1. Nurs 324 Lela Hosler Katie Laurain Ronald Lloyd Kymberly Otremba

3.  Leininger initially envisioned the culture care theory as a way to promote peaceful relationships among and between cultures (Leininger, 2007).  The purpose for her theory was to provide nurses with theory-based research and provide culturally congruent care to patients (Black, 2011).

4. Leininger’s theory was not readily accepted in the nursing field.  Her theory was introduced to nursing in the 1950s and 1960s. The nurses at that time did not feel that the cultural care theory was relevant or necessary. Leininger continued to be persistent and enthusiastic about her theory and was able to start attracting the attention of a few other nurses.  It wasn’t until her book Culture Care Diversity and Universality was released in 1991 that her theory actually took hold.  Her third edition of Transcultural Nursing is thought to be the best transcultural nursing book available. This book has made many feel that her theory is the biggest breakthrough in nursing in the 20 th century (Leininger, 2002). Nurses are teaching and using the theory without full understanding or proper knowledge.  “Some nurses use theories and models in inaccurate, misleading, or confusing ways with loss of the original inventor’s ideas” (Leininger, 2002).  Other nurses attempt to provide transcultural nursing courses that are not prepared in this field (Leininger, 2002).

5.  Culture care nursing theory is one of the oldest theories. It is the only theory explicitly focused on close interrelationships of culture and care on well- being, health, illness, and death. The theory is also the most holistic and multidimensional theory available (Leininger, 2002).  “The purpose and goal of the theory is to use research findings to provide culturally congruent, safe, and meaningful care to clients of diverse or similar cultures. The three modes for congruent care, decisions, and actions proposed in the theory are predicted to lead to health and well-being, or to face illness and death” (Leininger, 2002).

6.  Leininger states that her theory was influenced by her firm belief in God, and preparation in philosophy, religion, education, nursing, anthropology, biological sciences, and related areas (Leininger, 2002).  With her beliefs strong, Leininger knew that “in developing the theory, a major hurdle for nurses was to discover culture care meanings, practices, and factors influencing care by religion, politics, economics, world view, environment, cultural views, history, language, gender and others. These factors needed to be included for culturally competent care” (Leininger, 2002).

7. Born: July 13, 1925 1945- Entered the Cadet Nurse Corps with her sister. 1950- Received a Bachelor of Science degree in Biological Science, with a minor in Philosophy and Humanistic Studies, from Benedictine College in Atchison, Kansas. 1950- Opened a psychiatric nursing service and educational program at Creighton University in Omaha, Nebraska. 1954- Received a Master of Science in Nursing degree, with a minor in Psychiatric Mental Health Nursing and Psychology, at The Catholic University of America in Washington, DC. 1954-1960- Associate Professor of Nursing (1954-1959) and Director of the Graduate Program in Psychiatric Nursing at the University of Cincinnati. She also studied in this university, pursuing further graduate studies in curriculum, social sciences and nursing (1955-58). 1960- Began the first graduate program in psychiatric nursing at the University, and first clinical specialist program in child psychiatric nursing in the country. She also co-authored one of the first psychiatric nursing texts, Basic Psychiatric Nursing Concepts (1960), which has been published in eleven languages and used worldwide. 1960- Pursued doctoral studies; was awarded a National League of Nursing Fellowship for fieldwork in the Eastern Highlands of New Guinea, where she studied the convergence and divergence of human behavior in two Gadsup villages. was the first to coin the concept "culturally congruent care" which was the goal of the Theory of Culture Care.

8. 1965- Doctoral program in Cultural and Social Anthropology at the University of Washington in Seattle and became the first professional nurse to earn a Ph.D. in anthropology. 1966- Appointed Professor of Nursing and Anthropology at the University of Colorado– the first joint appointment of a professor of nursing and a second discipline in the United States. 1969-1974- Dean, Professor of Nursing, and Lecturer in Anthropology at the University of Washington, School of Nursing. 1974-1980- Dean, Professor of Nursing, Adjunct Professor of Anthropology, and Director of the Center for Nursing Research and of the Doctoral and Transcultural Nursing Programs at the University of Utah College of Nursing. 1975- She was the first full-time President of the American Association of Colleges of Nursing and one of the first members of the American Academy of Nursing. 1981-1995- Began tenure at Wayne State University as Professor of Nursing and Director of the Center for Health Research at the College of Nursing, as well as Adjunct Professor of Anthropology in the College of Liberal Arts and Director of the Transcultural Nursing Program 1989-1995- Established the Journal of Transcultural Nursing and served as editor. 1995- June 1, retired as professor emeritus from Wayne State University. (Biography, 2007)

9.  Dr. Leininger had a very strong belief in God and being a lifetime learner. By looking at her timeline one can see she spent many of her years as a student and as a professor. Her dedication to her discipline has earned her many awards and recognition as one of the top people in her field.  Her main reason for creating this theory was to provide culturally congruent care to patients. This link had not been established when she first started thinking about the cultural differences she was noticing in her nursing practice.

