Theory of Culture Care Diversity and Universality

By Madeleine M. Leininger

Gerald Ian Dela Cruz

Madeleine M. Leininger

Educational Background:

1948 - Received her basic nursing education at St. Anthony’s School of Nursing, Denver, Colorado

1950 - Earned bachelor of science from Mount St. Scholastica College (now known as Benedictine College), Atchison, Kansas

1954 – had a master of science in psychiatric-mental health

nursing form the Catholic University of America, Washington, DC

1965 – a Ph.D. in cultural and social anthropology from the University of Washington, Seattle.

She is a Fellow in the American Academy of nursing and holds honorary doctorates from Benedictine College, the University of Indianapolis, and the University of Kuopio, Finland.

1998 – she was named a “Living Legend” by the American Academy of Nursing

Brief Background on the Formulation of the Theory

In the 1940s Leininger recognized the importance of caring to nursing, statements of appreciation for nursing care made by patients alerted her to caring values and led to her longstanding focus on care as the dominant ethos of nursing.

While working as a clinical child nurse specialist with disturbed children and their parents, she observed recurrent behavioral differences among the children, and finally concluded that these differences had a cultural base.

She identified a lack of knowledge of the children’s culture as the missing link to understand the variations needed in care of clients.

In the mid-1950s she declared that care is the essence and central domain of nursing. She held that care and caring were basic and essential human needs for human growth, development, and survival

Leininiger built her theory of transcultural nursing on the premise that the people of each culture can not only know and define the ways which they experience and perceive their nursing care world but also relate these experiences and perceptions to their general health beliefs and practices.

Transcultural Nursing – an area of study and practice focuses on cultural care (caring) values, beliefs and practices of particular cultures.

Overview of the Theory Leininger introduced her theory Culture Care Diversity and Universality in the early

1960s to provide culturally congruent and competent care.

The Theory Culture Care Diversity and Universality was developed to establish a substantive knowledge base to guide nurses in discovery and use of transcultural nursing practices.

During the post-World War II period, Leininger realized that nurses would need transcultural knowledge and practices to function with people of diverse culture worldwide because many new immigrants and refugees were coming to America, and the world was becoming more multicultural.

Culture Care or Culture Care Diversity and Universality Theory:

belief that cultures have both health practices that are specific to one culture and prevailing patterns that are common across cultures.

Purpose: To discover, document, analyze, and identify the cultural and care factors influencing humans in health, sickness, and dying and to thereby advance and improve nursing practices

Goal: To use research-based knowledge to provide culturally congruent, safe, beneficial, and satisfying care to people of diverse or similar cultures for their health and well-being or for meaningful dying.

Theory Assumptions:

1. Care is essential for human growth, development, and survival and for facing death or dying

2. Care is essential to curing and healing; there can be no curing without caring.3. The forms, expressions, patterns, and processes of human care vary among all cultures of the world4. Every culture has generic (lay, folk, or naturalistic) care, and most also have professional care practices.5. Culture care values and belief are embedded in religious, kinship, social, political, cultural, economic, and historical dimensions of the social structure and in language and environmental contexts.6. Therapeutic nursing care can occur only when culture care values, expressions, and/or practices are known and used explicitly to provide human care.7. Differences between caregiver and care receiver expectations need to be understood in order to provide beneficial, satisfying, and congruent care.8. Culturally congruent, specific, or universal care modes are essential to the health or well-being of people of all cultures.9. Nursing is essentially a transcultural care profession and discipline

Orientational Theory Definitions Culture Care Culture Care Culture care diversity Culture care universality Professional care Generic (folk and lay) care Health Culture care preservation or maintenance Cultural care accommodation or negotiation Culture care repatterning or restructuring

Ethnohistory Environmental context Worldview Kinship and social factors Religion and spiritual factors Political factors Technological factors Educational factors Economical factors Environmental factors Culturally congruent care

Major Theoretical Tenets

Leininiger identified several predictive tenets or premises as essential for nurses and other to use:

1.Cultural care diversities and similarities or Commonalities that would be found within cultures

• This tenet challenges nurses to discover this knowledge so that nurses could use cultural data to provide therapeutic outcomes.

