Donnabelle Allauigan and Ericka Sarmiento
In an ever-changing world, society tends to become increasingly diverse, in terms of behaviors, values beliefs and norms. With constant internal and environmental stimuli, such behaviors, values, beliefs and norms develop overtime which creates a mark in the mind of every individual, and is observed through social practices, religious structures and artistic expression. The end result of such change is what we recognize now as culture. Culture directs an individual’s thinking, doing and being. Within the context of nursing practice, cultural backgrounds can influence views on health and well-being and illness, which in turn might have an effect on their perceptions on healthcare and healthcare outcomes. Due to the recurrent concerns regarding the challenges encountered in the care for culturally diverse patients, transcultural care has become an important aspect of health care. Nowadays the goal of the medical system is to provide optimal and holistic care for all patients, to be culturally competent is an ingredient in order to accomplish quality care and health outcomes. The need for clinicians to become more sensitive to cultural differences and gain an understanding of transcultural concepts has been repeatedly stressed by Leininger (1988) and is the aim of this piece of writing.
Our group hails from diverse locations and is working in different parts of not only the Philippines, but also of the world. With different upbringings and different customs that we grew up with and encounter on a daily basis as nurses, we chose Madeleine Leininger, who was a pioneer in her time, as our nursing theorist.
When Madeleine Leininger’s name was suggested, the majority immediately agreed on her because of the concept that she has developed; the Theory of Culture Care. Culture Care or Transcultural Nursing deals with nursing and the culture of the clients. And as we are nurses who are working in various nursing fields, in different locations, the group saw how it can be adapted to our profession. Seeking further knowledge on it and how it applies to our specialization, will enhance each individual further as efficient nurses.
The concept is also applicable not only to our work but also to us, students of Masters of Arts in Nursing, because we are currently adapting to a new culture with a different study environment, having interactions with people in various locations by various forms of media. This concept would not only be applied in the work setting but also in our education.
With this, our group encourages you to read through our study and we hope that you will be able to understand and appreciate its contents. We feel confident that after going through our output, you will come to conclude that nursing transcends all cultures, providing care for every race and nation.
BIOGRAPHY OF LEININGER
DENNIS N. MUÑOZThe Transcultural Nursing Society, founded in 1974, “...continues to serve as an important annual forum to bring nurses together worldwide with common and diverse interests to improve care to people of diverse and similar cultures. Members are active in consultation, teaching, research, direct care and in policy-making in national and transnational arenas” (TCN Website, www.tcns.org). Dr. Leininger, credited with saying, “Caring is the essence of nursing,” established the Caring Conferences in 1978 as a forum for nurse scholars interested in advancing caring knowledge to gather for formal presentations, informal dialogue, and to evolve research related to caring sciences. This once small group has evolved into the International Association for Human Caring (IAHC).
All this began in the 1950’s, when Madeleine Leininger became fascinated with anthropology, finding many concepts she believed were pertinent to nursing. She became the first professional nurse to receive a PhD in cultural and social anthropology, and her vision of the “blending” of two fields, nursing and anthropology, led to her “Culture Care Diversity and Universality: A Worldwide Theory of Nursing.” As the mother of transcultural nursing and founder of the Transcultural Nursing Society, she has advanced transcultural nursing through education, research, administration, and practice. Dr. Leininger has been in demand for over 35 years as a consultant and speaker on issues relate to transcultural nursing and human caring in education and research, and continues such engagements to the present.
EDUCATION, PROFESSION AND PROFESSORIAL WORKS OF
DR. MADELEINE M. LEININGER
(In time line presentation)
DR. MADELEINE M. LEININGER was born in Sutton, Nebraska on July 13, 1925, lived on a farm with four brothers and sisters, and graduated from Sutton High School. Her desire to pursue a career in nursing was due to her inspiration and experience with her aunt who suffered from congenital heart disease.
Dr. Leininger is a nationally and internationally known educator, author, theorist, administrator, researcher, consultant, and public speaker. She has been a distinguished visiting professor and scholar at approximately 70 universities in the United States, Canada, and overseas. As of 1995, she has written 25 books, published over 200 articles and book chapters, produced numerous audio and video recordings, and developed a software program. She has also given over 850 keynote and public lectures in US and around the world. Her areas of expertise are transcultural nursing, comparative human care, qualitative research methods, cultural care theory, culture of nursing and health fields, anthropology, and the future of nursing. Dr. Leininger’s professional career is recognized as an educator and academic administrator (1956-1995), writer (1961-1995), lecturer (1965-1995), consultant (1971-1992), and leader in the field of transcultural nursing (1966-1995).
