MADELEINE LEININGER

MADELEINE M. LEININGER

YEAR DEGREE EARNED SCHOOL / UNIVERSITY

1948 basic nursing education

St. Anthony’s School of Nursing, Denver,

CO

1950 bachelor of science Mount St. Scholastica College, Atchison, KS

1954 master of science in psychiatric-mental

health nursing

The Catholic University of America,

Washington, DC

1965 Ph.D. in cultural and social anthropology

University of Washington, Seattle

MADELEINE M. LEININGER A Fellow in the American Academy of

Nursing and holds honorary doctorates from Benedictine College, the University of Indianapolis, and the University of Kuopio , Kuopio, Finland

In 1998, she was named a “Living Legend” by the American Academy of Nursing

Professor Emeritus, College of Nursing, Wayne State University

Founder of transcultural nursing

Historical Development of the Theory

In the 1940s Leininger (1991) recognized the importance of caring to nursing.Statements of appreciation for nursing care made by patients alerted her to caringvalues and led to her longstanding focus on care as the dominant ethos of nursing.During the mid-1950s, she experienced what she describes as cultural shock whileshe was working in a child guidance home in the midwestern United States. Whileworking as a clinical nurse specialist with disturbed children and their parents, she observed recurrent behavioral differences among the children, and finally concluded thatthese differences had a cultural base. She identified a lack of knowledge of the children`scultures as the missing link in nursing to understand the variations neededin care of clients. This experience led her to become the first professionalnurse in the world to earn a doctorate in anthropology, and led to the developmentof the new field of transcultural nursing

Leininger first used the terms transcultural nursing, ethnonursing, and crosscultural nursingin the 1960s. In 1966, at the University of Colorado, she offered the firsttranscultural nursing course with field experiences and has been instrumental inthe development of similar courses at a number of other institutions (Leininger, 1979).In 1995, Leininger affirmed her 1978 definition of transcultural nursing as:

“a substantive area of study and practice focused on comparative cultural care(caring) values, beliefs, and practices of individual or groups of similar or differentcultures with the goal of providing culture-specific and universal nursing carepractices in promoting health or well-being or to help people to face unfavorable human conditions,illness, or death in culturally meaningful ways.”

Historical Development of the Theory

In 1979 she defined ethnonursing as:

“the study of nursing care beliefs, values, and practices as cognitivelyperceived and known by a designated culture through their direct experience, beliefs, and value system.”

The term transcultural nursing (rather than "cross-cultural") is used today to refer to the evolving knowledge and practices related to this new field of study and practice. Leininger (1991, 1995) stresses the importance of knowledge gained from direct experience or directly from those who have experienced and labels such knowledge as emic, or people-centered. This is contrasted with etic knowledge, which describes the professional perspective. She contends that emically derived care knowledge is essential to establish nursing`s epistemological and ontological base for practice.

Historical Development of the Theory Leininger built her theory of transcultural nursing on the premise that the

peoplesof each culture can not only know and define the ways in which they experience and perceive their nursing care world but also relate these experiences and perceptions to their general healthbeliefs and practices. Based on this premise, nursing care is derived and developed from the cultural context in which it is to be provided.

Leininger (1991) asserts that human care is central to nursing as a discipline and as a profession. She, and others, have studied the phenomena of care for over four decades. They recognize and are proponents of preservation of care as theessence of nursing. With this increasing recognition of care as essential to nursing knowledge and practice, Leininger labeled her theory Culture Care. She drew upon anthropology for the culture component and upon nursing for thecare component. Her belief that cultures have both health practices that are specific to one culture and prevailing patterns that are common across cultures led to the addition of the terms diversity and universality to the title of her theory. Thus, the most current title of Leininger`s theory is Culture Care or Culture Care Diversity and Universality.

Leininger’s Sunrise Model

Theory of Culture Care Diversity and Universality

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 system(s), 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/maintenance, cultural care accommodation/negotiation and cultural care re-patterning or restructuring. It is here that nursing care is delivered.

