In the contemporary world, the knowledge about cultural diversity has become increasingly important for nurses. Values, attitudes, and norms of different cultures demand appreciation since these factors have accentuated the need for all-inclusive and culturally competent nurses. Nursing theories hold that individuals with diverse cultural origins may have varied needs for health. Therefore, there is a need to embolden the study, description, and prediction of nursing phenomenon by the use of congruent cultural nursing care practices. The idea of culture stems from an anthropological setting while the concept of care springs from a nursing context. This paper describes, evaluates, and discusses the application of Madeleine Leininger’s nursing mid-range theory of culture care whilst providing the learner with an opportunity to connect theory and research to nursing phenomena.
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Madeleine Leininger’s Background and Development of Nursing Theories
Madeleine Leininger who lived from 13 July 1925 to 10 August 2012 was an author, scholar, professor, administrator, consultant, and a nursing theorist and anthropologist (Jeffreys, 2008). After her high school education at Sutton High School, the author reveals that Madeleine Leininger pursued a nursing diploma at St. Anthony’s Hospital School of Nursing before she furthered her education at Mount St. Scholastica College (currently known as the Benedictine College) and Creighton University where she earned relevant nursing undergraduate degrees. The development of the transcultural treatment theories dates back to the 1950s when Leininger started a psychiatric treatment facility and a learning curriculum at Creighton University in Omaha. Many scholars and nursing theorists recognise her as the as the founder of transcultural nursing. Later, in 1954, she received a Master of Science Degree in Nursing at the Catholic University of America. At the same year, the University of Cincinnati absorbed her to work as an Associate Professor and Director of the Graduate Programme in Psychiatric Mental Health Nursing and Psychology (Jeffreys, 2008). In 1966, she graduated from the University of Washington, Seattle, with a PhD in Cultural and Social Anthropology. Today, she is recognised as the first professional nurse to seek knowledge about cultural and social anthropology.
The interest of Leininger’s in nursing psychology developed during early years of her career. At one time, Leininger revealed that her aunt who ailed a congenital heart disease worn her heart to the field of nursing (Sagar, 2012). Moreover, early psychiatric interventions seemed too outdated for her to realise the needs of a culturally diverse society. This occurrence of traditional nursing interventions in a modern and complex society necessitated the need for the development of holistic nursing techniques to address the needs and behaviours of diverse cultures. After conducting adequate research, she gathered enough knowledge that helped her integrate nursing and anthropology. The growing interest in the nursing discipline is what led her to pursue a doctoral programme in Cultural and Social Anthropology. Before her demise in 2012, Madeleine Leininger had served numerous leadership positions as a nursing theorist consultant and professor of nursing and anthropology in a variety of universities in the United States.
Phenomenon of Concern or Problems Addressed by the Theory
Madeleine Leininger’s theory of culture care focuses on contemporary culturally diverse care factors that have profound impacts on the health of individuals or groups (Butts & Rich, 2010). The purpose of the transcultural theory is to develop a harmonious civilisation care training using evocative research results. The theory addresses the need to integrate nursing techniques and anthropological concepts to nurse diseases from a cultural outlook of a patient. It seeks the understanding of nursing practitioners to treat patients without interfering with their cultural values. The theory holds that the assimilation of religious and cultural rites into the care plan can profoundly determine the recovery of the patient. To incorporate the theory into practice, Leininger established the Transcultural Nursing Society to harmonise the thoughts of nurses globally. The nursing society facilitates various issues such as nursing consultation, learning, direct care, ethnonursing research, and policymaking via an online platform to develop universally accepted holistic methods that find their use in health care (Jeffreys, 2008). Nevertheless, the greatest significance of the theory is to shift nurses from traditional ethnocentric perceptions to enriching multicultural nursing practices to improve the efficiency of administering special care to patients (Butts & Rich, 2010).
Leininger’s transcultural care theory uses inductive reasoning to elucidate congruent culture care norms and values. The theory develops on the behavioural patterns and commonality of patients. The development of Leininger’s concept uses an inductive research technique known as ethnonursing. Ethnonursing is a qualitative anthropological research method that is used for description, documentation, and explanation of nursing care concepts across disciplines (Sagar, 2012). Leininger used this inductive technique to study the beliefs, values, language, attitudes, and norms of different cultures in a nursing context. The use inductive reasoning makes the theory derive qualitative comparisons and inferences rather than quantitative inferences that nurses derived from traditional hypotheses. As a result, the conceptual framework allows representational analysis of culture care diversities and universality in an attempt to seek holistic nursing knowledge that meets the needs of a multicultural society (Butts & Rich, 2010).
