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 Madeleine Leininger

Theory of Culture Care

Diversity & Universality
 Leininger¶s Theory
‡ Caring is the essence of nursing and is unique to
nursing

‡ Does not rely upon the four nursing paradigms of

person, environment, health, and nursing
± ³Too restrictive for open discovery about
culture and care´
 Leininger¶s Theory
‡ Care & culture are inextricably linked
± Leininger recognized the importance of an
understanding of culture - both the nurse¶s
and the client¶s - to effective nursing practice.

‡ All cultures have practices related to caring.

± Practices common across cultures are culture
care O



± Practices specific to a given culture are culture
care



‡ Research findings indicate there is more
diversity than universality.
 Leininger¶s Theory
‡ To practice from a cultural perspective:
± Respect the culture
± Recognize the importance of the culture to
nursing care

‡ If not practiced:
± Patient can show signs of cultural conflict,
noncompliance, stress, and ethical or moral
concern
 Leininger¶s Sunrise ³Enabler´
A conceptual model to guide nursing judgments and
activities to provide culturally congruent care

(See Chitty & Black, 2007, pg. 343)

 ±ow does Leininger¶s theory
inform our practice?
‡ Remember«.culturally congruent care is ³care
that is beneficial and meaningful to the people
being served´ (Andrews & Boyle, 2003, p. 6)

± Culture should determine the way that

individuals receive care, based on the different
ways their cultures meet their basic needs.
± By 2050, white native-born Americans are
estimated to represent less than 50% of the
population. To care for this increasingly
diversified nation, nurses must embrace the
concept of culturally congruent care!
 Leininger in Practice Cont«
‡ Leininger¶s theory does not focus on medical
symptoms, disease, or treatment, it focuses on
the nurse¶s approach to care (this is truly a
holistic nursing idea!)

± Tailor your nursing care to your patients with

the goal of improving their comfort and
response to care

± Utilize this theory for holistic assessments of

the patient
 Leininger in Practice Cont«
‡ Spend time researching culture and asking
questions

± Get patient feedback

± Don¶t assume
± Remember to ask what the patient considers
good care
± Ask patients to describe their own experiences
with health care

‡ Finding out about their culture helps identify

the influencing factors related to their health
practices and concerns
 Leininger In Practice Cont«
‡ Leininger¶s Theory is flexible and widely useful

± it can be utilized with individuals, families,

groups, communities and institution in diverse
health systems (Andrews & Boyle, 2003, p. 6).

± No matter what type or setting of nursing you

pursue, there is always a model to guide your
care with concern to culture!
ey Points to Remember«..
CU|TURE


!
GU DES
!
"

CA#E
Levine¶s Conservation Model

Four Guiding Principles

of the
Art of Nursing
(1973)
Primary Focus = Conservation
of the Individual

‡ Adaptation to changes in health and disease so

as to preserve individual integrity

‡ Individuals require nursing care when they are

unable to adapt and retain wholeness
themselves.

‡ ³Conservation aims to maintain an equilibrium

conducive to health; accordingly, many nursing
interventions use conservation principles to
maintain patient wholeness´ (Leach, 2006).
 A Conceptual Model to
Guide Nursing Interventions
‡ Conservation of:
m Energy
m Structural Integrity
m Personal Integrity
m Social Integrity

 Nursing Interventions focus on 6




 
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6

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 Conservation of Energy
‡ Promote the body¶s energy balance when faced
with changes in psychological or physiological
processes so as to sustain life

‡ ³Energy conservation is based on the following

ideas:
± Patient activity is dependent on energy balance
± Illness increases energy demand
± Increased energy demand can be measured by
the level of fatigue´ (Leach, 2006)
 Conservation of Structural
Integrity

‡ Age and illness can produce structural changes

which require adaptation

‡ Through conservation of structural integrity,

patients will feel intact and whole and
subsequently manifest improvements in self-
identity (Leach, 2006)
 Conservation of Personal
Integrity
‡ The conservation of personal integrity aims to
protect personal identity, an intrinsic factor to
wholeness of the individual

