Madeleine Leninger was born on July 23 1925 in Sutton, Nebraska. She is a Fellow of the Royal College of Nursing in Australia, and a Fellow of the American Academy of Nursing. Her theory of Culture Care is now a nursing discipline. In this modern health care system, nurses should consider culture as an important aspect to provide holistic care.
Rationale for selecting Leininger’s theory
We selected Madeleine Leininger’s Theory of Culture Care: Diversity and Universality for our clinical practice with many reasons. We observe diversity among our patient population on a daily basis. Patients come from different cultures with different values and beliefs. One practice that is accepted in one society or culture may not be accepted in another culture. Patients have the right to get the care based on their cultural values and beliefs. For this reason, it is one of the major responsibilities of nurses to provide culturally competent holistic care to improve patient outcome. For this reason it is of utmost importance to promote cultural competence among all nurses. Leininger (2006a: 16) refers to culturally congruent care as ‘knowledge, acts, and decisions used in sensitive and knowledgeable ways to appropriately and meaningfully fit the cultural values, beliefs, and life ways of clients for their health and well-being, or to prevent illness, disabilities, or death.
Biography of Madeleine Leininger
Madeleine Leininger is well known to as a nursing theorist who developed transcultural nursing model. She was born in Sutton, Nebraska in July 23, 1925. She
received her nursing diploma from St. Anthony’s School of Nursing in Denver, and in 1950, she received her bachelor of Nursing from St. Scholastica College. She completed her Master of Science in mental health nursing from Catholic University of America in 1954. She attended University of Washington in 1965 and studied cultural and social anthropology in which she was awarded a Ph.D. In her earlier years in the nursing profession, she realized “care” as one of the important function in nursing. Transcultural nursing was an idea that was formulated by Leininger when she realized that the behaviors of the children in the guidance home were recurrent patterns from their cultural background. Transculture theory was developed to provide nursing care in a holistic and comprehensive approach. Her theory gives nurses avenues on how to provide care in harmonious way through applying the patient’s cultural beliefs, values and practices.
Classification of the Theory
McEwen & Wills (2011) places Leininger’s Theory in the high middle range theory classification based on the level of abstraction or degree of specificity. Leininger states that it is not a grand theory because it has particular dimensions to assess for a total picture. It is a holistic and comprehensive approach, which has led to broader nursing practice applications than is traditionally expected with a middle-range, reductionist approach .
Assumptions of Theory of Culture Care
The central focus of the theory is care. Caring is important for health, well-being, healing, growth, survival, and for facing illness or death. Culture care is a wholistic approach to serve human beings in health, illness and dying. There is no cure without giving and receiving care. Concepts of culture care have different and similar aspects in different parts of the world. Each human culture varies in folk remedies, professional knowledge and practice. Knowledge regarding this variation is important for the nurses to know to provide quality care. Worldview, language, religious, spiritual, social, political, educational, economic, technological, ethno historical, and environmental factors affect culture care values, beliefs and practices. Healthy applications of culturally based care promote the wellbeing of the patient. Thorough knowledge of the culture is necessary to provide competent care to the clients. Clients who experience nursing care without incorporating the cultural issues experience stress, cultural conflict, noncompliance, and ethical moral concerns.
Major concepts of the theory
Understanding of major concepts of theory is important to understand the whole theory. Care is to assist others with real or anticipated needs in an effort to improve a human condition of concern or to face death. Caring is an action or activity directed towards providing care. Culture refers to learned, shared, and transmitted values, beliefs, norms, and life ways of a specific individual or group that guide their thinking, decisions, actions, and patterned ways of living. Cultural care refers to multiple aspects of culture that influence and enable a person or group to improve their human condition or to deal with illness or death. Cultural care diversity refers to the differences in meanings, values, or acceptable modes of care within or between different groups of people. Cultural care universality refers to common care or similar meanings that are evident among many cultures. Person refers to an individual human caring and cultural being as well as a family, group, a social institution, or a culture. Nursing is a learned profession with a disciplined focused on care phenomena. Worldview refers to the way people tend to look at the world or universe in creating a personal view of what life is about. Cultural and social structure dimensions include factors related to religion, social structure, political/legal concerns, economics, educational patterns, and the use of technologies, cultural values, and ethno history that influence cultural responses of human beings within a cultural context. Health refers to a state of well-being that is culturally defined and valued by a designated culture. Cultural care preservation or maintenance refers to nursing care activities that help people of particular cultures to retain and use core cultural care values related to healthcare concerns or conditions. Cultural care accommodation or negotiation refers to creative nursing actions that help people of a particular culture adapt to or negotiate with others in the healthcare community in an effort to attain the shared goal of an optimal health outcome for client(s) of a designated culture (Summarized from Leininger, 2001, pp. 46-47).
