Leininger2 - Culture Care Universality & Diversity

Culture Care Universality Culture Care Universality & & Diversity

A Theory of NursingA Theory of Nursing

ByBy

Dr. M. LeiningerDr. M. Leininger

Central Purpose of the Central Purpose of the TheoryTheory

To discover and explain To discover and explain diverse and universal diverse and universal culturally based care culturally based care factors influencing the factors influencing the health, well being , health, well being , illness or death of illness or death of individuals or groupsindividuals or groups

Goal of the TheoryGoal of the Theory

To provide culturally To provide culturally congruent care that congruent care that would contribute to the would contribute to the health or well being of health or well being of people or to help them people or to help them face disabilities, face disabilities, dying, or death using dying, or death using the three modes of the three modes of nursing care actions nursing care actions and decisionsand decisions

Modes of Nursing Care Modes of Nursing Care Actions and DecisionsActions and Decisions

Culture Care Culture Care Preservation or Preservation or MaintenanceMaintenance

Culture Care Culture Care Accommodation Accommodation or Negotiationor Negotiation

Culture Care Culture Care Repatterning or Repatterning or RestructuringRestructuring

Culture Care Preservation Culture Care Preservation or Maintenanceor Maintenance

Refers to those assistive, supporting, Refers to those assistive, supporting, facilitative or enabling professional facilitative or enabling professional actions and decisions that help actions and decisions that help people of a particular culture to people of a particular culture to retain and/or preserve relevant care retain and/or preserve relevant care values so that they can maintain values so that they can maintain their well being, recover from illness, their well being, recover from illness, or face handicaps and/or death or face handicaps and/or death

Client Care Preservation or Client Care Preservation or MaintenanceMaintenance

Leininger’s theory gives credibility to Leininger’s theory gives credibility to traditional generic care practices which traditional generic care practices which have beneficial health outcomes and have beneficial health outcomes and have withstood the test of timehave withstood the test of time

Through the mode of culture care Through the mode of culture care preservation, acupuncture can be used preservation, acupuncture can be used in conjunction with Western treatment in conjunction with Western treatment modes to treat illness or reduce painmodes to treat illness or reduce pain

Culture Care Culture Care Accommodation or Accommodation or

NegotiationNegotiation

Refers to those assistive, supporting, Refers to those assistive, supporting, facilitative, or enabling creative facilitative, or enabling creative professional actions and decisions professional actions and decisions that help people of a designated that help people of a designated culture (or subculture) to adapt to or culture (or subculture) to adapt to or to negotiate with others for a to negotiate with others for a beneficial or satisfying health beneficial or satisfying health outcome with professional care outcome with professional care providersproviders

Culture Care Culture Care Accommodation or Accommodation or

NegotiationNegotiation

Sometimes generic care practices need Sometimes generic care practices need to be modified through culture care to be modified through culture care accommodationaccommodation

If a Greek client who eats too much If a Greek client who eats too much salty feta cheese and olives requires a salty feta cheese and olives requires a low sodium diet, then the client, along low sodium diet, then the client, along with family and nurse need to explore with family and nurse need to explore ways to enjoy Greek cultural foods with ways to enjoy Greek cultural foods with a lower sodium contenta lower sodium content

Culture Care Repatterning Culture Care Repatterning or Restructuringor Restructuring

Refers to those assistive, supporting, Refers to those assistive, supporting, facilitative, or enabling professional facilitative, or enabling professional actions and decisions that help a client’(s) actions and decisions that help a client’(s) reorder, change , or greatly modify their reorder, change , or greatly modify their lifeways for new, different , and beneficial lifeways for new, different , and beneficial health care patterns while respecting the health care patterns while respecting the client(s) cultural values and beliefs and client(s) cultural values and beliefs and still providing beneficial ore healthier still providing beneficial ore healthier lifeways than before the changes were lifeways than before the changes were coestablished with the client(s)coestablished with the client(s)

Culture Care Repatterning Culture Care Repatterning or Restructuringor Restructuring

Culture care Repatterning may be Culture care Repatterning may be necessary if a family practiced necessary if a family practiced “coining” on their children, a generic “coining” on their children, a generic practice where a coin is rubbed over practice where a coin is rubbed over painful areas to eliminate “bad wind” painful areas to eliminate “bad wind” in the body causing dark bruisingin the body causing dark bruising

This practice may be misinterpreted This practice may be misinterpreted as child abuse by authoritiesas child abuse by authorities

Culture Care Repatterning Culture Care Repatterning or Restructuringor Restructuring

Culture care repatterning would occur when Culture care repatterning would occur when the nurse teaches that this care practice is the nurse teaches that this care practice is not acceptable in the new country and not acceptable in the new country and would explore alternative generic practices would explore alternative generic practices for elimination of “bad wind”for elimination of “bad wind”

Sometimes the nurse will need to do the Sometimes the nurse will need to do the repatterning such as when the nurse values repatterning such as when the nurse values female independence and assertiveness but female independence and assertiveness but the female clientthe female client comes from a patriarchal comes from a patriarchal cultureculture

