Culture care diversity and universality theory

Her Culture Care Diversity & Universality theory was one of the earliest nursing theories and it remains the only theory focused specifically on transcultural nursing with a culture care focus.
Her theory is used worldwide.
Dr. Leininger served as dean and professor of nursing at the university of Washington and Utah and she helped initiate and direct the first doctoral programs in nursing.

1. Content Background, Education, Experience of the Theorist: Dr. Madeleine M. Leininger Service of Dr. Leininger Rationale for the transcultural nursing: signs & need Overview of the theory Factors leading to theory Theory includes; definition, purpose, goals, assumptions, major tenets The sunrise model Application of the theory – Metaparadigm Current status of the theory Strengths & weaknesses Summary 1

2. Dr. Madeleine Leininger PhD, LHD , DS , CTN, RN, FAAN, FRCNA 2 Theory of Culture Care Diversity and Universality & The “ Sunrise Model”

3. B ackground Was born in Sutton , Nebraska in 1925 –july-13 she was blended in terms of awareness culture. lived on a farm with two brothers and sisters. 3

4. Education 4 Attended Sutton High School. Diploma nurse from St.Anthony’s school of nursing in Denver, Colorado Obtained BSN in St. Scholastica college in Atchison in Kansas. Obtained MSN in Catholic University of America in Washington DC. Obtained PhD in Anthropology in University of Washington .

5. Experience and findings 5 Dr. Leininger was the first professional nurse with a graduate preparation to complete a PhD in social and cultural anthropology at the university of Washington. Dr . Leininger is the founder of transcultural nursing. She brought nursing and anthropology together and coined the term transcultural nursing as an essential formal area of study and practice.

6. 6 Her Culture Care Diversity & Universality theory was one of the earliest nursing theories and it remains the only theory focused specifically on transcultural nursing with a culture care focus. Her theory is used worldwide. Dr. Leininger served as dean and professor of nursing at the university of Washington and Utah and she helped initiate and direct the first doctoral programs in nursing. Experience and findings cont…,

7. Dr. Leininger’s a living nursing legend 7 She is a professor emeritus in the college of nursing at Wayne state university and adjunct professor at the university of Nebraska ,college of nursing . She facilitated the development of master’s degree programs in nursing at American and Overseas institutions . Dr.Leininger has written more than 30 books , Published more than 250 articles and conducted More than 1200 public lectures throughout the United States and abroad .

8. 8 Developing the theory Developed in the mid-1950s and early 1960s Began when Dr. Leininger observed that children of different culture required different needs. Providing care that is culturally congruent. Culture Care theory not only focuses on nurse-client interaction but the focus also includes care for families, groups, communities, cultures and institutions.

9. Developing the theory, cont…, 9 She developed her theory of Transcultural Nursing by : Defining the ways on how people of different cultures can see their nursing world Focusing on the people’s general beliefs and practices. Described her theory as “creative and systematic way of discovering new knowledge ” Increasingly relevant due to migration and diversity grows .

10. 10 Broad theory :impact of culture on all aspects of human life. Focused :preservation and accommodations. Her belief that different cultures have both health practices that are specific to one’s culture and prevailing patterns are common across cultures led to the addition of terms “Diversity "and “Universality” to the title of her theory. Developing the theory, cont…,

11. Culture Care Diversity and Universality 11 The theory Dr . Leininger, focuses on describing, explaining and predicting nursing similarities and differences focused primarily on human care and caring in human cultures . The Culture Care Diversity & Universality theory does not focus on medical symptoms, disease entities or treatments . It is instead focused on those methods of approach to care that means something to the people to whom the care is given.

12. Culture Care Diversity and Universality 12 A combination of anthropology & nursing beliefs & principles Leininger recognized that one of the most important contributions of anthropology to nursing is the realization that health and illness states are strongly influenced by culture . In fact, many nurse leaders hold that “it has been the most significant breakthrough in nursing and the health fields in the 20th century and will be in greater demand in the 21st century”(Leininger,1997).

13. 13 Culture Care Diversity and Universality , cont…, Dr. Leininger established the first Caring Research Conference in 1978. She developed the theory of Culture Care with the ethno nursing method . The ethno nursing method was the first nursing research method and has been used for decades . She conducted the first transcultural nursing field study in early 1960s as she lived alone with the Gadsup of Eastern Highlands of New Guinea.