Major Propositions of the Theory
Leininger (1991) proposes that there are three modes for guiding nurse’s judgments, decisions, or actions in order to provide appropriate, beneficial, and meaningful care. They are cultural preservation or maintenance, cultural care accommodation or negotiation, and cultural care repatterning or restructuring. Cultural preservation or maintenance retain or preserve relevant care values so that clients can maintain their well-being, recover from illness, or face handicaps and/or death. Cultural care accommodation or negotiation adapt or negotiate with the others for a beneficial or satisfying health outcome. Cultural care repatterning or restructuring records, change, or greatly modify client’s life ways for a new, different and beneficial health care pattern (Leininger, 2002). The modes have greatly influenced the nurse’s ability to provide culturally congruent nursing care, as well as fostering culturally-competent nurses. These three modes of action can lead to the deliverance of nursing care that best fits with the client’s culture and thus reduce cultural stress and chance for conflict between the client and the caregiver.
Examples from the literature of how the theory been used
According to the article the expression of pain and its management has social and cultural facts that affect the biological state of the person, therefore many societies and cultures have their own ways and perception to pain and how they treat it. In this article the nurses who were giving care to the patient used the international treatment guideline which is a stepwise approach to the treatment of chronic non-cancer pain, involving not only over-the counter anti-inflammatory drug, but also lower dose opioids (Lu & Javier, 2006). The nursing decisions that were used in this article are cultural care accommodation and negations in which the nurses incorporated the holistic approach of using “hilot.” Hilot is a form of traditional Filipino healing massage; the patients were allowed to use natural topical ointment which is commonly found in their culture for relief of pain. This process allowed the patients to be comfortable with the care that they received due to incorporating cultural believes with western medications. This also allowed the patient to have knowledge that is related to the treatment of pain, cultural values and heritage especially in the older population who view pain medication such as opioids and administration of it as addictive and would rather suffer through it than to use it. The rational for this is because of the beliefs in the Filipino culture by both prescribing doctors, nurses who administer the medications and the patient that there will be high incidents of the patient becoming addicted opiods when used in treating chronic pain.
The theory of Madeleine Leininger’s will be integrated into practice in the work place by first reviewing the care and cultural values that fits the patient. This will be done by the way the nurse approach, work with and assist or help the patient. The integration will be approach through culturally congruent care or care that fits the culture, because care is enabling process by which the nurse will facilitate assist, guide and help the patient to link what the nurse is trying to help them in the treatment of their disease. This approach will help the nurse mange the diseases from a unique cultural perceptive of the patient. The nurse will monitor home remedies that are unique to the patient during admission and determine if any of them are contraindicated with the medications which the patient was taking. Also integrating religious rituals into the care plan can help make a significant impact on the success of the patient’s treatment; it will impact on the perception of the patient’s health, disease process and treatment. With the patient’s permission, involving close family member can give the patient emotional support. Including respect of cultural values may allow the patient to express themselves to the nurse because they may view this as a sign of respect. When a nurse is having difficulty
to get the patient to buy into to a particular treatment, negotiating will help them adapt without compromising the patient’s values. When the nurse develops the basic understanding of health behavior of a culture, this helps to have a positive impact on the nurse-patient relationship.
Concrete examples of how theory would be integrated
During assessment, the plan of care for the patient will be established. This will give the nurse clear concise pertinent information about the patient. Cultural needs such as language barrier, dietary restrict, and beliefs will be assessed. Also rituals that may affect the patient’s care such as dietary restrict will be considered. An example is if the patient is Jewish, or Seventh day Adventist food product or meat made from pork should be omitted from their dietary tray. Meal planning is important because diet plays such an import healing process in the patient’s illness. Language barrier is another cultural issue that may arise during the patient’s stay in the hospital. Using the right interpreter such as someone who is certified and competent in the patient’s language is beneficial to prevent the wrong information being given to the patient. All these will be beneficial, helpful, assistive, and therapeutic in the board sense to maintain an open communication between the nurse and the patient.
In today’s healthcare field, it is required for nurses to 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 whom they are as individuals, and it is that culture that can greatly affect their health, as well as their reactions to treatments and care. The practice of nursing today demands that the nurse identify and meet the cultural needs of
diverse groups understand the social and cultural reality of the client, family, and community, develop expertise to implement culturally acceptable strategies to provide nursing care, and identify and use resources acceptable to the client (Boyle, 1987).
When Leininger’s Transcultural Nursing theory guides nursing practice, nurses can look at how a patient’s cultural background is involved in his or her 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. Nursing is in a new phase of health emphasis where there is an increased display of cultural identity, accompanied by increased demands for culture specific care and general health services. Unquestionably, it is the theory of today and tomorrow and one which will grow in use in the future in our growing and increasingly multicultural world. The research and theory provide a new pathway to advance the profession of nursing and the body of transcultural knowledge for application in nursing practice, education, research, and clinical consultation worldwide.