Major Concepts

Transcultural nursing 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.

Ethnonursing 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).

Nursing 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.

Professional nursing care (caring) 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 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.

Major Concepts Health 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 lifeways.

Human beings 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.

Society/environment are not terms that are defined by Leininger; she speaks instead of worldview, social structure, and environmental context.

Worldview 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 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, technologic and cultural values, ethnohistorical factors, and how these factors may be interrelated and function to influence human behavior in different environmental contexts.

Major Concepts 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.

Culture is the learned, shared and transmitted values, beliefs, norms, and lifeways of a particular group that guides their thinking, decisions, and actions in patterned ways.

Culture care is defined as the subjectively and objectively learned and transmitted values, beliefs, and patterned lifeways that assist, support, facilitate, or enable another individual or group to maintain their well-being, health, improve their human condition and lifeway, or to deal with illness, handicaps or death.

Culture care diversity 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.

Culutre care universality 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)

Subconcepts Generic (folk or lay) care systems are culturally learned and transmitted, indigenous (or

traditional), folk (home-based) knowledge and skills used to provide assistive, supportive, enabling, or facilitative acts toward or for another individual, group, or institution with evident or anticipated needs to ameliorate or improve a human life way, health condition (or well-being), or to deal with handicaps and death situations.

EmicKnowledge gained from direct experience or directly from those who have experienced. It is generic or folk knowledge.

Professional care system(s) are defined as formally taught, learned, and transmitted professional care, health, illness, wellness, and related knowledge and practice skills that prevail in professional institutions usually with multidisciplinary personnel to serve consumers.

EticKnowledge which describes the professional perspective. It is professional care knowledge.

Ethnohistory includes those past facts, events, instances, experiences of individuals, groups, cultures, and instructions that are primarily people-centered (ethno) and which describe, explain, and interpret human lifeways within particular cultural contexts and over short or long periods of time.

Care as a noun is defined as those abstract and concrete phenomena related to assisting, supporting, or enabling experiences or behaviors toward or for others with evident or anticipated needs to ameliorate or improve a human condition or lifeway.

Care as a verb is defined as actions and activities directed toward assisting, supporting, or enabling another individual or group with evident or anticipated needs to ameliorate or improve a human condition or lifeway or to face death.

Subconcepts

Three modes of nursing care decisions and actions

(a) Cultural care preservation 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.

(b) Cultural care accommodation 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.

(c) Culture care repatterning, or restructuring includes those assistive, supporting, facilitative, or enabling professional actions and decisions that help a client(s) reorder, change, or greatly modify their lifeways for new, different, and beneficial health care pattern while respecting the client(s) cultural values and beliefs and still providing a beneficial or healthier lifeway than before the changes were coestablished with the client(s). (Leininger, 1991)

Subconcepts

Culture shock may result when an outsider attempts to comprehend or adapt effectively to a different cultural group. The outsider is likely to experience feelings of discomfort and helplessness and some degree of disorientation because of the differences in cultural values, beliefs, and practices. Culture shock may lead to anger and can be reduced by seeking knowledge of the culture before encountering that culture.

Cultural imposition refers to efforts of the outsider, both subtle and not so subtle, to impose his or her own cultural values, beliefs, behaviors upon an individual, family, or group from another culture. (Leininger, 1978)

Analysis It was stated that the nurse will help the client move towards amelioration

or improvement of their health practice or condition. This statement would be of great difficulty for the nurse because instilling new ideas in a different culture might present an intrusive intent for the “insiders”. Culture is a strong set of practices developed over generations which would make it difficult to penetrate.

The whole activity of immersing yourself within a different culture is time-consuming for you to fully understand their beliefs and practices. Another is that it would be costly in the part of the nurse.

Because of its financial constraints and unclear ways of being financially compensated, it can be the reason why nurses do not engage much with this king of nursing approach.

Because of the intrusive nature, resistance from the “insiders” might impose risk to the safety of the nurse especially for cultures with highly taboo practices.

