Easter College Incorporated

Department of Nursing
Easter School Rd., Guisad, Baguio City

TRANSCULTURAL NURSING THEORY

By Madeleine Leininger

“Caring is the essence of nursing and unique to nursing”

Preapred by:
GALINO, Cynforosa
LAGUYO, Hyacinth
PIAYAS, Shenieah Jhoy

Checked by:

Nikki Dale D. Laza-Dalgis, RN

TFN, Instructor

BACKGROUND
MADELEINE LEININGER, PhD, LHD, CTN, FAAN, LL,
FRCNA
Born: July 13, 1925, Sutton, Nebraska, United States
Died: August 10, 2012, Omaha, Nebraska, United States
Full name: Madeleine M. Leininger
Education: University of Washington
Nationality: American
 Mother of Transcultural Nursing
 Founder of Transcultural Nursing Society
 Desired to pursue nursing because of her aunt who suffered from congenital heart
disease

 1945 – Received diploma in nursing from St. Anthony’s School of Nursing in Denver,
Colorado (she also was a Cadet Corps nurse)
 1950 – B.S. degree in biological science minor in philosophy and humanistic studies
from Benedictine College in Atchison, Kansas
 1954 – M.S. in psychiatric and mental health nursing from the Catholic University of
America in Washington, D.C.
 1965 – Ph.D. in cultural and social anthropology from University of Washington,
Seattle
 1969 – Dean of the University of Washington, School of Nursing
 1975 – President of the American Association Colleges of Nursing And one of the first
members of the American Academy of Nursing
 1980 – Dean, Professor of Nursing, Adjunct Professor of Anthropology, and Director of
the Center for Nursing Research and the Doctoral and Transcultural Nursing Programs
at the University of Utah College Nursing
 1995 – Retired aa Professor Emeritus of Nursing at Wayne State University and
adjunct faculty member at the University of Nebraska Medical Center in Omaha

Her official certifications read:

 LL (Living Legend)
 Ph.D. (Doctor of Philosophy
 LHD (Doctor of Human Sciences)
 DS (Doctor of Science)
 CTN (Doctor of Science)
 RN (Registered Nurse)
 FAAN (Fellow American Academy of Nursing)
 FRCNA (Fellow of the Royal College of Nursing in Australia).

WORKS
 Basic Psychiatric Concepts in Nursing (1960) – translated in 11 languages and used
worldwide
 Qualitative Research in Nursing (1985)
 Nursing and Anthropology: Two Worlds to Blend
 Transcultural Nursing: Concepts, Theories, and Practice (2002)
 Written and edited 28 books
 Published over 300 articles and 60 book chapters
 Given over 1, 000 keynote and public lectures in US around the world
 Established Journal of Transcultural Nursing (Editor from 1989-1995)
 Launched first undergraduate and graduate courses and programs in Transcultural
Nursing (1970)
 Initiated idea of a clinical specialist in transcultural nursing
 Nominated for Nobel Peace Prize for significant and worldwide breakthrough
transcultural health care

TRANSCULTURAL NURSING THEORY

 A legitimate and formal area of study, research, and practice, focused on culturally
based care, values, and practices to help cultures or subcultures maintain or regain their
health and face disabilities or death in culturally congruent and beneficial caring ways.
(Leininger, 1999)

PURPOSE OF THE THEORY

 Discover the cultural views or people’s perception of care as they know, believe, and
practice it and then use the knowledge with appropriate professional actions to guide
care practices.

THEORETICAL INFLUENCES
 Leininger’s theory of culture care diversity isn’t a borrowed theory, but rather an
outcome of an individual curiosity and of independent work with the goal of improving
care with regards to people with diverse cultures. World War II gave light wherein the
theory developed; it was then when immigrants from different countries around the
world with diverse cultural background moved to the United States and to other places
worldwide.
 The major event that happened that led her to her theory was when she was working
at the child guidance home in the mid1950s in Cincinnati. By direct observation, she
discovered that the staff lacked understanding of cultural factors influencing the
behaviour of the children. She also noticed that even her nursing decisions didn’t have
any help to the children effectively. This is when she started posing questions to herself
and to other staff about cultural differences among children and therapy outcomes.
 Margaret Mead became a visiting professor in the Department of Psychiatry,
University of Cincinnati and Leininger discussed the potential interrelationships between
nursing and anthropology.
 Realizing the need of further knowledge about the said discovery, Leininger pursued
her PhD in cultural, social, and psychological anthropology. She focused on the Gadsup
people of the Eastern Highlands of New Guinea, where she undertook an ethnographical
and ethnonursing study of two village