•Leininger has stated that human beings are born, they live, and they die with their specific cultural values and beliefs, as well as with their historical and

environmental context, and that care has been important for their survival and well-being

2. Worldview and Social Structure factor

• This includes religion (and spirituality), political and economical considerations, kinship (family ties), education, technology, language expressions, the environmental context, and cultural history – were important influences on health care outcomes.

• This broad and multifaceted view provided a holistic perspective for understanding people and grasping their world and environment within a historical context.

• Data from this holistic research-based knowledge was predicted to guide nurses for the health and well-being of the individual or to help disabled or dying clients from different cultures.

•Nurses needed to become aware of the social structure, cultural history, language use and the environment in which people lived in order to understand cultural and care expressions.

3. Differences and Similarities between Professional and Generic Care

• Elucidating the differences between these two kinds of care would identify gaps in care, inappropriate care, and also beneficial care.

• Such findings would influence the recovery (healing), health, and well-being of clients of different cultures.

Three Modalities

Leininger identified three new creative ways to attain and maintain culturally congruent care to fit clients’ particular needs:

• Culture care preservation or maintenance• Culture care accommodation or negotiation• Culture care restructuring or repatterning

The Sunrise Enabler: A Conceptual Guide to Knowledge Discovery

Leininger developed the sunrise enabler to provide a holistic and comprehensive conceptual picture of the major factors influencing Culture Care Diversity and Universality.

The model can be a valuable visual guide to elucidating multiple factors that influence human care and cultural lifeways of different cultures.

The enabler serves as a cognitive guide for the researcher to reflect on different predicted influences on culturally based care.

Example of Transcultural Nursing

Daniel Saunders, 8 years old, has accompanied to the emergency department by his mother and grandmother. He has had acute abdominal pain for two days. The nurse notes that his mother defers questions about Daniel to him or to his grandmother and that none of the three respond immediately to question posed or comments made by the staff or look directly at members of the staff. They sit close together but do not touch one another. The physician wants to admit Daniel for exploratory abdominal surgery. Daniel’s mother will not sign the admission and surgical permission forms until his grandmother has given her approval to do so. At his point, Daniel’s grandmother takes a bag of cornmeal from her pocket and begins to sprinkle it around Daniel.

Nurse who lacks transcultural knowledge

Nurse who have transcultural knowledge

• views this family as strange and suspicious

• lack of direct eye contact leads to questions of what they are hiding

• mother appears indecisive

• family members don’t even seem to much from each other since they do not touch

• what is the deal with the cornmeal?

• recognize that this is a Navajo family and the family members are demonstrating typical characteristics• Navajo culture is a matriarchial culture whose members defer to the wisdom of elders. • Daniel is included in responses to questions asked as a value of culture is for the individual to speak for him or herself• lack of direct eye contact and pauses after questions or statements are made by another are indications of respect and a degree of thought and attention being given to the content of the message• Navajo family members demonstrate their caring for one another through being physically close, but not through touching

Nurse who lacks transcultural knowledge

Nurse who have transcultural knowledge

• Illness is viewed as a lack of or disturbance of one’s harmony. • Rituals, such as sprinkling the person with cornmeal, are important to restore harmony - nurse needs to note that it is important to save the cornmeal to return it to the familyAfter Daniel’s surgery:• nurse can anticipate that he will accept pain relief• it is also likely that as many relatives as are available will want to visit – such family support is another cultural value. Discharge Instruction:• b.i.d. antinbiotic - the timing of the administration of his medication should be tied to natural events such as sunup and sundown rather than with meals or some other activity. • Navajo sense of time tends to be casual and relative and meal times are likely to be flexible.