Dr. madeleine m. Leininger July 1925-August 2012 Transcultural Nursing

Transcultural Nursing The goal of transcultural nursing involves planning nursing care based on knowledge that is culturally defined, classified, and tested. That knowledge is then used to provide culturally congruent care to patients (Chitty & Black, 2011, p 316).

Madeleine Leininger Leininger is largely known for developing a theory of cultural care for nursing. Through her theory the Transcultural Nursing Society was formed. The formation of a Master’s degree in Transcultural Nursing is also credited to Leininger.

Leininger’s Education Leininger received her diploma in Nursing from St. Anthony’s School of Nursing in Denver, CO. Two years later she received her bachelor of science degree in biological science from Benedictine College in Kansas In 1954 she received her MSN from Catholic University in Washington, D.C. In 1965 Leininger received her PhD in anthropology from the University of Washington in Seattle.

Origins of Transcultural Nursing Early in her nursing career, Leininger observed children of different cultures having different behaviors and needs. During her doctoral work in cultural anthropology she became more convinced of the cultural differences presented in healthcare. Identified a lack of cultural care and knowledge as the missing link to understanding the many variations required in patient care. These observations and experiences led Leininger to develop a theory of cultural care for nursing. Early in her career while working in a child guidance home, Leininger experienced what she called “culture shock” when she realized recurrent behaviors seemed to appear on a cultural basis. It was this revelation that led her to pursue studies in cultural differences presented in healthcare. Leininger identified a lack of cultural and care knowledge as the missing link to nursing’s understanding of the many variations required in patient care to support compliance, healing, and wellness. (Sitzman, 2011).

Leininger defined transcultural nursing as: “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” (Sitzman, 2011, p97)

Providing Transcultural Care in Nursing Leininger viewed caring as the essence of nursing She promoted a nurse-patient relationship that creatively designs a new or different care lifestyle that is culturally congruent for the patient (Chitty & Black, 2011, p 316). The goal is for nurses to view patients in the context of their cultures Leininger recognized that the values and practices of a specific culture are influenced by language, worldview, spiritual belief, education, economics, technology and environment (Clarke, McFarland, Andrews & Leininger, 2009). Ultimately, Leininger’s goal was for patients to receive culturally congruent care.

Providing Transcultural Care in Nursing Leininger focused first on nurses respecting the culture of patients and then understanding how important it is to their care. “Beneficial, healthy, and satisfying culturally based nursing care contributes to the well being of individuals, families, groups, and communities within their environmental context” (Clarke, McFarland, Andrews & Leininger, 2009, p. 235). Once achieved, the nurse plans care with awareness to health beliefs and practices of the patient’s culture. “Every human culture has lay (generic, folk, or indigenous) care knowledge and practices and usually some professional care knowledge and practices which vary transculturally” (Clarke, McFarland, Andrews & Leininger, 2009, p. 235).

Culturally Competent Nurses: Have thoroughly assessed and acknowledged their own cultural beliefs and practices. Consciously address the fact that culture affects nurse- client exchanges. Ask each patient what their cultural practices and preferences are with compassion and clarity. Incorporate the client’s personal, social, environmental, and cultural needs/beliefs into the plan of care whenever possible. Respect and appreciate cultural diversity, and strive to increase knowledge and sensitivity. (Sitzman, 2011, pg 97). Kathryn- I added this slide and picture… Don’t know if you can make it blend in nicely like you did with the other pictures? I couldn’t figure out how to do it.

The Sunrise Model To assist nurses in providing culturally congruent care, and making decisions based on culturally diverse knowledge, Leininger developed the sunrise model shown on the next slide. The “sunrise model” helps the nurse to use cultural assessment data to better understand its influence on the patients life (Chitty, 2011, pg 316)

Use of the sunrise model guides the assessment of cultural data for an understanding of it’s influence on the patient’s life. As you can see almost every factor affects another one in some way.

Implications & Consequences “The nursing outcome of culturally congruent nursing care is health and well-being for the patient” (Chitty, 2011, pg 316) By providing care that is congruent with patients’ culture, the patient will be more likely to be compliant with interventions. “Clients who experience nursing care that fails to be reasonably congruent with the client’s cultural beliefs and values will show signs of stress, cultural conflict, noncompliance, and ethical moral concerns” (Sitzman, 2011, pg 97)

Evaluating Leininger’s Nursing Model The 4 global concepts of nursing theories as described by Leininger: Person- The person is defined by cultural and structural dimensions as shown in the sunrise model. Leininger believes that each person deserves culturally congruent care that promotes well being. Environment- The environment plays a large cultural role in each patients care. It’s composed of many different factors unique to each patient. Health- “refers to a state of well-being that is culturally defined and valued by a designated culture” (Sitzman, 2011, p. 95) Nursing- “a learned profession with a disciplined focused on care phenomena” (Sitzman, 2011, p. 95) Leininger's Theory of Culture Care Diversity and Universality encompasses all cultures, racial, ethnic, or minority groups and is applicable to subgroups within the dominant societal culture (McFarland, 2008)

Transcultural Nursing for Other Professions Leininger’s cultural care model is wholistic and comprehensive Applicable for all nursing practices as patients of different cultures require nursing care for all reasons. Medicine, social work, physical and occupational therapy have embraced & utilized Leininger’s theories (Clarke, McFarland, Andrews, & Leininger, 2009). Leininger’s theory has also attracted the attention and interest of scholars in theology, religious studies, engineering, management, business, education, sociology, and even anthropology (Clarke, McFarland, Andrews, & Leininger, 2009, p 235).

