Madeleine Leininger Interview Part 1

Summary

Dr. Madeleine Leininger's visit to Home Care of Rochester in 2008 highlighted her pioneering work in transcultural nursing. She emphasized the importance of understanding diverse cultures to provide culturally congruent care, a concept she found lacking in existing theories. Leininger's ethnonursing research method, a qualitative approach, aimed to unlock cultural insights and ensure patient protection. Today, transcultural care is federally mandated, and nine states require physicians to demonstrate knowledge in this field, reflecting a significant transformation in healthcare practices.

Takeaways

• 📚 Dr. Madeleine Leininger pioneered the discipline of transcultural nursing, which began in the late 1950s and is the only single discipline created by nursing.
• 🌐 Transcultural nursing is important for addressing the critical deficit in understanding and caring for people of diverse cultures, emphasizing the need to know about their culture and what care means to them.
• 🔍 Dr. Leininger found existing theories inadequate for addressing cultural aspects of care, leading to the development of new theories and approaches that consider culture and care holistically.
• 🌟 The goal of transcultural nursing is to provide culturally congruent care, which is care that fits or is sensitive to the culture of the individual receiving care.
• 📈 There has been a significant transformation in the approach to patient care, with a shift towards a more holistic understanding that includes cultural considerations.
• 🏥 Culturally congruent care is now a federal mandate, and in some states, physicians cannot become licensed without demonstrating knowledge and practice of transcultural human care.
• 🔑 Trust is identified as a universal and dominant care construct in transcultural nursing, essential for establishing a relationship where patients feel comfortable sharing their experiences and concerns.
• 🤝 Trust is established through gestures, mannerisms, and open communication, allowing patients to reveal their 'inner secrets' and feel understood by their caregivers.
• 🌍 Dr. Leininger's ethnonursing research method was developed to address the lack of a qualitative methodology that could unlock cultural insights and ensure the protection of participants' voices.
• 💡 The significance of transcultural nursing is highlighted by its ability to provide meaningful, sensitive, and useful care that patients are likely to adopt or respond to positively.
• 🛑 Cultural misunderstandings in healthcare settings can lead to negative outcomes, such as fear and avoidance of certain medical procedures, which transcultural nursing aims to prevent.

Q & A

Who is Dr. Madeleine Leininger and what did she contribute to the field of nursing?

Dr. Madeleine Leininger is a pioneer in the field of transcultural nursing. She established the discipline of transcultural care theory and research, which is the only single discipline created by nursing, focusing on the cultural aspects of patient care.

What is the significance of transcultural nursing in healthcare?

Transcultural nursing is significant because it addresses the critical need to understand and respect the diverse cultures of patients worldwide. It helps in providing care that is sensitive and meaningful to different cultural backgrounds, leading to better patient outcomes.

Why was it important for Dr. Leininger to develop a new understanding and approach to patient care?

Dr. Leininger found that existing theories were not sensitive or open to discovering cultural aspects of care. She developed a new approach to provide a holistic understanding of patient care that integrates cultural considerations.

What is the goal of transcultural nursing theory?

The goal of transcultural nursing theory is to provide culturally congruent care, which means care that fits or is sensitive to the patient's cultural background.

What is the significance of the year 1959 in the context of transcultural nursing?

In 1959, Dr. Leininger set the goal of transcultural nursing to provide culturally congruent care, marking the beginning of a formal approach to integrating cultural understanding into nursing practice.

How has the importance of transcultural nursing evolved over time?

Over time, the importance of transcultural nursing has grown significantly. It is now a federal mandate in the United States, and there are nine states where physicians cannot become licensed without demonstrating knowledge and practice of transcultural care.

What is the Ethno Nursing Research Method developed by Dr. Leininger?

The Ethno Nursing Research Method is a qualitative research approach developed by Dr. Leininger to unlock and understand the cultural perspectives of patients, ensuring their voices are heard and respected in the healthcare setting.

Why was there a need for a new methodology in transcultural nursing research?

There was a need for a new methodology because existing quantitative methods focused on numbers and did not adequately capture the quality of life or cultural nuances that are essential in understanding patient care.

What is the role of trust in transcultural nursing?

Trust is a universal and dominant care construct in transcultural nursing. It is essential for establishing a rapport with patients, allowing them to share their experiences and cultural perspectives, which is crucial for providing culturally congruent care.

Can you provide an example of how trust is built in transcultural nursing?

An example of building trust in transcultural nursing is when patients begin to share personal and sensitive information, indicating that they feel secure and respected in their cultural identity within the healthcare setting.

How does cultural understanding impact the use of medical technology in patient care?

