Pengantar

Faktor sosial budaya pengaruhi kesehatan

(Blum)
Manusia adalah mahluk sosial
Manusia adalah mahluk berbudaya
Kebudayaan mempengaruhi perilaku
manusia
Definisi MASYARAKAT
Kesatuan hidup dari mahluk-mahluk
manusia yang terikat oleh sistem adat
istiadat tertentu (Koentjaraningrat)

Kelompok manusia yang terbesar yang

mempunyai kebiasaan, sikap, tradisi, dan
perasaan persatuan yang sama (Gillin &
Gillin)
 Unsur-unsur Masyarakat
Kesatuan Sosial
Bentuk dan susunan dari kesatuan-kesatuan
individu yang berinteraksi dalam kehidupan
masyarakat meliputi : kerumunan, golongan dan
kelompok
Pranata Sosial
Himpunan norma-norma dari segala tingkatan
yang berkisar pada suatu kebutuhan pokok
dalam kehidupan masyarakat.
Ciri dari masyarakat (1)
Adanya sejumlah orang
Tinggal dalam suatu daerah tertentu
Mengadakan hubungan satu sama lain
yang teratur
Membentuk sistem hubungan antar
manusia
Terikat karena kepentingan yang sama
Fungsi Pranata
Sebagai pedoman bertingkah laku
Menjaga keutuhan
Sebagai sistem pengendalian sosial
Pengertian Norma (1)
Cara (usage)
Bentuk perbuatan antar individu
Penyimpangan berakibat celaan
Kebiasaan (folkways)
Bentuk perbuatan yang diulang dalam bentuk
yang sama
Lebih mengikat daripada cara
Pengertian Norma (2)
Tata Kelakuan (mores)
Kebiasaan yang dianggap cara berperilaku dan
diterima sebagai norma pengatur
Pelanggaran akan dihukum
Adat Istiadat (customs)
Tata kelakuan yang kekal serta kuat intgrasinya
dengan pola-pola perilaku masyarakat
Pelanggaran akan menerima sanksi keras
Cara Pengendalian Sosial
Mempertebal keyakinan akan kebaikan
norma
Memberi penghargaan bagi yang taat
Mengembangkan rasa malu bagi mereka
yang menyimpang
Menimbulkan rasa takut
Menciptakan sistem hukum dengan sanksi
yang tegas
 Aspek Sosial yang
Mempengaruhi Kesehatan a.l
Umur :
misal penyakit infeksi v.s penyakit degeneratif
Jenis kelamin
Misal kanker payudara
Pekerjaan
Pekerja tambang v.s petani
Sosial ekonomi
KEBUDAYAAN
Asal kata budhayah (Sansekerta) : bentuk
jamak dari budi atau akal
Kebudayaan : hal-hal yang bersangkutan
dengan akal
Kluckhohn mengumpulkan 160 definisi
kebudayaan
 Pengertian Kebudayaan

Seluruh kelakuan dan hasil kelakuan

manusia yang teratur oleh tata kelakuan
yang harus didapatkannya dengan belajar
dan yang semuanya tersusun dalam
kehidupan masyarakat (Koentjaraningrat)
Kebudayaan :
Pengertian :
Kebudayaan atau yang disebut peradaban ; adalah pemahaman
yang meliputi : pengetahuan, kepercayaan , seni, moral,
hukum, adat istiadat yang diperoleh dari anggota masyarakat
( Taylor 1997 )
Pendapat umum sesuatu yang baik dan berharga dalam
kehidupan masyarakat. ( Bakker 1984 )
Pola tingkah laku mantap : pikiran, perasaan, dan reaksi yang
diperoleh dan terutama diwujudkan oleh simbul-simbul pada
pencapaian tersendiri dari kelompok manusia yang bersifat
universal ( Kroeber & klukhon 1950 )
Konsep Kebudayaan
Kebudayaan berasal dari bahasa sansekerta budayah /
bodhi yang berarti budi akal atau segala sesuatu yang
berkaitan dengan akal. Budaya dapat dipisahkan sebagai
kata majemuk Budi & Daya yang berupa : cipta , rasa, karsa,
karya ( kuncoroningrat 1980 )

3. Dimensi wujud kebudayaan

a. Dimensi gagasan , konsep, pikiran manusia. Wujud
ini disebut sistem budaya sifatnya abstrak, tidak
dapat dilihat berpusat pada kepala.
b. Dimensi aktifitas : disebut sistem sosial ; berupa
aktifitas manusia yang saling berinteraksi, sifat konkrit
dapat diamati atau diobsevasi
Unsur-unsur Budaya
1. Sistem religi
2. Sistem dan organisasi masyarakat
3. Sistem pengetahuan
4. Bahasa
5. Kesenian
6. Mata pencaharian
7. Teknologi dan peralatan
Wujud Kebudayaan
Bentuk kompleks dari ide-ide, gagasan,
nilai-nilai, norma dan peraturan
Bentuk kompleks dari aktifitas kelakukan
berpola
Bentuk kompleks dari benda hasil karya
manusia
 Konsep mempelajari
kebudayaan
1. Hindari sikap ethnocentrism (memberi penilaian
tertentu kepada kebudayaan yang dipelajar)

