Theoretical Foundation of Nursing

Grand Nursing Theories

Grand theories are abstract, broad in scope, and complex, therefore requiring further research for
clarification.

Grand nursing theories do not guide specific nursing interventions but rather provide a general
framework and nursing ideas.

Grand nursing theorists develop their works based on their own experiences and their time, explaining
why there is so much variation among theories.

Address the nursing metaparadigm components of person, nursing, health, and environment

Theorists

A. Madeleine M. Leininger : Transcultural Nursing Theory (Links to an external site.) / Culture Care

Theory of Diversity and Universality

I. Biography of Madeleine Leininger

Madeleine Leininger (July 13, 1925 – August 10, 2012)

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 backgrounds.

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.

Education

1945 - entered the Cadet Nurse Corps (a federally-funded program to increase the
number of nurses trained to meet anticipated needs during World War II)

earned a nursing diploma - St. Anthony’s Hospital School of Nursing

undergraduate degrees -Mount St. Scholastica College and Creighton University.

1951-1954 - earned the equivalent of a BSN through her studies in biological sciences,
nursing administration, teaching, and curriculum
1954 - received a Master of Science in Nursing from the Catholic University of
America

1965 - embarked upon a doctoral program in Cultural and Social Anthropology at the
University of Washington in Seattle
- became the first professional nurse to earn a Ph.D. in anthropology

II. Transcultural Nursing Theory

a. involves knowing and understanding different cultures concerning nursing and health-illness caring
practices, beliefs, and values to provide meaningful and efficacious nursing care services to people’s
cultural values health-illness context.

b. focuses on the fact that different cultures have different caring behaviors and different health and
illness values, beliefs, and patterns of behaviors.

c. the cultural care worldview flows into knowledge about individuals, families, groups, communities,
and institutions in diverse health care systems. This knowledge provides culturally specific meanings and
expressions about care and health. The next focus is on the generic or folk system, professional care
system(s), and nursing care. Information about these systems includes the characteristics and the
specific care features of each. This information allows for the identification of similarities and differences
or cultural care universality and cultural care diversity.

III. Major Concepts of the Transcultural Nursing Theory

Transcultural Nursing

Transcultural nursing is defined as a learned subfield or branch of nursing that focuses upon the
comparative study and analysis of cultures concerning nursing and health-illness caring practices,
beliefs, and values to provide meaningful and efficacious nursing care services 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).

Nursing

Nursing is defined as a learned humanistic and scientific profession and discipline which is focused on
human care phenomena and activities 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.

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

Health

It is a state of well-being that is culturally defined, valued, and practiced. It reflects individuals’ (or
groups) ‘ ability to perform their daily role activities in culturally expressed, beneficial, and patterned
lifeways.

Human Beings

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

Leininger did not define these terms; she speaks instead of worldview, social structure, and
environmental context.

Worldview

Worldview is how people look at the world, or 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.

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 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 lifeway, or 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 related to assistive, supportive, or enabling
human care expressions.

Culture Care Universality

Culture care universality indicates the common, similar, or dominant uniform care meanings, patterns,
values, lifeways, or symbols 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. It is generic or
folk knowledge.

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

The knowledge that 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 describe, explain, and interpret human
lifeways within particular cultural contexts 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.

CareCare 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 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 the outsider’s efforts, both subtle and not so subtle, to impose their own
cultural values, beliefs, behaviors upon an individual, family, or group from another culture. (Leininger,
1978)

IV. Sunrise Model of Madeleine Leininger’s Theory

- enables nurses to develop critical and complex thoughts about nursing practice. These thoughts
should consider and integrate cultural and social structure dimensions in each specific context, besides
nursing care’s biological and psychological aspects.

Madeleine Leininger's Sunrise Model

The cultural care worldview flows into knowledge about individuals, families, groups, communities, and
institutions in diverse health care systems. This knowledge provides culturally specific meanings and
expressions concerning 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. This information allows for the identification of similarities and differences
or cultural care universality and cultural care diversity.

V. Three modes of nursing care decisions and actions

Cultural care preservation or Maintenance

Cultural care preservation is also known as maintenance. It 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.

Cultural 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 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 established with the
clients. (Leininger, 1991)

VI. Assumptions

-Different cultures perceive, know, and practice care differently, yet there are some commonalities
about care among all world cultures.

-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 there will be cultural similarities and differences between the care-receivers (generic) and the
professional caregivers in any culture.
-Care is the distinct, dominant, unifying, and central focus of nursing, and while curing and healing
cannot occur effectively without care, care may occur without a cure.

-Care and caring are essential for humans’ survival and 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 of serving 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 nurse knows the clients. 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, beliefs, and values), the client will demonstrate signs of
stress, noncompliance (Links to an external site.), cultural conflicts, and/or ethical or moral concerns.

Analysis

-In Leininger’s nursing theory, it was stated that the nurse would 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 that would
make it difficult to penetrate.

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

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

VII. Strengths

Leininger has developed the Sunrise Model in a logical order to demonstrate the interrelationships of
the concepts in her theory of Culture Care Diversity and Universality.
Leininger’s theory is essentially parsimonious in that the necessary concepts are incorporated in such a
manner that the theory and its model can be applied in many different settings.

It is highly generalizable. The concepts and relationships presented are at a level of abstraction, which
allows them to be applied in many different situations.

Though not simple in terms, it can be easily understood upon the first contact.

Weakness

The theory and model are not simple in terms.

VIII. Conclusion

-According to transcultural nursing, nursing care aims to provide care congruent with cultural values,
beliefs, and practices.

-Cultural knowledge plays a vital role for nurses on how to deal with the patients. To start, it helps
nurses to be aware of how the patient’s culture and faith system provide resources for their experiences
with illness, suffering, and even death. It helps nurses understand and respect the diversity that is often
present in a nurse’s patient load. It also helps strengthen a nurse’s commitment to nursing based on
nurse-patient relationship (Links to an external site.)s and emphasizing the whole person rather than
viewing the patient as simply a set of symptoms or illness. Finally, using cultural knowledge to treat a
patient also helps a nurse be open-minded to treatments that can be considered non-traditional, such as
spiritually based therapies like meditation and anointing.

-Nowadays, nurses must 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 who they are as
individuals, and it is that culture that can greatly affect their health and their reactions to treatments
and care. With these, awareness of the differences allows the nurse to design culture-specific nursing
interventions.

-Through Leininger’s theory, nurses can observe how a patient’s cultural background is related to their
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 backgrou