DR.

CARLOS LANTING COLLEGE

COLLEGE OF NURSING

TRANSCULTURAL NURSING THEORY

MADELEINE LEININGER

BIOGRAPHY

- One of the first nursing theorist and transcultural global

nursing consultant.
- MSN - Catholic University in Washington DC.
- PhD in anthropology - University of Washington.
- She developed the concept of transcultural nursing and the
ethnonursing research model.
- Madeleine Leininger is considered as the founder of the
theory of transcultural nursing.
- Her theory has now developed as a discipline in nursing.
- Evolution of her theory can be understood from her books:
o Culture Care Diversity and Universality (1991)
o Transcultural Nursing (1995)
o Transcultural Nursing (2002)
- Transcultural nursing theory is also known as Culture Care
theory.
- Theoretical framework is depicted in her model called the Sunrise
Model (1997).

TRANSCULTURAL NURSING

A substantive area of study and practice focused on comparative cultural care (caring) values, beliefs,
and practices of individuals or groups of similar or different cultures with the goal of providing 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.

The Transcultural Nursing Theory first appeared in Leininger’s Culture Care Diversity and
Universality, published in 1991, but it was developed in the 1950s. The theory was further developed
in her book Transcultural Nursing, which was published in 1995. In the third edition of Transcultural
Nursing, published in 2002, the theory-based research and the application of the Transcultural theory
are explained.

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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TRANSCULTURAL NURSING THEORY

MADELEINE LEININGER
MAJOR CONCEPTS

Transcultural Nursing

Transcultural nursing is defined 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.

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).

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 in order 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 individual, group, or
institutional cultural values, beliefs, and lifeways in order to provide or support meaningful, beneficial,
and satisfying health care, or well-being services.

Worldview

Worldview is the way in which people look at the world, or at 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.

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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TRANSCULTURAL NURSING THEORY

MADELEINE LEININGER
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 the 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 and lifeway, or to 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 that are related to assistive, supportive, or
enabling human care expressions.

Culture Care Universality

Culture care universality indicates the common, similar, or dominant uniform care meanings, pattern,
values, lifeways or symbols that are 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 is generic
or folk knowledge.
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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TRANSCULTURAL NURSING THEORY

MADELEINE LEININGER
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

Knowledge which 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 which describe, explain, and
interpret human lifeways within particular cultural contexts and 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 to 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 efforts of the outsider, both subtle and not so subtle, to impose his or her
own cultural values, beliefs, behaviors upon an individual, family, or group from another culture.
(Leininger, 1978)

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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TRANSCULTURAL NURSING THEORY

MADELEINE LEININGER
DOMINANT (EMIC) COMPARATIVE FEATURES OF GENERIC (FOLK) AND PROFESSIONAL
HEALTH CARE FORM THE CONSUMER’S VIEW

Generic Folk, Lay Care/Caring Professional Health Care

1. Is humanistically oriented and people-centered. 1. Is a scientifically oriented and patient illness
centered.
2. Uses practical knowledge in familiar ways to care 2. Uses strange or unfamiliar terms and approaches
for others. to treat patients.
3. Focuses on broad holistic lifeways, beliefs, values, 3. Seems fragmented and focuses on symptoms,
and life experiences and worldviews of people. body-mind parts, specific diagnoses, and curative
medical treatments with many diverse staff.
4. Has as its focus caring and curing modes with the 4. Has as its major focus body – mind curing modes
use of home, community, or familiar resources. in unfamiliar medical or hospital settings.
5. Relies on lay practices and understanding cultural 5. Relies on biophysical and emotional factors of
factors to help people regain health and for doing patients with pathologies and treatment regimes.
daily functions.
6. Focuses on preventing illnesses and deaths by 6. Focuses on repairing body or mind conditions
maintaining cultural rules, practices, and taboos based on medical specialists in the profession and
known and tested in the culture over time. some care givers.
7. Focuses on how to use folk home remedies and 7. Cost for services are very high and often beyong
carers or healers as they know what is best for the ability for many poor or minority cultures to use.
client. A client goes to professional staff or hospital Consumers tend to avoid using unless they have
as a last resort. lots of money.
8. Reflects high cultural modes of communication. 8. Reflects low cultural context modes of
communication.
9. Limits use of high-tech tools and instruments; uses 9. Uses many high-tech tolls and machines in hospital
more cultural rituals. with rituals.
*These emic or local characteristics were obtained from Leininger’s in-depth qualitative ethnonursing study with many different cultural
informants over nearly two (2) decades (1973 – 1990). The characteristics reflect the people’s emic views of differences between the
generic folk or lay system with those of professional care systems in 15 non-Western cultures.

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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TRANSCULTURAL NURSING THEORY

MADELEINE LEININGER
LEININGER’S SUNRISE MODEL

The Sunrise Model 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 care.

