TRANSCULTURAL
NURSING
MADELEINE LEININGER
"HUMAN CARING IS A
UNIVERSAL PHENOMENON,
BUT THE EXPRESSIONS,
PROCESSES, AND PATTERNS
VARY AMONG CULTURES"
Born on 13 July 1925, Sutton, Nebraska,
United States
"MARGARET MEAD OF NURSING"
1948- Diploma in Nursing from [Link]'s
School of Nursing, Denver Colorado
1985-first publishes her theory in Nursing
Science Quarterly
1991- Published her book Culture Care
Diversity and Universality: A Theory of
Nursing
Recognized worldwide as the founder of
Transcultural Nursing, a program that she
MADELEINE LEININGER created in the school in 1974
TERMS AND
DEFINITIONS
CULTURE Broadly defines a set of values, beliefs, traditions, that are held by a specific group of people.
RELIGION Set of beliefs in a divine or super human power to be obeyed and worshipped as the creator.
Group of people who share a common and distinctive culture and are members of a specific
ETHNIC group.
ETHNICITY A consciousness of belonging to a group
CULTURAL The sense of being part of an ethnic group or culture
IDENTIFY
CULTURE- Commonalities of values, norms of behavior, and life patterns that are similar to different
UNIVERSALS cultures
CULTURE- Values, beliefs, and patterns of behavior that tend to be unique to a designate culture
SPECIFICS
TERMS AND
DEFINITIONS
MATERIAL CUTURE Refers to objects
NON-MATERIAL Refers to believe, customs, languages, social institutions
CULTURE
SUBCULTURE Composed of people who have a distinct identity but are related to a larger cultural group
BICULTURE A person who crosses two cultures, lifestyles, and sets of values.
DIVERSITY Refers to the fact or state of being different.
Individuals who have taken on usually observable features of another culture. People of
ACCULTURATION minority groups tend to assume the practices of the dominant society resulting in a blended
culture.
CULTURE The state of being disoriented or unable to respond to a different cultural environment
SHOCK
TERMS AND
DEFINITIONS
ETHNIC GROUPS Share a common social and cultural heritage that is passed on to successice genereations
ETHNIC IDENTITY Refer to a subjective perspective of the person's heritage and to a sense of belonging to a
group that is distinguishable than the other.
RACE The classification of people according to shared biologic characteristics, genetic markers or
features.
CULTURE CARE Indicates the "variabilities and/or differences" in meanings, patterns, values, or symbols of
DIVERSITY care within or between collectives enabling human care expressions
CULTURE CARE Indicates the "common,similar" dominant uniform care meanings, patterns, values,
UNIVERSALITY lifeways, o symbols that are manifest among many cultures.
TRADITIONAL CONCEPTS OF HEALTH AND
DISEASE
When viewed across a variety of multicultural groups, explanations for health and
disease that characterized many traditional beliefs can be seen as highly complex,
dynamic, and interactive A failure to understand and appreciate these "differences" can
have serious implications for the success of any HPDP Effort
Be aware that health concepts held by many cultural groups may result in people
choosing not to seek Western Medical treatment procedures because they do not view the
illness or disease as coming from within themselves
Be aware that in many Eastern cultures and other cultures in the developing world, the
focus of control for disease causality often is centered outside the individual, whereas in
Western Cultures, the focus of control tends to be more internally oriented
Remember that if a more traditional person does seek Western medical treatment then
that person might not be able to provide or describe his or her symptoms in precise terms
than the Western medical practitioner can readily treat
Recognize that individuals from other cultures might not follow through with health-
promoting or treatment recommendations because they perceive the medical or other
health-promoting emncounter as a negative or perhaps even hostile experience
TRADITIONAL CONCEPTS OF HEALTH AND
DISEASE
Acknowledge that many individual patients and health care practitioners have specific
notions about health and disease causality treatment called explanatory models.
