Madeleine Leininger’s Transcultural Nursing Theory

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The Transcultural Nursing Theory or Culture Care Theory by Madeleine Leininger involves knowing and understanding different cultures with respect to nursing and health-illness caring practices, beliefs and values with the goal to provide meaningful and efficacious nursing care services to people according to their cultural values and health-illness context.

It focuses on the fact that different cultures have different caring behaviors and different health and illness values, beliefs, and patterns of behaviors.

The cultural care worldview flows into knowledge about individuals, families, groups, communities, and institutions in diverse health care systems. This knowledge provides culturally specific meanings and expressions in relation to care and health. The next focus is on the generic or folk system, professional care system(s), and nursing care. Information about these systems includes the characteristics and the specific care features of each. This information allows for the identification of similarities and differences or cultural care universality and cultural care diversity.

Next are nursing care decisions and actions which involve cultural care preservation/maintenance, cultural care accommodation/negotiation and cultural care re-patterning or restructuring. It is here that nursing care is delivered.

Description

In 1995, Leininger defined transcultural nursing as “a substantive area of study and practice focused on comparative cultural care (caring) values, beliefs, and practices of individuals or groups of similar or different cultures with the goal of providing culture-specific and universal nursing care practices in promoting health or well-being or to help people to face unfavorable human conditions, illness, or death in culturally meaningful ways.”

The Transcultural Nursing Theory first appeared in Leininger’s Culture Care Diversity and Universality, published in 1991, but it was developed in the 1950s. The theory was further developed in her book Transcultural Nursing, which was published in 1995. In the third edition of Transcultural Nursing, published in 2002, the theory-based research and the application of the Transcultural theory are explained.

Major Concepts

Transcultural Nursing

Transcultural nursing is defined as a learned subfield or branch of nursing which focuses upon the comparative study and analysis of cultures with respect to nursing and health-illness caring practices, beliefs, and values with the goal to provide meaningful and efficacious nursing care services to people according to their cultural values and health-illness context.

Ethnonursing

This is the study of nursing care beliefs, values, and practices as cognitively perceived and known by a designated culture through their direct experience, beliefs, and value system (Leininger, 1979).

Nursing

Nursing is defined as a learned humanistic and scientific profession and discipline which is focused on human care phenomena and activities in order to assist, support, facilitate, or enable individuals or groups to maintain or regain their well-being (or health) in culturally meaningful and beneficial ways, or to help people face handicaps or death.

Professional Nursing Care (Caring)

Professional nursing care (caring) is defined as formal and cognitively learned professional care knowledge and practice skills obtained through educational institutions that are used to provide assistive, supportive, enabling, or facilitative acts to or for another individual or group in order to improve a human health condition (or well-being), disability, lifeway, or to work with dying clients.

Cultural Congruent (Nursing) Care

Cultural congruent (nursing) care is defined as those cognitively based assistive, supportive, facilitative, or enabling acts or decisions that are tailor-made to fit with individual, group, or institutional cultural values, beliefs, and lifeways in order to provide or support meaningful, beneficial, and satisfying health care, or well-being services.

Health

It is a state of well-being that is culturally defined, valued, and practiced, and which reflects the ability of individuals (or groups) to perform their daily role activities in culturally expressed, beneficial, and patterned lifeways.

Human Beings

Such are believed to be caring and to be capable of being concerned about the needs, well-being, and survival of others. Leininger also indicates that nursing as a caring science should focus beyond traditional nurse-patient interactions and dyads to include families, groups, communities, total cultures, and institutions.

Society and Environment

These terms are not defined by Leininger; she speaks instead of worldview, social structure, and environmental context.

Worldview

Worldview is the way in which people look at the world, or at the universe, and form a “picture or value stance” about the world and their lives.

Cultural and Social Structure Dimensions

Cultural and social structure dimensions are defined as involving the dynamic patterns and features of interrelated structural and organizational factors of a particular culture (subculture or society) which includes religious, kinship (social), political (and legal), economic, educational, technological and cultural values, ethnohistorical factors, and how these factors may be interrelated and function to influence human behavior in different environmental contexts.

Environmental Context

Environmental context is the totality of an event, situation, or particular experience that gives meaning to human expressions, interpretations, and social interactions in particular physical, ecological, sociopolitical and/or cultural settings.

Culture

Culture is the learned, shared and transmitted values, beliefs, norms, and lifeways of a particular group that guides their thinking, decisions, and actions in patterned ways.

Culture Care

Culture care is defined as the subjectively and objectively learned and transmitted values, beliefs, and patterned lifeways that assist, support, facilitate, or enable another individual or group to maintain their well-being, health, improve their human condition and lifeway, or to deal with illness, handicaps or death.

