{Madeleine Leininger’s

Culture Care TheoryClemson University

Nursing TheoryJuliann Trumpower

Background

• She is the founder of the theory of Culture Care/Transcultural Theory.

• She was the first nurse researcher to study the importance of culture in regards to individual health and caring behaviors.

• In her Sunrise Model the theoretical framework is depicted.

• The roots of her theory come from her extensive research and clinical practices with multiple different cultural groups.

• This theory has now developed as a discipline in nursing.

1948-Diploma in Nursing from St. Anthony’s School of Nursing

1950-BS in Biological Science from Benedictine College 1953-MSN from Catholic University, Washington D.C 1965-Ph.D in Anthropology from University of Seattle 1966-The first course of transcultural nursing was

available for nursing students at the University of Colorado.

Nominated for Nobel Peace Prize Author of 30 books and over 220 publicationsAfter 50 years of of study and research it is recognized as a major, relevant and dominant theory in nursing

Timeline of Madeline Leininger

In the mid 1940s she began to realize that the concept of care was an important aspect of nursing.

After WWII, She began to see increased immigration and began to notice behavioral differences and how this affected care.

She believed that a nurse’s inability to culturally understand their patient led to a significant decrease in the quality of care provided. Her theory states that providing care measures that are in harmony with an individual or groups culture, beliefs, practices and values are necessary for providing quality care.

Central purpose was to discover, document and explain diverse and universal culturally based care factors influencing health, well-being, illness or death.

Purpose of culture care theory

Framework is used to help nurses avoid ethnocentric assessments

Leininger used frameworks from anthropology as well as care constructs from a nursing approach.

Purpose was to improve the quality of nursing care by creating the first ever transcultural nursing theory based on research of both universal and diverse cultural phenomena.

Sunrise Model

Theoretical foundations

Care is the central focus of nursing Care is essential for health and well-being, illness

and dying Every culture’s health practices and behaviors can

vary and are to be valued. Care is the best way to describe role of a nurse.

Culture care is the best way to approach this role. Nursing care must include examination of cultural

and social structure, world view, values/beliefs, language, and environmental contexts (per sunrise model)

Culturally congruent care improves the health and well being

Theory and assumptions

“Im black, white, asian, fat, female and fury AND everyone loves me”

Culture and Care are two major constructs of Theory Care- those aiding, encouraging, and enabling acts or thoughts toward others with

obvious or anticipated needs which help improve life or lessen illness/distress.

Culture-learned, shared and transmitted values, beliefs, norms of a group that influence behaviors. It defines health, illness and the search for relief from disease or distress. Guides human decisions and actions

Culture Care- aspects of culture that influence or enable person to deal with illness/death. Culturally based care is essential for well-being, health, growth, survival or facing hardships and death.

Transcultural Care- practice focused on cultural care values, beliefs and practices of individuals or groups of similar or different cultures with goal of providing culture specific practices in order to promote health and wellness or deal with death and or illness.

Culture Care diversity and universality Differences in meanings, values or care of different groups of people common care or similarities among culture

Concept Definitions

Nursing- learned profession with a disciplined focus on care phenomenon

Worldview- personal view of meaning of life Health- state of well-being that is culturally defined and valued Emic- refers to an insider’s views of knowledge of the culture Etic- the outsider’s viewpoints of the culture and reflects more on

the professional angles of nursing Generic care- learned or passed down indigenous, traditional, or

folk knowledge and practices provided to improve well-being or help with illness, death or other human conditions,

Professional care-formal, cognitive knowledge and practices generally learned through educational instititutions.

Early nurse theorists focused on the four metaparadigms of person, environment, health and nursing. Dr. Leininger found these concepts limited, inappropriate, and inadequate to fully explain nursing and was greatly concerned with the fact that care and culture were not included in these metaparadigms.

Concept Definitions

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{Culture Care Preservation and Maintenance

Culture Care Accomodation/Negotiation

Culture Care Repatterning and Restructuring

{States with laws mandating culture competence in healthcare

Despite advances in science, technology and pharmaceuticals, there remain great healthcare disparities amongst culturally diverse populations.

Estimated 33% of U.S. population made up of cultural minorities.

Research has shown that provider-patient communication is linked to satisfaction, ADHERANCE to medical instructions, and health outcomes

Culture competence improves outcomes and quality of care while reducing health care disparities

Changes in healthcare laws have changed the traditional “fee for service”, to reimbursement based on outcomes and quality.

Comprehensive, holistic and culturally sensitive care develops trust

Application to Nursing

Many cultures studied in depth over last 50 years using Leininger’s theory.

More Research needed to determine how culturally competent care affects outcomes and disparities. Need for empirical data.

National Institute of Health (NIH) and Agency for Healthcare Research and Quality (AHRQ) and other groups have increased funding for cultural education and research

New areas of research importance Lesbian, Gay, Bisexual and Transgender- huge disparities

in healthcare and unique healthcare needs that go unaddressed

Adolescent culture- Active listening, use of peers Refugee- influx of refugees, many with PTSD as rape and

torture common war tactic

Research

“have you decided on a birth control method for after the baby is born”

Doctor refused to treat daughter of lesbian couple, while unethical- it is

NOT illegal!

Research indicates nursing faculty not adequately prepared to teach culture care or mentor in cultural sensitivity

Need for broad holistic approaches and teaching strategies to promote student education and application to their nursing practice

Researchers agree transcultural nursing should be integrated throughout curriculum.

Transcultural education limited and varied between institutions..

2002 Laison Committee on Medical Education required culture competence integration into curriculum for accredidation of medical schools. As of yet, not required of nursing programs.

Need for unified conceptual teaching framework Immersion programs had best training outcomes

Education

Affordable Care Act- move from fee for service to reimbursement based on outcomes.

Hospitals and healthcare systems and practices can no longer survive without improving quality and outcomes which has necessitated addressing healthcare disparities amongst diverse groups and cultures

Private insurers such as Aetna, Blue Cross Blue Shield and Kaiser have developed initiatives toward culture competence in recognition of its relationship to improved quality and outcomes and decreased disparities

Federal government developed Health Disparities Coalition focused on addressing health disparities in community health clinics

Accrediting agencies such as the Joint Commission on Accredidation of Healthcare Organizations (JCAHO) exploring opportunities to track disparities and cultural competence

Administration