THEORETICAL FOUNDATIONS IN NURSING

MADELEINE LEININGER’S THEORY OF

TRANSCULTURAL NURSING
(Week No.11)

INTRODUCTION

Transcultural nursing has been integrated into modern nursing education due to the
increased heterogeneity of patient populations. As more people from a variety of cultures and
with a variety of ethnicities now utilize healthcare facilities, nurses need to be aware of their
varying perceptions and levels of tolerance for healthcare. This situation can lead to departures
from the practice norms that would otherwise direct patient care, thus opening up a wide array
of options regarding treatments and follow-ups. Decision-making in patient care involves many
important considerations, including patients' attitudes and how they will react to treatment
advice (Albougami etal. 2016)

Leininger’s Transcultural Theory is for nursing care to have beneficial meaning and health
outcomes for people of different or similar cultural backgrounds. This module focuses on the
discussion of the Transcultural theory of Leininger for the student nurses to be aware to the
cultural needs of clients, relevant to understand the social and cultural reality of the client,
family, and community.

LEARNING OUTCOME

After finishing this module the student will be able to:

1. Know the purpose of the theory

Far Eastern University 1

Manila, Philippines
 THEORETICAL FOUNDATIONS IN NURSING

2. Define key terms

3. Explain the Concept of Leininger’s theory of Transcultural Nursing
4. Understand the concept of culture

OUTLINE
1. Credentials and Background of the Theorist
2. Definition of terms
3. Major Assumptions
4. Theoretical Assertions
a. Nursing
b. Health
c. Environment
d. Person
5. References

CONTENT

Credentials and Background of the Theorist

Madeleine Leininger was born on July 13, 1925 in Sutton, Nebraska. She lived in a farm with
her four brothers and sisters and graduated from Sutton High School. After graduation from
Sutton High she was in the U.S. Army Nursing Corps while pursuing a basic nursing program.
It was due to her aunt who suffered from congenital heart disease that led her to pursue a
career in nursing.

In 1945, Madeleine Leininger, together with her sister, entered the Cadet Nurse Corps which is a federally-
funded program to increase the numbers of nurses being trained to meet anticipated needs during World
War II.

Far Eastern University 2

Manila, Philippines
 THEORETICAL FOUNDATIONS IN NURSING

She earned a nursing diploma from St. Anthony’s Hospital School of Nursing, followed by undergraduate
degrees at Mount St. Scholastica College and Creighton University. Leininger opened a psychiatric nursing
service and educational program at Creighton University in Omaha, Nebraska. She earned the equivalent of
a BSN through her studies in biological sciences, nursing administration, teaching and curriculum during
1951-1954. She received a Master of Science in Nursing at Catholic University of America in 1954.

In 1965, Leininger embarked upon a doctoral program in Cultural and Social Anthropology at the University
of Washington in Seattle and became the first professional nurse to earn a PhD in anthropology.

Madeleine Leininger was an internationally known educator, author, theorist, administrator, researcher,
consultant, public speaker and the developer of the concept of transcultural nursing that has a great impact
on how to deal with patients of different culture and cultural background.

She is a Certified Transcultural Nurse, a Fellow of the Royal College of Nursing in Australia, and a Fellow of
the American Academy of Nursing. Her theory is now a nursing discipline that is an integral part of how
nurses practice in the healthcare field today.

Purpose of the Transcultural Nursing Theory

• The central purpose of the theory is to discover and explain diverse and universally culturally based
care factors influencing health, well-being, illness, or death of individual or groups.

• This theory could also be used in research studies, in order to provide culturally congruent, safe, and
meaningful care to clients of diverse or similar cultures.

Far Eastern University 3

Manila, Philippines
 THEORETICAL FOUNDATIONS IN NURSING

MAJOR CONCEPTS AND DEFINITIONS

Definition
1. Transcultural Nursing 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.
Transpersonal caring relationships are a spiritual union. Sitzman (2007)
describe the relationship as a "connection that embraces the spirit or
soul of the other through the process of full, authentic, caring/healing
attention in the moment. Nurses who practice transpersonal caring show
a genuine desire to be present and centered in their interactions with
their patients.

2. 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).
3. Professional Nursing Formal and cognitively learned professional care knowledge and practice
Care 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.
4. Cultural and Social This involves dynamic patterns and features of interrelated structural
Structure Dimension 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,

Far Eastern University 4

Manila, Philippines
 THEORETICAL FOUNDATIONS IN NURSING

and how these factors may be interrelated and function to influence

human behavior in different environmental contexts.
5. Traditional Concepts of Be aware that health concepts held by many cultural groups may result
Health and Disease in people choosing not to seek Western medical treatment procedures
because they do not view the illness or disease as coming from within
themselves.

In Eastern cultures and other cultures in the developing world, the focus
of control for disease causality often is centered outside the individual,
whereas in Western cultures, the focus of control tends to more internally
oriented.

Recognize the need to be more flexible in the design programs, policies,

and services to meet the needs and concerns of the culturally diverse
population, groups that are likely to be encountered.
6. Care Refers to assisting, supporting, enabling behaviors that ease or improve
a person’s condition.
Essential for a person’s survival, development, and ability to deal with
life’s events.
7. Cultural Care The values and beliefs that assist, support, or enable another person or
group to maintain well-being, improve personal condition, or face death
or disability.
8. World view Refers to the outlook of a person based on a view of the world or
universe.
9. Folk health or Well being Refers to care or care practices that have special meaning in the culture.
System
10. Traditional Concepts of Be aware that folk illnesses are generally learned syndromes that
Illness Causality individuals from particular cultural groups claim to have and from which
their culture defines etiology, behaviors, diagnostic procedures,
prevention methods, and traditional healing or caring practices.

