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Madeleine Leininger

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Transcript of Madeleine Leininger

Madeleine Leininger
The Concept of Trancultural Nursing: Culture Care Theory

1945- "The post depression Period, Madeleine and her sister entered the Cadet Nurse Coprs (a federally funded program to increase the numbers of nurses being trained to meet anticipated needs during World War II) and a diploma program at St. Anthony's School of Nursing in Denver, Colorado. They were the only persons entering the nursing profession within several near by countries" (Munoz, 2013).
History of Madeleine Leininger
1950 - She earned the equivalent of a B.S.N. through her studies in biological sciences, nursing administration, teaching and curriculm at St. Scholastica at Atchinson, Kansas (Munoz, 2013).
Mid 1950'- "The theory of culture care diversity and universality began to develop when Leninger was working as a clincal specialist in psychiatric nursing in a child guidance home" (Leniniger, 1996, p. 72).
1954- M.S.N. in Psychiatric and mental Health Nursing (Munoz, 2013).

1965- Ph.D. in Cultural and a Ph.D. of Social Anthropology at the University of Washington (Munoz, 2012).
Accomplishments
Why I chose Madeleine Leininger.
The founder of The Transcultural Nursing Society (Miller, 2007).

The founder of The International Association of Human Caring (Miller, 2007).

"The first nurse anthropologist with doctoral preparation in cultural anthropology" (Leininger, 1988, p. 153".
I am from as far south as you can be. I worked and lived on the MS/LA Gulfcoast my entire life. I knew we had different cultures. I treated Russian, Vietnamese, Korean, Mexican, African American, and the local cajuns mostly. I moved to Iowa in 2009 and had a huge culture shock. I was the other culture in fields of corn. No could understand me and everyone sounded rude. I had adjusments in my care plans for other culures when I back south. The shoe is on the other foot now and I could not believe how Iowas lived. So when I read the list of theorists to choose. Madeleine Leininger had my heart.
Cultural Care Theory: The Theory of Culture Care Diversity and Universality
"learned scientific and humanistic profession and discipline focused on human care phenomena and caring activities in order to assist support, facilitate or enable individuals or groups to maintain or regain their health or well-being in culturally meaningful and beneficial ways, or to help individuals face handicaps or death." (Leininger, 1995 p. 75).
Key concepts that are central to the culture care theory.
human care/caring
culture
culture care
culture care diversity
worldview
cultural and structural dimensions
environment context
ethnohistory
emic
etic
health
transcultural nursing
culture care preservation and/or maintenance
culture care accommodation and/or negations
culture care repatterning and or/or reconstructing
culturally component nursing care (Leininger, 2006 p.51)
The arch of the sunrise is the cultural and social dimensions and the rays are the basic elements of culture. The core integration of rays shows the effect on the influences on care. The middle shows a how his affects the person, family and groups in the health system. Nursing care is overlapped by emic and etic. From there the three types of nursing strategies (Leininger, 2006).
The Sunrise Model
Devices to tease out data bearing on culture care, health, and related nursing phenomena
The Sunrise Model
Domain Inquiry Enabler
Observation Participation-Reflection
Stranger to Trusted Friend Enabler
Acculturation Health Care Assessment Enabler
Key concepts that are central to the culture care theory.
human care/caring
culture
culture care
culture care diversity
worldview
cultural and structural dimensions
environment context
ethnohistory
emic
etic
health
transcultural nursing
culture care preservation and/or maintenance
culture care accommodation and/or negations
culture care repatterning and or/or reconstructing
culturally component nursing care (Leininger, 2006 p.51)
Four Phases of Analysis
1. Collecting, describing, and documenting raw data.
2. Identification and categorization of descriptors and components.
3. Pattern and contextual analysis.
4. Major themes, research findings, theoretical formulations, and recommendations (Leininger, 2006 p. 51).
Transculture factors to consider
communication and language
gender consideration
sexual orientation
ability/disablilty
occupations
age
interpersonal relationships
appearance
dress
use of space
food
meal preparation
related life ways
(Leininger, 2006).
Short Culturalogical Assessment
1. Recording observations.
2. Listening and learning from he client about the cultural values, beliefs, and practices.
3. Identifying and documenting recurrent patterns and narratives with client meanings.
4. Synthesizing expressed themes and patterns of care.
5. Developing a culturally based plan of care. (Leininger, 2006)
Theory Link to Nursing Practice
"This theory has relevance and significance for nurses in all cultures to reduce nurse burnout, cultural shock, marked ethnocentrism, and many other nursing conditions and practices"(Leninger, 1988 p.159).
"The theory is unique as a guide to obtain in-depth knowledge of particular cultures and of professional nursing's culture care patterns and themes" (Leininger, 1988, p.159).
"Quality health care will become a marketable item with favorable positive cost benefits as it is now being promoted in commercial businesses"(Leininger, 1988, p.159).
"The use of anthropological and transcultural care knowledge are essential for accurate reliable health care"(Leininger, 1988, p. 159).
"In the early 1940's, there were very few patients one would consider as 'foregneirs' in the hospitals"(Leininger, 1992, p.1)
"Moreover, whatever the cultural differences, it is the nurse who is expected to provide the most direct and continuous care to patients in acute or chronic illness states." Leininger, 1992, p.1)
Madeleine Leininger Quotes
Key concepts that are central tothe culture care theory.
Critique of Transcultural Theory
Culture care theory is a large discipline of nursing practice, research and education. The theory "has had an enormous impact on nursing practice and the opportunities for continuing applications in the 21st century are endless" (Nelson, 2006, p. 52).

"Transcultural nursing concepts and cultural care theory gave nurses an entirely new way to understand individuals, families, and cultures" (Leininger, 1988, p. 155).

