MADELEINE LEININGER CULTURE CARE THEORY

MADELEINE LEININGER

She is considered as the founder of the theory of transcultural nursing.

Her theory has now developed as a discipline in nursing.

Theoretical framework is depicted in her model called the Sunrise Model (1997).

One of the first nursing theorists and transcultural global nursing consultants.

MSN - Catholic University in Washington DC.

PhD in anthropology - University of Washington.

She developed the concept of transcultural nursing and the ethno-nursing research model.

Transcultural nursing

Is 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

CULTURE CARE THEORY OF DIVERSITY AND UNIVERSALITY

Through her observations while working as a nurse, Madeleine Leininger identified a lack of cultural and care knowledge as the missing component to a nurse's understanding of the many variations required in patient care to support compliance, healing, and wellness which led her to develop the theory of Transcultural Nursing also known as Culture Care Theory.

This theory attempts 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 individual, group's, or institution's cultural values, beliefs, and lifeways."

The main focus of Leininger's theory is for nursing care to fit with or have beneficial meaning and health outcomes for people of different or similar cultural backgrounds. With these, she has developed the Sunrise Model in a logical order to demonstrate the interrelationships of the concepts in her theory of Culture Care Diversity a id Universality.

Culture

is also beliefs, habits, likes, dislikes, customs and rituals learned from one's family

Culture

Is learned, shared and transmitted values, beliefs, norms and life way practives of a particular group that guide thinking, decisions, and actions in patterned ways.

Culture

Is learned by each generation through both formal and informal life experiences

Language

is primary through means of transmitting culture.

The practices of particular culture often arise because of the group's social and physical environment.

Culture practice & beliefs are adapted over time but mainly remain constant as long as they satisfy needs.

Set of values, beliefs and traditions. that are held by a specific group of people and handed down from generation to generation

Religion

Is a set of belief in a divine or super human power (or powers) to be obeyed and worshipped as the creator and ruler of the universe.

Ethnic

Refers to a group of people who share a common and distinctive culture and who are members of a specific group

Ethnicity

A consciousness of belonging to a group

Cultural Identity

The sense of being part of an ethnic group or culture

Cultural-Universals

Commonalities of values, norms of behavior, and life patterns that are similar among different cultures.

Culture-Specifies

Values, beliefs, and patterns of behaviors that tend to be unique to a designated culture.

Material Culture

Refers to objects (dress, art, religious artifacts).

Non-Material Culture

Refers to beliefs customs, language, social institutions

Subculture

Composed of people who have a distinct identity but are related to a larger cultural group.

Bicultural

A person who crosses two cultures, lifestyles, and sets of values.

Diversity

Refers to the fact or state of being different. Diversity can occur between cultures and within a cultural group.

Acculturation

People of a minority group tend to assume the attitudes, values, beliefs, and practices of the dominant group.

Cultural Shock

The state of being disoriented or unable to respond to a different cultural environment because of its sudden strangeness, unfamiliarity, and incompatibility to a stranger's perceptions and expectations is differentiated from others by symbolic markers (cultures, biology, territory, religion)

Ethnic Groups

Share a common social and cultural heritage that is passed on to successive generations

Ethnic Identity

Refers to a subjective perspective of the person's heritage and to a sense of belonging to a group that is distinguishable from other groups.

Race

The classification of people according to shared biologic characteristics, genetic markers, or features. Not all people of the same race have the same culture.

Cultural Awareness

It is an in-depth self-examination of one's own background, recognizing biases and prejudices and assumptions about other people

Culturally Congruent Care

Care that fits the people's valued life patterns and set of meanings-which is generated from the people themselves, rather than based on predetermined criteria

Culturally Competent Care

Is the ability of the practitioner to bridge cultural gaps in caring, work with cultural differences and enable clients and families to achieve meaningful and supportive caring.

The Sunrise Model of Leininger's Theory

This 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.

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 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. This information allows for the identification of similarities and differences or cultural care universality and cultural care diversity.

Next are 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

Culture Care Preservation or Maintenance

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

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

includes those assistive, supporting, facilitative, or enabling professional actions and decisions that help a clients reorder, changes, 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).

Transcultural Nursing

This 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

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)

This 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

This 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

This 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

These 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, ethno-historical factors, and how these factors may be interrelated and function to influence human behavior in different environmental contexts

Cultural Care

This 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

This 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)

Additional 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 providers 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 casualties and may require several different approaches to diagnoses, treatment, and cure including folk and Western medical interventions.

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.

Application to Nursing

The goal is to foster understanding, respect, and appreciation for the diversity of patients beliefs.

values, spirituality, and cultural perspectives regarding illness, including its meaning, cause. treatment, and outcomes. It also emphasizes promoting holistic self-care by supporting the development of physical, emotional, and spiritual well-being through practices such as Ayurveda and Panchakarma.

Theory in View of Metaparadigms

Nursing

This 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.

Person

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

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 life ways.

Environment

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. These terms are not defined by Leininger; she speaks instead of worldview, social structure, and environmental context

Assessment

Determine the client's cultural heritage and language skills, & if any of health beliefs relate to the cause of the illness or to the problem.

Collect information that any home remedies the person is taking to treat the symptoms.

Nurses should evaluate their attitudes toward ethnic nursing care.

Self-evaluation helps the nurse to become more comfortable when providing care to clients from diverse backgrounds.

Understand the influence of culture, race & ethnicity on the development of social emotional relationship, child rearing practices & attitude toward health.

Collect information about the socioeconomic status of the family and its influence on their health promotion and wellness,

Identify the religious practices of the family and their influence on health promotion belief in families.

Understanding of general characteristics of the major ethnic groups, but always individualizing care

Diagnosis

The nursing diagnosis for clients should include potential problems in their interaction with the health care system and problems involving the effects of culture.

Planning & Interventions

The planning and implementation of nursing interventions should be adapted as much as possible to the client's cultural background.

Evaluation

Evaluation should include the nurse's self-evaluation of attitudes and emotions toward providing nursing care to clients from diverse sociocultural backgrounds.

Self-evaluation by the nurse is crucial as he or she increases skills for interaction

Assumptions of the Theory

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, ethno-historical, 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 in any culture there will be cultural similarities and differences between the care-receivers (generic) and the professional caregivers.

Care is a distinct, dominant, unifying and central focus of nursing, and, while curing and healing cannot occur effectively without care, care may occur without cure.

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 the 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, cultural conflicts, and/or ethical or moral concerns.

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 that are presented are at a level of abstraction which allows them to be applied in many different situations.

It can be easily understood upon the first contact.

Weaknesses

The theory and models are not simple in terms.