Far Eastern University 5

Manila, Philippines
 THEORETICAL FOUNDATIONS IN NURSING

11. Concept of Culture This is learned by each generation through both formal and informal
life experiences.
12. Cultural Awareness It is an in-depth examination of one’s own background, recognizing
biases and prejudices, and assumptions about other people.

Far Eastern University 6

Manila, Philippines
 THEORETICAL FOUNDATIONS IN NURSING

Major Concepts

Leininger (1991) identified three nursing decision and action models to

achieve cultural congruent care. All the models of professional decisions and
actions are aimed to assist, support, or enable people of particular cultures.

3 Models for Congruent Decisions and Actions

1. Cultural preservation or maintenance. Retain and or preserve

relevant care values so that clients can maintain their well-being,
recover from illness, or face handicaps and/or death.

2. Cultural care accommodation or negotiation. Adapt/negotiate with

others for a beneficial or satisfying health outcome.

3. Cultural care repatterning or restructuring. Change or greatly

modify client’s life ways for a new, different and beneficial health care
pattern.

Concepts..
• Illness and wellness are shaped by a various factors including
perception and coping skills, as well as the social level of the patient.

• Cultural competence is an important component of nursing.

• Culture influences all spheres of human life. It defines health, illness,

and the search for relief from disease or distress.

• Religious and Cultural knowledge is an important ingredient in health

care.

• The health concepts held by many cultural groups may result in

people choosing not to seek modern medical treatment procedures.

• Health care provider need to be flexible in the design of programs,

policies, and services to meet the needs and concerns of the culturally
diverse population, groups that are likely to be encountered.

• Most cases of lay illness have multiple causalities and may require
several different approaches to diagnosis, treatment, and cure
including folk and Western medical interventions..

Far Eastern University 7

Manila, Philippines
 THEORETICAL FOUNDATIONS IN NURSING

• The use of traditional or alternate models of health care delivery is

widely varied and may come into conflict with Western models of
health care practice.

• Culture guides behavior into acceptable ways for the people in a

specific group as such culture originates and develops within the social
structure through interpersonal interactions.

• For a nurse to successfully provide care for a client of a different

cultural or ethnic to background, effective intercultural communication
must take place.

Far Eastern University 8

Manila, Philippines
 THEORETICAL FOUNDATIONS IN NURSING

The Sunrise Model of Madeleine Leininger’s Theory

The Sunrise Model on Cultural Care

The Sunrise Model 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.

In this model, the goal of the

nurse is to render efficient and
effective nursing care.
Leininger’s model of cultural
care can be viewed as the rising
sun. The model reflects
influences of one’s worldview on
cultural and structure
dimensions. The cultural and
social structure dimensions
include technological, religious,
philosophic, kinship, social,
value and lifeway, political,
legal, economic, and educational
factors. Each of these identified
systems affects health. These
cultural and social structure
dimensions in turn influences
environment and language,
wherein emphasis should be
placed since this is where the
patient/client find themselves such as home conditions, access to particular
types of food and family access to transport. Environment and language
influence the involved health systems – the folk, professional and nursing
systems. The folk health system includes the traditional beliefs and practices
on health care while the professional health systems are those practices. This

Far Eastern University 9

Manila, Philippines
 THEORETICAL FOUNDATIONS IN NURSING

knowledge provides culturally specific meanings and expressions in relation to

care and health. The next focus is on the generic or folk system, professional
care systems, and nursing care. Information about these systems includes the
characteristics and the specific care features of each. The combination of the
folk health system and the professional health system meets the biological,
psychosocial, and cultural health needs of the patient/client. This information
allows for the identification of similarities and differences or cultural care
universality and cultural care diversity. It is followed by nursing care decisions
and actions which involve cultural care preservation or maintenance, cultural
care accommodation or negotiation and cultural care repatterning or
restructuring. It is here that nursing care is delivered.

THEORETICAL ASSERTIONS

NURSING
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

1. Referred to as human being

2. 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.

HEALTH

1. 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.

Far Eastern University 10

Manila, Philippines
 THEORETICAL FOUNDATIONS IN NURSING

ENVIRONMENT

1. This is not specifically defined by Leininger.

2. The concepts of worldview, social structure, and environmental context

are discussed.

3. It is closely related to the concept of culture.

Refer to the links below on Leininger’s interview on the importance of

transcultural nursing:
https://www.youtube.com/watch?v=a4GTo_uthZQ
https://www.youtube.com/watch?v=6xchWCgeMM4

REFERENCES

Alligood, M. R., & Marriner-Tomey, A. (2010). Nursing theorists and their

work (7th ed.). Maryland Heights, Mo.: Mosby/Elsevier.

Quimbao-Udan, J. (2020). Theoretical Foundation in Nursing 2nd Ed. APD

Publishing House

Prepared by:
JUDITH J. SUGAY, PhD, RN
Faculty, FEU-IN

Far Eastern University 11

Manila, Philippines