LEININGER’S CONTRIBUTION TO TRANSCULTURAL NURSING

MODULE 2

Culturally Competent
Nursing Care

Scope, Rationale, and

Factors Influencing
Transcultural Nursing

SCOPE, RATIONALE, AND FACTORS

INFLUENCING TRANSCULTURAL NURSING

Rationale for Culturally Competent

Care
In many parts of the world, there is growing awareness of social injustice
for people from diverse backgrounds and the moral imperative to
safeguard the civil and health care rights of vulnerable populations.
Vulnerable populations are groups that are poorly integrated into the
health care system because of ethnic, cultural, economic, geographic (rural
and urban settings), or health characteristics, such as disabilities or multiple
chronic conditions (Office of Minority
Health & Equity, 2013).

Immigration and migration result in growing numbers of immigrants,

people who move from one country or region to another for economic,
political, religious, social, and personal reasons.

The verb emigrate means to leave one country or region to settle in

another; immigrate means to enter another country or region for the
purpose of living there. People emigrate from one country or region and
immigrate to a different nation or region.

Nurses respond to global health care needs such as infectious disease

epidemics and the growing trends in health tourism, in which patients
travel to other countries for medical and surgical health care needs.

HISTORY HISTORY
The foundations of transcultural nursing were laid in the mid-1950s. In nursing, Peplau first
mentioned in 1950 that the cultures were an important variable affecting mental health. The
growing interest in Leininger’s transcultural nursing model has begun with population changes and
This is a promising field of study with which Turkish nurses have recently started to be familiar.
migration. Leininger tried to promote transcultural nursing movements. Much more attention was
Now that globalization is inevitable, studies on transcultural care practices will broaden the
paid to the care of individuals from different cultures in the 1960s. Since 1960s, nurses have been
horizons of Turkish nurses and the others all around the world.
carrying out studies aimed at providing particularly cultural care to people from all
communities/cultures. In 1962, King stated that psychopathological behaviors differ from culture to
culture. In addition to Leininger, a pioneer model of transcultural nursing, many nurses worked in the field
of cultural care including Boyle, Campinha- Bacote, Yahle Langenkamp, Giger and Davidhizar,
In 1969, the International Council of Nursing (ICN) began using cultural content in nursing. The Juntunen, Leuning, Swiggum et al., Purnell, Ryan, Carlton and Ali.
Transcultural Nursing Society (TCNS) was established in 1974 to train nurses in this area. This
organization aims to provide the nurses and other health care professionals with the basic
knowledge necessary to develop cultural skills in culturally sensitive practice, education, research Among these, there are researchers arguing that the models and theories of two modelists
and management. (Giger and Davidhizar and Purnell) who do myriads of studies on cultural care are extremely
simple, comprehensible and suitable for use in many different fields and cultures.
Since 1989, “Journal of Transcultural Nursing” has been published, aiming to train nurses about
transcultural care and improve their practice. Evidence-based studies have been conducted in this
area. Today, there are about 25 books and over 800 articles covering research, theory and
applications related to transcultural nursing.
 STANDARDS
GUIDELINES FOR THE PRACTICE OF CULTURALLY COMPETENT NURSING CARE

Cultural Competence

The bedrock of a great nurse-

patient relationship. Every
nurse should make this a
priority in their care.

CATEGORIES OF CULTURAL KEY CONCEPTS AND

COMPETENCIES PRINCIPLES IN
TRANSCULTURAL
Individual Cultural Competence
Refers to the care provided for an individual client by
NURSING PRACTICE
one or more nurses, physicians, social workers, and/or
other health care, education, or social services
professionals.

COMMUNICATION
Organizational Cultural Competence
Focuses on the collective competencies of the
members of an organization and their effectiveness in
SELF-AWARENESS
meeting the diverse needs of their clients, patients,
staff, and community.

GUIDELINES FOR THE PRACTICE OF CULTURALLY COMPETENT GUIDELINES FOR THE PRACTICE OF CULTURALLY COMPETENT
NURSING CARE NURSING CARE

01 Knowledge of Culture 02 Education and Training in 07 Patient Advocacy and 08 Multicultural Workforce
Culturally Competent Care Empowerment

03 Critical Reflection 04 Cross-Cultrual 09 Cross-Cultural Leadership 10 Evidence-Based Practice and

Communication Research

05 Culturally Competent 06 Cultural Competence in

Practice Health Care Systems
Organizations
 NURSING METAPARADIGM ON NURSING METAPARADIGM ON
LEININGER’S THEORY LEININGER’S THEORY
PEOPLE HEALTH
Humans are universally caring beings who survive in a Represents belief, values and practices or particular culture,
diversity of cultures through their ability to provide the health is both universal and diverse.
universality of care in a variety of ways according to different
cultures, needs and settings.
NURSING : CULTURALLY-BASED NURSING
ENVIRONMENT ACTION: (3 MODES OF DECISIONS AND
Worldwide view, which is the perception of their life and the ACTIONS)
world around them, social structure, and environmental
context (Ex. Belief, health practices) 1.Cultural preservation or maintenance
2.Cultural care accommodation or negotiation
3.Cultural care repatterning or restructuring

Transcultural Theory
LEININGER'S of Nursing
THEORY has transformed caregivers
previously less aware of patient
diversity and enhanced
helps to better define the expectations of the
nurse-patient relationship because ultimately the perceptions that could potentially
nurse is the one who implements care and is at be the difference between a
the patient's side for the majority of his or her patient's convalescence and
time receiving care. decline.

