Topic 1 – Introduction on Historical and
Foundations of Transcultural Nursing
Madeleine Leininger
 Born on July 13, 1925, and died in
August 10, 2012.
 She was an internationally known
educator, author, theorist, administrator,
researcher, consultant, and public
speaker.
 The developer of the concept of
transcultural nursing that has a great
impact on how to deal with patients of
different cultures and cultural
backgrounds.
 She is a Certified Transcultural Nurse,
a Fellow of the Royal College of
Nursing in Australia, and a Fellow of the
American Academy of Nursing.
 Her theory is now a nursing discipline
that is an integral part of how nurses
practice in the healthcare field today.
Nature, Definition, Importance, and
Rationale of Transcultural Nursing
TRANSCULTURAL NURSING
(NATURE)
 In her classic, groundbreaking book
titled “Nursing and Anthropology:
Two Worlds to Blend,” Leininger
(1970) analyzed the ways in which the
fields of anthropology and nursing are
interwoven and interconnected.
QUESTION: RELEVANCE OF
ANTHROPOLOGY IN NURSING?
 Leininger used the term transcultural
nursing (TCN) to describe the blending
of nursing and anthropology into an
area of specialization within the
discipline of nursing.
 Using the concepts of culture and care,
Leininger established TCN as a theory
and evidence-based formal area of study
and practice within nursing that focuses
on people’s culturally based beliefs,
attitudes, values, behaviors, and
practices related to health, illness,
healing, and human caring.
CULTURE AND ANTHROPOLOGY
 Anthropology: an academic discipline
that is concerned with the scientific
study of humans, past and present.
 Anthropology builds on knowledge from
the physical, biological, and social
sciences as well as the humanities.
 A central concern of anthropologists is
the application of knowledge to the
solution of human problems.
 Historically, anthropologists have
focused their education on one of four
areas:
o Sociocultural anthropology
o Biological/physical anthropology
o Archaeology
o Linguistics.
 Culture: one of the central concepts that
anthropologists study is culture. A
complicated, multifaceted concept,
culture has numerous definitions.
TRANSCULTURAL NURSING
(DEFINITION)
 Transcultural nursing is a humanistic and
scientific area of nursing study and
practice that focuses on how patterns of
behavior in health, illness, and caring
are influenced by the values and beliefs
of specific cultural groups. It applies this
knowledge in the planning and provision
of culturally appropriate care.
 TCN is sometimes used interchangeably
with cross-cultural, intercultural, and
multicultural nursing.
 The goal of TCN is to develop a
scientific and humanistic body of
knowledge in order to provide culture-
specific and culture-universal nursing
care practices for individuals, families,
groups, communities, and institutions of
similar and diverse cultures.
CULTURE-SPECIFIC VS CULTURE-
UNIVERSAL
 Culture-specific: refers to particular
values, beliefs, and patterns of behavior
that tend to be special or unique to a
group and that do not tend to be shared
with members of other cultures.
 Culture-universal: refers to the
commonly shared values, norms of
behavior, and life patterns that are
similarly held among cultures about
human behavior and lifestyles.
 Example: Although the need for food is
a “cultural universal”, there are
culture-specifics that determine what
items are:
o Considered to be edible;
o Acceptable methods used to prepare
and eat meals;
o Rules concerning who eats with
whom, the frequency of meals, and
gender- and age-related rules
governing who eats first and last at
meals time; and,
o The amount of food that individuals
are expected to consume.
TRANSCULTURAL NURSING
(IMPORTANCE)
 Leininger’s Theory of Culture Care
Diversity and Universality describes,
explains, and predicts nursing
similarities and differences in care and
caring in human cultures.
 Leininger cites eight factors that
influenced her to establish TCN as a
framework for addressing 20th-century
societal and health care challenges and
issues, all of which remain relevant
today:
1. A marked increase in the migration
of people within and between
countries worldwide.
2. A rise in multicultural identities, with
people expecting their cultural
beliefs, values, and ways of life to be
understood and respected by nurses
and other health care providers.
3. An increase in health care providers’
and patients’ use of technologies that
connect people globally and
simultaneously may become the
source of conflict with the cultural
values, beliefs, and practices of some
of the people receiving care.
4. Global cultural conflicts, clashes, and
violence that impact health care as
more cultures interact with one
another.
5. An increase in the number of people
traveling and working in different
parts of the world.
6. An increase in legal actions resulting
from cultural conflict, negligence,
ignorance, and the imposition of
health care practices.
7. A rise in awareness of gender issues,
with growing demands on health care
systems to meet the gender and age
specific needs of men, women, and
children.
 8. An increased demand for community
and culturally based health care
services in diverse environmental
contexts
LEININGER’S CONTRIBUTIONS TO
TRANSCULTURAL NURSING
 Providing Culturally Congruent
Nursing Care.
 Culturally congruent nursing care:
“refers to those cognitively based
assistive, supportive, facilitative, or
enabling acts or decisions that are mostly
tailor made to fit with an individual’s,
group’s or institution’s cultural values,
beliefs, and lifeways in order to provide
meaningful, beneficial, satisfying care
that leads to health and well-being.”
SCOPE, RATIONALE, AND FACTORS
INFLUENCING TRANSCULTURAL
NURSING
 Figure 1: Leininger’s Sunrise Enabler
to discover culture care.
