MADELEINE lEININGER Cultural Care Theory Aaron Phillips Anna Ingersoll Caitlin Buren Niki DeWall

INTRODUCTION Deciding how to care for a patient requires looking at the patient as a whole person from physiological, psychological, spiritual, and social perspective, it’s also important to consider the patients culture and cultural background.

MADELEINE’S MOTIVATION Madeleine Leininger developed the Culture Care theory also known as the Transcultural Nursing theory in the 1950’s and it was later published in 1991. Leininger believed that values and beliefs passed down to that patient from generation to generation can have as much of an effect on that patient’s health and reaction to treatment as the patient’s environment and social life.

PHILOSOPHIC VALUES/KNOWLEDGE Madeleine Leininger believed nursing values revolved around being caring and knowing what it was to care. Leininger discusses what it is to care in her theory. You must understand what it is to care in order to provide culturally congruent and competent treatment.

INFLUENCES Leininger proposed that there are three modes for guiding nurses judgments, decisions, or action in order to provide appropriate, beneficial, and meaningful care: preservation and/or maintenance; accommodation and/or negotiation; and re-patterning and/or restructuring. The modes have influenced nursing and the ability to provide culturally congruent nursing care, as well as fostering culturally-competent nurses.

Information and 4 Global Concepts Human Being Environment Health Nursing

Human being “Each person is unique and different from all other persons” (Chitty & Black, p. 275). Some personal cultural factors to consider in the healthcare industry: The male figure may be the dominant person in making medical decisions Illness may be viewed as bad fortune or punishment Eye contact may be disrespectful A language barrier may exist The concept of time may vary

HUMAN BEING CONTINUED Leninger’s cultural theory relates to an individual because it involves planning individualized nursing care around a patient’s values and beliefs. Nurses should, “realize that cultural norms must be included in the plan of care to prevent conflicts between nursing goals and patient/family goals” (Chitty & Black, p.234).

environment Environment includes all the circumstances, influences, and conditions that surround and affect individuals, families, and groups” (Chitty & Black, p. 277). Ways a person’s culture can influence one’s environment in healthcare: Wearing or placing objects to protect from evil spirits Burning candles or conducting rituals Having multiple visitors and/or family members at the bedside Leininger’s theory relates to a person’s environment because one’s environment is highly influenced by their culture. “Included in environment are the social and cultural attitudes that profoundly shape human experience”(Chitty & Black, p.277).

Health “Health practices are culturally determined and include nutritional habits, type and amount of exercise and rest, how one copes with stress, quality of interpersonal relationships, expression of spirituality, and numerous other lifestyle factors” (Chitty & Black, p.284). Some cultural beliefs relating to a person’s health may include: The consumption of certain foods, such as onion or garlic, to prevent illness The use of healers and/or rituals The use of folk or traditional medicines The degree of importance with taking medicine A person’s diet and level of physical activity Accepting blood products and other treatments

Health CONTINUED Leininger’s theory relates to one’s health because a person’s culture can impact the way they seek medical care, how they react to their illness, and how they respond to treatment (Quan, n.d.).

Nursing “Practice from a cultural perspective begins by respecting the culture of the patient and recognizing the importance of its relationship to nursing care” (Chitty & Black, p. 316). A few cultural aspects to consider when caring for patients and their families: Some cultures do not allow a male healthcare worker to care for their loved one, others do not allows females Some value touch and other may feel violated when working within their personal space May expect the nurse to make all decision for them and will not participate in self-care May not show or express pain concerns

Nursing Continued Leininger’s theory is associated with the nursing practice because in order to provide good nursing care, the nurse, “…recognizes each individual’s unique needs and tailors the plan of nursing care to take that uniqueness into consideration” (Chitty & Black, p.277).

Interpretation & inference As healthcare providers it is easy to interpret an individuals actions, not knowing whether your observation/opinion is right. As the “sunrise model” states, in order to reach and maintain balance, there are several key factors that play a role. To reach Culture Care (worldview), it must start with Culturally Congruent Care for the health/well being on an individual. From there it takes several steps, all of them being important to eventually reach the ultimate goal of worldview Cultural Care.

Implications; understanding what transcultural means In order to implicate this “theory” as it is referred to in Chitty and Black, one must focus on the patient in a culturally congruent manner. “Focus on culture care preservation, accommodations, or repatterning, depending on the patient’s need.” Being part of a transcultural environment, it is essential to be prepared in knowing, understanding and accepting each others differences and practices. As Margaret Chang and Anne Kelly write, “Core beliefs and value systems are held more strongly when people lose control over aspects of their life due to illness.” For this reason it is important to be an advocate for your patient and family members, upholding what they see as important. They also went on to express the importance of knowing what the patient’s concept is of their illness and its cause. This will in turn help the nurse to individualize, assess, prioritize and educate them on their needs and incorporate cultural beliefs into their plan of care.

