Middle Range Theory:

Leininger
PRESENTED BY:
Colleen Duckworth
Beau Geolina
Rachel Kelley
Zekè Lue

GNRS 508A
Summer 2018
Azusa Pacific University
Larry Rankin PhD, RN, CNE
 Leininger's Theory of Culture
Care Diversity and Universality
● First nurse anthropologist--founded
the discipline of transcultural nursing.
● She noted the gratitude that she
received from her patients-- decided
to focus on “care” as a central basis
for nursing.

● Recognized that children's behavior

appears to have a cultural foundation

● Identified a lack of cultural

awareness in the implementation of
patient compliance, wellness and
healing

● Her ideas formed the beginning of

Madeleine M. leininger 1925-2012 transcultural nursing construct
 Transcultural Nursing
“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
Leininger’s Theory: human conditions, illness, or death in culturally
meaningful ways” (p. 58).
The Breakdown
● Emphasis:
○ Cultural dynamics

○ Nurse-client relationship

● Goal:

○ To provide care that aligns with a

patient’s cultural beliefs, practices, and
values
 The Culture Care Theory:

● Nursing as a learned scientific and humanistic

profession

● Focuses on human care phenomena and caring

activities

● Help, support, facilitate, and/or enable patients to

maintain or regain health in culturally meaningful
ways, or to help them face handicaps or death.

Overview 3 modes to guide nursing judgments, decisions, or

actions in order to provide appropriate, beneficial, and
meaningful care:

● preservation and/or maintenance

● accommodation and/or negotiation

● re-patterning and/or restructuring.

(Leininger’s Culture Care Theory, n.d.)

 Culturological assessment provides complete, holistic
overview of patient’s background and addresses the
following:

● communication and language

● gender considerations
● sexual orientation

Culturological ●
●
ability and disability
occupation

Assessment ●
●
age
socioeconomic status
● interpersonal relationships
● appearance
● dress
● use of space
● foods and meal preparation and related lifeways

(Leininger’s Culture Care Theory, n.d.)

Image Credit: https://edgewood.org/offering-culturally-competent-care/
 Care: Assists with immediate and anticipated needs to
improve the human condition or face death

Culture: Learned or shared beliefs, norms, and lifeways to

specific groups or individual that guide thinking, decisions,
actions, and ways of living.

Culture Care Theory

Culture Care: Aspects of culture that influence an individual or
group to improve their condition or cope with illness or death

Key Terms Culture Care Diversity: Differences in meanings, values, and

accepted care among various groups of people

Culture Care Universality: Common care or meanings that are

shared between many cultures

Nursing: Profession with discipline of focus on care

phenomena

Worldview: How people view the world and universe; personal

(Leininger’s Culture Care Theory, n.d.)
views about the meaning of life
Image Credit: http://www.massagetoday.com/mpacms/mt/article.php?id=14603
 Cultural/Social Structure Dimensions: Factors that relate to
spirituality, social structure, and cultural values that influence cultural
responses from people within a cultural context

Health: State of well-being that is defined and valued by a designated

culture

Culture Care Theory Culture Care Preservation/Maintenance: Nursing care activities that
assist specific cultures retain and utilize cultural values in regard to
Key Terms health concerns and conditions

Cultural Care Accommodation/Negotiation: Creative nursing actions

that help people from designated cultures adapt to physical changes
and discuss health goals and optimal outcome with medical
professionals

Cultural Care Repatterning/Restructuring: Therapeutic actions taken

by culturally competent RNs that help patients modify personal
behaviors to achieve optimal health outcome while respecting a
patient’s cultural values

(Leininger’s Culture Care Theory, n.d.)

 ● Care provides the foundation of nursing as well as a
distinct, unifying focus

● Caring maintains health, healing, growth, well-being, and

helps an individual face death

Culture Care Theory ● Culture care helps nurses explain, interpret, and predict

Assumptions nursing care and practices

● Nursing is a humanistic, transcultural, and scientific

profession intended to serve humans across the globe

● Caring is necessary for healing to occur. Curing will not

occur without caring

● Each person has knowledge of caring, but professional

knowledge varies throughout cultures

(Leininger’s Culture Care Theory, n.d.)

 Culture care beliefs and practices are influenced by
different cultures. They tend to be embedded in
worldview, language, spirituality, politics, and
environment of a particular culture.

