Grand Canyon University
College of Nursing
NUR 502 – Theoretical Foundations for Nursing Roles and Practice
Grand Theorist Report
Grand Theorist Report-Madeline Leininger
Madeleine Leininger’s Culture Care Theory provides healthcare professionals with a baseline tool of how to communicate and give nursing care to all types of cultures. Because the world of nursing is very diverse, it is essential that healthcare professionals can communicate with their patients. If the patients culture is not considered when giving nursing care, the patients’ chances of experiencing optimal health and wellness will decrease. Madeleine Leininger began her nursing career in the 1940’s. It was then she discovered that nurses lacked cultural competency. This lack of cultural competency causes nurses to give inadequate care to their patients. Leininger stated, “I experienced culture shock and I felt helpless to assist children who so clearly expressed different cultural patterns and ways they wanted care”. (Nelson, 2007). This experience encouraged Leininger to develop the Culture Care Theory.
Madeleine Leininger studied ethnography, in which she developed ethnonursing methodology as a basis to help explore transcultural nursing. Within her studies she realized different cultures cared for their families in different ways, all of which were pertinent to the wellbeing of the patient. In conclusion, Leininger’s theory became known as the culture care theory.
The rationale for the selection of Madeleine Leininger’s Culture Care Theory is as follows:
Healthcare professionals and patients are influenced by their cultures. Nurses must be aware of their own culture to be able to accept another person’s culture. Culture influences the way we think, act, and respond to our environment. Healthcare professionals can promote trust. Provide better healthcare, lead to higher rates of acceptance of diagnosis and improve treatment adherence.
Dr. Madeleine Leininger was born in 1925 in Sutton, Nebraska (Boyle & Glittenberg, 2013). It was in 1948 that Leininger obtained her nursing degree from St. Anthony’s School of Nursing in Colorado and her Bachelors of Science in 1950 from Kansas (Boyle & Glittenberg, 2013). She went on to receive her PhD in cultural and social anthropology and continued to receive recognition and awards throughout her life. Not only considered to be one of the most influential scholars of the nursing profession, Leininger was also “the first nurse anthropologist and founded the discipline of transcultural nursing” (Ray, 2012, p. 6). She embodied the need of caring in nursing and life in general. All of her endeavors early on from being a third grade teacher (Ray, 2012) to obtaining her nursing degree, and beginning her career during World War II (Ray, 2012) were all considered to be influences to her development of the Culture Care Theory.
High-Middle Range Theory
Madeleine Leininger’s Culture Care Theory is identified as a high-middle range theory. High middle range theories encompass concepts of “caring, growth and development, self-transcendence, resilience, and psychological adaption” (McEwen, 2014, p. 217). Major concepts that are a part of Leininger’s Culture Care Theory are culture, culture care, and culture care differences that are related to transcultural human care (McEwen, 2014). This theory values consideration of a patient’s culture in nursing care.
