Leininger/ Newman/Pender

TRANSCULTURAL NURSING

Derived from the discipline of anthropology; conceptualized the theory to be relevant to nursing.
1. TRANSCULTURAL NURSING - is a comparative study of cultures to understand similarities (culture universal) and
difference (culture-specific) across human groups (Leininger, 1991).
2. CULTURE - -Set of values, beliefs and traditions, that are held by a specific group of people and handed down from
generation to generation

• also beliefs, habits, likes, dislikes, customs and rituals learn from one’s family.
• - the learned, shared and transmitted values, beliefs, norms and life way practices of a particular group
that guide thinking, decisions, and actions in patterned ways.
• RELIGION - Is a set of belief in a divine or super human power (or powers) to be obeyed and worshipped as the creator and
ruler of the universe.
• ETHNIC - refers to a group of people who share a common and distinctive culture and who are members of a specific group.
• ETHNICITY - a consciousness of belonging to a group.
• CULTURAL IDENTITY - the sense of being part of an ethnic group or culture.
• CULTURE-UNIVERSALS - commonalities of values, norms of behavior, and life patterns that are similar among different
cultures.
• CULTURE-SPECIFICS - values, beliefs, and patterns of behavior
• that tend to be unique to a designate culture.
• MATERIAL CULTURE - refers to objects (dress, art, religious artifacts)
• NON-MATERIAL CULTURE - refers to beliefs customs, languages, social institutions.
• CULTURAL SHOCK - the state of being disoriented or unable to respond to a different cultural environment because of its
sudden strangeness, unfamiliarity, and incompatibility to the stranger's perceptions and expectations as it is differentiated
from others by symbolic markers (cultures, biology, territory, religion).
• ETHNIC GROUPS – share a common social and cultural heritage that is passed on to successive generations.
• ETHNIC IDENTITY - refers to a subjective perspective of the person's heritage and to a sense of belonging to a group that is
distinguishable from other groups.
• RACE - the classification of people according to shared biologic characteristics, genetic markers, or features. Not all people
of the same race have the same culture.
• CULTURAL AWARENESS - an in-depth self-examination of one's own background, recognizing biases and prejudices and
assumptions about other people.
• CULTURALLY CONGRUENT CARE - Care that fits the people's valued life patterns and set of meanings -which is
generated from the people themselves, rather than based on predetermined criteria.
• CULTURALLY COMPETENT CARE - 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.
• ETHNONURSING- This 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 (Leinenger, 1979)
• NURSING- 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 in culturally meaningful and beneficial ways, or to help people face handicaps or deaths.
 • HEALTH- It 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- Such as believed to be caring and capable of being concerned about needs and well-being and survival of
others.
• Society and Environment- These term are not defined by Leininger.
NURSING DECISIONS

• Cultural preservation or maintenance.

• Cultural care accommodation or negotiation.
• Cultural care repatterning or restructuring.

MAJOR ASSUMPTIONS
❖ Illness and wellness are shaped by various factors including perception and coping skills, as well as the social level of the
patient.
❖ Cultural competence is an important component of nursing.
❖ Culture influences all spheres of human life. It defines health, illness, and the search for relief from disease or distress.
❖ Religious and Cultural knowledge is an important ingredient in health care.

The health concepts held by many cultural groups may result in people choosing not to seek modern medical treatment
procedures.
Health care provider 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 likely to be encountered.
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.

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.
Culture guides behavior into acceptable ways for the people in a specific group as such culture originates and develops within the
social structure through interpersonal interactions.
For a nurse to successfully provide care for a client of a different cultural or ethnic background, effective intercultural communication
must take place.

APPLICATION TO NURSING
To develop understanding, respect and appreciation for the individuality and diversity of patients beliefs, values, spirituality
and culture regarding illness, its meaning, cause, treatment, and outcome.
To encourage in developing and maintaining a program of physical, emotional and spiritual self- care introduce therapies
such as ayurveda and pancha karma.

