Nursing is a complex practice because it operates in a multicultural environment, as we know the world today is composed of individuals of different cultural orientations. As a requirement, nurses need to instill cultural competence in their practice since it has been proven to be a critical element in health care. Culture plays a role in bringing people together in a community setting; this means that culture is prerequisite in medical practice since it allows nurses to establish the close bond that exists between patients and medical professionals.
Culture shapes behavior and beliefs that a particular community exhibit and so medical treatments and activities can be heavily affected especially when culture acts as a hindrance. Sitzman and Eichelberger (2011) highlights that nurses can improve their practice if they have the necessary knowledge to understand social, structural, physiological, and cultural factors that affect health and wellness of patients. Sitzman and Eichelberger (2011) recommends as it provides insights for greater understanding of patients and their culture to enable diagnosis, prevention and treatment.
Background of the Theorist and Literature
The pioneer of the theory is Madeleine Leininger who has played a greater role in nursing by educating nurses for over three decades. “She was born in 1925 in Sutton, Nebraska, Leininger graduated from Saint Anthony School of Nursing in 1948” (Leininger, 1995). Her desire to continue with education saw her acquire Bachelor degree in Nursing from Mount Saint Scholastica College and later attained a Master degree in science from The Catholic University of America and in 1965 and later PhD in cultural and social anthropology. Leininger’s primary concern through the theory has always been focused on transforming patterns and practices of health care and thus instigating a closer relationship between nurses and patients. The theory presents models that are diverse and universal and instills knowledge to nurses on how they can understand diverse cultures and how they can operate on the confines of such beliefs to improve service delivery.
This will be conducted in line with analysis of health concepts and how diverse cultural environment can affect delivery of services to patients. In her practice she has engrossed in linking patient care and cultural orientation and according to her assertions, nursing is a humanistic and scientific discipline as whole that focuses on human care and culturally meaningful ways to help patients achieve health.
Leininger (1978) opines that nursing observation and decisions are guided by her theory where such decisions are customized to meet the different needs and requirements of patients based on their cultural values, beliefs and lifestyles. Sitzman and Eichelberger (2011) describes that the theory was developed from her strong discipline and concern with understanding people and their cultural backgrounds to excel on patient care.
During her early practice she realized that nursing practice was heavily dependent on care. The theory was coined when she realized that behavior of children depended so much on their cultural background, this theory was developed to provide comprehensive health care to patients. It provides the framework through which nurses provide care in a more orderly approach by considering cultural beliefs, values and practices of their patients. Leininger (1978) elaborates that the theory was prompted by her nursing practice, it has been established that when she was working as a clinical nurse she observed that children were often disturbed and this according to her was as a result of culture shock. This behavior was recurrent but was different among children; she continued observing the behavior before finally concluding that the missing link was cultural knowledge and understanding.
Literature that supports the theory is from Sunrise Model that was developed to provide a bigger picture of the theory by anchoring some of its assertions. This model is a conceptual tool that depicts myriad factors that have the potential of influencing congruent care with people of diverse cultures. Sunrise Model is useful in assessing healthcare of patients from different cultures of and taking note of demographic characteristics that forms an integral part of both the model and theory.
The theory uses deductive reasoning because it has its premises on strict observance of diverse patients from different cultures on a daily basis before coming up with a conclusion. It is vital in effectively understanding different cultures because one practice may be accepted in one culture but not in another. Moreover, it is important to note that patients usually have the right to access medical services irrespective of the culture they emulate. Nurses therefore have the responsibility of ensuring that all patients access the necessary services in a more holistic approach. The theory comes in to promote cultural competence because it is a necessary ingredient in nursing practice, knowledge should be customized to appropriately fit within different cultural values and beliefs.
According to Leininger (1988) caring is important for health, wellbeing, healing, growth, survival, and for facing illness or death. Cultural care is crucial in serving health needs, illness and dying of patients, there can never be cure without providing necessary care to the patient. The concept of culture varies because of unique aspects in different parts of the world; each individual is unique on characteristics exhibited such as language, religious, spiritual, social, political, educational factors that conclusively determine a culture.
Leininger (1988) defines the major concepts in order to fully understand the whole theory. It is important to note that care is defined as the urge to assist others by anticipating their needs with the intention of improving their health and wellness. Caring is the effort directed to patients in line with providing care. On the other hand, Leininger (1988) defines culture as values, belief and life norms that are learned, shared and transmitted and that guide thinking, decisions and daily activities.
Consequently, cultural care is multiple aspects of culture that can potentially influence and transform behavior of an individual to improve their life conditions, or deal with illness and death. Moreover, cultural care diversity are the differences that exist on different cultures based on interpretations, meanings, values and acceptable behavior between different groups in human population. Likewise, cultural care universality is the common or similar care behaviors that can be observed among people of different culture.
Other concepts that make up the theory include person, who is described as an individual making up a family, group or social institution, and nursing is a learned profession that is focused on providing care to patients. Cultural and social structure are dimensions such as religion, social orientations, political affiliations, economics characteristics and education level that defines individual and categorizes them in different cultural contexts.
According to Leininger (1978) health of an individual is described as state of well-being that is culturally defined and valued by people and their culture. Subsequently, cultural care preservation is nursing care actions that potentially help people of different cultures to attain core care values that assist in promoting health and wellness. Leininger (1978) further outlines that culture care accommodation describes creative nursing actions that help people of certain culture to adapt with beliefs and values of others in healthcare community setting.
