DR. MADELEINE M.

LEININGER
July 1925-August 2012

TRANSCULTURAL NURSING

Transcultural Nursing
The goal of transcultural nursing involves planning nursing care based on knowledge that is culturally defined, classified, and tested. That knowledge is then used to provide culturally congruent care to patients (Chitty & Black, 2011, p 316).

Madeleine Leininger
Leininger is largely known for developing a theory of cultural care for nursing. Through her theory the Transcultural Nursing Society was formed. The formation of a Masters degree in Transcultural Nursing is also credited to Leininger.

Leiningers Education
Leininger received her diploma in Nursing from St. Anthonys School of Nursing in Denver, CO. Two years later she received her bachelor of science degree in biological science from Benedictine College in Kansas In 1954 she received her MSN from Catholic University in Washington, D.C. In 1965 Leininger received her PhD in anthropology from the University of Washington in Seattle.

Origins of Transcultural Nursing

Early in her nursing career, Leininger observed children of different cultures having different behaviors and needs. During her doctoral work in cultural anthropology she became more convinced of the cultural differences presented in healthcare. Identified a lack of cultural care and knowledge as the missing link to understanding the many variations required in patient care. These observations and experiences led Leininger to develop a theory of cultural care for nursing.

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 (Sitzman, 2011, p97)

Providing Transcultural Care in Nursing

Leininger viewed caring as the essence of nursing She promoted a nurse-patient relationship that creatively designs a new or different care lifestyle that is culturally congruent for the patient (Chitty & Black, 2011, p 316). The goal is for nurses to view patients in the context of their cultures
Leininger recognized that the values and practices of a specific culture are influenced by language, worldview, spiritual belief, education, economics, technology and environment (Clarke, McFarland, Andrews & Leininger, 2009).

Ultimately, Leiningers goal was for patients to receive culturally congruent care.

Providing Transcultural Care in Nursing

Leininger focused first on nurses respecting the culture of patients and then understanding how important it is to their care.
Beneficial, healthy, and satisfying culturally based nursing care contributes to the well being of individuals, families, groups, and communities within their environmental context (Clarke, McFarland, Andrews & Leininger, 2009, p. 235).

Once achieved, the nurse plans care with awareness to health beliefs and practices of the patients culture .
Every human culture has lay (generic, folk, or indigenous) care knowledge and practices and usually some professional care knowledge and practices which vary transculturally (Clarke, McFarland, Andrews & Leininger, 2009, p. 235).

Culturally Competent Nurses:

Have thoroughly assessed and acknowledged their own cultural beliefs and practices. Consciously address the fact that culture affects nurseclient exchanges. Ask each patient what their cultural practices and preferences are with compassion and clarity. Incorporate the clients personal, social, environmental, and cultural needs/beliefs into the plan of care whenever possible. Respect and appreciate cultural diversity, and strive to increase knowledge and sensitivity.
(Sitzman, 2011, pg 97).

The Sunrise Model

To assist nurses in providing culturally congruent care, and making decisions based on culturally diverse knowledge, Leininger developed the sunrise model shown on the next slide. The sunrise model helps the nurse to use cultural assessment data to better understand its influence on the patients life (Chitty, 2011, pg 316)

Implications & Consequences

The nursing outcome of culturally congruent nursing care is health and well-being for the patient (Chitty, 2011, pg 316) By providing care that is congruent with patients culture, the patient will be more likely to be compliant with interventions. Clients who experience nursing care that fails to be reasonably congruent with the clients cultural beliefs and values will show signs of stress, cultural conflict, noncompliance, and ethical moral concerns (Sitzman, 2011,
pg 97)

Evaluating Leiningers Nursing Model

The 4 global concepts of nursing theories as described by Leininger:

Person- The person is defined by cultural and structural dimensions as shown in the sunrise model. Leininger believes that each person deserves culturally congruent care that promotes well being.
Environment- The environment plays a large cultural role in each patients care. Its composed of many different factors unique to each patient. Health- refers to a state of well-being that is culturally defined and valued by a designated culture (Sitzman, 2011, p. 95) Nursing- a learned profession with a disciplined focused on care phenomena (Sitzman, 2011, p. 95)

Transcultural Nursing for Other Professions

Leiningers cultural care model is wholistic and comprehensive
Applicable for all nursing practices as patients of different cultures require nursing care for all reasons.