Culture Care Diversity

Culture care diversity indicates the variabilities and/or differences in meanings, patterns, values, lifeways, or symbols of care within or between collectives that are related to assistive, supportive, or enabling human care expressions.

Culture Care Universality

Culture care universality indicates the common, similar, or dominant uniform care meanings, pattern, values, lifeways or symbols that are manifest among many cultures and reflect assistive, supportive, facilitative, or enabling ways to help people. (Leininger, 1991)

Subconcepts

Generic (Folk or Lay) Care Systems

Generic (folk or lay) care systems are culturally learned and transmitted, indigenous (or traditional), folk (home-based) knowledge and skills used to provide assistive, supportive, enabling, or facilitative acts toward or for another individual, group, or institution with evident or anticipated needs to ameliorate or improve a human life way, health condition (or well-being), or to deal with handicaps and death situations.

Emic

Knowledge gained from direct experience or directly from those who have experienced. It is generic or folk knowledge.

Professional Care Systems

Professional care systems are defined as formally taught, learned, and transmitted professional care, health, illness, wellness, and related knowledge and practice skills that prevail in professional institutions usually with multidisciplinary personnel to serve consumers.

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Etic

Knowledge which describes the professional perspective. It is professional care knowledge.

Ethnohistory

Ethnohistory includes those past facts, events, instances, experiences of individuals, groups, cultures, and instructions that are primarily people-centered (ethno) and which describe, explain, and interpret human lifeways within particular cultural contexts and over short or long periods of time.

Care

Care as a noun is defined as those abstract and concrete phenomena related to assisting, supporting, or enabling experiences or behaviors toward or for others with evident or anticipated needs to ameliorate or improve a human condition or lifeway.

Care

Care as a verb is defined as actions and activities directed toward assisting, supporting, or enabling another individual or group with evident or anticipated needs to ameliorate or improve a human condition or lifeway or to face death.

Culture Shock

Culture shock may result when an outsider attempts to comprehend or adapt effectively to a different cultural group. The outsider is likely to experience feelings of discomfort and helplessness and some degree of disorientation because of the differences in cultural values, beliefs, and practices. Culture shock may lead to anger and can be reduced by seeking knowledge of the culture before encountering that culture.

Cultural Imposition

Cultural imposition refers to efforts of the outsider, both subtle and not so subtle, to impose his or her own cultural values, beliefs, behaviors upon an individual, family, or group from another culture. (Leininger, 1978)

Leininger’s Sunrise Model

The Sunrise Model is relevant because it enables nurses to develop critical and complex thoughts towards nursing practice. These thoughts should consider, and integrate, cultural and social structure dimensions in each specific context, besides the biological and psychological aspects involved in nursing care.

Madeleine Leininger's Sunrise Model
Madeleine Leininger‘s Sunrise Model. Click to enlarge.

The cultural care worldview flows into knowledge about individuals, families, groups, communities, and institutions in diverse health care systems. This knowledge provides culturally specific meanings and expressions in relation to care and health. The next focus is on the generic or folk system, professional care systems, and nursing care. Information about these systems includes the characteristics and the specific care features of each. This information allows for the identification of similarities and differences or cultural care universality and cultural care diversity.

Next are nursing care decisions and actions which involve cultural care preservation or maintenance, cultural care accommodation or negotiation and cultural care repatterning or restructuring. It is here that nursing care is delivered.

Three modes of nursing care decisions and actions

1. Cultural care preservation or Maintenance

Cultural care preservation is also known as maintenance and includes those assistive, supporting, facilitative, or enabling 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.

2. Cultural care accommodation or Negotiation

Cultural care accommodation also known as negotiation, includes those assistive, supportive, facilitative, or enabling creative professional actions and decisions that help people of a designated culture to adapt to or negotiate with others for a beneficial or satisfying health outcome with professional care providers.

3. Culture care repatterning or Restructuring

Culture care repatterning or restructuring includes those assistive, supporting, facilitative, or enabling professional actions and decisions that help a clients reorder, change, or greatly modify their lifeways for new, different, and beneficial health care pattern while respecting the clients cultural values and beliefs and still providing a beneficial or healthier lifeway than before the changes were coestablished with the clients. (Leininger, 1991)

