Leininger's Transcultural Theory

Madeleine M. Leininger

PhD, LHD, DS, CTN, RN, FAAN, FRCNA

Madeleine Leininger was born in Sutton, Nebraska.

1948, she received her diploma in nursing from St. Anthony’s School of Nursing in Denver, Colorado.

1950, she earned a B.S. from St. Scholastica (Benedictine College) in Atchison, Kansas, in 1954 earned an M.S. in psychiatric and mental health nursing from the Catholic University of America in Washington, D.C.

1965, she was awarded a Ph.D. in cultural and social anthropology from the University of Washington, Seattle

1966, she offered first course in transultural nursing at the University of Colorado

1969, she was appointed dean of the University of Washington, School of Nursing, she remained in that position until 1974

She is considered by some to be the "Margaret Mead of nursing" and is recognized worldwide as the founder of transcultural nursing, a program that she created at the School in 1974.

She has written or edited 27 books and founded the Journal of Transcultural Nursing to support the research of the Transcultural Nursing Society, which she started in 1974.

1985 her theory was published in Nursing Science Quarterly

1991, her book Culture Care Diversity and Universality: A theory of Nursing was published

MADELEINE LEININGER’S CULTURE CARE:

DIVERSITY AND UNIVERSALITY THEORY

Early in her career as a nurse, Leininger recognized the importance of the concept of “caring” in nursing. Frequent statements of appreciation from patients for care received prompted Leininger to focus on “care” as being a central component of nursing. During the 1950s, while working in a child guidance home, Leininger experienced what she describes as a cultural shock when she realized that recurrent behavioral patterns in children appeared to have a cultural basis. Leininger identified a lack of cultural and care knowledge as the missing link to nursing’s understanding of the many variations required in patient care to support compliance, healing, and wellness (George, 2002).

These insights were the beginnings (in the 1950s) of a new construct and phenomenon

related to nursing care called transcultural nursing.

Leininger is the founder of the transcultural nursing movement in education research and practice. 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 practice of transcultural nursing addresses the cultural dynamics that influence the nurse–client relationship. Because of its focus on this specific aspect of nursing, a theory was needed to study and explain outcomes of this type of care. Leininger creatively developed the Theory of Culture Care: Diversity and Universality with the goal to provide culturally congruent holistic care.

Some scholars might place this theory in the middle range classification. Leininger holds that it is not a grand theory because it has particular dimensions to assess for a total picture. It is a wholistic and comprehensive approach, which has led to broader nursing practice applications than is traditionally expected with a middle-range, reductionist approach. (Personal communication with Penny Glynn on September 12, 2003).

Leininger’s theory is to provide care measures that are in harmony with an individual or group’s cultural beliefs, practices, and values. In the 1960’s she coined the term culturally congruent care, which is the primary goal of transcultural nursing practice.m Culturally congruent care is possible when the following occurs within the nurse-client relationship (Leininger, 1981):

'Together the nurse and the client creatively design a new or different care lifestyle for the health or well-being of the client. This mode requires the use of both generic and professional knowledge and ways to fit such diverse ideas into nursing care actions and goals. Care knowledge and skill are often repatterned for the best interest of the clients…Thus all care modalities require coparticipation of the nurse and clients (consumer) working together to identify, plan, implement, and evaluate each caring mode for culturally congruent nursing care. These modes can stimulate nurses to design nursing actions and decisions using new knowledge and culturally based ways to provide meaningful and satisfying holistic care to individuals, groups or institutions'

HIGHER LEVEL OF LEARNING How adults learn? Learning can be defined formally as the act, process, or experience of gaining knowledge or skills. Adults learn by making meaning of their experiences. We constantly make sense of our experiences and consistently search for meaning. The brain resists a meaningless stimulus that is why rote learning frustrates us, it doesn't give us any insights. When we call upon the brain's natural capacity to integrate information, however, we can assimilate boundless quantity [Conner 1997-2007]. Higher level of learning is what this "blog activity" fully intended to. Group H aspires to nothing less than the achievement of advanced learning. We would very much appreciate every piece of your "share" in this blog. Make your experiences meaningful by sharing it with us. It is like working on a puzzle, connecting each piece fitly to the other making one complete beautiful picture of a "Modern Nurse in a Culture Care Diversity and Universality." Hats off! "Culture Care Diversity and Universality Theory" has been the most significant breakthrough in nursing and the health fields in the 20th century and will be in greater demand in the 21st century” (Leininger,1997). Hurry up! Let's work on this breakthrough and see how it will change your day-to-day patient care. Travel with us in discovering specific and multifaceted culturally based care meanings and practices. Unravel the genuineness of individual culture and let it work loose in your chosen field of nursing to achieve an effective culturally congruent patient care. Here is how we give honor to whom honor is due. We give thanks to UPOU staff for creating such N-207 course activity that stimulates our brains to work and experience the real meaning of learning. Grabe! It is not just fulfilling the requirements. It fills the gap what is missing in our noble profession as nurses. Wherever we are, you brings us closer together to work for the advancement of nursing profession and create a merit in the healthworld of "caring." PRAISE GOD!