Medicine, social work, physical and occupational therapy have embraced & utilized Leiningers theories (Clarke, McFarland,
Andrews, & Leininger, 2009).

Leiningers theory has also attracted the attention and interest of scholars in theology, religious studies, engineering, management, business, education, sociology, and even anthropology (Clarke, McFarland, Andrews, & Leininger,
2009, p 235).

Transcultural Nursing for Other Professions

Care is a broadly used term that is applicable in many different professions Leininger stated caring is practically a part of all the philosophies in all hospitals now [and] now educators want to get it into the educational system, because they know to work with immigrants and refugees and people all over the world they need something from the theory that will help them in teaching (Clarke, McFarland, Andrews & Leininger, 2009, p. 237). Leininger has taught her theory to many including nursing, dentistry and mortuary students

Culture Care Theory in Practice & Situations

Culturally congruent nursing care is beneficial when values, expressions, or patterns are known and used appropriately and knowingly by the nurse (Sitzman, 2011, pg. 96). Aspects to consider include: (Berman, 2008, pg 313)
Family Patterns
Family is the basic unit of society
Matriarchal vs. patriarchal, nuclear vs. extended

Communication Style
Language barriers- avoid using slang terms which may have different meanings in different cultures

Time Orientation
Many cultures focus on present-time and therefore do not adhere to strict time schedules

Nutritional Patterns
Food choices and preparation preferences vary within cultures
Rice vs. pasta, steamed vs. boiled Hot vs. Cold foods Religious factors such as avoiding meat on certain days or only consuming Kosher foods

Resources & Weblinks

Berman, A., Snyder, S.J., Kozier, B., & Erb, G. (2008). Fundamentals of nursing: Concepts, process, and practice (8th ed.) Upper Saddle River, NJ: Pearson. Chitty, K.K., & Black, B.P. (2011). Professional nursing: Concepts and challenges (6th ed.) Maryland Heights, MO: Saunders. Clarke, P. N., McFarland, M. R., Andrews, M., & Leininger, M. (2009). Caring : Some reflections on the impact of the culture care theory by mcfarland & andrews and a conversation with leininger. Nurs Sci Q, 22(3), 233-239. doi: 10.1177/0894318409337020 McFarland, M. , & Eipperle, M. (2008). Culture care theory: a proposed practice theory guide for nurse practitioners in primary care settings . Contemporary Nurse, 28(1-2), 48-64. Retrieved October 01, 2012, from Nursing and Allied Health Collection via Gale: http://0-find.galegroup.com.libcat.ferris.edu/nrcx/start.do?prodId=NRC

Sitzman, K.L., & Wright Eichelberger, L. (2011). Understanding the work of nurse theorists: A
creative beginning (2nd ed). Retrieved from: http://nursing.jbpub.com/sitzman/ch15pdf.pdf Nursing Theory. http://nursing-theory.org/nursing-theorists/Madeline-Leininger.php

A nurse is caring for Mr. Hernandez, a 63 y.o. Hispanic male, on a medical surgical floor. He was admitted 3 days ago with the diagnosis of sepsis and two diabetic ulcers on his left foot. He has a history of uncontrolled type II diabetes, high cholesterol, and hypertension. Upon the initial interview he states to the nurse:
I dont know how this happened, I felt fine until this last week. I only had a fever and usually my wifes herbal tea and a cool washcloth on my forehead take care of that. I dont even remember doing anything to my foot, although I dont have as much sensation in my feet as I used to. Maybe when I was outside in the yard with the grandkids playing barefoot I did something? Its just been sore, but I thought it would heal on its own. The doctor said if the infection gets any worse I may lose my foot. I dont know what Ill do if that happens, I have to work, my entire family depends on it. I cannot wait until Im home. My wife will have a plate of homemade tortillas with my name on them. My wife is the best! Shes the one who made me come in here, she said my foot was getting worse and her special honey ointment wasnt doing the trick. I bet some of her tortillas, cookies and herbal tea will help me get over this infection!

Providing Culturally Congruent Care: A Case Study Using M. Leiningers Culture Care Theory

Case Study

Using the culture care theory, what factors shared in the story from Mr. Hernandez should be considered/addressed in the discharge plan? Develop two nursing diagnoses with interventions that will help to meet this patients cultural, physical, and emotional needs.
What are the implications if the nurse does not provide culturally congruent care?