Major Concepts of the Culture Care Theory
Numerous concepts have been developed in the light of the culture care theory. The major concepts of the theory include transcultural nursing, ethnonursing (aforementioned), professional nursing care, and cultural congruence. Jeffreys (2008) describes transcultural nursing as an approach to treatment that focuses on investigation of the patient’s cultural background prior to the development of a nursing plan. Transcultural nursing entails the performance of a comparative study and cultural analysis in relation to nursing and preservation of values, norms, attitudes, beliefs, and practices of the individual or group of patients. Ethnonursing is a conceptual framework that facilitates the study of nursing care factors in transcultural nursing (Sagar, 2012). Professional nursing care is a concept that deploys professional care systems to elucidate inductive reasoning by prompting cognitive thoughts to develop formally assistive, supportive, facilitative, and enabling nursing techniques with a view of improving the patient’s health condition. Lastly, cultural congruence is a formalist concept that builds on cultural dynamism. It explains the interaction between the provider of culture care and the patient (Jeffreys, 2008).
Interpretation of Leininger’s Definition of the Culture Care Theory
Leininger explicitly defined the conceptual framework for her culture care theory. The presentation of the model correlates with the anthropological concepts that help nurses elucidate knowledge about multicultural beliefs, values, norms, and practices. Jeffreys (2008) reveals that the nurse anthropologist clearly stated the propositions for nursing by providing relevant inferences about the relationship between the health of individuals and their cultural identity. The conceptualisation of these concepts in nursing situations has enabled nurses realise the importance of integrating anthropological concepts in nursing contexts in an attempt to derive the best nursing practices for culturally diverse patients. The implementation of the theory through the establishment of the transcultural nursing society makes it more explicit since it proves the functionality of the theory by the application of expertise knowledge (Sagar, 2012).
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The Relationships (Propositions) among the Major Concepts
An analysis of Leininger’s culture care theory reveals that the major concepts, namely transcultural nursing, ethnonursing, professional nursing care, and cultural congruence, function complimentarily to explicate comprehensive and relevant nursing decisions that enable nurses develop comprehensive treatment methods for patients of dissimilar cultures. While transcultural concepts seek the knowledge about the cultural background, ethnonursing concepts enable the nurse analyse the specific cultural factors by relating them to the patient’s health (Butts & Rich, 2010). Additionally, the study of the values, norms, language, attitudes, and practices of diverse cultures in a nursing perspective require nurses to base their judgement on professional nursing care whilst upholding all-encompassing cultural congruence. The interrelatedness between these concepts conceives sound nursing decisions for the treatment of patients.
Explicit and Implicit Assumptions (Values/Beliefs) Underlying the Theory
The culture care theory has numerous underlying assumptions that have developed criticism amongst the postulates and opponents of the theory. Sagar (2012) attests that the culture theory holds that diverse cultures perceive, understand, and exercise care in different ways. However, Leininger failed to explain the application of the theory where cultures exhibit common behaviours owing to the shared values, norms, attitudes, practices, knowledge, and/or language among other cultural characteristics. The theory also assumes that cultural values, beliefs, and practices remain the same for a particular culture. Undoubtedly, these cultural factors change with time due to modernity and influence. In addition, Leininger stresses the importance of rounded assessment of individuals, families, groups, and/or institutions in an attempt to deliver culturally congruent care. The evaluation of individuals in the process of cultural analysis forces the nurse to seek inherent cultural knowledge and values that exist within the client. In fact, these cultural valuation techniques pose the risk of time shortcomings where patient cases demand urgency. Furthermore, the theory assumes the importance of knowledge about curing and healing. The author puts more emphasis on the care concept. Inopportunely, the fact that care is the central focus of nursing does not necessarily guarantee cure and healing. Regardless of their relationship with culture care, cure and healing are inherent processes that occur within the patient (Jeffreys, 2008).