Culturally-based nursing care contributes to the well-

Culture Care Theory being of individuals, families, and communities alike

Assumptions Culturally congruent nursing care only occurs when the

nurse utilizes cultural values, community values,
expressions, and patterns appropriately with the patient
and family

Patients demonstrate cultural conflicts, noncompliance,

and ethical concerns when the nurse fails to provide care
congruent with their cultural values

(Leininger’s Culture Care Theory, n.d.)

 Theory generated from the nursing model: Danuta M. Wojnar’s theory
of caring is reaffirmed by Leininger’s culture care theory (Peterson &
Bredow, 2017). Caring is essential for nursing, culturally and otherwise.

Contribution to the discipline of nursing and health science: Leininger’s

theory has provided a basis of research and improvement in connection
between nurses and their patients. It also reduces health disparities
among certain cultures.

Guiding nursing research and practice: Cultural care is an influential

Why is it relevant? variable for quality of nursing care and outcomes of patients.
Transcultural care is studied and realized at the student and
professional levels of nursing practice (Long, 2016). International studies
show variation of cultural patterns in nursing care (Ansuya, 2012).
Specific cultures, such as in prisons, require culturally sensitive care
(Steefel, 2018).

Strengths: It is applicable in every nursing setting, since every patient

identifies with their own culture(s). It protects populations from lack of
nursing care through awareness, interventions, and influence on funding

Weaknesses: Results vary greatly depending on the region of nursing

practice. Funding or resources may be inadequate for certain services.
 PURPOSE OF THE STUDY
Identify racial differences in maternal comorbidities,
Article 1 peripartum characteristics, and maternal and fetal
outcomes (Shahul et al., 2015).

RESULTS OF STUDY
African American women are more likely to have
Racial disparities in comorbidities, risk factors for preeclampsia and are more likely to
complications, and maternal and fetal suffer adverse outcomes during peripartum care,
including death, as opposed to caucasian women
outcomes in women with (Shahul et al., 2015).
preeclampsia/eclampsia
APPROPRIATENESS OF THE NURSING MODEL/
MIDRANGE THEORY
This article demonstrates incongruity in care
between women of color and caucasian women.
Black women are more likely than caucasian
women to die as a result of preeclampsia and
eclampsia (Shahul et al., 2015).

Shahul, S., Tung, A., Minhaj, M., Nizamuddin, J., Wenger, J., Mahmood, E., . . . Rana, S.
(2015). Racial disparities in comorbidities, complications, and maternal and fetal
outcomes in women with preeclampsia/eclampsia. Hypertension in pregnancy,
34(4), 506-515. doi:10.3109/10641955.2015.1090581
 PURPOSE OF THE STUDY

Article 2 To explore health seeking behaviors of black men as to the

reasoning for the disportionate elevation of chronic
illnesses using Leininger's Theory of Culture Care Diversity
and Universality

RESULTS OF STUDY
Equal access to health resources would result in equal
A Theoretical approach to understanding outcomes in chronic illness regardless of race. It is
Black Men's Health Seeking Behavior important for healthcare providers to understand the social
barriers that motivate the behaviors of black men

APPROPRIATENESS OF THE NURSING MODEL/

MIDRANGE THEORY
The nursing Model midrange theory is all about health care
providers understanding how culture affects their patients
so that they can better understand how to provide care that
will be patient centered. By understanding how culture
influences the black man, health care providers will be
Plowden, K. (2003). A theoretical approach to understanding black men's health-
seeking behavior. Journal Of Theory Construction & Testing, 7(1), 27-31.
better prepared to provide care to this population
 Article 3
PURPOSE OF THE STUDY
To measure the effectiveness of a 2 week international
immersion program with training in language, culture, and
community nursing, on self awareness and self confidence
in dealing with different cultures.

