untitled

nursing. Findings from the theory could be the
knowledge to care for people of different cultures.
The idea of providing care was largely taken for
granted or assumed to be understood by nurses,
clients, and the public (Leininger, 1981, 1984). Yet
the meaning of “care” from the perspective of dif-
ferent cultures was unknown to nurses and not in
the literature prior to establishing the nursing the-
ory in the early 1960s. Care knowledge had to be
discovered with cultures.
Prior to her work, there were no theories explic-
itly focused on care and culture in nursing environ-
ments, let alone research studies to explicate care
meanings and phenomena in nursing (Leininger,
1981, 1988, 1990a, 1991, 1995). Theoretical and
practice meanings of care in relation to specific cul-
tures had not been studied, especially from a com-
parative cultural perspective. Leininger saw the
urgent need to develop a whole new body of cul-
turally based care knowledge to support transcul-
tural nursing care. Shifting nurses’ thinking and
attitudes from medical symptoms, diseases, and
treatments to that of knowing cultures and caring
values and patterns was a major task. But nursing
needed an appropriate theory to discover care, and
she held that her theory could open many new
knowledge doorways.

RATIONALE FOR TRANSCULTURAL
NURSING: SIGNS AND NEED

The rationale and need for change in nursing in
America and elsewhere (Leininger, 1970, 1978,
1984, 1989a, 1990a, 1995) was as follows:

1. There were increased numbers of global migra-
   tions of people from virtually every place in the
   world due to modern electronics, transporta-
   tion, and communication. These people
   needed sensitive and appropriate care.


2. There were signs of cultural stresses and cul-
   tural conflicts as nurses tried to care for
   strangers from many Western and non-
   Western cultures.


3. There were cultural indications of consumer
   fears and resistance to health personnel as they
   used new technologies and treatment modes
   that did not fit their values and lifeways.


4. There were signs that some clients from differ-
   ent cultures were angry, frustrated, and misun-
   derstood by health personnel due to cultural

ignorance of the clients’ beliefs, values, and ex-

pectations.

5. There were signs of misdiagnosis and mistreat-
   ment of clients from unknown cultures be-
   cause they did not understatnd the culture of
   the client.


6. There were signs that nurses, physicians, and
   other professional health personnel were be-
   coming quite frustrated in caring for cultural
   strangers. Culture care factors of clients were
   largely misunderstood or neglected.


7. There were signs that consumers of different
   cultures, whether in the home, hospital, or
   clinic, were being treated in ways that did not
   satisfy them and this influenced their recovery.


8. There were many signs of intercultural con-
   flicts and cultural pain among staff that led to
   tensions.


9. There were very few health personnel of differ-
   ent cultures caring for clients.


10. Nurses were beginning to work in foreign
    countries in the military or as missionaries,
    and they were having great difficulty under-
    standing and providing appropriate caring for
    clients of diverse cultures. They complained
    that they did not understand the peoples’
    needs, values, and lifeways.

For these reasons and many others, it was clearly

evident in the 1960s that people of different cul-

tures were not receiving care that was congruent

with their cultural beliefs and values (Leininger,

1978, 1995). Nurses and other health professionals

urgently needed transcultural knowledge and

skills to work efficiently with people of diverse

cultures.

While anthropologists were clearly experts

about cultures, many did not know what to do with

patients, nor were they interested in nurses’ work,

in nursing as a profession, or in the study of human

care phenomena in the early 1950s. Most anthro-

pologists in those early days were far more inter-

ested in medical diseases, archaeological findings,

and in physical and psychological problems of cul-

ture. So, Leininger took a leadership role in the new

field she called transcultural nursing. She needed to

develop educational programs to provide culturally

safe and congruent care practices that could be

beneficial to cultures, to teach nurses about cul-

tures, and to fit the knowledge in with care prac-

tices. She initiated a number of transcultural

312 SECTION III Nursing Theory in Nursing Practice, Education, Research, and Administration