Madeleine ILeininger Theory PDF

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Running head: THEORY OF TRANSCULTURAL NURSING

Madeleine Leininger: Theory of Transcultural Nursing Jasmin Alolong, Folake Agbalaye, Gladys Mpemba, Adeline Kwaf Katu, Sarah Cadigan, Tawakalit Adebayo, Adrian Walker, and Victor Ologhobo

School of Nursing, University of Texas Permian Basin NURS 3362: Theoretical and Evidence Based Concepts of Professional Nursing Dr. Jackson November 24, 2020

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THEORY OF TRANSCULTURAL NURSING Introduction The Leininger Theory is a Transcultural Nursing Theory that deals with knowing and understanding different cultural practices on carrying out healthy caring methods, beliefs, and values to provide useful and practical nursing services to recipients according to their culture. The Theory is named after the theorist herself, Madeleine Leininger. Dr. Madeleine was the first nurse to hold a Doctor of Philosophy in cultural and social anthropology. She was born in Sutton, Nebraska, and began her nursing career after graduating from the diploma program at St. Anthony’s School of Nursing in Denver, where she was also in the U.S. Army Nurse Corps (Alligood, 2014). While working at the University Hospital in Cincinnati, she observed that majority of the staff were unaware of cultural factors that influence the behavior of children. She became concerned that her nursing decisions and actions, and that of other nurses was not helping children they were taking care of. This knowledge gap led her to pursue a doctorate degree in cultural, social, and psychological anthropology at University of Washington, Seattle (Alligood, 2014). Dr. Madeleine Leininger’s work on the Theory of Transcultural Nursing occurred during her study with the Gadsup People of the Eastern part of Papua New Guinea highland in the 1950s (Leininger,1995). During her two years with the indigenous people of New Guinea, she undertook an ethnographical and ethnonursing study of villages. Her experiences enlightened her to several marked cultural differences related to health and well-being practices and led to her development of Culture Care Theory that gave rise to the Theory of Transcultural Nursing (Leininger, 1995). Dr. Madeleine was able to discover that a lack of cultural and care knowledge is the missing piece to a nurse’s understanding of how to care and support compliance, healing,

THEORY OF TRANSCULTURAL NURSING and wellness. The idea sparked by her exposure paved the way for Leininger to expand nurses’ knowledge and understanding of diverse cultures lacking in healthcare. Dr. Madeleine Leininger defined nursing as 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 (Gonzalo, 2019) Overview of theory The Transcultural Nursing Theory or Culture Care Theory by Madeleine Leininger involves knowing and understanding different cultures with respect to nursing and health-illness caring practices, beliefs and values with the goal to provide meaningful nursing care to people in accordance to their cultural beliefs and illness. (Gonzalo, 2019). This theory focuses on the fact that there are different cultures that have different ways of caring for one’s health, illness values, beliefs, and behaviors. With the knowledge that nurses are acquainted with a diverse patient population, this theory goes into play by guiding and informing healthcare professionals on efficient and ethical way to deliver proper nursing care. Furthermore, the theory states that nurses cannot separate worldviews, social structures factors, and cultural beliefs or practices from health, wellness, illness, or care when working with a diversity of cultures because these factors are closely linked and interrelated. (McFarland, 2002). Ultimately, the goal of this theory is to implement a body of transcultural nursing knowledge for the best care practices by future generations of nurses beginning their journey into the healthcare field.

THEORY OF TRANSCULTURAL NURSING Major Concepts of Theory In developing her theory on transcultural nursing, Leininger uses four major tenets that are hypothesized and created with the Culture Care Theory (Leininger & McFarland, 2002). 1.

Culture care representations and practices are different, but there are similarities that make

them universal attributes. 2.

The influences of the cultural care model used in predicting health, illness, healing and

how persons deal with death and disability are the worldview, social structure factors, ethnohistory, environmental context, language, and generic and professional care. 3.