Metaparadigm ConceptsMetaparadigm Concepts

CareCare HealthHealth Environmental contextEnvironmental context NursingNursing PersonPerson

CareCare

Refers to abstract & Refers to abstract & concrete phenomena concrete phenomena related to assisting, related to assisting, supporting or enabling supporting or enabling experiences or behaviours experiences or behaviours toward or for others with toward or for others with evident or anticipated evident or anticipated needs to ameliorate or needs to ameliorate or improve human condition improve human condition or lifewayor lifeway

HealthHealth

Refers to a state of well Refers to a state of well being that is culturally being that is culturally defined, valued and defined, valued and practiced and which practiced and which reflects the ability of reflects the ability of individuals (or groups) to individuals (or groups) to perform their daily role perform their daily role activities in culturally activities in culturally expressed, beneficial and expressed, beneficial and patterned lifewayspatterned lifeways

Environmental ContextEnvironmental Context

Refers to the totality of an Refers to the totality of an event, situation, or event, situation, or particular experiences that particular experiences that give meaning to human give meaning to human expressions, expressions, interpretations and social interpretations and social interactions in particular interactions in particular physical, ecological, physical, ecological, sociopolitical and/or sociopolitical and/or cultural settingscultural settings

NursingNursing Leininger debates the inclusion of “nursing” in the Leininger debates the inclusion of “nursing” in the

traditional paradigm concepts because “nursing traditional paradigm concepts because “nursing should not be explained in terms of nursing itself”should not be explained in terms of nursing itself”

Nursing refers to a learned humanistic and scientific Nursing refers to a learned humanistic and scientific profession and discipline which is focused on human profession and discipline which is focused on human care phenomena and activities in order to assist, care phenomena and activities in order to assist, support, facilitate or enable individuals or groups to support, facilitate or enable individuals or groups to maintain or regain their well being (or health) in maintain or regain their well being (or health) in culturally meaningful and beneficial ways or to help culturally meaningful and beneficial ways or to help people face handicaps or deathpeople face handicaps or death

PersonPerson

Leininger does not identify Leininger does not identify person as a central concept person as a central concept of her theory because “it of her theory because “it would be inappropriate to would be inappropriate to focus only on the person as focus only on the person as central to nursing because central to nursing because nurses function with nurses function with families, families, groups,communities, and groups,communities, and institutions”institutions”

CritiqueCritique

SimplicitySimplicity GeneralityGenerality Empirical Empirical

Precision Precision Derivable Derivable

ConsequencesConsequences

SimplicitySimplicity Because the concepts of transcultural nursing Because the concepts of transcultural nursing

theory are complex and multiple, the theory is not theory are complex and multiple, the theory is not simplesimple

The theory is truly transcultural, global in scope The theory is truly transcultural, global in scope and highly complex requiring knowledge and and highly complex requiring knowledge and appreciation of transcultural and anthropology appreciation of transcultural and anthropology insightsinsights

Because of its holistic and comprehensive nature, Because of its holistic and comprehensive nature, several concepts and constructs related to social several concepts and constructs related to social structure, environment, and language are structure, environment, and language are important to understand to see how care and important to understand to see how care and health are influenced by these dimensionshealth are influenced by these dimensions

SimplicitySimplicity

The theory shows multiple interrelationships The theory shows multiple interrelationships of concepts and diversity of key conceptsof concepts and diversity of key concepts

It requires anthropological and transcultural It requires anthropological and transcultural nursing knowledge to be used fully and nursing knowledge to be used fully and accurately by nursing researchersaccurately by nursing researchers

Once the users of the theory have Once the users of the theory have conceptualized the theory, Leininger finds conceptualized the theory, Leininger finds that nursing students find it highly practical, that nursing students find it highly practical, relevant and more simple than complexrelevant and more simple than complex

GeneralityGenerality The theory demonstrates this criterion as it is a The theory demonstrates this criterion as it is a

qualitatively oriented theory that is broad, qualitatively oriented theory that is broad, comprehensive and worldwide in scopecomprehensive and worldwide in scope

It is useful and applicable to both groups and individualsIt is useful and applicable to both groups and individuals Many aspects of culture, care and health, as these Many aspects of culture, care and health, as these

factors impact on nursing, are being studiedfactors impact on nursing, are being studied From this culture-specific data, a few universal care From this culture-specific data, a few universal care

constructs are being identifiedconstructs are being identified More research is needed, and a greater number of the More research is needed, and a greater number of the

world’s cultural groups need to be studied to validate world’s cultural groups need to be studied to validate the caring constructsthe caring constructs

GeneralityGenerality

The theoretical model is a guide The theoretical model is a guide for the study of any culture and for for the study of any culture and for comparative study of several comparative study of several culturescultures

Findings from the theory are being Findings from the theory are being used in client care in a variety of used in client care in a variety of health and community settings health and community settings worldwideworldwide