MAJOR CONCEPTS OF TRANSCULTURAL THEORY

DEFENITION EXAMPLE
ETHNONURSING - This is the study of  Providing culturally sensitive care to
nursing care beliefs, values, and practices a native Filipino patient, considering their
as cognitively perceived and known by a traditional healing practices and beliefs
designated culture through their direct alongside medical treatments.
experience, beliefs, and value system
NURSING – A learned humanistic and  A nurse ensures culturally
scientific profession and discipline that is congruent
focused on human care phenomena and care by incorporating the patient's
activities to help patients maintain or cultural beliefs and practices into the
regain their well-being (or health) in treatment plan, fostering an environment
culturally meaningful and beneficial ways,
that respects diversity and promotes
or to help people face handicaps or death.
healing in a manner that aligns with the
patient's cultural context.
 PROFESSIONAL NURSING CARE -  A nurse recognizing and
Formal and cognitively learned accommodating the dietary restrictions of
professional care knowledge and practice a Hindu patient during their hospital stay,
skills obtained through educational ensuring their cultural and religious
institutions that are used to provide dietary preferences are respected and
assistive, supportive, enabling, or
integrated into their care plan.
facilitative acts to or for another
individual or group to improve a human
health condition (or well-being), disability,
lifeway, or to work with dying clients.
CULTURAL CONGRUENT (NURSING)  A nurse using traditional Chinese
CARE - cognitively based assistive, herbal remedies as complementary
supportive, facilitative, or enabling acts or treatments for a Chinese patient with the
decisions that are tailor-made to fit with patient’s consent.
the individual, group, or institutional,
cultural values, beliefs, and lifeways to
provide or support meaningful, beneficial,
and satisfying health care, or well-being
services.

HEALTH – A state of well-being that  A healthcare provider might adapt a

is culturally valued, practiced, and patient’s dietary plan to accommodate
reflects the ability of individuals (or their cultural preferences and restrictions,
groups) to perform their daily role such as creating a culturally sensitive
activities. meal plan for a Hindu patient who is
vegetarian for religious reasons.

HUMAN BEINGS - Such are believed to  A hospital setting where health care
be caring and capable of being concerned professionals must provide culturally
about others’ needs, well-being, and sensitive care to patients from various
survival. Nursing as a caring science ethnicities and beliefs, recognizing the
should focus beyond traditional nurse- unique needs and values of each
patient interactions and dyads to include individual within the context of their
families, groups, communities, total care.
cultures, and institutions.
SOCIETY AND ENVIRONMENT -  In a densely populated urban area,
Leininger did not define these terms; she a
speaks instead of worldview, social nurse might need to consider the
structure, and environmental context. increased risk of infectious diseases and
the accessibility of healthcare services
when developing a public health program
to address the specific needs of the local
population.
WORLDVIEW – The way people tend  A patient may have a holistic
to look out on the world or their perspective, believing that health is
universe to form a picture or a value closely linked to harmony with nature and
stance about their life or world around the community, which influences their
them. healthcare decisions and preferences.

ENVIRONMENTAL CONTEXT- is  Creating a calming and peaceful

the totality of an event, situation, or environment in a hospital room for a
particular experience that gives Muslim patient, including space and
meaning to human expressions, facilities for prayer, to accommodate
interpretations, and social their spiritual and cultural needs
interactions in particular physical, during their hospital stay.
 ecological, sociopolitical, and/or
cultural settings.

CULTURE – Learned, shared, and  The way a Native American

transmitted values, beliefs, norms, and patient's
lifeways of a particular group that healing practices, such as using
guides their thinking, decisions, and traditional herbs and rituals, may be
actions in patterned ways. integrated into their healthcare plan to
provide culturally sensitive and holistic
care.

CULTURAL CARE – An individual’s,  Cultural care in transcultural theory

group, or community’s different for Jehovah's Witnesses may involve
adaptation or learning, acquired and respecting their religious beliefs by
being used to improve and face their ensuring that healthcare practices align
everyday way of life, sickness, health with their principles, such as
and even facing death. accommodating their refusal of blood
transfusions and considering alternative
medical approaches that adhere to their
faith.

CULTURAL CARE DIVERSITY –  In the healthcare setting, nurses are

Variabilities and/or differences in trained to provide cultural care diversity
meanings, patterns, values, lifeways, by understanding and respecting the
or symbols of care within or between unique values, beliefs, and practices of
collectivities that are related to patients from various cultural
assistive, supportive, or enabling backgrounds to ensure personalized and
human care expressions. effective medical care.

