MADELEINE LEININGER

 Madeleine Leininger was born on July 13, 1925, in Sutton, Nebraska.

 1945- entered the Cadet Nurse Corps, a federally-funded program to increase the number of nurses trained to
meet anticipated needs during World War II.
 earned a nursing diploma from St. Anthony’s Hospital School of Nursing, followed by undergraduate degrees at
Mount St. Scholastica College and Creighton University.
 1951-1954- She earned the equivalent of a BSN through her studies in biological sciences, nursing
administration, teaching, and curriculum
 1954- received a Master of Science in Nursing from the Catholic University of America
 Served as Associate Professor of Nursing and Director of the Graduate Program in Psychiatric Nursing at the
University of Cincinnati.
 1969- 1974- appointed Dean of the University of Washington, School of Nursing
 1974 to 1980, Leininger served as 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.
 On August 10th, 2012, Leininger passed away at her home in Omaha, Nebraska.

TRANSCULTURAL NURSING THEORY

 Through her observations, while working as a nurse, Madeleine Leininger identified a lack of cultural and care
knowledge as the missing component to a nurse’s understanding of the many variations required inpatient care to
support compliance, healing, and wellness, which led her to develop the theory of Transcultural Nursing also
known as Culture Care Theory
 This theory attempts to provide culturally congruent nursing care through “cognitively based assistive, supportive,
facilitative, or enabling acts or decisions that are mostly tailor-made to fit with the individual, group’s, or
institution’s cultural values, beliefs, and lifeways.”
 Leininger’s theory’s main focus is for nursing care to fit with or have beneficial meaning and health outcomes for
people of different or similar cultural backgrounds. With these, she has developed the Sunrise Model in a logical
order to demonstrate the interrelationships of the concepts in her theory of Culture Care Diversity and
Universality.

DESCRIPTION

 In 1995, Madeleine Leininger defined transcultural nursing as “a substantive area of study and practiced focused
on comparative cultural care (caring) values, beliefs, and practices of individuals or groups of similar or different
cultures to provide 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.”

MAJOR CONCEPTS OF THE TRANSCULTURAL NURSING THEORY

Transcultural Nursing
Transcultural nursing is defined as a learned subfield or branch of nursing that focuses upon the comparative study and
analysis of cultures concerning nursing and health-illness caring practices, beliefs, and values to provide meaningful and
efficacious nursing care services to their cultural values and health-illness context.
Ethnonursing
This is the study of nursing care beliefs, values, and practices as cognitively perceived and known by a designated culture
through their direct experience, beliefs, and value system (Leininger, 1979).
Nursing
Nursing is defined as a learned humanistic and scientific profession and discipline which is focused on human care
phenomena and activities to assist, support, facilitate, or enable individuals or groups to maintain or regain their well-being
(or health) in culturally meaningful and beneficial ways, or to help people face handicaps or death.
Professional Nursing Care (Caring)
Professional nursing care (caring) is defined as formal and cognitively learned professional care knowledge and practice
skills obtained through educational institutions that are used to provide assistive, supportive, enabling, or 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) Care
Cultural congruent (nursing) care is defined as those cognitively based assistive, supportive, facilitative, or enabling acts
or decisions that are tailor-made to fit with 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
It is a state of well-being that is culturally defined, valued, and practiced. It reflects individuals’ (or groups) ‘ ability to
perform their daily role activities in culturally expressed, beneficial, and patterned lifeways.
Human Beings
Such are believed to be caring and capable of being concerned about others’ needs, well-being, and survival. Leininger
also indicates that nursing as a caring science should focus beyond traditional nurse-patient interactions and dyads to
include families, groups, communities, total cultures, and institutions.
Society and Environment
Leininger did not define these terms; she speaks instead of worldview, social structure, and environmental context.
Worldview
Worldview is how people look at the world, or the universe, and form a “picture or value stance” about the world and their
lives.
Cultural and Social Structure Dimensions
Cultural and social structure dimensions are defined as involving the dynamic patterns and features of interrelated
structural and organizational factors of a particular culture (subculture or society) which includes religious, kinship (social),
political (and legal), economic, educational, technological, and cultural values, ethnohistorical factors, and how these
factors may be interrelated and function to influence human behavior in different environmental contexts.
Environmental Context
Environmental context is the totality of an event, situation, or particular experience that gives meaning to human
expressions, interpretations, and social interactions in particular physical, ecological, sociopolitical, and/or cultural
settings.
Culture
Culture is learned, shared, and transmitted values, beliefs, norms, and lifeways of a particular group that guides their
thinking, decisions, and actions in patterned ways.
Culture Care
Culture care is defined as the subjectively and objectively learned and transmitted values, beliefs, and patterned lifeways
that assist, support, facilitate, or enable another individual or group to maintain their well-being, health, improve their
human condition lifeway, or deal with illness, handicaps or death.
Culture Care Diversity
Culture care diversity indicates the variabilities and/or differences in meanings, patterns, values, lifeways, or symbols of
care within or between collectives related to assistive, supportive, or enabling human care expressions.
Culture Care Universality
Culture care universality indicates the common, similar, or dominant uniform care meanings, patterns, values, lifeways, or
symbols manifest among many cultures and reflect assistive, supportive, facilitative, or enabling ways to help people.
(Leininger, 1991)