Empirical PrecisionEmpirical Precision The transcultural nursing theory is researchable, The transcultural nursing theory is researchable,

and qualitative research has been the primary and qualitative research has been the primary paradigm to discover largely unknown paradigm to discover largely unknown phenomena of care and health in diverse culturesphenomena of care and health in diverse cultures

Accuracy of data derived with the use of Accuracy of data derived with the use of ethnomethods or from an emic viewpoint is ethnomethods or from an emic viewpoint is leading to high validity and reliability of dataleading to high validity and reliability of data

The qualitative criteria of credibility and The qualitative criteria of credibility and confirmability from in-depth studies of informants confirmability from in-depth studies of informants and their contexts are becoming clearly evidentand their contexts are becoming clearly evident

ScopeScope

Theory has multiple levels of scope Theory has multiple levels of scope dealing with human cultures and dealing with human cultures and nursing worldwidenursing worldwide– Broad macro level (etic analysis)Broad macro level (etic analysis)– Middle range (emic analysis)Middle range (emic analysis)– Concrete empirical levelConcrete empirical level

Sunrise model pictorially depicts Sunrise model pictorially depicts

the multiple theoretical levelsthe multiple theoretical levels

Derivable ConsequencesDerivable Consequences

Professional StandardsProfessional Standards PracticePractice EducationEducation ResearchResearch AdministrationAdministration

Professional StandardsProfessional Standards

CNO’s “CNO’s “Guide to Nurses for Providing Guide to Nurses for Providing Culturally Sensitive Care”Culturally Sensitive Care”– In the section on In the section on Developing an Approach Developing an Approach

to Careto Care the following statement is used: the following statement is used: Creativity & commitment to client-focused Creativity & commitment to client-focused care are the key attributes necessary to care are the key attributes necessary to integrate cultural preferences into the plan of integrate cultural preferences into the plan of carecare

– Leininger has identified three modes of action Leininger has identified three modes of action or approaches that can be used to guide or approaches that can be used to guide nursing judgmentsnursing judgments

PracticePractice

The area where transcultural The area where transcultural knowledge has made the biggest knowledge has made the biggest contribution to practice is in working contribution to practice is in working with hard to reach populations which with hard to reach populations which could include the homeless, refugees, could include the homeless, refugees, illegal immigrantsillegal immigrants

It seems to be more useful in It seems to be more useful in community than in acute care nursingcommunity than in acute care nursing

EducationEducation Inclusion of culture & comparative care in nursing Inclusion of culture & comparative care in nursing

curricula began in 1966 at the University of curricula began in 1966 at the University of ColoradoColorado

The world's first master’s and doctoral programs in The world's first master’s and doctoral programs in transcultural nursing were implemented in 1977 at transcultural nursing were implemented in 1977 at the University of Utahthe University of Utah

Before then Leininger had established transcultural Before then Leininger had established transcultural nursing courses and a department of transcultural nursing courses and a department of transcultural nursing at the University of Washingtonnursing at the University of Washington

Since 1980, an increasing number of nursing Since 1980, an increasing number of nursing curricula emphasize transcultural nursing and carecurricula emphasize transcultural nursing and care

EducationEducation

In the late 1980’s , four master’s and four In the late 1980’s , four master’s and four doctoral programs in the U.S. offered doctoral programs in the U.S. offered transcultural nursing courses, research transcultural nursing courses, research experiences, and guided field study experiences, and guided field study experiencesexperiences

Leininger gives about 32 workshops per year Leininger gives about 32 workshops per year on human care and transcultural nursingon human care and transcultural nursing

A library containing her publications etc. has A library containing her publications etc. has been established at Madonna University in been established at Madonna University in LivoniaLivonia

ResearchResearch

To date, approximately 90 Western and non-To date, approximately 90 Western and non-Western cultures and sub-cultures have been Western cultures and sub-cultures have been studied largely with the use of the studied largely with the use of the ethnonursing and ethnographic research ethnonursing and ethnographic research methodsmethods

Over the past 4 decades, approximately 200 Over the past 4 decades, approximately 200 substantive transcultural nursing research substantive transcultural nursing research studies have been done in Western and non-studies have been done in Western and non-Western culturesWestern cultures

The majority have been published in the The majority have been published in the Journal of Transcultural NursingJournal of Transcultural Nursing

AdministrationAdministration A theoretical & research base is urgently A theoretical & research base is urgently

needed for knowledge to support nursing needed for knowledge to support nursing decisions and actions and to prevent major decisions and actions and to prevent major cultural conflicts in education & servicecultural conflicts in education & service

Less than 5% of nurse administrators have any Less than 5% of nurse administrators have any graduate preparation in transcultural nursinggraduate preparation in transcultural nursing

Only a few schools of nursing offer Only a few schools of nursing offer transcultural administration courses but there transcultural administration courses but there are no major masters or doctoral programs in are no major masters or doctoral programs in nursing with sequenced course offerings in nursing with sequenced course offerings in transcultural nursing administrationtranscultural nursing administration

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