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RELATED TERMS Culture : culture is defined as set of values, beliefs & traditions that are held by a specific group of people & handed down from generation to generation. Ethnic : refers to a group of people who share common & distinctive cultures & who are a members of a specific group. Ethinicity : a consiousness of belonging to a group. Ethinicity indicates some characteristics that a group shares in common, such as race, music of folk traditions.

Subcultures : composed of people who have distinct identity but are related to larger cultural group.

Diversity : refers to the fact or a state of being different. Cultural shock : the state of being or unable to respond to a different cultural environment because of its sudden strangeness, unfamilarity & incompability to the strangers perception & expectations as it is diffrentiated from others by symbolic markers. Eg. Religion.

Culturally congruent care : Care that fits the peoples valued life patterns & set of meaning- which is generated from the people themselves, rather than based on predetermined criteria. Culturally competent care : it is the ability of the practitioner to bridge cultural gaps in caring, work with cultural differences & enables clients & families to achieve meaningful & supportive care. Anthroplogy : the scientific study of the origin, behaviour & the physical, social & cultural development of human.

DEFINITION : Transcultural nursing as a major area of nursing that focuses on a comparative study & analysis of different cultures & subcultures in the world with respect to their caring behavior; nursing care; & health illness values, beliefs, & patterns of behavior with the goal of developing a scientific & humanistic body of knowledge to provide culture specific & culture universal nursing care practices.

ABOUT THE THEORIST : DR. MADELEINE M. LEININGER was born in Sutton, Nebraska on July 13, 1925, lived on a farm with four brothers and sisters, and graduated from Sutton High School. Her desire to pursue a career in nursing was due to her inspiration and experience with her aunt who suffered from congenital heart disease.

1950 Bachelors in Biological science from Benidictine college, Kans. 1954 Master of Science in Nursing degree, with a minor in Psychiatric Mental Health Nursing and Psychology, at The Catholic University of America in Washington, DC. 1954 to 1960 o Associate Professor of Nursing (1954-1959) o Director of the Graduate Program in Psychiatric Nursing at the University of Cincinnati 1965 o Doctoral program in Cultural and Social Anthropology at the University of Washington in Seattle o first professional nurse to earn a Ph.D. in anthropology

1966 Professor of Nursing and Anthropology at the University of Colorado .

1969 to 1974 Dean, Professor of Nursing, and Lecturer in Anthropology at the University of Washington, School of Nursing. 1974 to 1980 o Dean, Professor of Nursing, Adjunct Professor of Anthropology, o Director of the Centre for Nursing Research and Transcultural Nursing Programs at the University of Utah College of Nursing

1981 to 1995 o Professor of Nursing and Director of the Centre for Health Research at the College of Nursing Wayne State University, o Adjunct Professor of Anthropology in the College of Liberal Arts o Director of the Transcultural Nursing Program o Established the Journal of Transcultural Nursing o Initiated worldwide certification of transcultural nurses (CTN) . June 1995 Dr. Leininger retired as professor emeritus from Wayne State University

PUBLICATIONS : As of 1995, she has written 25books, published over 200 articles and book chapters, produced numerous audio and video recordings, and developed a software program. She has also given over 850 keynote and public lectures in US and around the world. Dr. Leininger is a nationally and internationally known educator, author, theorist, administrator, researcher, consultant, and public speaker.

EVOLUTION OF THEORY : Leiningers theory is derived from the discipline of anthropology, but she conceptualized the theory to be relevant to nursing. She has stated that in times there will be a new taxonomy of nursing practice that will reflect different kinds of nursing care, which are culturally defined, classified, & tested as guide to provide nursing care. she makes this prediction because culture is the broadest & the most holistic means to conceptualize, understand & be effective with people.

In the late 1940s Dr. Leninger held the belief that care is essence of nursing & the central dominate & unifying focus of nursing. She then began to understand that importance of nursing care that was based on the clients cultures that has unique values.

In mid 1950s, the experienced what she described as cultural shock while she was working in child guidance clinic, as a clinical nurse specialist with disturbed children & parents. This experience led her to become the first professional nurse in the world to earn a doctorate in anthropology, & let to the development of transcultural nursing.

PURPOSE AND GOAL OF THE THEORY To discover and elucidate diverse and universal culturally based care factors that influence an individual's or group's health, well-being, illness, or death is the principal purpose of the theory. Its goal is to use research findings to provide culturally congruent, competent, safe, and meaningful care to clients of different or similar cultures.

The ultimate and primary goal of the theory was to provide culturally congruent care for the life ways and values of people.

The three modes for congruent care, decisions, and actions proposed in the theory are expected to lead to wellness, prevent illness or to face death.

THEORY ASSUMPTIONS Care is essential for human growth and development, survival and to face death or dying. Care is essential to curing and healing; there can be no curing without caring. The forms, expression pattern and processes of human care vary among all cultures of the world.