14. 14 The services of Dr. Leininger Dr . Leininger wrote the first books on transcultural nursing. She developed and launched the first undergraduate and graduate courses and programs in transcultural nursing beginning in the 1970s. Dr . Leininger established and was the first editor of the Journal of Transcultural Nursing

15. 15 The awards & honors Dr . Madeleine Leininger has received many outstanding awards and honors and has been nominated for the Nobel Prize for her significant and worldwide breakthrough encouraging health disciplines to study and practice transcultural health care . She introduced as the “Margaret Mead of the health field” and “new Nightingale”

16. 16 The Leininger  Sunrise Model represents the structure of culture care theory by describing the relationship between anthropological and nursing beliefs and principles. This map or guide is called the Sunrise Enabler . Dr. Leininger’s sunrise model

17. She introduced in the early 1960s to provide culturally congruent and competent care (Leininger, 1991b, 1995). She believed that transcultural nursing care could provide meaningful, therapeutic health and healing outcomes. As she developed the theory, she identified transcultural nursing concepts, principles, theories, and research-based knowledge to guide, challenge, and explain nursing practices. Overview of the theory

18. Overview ctd… This was a significant innovation in nursing and has helped open the door to new scientific and humanistic dimensions of caring for people of diverse and similar cultures. The Theory of Culture Care Diversity and Universality was developed to establish a substantive knowledge base to guide nurses in discovery and use of transcultural nursing practices.

19. At this time, during the post–World War II period, Dr. Leininger realized nurses would need transcultural knowledge and practices to function with people of diverse cultures worldwide (Leininger, 1970, 1978). Many new immigrants and refugees were coming to America, and the world was becoming more multicultural. Leininger held that caring for people of many different cultures was a critical and essential need , yet nurses and other health professionals were not prepared to meet this global challenge . Overview ctd…

20. 20 Overview ctd… Instead, nursing and medicine were focused on using new medical technologies and treatment regimens. They concentrated on biomedical study of diseases and symptoms. Shifting to a trans-cultural perspective was a major but critically needed change.

21. A frequent question often posed to Dr . Leininger is, “What led you to develop your theory?” Her major motivation was the desire to discover unknown or little known knowledge about cultures and their core values , beliefs, and needs. The idea for the Culture Care Theory came to her while she was a clinical child nurse specialist in a child guidance home in a large Midwestern city (Leininger , 1970, 1991a, 1995 ). From her focused observations and daily nursing experiences with the children in the home, she became aware that they were from many different cultures, differing in their behaviors, needs , responses, and care expectations . Factors Leading to the Theory

22. The reality was a shock to Leininger, as she was not prepared to care for children of diverse cultures. Likewise, nurses, physicians, social workers, and health professionals in the guidance home were also not prepared to respond to such cultural differences. It soon became evident that she needed cultural knowledge to be helpful to the children. Factors ctd…

23. Her psychiatric and general nursing care knowledge and experiences were woefully inadequate . She decided to pursue doctoral study in anthropology . While in the anthropology program, she discovered a wealth of potentially valuable knowledge that would be helpful from a nursing perspective. To care for children of diverse cultures and link such knowledge into nursing thought and actions was a major challenge. Factors ctd…

24. At that time, she had questioned what made nursing a distinct and legitimate profession . She declared in the mid-1950s that care is ( or should be) the essence and central domain of nursing. Many nurses resisted this idea , because they thought care was unimportant, too feminine, too soft, and too vague, and that it would never explain nursing and be accepted by medicine (Leininger, 1970, 1977, 1981 , 1984). Factors ctd…

25. Factors ctd… Leininger firmly held to the claim and began to teach, study, and write about care as the essence of nursing, its unique and dominant attribute ( Leininger, 1970 , 1981, 1988, 1991a ). From both anthropological and nursing perspectives, she held that care and caring were basic and essential human needs for human growth, development, and survival (Leininger, 1977, 1981 ). She argued that what humans need is human caring to survive from birth to old age, when ill or well.

26. Factors ctd… Nevertheless, care needed to be specific and appropriate to cultures. Her next step in the theory was to conceptualize selected cultural perspectives and transcultural nursing concepts derived from anthropology. She developed assumptions of culture care to establish a new knowledge base for the new field of transcultural nursing. Synthesizing or interfacing culture care into nursing was a real challenge.