Assumptions Underlying the Theory
Leininger’s Culture Care theory describes the holistic approach to patient care and she expresses the necessity to view the patient’s overall cultural background to provide nursing care. Adopting aspects of transcultural nursing is crucial to our healthcare system and nurses are obligated to be sensitive and appreciative of all cultural variances. An individual’s values, beliefs, and customs should be considered when caring for patients or discussing their treatment plans with families. Transcultural sensitivity is a paradigm of nursing care. Culturally congruent nursing care and education that exudes familiarity will create an environment of trust and the patient will willingly contribute to their overall success in treatment. Metaparadigm is defined as having a broader worldview and conceptualization of four topics; person (human needs), environment, health, and nursing. (McEwen, 2014) Transcultural nursing is the “lifeway of an individual or a group with reference to values, beliefs, norms, patterns, and practices.” (McEwen, 2014)
Madeline Leininger’s theory of Transcultural Nursing starts with looking at the patient as a whole. This includes not only a physical assessment, but a cultural, spiritual and psychosocial assessment as well. Once the nurse has a better idea of the patient’s cultural background, they can begin to use the culturalogical assessment to create a plan of care that takes the patient’s cultural needs into consideration (Petiprin, 2016). In order to properly care for patients with cultural specific needs, the nurse must be aware of three nursing actions: cultural preservation, cultural care accommodation and cultural restructuring (Petiprin, 2016). The first step of cultural preservation is the awareness of the patient’s culture. Once the nurse and patient have established that relationship, the patient will be comforted that their cultural values are being acknowledged and preserved. The second action of cultural care accommodation is negotiation about a plan of care with the patient and nurse. Certain cultural practices can potentially be harmful to others involved in the patient’s plan of care and must be discussed and negotiated. For example, in some Hispanic cultures, a newborn is given a red string bracelet around their wrist or neck to ward off evil. This cultural practice, however, can be extremely dangerous to the newborn in terms of choking hazards. Therefore, the nurse must be understanding of the patient’s cultural practices, but be firm in modifying the practice for the safety of the baby. Perhaps the family could agree to the mother wearing the bracelet instead of the baby, or possibly tying the bracelet around the baby’s stroller instead. This is an issue that must be carefully discussed as to not offend, but to educate the patient on safety. The third action is to help the patient repattern or restructure their cultural practices in order to better fit everyone’s needs. Tying in with negotiation, there needs to be an open discussion about the patient’s wishes and what is considered safe practice in the hospital. Together, the patient and the nurse can develop a personalized and safe plan of care.
Major Propositions of the Theory
When looking at the world practically, diversity in industrialized nations is increasing rapidly (Ray, 2016). The main proposition of Madeline Leininger’s transcultural nursing theory is to be aware. Our world is ever changing and new cultural practices being discovered every day. Healthcare professionals must acknowledge the patient’s beliefs upon general assessment to better tailor their plan of care. Another important proposition of this theory is to be self-aware of how the patient’s culture makes the nurse or healthcare professional feel. Self-evaluation of attitudes towards caring for patient from different cultural background can change the way the nurse cares for their patients (Petiprin, 2016). In today’s society, nurses are required to be accepting of their patients’ cultural background. Being culturally sensitive can help the nurse involve the patient in their personal plan of care, resulting in better outcomes in care.
Examples in Literature
The objective of Leininger’s Theory is to provide culturally congruent nursing care to persons of different cultures and the healthcare worker to understand the acceptable forms of care within each. Research has shown that recognizing and understanding these cultural differences can positively influence nursing care and health. (Leininger & McFarland, 2006) More recently with nursing education and nursing scholars have used her theory as a basis for research for numerous articles on cultural implication to a variety of research studies related to health issues and the review of cultural education in nursing. (McEwen, 2014)
Integration into Practice
Nurses and other healthcare professionals will be able to use Leininger’s’ Culture Care theory as a foundation to give quality nursing care in the following ways: 1. educating the nurses in culture care will enable nurses to gather the proper assessment data. For example- “Hispanic males are very stoic in general, and do not readily admit to feeling pain. Native Americans don’t understand the need for medical care until they feel sick. As a result, they postpone care until they have a physical ailment that indicates long term complications of chronic disease such as diabetes”. (Burley, 2007). Nurses will be able to assess their patients to determine if they are experiencing pain and have the proper medication available when the patient requests the pain medication. Nurses will educate patients and family members on prevention of disease and illness. The patients and family members will be able to verbalize and demonstrate knowledge of understanding of disease prevention and illness. This will lessen readmission into the hospitals and promote optimal health and wellness; 2. Nurses will be able to assess their patients’ educational level and comprehension skills to provide individualized care to the patients’ culture beliefs which will promote optimal health and wellness. Patients must have care plans that are individualized to their culture environment and needs. For example: A patient who is hospitalized for a total knee replacement, who doesn’t have a high school diploma with limited reading skills will require a much different teaching method as opposed to the patient who has a master’s degree.
