Madeliene Leininger

Nursing Theorist M. Leininger: Culture Care Theory Nursing Theorist Madeliene Leininger: Culture Care Theory Madeliene Leininger was born in Sutton, Nebraska in 1925. In her early life she lived with her brothers and sisters on her father’s farm. She received her high school education from Scholastica College. She furthered her education at the Catholic University of America in Washington, D. C. and then went to the University of Washington, Seattle. Upon completion of her education she became the first professional nurse to complete a PhD on anthropology. Due to the broader approach in her education, she became the first to bring knowledge of anthropology and nursing together to develop the concept of transcultural nursing as an area of study necessary in the nursing field. She developed the Culture Care Diversity and Universality Theory with special focus at culture care. To date, due to the uniqueness of her perspective this theory is used across the world. She developed the theory in 1978 when she established the first caring research conference in which she established the ethnonursing method of research. Leininger conducted the first transcultural study in the field of research in the 1960s while she lived in the Gadsup villages of the Eastern Highlands of New Guinea. After publishing her first book in the field of transcultural nursing, she established the first graduate program. In the study, Leininger focused at enhancing emic, generic and etic professional care through establishing their similarities and differences to prevent possible gaps and conflicting areas which are non therapeutic to clients. While her prowess in the field of nursing developed, she established the Transcultural Nursing Society as the organization that officially governed the new discipline. This was established in 1974. Afterwards, she established the first journal of transcultural nursing and became the editor. Due to her progressive performance in the discipline of transcultural nursing she has received many honors and outstanding awards. Her significant worldwide breakthrough in encouraging advancement of health discipline has lead to her nomination for a Nobel Prize. Based on the theory of Culture Care Diversity and Universality, Leininger tries to describe and predict similarities in nursing and inherent differences which are focused at human care and cultures. The theory pays no attention to medical symptom, diseases and treatment but focuses on the methods of approach to care that gives significance to the person to whom the care is given. The theory was developed in the 1950s and 1960s to give care to people with cultural differences in lifestyles and values. Training nurses in this field enables them to offer care suitable to the people being administered. Due to focus on client nurse interaction the approach places the client at a better position of receiving better care and attention than when the medical approach to care is adopted. The focus is wide enough to serve not only different needs of individual but also communities, groups, families and institutions (Andrews & Boyle, 2007). Her first model in Culture Care Theory is called the Sunrise Enabler which offers the conceptual framework and guides a systematic study to the varied dimensions of the theory. This model is distinct in that it identifies three activities which include identification of the goals of nursing by addressing client oriented practices; assessing cultural factors affecting the care to the client and making appropriate judgment about the situation; making decision about the measures to be taken and taking action as influenced by the cultural context. The model uses information attained through research that identifies areas of congruence between cultures and nursing care especially in cultural values, lifestyles and beliefs of the client. In Culture Care Theory, Leininger identifies client caring as the heart of nursing which is unique to the field. While priming this focus, she criticizes the other four nursing concepts of person, environment, nursing and health arguing that nursing is both a profession and discipline and therefore the term ‘nursing’ cannot adequately explain the phenomenon of nursing. She views the concept of nursing as made of compassion, interest and concern for people. In this, concept care becomes central activity, the dominant and distinct unifying factor. Secondly, she views culturally founded care as useful for good health progress even when a client faces challenges such as handicaps or even when sick to the level of death. Thirdly, the healing of a client is based on care that is culturally driven and that there is no cure without this nature of care. Fourthly, care that is based on culture is characterized by comprehensiveness of service delivery, which is holistic and offers explanation to the areas of commonness between the nursing care practices and the culture of the client (Huber, 2006). Leininger views client care as an activity that occurs within a cultural context. She argues that culture is universal and diverse. Due to this, care must adapt to specific patterns of behavior distinguishing each society from another. According to transcultural scholars culture is distinguished by behavioral issues that are explicitly different from another. Leininger defines culture as ‘the lifeways of an individual or a group with reference to values, beliefs, norms, patterns, and practices’ (Leininger 1997, 38). She says that culture is an entity of a group of people which is transmitted across generations or across groups of members of the community. Leininger also holds the view that in order for nursing care to be effective, there is need to consider the ethnohistorical factors of the client, which hold a great value when examined from the ethnocultural perspectives. The ethnohistorical factors help in understanding the environmental context which involves the sociopolitical, ecological and cultural setting. In order to effectively make use of the ethnohistory of a community she calls for proper understanding of past occurrences of an individual and community which in one way or another influences a people’s lifeways. All the environmental factors give sense to the overall meaning of nursing care. The components which influence the theory are represented in the diagram below; Educational factors Technological factors Religious & philosophical factors Kinship & Social factors Environmental Context, Language & ethnohistory Cultural values, beliefs and lifeways Political & Legal factors Economic factors Care expressions patterns & practices Holistic Health/illness and death In the center of care, expressions, patterns and practices is the holistic health or illness or death approach with special focus to individuals, families, groups, communities or institutions founded on generic care, nursing care practices and professional care practices. These three practices of care are closely influenced by different factors; 1. Technological factors: Technology has been an essential element in offering nursing care. Development of technology has enhanced efficiency in operations of nurses across the world. Similarly, the quality of services offered, as well as, the diversity has immensely improved. Application of modern technology enhances operations of nurses especially when the technology is developed in a manner that creates congruence with the cultural values of a particular society. However, if technology does not support the cultural values of clients’ society the nursing care offered may fail to succeed as required. Even when there is an attempt to form a congruence of the technology and cultural factors, there may exist differences within groups, individuals and families. 