Lourdes Gutierrez R.N.

"I find Madeliene M. Leininger's Culture Care Diversity and Universality very helpful with my present work as the Nursing In-Service and Training Coordinator. It gives me light on how to approach patients and nurses as well of different nationalities. It reminds me once more that each individual is unique and their being is strongly affected by the culture which molded them from childhood to adulthood. Having personal interactions with almost 20 different nationalities for 14 years, I supposed it is enough time for me to know these people very well. But not until I read Leininger's work on Transcultural Nursing. I felt that I have to learn more deeply on how culture greatly affects person's perception of health and illness and the care for them to maintain health. Culturally congruent care makes sense. It fosters patient's independence on decision making concerning his health. And for us nurses, somehow we pay due respect for the patients' rights. Knowing each person from the cultural perspective of who s/he is provides guiding principle on handling personal interactions to avoid conflicts brought about by prejudices and misunderstanding of behaviors. Part of my orientation for new staff nurses is the introduction of Cultural Awareness. This lecture is being conducted also for old staff every two years. This provides guidelines on how to handle personal interactions with different nationalities, the dos and don’ts. This awareness creates conscious avoidance of conflict with everybody and enhances skill in interpersonal relationship with patients, co-workers, and other people in the work environment. Cultural awareness also helps the nurses to become courteous and respectful most of the time especially with their patients. With this kind of attitude, trust is being established and compliance to treatment is anticipated. Most importantly, it makes a person know more about himself and this gives way towards understanding others. Another part of the orientation is the introduction to their job description which includes their scope of practice. The fourth standard of the UAE Core Practice Standards for the Registered Nurse/Midwife states that a registered nurse/midwife should "Demonstrate Comfort with Diversity." This sounds so unique, it was considered crucial-in-context due to the diversity of the population, cultural and health care settings, roles, positions and structures. This is further explained by the presentation of the "Elements" which clearly speaks of provision of sensitive, appropriate care to the client and significant others within diverse religious, cultural and social contexts; respects and values the cultural needs and lifestyles of client and significant others. It also expects that a registered nurse/midwife will adapt care to cultural needs of clients but not to sacrifice soundness and/or safety. Registered nurse/midwife should ensure that own cultural background and beliefs do not influence the quality of care provided. S/he should respect the customs and beliefs of colleagues without compromising the quality of care and within the boundaries of the organization's requirements. The scope of nursing practice outlines the expected knowledge, skills and attitudes to meet the needs of the health care recipient or community at hand (SANC, 2001). It will also automatically limit the practice to which it is applicable making provision for delineation of responsibilities and autonomy within and across professions. Also, a Scope of Practice usually strengthens efforts to regulate practice and provides a corner stone to support the development of a profession (Dr. A. S van der Merwe). The professional and ethical practice is one of the domains of nursing. This domain reflects the registered nurse’s understanding of the professional code of conduct and their ability to work independently and in collaboration with others while maintaining professional standards. Working with others necessitates sensitivity to diversity in cultural and religious beliefs. Nurses work in varied proficiencies, at times independently and others as members of health care teams, and it is necessary that they are educationally prepared and able to demonstrate a level of ongoing competence and ethical practice that is culturally sensitive and promotes health and well-being within the community. Federal Department of Nursing, MOH, UAE. (2004). Scope of Practice Registered Nurse and/or Midwife. Abu Dhabi: Author. Ministry of Health (MOH), UAE. 2001. Professional Code of Conduct for Nurses. Abu Dhabi: Author Having said all these things, Transcultural Nursing, brought into being by Madeliene M. Leininger shaped such development into nursing practice. It opens thorough understanding on the impact of culture on culture care making the nurses involvement in provision of care so satisfying and rewarding."

