Trancu Notes

Three modes of nursing care decisions and actions
Cultural care preservation or Maintenance

Cultural care preservation is also known as maintenance. It includes those assistive, supporting,
facilitative, or enabling professional actions and decisions that help people of a particular culture
to retain and/or preserve relevant care values so that they can maintain their well-being, recover
from illness, or face handicaps and/or death.
Cultural care accommodation or Negotiation

Cultural care accommodation, also known as negotiation, includes those assistive, supportive,
facilitative, or enabling creative professional actions and decisions that help people of a
designated culture to adapt to or negotiate with others for a beneficial or satisfying health
outcome with professional care providers.
Culture care repatterning or Restructuring

Culture care repatterning or restructuring includes those assistive, supporting, facilitative, or enabling
professional actions and decisions that help clients reorder, change, or greatly modify their
lifeways for new, different, and beneficial health care pattern while respecting the clients’ cultural
values and beliefs and still providing a beneficial or healthier lifeway than before the changes
were established with the clients. (Leininger, 1991)
Conclusion
According to transcultural nursing, nursing care aims to provide care congruent with cultural values,
beliefs, and practices.
Cultural knowledge plays a vital role for nurses on how to deal with the patients. To start, it helps nurses
to be aware of how the patient’s culture and faith system provide resources for their experiences with
illness, suffering, and even death. It helps nurses understand and respect the diversity that is often present
in a nurse’s patient load. It also helps strengthen a nurse’s commitment to nursing based on nurse-patient
relationships and emphasizing the whole person rather than viewing the patient as simply a set of
symptoms or illness. Finally, using cultural knowledge to treat a patient also helps a nurse be open-
minded to treatments that can be considered non-traditional, such as spiritually based therapies like
meditation and anointing.
Nowadays, nurses must be sensitive to their patients’ cultural backgrounds when creating a nursing plan.
This is especially important since so many people’s culture is so integral in who they are as individuals,
and it is that culture that can greatly affect their health and their reactions to treatments and care. With
these, awareness of the differences allows the nurse to design culture-specific nursing interventions.
Through Leininger’s theory, nurses can observe how a patient’s cultural background is related to their
health and use that knowledge to create a nursing plan that will help the patient get healthy quickly while
still being sensitive to his or her cultural background.
Transcultural Nursing
Transcultural nursing is defined as a learned subfield or branch of nursing that focuses upon the
comparative study and analysis of cultures concerning nursing and health-illness caring practices, beliefs,
and values to provide meaningful and efficacious nursing care services to their cultural values and health-
illness context.
Cultural Congruent (Nursing) Care
Cultural congruent (nursing) care is defined as those cognitively based assistive, supportive, facilitative,
or enabling acts or decisions that are tailor-made to fit with the individual, group, or institutional, cultural
values, beliefs, and lifeways to provide or support meaningful, beneficial, and satisfying health care, or
well-being services.
APPLICATION TO NURSING
To develop understanding, respect and appreciation for the individuality and diversity of patients beliefs,
values, spirituality and culture regarding illness, its meaning, cause, treatment, and outcome.
To encourage in developing and maintaining a program of physical, emotional and spiritual self-care
introduce therapies such as ayurveda and pancha karma.
 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.
 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.
 Through her observations, while working as a nurse, Madeleine Leininger identified a lack of
cultural and care knowledge as the missing component to a nurse’s understanding of the many
variations required inpatient care to support compliance, healing, and wellness, which led her to
develop the theory of Transcultural Nursing also known as Culture Care Theory.
 This theory attempts to provide culturally congruent nursing care through “cognitively based
assistive, supportive, facilitative, or enabling acts or decisions that are mostly tailor-made to fit
with the individual, group’s, or institution’s cultural values, beliefs, and lifeways.”
 Leininger’s theory’s main focus is for nursing care to fit with or have beneficial meaning and
health outcomes for people of different or similar cultural backgrounds. With these, she has
developed the Sunrise Model in a logical order to demonstrate the interrelationships of the
