MADELEINE
LEININGER
Cultural
Care
Theory
Aaron Phillips
Anna Ingersoll
Caitlin Buren
Niki DeWall
INTRODUCTION
 Deciding how to care for a patient requires looking at the
patient as a whole person from physiological,
psychological, spiritual, and social perspective, it’s also
important to consider the patients culture and cultural
background.
MADELEINE’S MOTIVATION
 Madeleine Leininger developed
the Culture Care theory also
known as the Transcultural
Nursing theory in the 1950’s and
it was later published in 1991.
Leininger believed that values
and beliefs passed down to that
patient from generation to
generation can have as much of
an effect on that patient’s health
and reaction to treatment as the
patient’s environment and social
life.
PHILOSOPHIC VALUES/KNOWLEDGE
 Madeleine Leininger believed nursing values revolved around
being caring and knowing what it was to care. Leininger
discusses what it is to care in her theory. You must understand
what it is to care in order to provide culturally congruent and
competent treatment.
INFLUENCES
 Leininger proposed that there are three modes for
guiding nurses judgments, decisions, or action in order
to provide appropriate, beneficial, and meaningful care:
preservation and/or maintenance; accommodation and/or
negotiation; and re-patterning and/or restructuring. The
modes have influenced nursing and the ability to
provide culturally congruent nursing care, as well as
fostering culturally-competent nurses.
INFORMATION AND 4 GLOBAL
CONCEPTS
Human Being
Environment
Health
Nursing
HUMAN BEING
 “Each person is unique and different from all other persons”
(Chitty & Black, p. 275).
Some personal cultural factors to consider in the healthcare
industry:
• The male figure may be the dominant person in making medical
decisions
• Illness may be viewed as bad fortune or punishment
• Eye contact may be disrespectful
• A language barrier may exist
• The concept of time may vary
HUMAN BEING CONTINUED
 Leninger ’s cultural theory relates
to an individual because it
involves planning individualized
nursing care around a patient’s
values and beliefs. Nurses
should, “realize that cultural
norms must be included in the
plan of care to prevent conflicts
between nursing goals and
patient/family goals” (Chitty &
Black, p.234).
ENVIRONMENT
 Environment includes all the circumstances, influences, and
conditions that surround and affect individuals, families, and groups”
(Chitty & Black, p. 277 ).
Ways a person’s culture can influence one’s environment in healthcare:
• Wearing or placing objects to protect from evil spirits
• Burning candles or conducting rituals
• Having multiple visitors and/or family members at the bedside
Leininger ’s theory relates to a person’s environment because one’s
environment is highly influenced by their culture. “Included in
environment are the social and cultural attitudes that profoundly shape
human experience”(Chitty & Black, p.277).
HEALTH
 “Health practices are culturally determined and include nutritional
habits, type and amount of exercise and rest, how one copes with stress,
quality of interpersonal relationships, expression of spirituality, and
numerous other lifestyle factors” (Chitty & Black, p.284).
Some cultural beliefs relating to a person’s health may include :
• The consumption of certain foods, such as onion or garlic, to prevent
illness
• The use of healers and/or rituals
• The use of folk or traditional medicines
• The degree of importance with taking medicine
• A person’s diet and level of physical activity
• Accepting blood products and other treatments
HEALTH CONTINUED
Leininger’s theory relates
to one’s health because a
person’s culture can
impact the way they seek
medical care, how they
react to their illness, and
how they respond to
treatment (Quan, n.d.).
NURSING
 “Practice from a cultural perspective begins by respecting the
culture of the patient and recognizing the importance of its
relationship to nursing care” (Chitty & Black, p. 316 ).
A few cultural aspects to consider when caring for patients and
their families:
• Some cultures do not allow a male healthcare worker to care for
their loved one, others do not allows females
• Some value touch and other may feel violated when working
within their personal space
• May expect the nurse to make all decision for them and will not
participate in self-care
• May not show or express pain concerns
NURSING CONTINUED
Leininger’s theory is associated with the nursing
practice because in order to provide good
nursing care, the nurse, “…recognizes each
individual’s unique needs and tailors the plan of
nursing care to take that uniqueness into
consideration” (Chitty & Black, p.277).
INTERPRETATION & INFERENCE
 As healthcare providers it is easy to interpret an individuals
actions, not knowing whether your observation/opinion is
right.
 As the “sunrise model” states, in order to reach and maintain
balance, there are several key factors that play a role. To
reach Culture Care (worldview), it must start with
Culturally Congruent Care for the health/well being on an
individual. From there it takes several steps, all of them
being important to eventually reach the ultimate goal of
worldview Cultural Care.
IMPLICATIONS; UNDERSTANDING
WHAT TRANSCULTURAL MEANS
 In order to implicate this “theory” as it is referred to in Chitty and
Black, one must focus on the patient in a culturally congruent manner.
“Focus on culture care preservation, accommodations, or repatterning,
depending on the patient’s need.”
 Being part of a transcultural environment, it is essential to be
prepared in knowing, understanding and accepting each others
differences and practices.
 As Margaret Chang and Anne Kelly write, “Core beliefs and value
systems are held more strongly when people lose control over aspects
of their life due to illness.” For this reason it is important to be an
advocate for your patient and family members, upholding what they
see as important.
 They also went on to express the importance of knowing what the
patient’s concept is of their illness and its cause. This will in turn
help the nurse to individualize, assess, prioritize and educate them on
their needs and incorporate cultural beliefs into their plan of care.