27. The new Theory of Culture Care Diversity and Universality had to be soundly and logically developed (Leininger , 1976, 1978, 1990a, 1990b, 1991a ). Before her work, there were no theories explicitly focused on care and culture in nursing environments , let alone research studies to explicate care meanings and phenomena in nursing (Leininger, 1981, 1988, 1990a, 1991a, 1995 ). Theoretical and practice meanings of care in relation to specific cultures had not been studied , especially from a comparative cultural perspective . Factors ctd…

28. There were increased numbers of global migrations of people from virtually every place in the world due to modern electronics, transportation , and communication. These people needed sensitive and appropriate care . There were signs of cultural stresses and cultural conflicts as nurses tried to care for strangers from many Western and non- Western cultures . Rationale for Transcultural Nursing: Signs and Need

29. Rationale ctd…, 3. There were cultural indications of consumer fears and resistance to health personnel as they used new technologies and treatment modes that did not fit their values and life ways. 4. There were signs that some clients from different cultures were angry, frustrated, and misunderstood by health personnel owing to ignorance of the clients’ cultural beliefs, values, and expectations.

30. Rationale ctd…, 5. There were signs of misdiagnosis and mistreatment of clients from unknown cultures because health personnel did not understand the culture of the client. 6. There were signs that nurses, physicians, and other professional health personnel were becoming quite frustrated in caring for cultural strangers. Culture care factors of clients were largely misunderstood or neglected.

31. Rationale ctd… 7. There were signs that consumers of different cultures, whether in the home, hospital, or clinic, were being treated in ways that did not satisfy them and this influenced their recovery. 8. There were many signs of intercultural conflicts and cultural pain among staff that led to tensions.

32. Rationale ctd…, 9. There were very few health personnel of different cultures caring for clients. 10. Nurses were beginning to work in foreign countries in the military or as missionaries, and they were having great difficulty understanding and providing appropriate caring for clients of diverse cultures. They complained that they did not understand the peoples’ needs, values, and lifeways.

33. Theory includes, Definition Purpose Goals Assumptions Major tenets Conceptual models

34. Definition Leininger had defined transcultural nursing as an area of study and practice focused on cultural care (caring) values, beliefs, and practices of particular cultures (Leininger, 1978, 1984, 1995). Goal to provide culture specific and congruent care to people of diverse cultures Purpose of transcultural nursing was to use research-based knowledge to help nurses discover care values and practices and use this knowledge in safe, responsible, and meaningful ways to care for people of different cultures.

35. Assumptions Leininger identified 09 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 world.

36. Assumptions ctd…, 4. Every culture has generic (lay, folk, or naturalistic) care, and most also have professional care practices. 5. Culture care values and beliefs 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.

37. Assumptions ctd…, 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.

38. Major tenets of the theory (Leininger, 1978,1995 ) Commonalities Worldview and social structure factors Professional and generic care

39. Major tenets of the theory Commonalities A major tenet was that cultural care diversities and similarities would be found within cultures. Human beings are born, live, and die with their specific cultural values and beliefs. Cultural care is important for their survival and wellbeing. Transcultural nursing is missing from the traditional nursing. It is a challenge for nurses to discover transcultural nursing knowledge. That’s why Leininger predicted elements of care were culturally universal and applications are different.

40. Tenets ctd…, 2. Worldview and social structure factors This is another major tenet of the theory. Multiple factors are important and influence on health care outcomes. M ultifaceted view provides a holistic perspectives for understanding people and grasping their world. Nurses needed to become aware of the social structure and different cultures. Therefore nurses should have holistic cultural knowledge.

41. Tenets ctd…, 3. Professional and generic care Differences between two kinds of care were also predicted to influence the health and well being of clients. Ideas and actions could lead to nurse client conflicts, potential illnesses and even death. Such differences needed to be identified and resolved. Therefore cultural congruent care is very important as nurses.

42. The Sunrise Model Symbolizes the “rising of the sun” (care)

43. Application of the theory Metaparadigm

44. Current status Currently, the theory of culture care diversity and universality is being studied and used in many schools of nursing within the United States and other countries .

45. Current status ctd…, The theory has grown in recognition and value for several reasons. It is the only nursing theory that focuses explicitly and in depth on discovering the meaning, uses, and patterns of culture care within and between specific cultures. The theory provides a comparison of culture care between and within cultures. The theory has a built-in and tailor-made ethnonursing nursing research method that helps to realize the theory tenets.

