MADELEINE LEININGER The goal of transcultural nursing is to develop a scientific and

● The founder of the theory Transcultural Nursing/Culture humanistic body of knowledge in order to provide culture-specific
CareTheory and culture-universal nursing care practices to individuals, families,
● born on July 13, 1925, in Sutton.Nebraska groups, and communities from diverse back-grounds.
● was an internationally known educator, author, theorist,
administrator, researcher, consultant, public speaker, and Culture-specific
the developer of the concept of transcultural nursing ● refers to particular values, beliefs, and patters of behavior
● lack of cultural and cäre knowledge as the missing link to that tend to be special or unique to a group and that do
nursing. not tend to be shared with members of other cultures.
● She was the first in the 1960s to coin the concept of
"culturally congruent care," which was the goal of the Culture-universal
Theory of Culture Care, and today the concept is being ● refers to the commonly shared values, norms of behavior,
used globally. and life patterns that are similarly held among cultures
● Dean of the University of Washington, School of Nursing in about human behavior and lifestyles
1969 and remained in that position until 1974. In 1973,
under her leadership, the University of Washington was Transcultural nursing requires sophisticated assessment and analytic
recognized as the outstanding public institutional school of skills and the ability to plan, design, implement, and evaluate
nursing in the United States. nursing care for individuals, families, groups, and communities
● trip to New Guinea in the 1960s that opened her eyes to representing various cultures.
the need for nurses to understand their patients' culture
and background to provide care. She is considered by IMPORTANT IDEAS TO BE UNDERSTOOD ABOUT TRANS-CULTURAL
some to be the "Margaret Mead of nursing" and is NURSING SUCH AS THE FOLLOWING
recognized worldwide as the founder of transcultural 1. Care needs to be systematically studied to learn about
nursing, a program that she created at the School in 1974. human care(caring) in diverse and similar cultures in the
world and environments.
TRANSCULTURAL NURSING 2. Nurses need to be knowledgeable about their own
● Is a specialty within Nursing focused on the comparative cultural care heritage and of biases, beliefs, and prejudices
study and analysis of different cultures and subcultures. to work effectively with clients.
● Various groups are examined with respect to their caring 3. Nurses need to use trans culture-specific and comparative
behavior, nursing care, health and illness values, beliefs knowledge to guide caring practices for culturally
and patterns of behavior. congruent care.
● appeared less than 30 years ago since Madeleine Leininger 4. A focus on cultural care competencies for diverse cultures
first began to develop a theory of transcultural nursing as and universals (commonalities) is essential.
part of a doctoral study in anthropology. 5. Nurses should seek comprehensive, holistic, and
● Transcultural Nursing was developed because of the need comparative culture care phenomena.
to work with people from widely divergent cultural 6. Maintaining an open learning-discovery process about
atmosphere. care and culture is imperative.
● It is critical that nurses, because of their direct patient 7. Nurses need creative ways to provide culturally congruent
care, understand and work effectively within this diverse care practices
