MADELEINE LEININGER

Culture Care: Diversity and Universality Theory

Submitted to:

Ms. Baculi

TFN Professor

Submitted by:

Merin, Danica G.

Martinez, Benazir Dacallos

Oguan, Alexa Gayle

BSN 105 I Group 8

November 2023
MADELEINE LEININGER
Background

Madeleine M. Leininger is the founder of transcultural nursing and an influential

leader in human care philosophy. She is the first professional nurse with a Ph.D. in
cultural and social anthropology who also has graduate nursing training. She was born
in Sutton, Nebraska, and began her nursing profession after completing a diploma
program at Denver's St. Anthony's School of Nursing. While attending the basic nursing
school, she worked as a Cadet Corps nurse. In 1950, she graduated from Benedictine
College in Atchison, Kansas, with a B.S. in biological science and majors in philosophy
and humanistic studies. After graduation, she worked as an instructor, staff nurse, and
head nurse in a medical-surgical unit, as well as the director of the nursing service at
St. Joseph's Hospital in Omaha. She also studied nursing, nursing administration,
teaching, curriculum, and tests at Creighton University.

In 1954, Leininger earned her M.S.N. in psychiatric nursing from Catholic

University of America in Washington, DC, and went on to work at the University of
Cincinnati's College of Health, where she established the first graduate clinic
specialized program in child psychiatric nursing. Leininger developed Basic Psychiatric
Concepts in Nursing, which was published in 11 languages and used globally, during
her time directed the University of Cincinnati's first graduate-nursing program in
psychiatric nursing and the Therapeutic Psychiatric Nursing Center at the University
Hospital.

Mid1950s, in Cincinnati, while working at the child guidance home, she identified
a lack of cultural and care knowledge as the missing component to a nurse's
understanding of the many variations required inpatient care to support compliance,
healing, and wellness through her observations, which led her to develop the theory of
Transcultural Nursing, also known as Culture Care Theory.

Leininger's 1950s and 1960s work on transcultural nursing, focusing on shared

knowledge and theoretical research interests between nursing and anthropology, laid
the foundation for the field. Her book Nursing and Anthropology: Two Worlds Blends,
which introduced transcultural nursing, laid the foundation for culturally based
healthcare. Transcultural Nursing: Concepts, Theories, and Practice, the first definitive
publication on transcultural nursing in practice, identified major concepts and practices.
She showed in her writing that transcultural nursing and anthropology are
complementary but distinct disciplines.
 In 1966, the first transcultural nursing course was offered at the University of
Colorado. In 1969, she became Dean and Professor of Nursing at the University of
Washington, Seattle, and established the department of comparative nursing care
systems. She also led the establishment of the Research Facilitation Office, which
guided the first nurses in a special Ph.D. program in transcultural nursing. In 1974, she
was appointed Dean and Professor of Nursing at the University of Utah, where she
established the first doctoral program offerings and initiated the first masters and
doctoral programs in transcultural nursing.

Leininger received a National League of Nursing Fellowship in 1960 for fieldwork

in New Guinea's Eastern Highlands. In two Gadsup communities, she investigated the
convergence and divergence of human behavior. Leininger received multiple
distinctions while at Wayne State, including the coveted President's Award for
Excellence in Teaching, the Board of Governors Distinguished Faculty Award, and the
Gershenson Research Fellowship Award.

She was named a Living Legend by the American Academy of Nursing in 1998
and a Distinguished Fellow by the Royal College of Nursing in Australia. The Leininger
Transcultural Nursing Award was created in 1983 to reward exceptional and innovative
transcultural nursing leaders. In Madeleine Leininger's honor, this renowned award will
be known as the Leininger Transcultural Nursing Award and will be administered by the
Transcultural Nursing Society.

Her appointment followed a journey to New Guinea in the 1960s that taught her
the need of nurses understanding their patients' cultures and backgrounds in order to
give care. Some regard her as the "Margaret Mead of nursing," and she is widely
regarded as the originator of transcultural nursing, a curriculum she established at the
School in 1974.

