursing. In Fitzpatrick,

•

•

•

•

•
•

J. J. & W...
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Transcultural Nursing Powerpoint Presentation/Dr. Madeleine Leininger

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Theoretical Foundations of Nursing Practice

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  • She worked with children from culturally diverse backgrounds. This was due to the immigration after the war. She began to notice behavioral differences and questioned the cultural aspects of these differences in relation to care.
  • Leininger developed new terms for the basic tenents of her theory. The definitions of the concepts are important to understand the theory.
  • Cultural and social structural dimensions are factors related to religion, social structure, political/legal concerns, economics, educational patterns, the use of technologies, cultural values, ethnohistory and all of these factors influence cultural responses of human beings within a cultural context.
  • There are several specific assumptions inherent in this theory . They are the philosophical basis of culture Care: Diversity and Universality theory. They add meaning, depth, and clarity to the overall focus to arrive at culturally competent nursing care. Dr. Leininger expresses the importance of trust in order for the nurse to develop this kind of relationship with the individual or their family. The nurse must identify and address these factors consciously with each client in order to provide wholistic and culturally congruent care.
  • The relationship & structure between the concepts in the culture care theory is presented in the sunrise model. This model is viewed as rising sun and should be utilized as an available tool for nurses to use when conducting cultural assessments. It interconnects the concepts and forms a structure that is usable in practice and provides a systematic way to identify the beliefs, values, meanings, & behaviors of people. The dimensions of the model include technological, religious, philosophic, kinship, social, values & lifeway, political, legal, economic, & educational factors. These factors influence the environment & language which affects the overall health of the individual and if they do not feel understood may delay seeking care. Environment & language affect the overall health system which consists of the folk & professional health system. Folk health system – traditional beliefs Professional health system – learned knowledge.The combination of these systems creates the nursing profession which allows us to meet the cultural, spiritual, & physical needs of each individual. These factors help the nurse understand the client as a unique individual and not stereotype based on factors of race & ethnicity. The last dimension of the model helps nurses establish culturally congruent care through the utilization of three modalities, culture care preservation/maintenance, culture care accommodation/negotiation, or culture care repatterning/restructuring. Dr. Leininger did not
  • An example of the hispanic latino mexican cultural profile includes traditional medical practices, traditional diseases, and traditional remedies.
  • Transcultural Nursing Powerpoint Presentation/Dr. Madeleine Leininger