cultural atmosphere
● The most important aspect in developing cultural
competence is understanding the interrelatedness of
cultural concepts.
● Transcultural scholars and academics refer to
● Care as a universal phenomenon that transcends cultural
boundaries, and their aim is to incorporate transcultural
nursing into nursing curricula and clinical practices through
a research-based knowledge of cultures.
● the term transcultural nursing is sometimes used
interchangeably with cross-cultural, intercultural or
multicultúral nursing.
● In analyzing the Latin derivations of the prefixes associated
with these terms, you will notice that trans means across,
inter means between, and multi means many
● Transcultural nursing is an area of study or practice that
takes into account the specific values, beliefs, and ways of
life of people of diverse or similar cultures, with the goal of
using this knowledge in creative ways to provide culturally CULTURE
congruent care. ● Is a patterned of behavioral response that develops over
Transcultural nursing time as a result of imprinting the mind through social and
● is the blending of anthropology ard nursing in both theory religious structures and intellectual and artistic
and practice. manifestations.
● Recognizing that nursing is an art and a science, ● It is also the result of acquired mechanisms that may have
transcultural nursing enables us to. view our profession innate influences but are primarily affected by internal and
from a cultural perspective. external environmental stimuli.
● panethnic minority groups, ● Leininger and Mcfarland (2006), culture is the values,
beliefs norms and practices of a particular group that are
Anthropology learned and shared that guide thinking decisions, and
● refers to the study of humans and humankind, including actions in a patterned ways.
their. origins, behavior, social relation-ships, physical and ● Spector (2008), contends that culture is a
mental characteristics, customs, and development through metacommunication system based on no physical traits
time and in all places in the world. such as values, beliefs, attitudes, customs, language and
 behaviors that are shared by a group of people and are should focus beyond traditional nurse-patient interactions
passed down from one generation to the next. and dyads to include families, groups, communities, total
● Andres and Boyle (2016), culture represents a unique way cultures, and institutions.
of perceiving, behaving, evaluating the external
environment and such provides a blueprint for SOCIETY AND ENVIRONMENT
determining values, beliefs, and practices. ● Leininger did not define these terms; she speaks instead of
● She also recognized that one of anthropology's most worldview, social structure, and environmental context.
important contributions to nursing was the realization that
health and illness states are strongly influenced by culture. WORLDVIEW
● The cultural care worldview flows into knowledge about ● is how people look at the world, or the universe, and form
individuals, families, groups, communities, and institutions a "picture or value stance" about the world and their lives.
in diverse health care systems. This knowledge provides
culturally specific meanings and expressions about care SOCIETY AND ENVIRONMENT
and health. The next focus is on the generic or folk system, ● Leininger did not define these terms; she speaks instead of
professional care systems, and nursing care. worldview, social structure, and environmental context.