In 1975, she became the American Association of Colleges of Nursing's first full-
time President and one of the organization's initial members. From 1956 to 1995,
Leininger worked as an educator and academic administrator, a writer from 1961 to
1995, a lecturer from 1965 to 1995, a consultant from 1971 to 1992, and a leader in the
field of transcultural nursing from 1966 to 1995.

She was a retired Professor Emeritus of Nursing at Wayne State University and
an adjunct faculty member at the University of Nebraska Medical Center in Omaha. Her
official titles were LL (Living Legend), Ph.D. (Doctor of Philosophy), LHD (Doctor of
Human Sciences), DS (Doctor of Science), CTN (Doctor of Science), RN (Registered
Nurse), FAAN (Fellow American Academy of Nursing), and FRCNA (Fellow of the Royal
College of Nursing in Australia).

Transcultural Nursing Theory (Cultural Care)

Transcultural Nursing Theory (Cultural Care) is based on the fields of

anthropology and nursing. This theory is based on a comparative study and analysis of
various cultures and subcultures around the world in terms of their caring values,
expression, and health-illness beliefs and patterns of behavior, with the goal of
developing scientific and humanistic knowledge to provide culturally congruent nursing
care through “cognitively based assistive, supportive, facilitative, or enabling acts or
decisions that are mostly tailor-made to fit with the individual, group’s, or institution’s
cultural values, beliefs, and lifeways.”

Transcultural nursing is "a substantive area of study and practiced focused on

comparative cultural care (caring) values, beliefs, and practices of individuals or groups
of similar or different cultures to provide 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." Published in 1991, but it was
developed in the 1950s.

The Theory of Culture Care Diversity and Universality aims to understand the
interdependence of care and culture phenomena, highlighting differences and
similarities among cultures. This research-based knowledge is crucial for nursing
practice and healthcare providers, transforming nursing and healthcare for people of
diverse cultures. It supports transcultural nursing, as envisioned by Leininger, and has
led to therapeutic health outcomes, supporting the discipline of transcultural nursing.

Transcultural Care Theory provides for culture-specific and/or generic care that
is culturally congruent, safe, and useful to people of varied and similar cultures for their
health, well-being, and healing, as well as to assist people in dealing with disabilities
and death.

Transcultural Care Theory was independently formed based on Leininger's

philosophy of life, professional nursing experiences, anthropological knowledge,
intellectual scholarly curiosity, spiritual insights, and convictions. Nursing, according to
the theory, is a unique caring profession that covers a wide range of needs and is
influenced by ethnohistory, social structure, and external factors. Nursing is a dynamic
field that takes into account culture, religion, societal development, and a variety of
other elements affecting health and well-being. The theory's goal is to provide
comprehensive and holistic care techniques that address the complexities of humans
and varied cultural lifeways.

Ethnohistory is the study of the development of indigenous peoples' customs via

the examination of historical records as well as other sources of information about their
lives and history.

Leininger contended that the medical model, which concentrated on diseases

and symptom alleviation, was too restrictive for the caring discipline. The cultural care
theory must be wide, holistic, and culture-specific, with the goal of transforming nursing
and traditional medicine via the use of research-based knowledge.

Leininger’S Sunrise Model

 The Leininger Sunrise Model is a framework for culture care theory that
connects anthropological and nursing beliefs and principles. It aids nurses in cultural
evaluations of patients by examining various aspects of culture, including religious,
financial, social, technological, educational, legal, political, and philosophical
dimensions. These factors, along with language and social environment, significantly
influence the services provided by traditional and professional healthcare systems.

The nursing profession considers patients' physical, spiritual, and cultural needs,
aiming to achieve desired clinical outcomes. Leininger's model helps healthcare
professionals avoid stereotyping patients and utilizes three concepts: culture care
maintenance/preservation, culture care negotiation/accommodation, and culture care
restructuring/repatterning.