TRANSCULTURAL NURSING
(RATIONALE)
 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: 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.
 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.
 Emigrate: to leave one country or
region to settle in another.
 Immigrate: to enter another country or
region for the purpose of living there.
 In simpler terms, 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 – patients travel to other
countries for medical and surgical health
care needs.
 Technological advances in science,
engineering, transportation,
communication, information and
computer sciences, health care, and
health professions education result in
increased electronic and face-to-face
communications between nurses and
people from diverse backgrounds.
 Population demographics, health care
standards, laws, and regulations make
cultural competence integral to nursing
practice, education, research,
administration, and interprofessional
collaborations.
 History
 Mid-1950s: The foundations of
transcultural nursing were laid.
 1950: Peplau first mentioned that
cultures were an important variable
affecting mental health.
 1960s:
o The growing interest in Leininger’s
transcultural nursing model has
begun with population changes and
migration.
o Leininger tried to promote
transcultural nursing movements
Much more attention was paid to the
care of individuals from different
cultures.
o Since then, nurses have been carrying
out studies aimed at providing
particularly cultural care to people
from all communities/cultures
 1962: King stated that
psychopathological behaviors differ
from culture to culture.
 1969: The International Council of
Nursing (ICN) began using cultural
content in nursing.
 1974: Transcultural Nursing Society
(TCNS) was established 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 and management.
 1989: The “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.
 Present:
o Today, there are about 25 books and
over 800 articles covering research,
theory and applications related to
transcultural nursing.
o This is a promising field of study
with which Turkish nurses have
recently started to be familiar. Now
that globalization is inevitable,
studies on transcultural care practices
will broaden the horizons of Turkish
nurses and others all around the
world.
o 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 , Juntunen , Leuning ,
Swiggum et al., Purnell, Ryan,
Carlton and Ali.
o Among these, there are researchers
arguing that the models and theories
of two modelists (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.
Standards
 Guidelines for the practice of Culturally
Competent Nursing Care:

Definitions and Categories
of Cultural Competencies
 There is a general consensus that cultural
competence can be divided into two
major categories:
o Individual cultural competence –
refers to the care provided for an
individual client by one or more
nurses, physicians, social workers,
and/or other health care, education,
or social services professionals.
o Organizational cultural
competence – focuses on the
collective competencies of the
members of an organization and
their effectiveness in meeting the
diverse needs of their clients,
patients, staff, and community.
Communication
 Effective communication is the
following:
o Begins with an assessment of the
client’s ability to read, write, speak,
and comprehend messages.
o In contemporary society, it
sometimes requires literacy in the
use of computers, smartphones, and
numerous technology-assisted
medical or health devices.
o Includes the ability to convey
sincere interest in others, patience,
and willingness to intervene or begin
again when misunderstandings occur.
 To provide affordable, accessible, safe,
quality, efficacious, culturally congruent,
and culturally competent nursing and
health care, members of the
interprofessional health care team must
communicate effectively.
 Communication occurs verbally,
nonverbally, in writing, and in
combination with technology.
 Communication should be appropriate
for the client’s age, gender, health status,
health literacy, and related factors.
 When nurses communicate with others
from cultural and linguistic backgrounds
different from their own, the
 probability of miscommunication  Although humans have common culture-
increases significantly. universal needs, they also have culture-
 In promoting effective cross-cultural specific needs that are interconnected
communication with clients from diverse with their health-related values,
backgrounds, nurses SHOULD AVOID attitudes, beliefs, and practices.
technical jargon, slang, colloquial  In times of health and illness, humans
expressions, abbreviations, and seek the therapeutic (beneficial)
excessive use of medical terminology. assistance of various types of healers
to promote health and well-being,
Self-Awareness
prevent disease, and recover from illness
or injury.
 Humans are complex biological,  Humans seek therapeutic interventions
cultural, psychosocial, and spiritual from family and significant others;
beings who experience health and credentialed or licensed health care
illness along a continuum throughout providers; folk, traditional, indigenous,
the span of their lives from birth to religious, and/or spiritual healers; and
death. companion or therapy animals and pets
 All humans have the right to safe, as they perceive appropriate for their
accessible, and affordable nursing and condition, situation, or problem.
health care, regardless of national  Interventions are judged to have a
origin, race, ethnicity, gender, age, therapeutic effect when they result in a
socioeconomic background, religion, desirable and beneficial outcome,
sexual orientation, size, and related whether the outcome was expected,
characteristics. unexpected, or even an unintended
 Whether rich or poor; educated or consequence of the intervention.
illiterate; religious or nonbelieving; male
or female; black, white, yellow, red, or
brown, each person deserves to be
respected by nurses and other health
members of the health care team.
 As people from different racial, ethnic,
and cultural backgrounds travel and
comingle with those having backgrounds
that differ from their own, the likelihood
of intermarriage and offspring of
mixed racial and ethnic heritage
increases.
 Regardless of their national origin or
current citizenship, humans around the
world share culture-universal needs
for food, shelter, safety, and love; seek
well-being and health; and endeavor to
avoid, alleviate, or eliminate the pain
and suffering associated with disease,
illness, dying, and death.