2. Tidak menyadari kebudayaan lain, kecuali memasuki

masyarakat tersebut

3. Variasi kemudahan perubahan yang berbeda pada

tiap unsur kebudayaan

4. Unsur kebudayaan saling kait mengait

 Bentuk Perubahan Sosial Budaya

Perubahan terjadi secara lambat v.s cepat

Perubahan yang pengaruhnya kecil v.s
besar
Perubahan yang direncanakan v.s tidak
direncanakan
 Inovasi
Proses perubahan yang terjadi dalam
waktu yang pendek
Syarat inovasi :
1. Masyarakat merasa butuh perubahan
2. Perubahan dipahami dan dikuasai masyarakat
3. Perubahan dapat diajarkan
4. Perubahan tidak merusak prestise pribadi
atau kelompok
c. Wujud sebagai benda ( sistem konkrit ) hasil daya cipta
manusia yang berwujud benda

Kerangka Kebudayaan
1. Berbagai aspek kehidupan yang seluruhnya merupakan
ungkapan masalah kemanusiaan & budaya yang dapat
didekati dengan menggunakan pengetahuan budaya
( the humanistik ) dari berbagai disiplin ilmu
2. Hakekat manusia sebagai kesatuan atau universal akan
membentuk beraneka ragam kebudayaan yang masing-
masing sesuai dengan masa dan zamannya
Kedua masalah pokok tersebut memerlukan penjabaran
lebih lanjut dengan beberapa unsur: al
1). Kebudayaan dan Unsur-unsurnya
a. Peraturan dan perlengkapan hidup manusia : ( pakaian,
perumahan, transportasi) dsb
b. Mata pencaharian hidup dan sistem sistem ekonomi
(pertanian, peternakan, sistem produksi, distribusi) dll
c. Sistem kemasyarakatan ( system kekerabatan, orpol, sistem
hukum, sistem perkawinan ) dll
d. Bahasa ( lisan maupun tertulis)
e. Kesenian ( seni rupa, seni suara, seni gerak, seni pahat ) dll
f. Sistem pengetahuan ( pengathuan alam, fisika dll )
g. Religi ( sistem kepercayaan )
2). Wujud Kebudayaan
a. Wujud kebudayaan mempunyai sifat yang abstrak : artinya tidak dapat
dilihat tidak dapat diraba, hanya bisa diyakini keberadaannya.
Bertempat di alam pikiran/ di kepala. Misal : adat istiadat
setempat bersih desa
b. Wujud kebudayaan yang bersifat sosial ( sosial system) adalah
merupakan tindakan yang terpola dari manusia itu sendiri. Sistem ini
merupakan kegiatan setiap hari manusia itu sendiri ( kegiatan pasar,
kegiatan perkantoran) dll
c. Wujud kegiatan fisik : adalah merupakan seluruh hasil fisik dari
perbuatan manusia dalam masyarakat, bersifat konkrit , mis bangunan ,
komputer, OHP dll
3). Sistem Sosial dan Sistem Budaya
a. Sistem sosial dan sistem budaya merupakan sistem-
sistem yang secara analissis dapat dibedakan:
* Sisterm sosial : sistem ini lebih banyak mengkaji pada
kajian sosiologi yang mengarah kepada konsep
relasional
(hubungan manusia ) sebagai pengganti pengganti
konsep perilaku sosial.
Sistem sosial menjadi suatu model analisis bagi terhadap
organisasi sosial ( Talkot . Peron )sebagai sistem sosial
mempunyai bagian yang saling menguntungkan, saling
ketergantungan termasuk hubungan berdua kelompok kecil .
 4 Hal yang harus berada dalam sistem sosial
@. Ada 2 orang atau lebih
@ Terjadi interaksi diantara mereka
@ Mempunyai tujuan yang sama
@. Memiliki struktur simbul & harapan yang sama(Person)
b. Sistem budaya ( cultural system )
Merupakan ide ide dan gagasan manusia hidup bersama
dalam suatu masyarakat. Sistem budaya bagian dari
kebudayaan dalam pola adat istiadat, sistem norma, pranata
yang ada di masyarakat. Proses budaya ini dilakukan melalui
pembudayaan ( institutionalization) pelembagaan yang
dimulai dengan meniru kemudian diinternalisasikan.
Berbagai Kebudayaan Di Indonesia
Pola Pikir Budaya Barat
* Pikiran cenderung menekankan dunia obyektif dari
pada rasa sehingga membuahkan ilmu dan teknologi
* Filsafat dipusatkan pada ujud dunia rasio
* Cara berpikir dalam hidup lebih terpikat oleh kemajuan
material, serta teknis & ilmiah analisis
* Dasar kehidupan adalah : martabat manusia
kebebasan & teknologi
Ket :
*Manusia adalah ukuran segala-galanya
manusia mempunyai kemampuan menyempurnakan
diri yang bertitik tolak rasio , intelek , pengalaman,
kemampuan sebagai ukuran dan bukan kebijakan
hati. Kepuasan diperoleh lewat usaha keras sehingga
persaingan keras