In different environmental contexts, the generic emic and professional ethic health factors

have a huge influence on health and illness outcomes. 4.

a) Culture care preservation b) culture care accommodation, negotiation; and c) culture

care repatterning and/or restructuring are the three culturally based actions and decision modes that guide in providing culturally compatible, secure, and significant health care to cultures Leininger’s theory is developed using anthropology and nursing disciplines (Leininger, 1991). She described transcultural nursing as an area of nursing that focuses on the relative study and assessment of different cultures and subcultures that exist, while ensuring respect of their caring values, expressions, health-illness views, and form of behavior. Leininger’s theory on transcultural nursing serves the purpose of discovering human care differences and universalities in relation to worldview, social structure, and other dimensions (Alligood, 2014). Also, her theory on transcultural nursing serves to find methods to provide culturally compatible care to persons of different or same cultures to preserve or regain their well-being or health, or to experience death in a way that is culturally appropriate (Leininger, 1991). Leininger contends

THEORY OF TRANSCULTURAL NURSING that since culture and care knowledge are the most important means of understanding people, both are central to and imperative to nursing education and practice. She states that because we live in a multicultural world, transcultural nursing is one of the most important, relevant, and promising areas of study, research, and practice (Leininger, 1991). She foresees that cultural nursing knowledge and skills will be vital when making all nursing decisions and actions for effective and successful outcomes (Leininger & McFarland, 2002b). These are the major concepts in Madeleine Leininger’s transcultural nursing theory (Alligood, 2014): Transcultural Nursing: Transcultural nursing is an area of humanistic and scientific knowledge and practices that are focused on providing meaningful and efficacious nursing care services to people according to their cultural values and health-illness context. Culturally Competent Nursing Care: Culturally competent nursing care has to do with the use of culturally grounded care and health awareness in sensitive, inventive, and meaningful ways to conform to the way of living and needs of individuals or groups for beneficial and meaningful health and well-being, or to face illness, disabilities, or death. Ethnonursing: Ethnonursing is the study of nursing care beliefs, values, and practices that are cognitively perceived and known by a designated culture through their direct experience, beliefs, and value system. Environmental Context: Environmental context has to do with every aspect of an environment (physical, geographic, and sociocultural), situation, or event that gives interpretative meanings to guide human expressions and choices with reference to an environment or situation in particular.

THEORY OF TRANSCULTURAL NURSING Ethnohistory: Ethnohistory is the sequence of facts, events, or development over time as known, witnessed, or documented about a particular people’s culture. Health: Health is a state of well-being or a restorative state that is culturally constituted, defined, valued, and practiced by individuals or groups and that helps them to function in their daily lives. Emic/Etic: Emic is the local, indigenous, or the insider’s view and value about a phenomenon. Etic is the outsider’s or universal view and value about a phenomenon. Human Care and Caring: This refers to the abstract and manifest phenomena with representation of supportive ways to help others or self with evident or anticipated needs that will improve health, human condition, way of life, or to face dying. Culture: Culture is a patterned way of life, values, norms and beliefs of individuals or institutions that are learned, shared, and can be passed from one generation to another. Culture Care: Culture care is the subjectively and objectively learned and transmitted values, beliefs, and way of life that facilitates or assists another person or group of persons to maintain their well-being, health, improve their human condition and lifeway, or to deal with illness, handicaps, or death. Culture Care Diversity: This refers to cultural variability or differences in care beliefs, meanings, patterns, values, symbols, and lifeways within and between cultures and human beings. Cultural Care Universality: Cultural Care Universality has to do with similar and culturally based care meanings, patterns, values, symbols, and way of life that reflects care as a universal humanity.