    1. 1. THEORY OF TRANSCULTURAL NURSING Madeleine M. Leininger, PhD, RN, CTN, LHD, DS, PhDNSc, FAAN Shelley Bonner BSN, BPsySc University of Arkansas October 7, 2013
    2. 2. Biography • Born in Sutton, Nebraska & lived on a farm with 4 brothers and sisters. • In 1948, graduated from St. Anthony‟s School of Nursing in Denver, Colorado. • In 1950, received a B. S. from Mount St. Scholastica (Benedictine College) in Atchison, Kansas. • Earned equivalent of BSN through studies in biological sciences, nursing administration, teaching & curriculum at Creighton University in Omaha, Nebraska, 1951-1954. • In 1954, M. S. N. in Psychiatric and Mental Health Nursing from the Catholic University of America in Washington, D. C. (Tomey & Alligood. 2001).
    3. 3. Biography • From 1955-58, she pursued further graduate studies and directed the Child Psychiatric Nursing Program as Associate Professor of Nursing. • 1960 pursued doctoral studies, during which she received a National League of Nursing Fellowship for fieldwork in the Eastern highlands of New Guinea. • She studied convergence and divergence of human behavior in two Gadsup villages • In 1966, was awarded a Ph. D. in cultural and social anthropology from the University of Washington, Seattle. (Florida Atlantic University, 2011 March 15)
    4. 4. Career • 1954 Associate Professor of Nursing at the University of Cincinnati. • 1966-1969 Held a joint appointment in the College of Nursing and • • • • Anthropology and directed the nurse scientist program at the University of Colorado. 1969-1974 Dean & Professor of Nursing at University of Washington, & lecturer in Dept of Anthropology. 1974-1981 Dean & Professor of Nursing, Adjunct Professor of Anthropology University of Utah. 1981-1985 Professor of Nursing, Adjunct Professor of Anthropology, & Transcultural Nursing at Wayne State University. 1995 – Adjunct Clinical Professor of Nursing at the University of Nebraska. • (Cameron & Luna, 2005)
    5. 5. Honors • Fellow of the American Academy of Nursing • Distinguished Fellow of the Royal College of Nursing, Australia • Living Legend by the American Academy of Nursing 1998 • Honorary degrees from Benedictine College, University of Indianapolis, and University of Kuopio, Finland. • (Florida Atlantic University, 2011).
    6. 6. Beginnings of Theory • In mid 1940‟s, working with med-surg patients she began to realize how the concept of human care was important in nursing. • After WWII, she worked as a clinical specialist in child mental health in a child guidance center. • Children were from culturally diverse backgrounds due to immigration • Began to notice behavioral differences and questioned the cultural aspects of these differences in relation to care.  Searched the known psychoanalytic and mental health theories  Her continued observations, questioning, and linking the concepts of human care and culture led to her establishing the theory of culture care & transcultural nursing. (Cameron, C. & Luna, L., 2005).
    7. 7. Definitions • Caring – action or activity towards providing care. • Care – assist others with real or anticipated needs to promote health & wellness. • Culture – Learned, shared, & transmitted values, beliefs, norms of a group that influences behavior. • Cultural Care – aspects of culture that influence or enable a person to deal with illness or death. • Culture care diversity & universality • Diversity – differences in meanings, values, or care of different groups of people. • Universality – common care or similarities among cultures. • (Tomey & Alligood, 2001)
    8. 8. Definitions • Nursing – learned profession with a disciplined focus on care phenomenon. • Worldview – personal view of meaning of life. • Health – state of well-being that is culturally defined and valued by the culture. (Tomey & Alligood, 2001).
    9. 9. Definitions • Dr. Leininger distinguishes between emic & etic perspectives of culture. • Emic refers to an insider‟s views and knowledge of the culture • Etic means the outsider‟s viewpoints of the culture and reflects more on the professional angles of nursing. (Cameron, C. & Luna, L., 2005).
    10. 10. Transcultural Theory Concepts • Uses culture to understand behavior. • All cultures are not alike. • Culture influences all spheres of life. It defines health, illness, and the search for relief from disease or distress. • Each person viewed as unique with differences that are respected. • Cultural Competence is important in nursing. • Cultural Competence is a combination of culturally congruent behaviors, practice attitudes, & policies that allow nurses to work effectively in cross cultural situations. • Sagar, 2012)
    11. 11. Transcultural Theory Concepts • She criticizes the nursing metaparadigm concepts of person, environment, health, and nursing. • Leininger considers nursing a discipline and a profession and the term • • • • „nursing‟ cannot explain the phenomenon of nursing. The term “person” is too limited and culture-bound to explain nursing, as the term “person” does not exist in every culture. The concept of “health” is not distinct to nursing as many disciplines use the term. Instead of “environment” Leininger uses the concept “environmental context” which includes „events with meaning‟ and „interpretations‟ given to them in particular physical, ecological and sociopolitical and or cultural settings. (Sagar, 2012)
    12. 12. Definitions • Apart from culture and environmental context, ethnohistory is also meaningful when examining care from the cultural perspective. • Ethnohistory refers to past events and experiences of individuals or groups, which explain human life ways within particular cultural contexts over short or long periods.
    13. 13. Underlying Assumptions • Care is the essence and central focus of nursing.. • Caring is essential for health and well-being, healing, growth, survival, and • • • • • • also for facing illness or death. Culture care is the broadest wholistic perspective to guide nursing care practices. Nursing‟s central purpose is to serve human beings in health, illness and if dying. There can be no curing without the giving and receiving of care. Every human culture has folk remedies, professional knowledge and professional care practices that vary. Beneficial healthy, satisfying culturally based nursing care enhances the well-being of clients. New ways of knowing are attained through the qualitative paradigm. • (Tomey & Alligood, 2001)