SUBCONCEPTS

Generic (Folk or Lay) Care Systems

Generic (folk or lay) care systems are culturally learned and transmitted, indigenous (or traditional), folk (home-based)
knowledge and skills used to provide assistive, supportive, enabling, or facilitative acts toward or for another individual,
group, or institution 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
Knowledge gained from direct experience or directly from those who have experienced it. It is generic or folk knowledge.
Professional Care Systems
Professional care systems are defined as formally taught, learned, and transmitted professional care, health, illness,
wellness, and related knowledge and practice skills that prevail in professional institutions, usually with multidisciplinary
personnel to serve consumers.
Etic
The knowledge that describes the professional perspective. It is professional care knowledge.
Ethnohistory
Ethnohistory includes those past facts, events, instances, experiences of individuals, groups, cultures, and instructions
that are primarily people-centered (ethno) and describe, explain, and interpret human lifeways within particular cultural
contexts over short or long periods of time.
Care
Care as a noun is defined as those abstract and concrete phenomena related to assisting, supporting, or enabling
experiences or behaviors toward or for others with evident or anticipated needs to ameliorate or improve a human
condition or lifeway.
Care
Care as a verb is defined as actions and activities directed toward assisting, supporting, or enabling another individual or
group with evident or anticipated needs to ameliorate or improve a human condition or lifeway or face death.
Culture Shock
Culture shock may result when an outsider attempts to comprehend or adapt effectively to a different cultural group. The
outsider is likely to experience feelings of discomfort and helplessness and some degree of disorientation because of the
differences in cultural values, beliefs, and practices. Culture shock may lead to anger and can be reduced by seeking
knowledge of the culture before encountering that culture.
Cultural Imposition
Cultural imposition refers to the outsider’s efforts, both subtle and not so subtle, to impose their own cultural values,
beliefs, behaviors upon an individual, family, or group from another culture. (Leininger, 1978)

The Sunrise Model of

Leininger’s Theory:

▪ This is relevant
because it enables
nurses to develop
critical and complex
thoughts towards
nursing practice.

These thoughts
should consider, and
integrate, cultural
and social structure
dimensions in each
specific context,
besides the biological
and psychological
aspects involved in
nursing
THREE MODES OF NURSING CARE DECISIONS AND ACTIONS

Cultural care preservation or Maintenance

Cultural care preservation is also known as maintenance. It includes those assistive, supporting, facilitative, or enabling
professional actions and decisions that help people of a particular culture to retain and/or preserve relevant care values so
that they can maintain their well-being, recover from illness, or face handicaps and/or death.
Cultural care accommodation or Negotiation
Cultural care accommodation, also known as negotiation, includes those assistive, supportive, facilitative, or enabling
creative professional actions and decisions that help people of a designated culture to adapt to or negotiate with others for
a beneficial or satisfying health outcome with professional care providers.
Culture care repatterning or Restructuring
Culture care repatterning or restructuring includes those assistive, supporting, facilitative, or enabling professional actions
and decisions that help clients reorder, change, or greatly modify their lifeways for new, different, and beneficial health
care pattern while respecting the clients’ cultural values and beliefs and still providing a beneficial or healthier lifeway than
before the changes were established with the clients. (Leininger, 1991)