Jennifer Suhail, R.N.

"After passing the board, I wasn’t able to have the chance to work in Philippines, instead I flew to Bahrain, and had my first clinical exposure there. It was quite difficult for me to adapt at first because there were two groups of people that I have to deal with, first was the multinational nurses from US, UK, India, China, Malaysia, Bahraini and second was the patients who were mostly Bahraini’s, Saudia, Indians, Filipinos, and few Americans. Language was the great barrier for me and the Bahraini cultures. And so part of our in-service training was to learn the Bahraini language in order to communicate with the patients, to understand their culture and their beliefs/ religion. And so as the same case here in Pakistan where I am currently based and been working for quite a long time now. When I joined here 14 years ago, I’d seen a lot of differences in nursing practices, actually poor nursing practices. Nursing education in Pakistan that time was not that strong as compare now a days. Nursing was not even considered a profession here before, a so called nurse was just considered a person who clean the vomit of the patient or just to follow whatever doctor’s order. But where we are now? due to the research and emphasizing the importance of providing patients quality care, the nurses learned the nursing process, the nurses learned that understanding the patient’s cultures and beliefs actually helps in improving patients condition or even learned how to face death. ICU is obviously the most critical unit in the hospital. Once the patient is admitted in ICU, no one sure what will be the progress of his/her condition, will she/he be transferred back to the ward? discharge home? or say goodbye?, but while the patient is admitted in ICU, incorporating the patient’s personal, social, environmental and cultural needs/beliefs into the plan of care works a lot. For instances, some patient’s prefer to be look after by a female nurse and vice versa…to a female patient, to be look after by a male staff is against their religion and culture. Some of the patient’s relative believes that keeping a verse from Holy Quran tied on their arms will keep the patient well or die in peace. Understanding such beliefs actually promotes a good relationship between nurse and patients or/and patients families. It builds trust and cooperation that made us able to provide a holistic nursing care. "

Vladimir Milaor, R.N.

"When I was working in the ER/OPD, I usually do health teachings to our patients. I can recall situations when i was communicating with patients with different cultural backgrounds. I realized that dealing with clients from diverse cultures should receive special considerations when rendering nursing care. Let me site an example. There was a Caucasian client that I was communicating with, I noticed that he was constantly establishing direct eye contact when i was talking, which is in contrast with some Asians who may not look directly into my eyes during conversation. Well, nurses should be aware that how people may behave may be a reflection of their culture.And having an understanding on Transcultural nursing is very important for nurses to better interpret a client’s behavior. Like, how would you react to a Caucasian who establishes eye contact or to an Asian who doesn’t establishes eye contact during conversation? Rudeness or a cultural reflection of how they pay attention to you? I also noticed that most Asian patients are less aggressive and talk less compared to patients from the west like the Caucasians. As matter of fact i can still recall a very personal experience during my young nursing years. I was a fresh graduate and was having my first clinical exposure as a professional nurse. I was communicating with a Caucasian client, when he showed me a hand gesture that may universally mean "let's have sex"... I should have clarified the meaning of that because that hand gesture may have a different interpretation as per his cultural background. But may be because i felt harassed, i just ignored it and stopped the conversation by making myself busy with some other things. That was my way of drawing the line between personal and professional aspects of me. And I may say that the behavior i posed that time also reflects my cultural background of having to talk less rather than be aggressive and make a scene. I share this experience not to discriminate race, but to make a clearer picture of how diverse cultures are. Some cultures show feelings that in their generic (folk) cultures may be acceptable, but may be interpreted as rudeness by people from a different culture. I read Leininger’s work and I was amazed with it because her theory is “TRANSCULTURAL” T-he broadest holistic means to know, interpret, explain or predict nursing care phenomenon (to guide nursing care practices) is CULTURE CARE. R-equired (essential) to curing and healing is CARING. For there would be no curing without caring. A- beneficial, healthy and satisfying culturally based nursing care contributes to the well being of individuals, families, groups and communities within their environmental context. N-ursing is a Transcultural humanistic care discipline and profession with the central purpose to serve human beings worldwide S-imilarities and differences in culture care between professional caregivers and client (generic) exist in any human culture worldwide. C-are is the essence of nursing and a distinct, dominant, central and unifying focus. U-niversal phenomenon in human caring are in other word 'similar' but culture care concepts, meanings, expressions, patterns, processes and structural forms of care are 'different' (diversity) L-ife’s essentials for well-being, health, healing, growth survival, and to face handicaps or death is CARING. T-o have culturally congruent or beneficial nursing care, the nurse should know the client’s culture care values, expressions and patterns. U-man (human) culture has generic (lay, folk or indigenous) care knowledge & practices and usually professional care knowledge & practices, which vary culturally. R-eligious, world view, language, kinship, political, educational, economic, technological, ethnohistorical, and environmental context of a culture influences cultural care values, beliefs and practices. A-ny client who experiences nursing care that fails to be a reasonably congruent with the client’s beliefs, values and caring lifeways will show signs of cultural conflicts, noncompliance, stresses, and ethical or moral concerns. L-earning new ways and different ways to discover epistemic and ontological dimensions of human care transculturally through the qualitative paradigm."