    14. 14. Synthesizing the assumptions • “Care” has the greatest epistemic and ontologic explanatory power to explain nursing. • A culturally competent nurse is one who: • Consciously addresses the fact that culture affects nurse-client exchanges. • Has compassion and clarity & inquires regarding cultural preferences and practices. • Incorporates client‟s personal, social, environmental, and cultural beliefs into plan of care whenever possible. • Respects cultural diversity and strives to increase knowledge and sensitivity. • (Tomey & Alligood, 2001)
    15. 15. Primary Themes and Sunrise Model • The concept of culture was derived from anthropology and the concept of • • • • • care was derived from nursing. The ultimate goal of the theory is to provide cultural congruent nursing care practices. If one fully discovers care meanings, patterns, and process, one can explain and predict health or well-being. Health and care behaviors vary among cultures, therefore nursing care cannot be determined through superficial knowledge and limited contact with a cultural group. Nursing care must be based on knowledge by examining social structure, world view, cultural values, language, and environmental contexts. This is depicted in the sunrise model. (Cameron, C. & Luna, L., 2005).
    16. 16. Sunrise Model Cognitive Map for nurses – different influences that explain care. (Sagar, 2012)
    17. 17. Care Modalities • Dr. Leininger does not use the term nursing intervention because it communicates the ideas of cultural interference and imposition practices. • She prefers the care modalities term because it has a connotation of nurse and individual working together to implement care. (Cameron, C. & Luna, L., 2005).
    18. 18. Three Modalities • There are three modes/modalities for guiding nursing care judgments, decisions, or actions to provide appropriate, beneficial and meaningful care: • Preservation and/or maintenance • Accommodation and/or negotiation • Re-patterning and/or restructuring These modes have substantively influenced nurses’ ability to provide culturally congruent nursing care and have fostered the development of culturallycompetent nurses. (Cameron, C. & Luna, L., 2005).
    19. 19. Cultural Preservation or Maintenance • Professional actions and decisions that help people of a particular culture to retain and/ or preserve relevant care values so that they can maintain their well-being, recover from illness, or face handicaps and/or death. Nurse should be non-judgmental and should not tell them that their way is wrong. (Cameron, C. & Luna, L., 2005).
    20. 20. Cultural Care Accommodation or Negotiation • Professional actions and decisions that help people of a designated culture to adapt to or to negotiate with others for beneficial or satisfying health outcomes with professional care providers. • An example would be if an individual were using a folk remedy to treat a wound. Instead of telling them it will not help, a nurse could ask “Is it working for you, or are you getting better?”. (Cameron, C. & Luna, L., 2005).
    21. 21. Cultural Care Repatterning/Restructuring • Professional actions and decisions that help clients reorder, change, or greatly modify their life ways for new, different, and beneficial health care patterns while respecting the client‟s cultural values and beliefs and still providing more beneficial or healthier life ways than before the changes were established with the clients. • The nurse could show the patient a different medicine and give them information concerning the new medicine such as it has helped her and others to heal. Explain that it will help if they use it on a regular basis and not just one time. (Cameron, C. & Luna, L., 2005).
    22. 22. Dr. Leininger initiated the establishment of the: • Committee on Nursing and Anthropology • In 1988, the International Association for Human Caring was formed • Encourages scholarly exchange of ideas. • Transcultural Nursing Society in 1974. • Brings nurses together worldwide with common and diverse interests to improve culture care for diverse groups. • Members are active in consultation, teaching, research, direct care and policy-making in national and transnational areas. • Website: www.tcns.org (Cameron & Luna, 2005, p.188)
    23. 23. Clinical Case Scenario • A 45 y/o man of Asian descent who is less than 24 hours post- surgical exploratory laparotomy is frequently asked if he is in pain. He continuously answers „no‟ though his facial expressions indicate otherwise. Upon questioning this phenomenon, it is realized that people of Asian culture do not admit to pain because it is a sign of weakness. The patient takes medication when given, but will not ask for it. Due to his cultural beliefs he is unable to express emotions relating to his level of pain because it is culturally unacceptable. The nurse would use cultural accommodation to adjust a patients plan of care to meet their specific physical needs using a visual scale to assess pain and providing pain medication as indicated.
    24. 24. Online resources to assist in implementing cultural competence: • University of Washington Medical Center‟s Culture Clues http://depts.washington.edu/pfes/CultureClues.htm • Ethnomed http://ethnomed.org/culture/hispanic-latino/mexicancultural-profile • Health Resources Service Administration (HRSA) http://www.hrsa.gov/culturalcompetence/index.html
    25. 25. References • Cameron, C. & Luna, L. (2005). Leininger‟s transcultural nursing. In Fitzpatrick, • • • • • • J. J. & Whall, A. L., Conceptual models of nursing: Analysis and application (p. 177). Upper Saddle River, NJ: Pearson Prentice Hall. Florida Atlantic University. (2011, March 15). The Madeleine M. Leininger Collection on Human Caring and Transcultural Nursing, circa 1950-. Retrieved from http://nursing.fau.edu/uploads/docs/527/Leininger_M_ARC008_GenDescr.pdf. Sagar, P. L. (2012). Madeleine Leininger Theory, In Transcultural nursing theory & models: Application in nursing education, practice, & application (pp.1-13). New York, NY: Springer Publishing Company. Tomey & Alligood. (2001). Madeleine Leininger‟s culture care: Diversity and universality theory. Understanding the Work of Nurse Theorists, (p. 94). Retrieved from http://nursing.jbpub.com/sitzman/ch15pdf.pdf Weiner, l., Mcconnell, D. G., Latella, l., & Ludi, E. (2012). Cultural and religious considerations in pediatric palliative care. Palliative Support Care. 11(1): 47-67. doi: 10.1017/S1478951511001027. YouTube. (2012, Jan.25). Madeleine Leininger Interview Part 1. Retrieved from ww.youtube.com/watch?v=4GTo_uthZQ YouTube. (2012, Jan. 25). Madeleine Leininger Interview Part 2. Retrieved from http://www.youtube.com/watch?v=6xchWCgeMM4

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