Transcultural Nursing for Other Professions Care is a broadly used term that is applicable in many different professions Leininger stated “caring is practically a part of all the philosophies in all hospitals now [and] now educators want to get it into the educational system, because they know to work with immigrants and refugees and people all over the world they need something from the theory that will help them in teaching” (Clarke, McFarland, Andrews & Leininger, 2009, p. 237). Leininger has taught her theory to many including nursing, dentistry and mortuary students

Culture Care Theory in Practice & Situations Culturally congruent nursing care is beneficial when values, expressions, or patterns are known and used appropriately and knowingly by the nurse (Sitzman, 2011, pg. 96). Aspects to consider include: (Berman, 2008, pg 313) Family Patterns Family is the basic unit of society Matriarchal vs. patriarchal, nuclear vs. extended Communication Style Language barriers- avoid using slang terms which may have different meanings in different cultures Time Orientation Many cultures focus on “present-time” and therefore do not adhere to strict time schedules Nutritional Patterns Food choices and preparation preferences vary within cultures Rice vs. pasta, steamed vs. boiled “Hot vs. Cold” foods Religious factors such as avoiding meat on certain days or only consuming Kosher foods This was my best interpretation… What do you think?

Resources & Weblinks Berman, A., Snyder, S.J., Kozier, B., & Erb, G. (2008). Fundamentals of nursing: Concepts, process, and practice (8th ed.) Upper Saddle River, NJ: Pearson. Chitty, K.K., & Black, B.P. (2011). Professional nursing: Concepts and challenges (6th ed.) Maryland Heights, MO: Saunders. Clarke, P. N., McFarland, M. R., Andrews, M., & Leininger, M. (2009). Caring : Some reflections on the impact of the culture care theory by mcfarland & andrews and a conversation with leininger. Nurs Sci Q, 22(3), 233-239. doi: 10.1177/0894318409337020 McFarland, M. , & Eipperle, M. (2008). Culture care theory: a proposed practice theory guide for nurse practitioners in primary care settings. Contemporary Nurse, 28(1-2), 48-64. Retrieved October 01, 2012, from Nursing and Allied Health Collection via Gale: http://0-find.galegroup.com.libcat.ferris.edu/nrcx/start.do?prodId=NRC Sitzman, K.L., & Wright Eichelberger, L. (2011). Understanding the work of nurse theorists: A creative beginning (2nd ed). Retrieved from: http://nursing.jbpub.com/sitzman/ch15pdf.pdf Nursing Theory. http://nursing-theory.org/nursing-theorists/Madeline-Leininger.php Katie- Wasn’t sure exactly how to cite the nursing theory.org website? Maybe you can find more info such as author, dates, etc..

Providing Culturally Congruent Care: A Case Study Using M Providing Culturally Congruent Care: A Case Study Using M. Leininger’s Culture Care Theory A nurse is caring for Mr. Hernandez, a 63 y.o. Hispanic male, on a medical surgical floor. He was admitted 3 days ago with the diagnosis of sepsis and two diabetic ulcers on his left foot. He has a history of uncontrolled type II diabetes, high cholesterol, and hypertension. Upon the initial interview he states to the nurse: “I don’t know how this happened, I felt fine until this last week. I only had a fever and usually my wife’s herbal tea and a cool washcloth on my forehead take care of that. I don’t even remember doing anything to my foot, although I don’t have as much sensation in my feet as I used to. Maybe when I was outside in the yard with the grandkids playing barefoot I did something? It’s just been sore, but I thought it would heal on it’s own. The doctor said if the infection gets any worse I may lose my foot. I don’t know what I’ll do if that happens, I have to work, my entire family depends on it. I cannot wait until I’m home. My wife will have a plate of homemade tortillas with my name on them. My wife is the best! She’s the one who made me come in here, she said my foot was getting worse and her special honey ointment wasn’t doing the trick. I bet some of her tortillas, cookies and herbal tea will help me get over this infection!” Okay let me know what you think of the case study, feel free to add/change stuff! We’ll also need to create an answer key.

Case Study Using the culture care theory, what factors shared in the story from Mr. Hernandez should be considered/addressed in the discharge plan? Develop two nursing diagnoses with interventions that will help to meet this patients cultural, physical, and emotional needs. What are the implications if the nurse does not provide culturally congruent care?