CULTURAL CARE UNIVERSALITY –  The hospital's commitment to
Common, similar, or dominant uniform provide a culturally sensitive and inclusive
care meanings, patterns, values, lifeways, healthcare services, ensuring that
or symbols that manifest among many patients from diverse backgrounds feel
cultures and reflective assistive, respected and understood during their
supportive, facilitative, or enabling ways
treatment.
to help people. (The term universality is
not used in an absolute way or as a
significant statistical finding.)
ETHNOCENTRISM – The  A healthcare provider, who is
perception that one’s own way is best culturally rooted in Western medicine,
when viewing the world. dismisses the traditional healing practices
of a Native American patient, believing
their own approach to be superior without
considering the patient's cultural beliefs
and preferences.
ETHNIC – A term that relates to  Tailoring a patient’s dietary plan to
races or large groups of people align with their specific cultural
classified according to common traits preferences and restrictions, ensuring
or customs. that the care provided respects their
ethnic background and dietary traditions.
 SUBCONCEPTS OF TRANSCULTURAL NURSING THEORY

DEFENITION EXAMPLES
GENERIC (FOLK OR LAY) CARE  A hospital using a standard pain
SYSTEMS -are culturally learned and management protocol for all patients,
transmitted, indigenous (or traditional), regardless of their cultural
folk (home-based) knowledge and skills
background, which may not consider
used to provide assistive, supportive,
enabling, or facilitative acts toward or for individual cultural variations in pain
another individual, group, or institution perception and treatment preferences.
with evident or anticipated needs to
ameliorate or improve a human life way,
health condition (or well-being), or to deal
with handicaps and death situations.
EMIC CARE – Learned and transmitted  When caring for a Hindu patient,
lay, indigenous, traditional, or local folk emic care would mean acknowledging
knowledge and practices. their dietary restrictions and ensuring that
the food provided aligns with their
vegetarian or religious dietary
preferences.

ETIC CARE – Explicit cognitively The universal use of hand hygiene

learned professional care knowledge practices in a healthcare setting,
and practices obtained generally regardless of a patient’s cultural
through educational institutions. background, to prevent the spread of
infection and ensure patient safety.

CARING – service or an act of  The way a nurse may practice a

rendering/giving care. sense of shared identity and
interconnectedness, by forming close,
personal relationships with patients and
their families, providing emotional
support, and involving them in the
decision-making process to ensure a
culturally congruent and caring
healthcare experience.

CULTURE SHOCK – A disorder that  In a healthcare setting, a Jehovah’s

occurs in response to transition from Witness patient may experience culture
one cultural setting to another. shock when they encounter medical
procedures like blood transfusions that
conflict with their religious beliefs.

CULTURAL IMPOSITION - refers to  A nurse insisting that a vegetarian

the outsider’s efforts, both subtle and eat meat because it is the standard
not so subtle, to impose their own dietary practice in their own culture,
cultural values, beliefs, behaviours
disregarding the patient’s dietary
upon an individual, family, or group
from another culture. choices and cultural beliefs.
 CULTURAL AND SOCIAL  The family unit plays a central role
STRUCTURE DIMENSIONS – The in healthcare decisions, and healthcare
people/person's activity in daily living choices are often influenced by the
and the influences of their culture, extended family’s opinions and values.
traditions, beliefs, how their political
views help, education and even new
technologies, primitive history that
affects cultural responses of people
within cultural context.

3 MODES OF NURSING CARE DECISIONS AND ACTIONS

 CULTURAL CARE PRESERVATION AND MAINTENANCE – Rendering care and

giving importance to people’s culture, belief and respecting their values and practices
regarding health care status and scope of health care understanding.
Example: An Indigenous patient receives traditional herbal remedies and healing
practices in addition to conventional medical treatment, respecting and preserving
their cultural beliefs and practices for holistic care.
 CULTURAL ACCOMMODATION AND NEGOTIATION – Offering other alternative
ways of rendering health care that is acceptable to people and community for a better
result that is shared by the health care provider and health care receiver.
Example: A healthcare provider adjusts medication timing for a muslim patient
fasting during Ramadan to respect their religious practices while maintaining effective
treatment.
 CULTURAL REPATTERNING AND RESTRUCTURING - Enabling professional actions
and decisions that help clients reorder, change, or greatly modify their lifeways for
new, different, and beneficial healthcare patterns.
Example: A nurse involve working with patient to adapt their traditional healing
rituals and ceremonies to a hospital setting, allowing them to maintain their cultural
practices while receiving medical care.

LEININGER’S SUNRISE ENABLER TO DISCOVER CULTURE CARE

GOAL OF THE THEORY
 Provide culturally congruent and responsible care that reasonably fits with the
client’s culture needs, beliefs, and lifeway realities.

ETHNONURSING RESEARCH METHOD

 A qualitative nursing research method focused in helping researchers study
transcultural human care phenomena and discovers the knowledge nurses
need to provide care in an increasingly multicultural world.