Consequences According to Chitty and Black, Jan the nurse, experienced first hand how a cultural barrier negatively impacted her patient and family to the point that they no longer wanted her services and requested a new nurse. This all could have been avoided had Jan known it was considered rude to decline an offer. Cultural barriers happen all to often while patient’s are at the hospital. Some religions do not allow blood products, while others believe having a spiritual leader at their bedside chanting while the patient is actively dying, does something for their spirit. We as nurses and healthcare providers are not to judge, but to accept and accommodate these differences. Once we accept cultural differences and adapt our methods to suit their cultural beliefs, we will have successfully transitioned into Transcultural Care.

Clarification of origins The theory of Culture Care Diversity and Universality began to be developed in the mid-1950’s. Cultural factors and humanistic care in nursing were the major missed dimensions in nursing practices—especially evident in working with children from different cultures. Culturally based care was absent with the nursing and other staff members, and only physical and emotional needs of the clients were considered. (Fawcett, 2002)

Is this philosophy unique to nursing Leininger stated that care is the essence of nursing, other health professions (medicine, social work, physical therapy, occupational therapy) have embraced, cited, adapted, and/or applied her culture care theory in their respective fields. Leininger’s theory has attracted the attention and interest of scholars in theology, religious studies, engineering, management, business, education, sociology, and even anthropology, the discipline from which Leininger initially drew inspiration in formulating the culture care theory.

Cultural Care Theory Does it adequately describe the four global concepts? The Cultural Care Theory covers all four Global Concepts: human being, environment, health, and nursing. Madeleine Leininger does not specifically discuss global concepts in her theory, but her theory is applicable to each concept. Our country continues to become more culturally diverse and the Cultural Care Theory is more relevant than ever before. The Cultural Care Theory may be utilized at the bedside or in a broader aspect such as public health.

Cultural care practice situations Every nursing encounter is an opportunity to practice cultural awareness. Inpatient settings The cultural aware nurse will assess their client’s personal, social, environmental, and cultural needs/beliefs and incorporate them into their plan of care in an inpatient setting. Hospice Assessing religious, cultural, and ethnic beliefs/values into the end of life care plan.

Cultural expression of Pain Case Study Mrs. L, a 42-year old Asian woman, became ill and required surgery while visiting her daughter in the United States. After surgery, she was given a patient-controlled analgesia pump. The nurse explained to Mrs. L how to self-administer medication when she felt pain. Mrs. L smiled and nodded her head when asked whether she understood the instructions. Much later the nurse noticed that this patient appeared to be in great pain. After talking with Mrs. L’s daughter, the nurse realized that Mrs. L had not understood how to use the equipment but was unwilling to ask for additional instructions or complain of pain. Which statements are true about the following case study? Mrs. L may have a language barrier. Out of respect for authority, she may not speak until spoken to and may verbally agree with anything nurses propose. Asian’s only smoke opium for pain relief. (Chitty & Black, 2011)

conclusion Madeleine Leininger’s development of the transcultural nursing theory centered around the relationship between a patient’s culture and how it relates to the care they receive. Leininger believed the soul of nursing stems from a nurses ability to care Nurses are often so focused on treating a patients physical problems, they tend to forget the emotional and spiritual aspect of nursing, which may in fact be more important at times. Leininger’s thoery is still being practiced to this day, and becomes more and more important as our world becomes more diverse.

references Chang, M., & Kelly, Ann. (2007). Patient Education: Addressing Cultural Diversity and Health Literacy Issues. Medscape News Today, 27(5):411-417. Retrieved from http://www.medscape.com/viewarticle/564667_3. Chitty, K.K., & Black, B.P. (2011). Professional Nursing: Concepts & Challenges (6th ed.). Maryland Heights, MO: Saunders Elsevier. Clarke, P., McFarland, M., Andrews, M., & Leininger, M. (2009). Caring: some reflections on the impact of the culture care theory by McFarland & Andrews and a conversation with Leininger. Nursing Science Quarterly, 22(3), 233-239. doi:http://0dx.doi.org.libcat.ferris.edu/10.1177/08943184093 37020 Fawcett, J. (2002). Scholarly dialogue. The nurse theorists: 21st- century updates -- Madeleine M. Leininger. Nursing Science Quarterly, 15(2), 131-136.

References continued Nursing Theory (2011). Madeleine Leininger. Retrieved from http://nursing-theory.org/nursing-theorists/MadelineLeininger.php Transcultural Nursing. (2012). Nursing Theories. Retrieved from http://currentnursing.com/nursing_theory/transcultural_ nursing.html The University of the Philippines Open University. (2011). Leininger's theory of culture care. Retrieved from: http://nursingtheories.blogspot.com/2011/07/leiningers- theory-of-culture-care.html Quan, K. (n.d.). Cultural differences that affect health care. Retrieved from http://www.netplaces.com/new-nurse/what-you- learned-in-school/cultural-differences-that-affect-health- care.htm