GOALS OF TRANSCULTURAL NURSING

“to give culturally congruent nursing care, and to provide culture specific and universal nursing care practices for the health
and well-being of people or to aid them in facing adverse human conditions, illness or death in culturally meaningful ways.”
 PRACTICE
Communities are becoming more multicultural, and health personnel are being expected to respond to client’s diverse cultural
needs. Immigrants and people from unfamiliar cultures are generally expecting nurses to respect their cultural values, beliefs, and
lifeways.
EDUCATION

Since 1980, An increasing number of nursing curricula emphasize transcultural nursing and care.

RESEARCH

Several research nurses are testing transcultural nursing in US and other countries. Many cultures have been studied utilizing this
theory.
“Care is the heart of nursing; Care is power; Care is essential to healing (or well-being); Care is curing; and Care
is (or should be) the central and dominant focus of nursing and transcultural nursing decisions and actions.”

HEALTH AS EXPANDING CONSCIOUSNESS

We have to embrace a new vision of health. Our caring must be linked with a concept of health that encompasses and goes beyond
disease. The theory of health as expanding consciousness provides that perspective.
-(Newman, 2008, p. 2).

-born on October 10, 1933, in Memphis, Tennessee.

-She earned a bachelor’s degree in home economics and English from Baylor University in Waco, Texas, and a second bachelor’s degree
in nursing from the University of Tennessee in Memphis (M. Newman, curriculum vitae, 1996).
-Her master’s degree in medical-surgical nursing and teaching is from the University of California, San Francisco.
-She earned her PhD in nursing science and rehabilitation nursing in 1971 from New York University.
-Professor at the University of Minnesota in Minneapolis until her retirement in 1996, where she is Professor Emeritus.
-Director of Nursing for the Clinical Research Center at the University of Tennessee
-Acting Director of the PhD Program in the Division of Nursing at New York University, and
-Professor- in-Charge of the Graduate Program and Research in Nursing at Pennsylvania State University (M. Newman, curriculum vitae,
2000).

-Outstanding Alumnus Award from the University of Tennessee College of Nursing in Memphis in 1975 and 2002;
-Distinguished Alumnus Award, Division of Nursing, from New York University in 1984;
-Admission to the Hall of Fame at the University of Mississippi School of Nursing in 1988;
-Latin-American teaching fellow in 1976 and 1977; and -American Journal of Nursing scholar in 1979.
-E. Louise Grant Award for Nursing Excellence from the University of Minnesota in 1996;
-Nursing Theorists, Portraits of Excellence, vol. 1, 1990 videotape series sponsored by the Helene Fuld Health Trust (M. Newman,
curriculum vitae, 2000; personal communication, 2004).
-Sigma Theta Tau Founders Elizabeth McWilliams Miller Award for Excellence in Research in 1993; and received the Nurse Scholar
Award at Saint Xavier University School of Nursing in 1994 (M. Newman, curriculum vitae, 2000).

THEORETICAL SOURCES
Martha Rogers: Science of
Unitary Human Beings
Hegel’s Fusion of Opposites
Bentov’s explication
Bohm’s Theory of Implicate Order
Young’s Theory of Human Evolution
Moss’s experience of love as the
highest level of consciousness
HEALTH
-the “pattern of the whole” of a person and includes disease as a manifestation of the pattern of the whole, based on the premise that life
is an ongoing process of expanding consciousness (Newman, 1986).
-“a trans-formative process to more inclusive consciousness” (Newman, 2008, p. 16).Health and the evolving pattern of consciousness
are the same.
-the essence of the emerging paradigm of health is recognition of pattern. Newman (1994) sees the life process as progression toward
higher levels of consciousness.

PATTERN
-information that depicts the whole and understanding of the meaning of all of the relationships at once (M. Newman, personal
communication, 2004).
-a fundamental attribute of all there is, and it gives unity in diversity (Newman, 1986).
Characteristics of pattern include movement, diversity, and rhythm.
Pattern is conceptualized as being somehow intimately involved in energy exchange and transformation (Newman, 1994).