MAJOR THEORETICAL ASSUMPTIONS

 Care is the essence and the central dominant, distinct, and unifying focus of nursing.
 Humanistic and scientific care is essential for human growth, well-being, health,
survival, and to face death and disabilities;
 Care (caring) is essential to curing or healing, for there can be no curing without
caring.
 Culture care is the synthesis of two major constructs that guide the researcher to
discover, explain, and account for health, well-being, care expressions, and other
human conditions;
 Culture care expressions, meanings, patterns, processes, and structural forms are
diverse but some commonalities (universalities) exist among and between cultures;
 Culture care values, beliefs, and practices are influenced by and embedded in the
worldview, social structure factors (e.g., religion, philosophy of life, kinship, politics,
economics, education, technology, and cultural values), and the ethnohistorical
environmental contexts;
 Every culture has generic (lay, folk, naturalistic; mainly emic) and usually some
professional (etic) care to be discovered and used for culturally congruent care
practices;
 Culturally congruent and therapeutic care occurs when culture care values, beliefs,
expressions, and patterns are explicitly known and used appropriately, sensitively,
and meaningfully with people of diverse or similar cultures;
 The three theoretical modes of care offer new, creative, and different therapeutic
ways to help people of diverse cultures;
 Qualitative research paradigmatic methods offer important means to discover largely
embedded, covert, epistemic, and ontological culture care knowledge and practices;
and
 Transcultural nursing is a discipline with a body of knowledge and practices to attain
and maintain the goal of culturally congruent care for health and well-being.

STRENGTHS AND WEAKNESSES

Strengths:
 With the theory focused on the concept of culture in providing nursing care to
patients, it helps the nurse to be more culture sensitive. Nurses should be mindful on
different cultures that require them to respond to the needs of the patient for
effective nursing care.
 The concepts and relationships that are presented are at the level of abstraction
which allows it to be applied in many different situations, thus making the theory
highly generalizable.
  Compared to other theories which focused on people, health, environment, and
nursing, Leininger highlighted on care as core of nursing, however with the
assumption of it’s based on culture data.

Weakness:
 It can also be the primary cause of error in making clinical decisions like
misperception of the outcomes and misperception of the values patients place in
outcomes. Uniqueness of an individual must be considered to aid in data taking.
 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 nurse.
 The theory doesn’t give any attention to the disease, symptoms, treatment, etc.

THEORETICAL IMPLICATIONS
Practice
 Nurses are now realizing the importance of transcultural nursing in human care,
especially Filipino nurses who are working overseas. With today’s heightened public
awareness of healthcare costs, different cultures, and human rights, there is much
greater demand for comprehensive, holistic, and transcultural people care to protect
and provide quality-based care and to prevent legal suits related to improper client
care.

Education
 There is still a critical need for nurses to be educated in transcultural nursing in
undergraduate and graduate programs. There is also still a need for well-qualified
faculty prepared in transcultural nursing to teach and guide research in nursing
schools.
Research
 With today’s nurses being exposed to different cultures, and the increasing
number of nurses being interested in the world of transcultural nursing; it will be
rational to predict that there will be more advancement with regards to the qualitative
research in diverse cultures. This can also help the future nurses who have the
interest in research.

NURSING PROCESS
ASSESSMENT DIAGNOSI PLANNING INTERVENTIO EVALUATIO
S N N
 Determine  Should  Should be  Same as  Should
client’s include adapted as planning include the
cultural potential much as nurse’s
heritage and problems possible to evaluation of
language skills in their the client’s her attitude
 Ask about interaction cultural towards
client’s health with the background giving care
beliefs health  Evaluation
 Determine if care continues
client is taking system throughout
any home and and should
remedies problems include
 Self-evaluation involving feedback
for nurses is the effects from client
needed of culture and family

REFERENCES:
McFarland M. & Wehbe-Alamah H. (2014). Leininger’s Culture Care Diversity and
Universality: A Worldwide Nursing Theory
Tomey, A. M., & Alligood M. R. (2002). Nursing Theorist and Their Work 5 th Edition
Melo, L. P. D. (2013). The Sunrise Model: a Contribution to the Teaching of Nursing
Consultation in Collective Health. American Journal of Nursing Research, 1(1), 20-23.

Leininger, M., 1999. What is transcultural nursing and culturally competent care? Journal
of Transcultural Nursing Jul 13(3),189-192.
McFarland, M., 2012. Ethnonursing: A Qualitative Research Method for Studying
Culturally Competent Care Across Disciplines
http://nursingtheories.blogspot.com/2011/07/leiningers-theory-of-culture-care.html
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http://www.madeleine-leininger.com/cc/infofacts.pdf
http://www.madeleine-leininger.com/cc/sunrise2015.pdf
http://www.unmc.edu/news.cfm?match=9762