According to Leininger (1995) major propositions of the theory are that there are three aspects that guide judgments, decisions and actions of nurses to ensure that nursing practice is appropriate, beneficial and meaningful to patients and community. Leininger (1995) also reveals that these aspects include preservation of cultural knowledge and orientation and rearranging aspect of cultural care.
Notably, cultural preservation would preserve and retain values that patients need in ensuring their well-being and recovery from illness. Subsequently, cultural care accommodation makes it possible for patients to adapt with others in order to achieve favorable health outcomes. Consequently, cultural care restructuring may record, change or potentially modify life ways of an individual in order to benefit from healthcare service provision. Leininger (1995) opines that these factors are important in nursing because they influence ability of nurses to provide culturally congruent nursing care, as well as fostering culturally-competent nurses. Moreover, Leininger (1995) ascertains that such aspects can ensure effective cultural care provision that is congruent to cultural endowment of a patient and thereby eliminating stress and conflict between patient and care giver.
Evaluation of the Theory
Several specific assumptions underline the theory and the concepts discussed above, these assumptions are implicit and focus on beliefs and values. Leininger (1995) confirms that these assumptions add value by reinforcing meaning, depth and focus especially in order to arrive at culturally competent nursing care. These assumptions are numerous and include; care is essential and forms the focal point in nursing, care is essential for health and well-being because it ensures healing, growth and survival.
Moreover, care is broad and multifaceted in order to guide nursing care practices, objectives of nursing is to serve by humanity against illness and death, and no provision of care without giving and receiving care. In addition, culture is considered different based on characteristics and orientations and every human demonstrate different cultural characteristics, knowledge and professional care practices.
Notably, Leininger (1995) assumes that numerous factors affect provision of service because nursing practice is influenced by religious, spiritual, social, political, educational, economic, technological and environmental dimensions. Significantly, it is assumed that well-being of clients is enhanced through beneficial, healthy and culturally satisfying behaviors and values.
The four concepts of nursing of client, environment, health and nursing have been effectively described since they also form part of the foundation for the theory. Client here has been implied to be a patient, an individual with different cultural orientation in need of medical care in order to eradicate illness and death. Nursing is a learned profession that produces nurses who actually provide nursing care and services to the needy in society. Consequently health has been included in the theory to refer to a state of well-being that is defined by culture and valued by that specific culture, while environment encompasses the different facets such as social, economic and political dimensions that affect service delivery.
The theory is lucid and shows consistency because it offers valuable information on the link between care and culture; it continues to generate more domains to allow consistent inquiry through research and humanistic knowledge. “The theory consistently challenge nurses to seek both universal and diverse culturally based care phenomena by diverse cultures, the culture of nursing, and the cultures of social unsteadiness worldwide” (Leininger, 1995).
Application of the Theory
The theory guides action of nurses by ascertaining that acceptance of cultural orientation is critical in defining needs of patients and also provides insights that make it possible to effectively understand different cultures especially those working abroad. The theory is helpful as it opens up nurses to provide services and care for patients irrespective of their cultural orientations and endowments. Moreover, the theory is important as it guides anticipation and and response to diverse cultural and medical care needs of patients. In addition, the theory guides education and research by ensuring that valuable cultural concepts are added into the curriculum to keep pace with the ever-changing medical and cultural needs of clients.
Theory by Leininger is integrated into nursing practice by constantly reviewing care and cultural values that effectively maps the needs of a patient. In return it will help nurses manage diseases that arise from unique cultural orientations of a patient and thus make monitoring home remedies easy because they determine the type of care that a patient is entitled.
Leininger (1995) highlights that the theory guide actions by integrating religious rituals into care plans and to help make significant impacts and ensure success in providing treatment to patients, this influences the perception of the patient’s health, disease process and treatment. Significantly, the theory will guide permission sought by nurses by ensuring the involvement of family members with same cultural values; this ensures that patients express themselves effectively.
Leininger (1988) outlines that when a nurse develops the basic understanding of health behavior of a culture, this helps to have a positive impact on the nurse-patient relationship. The theory improves patient assessment because it promotes thorough interrogation and analysis of cultural needs such as language barrier, dietary restricts, and beliefs will be assessed.
The theory can effectively be used in advance nursing practice to perform diagnosis, treatment and prevention of illness and death. This will be made possible through looking into the background of the patient and then use the knowledge to prepare a nursing plan that will help the patient get healthy quickly while still being sensitive to his or her cultural background. Moreover, Leininger (1995) acknowledges that nursing practice is constantly changing and so the theory will guide advance nursing practice by spearheading educational responsibilities, fostering research activities and advocating for worldwide consultancy in the practice to the benefit of patients.
Advance nursing practice requires nurses to be sensitive to cultural backgrounds of their clients because culture is an integral part of medical care and thus greatly affects reactions to treatment. Moreover, nursing practice demands that nurses must potentially identify cultural needs of patients by focusing on family and entire community to develop expertise on how to handle their needs. This theory is fundamental in nursing practice because it provides the necessary knowledge that aid decision making and actions of nurses as they try to provide medical care services to clients.
Leininger, M. M. (1978). Transcultural nursing: Concepts, theories, and practices. New York,
Leininger, M. M. (1988). Leininger’s theory of nursing: Cultural care diversity and universality.
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Leininger, M. M. (1995). Transcultural nursing: Concepts, theories, research, and practice.
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Sitzman, K. and Eichelberger, L. W. (2011). Understanding The Work Of Nurse Theorists: A
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