The post depression Period, Madeleine and her sister entered the Cadet Nurse Corps (a federally-funded program to increase the numbers of nurses being trained to meet anticipated needs during World War II ) and a diploma program at St. Anthony’s School of Nursing in Denver, Coloradao. They were the only persons entering the nursing profession within several nearby counties.
Madeleine Leininger went on to receive a Bachelor of Science degree in Biological Science, with a minor in Philosophy and Humanistic Studies, from Benedictine College (formerly Mount St. Scholastica College) in Atchison, Kasas
Dr. Leininger opened a psychiatric nursing service and educational program at Creighton University in Omaha, Nebraska.
Ø She earned the equivalent of a BSN through her studies in biological sciences, nursing administration, teaching and curriculum during 1951-1954.
Ø While working in a child guidance home, Leininger experienced what she describes as a cultural shock when she realized that recurrent behavioral patterns in children appeared to have a cultural basis. She identified a lack of cultural and care knowledge as the missing link to nursing understands of the many variations required in patient care to support compliance, healing, and wellness (George, 2002). the beginnings (in the 1950s) of a new construct and phenomenon called transcultural nursing.
She received a Master of Science in Nursing degree, with a minor in Psychiatric Mental Health Nursing and Psychology, at The Catholic University of America in Washington, DC.
She moved on to serve as Associate Professor of Nursing (1954-1959) and Director of the Graduate Program in Psychiatric Nursing at the University of Cincinnati.
Ø She also studied in this university, pursuing further graduate studies in curriculum, social sciences and nursing (1955-58)
There she began the first graduate program in psychiatric nursing at the University, as well as the first clinical specialist program in child psychiatric nursing in the country. During this time she also co-authored one of the first psychiatric nursing texts, Basic Psychiatric Nursing Concepts (1960), which has been published in eleven languages and used worldwide.
Ø Early in her career, Leininger observed that traditional psychiatric interventions did not adequately address the needs and behaviors of children of differing cultural backgrounds.
Ø While at the University of Cincinnati, she discussed her concerns regarding the influence of cultural factors in nursing care, as well as the potential of integrating the fields of nursing and anthropology, with visiting professor Margaret Mead.
She pursued doctoral studies beginning in 1960; during this time she was awarded a National League of Nursing Fellowship for fieldwork in the Eastern Highlands of New Guinea, where she studied the convergence and divergence of human behavior in two Gadsup villages.
Ø Dr. Leininger was the first in the 1960s to coin the concept "culturally congruent care" which was the goal of the Theory of Culture Care, and today the concept is being used globally.
Leininger embarked upon a doctoral program in Cultural and Social Anthropology at the University of Washington in Seattle and became the first professional nurse to earn a Ph.D. in anthropology.
Dr. Leininger was appointed Professor of Nursing and Anthropology at the University of Colorado– the first joint appointment of a professor of nursing and a second discipline in the United States.
She was Dean, Professor of Nursing, and Lecturer in Anthropology at the University of
Washington, School of Nursing.
Ø In 1973, under her leadership, the University of Washington was recognized as the outstanding public institutional school of nursing in the United States.
Dr. Leininger served as Dean, Professor of Nursing, Adjunct Professor of Anthropology, and Director of the Center for Nursing Research and of the Doctoral and Transcultural Nursing Programs at the University of Utah College of Nursing
Ø She was the first full-time President of the American Association of Colleges of Nursing and one of the first members of the American Academy of Nursing in 1975.
She began her tenure at Wayne State University as Professor of Nursing and Director of the Center for Health Research at the College of Nursing, as well as Adjunct Professor of Anthropology in the College of Liberal Arts and Director of the Transcultural Nursing Program
Ø While at Wayne State, Dr. Leininger won numerous awards, including the prestigious President’s Award for Excellence in Teaching, the Board of Governors’ Distinguished Faculty Award, and the Gershenson’s Research Fellowship Award.
Ø She was presented with the Women in Science Award from California State University, in addition to many other honors and awards she received throughout her career, 1990
Ø She also established the Journal of Transcultural Nursing and served as editor from 1989-1995.
Ø She initiated and promoted worldwide certification of transcultural nurses (CTN) for client safety and knowledgeable care for people of diverse cultures.