Examples of Implementation of the Theory
Implementation of Madeleine Leininger’s Culture Care Theory upon initial assessment and thereafter will promote quality nursing care. Nurses will be able to individualize the patients care plan specific to their patients’ needs which will promote an environment that is inclusive of the patients’ culture values. For example: 1. “Hispanic male patients are very stoic and don’t readily admit to feeling pain” (Burley, 2007). Nurses will ask open ended questions about pain and pain control. When the patient does decide they want pain medication to relieve their pain, the pain medication will be readily available as opposed to having the patient wait longer in pain while the physician is called by the nurse to get the medication ordered. The patient’s pain control outcome can be measured with this technique in place. Patients will be able to participate in activities that promote optimal health and wellness with their pain level controlled. Patients will report their pain levels as being controlled and attended to by the healthcare team which will increase patient satisfaction ratings; 2. “Native Americans don’t understand the need for medical care until they feel sick. As a result, medical attention is not sought until their medical condition indicates long term complications of chronic disease such as diabetes.” (Burley, 2007). Nurses will educate the patients and caregivers on disease prevention. For example: Patients and caregivers will be educated on the proper foods to eat, and exercise to manage and prevent diabetes. This will lessen readmission into the hospitals and decrease mortality rates of chronic illness and disease.
Leininger’s Culture Care Theory can be utilized in practice to ensure that the culture of a patient is maintained and considered when delivering nursing care. There continues to be a growth in multicultural population in today’s healthcare. This requires cultural competence to be incorporated into nursing education through schools and education for clinical practice. This requires a nurse to be unbiased and “understand his/her own world views and those of the patient, to avoid stereotyping and misapplication of scientific knowledge” (Ansuya, 2012, p. 5). The American Nurses Association implemented a new standard for nurses to include cultural congruence into practice (Marion, Douglas, Lavin, Barr, Gazaway, Thomas & Bickford, 2017). The Culture Care Theory provides a strong foundation to work in conjunction with this standard and expand the knowledge of nurses to provide holistic and culturally competent care.
Ansuya. (2012). Transcultural nursing: cultural competence in nurses. International Journal of Nursing Education, 4(1), 5-7.
Boyle, J. S. PhD, RN, MPH, FAAN. (2013). Madeleine Leininger, PhD, LHD, RN, FRCA, FAAN: A Remembrance. Journal of Transcultural Nursing, 24(1), 5.
Burley, Pam. RN. (03/01/2007). 10 Barriers to compliance – and how to overcome them.
Modern Medicine. Retrieved from www.modernmedicine.com
How Culture Influences Health. (2014). Caring for Kids New to Canada. Retrieved from http:
Leininger, M. m., & McFarland, M. (2006) Culture Care Diversity and Universality: A
Worldwide Nursing Theory (2ndEd.). Sudbury, MA: Jones and Bartlett
Marion, L, Douglas, M., Lavin, M., Barr, N., Gazaway, S., Thomas, E., & Bickford, C. (2017).
Implementing the New ANA Standard 8: Culturally Congruent Practice. Online Journal ofIssues in Nursing, 22(1), 1doi:10.3912/OJIN.Vol22No01PPT20
McEwen, M. (2014). Theoretical Basis for Nursing. Philadelphia: Lippincott Williams &
Nelson, Jean PDD, RN. (2006). Madeleine Leininger’s Culture Care Theory: The Theory of
Culture Care Diversity and Universality. Continuing Education Article. Vol. 10, No.
Retrieved from ed.a.ebscohost.com.lopes.idm.oclc.org
Petiprin, A. (2016). Madeleine Leininger’s Contribution to Nursing Theory: Transcultural
Ray, M. A. (2012). Remembering Madeleine M. Leininger, PhD, LHD, DS, RN, CTN, FAAN, FRCNA, 1925-2012. International Journal for Human Caring, 16(4), 6-8.
Ray, M. A. (2016). Transcultural caring dynamics in nursing and health care (2nd Ed.).
Philadelphia: F.A. Davis Company.