untitled

the phrase nursing interventionbecause this term
often implies to clients from different cultures that
the nurse is imposing his or her (etic) views, which
may not be helpful. Instead, the term nursing ac-
tions and decisionsis used, but always with the
clients helping to arrive at whatever actions or de-
cisions are planned and implemented. The modes
fit with the clients’ or peoples’ lifeways and yet are
therapeutic and satisfying for them. The nurse can
draw upon scientific nursing, medical, and other
knowledge with each mode.
Data collected from the upper and lower parts of
the sunrise enabler provide culture care knowledge
for nurse researchers to discover and establish use-
ful ways to provide quality care practices. Active
participatory involvement with clients is essential
to arrive at culturally congruent care with one or all
of the three action modes in order to meet clients’
care needs in their particular environmental con-
texts. The use of these modes in nursing care is
one of the most creative and rewarding features of
transcultural and general nursing practice with
clients of diverse cultures.
It is most important (and a shift in nursing) to
carefully focus on the holistic dimensions, as de-
picted in the sunrise enabler, to arrive at therapeu-
tic culture care practices. All the factors in the
sunrise enabler (which include worldview and
technological, religious, kinship, political-legal,
economic, and educational factors, as well as cul-
tural values and lifeways, environmental context,
language, ethnohistory, and generic (folk) and pro-
fessional care practices) must be considered to ar-
rive at culturally congruent care (Leininger, 2002).
Care generated from the culture care theory will
only become safe, congruent, meaningful, and ben-
eficial to clients when the nurse in clinical practice
becomes fully aware of and explicitly uses knowl-
edge generated from the theory and ethnonursing
method whether in a community, home, or institu-
tional context. The culture care theory, along with
the ethnonursing method, are powerful means for
new directions and practices in nursing. Incorpo-
rating culture specific care into client care is essen-
tial to practice professional care and to be licensed
as registered nurses. Culture specific care is the safe
means to ensure culturally based holistic care to fit
the client’s culture—a major challenge for nurses
who practice and provide services in all health-care
settings.

THE USE OF CULTURE

CARE RESEARCH FINDINGS

Over the past five decades, Dr. Leininger and other

research colleagues have used the culture care the-

ory and the ethnonursing method to focus on the

care meanings and experiences of 100 cultures

(Leininger, 2002); they discovered 187 care con-

structs in Western and non-Western cultures

(Leininger, 1998), as reported in the Journal of

Transcultural Nursing(1989 to 1999). Leininger has

listed the 11 most dominant constructs of care in

priority ranking, with the most universal or fre-

quently discovered first: respect for/about, concern

for/about; attention to (details)/in anticipation of;

helping-assisting or facilitative acts; active helping;

presence (being physically there); understanding

(beliefs, values, lifeways, and environmental); con-

nectedness; protection (gender related); touching;

and comfort measures (McFarland, 2002). These

care constructs are the most critical and important

universal or common findings to consider in nurs-

ing practice, but care diversities must also be con-

sidered. Although many of these dominant care

constructs may be found in certain cultures, diver-

sities will also be found. The ways in which culture

care is applied and used in specific cultures will re-

flect both similarities and differences among (and

sometimes within) different cultures. Next, three

ethnonursing studies will be reviewed with focus

on the findings, which have implications for nurs-

ing practice.

CULTURE CARE OF LEBANESE

MUSLIMS IN THE UNITED STATES

In the late 1980s, Luna (1989), conducted an ethno-

nursing study of the culture care of Arab Muslim

cultural groups in a large urban community in the

Midwestern United States. In 1989, she published

the findings relevant to the culture care of Lebanese

Muslim Americans using Leininger’s three modes

of nursing decisions and actions to provide cultur-

ally congruent and responsible care. The study fo-

cused on the care for Lebanese Muslims in the

hospital, clinic, and home-community contexts.

She stated: “[An] understanding [of] the cultural

context in which Lebanese Muslims attempt to

adapt, survive, and practice their faith in America

necessitates a look into the community into which

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