* Kebebasan dimulai dari sosialisasi anak dengan

membiarkan membentuk dirinya sendiri dalam
mengembangkan bakat , bebas dari campur tangan orang tua
dan mengarah spesialisasi
* Teknologi merupakan kebutuhan manusia, teknologi
menghasilkan dinamisme tentang manajemen keberanian
berusaha, dan penguasaan materi
Pola Pikir Budaya Timur
Pada intinya bersumber dari agama, menyukai intuisi dari
pada akal budi. Pemikir timur lebih menekankan segi dalam
jiwa, bersifat khayalan. Timur lebih disiplin mengendalikan diri,
mengedepankan keharmonisan dengan alam sebab alam
memberikan makan, tempat berteduh, Keberhasilan diperoleh
dengan cara meditasi, terikat dengan mistik. Menegakan
norma bersumber dari ajaran agama. Nilai kehidupan tertinggi
datang dari dalam nurani seperti nrimo karena takdir, pepesten,
pasrah.
Rumusan Kebudayaan Nasional Indonesia
Menurut hasil rapat Kebudayaan Nasional Indonesia
1936 oleh Sutan Takdir Alisabana Cs dengan Ki Hajar
Dewantoro & Dr Soetomo merumuskan sebagai berikut :
Kebudayaan bangsa Indonesia adalah kebudayaan yang
timbul dari sebuah usaha budinya rakyat Indonesiasendiri
dengan rumusan : BHINEKA TUNGGAL IKA dan bertumpu
pada kebudayaan lama dan asli terdapat sebagai puncak
kebudayaan di daerah daerah diseluruh Indonesia yang ber
idiologi PANCASILA
Puncak kebudayaan daerah bersifat universal
Jenis Kebudayaan Di Indonesia

a. Kebudayaan Modern
Kebudayaan modern biasanya berasal dari manca negara
datang di Indonesia merupakan budaya/ kesenian import.
Budaya modern akting, penampilan, dan kemampuan
meragakan diri didasari sifat komersial. Budaya modern
lebih mengesampingkan norma , gaya menjadi idola
masyarakat dan merupakan target sasaran Contoh : film,
musik jazz
b. Kebudayaan Tradisional
Bersumber dan berkembang dari daerah setempat.
Penampilan mengutamakan norma dengan mengedepankan
intuisi bahkan bersifat bimbingan
Dan petunjuk tentang kehidupan manusia. Kebudayaan
tradisional kurang mengutamakan komersial dan sering
dilandasi sifat kekeluargaan. Contoh : Ketoprak, wayang orang,
keroncong, ludruk

c. Budaya Campuran
Budaya campuran pada hakekatnya merupakan campuran
budaya modern dengan budaya tradisional yang berkembang
dengan cara asimilasi ataupun defusi. Kebudayaan campuran
sudah memperhitungkan komersiel tapi masih mengindahkan
norma dan adat setempat. Contoh : Musik dangdut, orkes
gambus, campur sari
Perubahan Kebudayaan
Kebudayaan berubah dengan cara :
1. Defusi : adalah penyebaran unsur kebudayaan dari suatu
masyarakat ke masyarakat lain antar individu antar
keluarga ataupun golongan.
Difusi ini dapat menyebar dengan cara :
a. Penetration Pacifiqua : masuknya unsur
kebudayaan dari masyarakat satu kemasyarakat
lain tanpa adanya paksaan : mis listrik masuk desa
b. Penetration Hard : masuknya unsur kebudayaan
dari masyarakat satu kemasyarakat lain disertai
kekerasan : misal model pakaian yang tidak sesuai
dengan adat setempat
c. Penetration symbolik : masuknya kebudayaan secara
berdampingan saling menguntungkan dan tidak
merugikan contoh koperasi
2. Akulturasi : adalah diterimanya kebudayaan lain/luar
kemudian diolah menjadi kebudayaan sendiri . Mis : politik
dakwah, pendidikan. Musik padang pasir menjadi musik
gambus.
3. Asimilasi : Terjadi pada kelompok masyarakat yang tidak
sama kebudayaannya tapi dapat hidup secara berdampingan
dengan damai saling mendekat lambat laun menjadi sama
bahkan menjadi model kebudayaan yang baru. Kebudayaan
ini dibentuk dari unsur yang berbeda-beda oleh mobilitas
penduduk
Contoh : keroncong dan langgam menjadi campur sari
Timbulnya Kebudayaan
Kebudayaan bisa timbul secara :
a. Discavery ; adalah penemuan sesuatu yang baru yang
terjadi dengan tidak sengaja dan secara kebetulan serta
tidak direncanakan. Contoh penemuan obat kina
b. Invention : kebudayaan tercipta karena suatu rancangan/
perencanaan kebudayaan dengan melalui suatu proses.
Contoh model pakaian, komputer. OHP dll
Kelompok Sosial
1. Pengertian
Suatu kesatuan yang terdiri dari 2 (dua ) atau lebih
individu yang mengadakan interaksi yang cukup intensif
dan teratur sehingga diantara individu sudah ada
pembagian tugas berdasarkan norma yang berlaku
2. Jenis-jenis kelompok
a. Kelompok primer ( Face to face Group ) terjadinya
kelompok sosial yang anggota-anggota sering berhadapan
muka, saling mengenal dari dekat, dan berhubungan secara
erat.
Ciri-ciri Kelompok Primer :
1). Mengindahkan norma
2). Mengutamakan kelompok
3). Mengembangkan kecakapan demi kepentingan
kelompok
contoh : Dalam masyarakat ( RT ), kelompok kawan
sepermainan
2. Kelompok Skunder
Interaksi yang langsung berhubungan, tapi saling berjauhan
walaupun bersifat formil, kurang bersifat kekeluargaan, pasif
tapi lebih bersifat obyektif. Berperan untuk tujuan rasional
Contoh : Kelompok studi banding
Kelompok lawatan olah raga
3. Kelompok Formal & Informal