Madeleine Leininger

Leininger’s assumptions
derived from her theory:
Leininger’s theory is to provide care measures that are
in harmony with an individual or group’s cultural beliefs, Care is the essence and central focus of nursing.
practices, and values.

Caring is essential for health and well-being, healing,

growth, survival, and also for facing illness or death.
In 1960's she coined the term CULTURALLY CONGRUENT
CARE, which is the primary goal of TRANSCULTURAL
NURSING PRACTICE. Culture care is a broad holistic perspective to guide
nursing care practices.
 Leininger’s assumptions Leininger’s assumptions
derived from her theory: derived from her theory:

Nursing’s central purpose is to serve human beings in Every human culture has folk remedies, professional
health, illness, and if dying. knowledge, and professional care practices that vary.

There can be no curing without the giving and receiving Cultural care values, beliefs, and practices are influenced
of care. by worldview and language, as well as religious, spiritual,
social, political, educational, economic, technological,
Culture care concepts have both different and similar ethnohistorical, and environmental factors.
aspects among all cultures of the world.

Leininger’s assumptions TRANSCULTURAL NURSING ENABLES

derived from her theory: NURSES TO:

Communicate more effectively with Accurately assess the cultural

Beneficial, healthy, satisfying culturally based nursing care clients from diverse cultural and expression of pain
enhances the well-being of clients. linguistic backgrounds

Culturally beneficial nursing care can only occur when cultural Provide culturally appropriate
Assist those of various cultures with
care values, expressions, or patterns are known and used interventions to prevent or alleviate
mental health problems
appropriately and knowingly by the nurse providing care. discomfort

Clients who experience nursing care that fails to be reasonably

congruent with the client’s cultural beliefs and values will show Assess the for parent-child relationship
signs of stress, cultural conflict, noncompliance, and ethical that promote the health and well-being
of children
moral concerns.

Instances of Cultural CULTURAL SELF

ASSESSMENT AND CULTURAL
Impacts in ASSESSMENT OF CLIENT.

Nursing Care Giger and Davidhizar’s Transcultural

Assessment Model

1.Transcultural nursing and culturally diverse

nursing,
2.Culturally competent care,
Nursing technique of
3.Culturally unique individuals
"palpation," or touch 4.Culturally sensitive environments
5.Health and health status based on culturally
specific illness and wellness behaviors.
 Giger and Davidhizar’s COMMUNICATION
Transcultural
Assessment Model Communication, verbal and nonverbal, account for a
large portion of the cultural disconnect between student
nurses and their patients (Momeni, Jirwe, & Emami,
COMMUNICATION 2008).
SPACE
A mutual understanding of the patient’s cultural needs
SOCIAL ORGANIZATION
must be achieved through communication.
TIME
ENVIRONMENTAL CONTROL
BIOLOGIC VARIATIONS

SPACE SOCIAL ORGANIZATION

Humans vary greatly in their comfort level related to Humans often learn and adopt cultural beliefs through
personal space. Some of these spatial concerns are social organization. Individuals from culturally diverse
related to personal preferences, while others are a backgrounds will all manifest different degrees of
reflection of cultural principles. acculturation into the beliefs of their dominant culture.

Nurses must be aware of their patients’ comfort level In some circumstances cultural values stem from the
related to body distance during conversation, proximity opinion of elders or patriarchs, while others place value
to family members, perception of space, eye contact, on position in family.
and personal and cultural touch practices (Giger &
Davidhizar, 2004)

TIME ENVIRONMENTAL CONTROL

Many countries and cultures are oriented with a focus Environmental control can be explained in the patient’s
on the past. ability, within their cultural system, to plan activities that
control their environment as well as their perception of
To understand individualistic views of culture, nurses personal control over factors in the environment.
must assess patient views about passage of time, points
in time, and duration of time.
 BIOLOGICAL VARIATION

When assessing a patient’s cultural underpinnings,

biological variations need to be evaluated carefully to
avoid stereotypes and discrimination.

Race, Body Structure, genetic variations, nutritional

preferences and psychological characteristics.

“We may have different religions, different

languages, different colored skin, but we all
belong to one human race.”
THANK YOU
- Kofi Annan -
END OF MODULE 2
S E E Y O U N E X T M E E T I N G !