1. { Madeleine Leininger’s
Culture Care Theory
Clemson University
Nursing Theory
Juliann Trumpower

2. Background
• She is the founder of the theory of Culture
Care/Transcultural Theory.
• She was the first nurse researcher to study
the importance of culture in regards to
individual health and caring behaviors.
• In her Sunrise Model the theoretical
framework is depicted.
• The roots of her theory come from her
extensive research and clinical practices with
multiple different cultural groups.
• This theory has now developed as a
discipline in nursing.

3.  1948-Diploma in Nursing from St. Anthony’s School of
Nursing
 1950-BS in Biological Science from Benedictine College
 1953-MSN from Catholic University, Washington D.C
 1965-Ph.D in Anthropology from University of Seattle
 1966-The first course of transcultural nursing was available
for nursing students at the University of Colorado.
 Nominated for Nobel Peace Prize
 Author of 30 books and over 220
publications
After 50 years of of study and research it is recognized as a
major, relevant and dominant theory in nursing
Timeline of Madeline
Leininger

4.  In the mid 1940s she began to realize that the concept of care was
an important aspect of nursing.
 After WWII, She began to see increased immigration and began to
notice behavioral differences and how this affected care.
She believed that a nurse’s inability to culturally understand their
patient led to a significant decrease in the quality of care provided.
Her theory states that providing care measures that are in harmony
with an individual or groups culture, beliefs, practices and values
are necessary for providing quality care.
 Central purpose was to discover,
document and explain diverse and
universal culturally based care factors
influencing health, well-being, illness or
death.
Purpose of culture
care theory

5.  Framework is used to help nurses avoid
ethnocentric assessments
 Leininger used frameworks from anthropology as
well as care constructs from a nursing approach.
 Purpose was to improve the quality of nursing care
by creating the first ever transcultural nursing
theory based on research of both universal and
diverse cultural phenomena.
 Sunrise Model
Theoretical foundations

6.  Care is the central focus of nursing
 Care is essential for health and well-being, illness
and dying
 Every culture’s health practices and behaviors can
vary and are to be valued.
 Care is the best way to describe role of a nurse.
Culture care is the best way to approach this role.
 Nursing care must include examination of cultural
and social structure, world view, values/beliefs,
language, and environmental contexts (per sunrise
model)
 Culturally congruent care improves the health and
well being
Theory and assumptions

7. “Im black, white, asian, fat, female and fury AND
everyone loves me”

8.  Culture and Care are two major constructs of Theory
 Care- those aiding, encouraging, and enabling acts or thoughts toward others with
obvious or anticipated needs which help improve life or lessen illness/distress.
 Culture-learned, shared and transmitted values, beliefs, norms of a group that influence
behaviors. It defines health, illness and the search for relief from disease or distress.
Guides human decisions and actions
 Culture Care- aspects of culture that influence or enable person to deal with
illness/death. Culturally based care is essential for well-being, health, growth, survival
or facing hardships and death.
 Transcultural Care- practice focused on cultural care values, beliefs and practices of
individuals or groups of similar or different cultures with goal of providing culture
specific practices in order to promote health and wellness or deal with death and or
illness.
 Culture Care diversity and universality
 Differences in meanings, values or care of different groups of people
 common care or similarities among culture
Concept Definitions

9.  Nursing- learned profession with a disciplined focus on care
phenomenon
 Worldview- personal view of meaning of life
 Health- state of well-being that is culturally defined and valued
 Emic- refers to an insider’s views of knowledge of the culture
 Etic- the outsider’s viewpoints of the culture and reflects more on the
professional angles of nursing
 Generic care- learned or passed down indigenous, traditional, or folk
knowledge and practices provided to improve well-being or help with
illness, death or other human conditions,
 Professional care-formal, cognitive knowledge and practices generally
learned through educational instititutions.
 Early nurse theorists focused on the four metaparadigms of person,
environment, health and nursing. Dr. Leininger found these concepts
limited, inappropriate, and inadequate to fully explain nursing and was
greatly concerned with the fact that care and culture were not included
in these metaparadigms.
Concept Definitions

10. {

11. {
Culture Care Preservation and Maintenance
Culture Care Accomodation/Negotiation
Culture Care Repatterning and Restructuring

12. {
States with laws mandating
culture competence in healthcare

13.  Despite advances in science, technology and pharmaceuticals, there
remain great healthcare disparities amongst culturally diverse
populations.
 Estimated 33% of U.S. population made up of cultural minorities.
 Research has shown that provider-patient communication is linked to
satisfaction, ADHERANCE to medical instructions, and health
outcomes
 Culture competence improves outcomes and quality of care while
reducing health care disparities
 Changes in healthcare laws have changed the traditional “fee for
service”, to reimbursement based on outcomes and quality.
 Comprehensive, holistic and culturally sensitive care develops trust
Application to Nursing

14.  Many cultures studied in depth over last 50 years using
Leininger’s theory.
 More Research needed to determine how culturally competent
care affects outcomes and disparities. Need for empirical data.
 National Institute of Health (NIH) and Agency for Healthcare
Research and Quality (AHRQ) and other groups have increased
funding for cultural education and research
 New areas of research importance
 Lesbian, Gay, Bisexual and Transgender- huge disparities in
healthcare and unique healthcare needs that go unaddressed
 Adolescent culture- Active listening, use of peers
 Refugee- influx of refugees, many with PTSD as rape and torture
common war tactic
Research

15. “have you decided on a
birth control method for
after the baby is born”

16. Doctor refused to treat daughter of lesbian
couple, while unethical- it is NOT illegal!

17.  Research indicates nursing faculty not adequately prepared to teach
culture care or mentor in cultural sensitivity
 Need for broad holistic approaches and teaching strategies to
promote student education and application to their nursing practice
 Researchers agree transcultural nursing should be integrated
throughout curriculum.
 Transcultural education limited and varied between institutions..
 2002 Laison Committee on Medical Education required culture
competence integration into curriculum for accredidation of medical
schools. As of yet, not required of nursing programs.
 Need for unified conceptual teaching framework
 Immersion programs had best training outcomes
Education

18.  Affordable Care Act- move from fee for service to reimbursement
based on outcomes.
 Hospitals and healthcare systems and practices can no longer survive
without improving quality and outcomes which has necessitated
addressing healthcare disparities amongst diverse groups and cultures
 Private insurers such as Aetna, Blue Cross Blue Shield and Kaiser have
developed initiatives toward culture competence in recognition of its
relationship to improved quality and outcomes and decreased
disparities
 Federal government developed Health Disparities Coalition focused
on addressing health disparities in community health clinics
 Accrediting agencies such as the Joint Commission on Accredidation
of Healthcare Organizations (JCAHO) exploring opportunities to track
disparities and cultural competence
Administration