Formal = Resmi Informal = Tidak Resmi

Informal
Tidak didukung peraturan secara tertulis ( AD. ART)
Penbagian tugas, peranan, Norma, tingkah laku para
anggotanya tidak dirumuskan secara tegas.

Ciri Utama Kelompok

1. Terdapatnya dorongan yang sama antar individu untuk
mencapai tujuan yang sama
2. Terdapat interaksi yang berlainan dari individu yang berbeda
dengan kecakapan yang berbeda sehingga pembagian tugas
disesuaikan dengan keahlian masing-masing anggota

3. Pembentukan dan penegasan struktur organisasi :

Peranan peranan dan kedudukan herarki yang lambat laun
berkembang dengan sendiri, struktur dalam kelompok terdiri
dari susunan yang disesuaikan dengan kebutuhan dan tujuan
4. Terjadi penegasan-penegasan, norma-norma kelompok,
tingkah laku yang diharapkan seluruh anggota kelompok
Bentuk bentuk Kelompok
1. Crowd ( Kumpulan Orang Banyak) Merupakan kesatuan
kemasyarakatan ketika ada suatu pengumuman atau
adanya kumpulan individu pada suatu tempat tertentu.
Ciri-ciri
a. Terdapatnya orang banyak terjadi karena adanya
suatu pengumuman, pada suatu tempat tertentu
b. Ada interaksi, biasanya berupa komentar-komentar
c. Merupakan kesatuan dengan kepentingan dalam
waktu singkat
2. Golongan

Terjadi karena suatu ciri yang dapat ditentukan ada pada

sejumlah masyarakat secara obyektif. Penggolongan itun
biasanya untuk keperluan tertentu
Misalnya : Golongan Balita, golongan wanita, golongan pria
3. Kolektiv
a. Terjadi karena sejumlah warga dari suatu masyarakat
tampak sebagai kesatuan masyarakat berdasarkan
suatu komplek ciri-ciri yang mencolok
b. Terjadi adanya kebudayaan dengan adat istiadat serta
sistem norma dan kadang-kadng dengan bahasa
khusus dalam mengatur suatu kehidupan
c. Warga kolektif mempunyai kesadaran kepribadian
sebagai kesatuan kemasyarakatan karena ciri ciri yang
mencolok dari kesatuan kebudayaan tadi

contoh : Warga Negro, Indian, orang islam di Amerika

Bentuk lain dari Kelompok

1. Kelompok
Merupakan sekumpulan kelompok yang berinteraksi antar
anggotanya mempunyai adat istiadat tertentu , norma-
norma secara berkesinambungan. Rasa identitas yang sama
serta mempunyai organisasi dan sistem pimpinan. Sifat
kepemimpinannya berdasarkan kewibawaan dan kharisma,
serta hubungannya berdasarkan perorangan.
Contoh :
* Kelompok yang terikat hubungan keturunan , mis warga
batak
* Kelompok remaja, kelompok dasa wisma
* Kelompok organisasi adat
2. Himpunan
Merupakan kesatuan manusia yang berdasarkan sifat tugas
guna, sifat hubungan berdasarkan kontrak. Dasar
organisasinya secara formal. Pimpinan berdasarkan
wewenang dan hukum
Contoh :
* Himpunan berdasarkan pendidikan, yayasan
pendidikan : mis perkumpulan pemberantasan buta
huruf
Himpunan berdasarkan kelompok ilmu pengetahuan ; mis
organisasi profesi : IDI, PPNI, IBI dll
* Himpunan untuk kegiatan agama : mis organisasi gereja,
muhamadiyah, NU dsb

Stratifikasi Sosial
Pengertian :
Berasal dari bahasa STRUM = Strata yang berarti
perbedaan penduduk / masyarakat ke dalam kelas-kelas
secara bertingkat atau herarkis
Fungsi Stratifikasi
1. Membagi mengatur pembagian kerja sesuai dengan
kemampuan atau keahliannya
2. Mengatur imbalan jasa sebagai pendorong agar individu
bersedia melakukan kewajibannya sesuai dengan
tingkat kedudukannya
3. Membantu masyarakat memecahkan persoalan yang
dihadapinya
Penggolongan Lapisan dalam Masyarakat
Dengan ukuran sebagai berikut
a. Ukuran kekayaan
b. Ukuran kepangkatan
c. Ukuran kehormatan
Secara lapisan masyarakat diklasifikasikan ke dalam 3 kelas
1. Ekonomi, Politis. Keturunan
1). Ekonomi

