1. Madeleine Leininger’s
Transcultural Nursing
Josephine Ann J. Necor, RN

2. Madeleine Leininger
 The founder of the theory of
Transcultural Nursing / Culture
Care Theory
 Her theory has now developed as a
discipline in nursing.
 Evolution of her theory can be
understood from her books:
 Culture Care Diversity and
Universality (1991)
 Transcultural Nursing (1995)
 Transcultural Nursing (2002)
 Theoretical framework is depicted
in her model called the Sunrise
Model (1997).

3.  One of the first nursing
theorists and transcultural
global nursing consultant.
 MSN - Catholic University
in Washington DC.
 PhD in anthropology -
University of Washington.
 She developed the concept
of transcultural nursing
and the ethnonursing
research model.

4. -MIDDLE RANGE
NURSING THEORY
Transcultural
Nursing Theory

5. THEORETICAL SOURCES
 Derived from the discipline of anthropology;
conceptualized the theory to be relevant to
nursing.

6. USE OF EMPIRICAL EVIDENCE
 Leininger favors ethnomethods as the desired and
meaningful approach to study care because these
methods are directed toward discovering the people’s
“truth” views, beliefs, and patterned lifeways.

7. MAJOR CONCEPTS
AND DEFINITIONS

8. MAJOR CONCEPTS AND DEFINITIONS
TRANSCULTURAL NURSING - is a
comparative study of cultures to
understand similarities (culture
universal) and difference (culture-
specific) across human groups
(Leininger, 1991).

9. MAJOR CONCEPTS AND DEFINITIONS
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.

10. MAJOR CONCEPTS AND DEFINITIONS
- Culture is learned by each generation through both
formal and informal life experiences.
- Language is primary through means of transmitting
culture.
- The practices of particular culture often arise because of
the group's social and physical environment.
- Culture practice and beliefs are adapted over time but
they mainly remain constant as long as they satisfy
needs.

11. MAJOR CONCEPTS AND DEFINITIONS
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.

12. MAJOR CONCEPTS AND DEFINITIONS
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.

13. MAJOR CONCEPTS AND DEFINITIONS
SUBCULTURE - composed of people who have a distinct
identity but are related to a larger cultural group.
BICULTURAL – a person who crosses two cultures, lifestyles,
and sets of values
DIVERSITY - refers to the fact or state of being different.
Diversity can occur between cultures and within a cultural
group.
ACCULTURATION - People of a minority group tend to
assume the attitudes, values, beliefs, find practices of the
dominant society resulting in a blended cultural pattern.

14. MAJOR CONCEPTS AND DEFINITIONS
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.

15. MAJOR CONCEPTS AND DEFINITIONS
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.

16. Nursing Decisions
Leininger (1991) identified three nursing decision and
action modes to achieve culturally congruent care.
 Cultural preservation or maintenance.
 Cultural care accommodation or negotiation.
 Cultural care repatterning or restructuring.

17. 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.

18. MAJOR ASSUMPTIONS
 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.

19. MAJOR ASSUMPTIONS
 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 inter personal
interactions.
 For a nurse to successfully provide care for a client of a
different cultural or ethnic background, effective
intercultural communication must take place.

20. 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.

21. HEALTH PRACTICES IN
DIFFERENT CULTURES
 Use of Protective Objects
 Use of Substances
 Religious Practices
 Traditional Remedies
 Healers
 Immigration
 Gender Roles
 Beliefs about mental health
 Economic Factors
 Time Orientation
 Personal Space

22. Goal 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.”

25. The Sunrise Model
• Symbolizes the “rising of the sun (care)”
• The upper half of the circle depicts components of the social structure
and world view factors that influence care and health through
language and environment. These factors influence the folk,
professional, and nursing system(s), which are in the lower half of the
model.
• The two halves together form a full sun, which represents the universe
that nurses must consider to appreciate human care and health.
• The nursing subsystem can act as a bridge between the folk and
personal health systems through the three types of nursing care
actions: cultural care preservation, cultural care accommodation, and
cultural repatterning.

26. ACCEPTANCE BY THE
NURSING COMMUNITY

27. PRACTICE
 Accepted in the nursing 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.

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

29. RESEARCH
 Several research nurses are testing
transultural nursing in US and other
countries. Many cultures have been studied
utilizing this theory.

30. CRITIQUE
 Simplicity – not simple; truly transcultural, global
in scope, and highly complex; holistic and
comprehensive
 Generality – general; qualitatively-oriented theory
that is broad, comprehensive, and worldwide in
scope; useful and applicable to groups and
individuals with the goal of rendering culture-
specific nursing care.

31. CRITIQUE
 Empirical Precision – researchable; qualitative
research has been the primary paradigm to discover
largely unknown phenomena of care and health in
diverse cultures
 Derivable Consequences – has important
outcomes for nursing; culture-specific care is
necessary and essential new goal in nursing; useful
and applicable to nursing practice, education, and
research

32. REFERENCES
 www.currenrnursing.com
 Tomey, A.M., (1994). Nursing Theorists and Their
Work. 3rd ed. Missouri: Mosby

33. THANK YOU!