THEORY OF TRANSCULTURAL NURSING Worldview: Worldview has to do with the way that an individual or group of people understand the world around them as a value, stance, picture, or their perspective about life and the world. Cultural and Social Structure Dimension: Cultural and social structure dimension has to do with dynamic, holistic, and interrelated patterns of structured features of a culture (or subculture), including religion (or spirituality), kinship (social), political characteristics (legal), economics, education, technology, cultural values, philosophy, history, and language. Cultural Care Preservation or Maintenance: This refers to assistive, supportive, facilitative, or enabling professional actions and decisions that help people of a particular culture to retain or maintain meaningful care values and lifeways for their well-being, to recover from illness, or to deal with handicaps or dying. Culture Care Accommodation or Negotiation: These are assistive, supportive, facilitative, or enabling professional actions and decisions that help people of a designated culture (or subculture) to adapt to or to negotiate with others for meaningful, beneficial, and congruent health outcomes. Culture Care Repatterning or Restructuring: Culture Care repatterning or restructuring are the assistive, supportive, facilitative, or enabling professional actions and decisions that help clients reorder, change, or modify their lifeways for new, different, and beneficial health outcomes. The importance of Leininger’s theory Transcultural nursing has an important role in nursing. The ability to provide nursing care that is culturally specific to the requirement of a patient is an essential goal in nursing. This places the transcultural nursing theory central to the domain of nursing knowledge acquisition

THEORY OF TRANSCULTURAL NURSING and use. This theory is quite useful, applicable, and of great essence to nursing practice, education, and research. Care as the primary focus and base of nursing knowledge and practice is very important for advancing nursing knowledge and practices (Ray, 2013). Other importance of Leininger’s theory of Transcultural nursing are highlighted below. Preservation and Maintenance Approach: This has to do with choices that would help to maintain and preserve desirable values and beliefs. An example is the encouragement of direct care such as bathing, feeding, and other activities of daily living by family members, especially those that are interested in actively contributing in the care of a loved one (Sagar, 2011) Negotiation and Accommodation: Transcultural nursing helps with adaptation and transaction for care that is fitting for the culture of the individual, families or groups. For example, a nurse teaches a Filipino American patient that although garlic may lower his blood pressure, he still needs to take the antihypertensive medications that are prescribed by the care provider (Sagar, 2011). Repatterning or Restructuring: This has to do with working with the individual in a mutual decision-making process that accommodates his/her cultural needs. The nurse modifies or changes the nursing action to achieve better health outcomes while taking into consideration the patient’s cultural needs (Sagar, 2011). The nurse sets mutual decisions with the patient to use change or modification in the care plan to achieve improved health outcomes. An example is when there is a patient who does not believe that they need an advance directive because “death is up to God.” The nurse can educate her about having her wishes followed when she can no longer make decisions or speak for herself. How Transcultural Nursing applies to nursing practice:

THEORY OF TRANSCULTURAL NURSING Madeleine Leininger advocated that nursing is a humanistic and scientific mode of helping a client through specific cultural caring processes (cultural values, beliefs and practices) to improve or maintain a health condition (Alligood, 2014). Nursing is 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. Transcultural nursing as a learned subfield or branch of nursing which focuses upon the comparative study and analysis of cultures with respect to nursing and health-illness caring practices, beliefs, and values with the goal to provide meaningful and efficacious nursing care services to people according to their cultural values and health-illness context (Alligood, 2014). Focuses on the fact that different cultures have different caring behaviors and different health and illness values, beliefs, and patterns of behaviors. Awareness of the differences allows the nurse to design culture-specific nursing interventions. Evaluation of Madeleine Leininger’s Theory Overall, according to the practice of transcultural nursing, it is an imperative practice to provide care to patients that is consistent with their cultural values and beliefs. A patient's individualized culture and belief system provides insight to caregivers about the resources available to a patient to aid in the understanding and coping with a disease (Gonzalo, 2019). Diversity is extremely prevalent in the healthcare industry and should be upheld to a high standard. As a nurse, it is our responsibility to treat our patients as a holistic individual, not just a set of symptoms or stereotyped based on a disease process. Every patient is unique and psychological factors need to be addressed alongside the physiological manifestations. Being open minded to non-traditional methods of treatment allows a variety of options to be presented

