Culture Care Universality &

Diversity

A Theory of Nursing
By
Dr. M. Leininger
Central Purpose of the Theory
 To discover and explain
diverse and universal
culturally based care factors
influencing the health, well
being , illness or death of
individuals or groups
 Goal of the Theory
 To provide culturally
congruent care that
would contribute to the
health or well being of
people or to help them
face disabilities, dying,
or death using the three
modes of nursing care
actions and decisions
Modes of Nursing Care Actions
and Decisions
 Culture Care
Preservation or
Maintenance
 Culture Care
Accommodation or
Negotiation
 Culture Care
Repatterning or
Restructuring
Culture Care Preservation or
Maintenance
 Refers to 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
Client Care Preservation or
Maintenance
 Leininger’s theory gives credibility to
traditional generic care practices which
have beneficial health outcomes and
have withstood the test of time
 Through the mode of culture care
preservation, acupuncture can be used
in conjunction with Western treatment
modes to treat illness or reduce pain
Culture Care Accommodation
or Negotiation
 Refers to those assistive, supporting,
facilitative, or enabling creative
professional actions and decisions that
help people of a designated culture (or
subculture) to adapt to or to negotiate
with others for a beneficial or satisfying
health outcome with professional care
providers
Culture Care Accommodation
or Negotiation
 Sometimes generic care practices need to be
modified through culture care
accommodation
 If a Greek client who eats too much salty
feta cheese and olives requires a low sodium
diet, then the client, along with family and
nurse need to explore ways to enjoy Greek
cultural foods with a lower sodium content
Culture Care Repatterning or
Restructuring
 Refers to those assistive, supporting,
facilitative, or enabling professional actions and
decisions that help a client’(s) reorder,
change , or greatly modify their lifeways for
new, different , and beneficial health care
patterns while respecting the client(s) cultural
values and beliefs and still providing beneficial
ore healthier lifeways than before the changes
were coestablished with the client(s)
Culture Care Repatterning or
Restructuring
 Culture care Repatterning may be
necessary if a family practiced “coining”
on their children, a generic practice
where a coin is rubbed over painful
areas to eliminate “bad wind” in the
body causing dark bruising
 This practice may be misinterpreted as
child abuse by authorities
Culture Care Repatterning or
Restructuring
 Culture care repatterning would occur when
the nurse teaches that this care practice is not
acceptable in the new country and would
explore alternative generic practices for
elimination of “bad wind”
 Sometimes the nurse will need to do the
repatterning such as when the nurse values
female independence and assertiveness but the
female client comes from a patriarchal culture
 Metaparadigm Concepts
 Care
 Health
 Environmental context
 Nursing
 Person
 Care
 Refers to abstract & concrete
phenomena related to
assisting, supporting or
enabling experiences or
behaviours toward or for
others with evident or
anticipated needs to
ameliorate or improve human
condition or lifeway
 Health
 Refers to a state of well being
that is culturally defined,
valued and practiced and
which reflects the ability of
individuals (or groups) to
perform their daily role
activities in culturally
expressed, beneficial and
patterned lifeways
 Environmental Context
 Refers to the totality of an
event, situation, or particular
experiences that give meaning
to human expressions,
interpretations and social
interactions in particular
physical, ecological,
sociopolitical and/or cultural
settings
 Nursing
 Leininger debates the inclusion of “nursing” in the
traditional paradigm concepts because “nursing should
not be explained in terms of nursing itself”
 Nursing refers to a learned humanistic and scientific
profession and discipline which is focused on human
care phenomena and activities in order 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
 Person
 Leininger does not identify
person as a central concept
of her theory because “it
would be inappropriate to
focus only on the person as
central to nursing because
nurses function with families,
groups,communities, and
institutions”
 Critique
 Simplicity
 Generality
 Empirical Precision
 Derivable
Consequences
 Simplicity
 Because the concepts of transcultural nursing theory
are complex and multiple, the theory is not simple
 The theory is truly transcultural, global in scope and
highly complex requiring knowledge and appreciation
of transcultural and anthropology insights
 Because of its holistic and comprehensive nature,
several concepts and constructs related to social
structure, environment, and language are important
to understand to see how care and health are
influenced by these dimensions
 Simplicity
 The theory shows multiple interrelationships
of concepts and diversity of key concepts
 It requires anthropological and transcultural
nursing knowledge to be used fully and
accurately by nursing researchers
 Once the users of the theory have
conceptualized the theory, Leininger finds that
nursing students find it highly practical,
relevant and more simple than complex
 Generality
 The theory demonstrates this criterion as it is a qualitatively
oriented theory that is broad, comprehensive and worldwide
in scope
 It is useful and applicable to both groups and individuals
 Many aspects of culture, care and health, as these factors
impact on nursing, are being studied
 From this culture-specific data, a few universal care
constructs are being identified
 More research is needed, and a greater number of the
world’s cultural groups need to be studied to validate the
caring constructs
 Generality
 The theoretical model is a guide for the
study of any culture and for
comparative study of several cultures
 Findings from the theory are being used
in client care in a variety of health and
community settings worldwide
 Empirical Precision
 The transcultural nursing theory is researchable, and
qualitative research has been the primary paradigm
to discover largely unknown phenomena of care and
health in diverse cultures
 Accuracy of data derived with the use of
ethnomethods or from an emic viewpoint is leading
to high validity and reliability of data
 The qualitative criteria of credibility and confirmability
from in-depth studies of informants and their
contexts are becoming clearly evident
 Scope
 Theory has multiple levels of scope dealing
with human cultures and nursing worldwide
– Broad macro level (etic analysis)
– Middle range (emic analysis)
– Concrete empirical level