It is highly commendable that Leininger was able to formulate a theory which is specified to a multicultural aspect of care. On the other side, too much was given to the culture concept per se that Leininger failed to comprehensively discuss the functions or roles of nurses. It was not stated on how to assist, support or enable the client in attuning them to an improved lifeway.

Strength and Weakness

Strengths

Leiniger 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 it 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.

Though not simple in terms, it can be easily understood upon first contact.

Weakness

The theory and model are not simple in terms.

Application of the theory

The theory of Culture Care Diversity and Universality is based on, and calls for, qualitative rather than quantitative research. The development of hypotheses is characteristic of positivistic, quantitative research. The development of research questions, and of relational statements, is characteristic of qualitative research. Leininger (1991) states that nursing science should be defined "as the creative study of nursing phenomena which reflects the systematization of knowledge using rigorous and explicit research methods within either the qualitative or quantitative paradigm in order to establish a new or to advance nursing`s discipline knowledge". However, Leininger has developed a qualitative method for studying culture and care. She calls this the ethnonursing research method and indicates the qualitative methodology is the most appropriate for studying the emic views and beliefs of people. The principles that guide the ethnonursing research method are to:

Maintain an open discovery, active listening, and a genuine learning attitude in working with informants in the total context in which the study is conducted.

Maintain an active and curious posture about the "why" of whatever is seen, heard, or experienced, and with appreciation of whatever informants share with you.

Record whatever is shared by informants in a careful and conscientious way for full meanings, explanations, or interpretations to preserve informant ideas.

Seek a mentor has experience with the ethnonursing research method to act as a guide.

Clarify the purposes of additional qualitative research methods if they are combined with the ethnonursing method such as combining life histories, ethnography, phenomenology, or ethnoscience.

CULTURE CARE: MEANINGS, PATTERNS AND EXPRESSIONS FOR BAGANDA WOMEN AS AIDS CAREGIVERS WITHIN LEININGER'S THEORY

by JOAN MARY MACNEIL December, 1994  Advisor: Madeleine M. Leininger, PhD, RN, FAAN Major: Nursing Degree: Doctor of Philosophy  In Uganda, AIDS patients are increasingly cared for at home by women in their traditional role of family caregiver. This

transcultural nursing study utilized Leininger's (1991) Culture Care Theory to discover the meanings, patterns, and expressions of AIDS caregiving for Ugandan women within the largest culture in the country, the Baganda.

 Ethnonursing, supported by life history and Leininger's (1988, 1990, 1991, 1993) Sunrise Model, was used to inductively

discover the meanings, patterns, and expressions of care among 12 key and 25 general Baganda informants providing AIDS caregiving to family members. In-depth data were collected by interviewing informants selected from home based nursing care programs in the Rakai/Masaka and the Kampala areas. Data were analyzed using Leininger's (1990) four Phases of Ethnonursing Analysis for Qualitative Data. Specific qualitative criteria were applied throughout the study (Lincoln & Guba, 1985; Leininger, 1991).

 Six major themes were identified which were supported with descriptors and patterns. Five reflected commonalities among

Baganda women as AIDS caregivers, and one addressed diversity. The findings highlighted the tremendous struggle of Baganda women to provide care and love for family members with AIDS, identified intergenerational care as essential for survival and prevention of HIV infection, and offered insight into improving the quality of life for those who are HIV positive.

 Care knowledge from these findings can be used to provide culturally congruent nursing care to Baganda families who are

afflicted with AIDS through all three modes of professional nursing actions and decisions: cultural care preservation/maintenance, cultural care accommodation/negotiation, and cultural care repatterning or restructuring, and lend support to the development of a global care knowledge from a transcultural perspective.

References

George, J. (2008). Nursing Theories: The Base for Professional Nursing Practice. Norwalk, Connecticut: Appleton & Lange.

http://nursingtheories.weebly.com/madeleine-m-leininger.html

THANK YOU.