THEORY OF TRANSCULTURAL NURSING to the patient. Creating that strong nurse patient relationship is effective in adherence to treatment plans, and increased motivation that is needed in times of illness. Leininger’s theory allows nurses to reflect on each patient's cultural values and how those values affect healthcare. When creating a nursing care plan, keeping cultural considerations in mind to allow for optimal healing and progression towards success. Individuals describe themselves based on culture. The more information a nurse can gather, the more individualized the treatment plan can be developed. Patient centered care is valuable in nursing practice as a whole to obtain optimal outcomes. Research studies relevant to transcultural nursing One of the research studies that has used Leininger’s transcultural nursing theory is a research study on care of preterm infants in a Ghanaian community showed the importance of transcultural nursing. The study highlighted the scarcity on the influence of culture on caregiving experiences. The study had an aim of understanding the influence of sociocultural practices on caring for preterm infants in the Ghanaian community. It was discovered that the use of traditional herbal medicines are deemed effective when treating traditional illnesses among preterm infants and having an awareness of the influence of culture in care of preterm infants in the community is important in creating mediations for infant survival. Considering the values ascribed to cultural practices, nurses and healthcare professional need to be able to navigate within the culturally congruent structure of communities and provide patient centered care that is safe for preterm infants. When nurses understand the cultural framework in which they find themselves, they will be able to provide adequate care to patients in the community. Similarly, The article “Transcultural nursing: how do nurses respond to cultural need” showed the relevance of understanding the cultures of other people to effectively meet their

THEORY OF TRANSCULTURAL NURSING needs (Narayansamy, 2003). The research study aimed at understanding how nurses respond to the cultural needs of their clients. It was discovered that most participants in the study believed that patients’ cultural needs should be considered. Furthermore, most of the nurses in the study believed that they responded to the cultural needs of the patients through their religious practices, diets, communication, dying, and prayer. Also, a significant number of the research participant showed wiliness to further their education on meeting the cultural needs of clients (Narayansamy, 2003). Theory of Transcultural Nursing is well valued worldwide. It provides practicing nurses with a holistic and culturally based research findings to use as they care for clients of diverse and similar culture all around the world. Additionally, this theory is important to nursing as it creates fresh insights about care, health, and well-being. Lastly, it provides a pathway, through research, to advance the nursing profession for application in practice, education, and research.

THEORY OF TRANSCULTURAL NURSING References Alligood, M.R. (2014). Nursing Theorists and Their Work. Elsevier Mosby. Adama, E.A., Sundin D., Bayes S. (2020). Sociocultural Practices Affecting the Care of Preterm Infants in the Ghanaian Community. Journal of Transcultural Nursing. https://doi.org/10.1177/1043659620975098 Finn, J. M. (1993). A Transcultural Nurse’s Adventures in Costa Rica: Using Leininger’s Sunrise Model for Transcultural Nursing Discoveries. Journal of Transcultural Nursing, 4(2), 19– 23. https://doi.org/10.1177/104365969300400204 Gonzalo, A (2019). Madeleine Leininger: Transcultural Nursing Theory. Retrieved November 25, 2020, from https://nurseslabs.com/madeleine-leininger-transcultural-nursing-theory/ Leininger, M. (1991c). The transcultural nurse specialist: Imperative in today’s world. Perspective in Family and Community Health, 17, 137–144. Leininger, M. (1995a). Culture care theory, research, and practice. Nursing Science Quarterly, 9(20), 71–78. Leininger, M., & McFarland, M. R. (2002). Transcultural nursing: Concepts, theories, research, & practice (3rd ed.). New York: McGraw-Hill. McFarland, M. R. (2002b). Part II: Selected research findings from the culture care theory. In M. Leininger & M. R. McFarland (Eds.), Transcultural nursing: Concepts, theories, research, & practice (3rd ed., pp. 99–116). New York: McGraw-Hill. McFarland, M. R., & Wehbe-Alamah, H. B. (2019). Leininger’s Theory of Culture Care Diversity and Universality: An Overview With a Historical Retrospective and a View

THEORY OF TRANSCULTURAL NURSING Toward the Future. Journal of Transcultural Nursing, 30(6), 540–557. https://doi.org/10.1...