Cultural understanding is crucial in the use of medical technology as it can help healthcare providers navigate cultural fears or taboos associated with certain procedures. For example, the use of a sonogram in Japan was initially met with fear due to cultural beliefs, which required a transcultural approach to address and alleviate.

Outlines

00:00

🌟 Transcultural Nursing Discipline Establishment

Dr. Madeleine Leininger's visit to Home Care of Rochester in 2008 is highlighted, where she shared her theories and research on transcultural nursing. The discipline, which began in the late 1950s, is the only one created by nursing and focuses on caring for people of diverse cultures with an understanding of their cultural needs. The importance of this discipline is underscored by the critical need to address the deficit in cultural care, which was initially overwhelming due to the lack of existing theories that were sensitive to cultural nuances. Leininger's work led to the development of a new understanding and approach to patient care, aiming to provide culturally congruent care. This approach has had dramatic outcomes, opening doors to cultural understanding and the provision of care that is sensitive to cultural differences. The discipline's goal is to ensure that care is meaningful, sensitive, and useful to the culture it serves, with Leininger's ethnonursing research method being a significant development in the field, emphasizing qualitative aspects of care over quantitative measures.

05:00

🌱 Cultural Congruence in Healthcare: A Federal Mandate

This paragraph discusses the evolution and significance of culturally congruent care, which has become a federal mandate in the United States. It highlights the transformation in healthcare over the past 20 years, emphasizing the importance of understanding and practicing transcultural human care. The paragraph notes that in nine states, physicians cannot be licensed without demonstrating knowledge and practice of transcultural care. The concept of care is defined as an enabling process that facilitates, assists, and guides individuals, linking the care provided with their cultural context. Trust is identified as a universal care construct, essential for effective healthcare interactions. The paragraph provides examples of cultural misunderstandings in healthcare settings, such as the fear of technology in Japanese culture and the discomfort of Middle Eastern women with male medical staff during intimate procedures. It illustrates the importance of transcultural nursing in overcoming these barriers and ensuring that care is culturally sensitive and effective.

10:03

🛡️ Overcoming Cultural Barriers in Medical Settings

The third paragraph of the script delves into specific examples of cultural barriers encountered in medical settings and how they can be overcome with the help of transcultural nursing. It recounts an incident in Japan where the use of sonography was feared due to cultural beliefs, and another in Detroit, Michigan, involving Middle Eastern women who were uncomfortable with the bright lights and male medical staff during a gynecological examination. The narrative demonstrates the importance of cultural sensitivity and the role of a transcultural nurse in mediating these situations, ensuring that patients feel safe and understood. The paragraph emphasizes the need for healthcare providers to be aware of and respect cultural differences to provide effective and compassionate care.

Keywords

💡Transcultural Nursing Theories

Transcultural Nursing Theories refer to a set of principles and practices that aim to understand and address the cultural differences in patient care. In the video, Dr. Madeleine Leininger emphasizes the importance of these theories in providing culturally congruent care, which is care that is sensitive and appropriate to a patient's cultural background. The theories are foundational to the discipline of transcultural nursing, which is a formal area of study and practice that began in the late 1950s.

💡Cultural Deficit

The term 'cultural deficit' in the context of the video highlights the lack of knowledge and understanding of diverse cultures in the healthcare system. Dr. Leininger points out that it was a critical issue to address because healthcare providers needed to know about patients' cultures to provide effective care. The concept is central to the development of transcultural nursing theories, which aim to bridge this gap.

💡Ethno Nursing Research Method

The Ethno Nursing Research Method is a qualitative research approach developed by Dr. Leininger to study cultural aspects of nursing and health care. It allows for an in-depth exploration of patients' experiences and cultural practices related to health and illness. In the video, Dr. Leininger mentions this method as a crucial development in the field, as it provided a way to 'unlock' cultural insights and ensure that patients' voices were heard and respected.

💡Culturally Congruent Care

Culturally Congruent Care is a goal of transcultural nursing, which seeks to provide care that is meaningful, sensitive, and appropriate to the cultural needs and preferences of the patient. In the video, Dr. Leininger discusses this as the ultimate aim of her theories, emphasizing that such care leads to better patient outcomes and satisfaction. It is now a federal mandate, indicating its significance in modern healthcare.

💡Discipline of Transcultural Nursing

The 'Discipline of Transcultural Nursing' is a formal academic and professional field that Dr. Leininger established. It is unique as the only single discipline created by nursing. The discipline focuses on understanding cultural differences in health care and developing practices that respect and incorporate these differences. The video script underscores its importance in shaping the way nurses approach patient care.