46. 4.The theory of culture care is the only theory that searches for comprehensive care on multiple factors in a culture to construct a holistic knowledge base about care. 5. The theory has both abstract and practical dimensions. 6. The theory of culture care is a synthesized concept; integrated with the ethnonursing method, it has already provided a wealth of many new insights showing different ways to care for people of diverse cultures. Current status ctd…,

47. The theory and its research findings are stimulating to use safe, appropriate, culture-specific care in clinical and community settings. The theory is frequently used to conduct culturally congruent health care assessments. Interdisciplinary health personnel are becoming aware of transcultural nursing concepts which help them in their work. Current status ctd…,

48. Informants are often very pleased to have their culture understood and to have care made to fit their values and beliefs, a most rewarding benefit of the theory. 9. Users of the theory are thinking reflectively and valuing it. The theory encourages the researcher or clinician to discover culture from the people and to let them be in control of their ideas and their accounts. Current status ctd…,

49. 10. Nurse researchers who have been prepared in transcultural nursing and have used the theory and method. 11. Nurses who have used the theory and findings over time often speak of how much they have learned about themselves, new cultures, and, caring values and practices. Current status ctd…,

50. Strengths and weaknesses Strengths Recognition of the importance of culture and its influence on everything. This theory was tested by a number of people in a variety of settings and cultures. The Sunrise enabler provides guidance for the areas in which information is needed. Weakness/ Limitations Limited graduate nurses are academically prepared for culture care nursing.

51. The purpose of the culture care theory (along with the ethnonursing method) has been to discover culture care with the goal of using the knowledge to combine generic and professional care. The goal is to provide culturally congruent nursing care using the three modes of nursing actions and decision making(Leininger, 1991b, 1995). Summary

52. The clinical use of the three major care modes culture care preservation or maintenance culture care accommodation or negotiation culture care repatterning or restructuring Summary ctd…,

53. Summary ctd…, The Theory of Culture Care Diversity and Universality is one of the most comprehensive yet practical theories to advance transcultural and general nursing knowledge is essential to improve care to people. Nursing students and practicing nurses have the strongest advocates of the culture care theory (Leininger, 2002).

54. Summary ctd…, Dr. Leininger’s sunrise model is a visual guidance for the theory. This is also helpful to decision making in cultural congruent care using 03 modalities.

55. Summary ctd…, The theory is useful to nurses and to nursing and to professionals in other disciplines such as physical, occupational, and speech therapy, medicine, social work, and pharmacy. Health care practitioners in other disciplines are beginning to use this theory, because they also need to become knowledgeable about and sensitive and responsible to people of diverse cultures who need care.

56. 65 Take home message Be aware of cultural background of the client before taking decision about nursing care…

57. References Leininger, M. (1978). Transcultural nursing: Concepts, theories, and practices. New York: John Wiley & Sons. Leininger, M. (1984). Care: The essence of nursing and health. Thorofare, NJ: Slack. Leininger, M. (1995). Transcultural nursing: Concepts, theories, research, and practice. Columbus, OH: McGraw Hill College Custom Series. Leininger, M. M. (2002). Part I: The theory of culture care and the ethnonursing research method. In: M. M. Leininger & M. R. McFarland (Eds.), Transcultural nursing: concepts, theories, and practice (3rd ed., pp. 71–98). Sudbury, MA: Jones and Bartlett. Leininger, M. (1991b). The theory of culture care diversity and universality. In: M. Leininger (Ed.), Culture care diversity and universality: A theory of nursing (pp. 5–68). New York: National League for Nursing Press. Leininger, M. (1989a). Transcultural nursing: Quo vadis (where goeth the field)? Journal of Transcultural Nursing, 1(1), 33–45. Leininger, M. (1989b). Transcultural nurse specialists and generalists: New practitioners in nursing. Journal of Transcultural Nursing, 1(1), 4–16. Leininger, M. (1990c). Ethnomethods: The philosophic and epistemic basis to explicate transcultural nursing knowledge. Journal of Transcultural Nursing, 1(2), 40–51. Leininger, M. (1997a). Overview and reflection of the theory of culture care and the ethnonursing research method. Journal of Transcultural Nursing, 8(2), 32–51.

58. Questions?