10. The sunrise model was created by Leininger not as a theory but a tool to be used with her theory to gain new knowledge and practices in health care context (Leininger, 2002).

11.  “Practice from a cultural perspective begins by respecting the culture of the patient and recognizing the importance of its relationship to nursing care”(Chitty, 2011)  Nurses need to plan care taking into consideration a person’s health beliefs and cultural practices and traditions

12.  According to the Transcultural Nursing Society, every person is entitled to these basic rights:  “Access to quality care including qualified healthcare professionals, organizations and resources. Access to culturally and linguistically competent healthcare providers Respectful care with recognition for personal dignity, privacy and confidentiality Informed participation in one’s own health care. Involvement of family members and significant others in healthcare delivery and decision making if desired by the care recipient Accept or refuse care and negotiate with healthcare providers to achieve culturally congruent care Freedom from healthcare treatments that involve coercion, bribery and illicit activities that place one’s well-being at risk. Receive care in an environment in which physical, psychological, spiritual and cultural safety is assured for the person and his/her family, and significant others Receive care without putting one’s self or loved ones in jeopardy or harm’s way” (Andrews et al, 2013).

13.  Culture is a major environmental influence  “Culture consists of the attitudes, beliefs, and behaviors of social and ethnic groups that have been perpetuated through generations” (Black, 2011)  Culture affects how a person views health, illness, and treatment  Culture influences what kind of treatment and what kind of practitioner a person seeks

14.  Health behaviors  Culture can influence health behaviors such as diet, physical activity, smoking, and alcohol  Locus of control- people can be influenced by either an internal or external view of control  Culture would be considered an external locus of control (Chitty, 2011)

15.  “Health professionals need to be able to demonstrate an awareness of other social determinants of health such as stereotyping, racism, discrimination and hostility that directly affect health outcomes” (Bidzinski, et al, 2012)  Nurses need to be cautious not to stereotype patients who belong to different ethnic groups. Although a person may practice a certain religion or belong to a specific ethnic group nurses should still make an individualized care plan for that person  “one size doesn’t fit all” (Chitty, 2011)

16.  Care is the essence of nursing  It is a dominant and distinct focus  Care is essential for well being, health, and healing

17.  There would not be healing without caring.  Culture care is the holistic approach to know, explain, interpret, and predict nursing care and guide nursing practice.  Nursing is transcultural and serves human beings worldwide.

18.  Care is based on different cultures.  Nurses must be aware of cultures to properly care for the patient.  Every human culture has a generic care knowledge and practice.  Cultural beliefs and practices are influenced by religion, social, political, economic or environmental context.  Knowing ones culture can allow us to appropriately treat our patients

19.  Cultural differences among nurses and patients exist worldwide.  Being aware of ones culture will provide efficient care.  Culture care is the broadest holistic means to know, explain, interpret and predict nursing care phenomena to guide nursing care and practices.

20.  Cultural differences worldwide can cause failure in nursing care.  Nursing care that fails cultural beliefs may cause non-compliance, stress or ethical and moral concerns.  It is imperative to put cultural differences aside to maintain effective nursing practice.

21.  Leininger defined nursing as a learned scientific and humanistic profession that focused on caring for humans. Care includes assisting, supporting, facilitating or enabling individuals or groups to maintain health and well-being in culturally meaningful and beneficial ways. (Leininger, M.M., & McFarland, M.R. (2002).

22. Clarification of Origins Content Narrow View Practice Situations Case Study

23.  Black (2011) suggests Leininger’s theory was influenced by her early nursing experiences noting differences in relation to culture and health practices (p.316).  The philosophy of transcultural nursing is not unique to nursing. In fact, Black (2011) notes Leininger’s broad theory “considers the impact of culture on all aspects of human life, with particular attention to health and caring practices” (p.316).