@. Uper class ( Tingkat atas ) adalah kelompok klas yang

mempunyai tingkat penghasilan tinggi, mereka yang
mempunyai barang yang berharga. Seperti tanah,
emas mobil misal sebagai direktur, pengusaha sukses.
@. Midle class ( Klas menengah )
Mereka berada pada tingkat pendapatan yang cukup
cukup saja untuk memenuhi kebutuhan hidup
contoh : pegawai negeri, pedagang
@. Low Class ( klas bawah )
Mereka yang berada pada tingkat pendapatan yang
rendah : mis kaum buruh, pedagang asongan
2) Politis
Stratifikasi sosial yang dimaksud adalah pembedaan
cara pandang terhadap lapisan sosial yang dibedakan
pribumi dan atau non pribumi
3) Jabatan
Didasarkan pada jabatan anggota dimasyarakat
Mis : Gubernur, Direktur perusahaan, Bupati dll
Aspek Sosial Budaya Yang Mempengaruhi Hidup Sehat
Pendahuluan
Kesehatan mencakup seluruh aspek kehidupan. Konsep
kesehatan tidak saja berorientasi pada aspek klinis saja, tetapi
lebih berorientasi pada ilmu-ilmu lain yang ada kaitannya
dengan kesehatan & kemasyarakatan , a.l : Ilmu Sosiologi,
Psikologi, Perilaku dll yang kegunaannya sebagai penunjang
yang sekaligus sebagai faktor yang mempengaruhi derajat
kesehatan.
Salah satu cabang sosiologi yang membahas kebudayaan
termasuk didalamnya adalah : Pengetahuan, kepercayaan,
kesenian, moral, hukum, adat-istiadat yang dilakukan
oleh masyarakat
 Di negara maju terdapat unsur kebudayaan yang dapat
menunjang peningkatan status kesehatan seperti tingkat
pendidikan yang optimal sosial ekonomi yang tinggi, lingkungan
hidup yang baik

Di Negara berkembang terjadi sebaliknya. Melihat luasnya

masalah tersebut maka Perawat sebagai salah satu petugas
kesehatan harus mempelajari ilmu tersebut diatas agar
mengenal pengaruh dari masing-masing faktor. Faktor tersebut
a.l :
1.Pengaruh Sosial Budaya Terhadap Kesehatan

Masyarakat :
Masalah yang kita hadapi adalah jumlah penduduk
yang besar dengan pertumbuhan yang cukup tinggi
Serta penyebaran yang tidak merata. Tingkat pengetahuan dan
pendidikan yang rendah terutama pada golongan wanita,
kebiasaan yang negatif yang berlaku di masyarakat serta adat
istiadat & kepercayaan yang kurangnya peran serta masyarakat
terhadap pembangunan kesehatan

Kondisi sosial budaya masyarakat yang mendukung

adalah semangat gotong royong dan kekeluargaan serta
bermusyawarah dalam mengambil keputusan
Masalah lain yang sering muncul adalah dampak dari
industrialisasi adalah timbulnya kawasan kumuh ( SLUMP AREA)
serta Ibu-Ibu karier tidak/ kurang memberi ASI pada bayinya
secara optimal
# Kurangnya pengetahuan ibu tentang cara pemilihan
jenis/ bahan makanan, cara memasak dan cara
penyajian secara serasi
# Sebagian besar ibu-ibu masih berpandangan makan
itu yang penting kenyang tanpa memperhatikan nilai gizi
# Pengaruh pola makan terhadap timbulnya penyakit mis :
anaemi, pre eklamsi, Diabites melitus dll

# Budaya pantang terhadap makan makanan tertentu yang

mestinya sangat dibutuhkan
# Proses kehamilan & persalinan merupakan penyebab
kematian tertinggi pada wanita yang berkisar 94,4%
disebabkan perdarahan, infeksi, anemi.
INTERAKSI SOSIAL
Hubungan Timbal Balik

Merupakan hubungan vital

Menentukan wujud
Pergaulan kearah kemajuan

Keuntungan dari interaksi

Pengertian

Beberapa pendapat tentang interaksi

1. VEWCOMB : interaksi sosialadalah pedoman
masyarakat
2. GERUNGAN: Hub 2 orang / lebih yang saling
mempengaruhi untuk menuju perbaikan dan
kemajuan
3. ASTRID S. SUTANTO : proses komunikasi yang
saling mempengaruhi dalam masyarakat dengan
akibat terjadinya perubahan ataupun proses sosial
BENTUK-BENTUK INTERAKSI SOSIAL

Hubungan interaksi meliputi

Fisik psikis rohani

Kegiatan fisik kegiatan rerligius

rasa empati
Klasifikasi bentuk interaksi
( WOOD WORTH )