June 1, 1995
Dr. Leininger retired as professor emeritus from Wayne State University
Dr. Leininger’s titles include:
1. Professor Emeritus of Nursing, Wayne State University College of Nursing;
2. Adjunct Clinical Professor at University of Nebraska College of Nursing;
3. Fellow of the American Academy of Nursing;
4. Distinguished Fellow of the Royal College of Nursing (Australia).
5. She was honored as a Living Legend by the American Academy of Nursing (1998),
6. Holds honorary degrees from Benedictine College (LHD, 1975),
7. University of Indianapolis (DS, 1990),
8. University of Kuopio, Finland (PhDNSc, 1991).
THEORY DEVELOPMENT AND HISTORICAL BACKGROUND
Leininger’s theory of Cultural Care is a product of devoted consciousness of an ever changing world, wherein individual is at play with society and their environment. It is not a borrowed theory but it an outcome of independent work with the goal of improving care given to meet different health care needs of diverse cultures. The core of the theory was derived from all her experiences in hospital, clinic and in the community setting. World War II became the nest wherein the theory developed; it was during this period that many immigrants and refugees from diverse cultures were moving to the United States and to other places worldwide. With direct observations and interactions with clients of diverse cultures, with variety of health conditions, she became conscious that recovery from illnesses and or maintaining health and wellbeing was greatly affected by how health care was provided to them. The major event that led to the development of her theory happened in the early 1950’s where she worked as a clinical specialist caring for mildly disturbed children of diverse cultural backgrounds. During her exposure it became evident to her that nurses and other health professionals failed to appreciate the important role of culture in healing, caring process and in mental treatment practices. An attempt to use other health care models and other ideas popular during that period was made but was placed in vain due to inadequacy of their methods to address her clients’ needs. She then concluded that understanding and responding appropriately and therapeutically to clients of different cultures was a critical need that warranted further study and research. In order to have a full understanding of different cultures she decided to pursue an academic doctoral program in anthropology. Resistance was met during the conceptualization of bringing together culture and care together, primarily due to lack of studies to back her up and lack of interest from nurses and other health practitioners. However the need became more and more apparent as she went on with her study and in due course, after five decades study and research, the theory has been established as a major, relevant and dominant theory in nursing.
By Farrah Sayo
The philosophical roots of the theory are from the theorist’s extensive and diverse nursing experiences, anthropological insights, life experiences, values, and creative thinking. Her firm belief in God’s creative and caring ways has always been important to her. Preparation in philosophy, religion, education, nursing, anthropology, biological sciences, and related areas influenced her holistic and comprehensive view of humans. And as the first graduate professional nurse to pursue a PhD in anthropology with the desire to advance nursing theory, she saw great potential for developing relationships between nursing and anthropology and expanding the prevalent mind-body medical and nursing views. Comparative care meanings, expressions, symbols, and practices of different cultures were powerful new ways to practice nursing. Theorizing about the culture and care relationships as a new discipline focus was intellectually exciting to her. Interestingly, anthropologists had not studied care in health and illness when she began the theory in the 1950s. In developing the theory, a major hurdle for nurses was to discover culture care meanings, practices, and factors influencing care by religion, politics, economics, worldview, environment, cultural values, history, language, gender, and others. Hence, the sunrise model was developed. If nurses use the model with the theory, they will discover factors related to cultural stresses, pain, racial biases, and even destructive acts as nontherapeutic to clients. One can also reduce and prevent violence in the workplace, anger, and noncompliance with data findings from the model when used with the three prescribed modes of action: a. Cultural preservation or maintenance b. Cultural care accommodation or negotiation c. Cultural care repatterning or restructuring. And because nurses are the largest group of health care providers, a significant difference in quality care and preventing legal suits can occur. The sunrise model used in conjunction with the theory is a powerful means for new knowledge and practices in health care contexts.
INFLUENCES ON THE THEORY
Gayzell A. de Jesus
Dr. Madeleine Leininger was especially candid when asked about her influences in formulating the Culture Care Theory. She said that there was no one person or philosophic school of thought or ideology per se that directly influenced her thinking. Dr. Leininger used creative thinking and her experiences as a nurse-anthropologist in working on the interrealationships between culture and care. Her philosophical interest and conceptual orientation of the Culture Care Theory were derived primarily from holistic nursing and anthropological perspective of human beings living in different places and circumstances.
She formulated a derived theory from the discipline of anthropology and conceptualized it in a new and unique way relevant to nursing. She defined transcultural nursing as “a major area of nursing which focuses upon a comparative study and analysis of different cultures and subcultures in the world with respect to their caring behavior; nursing care; and health-illness values, beliefs, and patterns of behavior with the goal of developing a scientific and humanistic body of knowledge in order to provide culture specific and culture-universal nursing care practices.”