💡Holistic Concept

A 'holistic concept' in the context of the video refers to an approach that considers the whole person, including their physical, emotional, social, and cultural aspects. Dr. Leininger mentions that the theories she developed provide a new understanding and approach to patient care that is holistic, integrating cultural considerations into the care provided.

💡Federal Mandate

The 'Federal Mandate' mentioned in the video refers to a law or regulation at the national level that requires certain standards to be met. In this case, it mandates that culturally congruent care must be provided in healthcare settings. This shows the recognition and enforcement of the importance of cultural competence in patient care.

💡Trust

Trust is identified as a universal care construct in transcultural nursing. It is essential for establishing a therapeutic relationship where patients feel safe to share their concerns and experiences. In the video, Dr. Leininger gives examples of how trust can be a barrier or facilitator in patient care, such as the reluctance of Japanese women to use sonograms due to fear and the importance of trust in sharing personal health information.

💡Qualitative Methodology

Qualitative Methodology in the video refers to a research approach that focuses on understanding the quality of life and experiences of individuals. Dr. Leininger contrasts this with quantitative methodologies that rely on numbers and statistics. She developed the Ethno Nursing Research Method as a qualitative approach to capture the richness of cultural experiences in healthcare.

💡Cultural Sensitivity

Cultural Sensitivity is the ability to understand and respect cultural differences, which is crucial in providing effective healthcare. In the video, Dr. Leininger discusses how her theories and the discipline of transcultural nursing promote cultural sensitivity, leading to better patient outcomes and more appropriate care.

💡Care Constructs

Care Constructs in the video refer to the fundamental concepts or elements that underpin the provision of care. Dr. Leininger mentions 'trust' as a dominant care construct that is universal across cultures. Understanding these constructs is vital for nurses to provide care that is in harmony with the patient's cultural beliefs and values.

Highlights

Dr. Madeleine Leininger's visit to Home Care of Rochester in 2008 to share her transcultural nursing theories.

Transcultural nursing as a discipline created by nursing, formalized in the late 1950s.

The critical need for understanding diverse cultures in patient care.

The absence of existing theories that were sensitive to cultural aspects of care.

The development of a new holistic approach to patient care integrating culture and care.

The introduction of the goal to provide culturally congruent care.

The significance of cultural congruence in care and its impact on patient outcomes.

The development of the ethnonursing research method by Dr. Leininger.

The qualitative approach to methodologies in contrast to the prevailing quantitative focus.

The importance of trust as a universal care construct in transcultural nursing.

Cultural nuances affecting trust, such as political safety and misinterpretation concerns.

The role of trust in sharing personal and sensitive health information.

Cultural differences in the perception of medical technology, such as sonograms in Japan.

The impact of cultural taboos on patient care, illustrated by the example of中东 women in Detroit.

The importance of culturally sensitive healthcare providers in patient care.

The transformation in healthcare practices towards providing culturally congruent care, now a federal mandate.

The requirement for physicians to demonstrate transcultural human care knowledge for licensing in nine U.S. states.

The definition of caring as an enabling process that facilitates and assists individuals in relation to their culture.

