Madeleine Leininger

Nursing theorist and professor

• Born: July 13, 1925
• Birthplace: Sutton, Nebraska
• Died: August 10, 2012
• Place of death: Omaha, Nebraska

Education: St. Anthony’s Hospital of Nursing; Benedictine College; Creighton University; Catholic University of America; University of Washington

Significance: Beginning in 1955, Madeleine Leininger developed the discipline of transcultural nursing theory and in so doing helped to introduce the broader concept of transcultural health care. She incorporated anthropology’s understanding of culture into the discipline of nursing.

Background

Leininger was raised on a farm in Sutton, Nebraska, by her parents George and Irene, and developed an interest in nursing due to an aunt who suffered from a congenital heart problem. Graduating high school during World War II, she entered the Cadet Nurse Corps, a federal program to train nurses to meet the needs of the war, and was awarded a nursing diploma from St. Anthony’s Hospital of Nursing in 1948. The war ended shortly after and she continued her undergraduate education at Benedictine College and Creighton University before earning a master of science in nursing from Catholic University of America in 1954.

Leininger was the first to write about what was later termed transcultural nursing. At the time she was working as a mental health specialist with children from diverse cultural backgrounds, and became concerned that her mental health training had come with a "one size fits all" assumption with respect to culture that, when she put it into practice, she did not find effective. Furthermore, she observed that those working around her took no interest in the cultural differences of the patients, and made no allowances for any effect those difference might have on the best treatment practices or caring processes.

In the postwar years, psychoanalysis gained significant traction in health care and was no longer considered of relevance only to abnormal psychology. The age of mainstream therapy was beginning. This helped provide Leininger with the methodological tools and language she needed to grapple with the problem she saw before her, and was sufficient for her to articulate the broad strokes of what became transcultural nursing, in a series of articles on psychiatric nursing published beginning in 1955.

Development of Transcultural Nursing

Leininger returned to school at the University of Washington in order to better ground her work in cultural and social anthropology, in which she was awarded a PhD in 1966. Later that same year, she taught the first class in transcultural nursing at the University of Colorado. In subsequent years, she was awarded three honorary doctoral degrees and helped found the Transcultural Nursing Society (TCNS), the first professional organization for the new discipline. The TCNS later named its annual award for excellence in the discipline after her. She founded the Journal of Transcultural Nursing in 1989 and served as its editor until 1995. She served as dean of the nursing school at both the University of Washington and the University of Utah, and was professor emeritus at Wayne State University in Detroit as well as an adjunct professor at the University of Nebraska Medical Center.

Leininger conceived of culture care theory as a theory of nursing that put care at the center of the activity of nursing, and necessitated a study of culture and care in order to understand that providing care means different things to patients of different cultures. Early modern medicine was essentially paternalistic: medical professionals held the expertise and made the medical decisions, sometimes with little in the way of real consultation with the patient. Cultural differences compounded this. While the doctrine of informed consent, which developed in medical ethics in the mid- to late twentieth century, states that patients should understand the medical or therapeutic choices facing them as well as possible and should be involved in the decision-making process, cultural differences pose a potential barrier that a translator’s ability alone cannot overcome. The patient and the health care professional may not possess the same frame of reference, worldview, and set of fundamental assumptions relevant to the patient’s condition and potential treatments.

Leininger’s work called for reconceptualizing care from this perspective. She published her first book, Nursing and Anthropology: Two Worlds to Blend (1970), with the aim of introducing nurses to the anthropological concepts most relevant to nursing work. The number of military nurses deployed to Southeast Asia during the Vietnam War, as well as the many mission nurses who had served in various countries, helped to drive interest in the intersection of culture and nursing. However, many of the other nurses publishing articles on their experiences had a limited theoretical framework to work with; Leininger had been the first professional nurse granted an anthropology PhD, and remained the only one for several years. It was clear to Leininger that teaching anthropology to nurses was not enough; transcultural nursing needed to be its own integrated discipline. The first true transcultural nursing textbook followed in 1978, incorporating more than two decades of her theoretical work and the field research of herself and others.

In 1998, the Fellows of the American Academy of Nursing awarded Leininger the title of "Living Legend." That same year, the Royal College of Nursing in Australia designated her a distinguished fellow for her achievements. She continued to refine her theories and publish articles through the last years of her life.

Impact

Leininger transformed the way health care is approached, and did so as a nurse in an era when the medical profession still resisted treating nursing seriously as a discipline grounded in research and evidence rather than a mere occupation. She reconceptualized nursing with new dimensions of care in mind.

Personal Life

Leininger had two sisters, Eulalia Leininger Hansen and Frances Leininger Ambrose, and two brothers, Paul and Bernard.

Principal Works

• Nursing and Anthropology: Two Worlds to Blend (1970)
• Transcultural Nursing: Concepts, Theories, and Practices (1978)
• Caring: An Essential Human Need (1981)
• Ethical and Moral Dimensions of Care (1990)
• Culture Care Diversity and Universality: A Theory of Nursing (1991)

Bibliography

Andrews, Margaret, and Joyceen Boyle. Transcultural Concepts in Nursing Care. Philadelphia: Lippincott, 2015. Print.

Giger, Joyce Newman. Transcultural Nursing: Assessment and Intervention. St Louis: Mosby, 2016. Print.

Leininger, Madeleine, and Marilyn McFarland. Transcultural Nursing: Concepts, Theories, Research, and Practice. New York: McGraw, 2002. Print.

McFarland, Marilyn, and Wehbe-Alamah Hiba. Leininger’s Culture Care Diversity and Universality: A Worldwide Nursing Theory. 3rd ed. Burlington: Jones, 2015. Print.

Munoz, Cora, and Joan Luckmann. Transcultural Communication in Nursing. Clifton Park: Delmar, 2004. Print.

Potter, Patricia A., Anne Griffin Perry, and Patricia Stockert. Fundamentals of Nursing. St Louis: Mosby, 2016. Print.

Purnell, Larry. Transcultural Health Care: A Culturally Competent Approach. Philadelphia: Davis, 2013. Print.