Assumptions

  • Different cultures perceive, know, and practice care in different ways, yet there are some commonalities about care among all cultures of the world.
  • Values, beliefs, and practices for culturally related care are shaped by, and often embedded in, “the worldview, language, religious (or spiritual), kinship (social), political (or legal), educational, economic, technological, ethnohistorical, and environmental context of the culture.
  • While human care is universal across cultures, caring may be demonstrated through diverse expressions, actions, patterns, lifestyles, and meanings.
  • Cultural care is the broadest holistic means to know, explain, interpret, and predict nursing care phenomena to guide nursing care practices.
  • All cultures have generic or folk health care practices, that professional practices vary across cultures, and that in any culture there will be cultural similarities and differences between the care-receivers (generic) and the professional caregivers.
  • Care is distinct, dominant, unifying and central focus of nursing, and, while curing and healing cannot occur effectively without care, care may occur without cure.
  • Care and caring are essential for the survival of humans, as well as for their growth, health, well-being, healing, and ability to deal with handicaps and death.
  • Nursing, as a transcultural care discipline and profession, has a central purpose to serve human beings in all areas of the world; that when culturally based nursing care is beneficial and healthy it contributes to the well-being of the client(s) – whether individuals, groups, families, communities, or institutions – as they function within the context of their environments
  • Nursing care will be culturally congruent or beneficial only when the clients are known by the nurse and the clients’ patterns, expressions, and cultural values are used in appropriate and meaningful ways by the nurse with the clients.
  • If clients receive nursing care that is not at least reasonably culturally congruent (that is, compatible with and respectful of the clients’ lifeways, belief, and values), the client will demonstrate signs of stress, noncompliance, cultural conflicts, and/or ethical or moral concerns.

Analysis

It was stated that the nurse will help the client move towards amelioration or improvement of their health practice or condition. This statement would be of great difficulty for the nurse because instilling new ideas in a different culture might present an intrusive intent for the “insiders”. Culture is a strong set of practices developed over generations which would make it difficult to penetrate.

The whole activity of immersing yourself within a different culture is time-consuming for you to fully understand their beliefs and practices. Another is that it would be costly in the part of the nurse.

Because of its financial constraints and unclear ways of being financially compensated, it can be the reason why nurses do not engage much with this kind of nursing approach.

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Because of the intrusive nature, resistance from the “insiders” might impose a risk to the safety of the nurse especially for cultures with highly taboo practices.

It is highly commendable that Leininger was able to formulate a theory which is specified to a multicultural aspect of care. On the other side, too much was given to the culture concept per se that Leininger failed to comprehensively discuss the functions or roles of nurses. It was not stated on how to assist, support or enable the client to attuning them to an improved lifeway.

Strengths

  • Leininger has developed the Sunrise Model in a logical order to demonstrate the interrelationships of the concepts in her theory of Culture Care Diversity and Universality.
  • Leininger’s theory is essentially parsimonious in that the necessary concepts are incorporated in such a manner that the theory and its model can be applied in many different settings.
  • It is highly generalizable. The concepts and relationships that are presented are at a level of abstraction which allows them to be applied in many different situations.
  • Though not simple in terms, it can be easily understood upon the first contact.

Weakness

  • The theory and model are not simple in terms.

Conclusion

According to transcultural nursing, the goal of nursing care is to provide care congruent with cultural values, beliefs, and practices.

Cultural knowledge plays a very important role for nurses on how to deal with the patients. To start off, it helps nurses to be aware of the ways in which the patient’s culture and faith system provide resources for their experiences with illness, suffering, and even death. It helps nurses to be understanding and respectful of the diversity that is often very present in a nurse’s patient load. It also helps strengthen a nurse’s commitment to nursing based on nurse-patient relationships and emphasizing the whole person rather than viewing the patient as simply a set of symptoms or illness. Finally, using cultural knowledge to treat a patient also helps a nurse to be open-minded to treatments that can be considered non-traditional, such as spiritually based therapies like meditation and anointing.

Nowadays, nurses are required to be sensitive to their patients’ cultural backgrounds when creating a nursing plan. This is especially important since so many people’s culture is so integral in who they are as individuals, and it is that culture that can greatly affect their health, as well as their reactions to treatments and care. With these, awareness of the differences allows the nurse to design culture-specific nursing interventions.

Through the help of Leininger’s theory, nurses can actually observe on how a patient’s cultural background is related to his or her health, and use that knowledge to create a nursing plan that will help the patient get healthy quickly while still being sensitive to his or her cultural background.

See Also

References and Sources

  • Leininger, M. (1978). Transcultural nursing: Concepts, theories, and practices. In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.
  • Leininger, M. (1979). Transcultural nursing. In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.
  • Leininger, M. M. (1991). Culture care diversity and universality: A theory of nursing. In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.

External Links

With contributions by Wayne, G., Ramirez, Q.

Last updated on
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Angelo Gonzalo, BSN, RN
Angelo Gonzalo earned his Nursing degree in the year 2010 and continued his studies at St. Paul University Manila taking up Masters of Arts in Nursing Major in Clinical Management. He worked as an intensive care nurse for more than six years. He advocates for proper training and development of new nurses, quality assurance and compassionate care. He has also been involved in community development for 10 years steering programs on good governance, health, sports, and education. Angelo aims to build a good foundation for aspiring nurses. He would like to impart the importance of understanding nursing theories that he hopes to be translated successfully to practice.

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