Cultural preservation involves nurses supporting cultural practices like

acupressure or acupuncture for anxiety and pain relief, while cultural negotiation
involves supporting patients and their families in cultural activities that do not pose
health risks. Cultural restructuring involves helping patients modify or change their
cultural activities, only when certain practices may cause harm to the patient or the
environment. These concepts can guide nurses in achieving their ultimate goals.

Leininger's (1995) holistic concept of a person, which focuses on cultural

variables, pushes nurses to comprehend behavior, adaptability, creativity, and
understanding of diverse cultures in order to provide innovative treatments.

Major Assumptions
This major assumption will support Leininger's Culture Care Diversity and
universality Theory. The definitions were taken from Leininger’s definitive book on the
theory.

1. Nursing's essence is care, and it is a distinct, dominant, central, and unifying

focus.
2. Care (caring) is essential for well-being, healing, growth, survival, and coping
with handicaps or death.
3. Culture care is the most comprehensive and holistic approach to understanding,
explaining, interpreting, and predicting nursing care instances in order to
influence nursing care actions.
4. Nursing is a transcultural humanistic and scientific discipline and profession with
the overarching goal of serving people all over the world.
 5. Care (caring) is essential to curing and healing since there can be no cure
without caring.
6. Cultural care concepts, meanings, expressions, patterns, processes, and
structural forms of care differ (diversity) and are similar (towards similarities and
universalities) across all cultures.
7. Every human culture possesses genetic (lay, folk, or indigenous) care knowledge
and practices, which differ cross-culturally.
8. Culture care values, beliefs, and practices are impacted by and tend to be
influenced by a certain culture's worldview, language, religious (or spiritual),
kinship (social), political (legal), educational, economic, technological,
ethnohistorical, and environmental setting.
9. Culturally based nursing care that is beneficial, healthy, and satisfying
contributes to the well-being of individuals, families, groups, and communities
within their environmental setting.
10. Culturally congruent or beneficial nursing care can occur only when the
individual, group, family, community, or cultural care values, expressions, or
patterns are known and employed appropriately and meaningfully by the nurse
with the people.
11. There are distinctions and similarities in culture care between professional
caregiver(s) and client (generic) care-receiver(s) in every human culture in the
entire world.
12. Clients who get nursing care that is inconsistent with their views, values, and
caring lifestyles will exhibit cultural conflicts, noncompliance, stress, and ethical
or moral concerns.
13. The qualitative paradigm opens up new ways of knowing and discovering
epistemic and ontological features of human care across cultures.

Critique Based on the Characteristics of the Theory

Clarity
The Culture care theory enables a broad, holistic, comprehensive perspective of
individuals, families, cultures, communities and populations. Nurse researchers and
others continue to develop many domains of inquiry using the theory to pursue
scientific and humanistic culture care knowledge. Leininger found that undergraduate
and graduate nursing students alike were excited to use the theory and discover how
practical, relevant and useful it can be to their work.
Simplicity
The theory is truly transcultural and global in scope; it is both intricate, elegant in it’s
simplicity, and applicable to nursing practice.

Generality
The culture care theory demonstrates the criterion of generality because it is a
qualitatively oriented theory that is broad, comprehensive, and worldwide in a scope.
The theory enables the nurse to address the provision of care from the perspective of a
multicultural worldview.

Accessibility
Qualitative research has been the empirical paradigm to discover largely unknown
phenomena of care and health in diverse cultures using the culture theory.

Importance
The theory culture care diversity and universality has guided the provision nursing care
for meaningful and beneficial client outcomes. Providing culture-specific, culturally
congruent care is a vital, necessary, and essential established goal in contemporary
nursing.

Application of the Theory in relation to the 4 Metaparadigms

Person
Leininger had some concern with the use of ‘person’ which is one of the four
metaparadigms from a transcultural knowledge perspective. In nonwestern cultures,
using the term ‘person’ or ‘individual’ may be culturally taboo as it does not agree with
the ‘collectivism’ concept of the culture and are too egocentric whereas in western
cultures, person and individualism are the dominating concepts. Leininger suggests
that the use of ‘person’ in the metaparadigm is questionable as it could lead to “cultural
clashes, biases and cultural imposition practices or to serious ethical-moral conflicts”
(Leininger et al, 2006, p.9). She suggests the use of the term human being as it is more
accepted transculturally and carries respect and dignity for people and I agree with her
(Leininger et al, 2006).