RESULTS OF STUDY
The 2-week medical service learning experience in Belize
significantly improved self-efficacy, self confidence, and
Influence of international service learning self-awareness among ADN nursing students towards
on nursing students’ self efficacy towards working with the Hispanic culture and developing cultural
competence.
cultural competence
APPROPRIATENESS OF THE NURSING MODEL/
MIDRANGE THEORY
This study recognizes the need for cultural understanding
in order to provide effective care among diverse patient
populations. Understanding the best method for teaching
cultural competence is essential to the development of
effective curriculum in nursing programs. The use of
Leininger’s theory as a basis for this study is appropriate.
Long, T. (2016). Influence of international service learning on nursing students’ self
efficacy towards cultural competence. Journal Of Cultural Diversity, 23(1), 28-33.
http://0search.ebscohost.com.patris.apu.edu/login.aspx?direct=true&db=rzh&AN=11
4334347&site=ehost-live

Article 4
Can managed care networks improve
perinatal mental healthcare for black and
minority ethnic (BME) women?
Edge, D. (2011). Can managed care networks improve perinatal mental healthcare
for black and minority ethnic (BME) women? Journal of Public Mental Health;
Brighton, 10(3). 151-163. Doi: 10.1108/17465721111175038
PURPOSE OF THE STUDY
To address an issue of concern that fewer than expected women from
black and minority ethnic (BME) backgrounds in the United Kingdom
(UK) access care and treatment of perinatal mental illness. Also, to
inform policy and plans for improvement of provision by establishing
managed care networks (MCNs) for perinatal mental health.
RESULTS OF STUDY
Only 27 of 45 healthcare stakeholders that responded had multi-agency
delivery of perinatal healthcare. Some groups reported poor network
care for all women, some reported no cultural specific care, and only
33% reported providing language services. More women from BME
backgrounds were found to receive their care from voluntary sectors,
because they provided a significant amount of specialized cultural care
and support. A proposed policy reform could reduce funding for
voluntary sectors.
APPROPRIATENESS OF THE NURSING MODEL/ MIDRANGE THEORY
Providing care that addresses a population’s cultural needs, according
to Leininger’s theory, is a necessary part of nursing. If the BME
population is more likely to receive care from culturally competent
facilities, the funding for these facilities should be maintained.
Furthermore, the facilities that do not provide culturally sensitive care
should at least be managed within a network of facilities that do
provide it, as well as begin to develop cultural care practices of their
own.
 1. True or false Transcultural nursing is based on the idea
of providing care based on medicinal practices and not
the individual?
○ If true elaborate
○ If false elaborate.
2. Which of the following are part of a culturological
assessment?
○ Communication/Language
○ Sexual orientation
○ Use of space
Class Questions ○
○
Socioeconomics status
These are all part of a culturological assessment
3. How does Leininger define the PERSON
○ A human being regarded as an individual
○ An individual with unique characteristics and
needs
○ A human being, family, group, community, or
institution
○ An individual with specific care requirements
4. Which middle range theory is influenced by Leininger’s
theory?
○ Lewin’s change theory
○ Wojnar’s caring theory
○ Kohlberg’s moral development theory
 Ansuya, B. (2012). Transcultural nursing: Cultural competence in nurses. International Journal of
Nursing Education, 4(1), 5-7. Retrieved from
https://www.researchgate.net/publication/314078347_Transcultural_Nursing_Cultural_Competence_in_
Nurses

Edge, D. (2011). Can managed care networks improve perinatal mental healthcare for black and
minority ethnic (BME) women? Journal of Public Mental Health; Brighton, 10(3). 151-163. Doi:
10.1108/17465721111175038

Leininger, M. (2001). Culture care diversity and universality: A theory of nursing. New York: National League
for Nursing Press.

References Leininger's Culture Care Theory. (n.d.). Retrieved from http://www.nursing-theory.org/theories-and-

models/leininger-culture-care-theory.php

Long, T. (2016). Influence of international service learning on nursing students’ self efficacy towards
cultural competence. Journal Of Cultural Diversity, 23(1), 28-33. Retrieved from
http://0search.ebscohost.com.patris.apu.edu/login.aspx?direct=true&db=rzh&AN=114334347&site=eho
st-live

Peterson, S. J. & Bredow, T. S. (2017). Middle range theories: Application to nursing research and
practice. (4th ed.). Philadelphia, PA: Lippincott, Williams, and Wilkins.

Shahul, S., Tung, A., Minhaj, M., Nizamuddin, J., Wenger, J., Mahmood, E., . . . Rana, S. (2015). Racial
disparities in comorbidities, complications, and maternal and fetal outcomes in women with
preeclampsia/eclampsia. Hypertension in pregnancy, 34(4), 506-515.
Doi:10.3109/10641955.2015.1090581

Steefel, L. (2018). Cultural humility: An active concept to drive correctional nursing practice. Journal of
Forensic Nursing, 14(1), 27-30. Doi: 10.1097/JFN.0000000000000187