"The theory is unique as it is the only nursing theory focused explicitly on culture are as the dominant domain of nursing inquiry" (Leininger, 2007, p. 9).

"The theory is a holistic, culturally based care theory that incorporates humanistic dimension about people in theory culture life context" (Leininger, 2007, p. 9).
Leininger's Most Significant contributions to Nursing/Health Care.
Sunrise Model-A comprehensive guide to ethnonursing research and a pictorial depiction of the theory of culture care diversity and universality (Leininger, 2006).
Observation-Participation-Reflection Enabler-Developed to help researchers move gradually from observer/active listener role, to roles with increasing levels of participation and eventually to a role involving primarily reflection and reconfirmation of findings with informal (Leininger, 2006).
Stranger-to-Trusted Friend Enabler-Developed to assist researchers or nurse clinician in self-assessment as they attempt to establish a trusting relationship with informants or clients (Leininger, 2006).
Acculturation Health Care Assessment Enabler-A guide for evaluting the degree of an informant's orientation toward traditional or nontraditional beliefs,values, and practices (Leininger, 2006).
Domain of Inquiry Enabler-Indicating the specific focus of study within chge broader domain of culture care and health (Leininger, 2006).
The Link Between Theory and Clinical Nursing Practice.
Nurses realize today and in the future we will be caring for more diverse patients as the world becomes even more multicultural (Leininger, 1988).

As stated by Leininger (1988) "This theory has relevance and significance for nurses to reduce nurse burnout, cultural shock, marked ethnocentrism, and many other nursing conditions and practice" (p. 159).

"Nursing is in a unique and enviable position to demonstrate quality care based on in-depth knowledge about the meanings and experiences related to healing clients and providing effective health care promotion services to the well, sick, disabled, or dying" (Leininger, 1988, p. 159).

"The use of anthropological and transcultural care knowledge is essential for accurate reliable health care" (Leininger, 1988, p. 159).
Assumptive Premises of the Theory
"Care
Culture
Caring
Cultural Care
Cultural Diversity
Cultural Care Universality
World View
Social Structure
Environmental Context
Folk Health
Health
Professional Health
Culural Care Preservation
Cultural Care Accommodation
Culture Care Repatterning or Restructuring" (Leininger, 1988, p. 155).
Overview
Transcultural nursing balances those culturally based care needs that have a direct influence on each individual’s health, well-being, illness, or approach to death (Nelson, 2006). The culture care theory displays the parallel between the theory and health. Focuses of the individual or community should be treated differently and separately, and personal uniqueness should always be considered (Leininger, 1994). Leininger gave nurses the Sunrise Model to work the theory of the cultural care, Universality and a quick assessment tool to begin adapting the theory to our practice.
Short Culturalogical Assessment
"1. Recording observations.
2. Listening to/learning from the client about cultural values, beliefs, and practices.
3. Identifying and documenting recurrent patterns and narratives with client meanings.
4. Synthesizing expressed themes and patterns of care.
5. Developing a culturally based plan of care"
(Leininger, 2006, p.75).
The development of the Culture Care Theory is the most significant middle range nursing theory given to our profession. "It also encourages nurses to shift from the medical paradigm to a nursing paradigm" (Leininger, 1988, p. 152).
Relationship and Structure
Sunrise Model
Individuals
families
groups
communities
intuition health and illness
Diverse Health Context
generic (folk) care
nursing care
professional care cure practices
Focus of Sunrise Model-cultural congruency
preservation/maintanence
accommodation/negotiation
well-being or dying
components influnce care
individuals
families
groups
sociocultural institution

1. Care is the essence of nursing and a distinct, dominant, and unifying focus.
2. Care (caring) is essential for well being, health, healing, growth survival, and to face handicaps or death.
3. Culture care is the broadest holistic means to know, explain, interpret, and predict nursing care phenomena to guide nursing care practices.
4. Nursing is a transcultural, humanistic, and scientific care discipline and profession with the central purpose to serve human beings worldwide.
5. Care (caring) is essential to curing and healing, for there can be no curing without caring.
6. Culture care concepts, meanings, expressions, patterns, processes, and structural forms of care are different (diversity) and similar (towards commonalities or universalities) among all cultures of the world.
7. Every human culture has lay (generic, folk, or indigenous) care knowledge and practices and usually some professional care knowledge and practices which vary transculturally.
8. Cultural care values, beliefs, and practices are influenced by and tend to be embedded in worldview, language, religious (or spiritual), kinship (social), political (or legal), educational, economic, technological, ethnohistorical, and environmental context of a particular culture.
9. Beneficial, healthy, and satisfying culturally based nursing care contributes to the well being of individuals, families, groups, and communities within their environmental context.
10. Culturally congruent or beneficial nursing care can only occur when the individual, group, community, or culture care values, expressions, or patterns are known and used appropriately and in meaningful ways by the nurse with the people.
11. Culture care differences and similarities between professional caregiver(s) and client (generic) care-receiver(s) exist in any human culture worldwide.
12. Clients who experience nursing care that fails to be reasonably congruent with their beliefs, values, and caring lifeways will show signs of cultural conflicts, noncompliance, stresses and ethical or moral concerns.
13. The qualitative paradigm provides new ways of knowing and different ways to discover the epistemic and ontological dimensions of human care transculturally. (Leininger, M. M., 1991, p.44-45).
Assumptions and orientational definitions
Purpose
The central purpose of the theory of culture care diversity and universality is to discover, document, interpret, and explain the phenomenon of culture care as a synthesized construct “ (Leininger, 1996, p.72).
“The purpose and goal of the transcultural nursing theory is to provide culturally congruent, safe, and meaningful care to clients of diverse or similar cultures” (Leininger, 2002, p. 190).
A parallel is needed for holistic care for each individual and community.
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