24. o Leininger’s theory on transcultural nursing has a direct impact on the four global concepts of nursing. o Cultural beliefs are integrated into every man, woman, and child o Chitty (2011) states, “Culture is an extremely important environmental influence affecting individuals” (p.278). The environment includes all factors surrounding an individual’s life as well as “cultural attitudes that profoundly shape human experience” (Chitty, 2011, p.277). o Health and illness is viewed differently in various cultures. Halloran (2009) infers that culture “determines the clients perception of health and illness and defines health care and treatment practices” (p.523). o Holistic nursing demonstrates respect for various cultures and integrates the patient’s values and belief system into his or her care.

25.  Leiningers theory is utilized in all aspects of nursing care  Based on the definition by Friedlander (n.d.), Leininger’s theory is abstract in that it is a concept without specific meaning. Various cultures have different perspectives on health and illness.  Sagar (2012) describes the many transcultural nursing models that stemmed from Leininger’s theory of culture care diversity.

26.  Culturediversity.org (2012) provides the following examples of situations where Leininger’s theory was applied.  Calling a patient by his or her first name can be considered offensive or even racist in some cultures. Referring to a patient as Mr. or Mrs. Is more respectful.  Restraining an African American patient by a Caucasian nurse can be considered racist without a good explanation as to the reasons for the restraint.  When addressing a deaf patient with an interpreter, it is important to face the patient and not the interpreter. Many deaf patients are good lip readers. Facing the interpreter makes the patient feel left out of the conversation

27.  Mrs. Jones, a 65 year old female was admitted to Select Specialty Hospital in January 2012. Several staff members were having difficulty establishing a rapport with the patient. Mrs. Jones was very particular as to who would provide her care. A brief investigation was done to see why she chose certain caregivers over others. All staff members who had contact the patient were interviewed regarding their experience with Mrs. Jones. One significant finding was discovered from all who were interviewed. Mrs. Jones had a bowl of candy at her bedside that she regularly offered to staff. It was discovered that those who declined the offer had a difficult time establishing a rapport. Those staff members who excepted the offering were successful in establishing the nurse patient relationship.

28.  The declination of offering from Mrs. Jones was perceived as offensive and uncaring to her. Her feeling on the staff members that refused was that “the nurses must be grossed out by accepting candy from a dirty patient”. Accepting a token of appreciation from Mrs. Jones made her feel important that she could give back to those who helped her regain wellness.

29. Andrews, M., Leininger, M., Leuning, C., Ludwig-Beymer, P., Miller, J., Pacquiao, D., & Papadopoulos, R. (2013, February 19). Human rights position statement. Retrieved from Transcultural nursing society : http://www.tcns.org/Humanrights1.html Bidzinski, T., Boustead, G., Gleave, R., Russo, J., & Scott, S. (2012). A journey to cultural safety. Australian Nursing Journal, 20(6), 43 Black, B. P. (2011). Nursing theory: the basis for professional nursing. In M. Iannuzzi & A. Zimmerman (Eds.). Professional nursing concepts & challenges (pp. 316-318). Maryland Heights, MO: Saunders Elsevier

30.  Chitty, K. (2011). Conceptual and philosophical bases of nursing. In M. Iannuzzi & A. Zimmerman (Eds.). Professional nursing concepts & challenges (pp. 272- 301). Maryland Heights, MO: Saunders Elsevier  Chitty, K. (2011). Illness, culture, and caring: impact on patients, families, and nurses. In M. Iannuzzi & A. Zimmerman (Eds.). Professional nursing concepts & challenges (pp. 222-252). Maryland Heights, MO: Saunders Elsevier  Friedlander, J. (n.d.). Abstract, concrete, general, and specific terms. Southwest Tennessee Community College. Retrieved from http://grammar.ccc.comment.edu/grammar/composition/abstract.htm

31.  Halloran, L. (2009). Teaching transcultural nursing through literature. Journal of nursing education, 48 (9) 523-528. doi: 10.3928/01484834-20090610-07  Leininger, M. (2002). Culture care theory: a major contribution to advance transcultural nursing knowledge and practices. Journal of transcultural nursing, 13, 189. doi: 10.1177/10459602013003005  Leininger, M. (2007). Theoretical questions and concerns: response from the theory of culture care diversity and universality perspective. Journal of transcultural nursing, 20, 9. doi: 10.1177/0894318406296784

32.  Leininger’s theory of culture care. (2011, July 7). Biography of Leininger. Retrieved from http://nursingtheories.blogspot.com/2011/07/leinigers-theory-of- culture-care.html  Sagar, P. (2012). Transcultural nursing theory and models, application in nursing education practice and administration. Retrieved from http://www.springerpub.com/samples/9780826107480_chapter.pdf  Transcultural Nursing. (2012). Basic concepts and case studies. Retrieved from http://www.culturediversity.org/cases.htm