1. Individu bertentangan dengan linkungan

Contoh : Penduduk urban
2. Individu memanfaatkan lingkungan
Contoh : perawat memanfaatkan organisasi
masyarakat yang sudah mantap
3. Individu berpartisipasi dalam lingkungan
Contoh : perawat ikut dalam pengurusan
suatu organisasi
4. Individu menyesuaikan dengan lingkungan

auto plastic allo plastik

( pasif ) ( aktif )
MADELEINE Born in Sutton, Nebraska July 13,
1925
LEININGER Received her Basic Nursing
Education from St. Anthonys School
of Nursing in 1948
Received her Bachelor of Science
from Mount St. Scholastica College in
1950
Received her Master of Science in
Psychiatric-Mental Health Nursing
from The Catholic University of
America in 1954
Received her Ph.D. in Cultural and
Social Anthropology from the
University of Washington in 1965
MADELEINE Dr. Leininger is the founder of
Transcultural Nursing
LEININGER She is a fellow in the American
Academy of Nursing
She was named a Living
Legend by the American
Academy of Nursing in 1998
She is Professor Emeritus in the
College of Nursing, Wayne State
University and Adjunct Professor
at the University of Nebraska
Medical Center, College of
Nursing, Omaha
 DEFINITION OF
TRANSCULTURAL NURSING

A substantive area of study and practice focused on

comparative cultural care (caring) values, beliefs and
practices of individuals or groups of similar or
different cultures with the goal of providing culture-
specific and universal nursing care practices in
promoting health or well-being or to help people to
face unfavorable human conditions, illness or death
in culturally meaningful ways.
 DEFINITION OF ETHNONURSING

The study of nursing care beliefs, values and

practices as cognitively perceived and known
by a designated culture through their direct
experience, beliefs and value system.
NURSING
PARADIGM
 HUMAN BEINGS

Humans are believed to be caring and to be capable of

being concerned about the needs, well-being and
survival of others.
Human care is universal, that is, seen in all cultures.
Humans are universally caring beings who survive in a
diversity of cultures through their ability to provide
the universality of care in a variety of ways according
to differing cultures, needs and settings.
 HEALTH

Defined as a state of well-being that is

culturally defined, valued and practiced, and
which reflects the ability of individuals (or
groups) to perform their daily role activities in
culturally expressed, beneficial and patterned
lifeways.
 ENVIRONMENT

Society or environment are not terms that are

defined by Leininger but she instead speaks of
worldview, social structure and environmental
context.
The concept of culture is closely related to
society or environment and is considered as a
central theme in her theory.
 NURSING

Defined as a learned humanistic and scientific

profession and discipline focused on human
care phenomena and caring activities in order
to assist, support, facilitate or enable
individuals or groups to maintain or regain
their health or well-being in culturally
meaningful and beneficial ways, or to help
individuals face handicaps or death.
 NURSING

Professional nursing care is defined as formal and

cognitively learned professional care knowledge and
practice skills, obtained through educational
institutions, that are expected to provide assistive,
supportive, enabling or facilitative acts to or for
another individual or group in order to improve a
human health condition (or well-being), disability,
lifeway or to work with dying clients.
 NURSING

Culturally congruent (nursing) care is defined as

those cognitively based assistive, supportive,
facilitative or enabling acts or decisions that
are tailor-made to fit with individual, group or
institutional cultural values, beliefs and
lifeways in order to provide or support
meaningful, beneficial and satisfying health
care or well-being services.
 TRANSCULTURAL NURSING

The term Transcultural Nursing is used today to refer

to the evolving knowledge and practices related to
this new field of study and practice.
Leininger stresses the importance of knowledge gained
from direct experience or directly from those who
have experienced and labels such knowledge as emic
or people-centered. This is in contrast with etic
knowledge or professional perspective.
 TRANSCULTURAL NURSING

Leininger contends that emically derived care

knowledge is essential to establish nursings
epistemological (the branch of philosophy that
studies the nature of knowledge, in particular its
foundations, scope, and validity)and ontological (the
most general branch of metaphysics, concerned with
the nature of being)base for practice.
 TRANSCULTURAL NURSING

Leininger built her theory of transcultural

nursing on the premise that the peoples of
each culture can not only know and define the
ways in which they experience and perceive
their nursing care world but also relate these
experiences and perceptions to their general
health beliefs and practices.
 TRANSCULTURAL NURSING

Leininger presented assumptions that support

her prediction that different cultures perceive,
know, and practice care in different ways, yet
there are some commonalities about care
among all cultures of the world.
She refers to the commonalities as universality
and to the differences as diversity.
 TRANSCULTURAL NURSING

Culture is the learned, shared and transmitted

knowledge of values, beliefs, norms andf
lifeways of a particular group that guides an
individual or group in their thinking, decisions
and actions in patterned ways .
 TRANSCULTURAL NURSING

Subculture is closely related to culture and

refers to a group that deviates in certain areas
from the dominant culture in values, beliefs,
norms, moral codes and ways of living with
some distinctive features of its own.
 TRANSCULTURAL NURSING