Sunrise model pictorially depicts

the multiple theoretical levels
 Derivable Consequences
 Professional Standards
 Practice
 Education
 Research
 Administration
 Professional Standards
 CNO’s “Guide to Nurses for Providing
Culturally Sensitive Care”
– In the section on Developing an Approach to
Care the following statement is used: Creativity &
commitment to client-focused care are the key
attributes necessary to integrate cultural
preferences into the plan of care
– Leininger has identified three modes of action or
approaches that can be used to guide nursing
judgments
 Practice
 The area where transcultural knowledge
has made the biggest contribution to
practice is in working with hard to reach
populations which could include the
homeless, refugees, illegal immigrants
 It seems to be more useful in
community than in acute care nursing
 Education
 Inclusion of culture & comparative care in nursing
curricula began in 1966 at the University of Colorado
 The world's first master’s and doctoral programs in
transcultural nursing were implemented in 1977 at
the University of Utah
 Before then Leininger had established transcultural
nursing courses and a department of transcultural
nursing at the University of Washington
 Since 1980, an increasing number of nursing
curricula emphasize transcultural nursing and care
 Education
 In the late 1980’s , four master’s and four doctoral
programs in the U.S. offered transcultural nursing
courses, research experiences, and guided field study
experiences
 Leininger gives about 32 workshops per year on
human care and transcultural nursing
 A library containing her publications etc. has been
established at Madonna University in Livonia
 Research
 To date, approximately 90 Western and non-Western
cultures and sub-cultures have been studied largely
with the use of the ethnonursing and ethnographic
research methods
 Over the past 4 decades, approximately 200
substantive transcultural nursing research studies
have been done in Western and non-Western
cultures
 The majority have been published in the Journal of
Transcultural Nursing
 Administration
 A theoretical & research base is urgently needed for
knowledge to support nursing decisions and actions
and to prevent major cultural conflicts in education &
service
 Less than 5% of nurse administrators have any
graduate preparation in transcultural nursing
 Only a few schools of nursing offer transcultural
administration courses but there are no major
masters or doctoral programs in nursing with
sequenced course offerings in transcultural nursing
administration
Happy Holidays