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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TRANSCULTURAL NURSING THEORY

MADELEINE LEININGER
THREE MODES OF NURSING CARE DECISIONS AND ACTIONS

Culture care preservation or Maintenance

Cultural care preservation is also known as maintenance and 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.

Culture 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 a 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 coestablished
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, ethnohistorical, 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 distinct, dominant, unifying and central focus of nursing, and, while curing and healing
cannot occur effectively without care, care may occur without cure.
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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TRANSCULTURAL NURSING THEORY

MADELEINE LEININGER
 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.

4 METAPARADIGMS

Nursing

Nursing is defined 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.

Health

It is 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.

Human Beings

Such are believed to be caring and to be capable of being concerned about the needs, well-being,
and survival of others. 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

These terms are not defined by Leininger; she speaks instead of worldview, social structure, and
environmental context.
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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TRANSCULTURAL NURSING THEORY

MADELEINE LEININGER
LEININGER’S SHORT CULTURALOGIC ASSESSMENT GUIDE

Phase V Develop a culturally-based client-nurse care plan as a co-participant for decisions

and actions for cultural congruent care.

Phase IV Synthesize themes and patterns of care derived from the information obtained in
phases I, II and III.

Phase III Identify and document recurrent client patterns and narratives (stories) with client
meanings of what has been seen, heard, or experienced.

Phase II Listen to and learn from the client abour cultural values, beliefs, and daily (nightly)
practices related to care and health in the client’s environmental context. Give
attention to generic (home or folk) practices and professional nursing practices.

Phase 1 Record observations of what you see, hear, or experience with clients (includes
dress and appearance, body condition features, language, mannerisms, and general
behavior, attitudes, and cultural features.

EXAMPLE OF TRANSCULTURAL NURSING

Daniel Saunders, 8 years old, has been accompanied to the emergency department by his
mother and grandmother. He has had acute abdominal pain for three days. The nurse notes that his
mother defers questions about Daniel to him or to his grandmother and that none of the three
respond immediately to questions posed or comments made by the staff or look directly at members
of the staff. They sit close together but do not touch one another. The physician wants to admit Daniel
for exploratory abdominal surgery. Daniel’s mother will not sign the admission and surgical
permission form until his grandmother has given her approval to do so. At this point, Daniel’s
grandmother takes a bag of cornmeal from her pocket and begins to sprinkle it around Daniel.

The nurse who lacks transcultural knowledge, or who is unicultural, likely views this family as
strange and suspicious. The lack of direct contacts leads to questions of what are they hiding. The
mother appears indecisive. The family members don’t seem to care much for each other since they
do not touch. And what is the deal with the cornmeal?

The transcultural nurse would recognize that this is a Navajo family and the family members
are demonstrating typical characteristics as described by Phillips and Lobar. The Navajo culture is a
matriarchal culture whose members defer the wisdom of elders. Thus, Daniel is accompanied by his
mother and grandmother, rather than by his mother and father. Also the grandmother is viewed as the
source of wisdom so her decision and support are necessary before the permission slips are signed,
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 DR. CARLOS LANTING COLLEGE
COLLEGE OF NURSING

TRANSCULTURAL NURSING THEORY

MADELEINE LEININGER
even though the dominant American culture considers Daniel’s mother the appropriate person to sign
these admission forms. Daniel is included in responses to questions asked as a value of the culture is
for the individual to speak for him or herself. The lack of direct eye contact and pauses after questions
or statements are made by another are indications of respect, and not trustworthiness. The pauses
are intended to convey both respect and a degree of thought and attention being given to the content
of the message. Navajo family members demonstrate their caring for one another through being
physically close, but not through touching. Illness is viewed as a lack of disturbance in one’s
harmony. The nurse needs to note that it is important to save the cornmeal to return it to the family.

After Daniel’s surgery, the nurse can anticipate that he will accept pain relied. It is also likely
that as many relatives as are available will want to visit – such family support is another cultural
value. Finally, should Daniel be on b.i.d. antibiotic when discharged, the timing of the administration
of his medication should be tied to natural events such as sunup and sundown rather than with meals
or some other activity. The Navajo sense of time tends to be casual and relative and meal times are
likely to be flexible.

ANALYSIS

It was stated that the nurse will 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 which would make it difficult to penetrate.

The whole activity of immersing yourself within a different culture is time-consuming for you to fully
understand their beliefs and practices. Another is that it would be costly in 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 safety of the
nurse especially for cultures with highly taboo practices.

It is highly commendable that Leininger was able to formulate a theory which 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 comprehensively discuss the functions or roles of nurses. It was not stated on how
to assist, support or enable the client to attuning them to an improved lifeway.
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