Madeline Leininger's Transcultural Nursing

Madeline Leininger is considered the precursor of transcultural nursing (Hood, 2014). As Sitzman & Eichelberger (2011) explained, Leininger defined transcultural nursing as “a substantive area of study and practice focused on comparative cultural care values, beliefs, and practices of individuals or groups of similar or different cultures with the goal of providing culture-specific and universal nursing care practices in promoting health or well-being or to help people to face unfavorable human conditions, illness, or death in culturally meaningful ways” (p. 94). Leininger introduced new definitions in nursing care that explained the tenets of her theory. Among these definitions, cultural preservation or maintenance and cultural accommodation or negotiations were key concepts to understanding Leininger’s transcultural nursing approach.

Leininger describes cultural care preservation or maintenance as “nursing care activities that help people of particular cultures to retain and use core cultural care values related to healthcare concerns or conditions” (Sitzman & Eichelberger, 2011, p.

95). Culturally congruent nursing care can be provided by incorporating patient’s cultural practices into their plan of care. Many cultures believe that the power of prayer, hot and cold remedies, and spiritual/religious rituals can positively affect health outcomes for the patients. Families that have strong ties with their ethnocultural background may feel disrespected and ignored if nursing care does not take into consideration their cultural beliefs and practices. An example of cultural care preservation or maintenance is allowing a patient to carry a rosary (beaded prayer artifact) with them before and after a surgical procedure. Allowing the patient to express their cultural beliefs enables true

self-expression.
Cultural care accommodation or negotiation, as defined by Leininger’s, refers to the “creative nursing actions that help people of a particular culture adapt to or negotiate with others in the healthcare community in an effort to attain the shared goal of an optimal health outcome for client(s) of a designated culture” (Sitzman & Eichelberger, 2011, p. 95). The nurse can provide cultural congruent care by negotiating the inclusion or exclusion of selective cultural practices to the patient’s plan of care. A compromise between the patient/family and the nurse can be obtained by accommodating specific cultural practices that have been established to promote patient’s well-being while surrendering practices and behaviors that can be detrimental to the patient’s progression towards rehabilitation and recuperation. For example, families could be allowed to bring their healers to the hospital setting (accommodation) to provide supportive cultural care. This intervention allows the nurse to include cultural practices such as pray and spiritual rituals that the patient/family consider an important component of the patient’s healing process. In addition, the nurse can negotiate quid pro quo terms with the patient by asking for increased adherence to the medical/nursing plan of care in collaboration with the patient’s healer.
The first step towards culturally congruent patient care is the nurse’s self-awareness towards their own cultural values and beliefs (Hood, 2014). Nurses who are capable of acknowledging their own cultural background, practices, and views are more inclined to remain receptive of their patient’s own cultural perceptions and needs. Therefore, more likely to provide transcultural care that implements cultural preservation/maintenance and cultural accommodation/negotiation. While cultural preservation or maintenance encourages the patient to remain true to his/her cultural beliefs and/or practices, cultural accommodation or negotiation encourages adherence to a universal nursing care and standard nursing interventions and requires patient’s flexibility and open-mindness to convert to the dominant’s culture healthcare practices.