Penalope Ovejera, R.N.

"I regard this theorist as a person who has very high respect for human mankind. As evidenced by her extensive work on Culture Care, she delved on every aspect of a client/person from diversed entities. Her teachings entail moral virtues of compassion, discipline and responsibility in addressing appropriate care to an individual based on their cultural background. Health-related decisions or choices of treatment are thereby optimized and rendered quickly if one is adept to Transcultural Nursing. This would definitely promote understanding and better relationship between the nurse and client. The concept of Universality is likewise correct in my opinion. I believe in setting standards which form point of measurement in the delivery of a good service. The goal of care is always the same but it is in the actual implementation of the care being provided that varies."

Kristine Joan Aguirre, R.N.

“Leininger’s Theory of Culture Care focuses on the differences and similarities among cultures with respect to human care, health, and illness. It supports culturally specific care that is humanistic, holistic and respectful of diverse values, beliefs and practices.” Indeed, Transcultural nursing help nurses to improve the delivery of quality nursing care to our patients. Having been working in the Emergency Room for four years, gives me an opportunity to render care to clients coming from a diversified Bicol culture. Bicol region has six provinces with seven dialects. Everyday, being the frontliner of the hospital, it is a challenge to learn our diverse ethnicity, cultural traditions, religious beliefs, and dialects and have it applied in devising the plan of care for my patients. Most of the time, I ask them their province of origin for me to understand fully their behaviors or reactions to illness and/or death. Bicolanos, being regarded as religious individuals would opt to be seen by a priest or pastors before any invasive surgical procedure or if death is imminent and we nurses, regardless of how toxic our duty is, should find time to look for a chaplain or contact their ministers for them to be anointed. Some of our clients coming from the far-flung areas of Camarines Sur and Albay, after their consultation in the ER, would still go for alternative medicine like taking herbal medicine and “hilots” for dislocated bones and body pains. There are clients from rich and known municipality of Camarines Sur would be mistakenly angry and demanding upon arrival in the ER department because of their way of talking and tone of voice, only to find out that it’s their normal way of conversing to people. They are just but some of the clients that I attend to in the fast paced world of Emergency Room department. Aside from doing rapid accurate assessment and treatment from a wide variety of illnesses of injury situations, ranging from a sore throat to a heart attack, it is a challenge to me to make a culturally congruent care plan for my clients. So as to provide the quality nursing care that is due to them.

Ann Benadette Zapanta R.N.

"As a nurse, I have been accustomed to having patients from different cultures. Leininger’s theory is the best theory that could be practiced by a Filipino nurse at that. Why because, a Filipino nurse is a global nurse. I have seen nurses in the US being accustomed to different patients, may they be Mexicans, African Americans or Caucasians. The Philippines is a country where diversity of cultures is most common. Imagine, just passing a few kilometers from Manila and you’ll be in Bulacan , where you’ll experience a different culture, pass Tarlac and another group of beliefs and practices, pass another and you’ll be in Pampanga and yet another group of culture and beliefs even different food delicacies. Pass upnorth , and you’ll be in Baguio, the Igorots, then the Ilocanos. I have seen almost all of the different Philippine cultures. That is why I believe that the Filipino nurse whether abroad or working locally is the most efficient cultural and anthropological nurse in the world. Among the many nationalities, I can say that we are readily adaptable and the most culture sensitive professionals. As a clinical instructor, lecturer and nursing coordinator, I am also aware of these cultures and I also apply them as necessary. I have students from all walks of life, from different parts of the country. I also have the responsibility of teaching my students to be culturally adaptive and sensitive." Your upward scrolling text goes here

Anthony Feleo, R.N.