MAJOR CONCEPTS OF THE CULTURAL AND SOCIAL STRUCTURE DIMENSIONS

TRANSCULTURAL NURSING THEORY ● defined as involving the dynamic patterns and features of
interrelated structural and organizational factors of a
TRANSCULTURAL NURSING particular culture (subculture or society) which includes
● Is defined as a learned subfield or branch of nursing that religious, kinship (social, political (and legal), economic,
focuses upon the comparative study and analysis of educational, technological, and cultural values, ethno-
cultures concerning nursing and health-illness caring historical factors, and how these factors may be
practices, beliefs, and values to provide meaningful and interrelated and function to influence human behavior in
efficacious nursing care services to their cultural values different environmental contexts.
and health-illness context.
CULTURAL AND SOCIAL STRUCTURE DIMENSIONS CONCEPTS
ETHNONURSING
● is the study of nursing care beliefs, values, and practices as ENVIRONMENTAL CONTEXT
cognitively perceived and known by a designated culture ● is the totality of an event, situation, or particular
through their direct experience, beliefs, and value system experience that gives meaning to human expressions,
(Leininger, 1979). interpretations, and social interactions in particular
physical, ecological, sociopolitical, and/or cultural settings
NURSING
● is defined as a learned humanistic and scientific profession CULTURE
and discipline which is focused on human care phenomena ● is learned, shared, and transmitted values, beliefs, norms,
and activities to assist, support, facilitate, or enable and lifeways of a particular group that guides their
individuals or groups to maintain or regain their well-being thinking, decisions, and actions in patterned ways.
(or health) in culturally meaningful and beneficial ways, or
to help people face handicaps or death. CULTURE CARE
● is defined as the subjectively and objectively learned and
MAJOR CONCEPTS OF THE transmitted values, beliefs, and patterned lifeways that
TRANSCULTURAL NURSING THEORY assist, support, facilitate, or enable another individual or
group to maintain their well-being, health, improve their
PROFESSIONAL NURSING CARE (CARING) human condition, or deal with illness, handicaps or death.
● is defined as formal and cognitively learned professional
care knowledge and practice skills obtained through CULTURAL AND SOCIAL STRUCTURE DIMENSIONS CONCEPTS
educational institutions that are used to provide assistive,
supportive, enabling, or facilitative acts to or for another CULTURE CARE DIVERSITY
individual or group to improve a human health condition ● indicates the variabilities and/or differences in meanings,
(or well-being). disability, lifeway, or to work with dying patterns, values, life ways, or symbols of care within or
clients. between collectives related to assistive, supportive, or
enabling human care expressions..
CULTURAL CONGRUENT (NURSING) CARE
● is defined as those cognitively based assistive, supportive, CULTURE CARE UNIVERSALITY
facilitative, or enabling acts or decisions that are tailor- ● indicates the common, similar, or dominant uniform care
made to fit with the individual, group, or institutional, meanings, patterns, values, lifeways, or symbols manifest
cultural values, beliefs, and life ways to provide or support among many cultures and reflect assistive, supportive,
meaningful, beneficial, and satisfying health care, or well- facilitative, or enabling ways to help people.
being services.

