Leininger Transcultural Nursing Theory

Introduction
Cultural competency is currently taken for granted in nursing theory and practice. However, cultural competency was not always normative. Madeline Leininger was the first nursing theorist, practitioner, and scholar to distinguish transcultural nursing as a unique means of providing top quality of care. The underlying principle of transcultural nursing, also known as ethnonursing, is applying anthropological and sociological principles to nursing practice. Contemporary nursing practice is culturally competent at its core primarily because the principles of Leininger’s nursing theory have become fully incorporated into education and professional practice.
Leininger: Describing the Theorist
Born in Nebraska, USA, Leininger recognized the importance of caring as a fundamental principle of the profession of nursing (“Madeline Leininger’s Culture Care,” n.d.). Leininger received several collegiate degrees, the first of which was a nursing diploma in 1950 from St. Anthony’s School of Nursing in Denver, during which time she worked in a children’s home and realized the importance of shifting away from the colonial and xenophobic approach towards one based on cultural competency (Busher Betancourt, 2015).
Her initial nurse education was followed by a Bachelor’s of Science from St. Scholastica (Benedictine College) in Kansas in 1954, followed by a Master’s in psychiatric and mental health nursing from Catholic University of America in Washington, D.C. in 1965, finally receiving the PhD in cultural and social anthropology from t he University of Washington in Seattle in 1965 (“Madeline Leininger’s Culture Care,” n.d.). Leininger was the first to put forth the concept of transcultural nursing: the concept of adapting nursing practices to be more culturally relevant.
Classification
Nursing theories are classified from levels of generality or abstraction, in what the theory is attempting to encompass. Metatheories are the most abstract, followed by grand nursing theories, middle range theories, and finally, practice theories that have daily relevance in the day-to-day operations of healthcare workers (McEwen & Wills, 2014). A metatheory is a paradigm, or a “theory about a theory,” (McEwen & Wills, 2014, p. 37). A grand theory is not as comprehensive in scope as a metatheory but is similarly as unspecific. Middle range theories become more specific and have specific relevance for nursing practice, administration, and public policy. Finally, practice theories are situation specific (McEwen & Wills, 2014). The practice theories are those that nurses work with each and every day. Transcultural nursing theory is a grand theory but one that has application to middle range and practice applications in healthcare.
Assumptions and Metaparadigms
The most fundamental assumption of Leininger’s (1988) transcultural nursing theory is that culture is a ‘missing link in nursing knowledge and practice,” as well as being a “wholistic concept” that is fully relevant to evidence-based nursing (Leininger, 1988, p. 152). One of the ways that transcultural nursing theory is fully integrated into nursing practice as a metaparadigm is related to the concepts of health, wellness, illness, and healing. Culture impacts the ways individual people think about what constitutes health, wellness, and illness. Likewise, culture impacts ne’s attitudes towards healthcare, interventions, treatments, and the role of doctors, nurses, and other healthcare workers. As Leininger (1994) herself points out in her extensive writings, transcultural nursing reveals the nuances of emic and etic knowledge, which are in turn linked to “quality of life, health, and well-being,” (p. 22). Etic knowledge is that which is developed by outsiders, or those who may be academic or professional in their approach (Leininger, 1999). Emic knowledge, on the other hand, refers to localized knowledge. Both emic and etic knowledge combine to inform transcultural nursing practice.
Major Concepts of the Theory
The major concepts of transcultural nursing theory are linked to sociology and anthropology. Health and healthcare are concepts that cannot be separated from culture. Culture determines attitudes towards health, wellness, illness, healing, and care. As such, it is impossible to provide healthcare without taking culture or cultural context into consideration. As important as cultural sensitivity is to nursing, equally as important is the concept of care itself. Transcultural nursing is based on both cultural competency and also on caring competency.
Major Propositions of the Theory
Transcultural nursing theory proposes that patients need to be treated in a culturally competent way. Each patient’s treatment plan needs to take into account their culture and family background. Moreover, the treatment plan needs to be finely honed and crafted according to their needs, which take into account cultural norms of communication and worldview. To promote patient health, the nurse cannot ignore culture, which includes religious beliefs, values, communication styles, identity, and other elements that are linked to culture.
How the Theory Has Been Used
Transcultural nursing theory has been used extensively in healthcare, to the point where it is practically taken for granted. Especially in multicultural societies, it is assumed that nurses are expected to have some degree of cultural competency. No nurse can be xenophobic and get away with their narrow minded attitudes for long, because from the moment one enters nursing school, it is assumed that cultural competency is integral to effective nursing care and practice.
In practice, transcultural nursing makes its way into every level of nursing from broad-based healthcare policies and administrative policies and programs, to individual nursing care practices. Nurse leaders use transcultural nursing theory by finding ways to overcome communications barriers, even more important than simply attempting to find translators that can overcome linguistic barriers. Culture informs attitudes and worldviews linked to health. This means that nurses need to recognize patient preferences for folk remedies and superstitious approaches to health while at the same time informing patients and their families about what they need to achieve desired health goals.
Action Plan: Theory Into Practice
Integrating theory into practice at my institution means implementing the theory at every level of administration and leadership. Nurses need to be fully trained in transcultural nursing and culture competency. This means that nurses need to be willing to ask questions and remain open-minded, communicating effectively with patients and their families. Also, transcultural nursing theory is put into practice by good nurse leadership that instructs all nursing staff as to how to address cultural barriers.
Examples
One example of how to implement transcultural nursing theory is that when patients present resistance to specific treatment interventions, the nurse learns more about why, and comes up with creative strategies and solutions that promote health and wellbeing according to the patient’s needs.
Conclusion
If transcultural nursing theory were guiding all nursing practice in my institution, patient’s needs would be heard and acknowledged. Evidence-bgased practice does not need to conflict with culturally competent care. Leininger understands the importance of cultural context in determining attitudes towards health, wellness, healing, illness, and wellbeing. If care is the fundamental basis of nursing, then transcultural nursing becomes crucial for top quality care.




References

Busher Betancourt, D.A. (2015). Madeline Leininger and the transcultural theory of nursing. The Downtown Review 2(1): : http://engagedscholarship.csuohio.edu/tdr/vol2/iss1/1
Leininger, M.M. (1988). Leininger's Theory of Nursing: Cultural Care Diversity and Universality. Nursing Science Quarterly 1(4): 152-160.
Leininger, M. (1994). Quality of life from a transcultural nursing perspective. Nursing Science Quarterly 7(1): 22-28.
Leininger, M. (1999). What is transcultural nursing and culturally competent care? Journal of Transcultural Nursing 10(1): 9.
“Madeline Leininger’s Culture Care,” (n.d.). http://nursing.jbpub.com/sitzman/ch15pdf.pdf
McEwen, M. & Wills, E. M. (2014). Theoretical Basis for Nusing. 4th Edition. Philadelphia: Wolters Kluwer.
Wayne, G. (2014). Madeline Leininger’s transcultural nursing theory. Nuselabs. https://nurseslabs.com/madeleine-leininger-transcultural-nursing-theory/