concepts in her theory of Culture Care Diversity and Universality.
 While working in a child guidance home during the 1950s, Madeleine Leininger experienced
what she described as a cultural shock when she realized that children’s recurrent behavioral
patterns appeared to have a cultural basis. She identified a lack of cultural and care knowledge as
the missing link to 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 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.
 For example, although the need for food is a culture- universal, there are culture-specifics that
determine what items are considered to be edible; acceptable methods used to prepare and eat
meals; rules concerning who eats with whom, the frequency of meals, and gender- and age-
related rules governing who eats first and last at meal time; and the amount of food that
individuals are expected to consume.
 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.
 The earliest recorded definition comes from a 19th century British pioneer in the field of
anthropology named Edward Tylor, who defines culture as the complex whole that includes
knowledge, beliefs, art, morals, law, customs, and any other capabilities and habits acquired by
members of a society (Tylor, 1871).
 Leininger defines culture as the “learned, shared, and transmitted values, beliefs, norms, and
lifeways of a particular group of people that guide thinking, decisions, and actions in a patterned
way…
 Culture is the blueprint that provides the broadest and most comprehensive means to know,
explain, and predict people’s lifeways over time and in different geographic locations”
(McFarland & Wehbe-Alamah, 2015a, p. 10).
 Culture influences a person’s definition of health and illness, including when it is appropriate to
self-treat and when the illness is sufficiently serious to seek assistance from one or more healers
outside of the immediate family.
 The choice of healer and length of time a person is allowed to recover, after the birth of a baby or
following the onset of an illness, are culturally determined. How a person behaves during an
illness and the help rendered by others in facilitating healing also are culturally determined.
 Culture determines who is permitted, or expected, to care for someone who is ill. Similarly,
culture determines when a person is declared well and when they are healthy enough to resume
activities of daily living and/or return to work. When someone is dying, culture often determines
where, how, and with whom the person will spend his or her final hours, days, or weeks
 In a classic study of culture by the anthropologist Edward Hall (1984), three levels of culture are
identified: primary, secondary, and tertiary.
 The primary level of culture refers to the implicit rules known and followed by members of the
group, but seldom stated or made explicit, to outsiders.
 The secondary level refers to underlying rules and assumptions that are known to members of the
group but rarely shared with outsiders. The primary and secondary levels are the most deeply
rooted and most difficult to change. The tertiary level refers to the explicit or public face that is
visible to outsiders, including dress, rituals, cuisine, and festivals.
 The term subculture refers to groups that have values and norms that are distinct from those held
by the majority within a wider society. Members of subcultures have their own unique shared set
of customs, attitudes, and values, often accompanied by group-specific language, jargon, and/or
slang that sets them apart from others.
 A subculture can be organized around a common activity, occupation, age, ethnic background,
race, religion, or any other unifying social condition.
 Spanish language and culture (Morris, 2015).
 Ethnicity is defined as the perception of oneself and a sense of belonging to a particular ethnic
group or groups. It can also mean feeling that one does not belong to any group because of
multiethnicity. It includes commitment to and involvement in cultural customs and rituals.

I’ve read that Madeleine Leinenger was appointed to a Child Guidance Home wherein andun yung mga
batang may behavioral problems and there she experienced the so called “culture shock”. She realized
that the children’s behavioral patterns is affiliated to their cultural background. And from that she found
out what is lacking sa nursing care that time, which is yung cultural awareness ng isang nurse. That is
why as a nurse we should be culturally aware or to have enough knowledge about different culture for us
to provide a culturally congruent care. And base on that experience, Leinenger then formulated the theory
of Transcultural Nursing.

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Three modes of nursing care decisions and actions

Cultural care preservation or Maintenance

Cultural care accommodation or Negotiation

Culture care repatterning or Restructuring

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