Leininger's sunrise model of transcultural nursing

Madeleine Leininger Transcultural Nursing Theory Model

Group 1:

Lovely Denis

Marie Andree Colas

Mary Auman

Patricia Philippe

Wendy Filias

Presentation Outline

Background

Place of birth, education, expertise, published works

Madeleine Leininger’ transcultural theory

Four Metaparadigms

Health

Environment

Nursing

Person

All concepts of theory

Concept #1

Concept #2

Theoretical Assumption

Conceptual Framework: Leininger’s Sunrise Model

Critique of theory, model with strengths and weakness

Theory implication for Nursing practice, education, research;

Implication on Nursing Education (with supportive article)

Implication on Nursing Practice

Implication on Nursing Research

Conclusion

References

Madeleine Leininger Background

Leininger was born in Sutton Nebraska on July 13, 1925

1948: Nursing diploma from St. Anthony’s Hospital of Nursing in. Was also a member of the U.S. Army Nurse Corps.

1950: Obtained her undergraduate education, bachelor’s degree in biological science at Benedictine College and Creighton University.

1954: Master of science in nursing from Catholic University of America in 1954. (Ray , 2012)

Madeleine Leininger Background cont.

1955: Leininger:

Developed the discipline of Transcultural nursing theory

Introduced the broader concept of transcultural healthcare

Incorporated anthropology into the discipline of nursing

1960: One of the first nurse leaders to use qualitative research methods

1966: Leininger returned to school at the University of Washington in and was awarded a PhD in anthropology.

Died in Omaha, Nebraska on August 10, 2012

Principal Works

1966: Leininger offered the first transcultural course at the University of Colorado

1968: Initiated the Committee of Nursing and Anthropology with the American Anthropology Association

1969: Dean and Professor of Nursing, and Lecturer in Anthropology at the University of Washington , Seattle

1974: Dean and Professor of Nursing and Adjunct Professor of Anthropology at the University of Utah, Salt Lake City

1981: Professor of Nursing, Adjunct Professor of Anthropology, Director of Transcultural Nursing at Wayne State University, Detroit (Kte’Pi, 2016)

Published Works

1960: Basic Psychiatric Concepts in Nursing; published in 11 languages

1970: Nursing and Anthropology: Two Worlds to blend

1978: Transcultural Nursing: Concepts, Theories and Practices

1981: Caring: An essential Human need

1989: Journal of Transcultural Nursing

1990: Ethical and Moral Dimension of Care

1991: Culture Care Diversity and Universality: A theory of Nursing

(Ray, 2012)

Awards and Honors

Board of Regent’s Distinguished Faculty Award

Distinguished Research Award

President’s Excellence in Teaching and Outstanding Graduate Faculty Mentor Award.

1995: Rusell Sage Outstanding Leadership Award

1998: "Living Legend“ Award by the Fellows of the American Academy of Nursing.

Distinguished fellow for her achievements by the Royal College of Nursing in Australia

(Leininger, 2008)

Four Metaparadigms

Transcultural Nursing. Transcultural nursing refers to a formal area of humanistic and scientific knowledge and practices focused on holistic culture care (caring) phenomena and competencies to assist individuals or groups to maintain or regain their health or well-being and to deal with disabilities, dying, or other human conditions in culturally congruent and beneficial ways (McFarland, 2014 ). Leininger (2007) describes nursing as a means to know and help cultures.

Health. Health refers to a state of well-being or a restorative state that is culturally constituted, defined, valued, and practiced by individuals or groups and that enables them to function in their daily lives (McFarland, 2014 ).

Four metaparadigms

Environmental. Environmental context refers to the totality of an environment – physical, geographic, and sociocultural – situation, or event with related experiences that give interpretative meanings to guide human expressions and decisions with reference to a particular environment or situation (McFarland, 2014)

Person. Leininger did not have a specific definition for person but according to here every human has generic care knowledge and practices, even professional care knowledge and practices, which vary transculturally and individually. The concept of human care and caring refer to a phenomena with expressions of assistive, supportive, enabling, and facilitating ways to help self or others in order to improve health, a human condition, or lifeways, or to facilitate disabilities or dying (McFarland, 2014)

Two Specific Concepts

Concept #1

Culture. Leininger defined culture as the learned, shared and transmitted values, beliefs, norms and lifeways of a particular culture that guide thinking, decisions, and actions in patterned ways. Leininger 2006, (as cited by McFarland, M. & Wehbe-Alamah, H. B., 2015). According to Leininger, culture can be viewed as the blueprint for guiding human actions and decision and includes features of any group or individual. McFarland & Wehbe (2015), from an anthropological perspective, culture is the most comprehensive way, to know, explain and predict people’s lifeways over time and in different geographic areas.

Two Specific Concepts

Concept #2

Worldview. Worldview refers to the way people trend to look out upon their world or their universe to form a picture or value about life or the world around them. (Leininger 2006, as cited by McFarland & Wehbe, 2015). Worldview provides a perspective of one’s orientation to life, people or groups that influence care or caring responses and decisions. According to McFarland and Wehbe, (2015) worldview guide person’s decision and actions, regarding his health and wellbeing.