Transcripts

in 2008 dr. Madeleine Leininger visited

home care of Rochester to share her

transcultural nursing theories

discipline of transcultural care theory

and research

and as you and others know I've been

working in this field to establish the

discipline now it is a discipline it is

the only single discipline created by

Nursing and it is called the discipline

of transcultural that means that it is a

formal area of study and practice and

that started in the late 1950s why is it

important because first of all it was a

critical deficit why in the world did we

think we could care for people of

diverse cultures of the world and not

know something about what is their

culture and what does care mean to the

culture and so those were very important

research and theoretical questions that

had to be addressed to me it first was

overwhelming because I couldn't there

were no theories that truly addressed

and work on ruled or even sensitive to

cultures and after studying it nearly 5

to 10 years different theories and even

going into the disciplines to say what

their theories were I came to the

conclusion that the theories that

existed would not really open the doors

to discover culture or to discover care

or to put care and culture together as a

holistic concept so what is really

happened is the importance it is a

complete kind of new understanding it is

a new approach to patient care it is a

not only most holistic approach of the

totality of the whole human being but it

also is providing some dramatic and I

mean dramatic

outcomes because the outcomes are really

opening the door to these cultures to

say aha you are interested in our

culture you are interested in what care

means and you're willing to provide

services that are going to be which is

the goal of the theory to provide

culturally congruent care or care that

fits or is sensitive to the culture well

I think there's a lot of many many

different examples but in the process of

studying using the theory and using my

ethno nursing research method because

that was the second problem there was no

theory to get into and there was no

methodology that would enable the people

to what I call unlock or tell what they

wanted to and to be sure that they were

protected and that what they said was

important to listen to and so the Epling

method was developed and that was very

very important but it was a difficult

thing because our methodologies were all

quantitative to the hilt numbers were

the only damn thing that counted and my

methodology was a qualitative that we

looked at what is the quality of life

what is it that these people are

responding to or what is it they want to

tell about something of the quality of

care

the significance of transcultural

nursing today

the game and the whole thing is to

provide which is the goal of the theory

to provide culturally congruent care or

care that fits the culture because the

importance is that if you theoretically

provide that it provides that it's

meaningful sensitive and is useful

they'll adopt it or go restate respond

to it or if you have to negotiate with

them they'll do it though so that's the

big goal now today in case you don't

know that started in 1959 when I said

the goal of transcultural nursing was to

provide culturally congruent care just

two years ago it is now a federal

mandate that culturally congruent care

must occur and now today in case you're

not aware and for nurses to know there

are now nine states where no physician

can become licensed unless they have

knowledge and can practice and

demonstrate transcultural human care is

that remarkable now that didn't exist

even 20 years ago likewise it didn't

exist for nursing for nearly 50 years so

there's been a great transformation in

the way you approach the way you work

with and the way you assist or help

people and caring as I have defined it

is an enabling in enabling process by

which you facilitate by which you assist

by which you guide by which you help

someone to link what you're trying to

help them with with their culture

CAIR constructs in transcultural nursing

and one load alma care constructs that

has been along with us is that that care

is doing we're nursing was a doing

culture do-do-do-do-do-do and that you

don't really care for people unless you

do something for them be it whatever it

might be her but there was more to that

that what we phone even with the

anglo-americans

that doing had to have something linked

with it and that doing was related to

the first dominant care construct they

became a universal and that was the

concept of trust if I didn't trust

somebody there's no way that I'm going

to begin to share with you what's going

on so that highest and the most

universal construct was trust so amid

American anglo-american would not really

share of us they saw signs that you

trusted them and they trusted you as a

reciprocal thing now that's a pretty

tall order and how do we know that well

we know it sometimes by their gestures

by their mannerisms sometimes they're

even candid and Frank enough to say I

don't know if I should really share with

you this and they'll tell what the

problem is why they're afraid to so the

trust may be linked to many things it

may be linked to the whole concept of

politically what is safe to say what

might I not say and what can I say

so there's a feeling ground when you

begin to work with people as how do you

know trust how do you know when trust is

established and one of the most

significant things is when the client or

the person or the recipient on two

begins to tell some of what I call the

in her secrets I shouldn't really tell

you this but I want you to know that in

the past I didn't trust white doctors

white nurses what blah blah blah

because they were afraid of the concept

of gossip or being misinterpreted of

what they were saying and this was

especially keen with sometimes the

Hispanics with a mexican-american were a

lot of distrust and misrepresentation

and misinformation got construed

disturbed so that it wasn't truthful so

Trust is really began to build on are

you getting to my truth and do you

understand the truth as I'm telling you

and that's a very important thing you

have to look for all kinds of indicators

of how it holds together well this is an

example of trust and when I went to

Japan the women when I was interviewing

them because I was curious as you know

with my sunrise in a blur one of the

dimensions we need to look at is how

they trust technology and what I found

in talking with the women when they went

into the delivery is that so often they

wheeled in the big machine and they were

going to do a sonogram they went to find

out exactly

boy or girl you know that the American

culture on knowing oil girl but to the

Japanese people this was very

frightening and I said what is it here

oh this machine could kill our baby we

don't want this technology we don't want

to use that now immediately if there was

a transcultural nurse she would

intercede in that it was the same way

when I was this was in Detroit Michigan

and it was on the ob/gyn and we had a

lot they Middle East

women who were there and the incredible

thing was they would put the bright

lights on the vagina the bright lights

on everything that was a sexual taboo

and what it did it just froze that

Iranian woman she wouldn't she wouldn't

respond at all second thing that frozen

was not only the technology of the

lights that all of those but there was a

male physician and a male nurse down

there by the vagina they wouldn't speak

they wouldn't say anything so one of my

first move was to say let us think about

what would happen if you dr. so-and-so

might go next door and have a cup of

coffee secondly we have a wonderful

nurse here and she was a trans culture

she will stay right here with you and

with your mother or sister because they

were the support and we did that and the

woman dilated and delivered the baby

within a short time now that was almost

magical well