HEALTH
● It is a state of well-being that is culturally defined, valued, CULTURE
and practiced. It reflects individuals' (or groups) ' ability to ● is learned, shared, and transmitted values, beliefs, norms,
perform their daily role activities in culturally expressed, and life ways of a particular group that guides their
beneficial, and patterned lifeways. thinking, decisions, and actions in patterned ways.

MAJOR CONCEPTS OF THE CULTURAL AND SOCIAL STRUCTURE DIMENSIONS SUB-CONCEPTS

TRANSCULTURAL NURSING THEORY GENERIC (FOLK OR LAY)

HUMAN BEINGS CARE SYSTEMS

● Such are believed to be caring and capable of being ● are culturally learned and transmitted, indigenous (or
concerned about others' needs, well-being, and survival. traditional), folk (home-based) knowledge and skills used
Leininger also indicates that nursing as a caring science to provide assistive, supportive, enabling, or facilitative
 acts toward or for another individual, group, or institution a beneficial or satisfying health outcome with professional
with evident or anticipated needs to ameliorate or care providers.
improve a human life way, health condition (or well-
being), or to deal with handicaps and CULTURE CARE REPATTERNING OR RESTRUCTURING
EMIC ● includes those assistive, supporting, facilitative, or
● Knowledge gained from direct experience or directly from enabling professional actions and decisions that help
those who have experienced it. If is generic or folk clients reorder, change, or greatly modify their life ways
knowledge. for new, different, and beneficial health care pattern while
PROFESSIONAL CARE SYSTEMS respecting the clients' cultural values and beliefs and still
● are defined as formally taught, learned, and transmitted providing a beneficial or healthier lifeway than before the
professional care, health, illness, wellness, and related changes were established with the clients.
knowledge and practice skills that prevail in professional ● Different cultures perceive, know, and practice care
institutions, usually with multidisciplinary personnel to differently, yet there are some commonalities about care
serve consumers. among all world cultures.
ETIC ● Values, beliefs, and practices for culturally related care are
● The knowledge that describes the professional shaped by, and often embedded in, "the worldview,
perspective. It is professional care knowledge. language, religious (or spiritual), kinship (social), political
(or legal), educational, economic, technological,
CULTURAL AND SOCIAL STRUCTURE DIMENSIONS SUB-CONCEPTS ethnohistorical, and environmental context of the culture.
● While human care is universal across cultures, caring may
ETHNOHISTORY be demonstrated through diverse expressions, actions,
● includes those past facts, events, instances, experiences of patterns, lifestyles, and meanings.
individuals, groups, cultures, and instructions that are ● Cultural care is the broadest holistic means to know,
primarily people-centered (ethno) and describe, explain, explain, interpret, and predict nursing care phenomena to
and interpret human lifeways within particular cultural guide nursing care practices.
contexts over short or long periods of time. ● All cultures have generic or folk health care practices, that
professional practices vary across cultures, and that there
CARE will be cultural similarities and differences between the
● as a noun is defined as those abstract and concrete care-receivers (generic) and the professional caregivers in
phenomena any culture.
related to assisting, supporting, or enabling experiences or behaviors ● Care is the distinct, dominant, unifying, and central focus
toward or for others with evident or anticipated needs to ameliorate of nursing, and while curing and healing cannot occur
or improve a human condition or lifeway. effectively without care, care may occur without a cure.
● Care and caring are essential for humans' survival and their
CARE growth, health, well-being, healing, and ability to deal with
● as a verb is defined as actions and activities directed handicaps and death
toward assisting, supporting, or enabling another ● Nursing, as a transcultural care discipline and profession,
individual or group with evident or anticipated needs to has a central purpose of serving human beings in all areas
ameliorate or improve a human condition or lifeway or of the world; that when culturally based nursing care is
face death. beneficial and healthy, it contributes to the wellbeing of
the clients) - whether individuals, groups, families,
CULTURE SHOCK communities, or institutions - as they function within the
● may result when an outsider attempts to comprehend or context of their environments
adapt effectively to a different cultural group. The outsider STRENGTHS
is likely to experience feelings of discomfort and ● Leininger has developed the Sunrise Model in a logical
helplessness and some degree of disorientation because of order to demonstrate the interrelationships of the
the differences in cultural values, beliefs, and practices. concepts in her theory of Culture Care Diversity and
Universality.
CULTURAL IMPOSITION ● Leininger's theory is essentially parsimonious in that the
● refers to the outsider's efforts, both subtle and not so necessary concepts are incorporated in such a manner
subtle, to impose their own cultural values, beliefs, that the theory and its model can be applied in many
behaviors upon an individual, family, or group from different settings.
another culture. ● It is highly generalizable. The concepts and relationships
presented are at a level of abstraction, which allows them
The SUNRISE MODEL to be applied in many different situations.
● is relevant because it enables nurses to develop critical ● Through not simple in terms, it can be easily understood
and complex thoughts about nursing practice. These upon on first contact
thoughts should consider and integrate cultural and social
structure dimensions in each specific context, besides WEAKNESS
nursing care's biological and psychological aspects. ● The Theory and model is not simple in terms
CULTURAL RESPECT
CULTURAL CARE PRESERVATION - Cultural respect is vital to reduce health disparities and
● is also known as maintenance. It includes those assistive, improve access to high-quality healthcare that is
supporting, facilitative, or enabling professional actions responsive to patients' needs, according to the National
and decisions that help people of a particular culture to Institutes of Health (NIH). Nurses must respond to
retain and/or preserve relevant care values so that they changing patient demographics to provide culturally
can maintain their well-being, recover from illness, or face sensitive care. This need is strikingly evident in critical care
handicaps and/or death units.