Conceptual Framework Sunrise Model

The sunrise model is a conceptual picture that portrays the components of Leininger’s transcultural nursing theory. It studies how the components influence the care and health status of individuals and families. The transcultural theory has diverse components such as social factors, cultural values and beliefs, folk and professional health systems. It helps the researcher examine how these components interact with each other in a gestaltic or whole perspective (Leininger, 1988).

The structure of cultural care theory is represented by the sunrise model. It describes the relationship between anthropological and nursing beliefs. The sunrise model connects the concepts of the theory with clinical practices. The three concepts that are utilized by the sunrise model are: cultural care maintenance/preservation, cultural care negotiation/accommodation, and cultural care restructuring/re-patterning (Albougami, 2016).

Conceptual Framework Sunrise Model

Cultural preservation is when nurses provide support to patients for their cultural practices. Some examples include acupuncture for anxiety and pain relief for medical interventions. Cultural negotiation is supporting the patient and family members to carry out cultural activities that cannot harm the patient’s health or other members in the healthcare setting. Cultural restructuring is done when certain cultural practices may cause harm to the patient or others in their environment (Albougami, 2016).

Theoretical Assumptions

Care is essential for human growth, well-being, and survival and to face death or disabilities (Leininger, 1988, p.155)

There are diverse and universal forms, expressions, patterns, and processes of human care that exist transculturally (p.155)

Care is the essence of nursing and the distinct, dominant and unifying feature of nursing (p.155)

Culture care is the broadest means to know, explain, account for and predict nursing care phenomena and to guide nursing care practices (p.55)

Knowledge of meanings and practices derived from world views, social structure factors, cultural values, environmental context, and language uses are essential to guide nursing decisions and actions in providing culturally congruent care (p. 155)

Theoretical Assumptions Cont.

Care is essential to curing; however, there can be no curing without caring, but there can be caring without curing Environmental context refers to the totality of an event, situation or particular experience that gives meaning to human expressions, including social interactions and physical, ecological, emotional and cultural dimensions (p. 156)

Folk health (well-being) system refers to traditional or local indigenous health care or cure practices that have special meanings and use to heal or assist people, which are generally offered in familiar home or community environmental contexts with their local practitioners (p.156)

Strengths of the Transcultural theory

The Transcultural Theory concentrates on the philosophy impression in the providing care to patients and helping the nurses to be ethnically subtle. Therefore, nurses should be mindful on diverse cultures which require them to respond to patient needs for adequate nursing care (Rivera, 2018)

Relationships and concepts are at the abstraction level making it applicable in various situations. Thus, the concept is made to be highly generalizable (Rivera, 2018)

Leininger’s highlighting of care as the nursing core when compared to other approaches which focused on health, environment, nursing and people is considered to be a significant strength.

(Rivera, 2018)

Weaknesses of the Transcultural theory

The concept might be the main source of error during clinical choices like the misunderstanding of results and values placed by individuals. The patient’s uniqueness must be considered for aid in data taking (Rivera, 2018).

Problems may arise when integrating or adapting the different can cause cultural shock to the nurse. Consequently, the approach does not give any attention to the symptoms, diseases as well as treatment. (Rivera, 2018)

Implication for Nursing practice

Uses 3 Modes combined with the Nursing Process in the Culture Care Diversity and Universality Theory

Preservation and/or maintenance (maintain desirable cultural values and helpful beliefs)

Accommodation and/or negotiation (helpful in adapting transactions for care that is fitting in the culture)

Repatterning and/or restructuring (mutual decision making process as nurse modifies the nursing action to achieve better health outcomes (Sagar, 2012)

Implication for Nursing Education

Preservation and/or maintenance: respect cultural beliefs that encourage formal education

Accommodation and/or negotiation: use interpreter and translator

Repatterning and/or restructuring : assist student leaders in reviewing standard guidelines and help leaders develop own cultural nursing philosophy (Sagar, 2012).

Implication for Nursing Research

Ethnonursing Process provides qualitative research

Enabler’s are used for their participatory process and friendliness in research. The researcher moves from stranger through friend in this process.

Stranger – Friend Enable;

Observation-Participation-Reflection Enabler)

4 Phases of Ethnonursing Analysis

Collect, describe, & document raw data

Identify & Categorize descriptors for coding data, compare similarities & differences

Check for pattern & context ideas

Synthesize, interpret, & analyze for major themes and recommendations

(Sagar, 2012).