CONSEQUENCES
 According to Chitty and Black, Jan the nurse, experienced first
hand how a cultural barrier negatively impacted her patient and
family to the point that they no longer wanted her services and
requested a new nurse. This all could have been avoided had Jan
known it was considered rude to decline an offer.
 Cultural barriers happen all to often while patient’s are at the
hospital. Some religions do not allow blood products, while
others believe having a spiritual leader at their bedside chanting
while the patient is actively dying, does something for their
spirit. We as nurses and healthcare providers are not to judge,
but to accept and accommodate these differences.
 Once we accept cultural differences and adapt our methods to suit
their cultural beliefs, we will have successfully transitioned into
Transcultural Care.
CLARIFICATION OF ORIGINS
 The theory of Culture Care Diversity and Universality began
to be developed in the mid-1950’s.
• Cultural factors and humanistic care in nursing were the major
missed dimensions in nursing practices—especially evident in
working with children from different cultures .
 Culturally based care was absent with the nursing and other staff
members, and only physical and emotional needs of the clients were
considered.
(Fawcett, 2002)
IS THIS PHILOSOPHY UNIQUE TO
NURSING
 Leininger stated that care is the essence of nursing, other health
professions (medicine, social work, physical therapy,
occupational therapy) have embraced, cited, adapted, and/or
applied her culture care theory in their respective fields.
 Leininger ’s theory has attracted the attention and interest of
scholars in theology, religious studies, engineering, management,
business, education, sociology, and even anthropology, the
discipline from which Leininger initially drew inspiration in
formulating the culture care theory.
CULTURAL CARE THEORY
D O ES IT AD EQ U AT ELY D ESC R IBE T H E F O U R G L O BAL
C O N C EPT S?
 The Cultural Care Theory covers all four Global
Concepts:
 human being, environment, health, and nursing.
 Madeleine Leininger does not specifically discuss
global concepts in her theory, but her theory is
applicable to each concept.
 Our country continues to become more culturally
diverse and the Cultural Care Theory is more relevant
than ever before.
 The Cultural Care Theory may be utilized at the bedside
or in a broader aspect such as public health.
CULTURAL CARE PRACTICE
SITUATIONS
Every nursing encounter is an opportunity to practice cultural awareness.
 Inpatient settings
 The cultural aware nurse will assess their client’s
personal, social, environmental, and cultural
needs/beliefs and incorporate them into their plan
of care in an inpatient setting.
 Hospice
 Assessing religious, cultural, and ethnic
beliefs/values into the end of life care plan.
CULTURAL EXPRESSION OF PAIN
CASE STUDY
 Mrs. L, a 42-year old Asian woman, became ill and required
surgery while visiting her daughter in the United States. After
surgery, she was given a patient -controlled analgesia pump. The
nurse explained to Mrs. L how to self -administer medication
when she felt pain. Mrs. L smiled and nodded her head when
asked whether she understood the instructions. Much later the
nurse noticed that this patient appeared to be in great pain. After
talking with Mrs. L’s daughter, the nurse realized that Mrs. L had
not understood how to use the equipment but was unwilling to ask
for additional instructions or complain of pain.
 Which statements are true about the following case study?
1. Mrs. L may have a language barrier.
2. Out of respect for authority, she may not speak until spoken to and may
verbally agree with anything nurses propose.
3. Asian’s only smoke opium for pain relief.
(Chitty & Black, 2011)
CONCLUSION
 Madeleine Leininger ’s development of the transcultural
nursing theory centered around the relationship between a
patient’s culture and how it relates to the care they receive.
 Leininger believed the soul of nursing stems from a nurses
ability to care
 Nurses are often so focused on treating a patients physical
problems, they tend to forget the emotional and spiritual
aspect of nursing, which may in fact be more important at
times.
 Leininger ’s thoery is still being practiced to this day, and
becomes more and more important as our world becomes
more diverse.
REFERENCES
 Chang, M., & Kelly, Ann. (2007). Patient Education: Addressing
Cultural Diversity and Health Literacy Issues. Medscape News
Today, 27(5):411-417. Retrieved from
http://www.medscape.com/viewarticle/564667_3.
 Chitty, K.K., & Black, B.P. (2011). Professional Nursing: Concepts
& Challenges (6th ed.). Maryland Heights, MO: Saunders
Elsevier.
 Clarke, P., McFarland, M., Andrews, M., & Leininger, M. (2009).
Caring: some reflections on the impact of the culture care
theory by McFarland & Andrews and a conversation with
Leininger. Nursing Science Quarterly, 22(3), 233-239.
doi:http://0dx.doi.org.libcat.ferris.edu/10.1177/08943184093
37020
 Fawcett, J. (2002). Scholarly dialogue. The nurse theorists: 21stcentury updates -- Madeleine M. Leininger. Nursing Science
Quarterly, 15(2), 131-136.
REFERENCES CONTINUED
 Nursing Theory (2011). Madeleine Leininger. Retrieved from
http://nursing-theory.org/nursing-theorists/MadelineLeininger.php
 Transcultural Nursing. (2012). Nursing Theories. Retrieved from
http://currentnursing.com/nursing_theory/transcultural_
nursing.html
 The University of the Philippines Open University. (2011).
Leininger's theory of culture care. Retrieved from:
http://nursingtheories.blogspot.com/2011/07/leiningers theory-of-culture-care.html
 Quan, K. (n.d.). Cultural differences that affect health care.
Retrieved from http://www.netplaces.com/new-nurse/what-youlearned-in-school/cultural-differences-that-affect-healthcare.htm