Therapeutic nursing care can only occur when client culture care values, expression and practices are known and used to provide human care. Difference between care giver and care receiver expectation need to be understood in order to provide beneficial, satisfying and congruent care. Culturally congruent specific or universal care modes are essential to the health or well-being of people of culture. Nursing is essentially a transcultural care profession and discipline.

PARADIGM & LEININGERS THEORY : Madeleine Leininger focused on care as an integral aspect of nursing. She has emphasized on concept of person, nursing, health and environment.

1. Concept of person : Refers to an individual human being, caring and cultural as well as a family, group, a social institution, or a culture. Humans are believed to be caring and capable of being concerned about the desires, welfares, and continued existence of others. Human care is collective, that is, seen in all cultures.

Humans have endured within cultures and through place and time because they have been able to care for infants, children, and the elderly in a variety of ways and in many different environments.

Thus, humans are universally- caring beings who survive in a diversity of cultures through their ability to provide the universality of care in a variety of ways according to differing cultures, needs, and settings.

2. Concept of environment: Refers to the physical or ecological environment and a context in which individuals and cultural groups live. Environment context is defined as being the totality of an event, situation & experience. Leininger speaks worldview, social structure, & environmental context instead of environment.

Her description of culture centres on a particular group (society) and the patterning of actions, thoughts, and decisions that occurs as the result of learned, shared, and transmitted values, beliefs, norms and life ways.

3. Concept of health : A broad spectrum of conditions, including well-being, illness, disability, and handicap. Madeleine Leininger discussed about components of health, specifically: health systems health care practices changing health patterns health promotions health maintenance

Health is a key concept in transcultural nursing. Because of the weight on the need for nurses to have knowledge that is specific to the culture in which nursing is being practiced, it is acknowledged that health is seen as being universal across cultures but distinct within each culture in a way that represents the beliefs, values, and practices of the particular culture. Thus, health is both universal and diverse.

4. Concept of Nursing : Leiningers defines nursing as a learned humanistic art & science that focuses upon personalized ( individual & group ) care behaviours, functions & processes directed towards promoting & maintaining health behaviours or recovery from illness which have physical psycho cultural , & social significance or meaning for those being assisted generally by professional nurse or one with similar role competence.

She gave three types of nursing actions that are culturally-based and thus consistent with the needs and values of the clients. These are: 1. Cultural care preservation/maintenance: 2. Cultural care accommodation/negotiation: 3. Cultural care repatterning/restructuring :

1. Cultural care preservation/maintenance: In this, the nurses action focus on supporting, assisting, facilitating & enabling of client or preserve or retain favourable health, to recover from illness or to face handicap or death.

2. Cultural care accommodation/negotiation : It creates professional efforts to facilitate, enable, assist or support action will help to clients adjustment to environment for facilitating satisfying health outcomes.

3. Cultural care repatterning/restructuring : It refers to professional actions that seek to help client change in meaningful health of life pattern.

THE SUNRISE MODEL A better way of understanding factors that influences a persons perception of well being is the sunrise enabler of Madeleine Leininger.

NURSING PROCESS & LEININGERS THEORY : 1. Assessment of nursing diagnosis 2. Planning & implementation 3. Evaluation

A. Assessment of nursing diagnosis : Assessing or gathering knowledge & information about the social structure & world view of the clients culture. Information regarding factors of technology, religion, philosophy, kinship, social structure, cultural values, beliefs, politics, legal system, economics, & education should be collected. It would be useful in preventing both culture shock & cultural imposition. After analyzing these information nurses identify the problem & state it in the form of nursing diagnosis.

B. Planning & implementation : Nursing care decisions & action need to be culturally based to best meet the needs of the client & provide culture congruent care. Three modes of action are : 1. Cultural care preservation/maintenance 2. Cultural care accommodation/negotiation 3. Cultural care repatterning/restructuring

C. Evaluation : Leiningers places a great deal of importance upon the need for nursing care to provide ways in which care will benefit the client & on the need to systematically study nursing care behaviour to determine which behaviour are appropriate to the lifeways & behavioural patterns of the culture is the equivalent to evaluation.

STRENGTHS AND LIMITATIONS OF THE THEORY STRENGTHS : It focused on the concept of culture in providing nursing care to our patients. It aids the nurse to be culture sensitive. Nurses should be conscious on different culture that necessitates them to respond to the needs of the patient who has different cultural values. It mainly focused on, in order to provide care, we should also understand the concept of culture.

LIMITATIONS : Not all the data that will be taken will be accurate and applicable to all clients. We should also consider the uniqueness of individual. This theory doesnt give any attention to the disease, symptoms etc.

If nursing practices fail to recognize culturological aspects of human needs, there will be signs of less efficacious nursing care practices and dissatisfaction with nursing services. There can be a problem in adapting or integrating the culture of the other which can be the cause of cultural shock on the part of the nurses. Studying culture doesnt mean that we could already relate to them, studying is different from actual experience.