Culture care is defined as the subjectively and

objectively learned and transmitted values,
beliefs and patterned lifeways that assist,
support, facilitate or enable another individual
or group to maintain well-being and health, to
improve the human condition and lifeway or
to deal with illness, handicaps or death.
 TRANSCULTURAL NURSING

Culture Care Diversity indicates the variabilities

and/or differences in meanings, patterns,
values, lifeways or symbols of care within or
between collectives that are related to
assistive, supportive or enabling human care
expressions.
 TRANSCULTURAL NURSING

Culture Care Universality indicates the common,

similar, or dominant uniform care meanings,
patterns, values, lifeways or symbols that are
manifest among many cultures and reflect
assistive, supportive, facilitative or enabling
ways to help people.
 TRANSCULTURAL NURSING

Worldview is the way in which people look at

the world, or at the universe, and form a
picture or value stance about the world and
their lives.
 TRANSCULTURAL NURSING

Cultural and social structure dimensions are defined as

involving the dynamic patterns and features or
interrelated structural and organizational factors of a
particular culture which includes religious, kinship,
political, economic, educational, technologic and
cultural values, ethnoshistorical factors and how
these factors may be interrelated and function to
influence human behavior in different environmental
contexts.
 TRANSCULTURAL NURSING

Environmental context is the totality of an

event, situation or particular experiences that
give meaning to human expressions,
interpretations and social interactions in
particular physical, ecological, sociopolitical,
and/or cultural setting.
 TRANSCULTURAL NURSING

Ethnohistory includes those past facts, events,

instances and experiences of individuals,
groups, cultures and institutions that are
primarily people-centered (ethno) and which
describe, explain, and interpret human
lifeways within particular cultural contexts
over short or long periods of time.
 TRANSCULTURAL NURSING

Generic (folk or lay) care systems are culturally learned

and transmitted, indigenous (or traditional), folk
(home-based) knowledge and skills used to provide
assistive, supportive enabling or facilitative acts toward
or for another individual, group or institution with
evident or anticipated needs to ameliorate or improve a
human lifeway, health condition (or well-being) or to
deal with handicaps and death situations.
 TRANSCULTURAL NURSING

Professional care systems are defined as

formally taught, learned and transmitted
professional care, health, illness, wellness and
related knowledge and practice skills that
prevail in professional institutions, usually with
multidisciplinary personnel to serve
consumers.
 TRANSCULTURAL NURSING

Care as a noun is defined as those abstract and

concrete phenomena related to assisting,
supporting, or enabling experiences or
behaviors toward or for others with evident or
anticipated needs to ameliorate or improve a
human condition or lifeway.
 TRANSCULTURAL NURSING

Care as a gerund is defined as actions and

activities directed toward assisting, supporting
or enabling another individual or group with
evident or anticipated needs to ameliorate or
improve a human condition or lifeway or to
face death.
 TRANSCULTURAL NURSING

Culture care preservation, also known as

maintenance, includes those assistive,
supportive, facilitative or enabling professional
actions and decisions that help people of a
particular culture to retain and/or preserve
relevant care values so that they can maintain
their well-being, recover from illness or face
handicaps and/or death.
 TRANSCULTURAL NURSING

Culture care accommodation, also known as

negotiation, includes those assistive,
supporting, facilitative or enabling creative
professional actions and decisions that help
people of a designated culture adapt to or
negotiate with others for a beneficial or
satisfying health outcome with proffesional
care providers.
 TRANSCULTURAL NURSING

Culture care repatterning, also known as restructuring,

includes those assistive, supporting, facilitative or
enabling professional actions and decisions that help
clients eorder, change or greatly modify their
lifeways for new, different and beneficial health care
patterns while respecting clients cultural values and
beliefs and providing a lifeway more beneficial or
healthier than before the changes were co-
established with the clients.
 Think about this

Education is an ornament in
prosperity and a refuge in
adversity.
Aristotle
(384 BC 322 BC)
Greek philosopher, a student of Plato and teacher
of Alexander the Great
 REFERENCE

George, Julia B., 2008, Nursing

Theories: The Base for
Professional Nursing Practice.
Fifth Edition. Prentice Hall
 Culture
Socially transmitted knowledge of values,
beliefs, norms, and lifeways of a particular
group that guides their thoughts and
behaviorsLeininger and colleagues

87
Visible and Invisible Components
Visibleeasily seen
Clothing, jewelry, charms, hairstyles, rubber
bands before tests and while kicking the
nicotine habit
Invisibleless observable
Value belief system that drives visible practices

88
Health Disparity

Diversity in healthcare combats inequity and disparity

89
 Transcultural Nursing

Comparative study of cultures to

understand similarities and differences
across human groupsLeininger
Mary Mahoney- brought forth awareness of
cultural diversity and the respect of the
individual regardless of background, race,
religion, or color
90
Definitions
Culture Spirituality
Ethnicity Congruence
Race Coherence
Color Faith
Ritual Hope
Prayer Spiritual distress
Meditation

91
 Culture
socially transmitted knowledge of values, beliefs,
norms, and habits of a particular group which
greatly impacts behavior and thought of the
individuals within that culture. It evolves over a
period of time as members of this group learn to
live within an environment. Culture has visible
and invisible components. In the US the
dominant culture is that of the Anglo-American.
There are various subcultures: Ozark culture, for
example AND within those subcultures are various
ethnic, religious and other identifiable groups

92
Ethnicity
shared identity r/t social and cultural
heritage, a common sense of identity, a
cultural groups perception of belonging
together: Irish, Vietnamese, or Brazilian are
examples cited in your text.