ASSUMPTIONS
✔ Different cultures perceive, know, and practice care in different ways, yet there are some commonalities about
care among all cultures of the world.
✔ Values, beliefs, and practices for culturally related care are shaped by, and often embedded in, the worldview,
language, religious (or spiritual), kinship (social), political (or legal), educational, economic, technological,
ethno-historical, and environmental context of the culture.
✔ While human care is universal across cultures, caring may be demonstrated through diverse expressions, actions,
patterns, lifestyles, and meanings.
✔ Cultural care is the broadest holistic means to know, explain, interpret, and predict nursing care phenomena to
guide nursing care practices.
✔ All cultures have generic or folk health care practices, that professional practices vary across cultures, and that in
any culture there will be cultural similarities and differences between the care-receivers (generic) and the
professional caregivers.
✔ Care is a distinct, dominant, unifying and central focus of nursing, and, while curing and healing cannot occur
effectively without care, care may occur without cure.
✔ Care and caring are essential for the survival of humans, as well as for their growth, health, well-being, healing,
and ability to deal with handicaps and death.
✔ Nursing, as a transcultural care discipline and profession, has a central purpose to serve human beings in all
areas of the world; that when culturally based nursing care is beneficial and healthy it contributes to the well-being
of the client(s) – whether individuals, groups, families, communities, or institutions – as they function within the
context of their environments
✔ Nursing care will be culturally congruent or beneficial only when the clients are known by the nurse and the
clients’ patterns, expressions, and cultural values are used in appropriate and meaningful ways by the nurse with
the clients.
✔ If clients receive nursing care that is not at least reasonably culturally congruent (that is, compatible with and
respectful of the clients’ lifeways, belief, and values), the client will demonstrate signs of stress, noncompliance,
cultural conflicts, and/or ethical or moral concerns.
Analysis

In Leininger’s nursing theory, it was stated that the nurse would help the client move towards amelioration or improvement
of their health practice or condition. This statement would be of great difficulty for the nurse because instilling new ideas in
a different culture might present an intrusive intent for the “insiders.” Culture is a strong set of practices developed over
generations that would make it difficult to penetrate.

The whole activity of immersing yourself within a different culture is time-consuming to understand their beliefs and
practices fully. Another is that it would be costly on the part of the nurse.

Because of its financial constraints and unclear ways of being financially compensated, it can be the reason why nurses
do not engage much with this kind of nursing approach.

Because of the intrusive nature, resistance from the “insiders” might impose a risk to the nurse’s safety, especially for
cultures with highly taboo practices.

It is highly commendable that Leininger formulated a theory that is specified to a multicultural aspect of care. On the other
side, too much was given to the culture concept per se that Leininger failed to discuss the functions or roles of nurses
comprehensively. It was not stated how to assist, support or enable the client to attuning them to an improved lifeway.

Strengths

 Leininger has developed the Sunrise Model in a logical order to demonstrate the interrelationships of the concepts
in her theory of

 Culture Care Diversity and Universality.

 Leininger’s theory is essentially parsimonious in that the necessary concepts are incorporated in such a manner
that the theory and its model can be applied in many different settings.
 It is highly generalizable. The concepts and relationships presented are at a level of abstraction, which allows
them to be applied in many different situations.
 Though not simple in terms, it can be easily understood upon the first contact.

Weakness

 The theory and model are not simple in terms.

Conclusion

According to transcultural nursing, nursing care aims to provide care congruent with cultural values, beliefs, and practices.

Cultural knowledge plays a vital role for nurses on how to deal with the patients. To start, it helps nurses to be aware of
how the patient’s culture and faith system provide resources for their experiences with illness, suffering, and even death. It
helps nurses understand and respect the diversity that is often present in a nurse’s patient load. It also helps strengthen a
nurse’s commitment to nursing based on nurse-patient relationships and emphasizing the whole person rather than
viewing the patient as simply a set of symptoms or illness. Finally, using cultural knowledge to treat a patient also helps a
nurse be open-minded to treatments that can be considered non-traditional, such as spiritually based therapies like
meditation and anointing.

Nowadays, nurses must be sensitive to their patients’ cultural backgrounds when creating a nursing plan. This is
especially important since so many people’s culture is so integral in who they are as individuals, and it is that culture that
can greatly affect their health and their reactions to treatments and care. With these, awareness of the differences allows
the nurse to design culture-specific nursing interventions.

Through Leininger’s theory, nurses can observe how a patient’s cultural background is related to their health and use that
knowledge to create a nursing plan that will help the patient get healthy quickly while still being sensitive to his or her
cultural background.