CONSCIOUSNESS
Consciousness is both the informational capacity of the system and the ability of the system to interact with its environment (Newman,
1994).
Consciousness includes not only cognitive and affective awareness, but also the “interconnectedness of the entire living system which
includes physicochemical maintenance and growth processes as well as the immune system” (Newman, 1990a, p. 38).
MOVEMENT-SPACE-TIME
Newman emphasizes the importance of examining movement-space-time together as dimensions of emerging patterns of
consciousness rather than as separate concepts of the theory (M. Newman, personal communication, 2004).

MAJOR ASSUMPTIONS
1.Health encompasses conditions heretofore described as illness or, in medical terms pathology...
2.These “pathological” conditions can be considered a manifestation of the total pattern of the individual...
3.The pattern of the individual that eventually manifests itself as pathology is primary and exists prior to structural or functional changes...
4.Removal of the pathology in itself will not change the pattern of the individual...
5.If becoming “ill” is the only way an individual’s pattern can manifest itself then that is health for that person...

NURSING
Newman emphasizes the primacy of relationships as a focus of nursing, both nurse-client relationships and relationships within clients’
lives (Newman, 2008).
“The emphasis of this process is on knowing/caring through pattern recognition” (Newman, 2008, p. 10).

The nurse-client relationship is characterized by “a rhythmic coming together and moving apart as clients encounter disruption of their
organized, predictable state” (Newman, 1999, p. 228).
-Newman has diagrammed this nurse-client interaction of coming together and moving apart through the processes of recognition,
insight, and transformation
-Nurses are seen as partners in the process of expanding consciousness, and are trans-formed and have their lives enhanced in the
dialogical process (Newman, 2008).

Within the theory, the role of the nurse in nurse-client interactions is seen as a “caring, pattern-recognizing presence” (Newman, 2008,
p. 16).
PERSON
Throughout Newman’s work, the terms client, patient, person, individual, and human being are used interchangeably. Clients are viewed
as participants in the transformative process.
-Persons as individuals are identified by their individual patterns of consciousness (Newman, 1986) and defined as “centers of
consciousness within an overall pattern of expanding consciousness” (Newman, 1986, p. 31).
ENVIRONMENT
Although environment is not explicitly defined, it is described as being the larger whole, which contains the consciousness of the
individual. The pattern of person consciousness interacts within the pattern of family consciousness and within the pattern of com-
munity interactions (Newman, 1986).
Client and environment are viewed as a unitary evolving pattern (Newman, 2008).
The assumption is that all matter in the universe-environment possesses consciousness, but at different levels. Interpretation of
Newman’s view clarifies that health is the interaction pattern of a person with the environment. Disease in a human energy field is a
manifestation of a unique pattern of person-environment interaction.
HEALTH
Health is the major concept of Newman’s theory of expanding consciousness.
A fusion of disease and non-disease creates a synthesis regarded as health (Newman, 1979, 1991, 1992).
Newman (1999) further elaborated her view of health by stating that “health is the pattern of the whole, and wholeness is” (p. 228).
“Manifest health, encompassing disease and non-disease, can be regarded as the explication of the underlying pattern of person-
environment” (Newman, 1994, p. 11).

HEALTH PROMOTION MODEL

• Born on August 16, 1941 in Lansing, Michigan, US.
• Daughter of Frank Blunk and Eileen Blunk.

• BSc, Michigan State University, East Lansing, 1964

• MSc, Michigan State University, East Lansing, 1965
• PhD, Northwestern University, Evanston, 1969
• American community health nursing educator.
• Fellow American Academy Nursing; member
• American Nurses Association (chairman research cabinet 1982-1984).
• Midwest Nursing Research Society (president 1985- 1987).
• American Academy Nursing (president 1991-1993).
• National Institutes of Health (national advisory