CULTURAL CARE CULTURAL COMPETENCE

● ACCOMMODATION, also known as NEGOTIATION, includes - The understanding of diverse attitudes, beliefs, behaviors,
those assistive, supportive, facilitative, or enabling creative practices and communication patterns attributable to a
professional actions and decisions that help people of a variety of factors.
designated culture to adapt to or negotiate with others for
 - Factors race, ethnicity, religion, historical and social Two Major Categories:
context, physical or mental ability, age, gender, sexual 1. organizational cultural competence
orientation, generational acculturation status. 2. individual cultural competence

CULTURAL COMPETENCE IN HEALTHCARE CULTURAL COMPETENCE

- According to health policy institute, cultural competence is According to the National Center for Cultural Competence
the ongoing process of capacity of healthcare system, (Georgetown University Center for Child and Human Development,
organizations and to provide for diverse patient cultural competence following characteristics:
population high quality care that is safe, patient and - A defined set of values and principles and demonstration
centered, evidence-based, and equitable. (The National of behaviors, attitudes, policies, and structures that enable
Quality Forum) them to work effectively cross-culturally.
- The goal is to provide the highest quality of care to every - capacity to (1) value diversity, (2) conduct self-assessment,
patient, regardless of race, ethnicity, cultural background, (3) manage the dynamics of difference, (4) acquire and
English proficiency or literacy. institutionalize cultural knowledge, and (5) adapt to
- A health care provider is cultural competent when: He/she diversity and the cultural contexts of the communities they
is able to deliver culturally appropriate and specifically serve.
tailored care to patients with diverse values, beliefs and - Incorporation of the previously mentioned items in all
behaviors. aspects of policy making, administration, practice, and
service delivery, and systematic involvement of
WHY DO WE NEED CULTURAL COMPETENCE IN 21ST CENTURY? consumers, key stakeholders, and communities.
● Everyone has a right to healthcare that meets their needs
● Immigration will impact demographics Culturally Congruent Care
● Growth of minority population - a holistic and focuses on the complex, interrelationship of
life ways, religion, kinship, politics, law, education,
FRAMEWORK FOR DELIVERING CULTURALLY COMPETENT technology, language, environmental context, and
SERVICES: worldview-all factors that contribute to culturally
Campinha-Bacote and Munoz (2001) proposed a five-component congruent care. (Leininger & McFarland, 2005)
model for developing cultural competence - defines as the provision of care that is meaningful and fits
1. Cultural awareness involves self-examination of in-depth with cultural beliefs and life ways.
exploration of one's cultural and professional background.
This component begins with insight into one's cultural Hand shake
healthcare beliefs and values. A cultural awareness ● USA, England, Germany, and New Zealand-it's used when
assessment tool can be used to assess a person's level of meeting Yor parting and if you know the other person well,
cultural awareness. you can skip this gesture
2. Cultural knowledge involves seeking and obtaining an ● France and the rest of Europe people shake hands even if
information base on different cultural and ethnic groups. they know each other well, sometimes even several times
This component is expanded by accessing offered through a day
sources such as journal articles, seminars, textbooks, ● Russia-shaking hands in a doorway is considered impolite
internet resources, workshop presentations and university and allegedly brings bad luck
courses. ● India, Middle East, and Asia - people can still hold each
3. Cultural skill involves the nurse's ability to collect relevant other's hands, even after they shook hand
cultural data regarding the patient's presenting problem ● Japan-handshakes are considered impolite, people bow
and accurately perform a culturally specific assessment. instead and the lower they bow the more respect they are
The Giger and Davidhizar model offers a framework for showing
assessing cultural, racial and ethnic differences in patients.
4. Cultural encounter is defined as the process that The National Council on Interpreting in Health Care (2006) has
encourages nurses to directly engage in cross-cultural developed the first set of national standards for medical interpreting
interactions with patients from culturally diverse professionals in the United States. The 32 national standards provide
backgrounds. Nurses increase cultural competence by guidelines on the following nine issues:
directly interacting with patients from different cultural ● ACCURACY: To enable other parties to know precisely
backgrounds. This is an ongoing process; developing what each speaker has said.
cultural competence cannot be mastered. ● CONFIDENTIALITY: To honor the private and personal
5. Cultural desire refers to the motivation to become nature of the health care interaction and maintain trust
culturally aware and to seek cultural encounters. among all parties.
component involves the willingness to be open to others, ● IMPARTIALITY: To eliminate the effect of interpreter bias
to accept and respect cultural differences and to be willing or preferenceRESPECT: To acknowledge the inherent
to learn from others. dignity of all parties in the interpreted encounter.
● CULTURAL AWARENESS: To facilitate communication
CULTURE IS CENTRAL TO THE DELIVERY OF HEALTHCARE. across cultural differences.
- It influences patients healthcare beliefs, practices, ● ROLE BOUNDARIES: To clarify the scope and limits of the
attitudes towards care, and trust in the system and in the interpreting role to avoid conflicts of interest.
individual providers. ● PROFESSIONALISM: To uphold the public's trust in the
- Cultural differences affect how health information and interpreting profession.
healthcare services are received, understood and acted ● PROFESSIONAL DEVELOPMENT: To attain the highest
upon. possible level of competence and service.
● ADVOCACY: To prevent harm to parties whom the
PRIMARY REASONS OF CULTURAL COMPETENCE IN HEALTHCARE interpreter serves.
1. Eliminate misunderstanding in diagnosis or in treatment
planning that may arise from differences in language
culture. or
2. Improve patient adherence with treatment.
3. Eliminate healthcare disparities

Cultural Competence