Health
Leininger has defined health as “a state of wellbeing that is culturally defined and
constituted. Health is a state of being to maintain and the ability to help individuals or
groups to perform their daily role activities in culturally expressed beneficial care and
patterned ways” (Leininger et al, 2006, p.10). All cultures have their ways of maintaining
health which have similarities and differences to other cultures and understanding
these components of health such as the particular culture’s rules for wellness, how
cultures know, transmit and practice healthcare, intergenerational practices and so on
have to be discovered, understood and respected in order to provide health and well-
being to that particular culture. Through this manner an appreciation for the similarities
and differences of the culturally varied approaches to health can occur. Many nurse
theorists have focused only on health as an outcome without knowledge of culture care
influences and have also failed to understand the importance, power or major
influences of care to explain health or wellbeing. Leininger stands firm and believes it is
“care and caring knowledge and actions that can explain and head to the health or
wellbeing of people in different or similar cultures (Leininger et al, 2006, p. 11).

Environment
The concept of environment is complex and is a multifaceted dimension in all cultures.
It requires a very extensive geophysical and social knowledge. The environmental
context also includes the ecological, spiritual, sociopolitical, kinship, environmental
symbols, and technological dimensions and gives clues about its influences on culture,
care expressions, ways of life, health, wellbeing and patterns of living for individuals,
families and communities. The environment has to be viewed from a holistic
perspective that goes beyond the traditional focus of nurses on the biophysical and
emotional environment (Leininger et al, 2006).

Nursing
Nursing as a concept of the metaparadigm is not agreeable to Leininger as it “it is not
logical to use nursing to explain nursing. It is a theoretical and logical contraindication
to use the same term to explain or predict the same phenomenon.” (Leininger et al,
2006, p. 7). She does not believe that ‘nursing’ should be a metaparadigm of nursing
and I concur for the simple fact it seems illogical to me as well.
References

Nursing Theorist and Their Work, Tenth Edition by Martha Railie Alligood [Book]

Understanding the Work of Nurse Theorist, 3rd Edition by Kathleen Sitzman

https://l.facebook.com/l.php?u=https%3A%2F%2Fdrive.google.com%2Fdrive
%2Ffolders%2F1LsHVW0SBdM1Kpjui0h6nHNQRRN7RQC_-%3Ffbclid
%3DIwAR0Cz5BSr_OJkQ0b2NYdRg5rqEeEmyjgBmxo1np7JklIaUjtOsY6iKJ9u
WU&h=AT3nXAZbdF3UuN1RoFPfnVbzaEEqo8PJT40ryN9d0fg20Hrug6djDrSC
O8wePNpl_unuQR4lGqsRaOM8e5XAjDMJO55m9hHJboFJN49rl5vJIZW06qkga
Mdu-FWx0-iUXxD_2A

Transcultural Nursing: Better & Effective Nursing Education for Improving Transcultural
Nursing Skills (Benefits) First Edition 2021 Editors: Ayla YAVA and Betul TOSUN
https://kurumsal.ankaranobel.com/wp-content/uploads/2022/02/TRANSCULTUR
AL-NURSING-book.pdf?
fbclid=IwAR0DYcpUukblvpHgnAV3JCoO7LdNDSXGEvXZsI1rXictnPCJmKpo1Bi
g4AI

The Theory of Culture Care Diversity and Universality by Marilyn R. McFarland and
Hiba B. Wehbe-Alamah credits: Jones & Bartlett Learning
https://samples.jbpub.com/9781284026627/McFarland_CH01_Sample.pdf

Business Bliss Consultants FZE. (November 2018). Madeleine Leininger Theory of

Transcultural Nursing. Retrieved from
https://nursinganswers.net/essays/madeleine-leininger-theory-of-transcultural-
nursing-nursing-essay.php?vref=1