Metaparadigm Concepts of Leininger’s Nursing Theory
Leininger’s culture care theory describes three of the four metaparadigms of nursing, namely people, nursing, and health. The nurse anthropologist perceives people as beings who have intrinsic capabilities of showing concern about the needs, wellbeing, and sustained being of others (Jeffreys, 2008). According to Leininger, human care is a collective practice that is existent among universally diverse communities. Leininger used the concept to explain why human beings exist in a multiplicity of cultures by their universality nature that prompts them to provide care for each other within diverse cultural settings that have varied needs (Butts & Rich, 2010). As Leininger explains in her theory, nursing is a culture care paradigm that she used to emphasise the importance of cultural congruence. Nurses need to appreciate the knowledge about culture care for the best nursing customs. Finally, she defines health as a condition of an individual or group’s wellbeing that characterises culturally defined values and practices that necessitate everyday activities in socially expressive, valuable, and premeditated ways of life. However, Leininger does not incorporate environment in her culture care theory. Instead, the nurse anthropologist talks about worldviews, social constructions, and societal contexts (Butts & Rich, 2010).
Clarity of the Theory
Statistical findings indicate that the application of transcultural concepts in nursing contexts has improved the health status of many patients who suffer from diverse health conditions (Sagar, 2012). The use of transcultural theory surpasses the wide-ranging human culture due to its universality that has facilitated the development of rounded health practices. Although many nurses have realised the importance of cultural nursing and appreciation of diverse cultures, the theory has failed to provide clarity in various nursing phenomena. Jeffreys (2008) reveals that the theory has sometimes led to the formulation of imprecise clinical decisions, especially where nurses fail to draw clear inferences about cultural congruence. This situation leads to outcome imperceptions pertaining to the valuation of patients. In addition, Leininger’s nursing theory fails to provide a lucid insight into disease symptoms and the processes of administering cure.
How the Theory will Guide Nursing Actions
Leininger’s theory finds its application in a number of nursing occupations in areas such as education, informatics, administration, and/or general nursing practice. In contemporary nursing contexts, nurses have used the culture care theory to describe, explain, predict, and document day-to-day experiences of their patients. The transcultural concept serves as a rationale for gathering valuable information about the correlation between their health and cultural perceptions. Therefore, it guides nurses to establish the best criteria for administering treatment by developing all-inclusive nursing decisions for patients. In addition, the theory has helped nurses develop a multidimensional cultural competence that reinforces their roles and confidence of handling patients who suffer from different health conditions (Butts & Rich, 2010).
Applicability of the Theory in My Nursing Occupation as a Clinical Staff Nurse
Leininger’s Culture Care Theory finds its applicability in my nursing occupation. I serve as a clinical staff nurse in the Respiratory Care Unit (RCU) at Jackson Health System where we deal with patients who suffer from tuberculosis. Caring is a crucial concept to the delivery of holistic nursing services to tuberculosis patients. Our nursing niche receives worldwide patients from culturally diverse regions such as Florida, Haiti, Thai, and South America among other regions. Apparently, nurses also come from diverse world cultures. Therefore, there is always an unending need for our nurses to understand the knowledge about cultural diversity to facilitate the recovery of clients by virtue of universality. Entirely, patients in the RCU rely on nurses. They expect the best care practices for them to regain their health. As a clinical stuff nurse, I use Leininger’s transcultural nursing premise to discover the perceptions of patients towards tuberculosis. The results from the concept help me draw central conclusions that relate the recovery of the patients to their cultural backgrounds (Jeffreys, 2008).
The integration of anthropological concepts in nursing contexts shifted the nursing standpoint in the past half a century. The improvement of Leininger’s culture care theory and other conceptual frameworks have made transculture become a universally accepted practice in many health institutions. Practically, culture care practices open up a clear path for communication between nurses and patients. In this manner, the theory enhances eccentricity of each party, thereby deriving a solution-oriented methodology for administering the treatment of patients. Nonetheless, the wholeness of the theory demands an in depth research to reveal the underlying assumptions that have left many questions for practitioners. It is investable to deal with culturally diverse patients in a multicultural society. For this reason, Madeleine Leininger’s theory of culture care remains a central concept in nursing.
Butts, J.B. & Rich, K.L. (2010). Philosophies And Theories For Advanced Nursing Practice. Sudbury. Jones & Bartlett Learning.
Jeffreys, M. (2008). Dynamics of Diversity: Becoming Better Nurses through Diversity Awareness. Web.
Sagar, P. (2012). Transcultural Nursing Theory and Models: Application in Nursing Education, Practice, and Administration. New York, NY: Springer Publishing Company, LLC.