2. Religious or philosophical concepts: Understanding cultural values entrenched in the people’s religious practices is necessary to enhancing ethnocultural nursing care. Across the world people view religion as an integral part of their life and seek to form congruence between the religious values and care activities, provided there is room for effectiveness in enhancing a healthy society. In addition, philosophical concepts that exist within a society determine how the client responds to care. In some instances, the philosophical doctrine may help develop congruence between the culture and care but in other instances the aspects may act as a deterrent if active measures are not taken into consideration in identifying the inherent gaps and the people’s ideological foundation. Therefore, there is a need to study the philosophical elements of a culture in which the nursing care need is to be offered. 3. Environmental factors: These include social factors and kinship; cultural values, beliefs, and lifeways and political and legal factors. The social factors include the issues surrounding the families or members of the community in their day to day activities. These include activities such as rituals and nutritional values. These may act as either a boost to nursing care or a deterrent. For instance, some cultural social practices and beliefs may deter a certain group of a larger society from eating some nutritional components, such as animal proteins. In such situations understanding other essential nutritional components that would offer similar nutritional value and which is allowable within the society can be encouraged. This helps in avoiding conflict of nursing care practices and cultural values. While the cultural and social factors may be conducive in enhancing care, the political factors may act as a deterrent to effective nursing care. This challenge may be based on the policy development, which may encourage the society to practice certain aspects of care while preventing others. Policy development may be either based on the cultural values of a society or influenced by the ruling class. Understanding the disparity between the expected target situation in nursing care and the available opportunities in achieving such a target may be a breakthrough in overcoming political hurdles in the nursing care profession and discipline. 4. Economic factors: Delivery of proper nursing care is dependent on the economic potential of a family, community or group of people within a community or a nation. The activities conducted towards effective nursing care have financial implications, some of which might be beyond the capability of many clients. In this case, the target population may fail to access the nursing care services (Center for the Study of Multiculturalism and Health Care, 1994). In other cases, holistic care may be challenged by the degree of financial sacrifice that individuals may be able to make. The nursing care offered may only be relative to the people’s economic prowess and as a result meeting the care target may be challenging. The community or a nation may also be discouraged in offering the comprehensive nursing care, opting to channel the funds to other development activities. For instance, the ongoing United States comprehensive care debate is a response to a situation whereby only a few people are able to access comprehensive care, either culture care or otherwise, while the large group of the society remains unable to access the care (Leininger, 1991). The need for such comprehensive care has also raised queries on the increase of national spending. 5. Educational factors: The level of information available either to the clients or to the culture care specialists may influence the level of delivery of client care. Leininger argues that comprehensive research is necessary in providing information that would necessitate filling the gaps between the cultural values or other influencing factor and professional approach to nursing care. In a community where sufficient research is conducted to identify common areas of interest or similarities, the services offered would be in less conflict with the community’s cultural values and thus increase the possibility of holistic approach to client health. Similarly, the level of education of clients would influence the level of adherence to the nursing care practices, which would directly impact on the health of the individuals or community (Leininger, 1991). Increased levels of literacy in culture care among clients and nurses offer a common platform for nursing care service delivery. The culture care theory has to date stood out as the most widely used and established theory used by nurses world wide. According to research on the influence of the theory in development of the nursing profession, many nurses believe that the theory has made the highest level of break-through in enhancing health practices through the 20th century and even getting much more attention in the 21st century (Bolsher & Pharris, 2008). Leininger gives an example of the role that the approach played after the terrible terrorist attack of September 11, 2001 in United States. In the contemporary, there has been increased need to understand factors surrounding the motive behind increased hatred which has led to transcultural hatred and subsequent killing of innocent people. Due to this transcultural knowledge for use worldwide has been essential in the care and nursing profession. The theory has been applied in broader and holistic manner in efforts to discover and offers substantial care to clients of different cultures (Leininger, 1991). In advancing the field of research, the theory has provided a basis of research in the fast developing discipline of transcultural nursing. This research has been useful in enriching the discipline with content for which it is gradually transforming the field and profession of nursing. There is progressive change in the nursing practices and thus contributing to a healthier population across cultural divide. Notably so far, the information gained through transcultural research exceed the full use as nurses trained in this field continue to look for more ways of putting the concepts into practices. Interestingly, the theory is further being applied by other nursing theorist to advance a holistic approach to client health (Leininger, 1991). In conclusion, all the components influencing the quality of nursing care are based on the society’s cultural and social structural dimensions. This approach to nursing care puts Leininger at a very central position especially so through the theory of Culture Care Diversity and Universality. References Andrews, M. & Boyle, J. (2007). Transcultural concepts in nursing care. Lippincott Williams & Wilkins. Bolsher, S. & Pharris, M. (2008). Transforming Nursing Education: The Culturally Inclusive Environment. Springer Publishing Company. Center for the Study of Multiculturalism and Health Care. (1994). The journal of multicultural nursing & health: official journal of the Center for the Study of Multiculturalism and Health Care, Inc, Volumes 1-3. Riley Publications. Huber, D. (2006). Leadership and nursing care management. Elsevier Health Sciences. Leininger, M. (1991). Culture care diversity and universality: A theory ofnursing. New York: National League for Nursing Press. Leininger, M. (1997). Overview and reflection of the theory of culture care and the ethnonursing research method. Journal of Transcultural Nursing,8(2), 32-51.