Reference

Albougami, A. S. (2016). Comparison of Four Cultural Competence Models in Transcultural Nursing: A Discussion Paper. International Archives of Nursing and Health Care,2(4). doi:10.23937/2469-5823/1510053

Broch, D., Crossetti, M., & Riquinho, D.L. (2017). Reflections on violence against women in the perspective of madeleine leininger. Journal of Nursing,11(12). 5079 – 5084. doi: 10.5205/1981-8963-v11i12a22588p5079-5084-2017

Bunting, M. (2016). Transcultural nursing strategies for carers of people with dementia. Nursing Older People, 28(3), 21-25. Retrieved from https://www.thecampuscommon.com/library/ezproxy/ticketdemocs.asp?sch=suo&turl=https://search-ebscohost-com.southuniversity.libproxy.edmc.edu/login.aspx?direct=true&db=c9h&AN=114135370&site=eds-live

Kte’pi, B. M. (2016). Madeleine Leininger. Salem Press Biographical Encyclopedia. Retrieved from https://www.thecampuscommon.com/library/ezproxy/ticketdemocs.asp?sch=suo&turl=hthtt://search-ebscohost-com.southuniversity.libproxy.edmc.edu/login.aspx?direct=true&db=ers&AN=113931063&site=eds-live

Leininger M. (2007). Theoretical questions and concerns: response from the theory of culture care diversity and universality perspective. Nursing Science Quarterly, 20(1), 9–13. Retrieved from https://www.thecampuscommon.com/library/ezproxy/ticketdemocs.asp?sch=suo&turl=http://search.ebscohost.com.southuniversity.libproxy.edmc.edu/login.aspx?direct=true&db=rzh&AN=106246570&site=eds-live

Reference cont

Leininger M. (2007). Theoretical questions and concerns: response from the theory of culture care diversity and universality perspective. Nursing Science Quarterly, 20(1), 9–13. Retrieved from https://www.thecampuscommon.com/library/ezproxy/ticketdemocs.asp?sch=suo&turl=http://search.ebscohost.com.southuniversity.libproxy.edmc.edu/login.aspx?direct=true&db=rzh&AN=106246570&site=eds-live

Leininger, M. (1988). Leininger's theory of nursing: Cultural care diversity and universality. Nursing Science Quarterly, (4), 152-160. Retrieved from https://www.thecampuscommon.com/library/ezproxy/ticketdemocs.asp?sch=suo&turl=https://search-ebscohost-com.southuniversity.libproxy.edmc.edu/login.aspx?direct=true&db=edsovi&AN=edsovi.00006236.198811000.00007&site=eds-live

Leininger, M. (2008). Overview of Leininger’s Theory of Culture Care Diversity and Universality. Retrieved from https://southuniversity-libguides-com.southuniversity.libproxy.edmc.edu/c.php?g=24294&p=6082594 http://www.madeleine-leininger.com/cc/overview.pdf

Maier-Lorentz, M. M. (2008). Transcultural nursing: Its importance in nursing practice. Journal of Cultural Diversity, 15(1), 37-43. Retrieved from https://www.thecampuscommon.com/library/ezproxy/ticketdemocs.asp?sch=suo&turl=https://search-ebscohost-com.southuniversity.libproxy.edmc.edu/login.aspx?direct=true&db=rzh&AN=105650439&site=eds-live

Reference cont

McFarland, M (2014). Culture Care Theory of Diversity and Universality. pp. 417-441 in Alligood, M. (2014). Nursing Theorists and their work. Eight edition. Elsevier Mosby. https://pdc-evs-ebscohost-com.southuniversity.libproxy.edmc.edu/EBscoViewerService/ebook?stsoken=AzJ

McFarland, M. R., & Wehbe-Alamah, H. B. (2015). Leininger’s Culture Care Diversity and Universality (Vol. Third edition). Burlington, MA: Jones & Bartlett Learning. Retrieved from https://www.thecampuscommon.com/library/ezproxy/ticketdemocs.asp?sch=suo&turl=https://search-ebscohost-com.southuniversity.libproxy.edmc.edu/login.aspx?direct=true&db=nlebk&AN=666051&site=eds-live

Mechanick, J. I., et al. (2012). Diabetes-specific nutrition algorithm: a transcultural program to optimize diabetes and prediabetes care. Current Diabetes Reports, 12(2), 180-194.

Pergert, P., Ekblad, S., Enskär, K., & Björk, O. (2008). Bridging obstacles to transcultural caring relationships—Tools discovered through interviews with staff in pediatric oncology care. European Journal of Oncology Nursing, 12(1), 35–43.

Ray, M. A. (2012). Remembering Madeleine M Leininger, PhD, LHD, DS, RN, CTN, FAAN, FRCNA. International Journal for Human Caring, 16(4), 6–8. Retrieved from https://www.thecampuscommon.com/library/ezproxy/ticketdemocs.asp?sch=suo&turl=http://search.ebscohost.com.southuniversity.libproxy.edmc.edu/login.aspx?direct=true&db=psyh&AN=2013-02410-001&site=eds-live

Sagar, PL. (2012). 1 Madeleine leininger’s theory of culture care diversity and universality. In A. Graubard & D. Bigelow (Eds.), Transcultural nursing theory and models: Application in nursing education, practice, and administration (pp8-14). New York, NY: Springer Publishing Company