"Imagine I’m your patient.....Im an Arab husband anxious of my wife's condition…anxious that other male might see the skin of my wife...anxious because that is my culture..would you do something about it please? ..I’m an Arab patient with strict conditions on food, how the food is prepared, anxious if it is 'Halal'….would you do something about it please?....I’m a Chinese Patient, and its New year's Eve, my culture dictates that its bad to be in a Hospital once the new year arrives, I must be out of the Hospital when the clock strikes 12mn, I promise to comeback….my stomach doesn't hurt that much….would you do something about it please?....I’m a Filipino patient, I have very close Family Ties, I am anxious to see them and let them know I’m OK after my operation, would you let my entire clan visit me? My Grand Parents, My Parents, my Brothers, my Sisters, My Tito & Titas, My nephew and niece, my cousins from my mother side, my cousin from my father side, my second cousins from my mother side, my second cousins from my father side.... and the list continues...would you do something about it please? other profession might be able to ignore these kinds of situations if the need doesn't present itself…But for a Nurse, it must come out naturally. Here, Dr. Leininger emphasized how important to consider cultural diversities, to learn, establish and maintain the 'cultural needs' of a patient. It is not simple. I have been working with different cultures in different places, cultures that I never heard of, cultures that you only appreciate in media, cultures that defy your own beliefs, cultures that sometimes undermine you, cultures that made you who you are right now, finding my own means to understand their needs, to accommodate their requests, to satisfy their contentment. I honestly do not know Dr. Leininger and her work, so you would only guess how astonished I was to know that there is someone who piloted this thing. Like the good Theorist said, caring is universal in human nature, the problem is the differences on how to apply this so called 'care', and in doing so, one must be aware, accommodate, and help restructure the needed care. "There can be no curing without caring, but there can be caring without curing"

Eleonor Almendral, R.N.

Last July 13 in the height of typhoon Basyang where our province mainly affected by it, our house (almost shanty)flooded due to heavy rains and as if it wasn't enough our neighbor's house whose only a concrete walls sets between us was on fire in the climax of the typhoon because of a negligent candle placed on a styrofoam bucket. So you can just imagine how confused I'am because I cannot decide weather to put our furniture and appliances outside the house or to put it in a high place. After an hour and a half the fire had already besiege and it did not affected our house even the other houses nearby due a combine effort of all our neighbors (no thanks to fire department). Filipino's called it "Bayanihan" a culture and tradition passed on from our ancestors that even without no blood connection we Filipino's always ready to lend a helping hand in times of crisis. This is what Leininger is saying all along that "There can be no curing without caring but there can be caring even without curing".That we can help one another even without no illness to cure, no symptoms to diagnose because it is natural for us to care most specially with the same group of people, race, gender, ethnic, or even status in life. Leininger implies to us nurses to pay respect to all the client/patient that placed in our care even with the same nationality we still all differ in upbringings, status in life, faith and beliefs.That we nurses should not be decremental and should always explain to our patient what procedure,and action we have to do because maybe it is not applicable to them due to mentioned above diffences. My thanks to all my group mates who poured out all there efforts in putting up this blog.

Merrilee Hilario, R.N.

"Leininger’s theory of culture care greatly emphasized the value of respect with one’s cultural beliefs, values, and practices as these will promote individualism, independence and self- satisfaction. As part of the medical team, the nurse must be equipped with cultural knowledge and skills to be able to give an efficient and effective nursing care. Nursing decisions and actions must reflect individual’s own beliefs, values and practices. This serves as our guide that everyone has a unique way of seeking other options or alternatives which they think would be beneficial and better for them. As a former company nurse, I can personally relate with the culture care theory of Leininger. I have worked in a multinational drug company that caters to different types of people from all walks of life. The people cling to diverse beliefs, values, and practices. Even with advance science and technology and their easy access to medical drugs that they could use to cure their disease or symptoms, surprisingly, there are some people whose way of thinking and attitudes still embrace superstitious belief. Hence, in seeking treatment of their ailments, they would still consider their spiritual healers and other forms of traditional way of treatment, like, using herbal medicines and combined these available medicines. During their nursing consultation with us in the nursing office, I have learned to respect heir beliefs and somehow just need to devise some ways to guide them in using in using the right medical care because we know that some herbal medicines combined with modern drugs can result to some serious health conditions when drug interactions occur."

Leininger's Transcultural Theory

The Cultural Care

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