Recognize that the more disparate differences are between the biomedical model and
that lay/popular explanatory models, the greater the potential for, or to encounter
resistance to Western HDPD Programs.
Be aware of the need to be flexible in the design of programs, policies, and services to
meet the needs and concerns of the culturally diverse population, groups that are like to
be encountered
CARE
Refers to assisting, supporting, CULTURAL CARE
or enabling behaviors that ease Refers to the values and beliefs that
or improve a person's conditions assist or support another person or
Has different meanings in group to maintain well being, improve
different cultures which can be the personal condition, or face death
determined by examining the and disability
group's view of the world, social DIVERSE CARE: different meanings,
structure and langugae patterns, values, beliefs, or symbols of
care indicative of health for a specific
culture
UNIVERSAL CARE: commonalities or
similarities in meanings, , patterns,
values, beliefs, or symbols of care
between different cultures
FOLK HEALTH or WELL
BEING SYSTEMS
Refers to care or care WORLD VIEW
practices that have a special Refers to the outlook of a person or
meaning in the culture group based on a view of the world or
universe
. These practices are used to
SOCIAL STRUCTURE: organizational
heal or assist people in the
factors of a particular culture, and how
home or community
these factors give meaning and order
to the culture
ENVIRONMENTAL CONTEXT: any event,
situation, or experience that gives
meaning to human expressions.
TRADITIONAL CONCEPTS OF ILLNESS
CAUSALITY
Be aware that folk illnesses are generally learned syndromes that individuals from
particular cultural groups claim to have and from which their culture defines the etiology
behaviors, diagnostic procedures, prevention methods, and traditional healing or caring
practices.
Remember that most cases of lay illness have multiple causalities and may require several
different approaches to diagnosis, treatment, and cure including folk and western medical
interventions
Recognize that folk illnesses that are perceived to arise from a variety of causes, may
require the service of a folk healer
Recognize that the use of traditional or alternate models of health care delivery is widely
varied and may come into conflict with Western models of health care practice
CONCEPT OF CULTURAL
CULTURE AWARENESS
Culture is learned be each generation
It is an in-depth examination of one's own
through both formal and informal life
background, recognizing biases and
experiences
prejudices and assumptions about other
Language is the primary means of people
transmitting culture
The practices of a particular culture often
arise because of the group's social and
physical environment
Culture practices and beliefs are adapted
over time but they remain constant as
long as they satify needs
PURPOSES OF KNOWING THE PATIENT'S
CULTURE AND RELIGION FOR HEALTH CARE
PERSONNEL
To heighten awareness of ways in which their own faith systems provides
resources
To foster understanding, respect, and appreciation for the individuality and
diversity
To strengthen in their commitment to relationship-centered medicine that
emphasizes care of the suffering person.
To facilitate in recognizing the role of the hospital chaplain and the patient's
clergy
To encourage in developing and maintaining a program of physical, emotional,
and spiritual self-care
CULTURALLY
CONGRUENT CARE
Care that fits the people's valued life practices and set of meanings which are
generated from the people themselves, rather than based on predetermined
criteria
CULTURALLY
COMPETENT CARE
It is the ability of the practitioner to bridge cultural gaps in caring, work with
cultural differences and enable clients and families to achieve meaningful and
supportive caring
NURSING DECISIONS
1. Culture preservation or maintenance.
2. Cultural care accommodation
3. Cultural care repatterning or restructuring
PURPOSE AND GOAL
OF THE THEORY
The central purpose of the theory is to discover and
explain diverse and universal culturally based care factor
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 structure
USE OF PROTECTIVE
PRACTICES
Protective objects can be worn or carried or hung in the home. Like amulets these
objects with magical powers.
USE OF SUBSTANCES
It is believed that certian food substances can be ingested to prevent illness.
E.g. eating raw garlic or onion to prevent illness or wear them on the body or hang
them in the home.