She developed the theory “based upon the belief that cultures can determine most of the care they desire or need from professional caregivers.” Culture Care theory is directed toward consumers of care to get their viewpoints, world views, knowledge and practices as bases for sound professional actions and decisions. It is comprehensive and holistic because it takes into account social structure, world view, values, environment, language expressions, and folk-professional systems to discover nursing knowledge.
Theory Definitions and Specifics of The Theory of Culture Care
Enrique Luis Nuguid
Dr. Leininger said that Illness and wellness are shaped by a various factors including perception and coping skills, as well as the social level of the patient. She also stressed that cultural competence is an important component of nursing and that religious and cultural knowledge is an important ingredient in health care. She stressed that value of culture is influential in all spheres of human life. It also defines health, illness, and the search for relief from disease or distress. Health concepts held by many cultural groups may result in people choosing not to seek modern medical treatment procedures and that health care providers 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 they likely to be encountered. Most cases of illness have multiple causalities and may require several different approaches to diagnosis, treatment, and cure including folk and western medical interventions. According to her studies, 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 that is why being a-depth with different cultures guide the behavior into acceptable ways for the people in a specific group since culture originates and develops within the social structure through inter personal interactions. Effective intercultural communication must take place so that nurse can successfully provide care for a client of a different cultural or ethnic to background.
DANICA MAE BARASI
The practice of transcultural nursing addresses the cultural dynamics that influence the nurse client relationship. Because of its focus on this specific aspect of nursing, a theory was needed to study and explain outcomes of this type of care. Leininger creatively developed the Theory of Culture Care: Diversity and Universality with the goal to provide culturally congruent wholistic care. Some scholars might place this theory in the middle range classification. Leininger holds that it is not a grand theory because it has particular dimensions to assess for a total picture. It is a wholistic and comprehensive approach, which has led to broader nursing practice applications than is traditionally expected with a middle-range, reductionist approach. (Personal communication with Penny Glynn on September 12, 2003). Leininger’s theory is to provide care measures that are in harmony with an individual or group’s cultural beliefs, practices, and values. In the 1960’s she coined the term culturally congruent care, which is the primary goal of transcultural nursing practice. Culturally congruent care is possible when the following occurs within the nurse-client relationship (Leininger, 1981): Together the nurse and the client creatively design a new or different care lifestyle for the health or well-being of the client. This mode requires the use of both generic and professional knowledge and ways to fit such diverse ideas into nursing care actions and goals. Care knowledge and skill are often repatterned for the best interest of the clients…Thus all care modalities require coparticipation of the nurse and clients (consumers) working together to identify, plan, implement, and evaluate each caring mode for culturally congruent nursing care. These modes can stimulate nurses to design nursing actions and decisions using new knowlwdge and culturally based ways to provide meaningful and satisfying holistic care to individuals, groups or institutions.
· Under Leninger's theory, the enthohistory of a patient is also important when evaluating adequate care. Under Leninger's theory, ethnohistory refers to "to the past events and experiences of individuals or groups, which explain human lifeways within particular cultural contexts over short or long periods.” For example, a person who may have been a member of an African tribe that does not traditionally believe in or trust medical professionals will require a nurse who is especially careful and slow to introduce medical treatments.
· Leninger’s theory also states that its cannot only be applied to the nurse-client relationship but also includes care for families, groups, communities, cultures and institutions. Her theory would be especially important in situations in which a nurse may be enlisted in the Army or a member of the Peace Corps, where there will be cultural as well as religious divides, and it would be of the utmost importance for the nurse to be able to address the differences provide care accordingly.
METAPARADIGM IN NURSING
Flor Kenneth Alobin
Madeleine Leininger focused on care as an integral aspect of nursing. Unlike other nursing theorists, she did not emphasized on basic concepts of person, nursing, health and environment.
Instead, she formulated the following descriptions of these:
PERSON: refers to an individual human caring and cultural being as well as a family, group, a social institution, or a culture.
Human beings are best explained in her assumptions. Humans are thus believed to be caring and capable of being concerned about the desires, welfares, and continued existence of others. Human care is collective, that is, seen in all cultures.
Он совсем забыл про кольцо на пальце, забыл, для чего приехал в Севилью. Он посмотрел на приближающуюся фигуру, затем перевел взгляд на кольцо. Из-за чего погибла Меган. Неужели ему предстояло погибнуть по той же причине.