‡ ³Conserving personal integrity is based on the

following ideas:
± Individuals require privacy and are responsible
for their own decisions
± Illness and hospitalization compromise
personal integrity, self-identity, and self-
respect´ (Leach, 2006).
 Conservation of Social
Integrity
‡ Social interaction and relationship of self to others is
key to unity of the individual

‡ ³Conserving social integrity is based on the following

principles:
± Individual life has meaning only in the context of
social life
± Individual behavior is influenced by the ability to
relate to various social groups
± Families often are affected by an individual¶s illness
± ±ospitalization results in social isolation´ (Leach,
2006)
Example of Levine¶s Conservation Model
www.ids--healthcare.com
www.ids
 ±ow does Levine¶s Model
inform our practice?
‡ Remember«Levine¶s Conservation Model is used to guide
nursing interventions with the goal of conserving integrity
of the individual through adaptation to physical and
psychological changes.

‡ Nursing actions and interventions should

aim to conserve 4 areas of integrity:
± Energy
± Physical Integrity
± Personal Integrity
± Social Integrity
 Nursing Interventions for
Conservation of Energy
‡ The nurse will foster balance between energy output and
input to avoid excessive fatigue

± Support adjustment to changes in living

situations (i.e. SNF)
± Improve nutritional status
± Control pain and anxiety
± Reduce patient activity when appropriate
± Promote exercise and
rehabilitation within the
patient¶s abilities, limitations
and comfort
 Nursing Interventions for
Conservation of Structural
Integrity
‡ The nurse will help maintain or restore the patient¶s body
structure by preventing physical breakdown and promoting
healing

± Precautions in infection and injury prevention

± Promote mobility
‡ Early ambulation to prevent complications of bed rest
± Assist in adaptation to decreased mobility
± Maintain musculoskeletal integrity through ROM exercises
± Maintain venous integrity through use of compression therapy
and/or TED hose
± Maintain skin integrity (early detection and
management of disease processes conserve
structural integrity)
± Positioning
 Nursing Interventions for
Conservation of Personal
Integrity
‡ The nurse will help maintain or restore the patient¶s sense
of identity and self-worth, acknowledging uniqueness of the
patient

± Respect one¶s privacy and property

± Support personal choice
± Enhance self-esteem through good hygiene and dress
± Foster independence
‡ Loss of independence negatively affects pride and self-
identity
‡ Provide knowledge and support, but encourage patient to
maintain independence
± Promote appropriate coping mechanisms
± Exercise
 Nursing Interventions for
Conservation of Social
Integrity
‡ The nurse will foster awareness that the patient is a social
being who interacts with others in their social environment.

± Promote meaningful social activities and outings

± Encourage family support & education
± Promote family participation in care
± Foster patient interaction with others
± Promote healing to restore the
patient¶s mobility
± Promote exercise to increase
the patient¶s ability to socialize
ey Points to Remember«.
Levine¶s Model focuses on conserving the
patient¶s ¢
  by regaining or maintaining
their:

‡ Energy
‡ Structural Integrity
‡ Personal Integrity
‡ Social Integrity
 References
‡ Andrews, M.M. & Boyle, J.S. (2003). ÷ OO
6
 O
 (4th ed.).
Lippincott: Philadelphia.

‡ Chitty, .. & Black, B.P. (2007) 



 O

6   (5th
ed.). Suanders Elsevier: St. Louis.

‡ Cox, R.A. (2003). Using NANDA, NIC, and NOC With Levine's Conservation Principles
in a Nursing ±ome.   


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Oct-Dec.

‡ Leach, M.J. (2006, August 1). Wound management: using Levine¶s conservation
model to guide practice. 

O   , 52 (8). Retrieved October 17,
2008, from http://www.o-wm.com/article/6024

‡ Mock V., St. Ours C., ±all S., Bositis A. , Tillery M. , Belcher A., rumm S. &
McCorkle R. (2007) Using a conceptual model in nursing research - mitigating fatigue
in cancer patients. 
O 
   O
 58(5), 503±512.

‡ Schaefer, ., Potylycki, M.J. (1993). Fatigue associated with congestive heart failure:
use of Levine's Conservation Model. 
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, 18, 260-268.

‡ www.madeleine-leininger.com