they migrate” (Luna, 1994, p. 15). Luna’s research
findings and the nursing practice implications re-
lated to the home and community context in the
late 1980s remain important as health care shifts
from hospital care services to home or community
settings. Luna discovered that attending a clinic in a
Midwestern United States urban context was often
a new and different approach to health care for
Lebanese Muslim women, especially during preg-
nancy and childbirth. Luna’s study revealed that
many women relied on the traditional midwife in
Lebanon for home deliveries. The routine of
monthly and weekly visits to the prenatal clinic was
incongruent with what these clients had experi-
enced in their home country. In the United States,
prenatal care in the clinic context involved long
waiting periods with the husband missing work to
take his wife to each appointment. Examination by
a male physician was culturally incongruent for the
women, so culture care negotiation and repatterning
was essential for culturally congruent care. Luna
described the clinic as culturally decontextualized
for clients and their families because the prenatal
care and the environmental clinic context in which
the care was provided were not congruent with the
clients’ cultural values, beliefs, and practices (Luna,
1989). Luna discovered some dominant and uni-
versal care constructs for Lebanese Muslim men,
which included surveillance, protection, and main-
tenance of the family. For Lebanese women, the
dominant and universal care constructs included
emphasizing the positive attributes of educating
the children and maintaining a family caring envi-
ronment according to the precepts of Islam. A
number of generic or folk care practices were dis-
covered relating to these care constructs that
should be recognized, preserved, and maintained
by nurses to enhance the health and well-being of
clients. For instance, the female network in the
Lebanese Muslim culture is very important at the
time of birth; Lebanese women come together to
care for one another and offer practical and emo-
tional assistance for new immigrants who are
struggling to survive in a new cultural context such
as the United States. By recognizing the benefits of
this network and by allowing women flexibility in
their visiting and presence in the hospital and clinic
contexts, the nurse would use culture care preser-
vation to maintain these generic care practices for
the health and well-being of clients.
Luna found that female modesty was an impor-
tant cultural care value for Lebanese women; this
was reflected in requests by female clients to have
only female nurses, physicians, and other care-
givers. Culture care accommodation of this generic
care practice was accomplished by nurses negotiat-
ing for these women to have female caregivers
whenever possible, which would promote health,
well-being, and client satisfaction with care. By in-
cluding Lebanese Muslim men in health teaching
and discharge planning, Luna discovered a way to
use culture care preservation that recognized the
family as a unit, rather than focusing on the indi-
vidual. Luna recognized that the patriarchal organ-
ization of the family should be preserved as a social
structure feature, which acknowledges males for
their roles in family care continuity rather than
being narrowly interpreted as males always being in
control. Negative stereotypes held by nurses about
the Arab males’ reluctance to participate in the
birth process were also discovered, often presenting
a barrier to giving nursing care. To counter this,
Luna suggested the nurses use culture care preser-
vation to maintain and support the generic culture
care practices of men, which included surveillance,
protection, and maintenance of the family.
Still another finding from Luna’s study was the
discovery of the importance of religious rituals to
many Muslim clients as an essential component of
providing care within their cultural context (Luna,
1989, 1994). Luna found that some Muslims pray
three to five times a day, and others do not pray at
all. During the culturalogical assessment (in the
hospital context), Luna suggested the nurse should
ask about the client’s wishes regarding prayer.
Culture care accommodation could be practiced by
negotiating for an agreeable time and a private
place for clients to pray, which for many Muslims is
an important cultural expression for their health
and well-being. She also suggested that nurses prac-
tice culture care accommodation for clients by ne-
gotiating with a social service organization that
served Arab clients in order to gather written and
video materials in the Arabic language related to
health for use in the hospital and clinic settings.
Luna (1989) identified approaches for culture care
repatterning to improve attendance at the prenatal
clinic for Lebanese Muslim women. Nurses should
avoid direct confrontation and spend considerable
time during the first clinic visit to educate womenCHAPTER 20 Application of Leininger’s Theory of Culture Care Diversity and Universality 329