RELIGIOUS PRACTICES
Religion strongly affects the way people attempt to prevent illness, and it
plays a strong role in rituals associated with health protection.
Traditional remedies,
Healers
IMMIGRATION
Every immigrant group has its own cultural attitudes, with ranging beliefs and
practices regarding these areas.
Gender roles
ILLNESS CAUSE AND
PREVENTION RELATED TO
FOOD
Food substances are classified as hot or cold with and without regard to their
actual temperature.
Traditional beliefs about mental health
ECONOMIC BARRIERS
Several economic barriers such as unemployment, underemployment,
homelessness, lack of health insurance, poverty, prevent people from
entering the health care system.
Time orientation
PERSONAL SPACE AND
TERRITORIALLITY
Personal space involves a person’s set of behaviors and attitudes toward the
space around himself.
Staff members and other clients frequently encroach on a client’s territory in
the hospital, which includes the clients room, closet, and belongings.
SOCIOCULTURAL FACTORS AND
THE NURSING PROCESS
Religious beliefs that affect the care of nursing:
Beliefs about birth and death
Beliefs about diet and food practices
Beliefs regarding medical care
THREE MODES OF NURSING
ACTION
1. CULTURE CARE PRESERVATION OR MAINTAINANCE
2. CULTURE CARE ACCOMMODATION OR NEGOTIATION
3. CULTURAL CARE RESTRUCTURING OR REPATTERNING.
ROLES OF THE NURSE
Determine the client's cultural heritage and language skills.
Determine if any of his health beliefs relate to the cause of the illness or to the problem.
Collect information that any home remedies the person is taking to treat the symptoms.
Nurses should evaluate their attitudes toward ethnic nursing care.
Self-evaluation helps the nurse to become more comfortable when providing care to clients from
diverse backgrounds
Understand the influence of culture, race ðnicity on the development of social emotional
relationship, child rearing practices & attitude toward health.
Collect information about the socioeconomic status of the family and its influence on their health
promotion and wellness
Identifiy the religious practices of the family and their influence on health promotion belief in families.
Understanding of the general characteristics of the major ethnic groups, but always individualize care.
The nursing diagnosis for clients should include potential problems in their interaction with the health
care system and problems involving the effects of culture.
The planning and implementation of nursing interventions should be adapted as much as possible to
the client's cultural background.
Evaluation should include the nurse's self-evaluation of attitudes and emotions toward providing
nursing care to clients from diverse sociocultural backgrounds.
Self-evaluation by the nurse is crucial as he or she increases skills for interaction. .
tHEORETICAL ASSERTIONS
PERSON ENVIRONMENT
Not specifically defined by
Is referred to as a human
Leininger.
being.
The concepts of world view,
Is caring and capable of being
social structure, and
concerned to others.
environmental context are
discussed.
Closely related to the concept of
culture..
tHEORETICAL ASSERTIONS
HEALTH NURSING
Is viewed as the state of being. Is defined as a learned humanistic art and
Culturally defined, valued, and science that focuses on personalize behaviors,
practiced. function, processes, to promote and maintain
Reflects the ability of individuals to health or recovery from illness.
perform their daily roles. Has physical, psycho-cultural and social
Includes health systems, health
significance for those being assisted.
care practices, health patterns, and
Uses 3 modes of action to deliver care.
health promotions and
Ethnonursing
maintenance.
Is the study of nursing care beliefs, values and
Is universal across all cultures yet
practices as cognitively perceived and known
defined differently by each to
by a designated culture through their direct
reflect by its specific values and
beliefs
experience, beliefs and values system.
(Leininger,1979 p15)
CONCLUSION
Nurses need to be aware and sensitive to the culture and
needs of the patients. The nurses need to understand the
social and cultural reality of the client, family and community
and to develop expertise to implement culturally acceptable
strategies to provide nursing care, and also to identify and use
resources acceptable to the client. (Boyle, 1987)
THANK YOU FOR
PARTICIPATING!