93
Race
not to be confused with ethnicity, is
biologically determined, such as nasal
bridges, eye shape.

94
Color
one of the biological attributes humans
possess: red & yellow, black & white

95
Ritual
according to Mosby, a detailed procedure
followed faithfully or regularly, like wearing
a religious charm for example

96
Prayer
an effective coping resource, a discussion
with God, a Divine Being

97
Meditation
creation of relaxation

98
Spirituality
what gives life or animation to an
individual, very personal

99
Congruence
an ideal condition of all systems, a sense of
harmony

100
Coherence
a sense of unity, togetherness, all the
pieces fit

101
Faith
a relationship with a divinity that incorporates
reasoning faith aka belief and trusting faith aka
action. Reasoning faith is belief in something for
which there is no proof. Transcendence is an
awareness of that which one cannot see in
ordinary physical ways. It gives purpose and
meaning to life. Faith is the substance of things
hoped for, the evidence of which is not seen

102
Hope
a concept, an attitude, motivating and
energizing, an entity that gives meaning
and purpose

103
Spiritual Distress
disruption of an individuals life principle

104
 Enculturation
Acculturation
Culture Birth
Assimilation
Processes
Biculturalism

105
Enculturation
socialization into ones primary culture as a
child- this is what occurs within the family
in which you are born and or reared

106
Acculturation

adapting to and adopting a new culture (a

culture meshing), taking on a new culture,

107
Assimilation

giving up ones ethnic identity for a more

dominant culture (a culture
metamorphosis),

108
Biculturalism

identification with two different cultures

109
Health Disparity Prevention
Cultural competence
an acquisition of the components discussed in
order to delivery culturally congruent care.
Incorporating the individuals culture in the
care delivered to that individual
Awareness-
Knowledge-
Skills-
Encounters
Desires
110
Cultural awareness
examination of ones own background,
recognizing biases, prejudices, and
assumptions about other people

111
Cultural knowledge
learning about others culture: health
beliefs, care practices, etc

112
Cultural skills

with an assessment of social, cultural, and

biophysical factors that influence the
treatment and care of various clients- Does
the nurse know where to apply the scrap of
brown paper bag on the baby to reduce the
hiccups?

113
Cultural encounters

engaging in activities with other cultures

that offers a learning opportunity

114
Cultural desires

motivation and commitment that prompts

an individual to learn about anothers
culture

115
 Traditional
health and illness belief

Illness is just a passing in lifes continuum whereas in another culture, illness

may be looked upon as a punishment or a disturbance of some equilibrium.
116
Cupping to encourage blood flow, ease stress, aches & pains

117
Coining- to promote healing

118
Cultural and Life Transitions
Pregnancy
Childbirth
Newborn care
Postpartum
Grief and loss

119
 Modern
health and illness beliefs

Whatever the culture or the circumstance, the healthcare provider must take into
consideration the whole person. Making certain not to impose ones on beliefs on
others but the respectfully abide by the belief of others as long as it does not
interfere with the healthcare delivery

120
 NSAIDs
Arginine - Possible Harmful Interaction
Feverfew - Possible Harmful Interaction
Garlic, Ginkgo - Possible Harmful Interaction
Policosanol - Possible Harmful Interaction
PC-SPES - Possible Harmful Interaction
Potassium Citrate - Possible Harmful
Interaction
Reishi - Possible Harmful Interaction
St. John's Wort, Dong Quai - Possible Harmful
Interaction
Vinpocetine - Possible Harmful Interaction
Vitamin E - Possible Harmful Interaction
White Willow - Possible Harmful Interaction
Herbs and Supplements - Possible Harmful
Interaction
Cayenne - Supplementation Possibly Helpful
Colostrum - Supplementation Possibly Helpful 121
Folate - Supplementation Possibly Helpful
Modern
health and illness beliefs

Be care not to impose (cultural oppression) ones

own beliefs on others, but respectfully abide by
the belief of others as long as it does not interfere
with healthcare delivery.
Be careful not to be judgmental, but take all facts
into play when performing an assessment
(cupping, coining, herbal supplements)-
investigate before you incriminate

122
Cultural Assessment
Cultural identity/ethno-history
Bio-cultural history
Social organization
Socioeconomic status
Language and communication
Religion and spirituality
Caring beliefs and practices
Experience with health care system
Be cognizant of ethnic backgrounds of the clients
you service, being careful not to cause any undo
tensions

123
Nursing Decision and
Action Modes
Cultural care preservation or
maintenance
Cultural care accommodation or
negotiation
Cultural care re-patterning or
restructuring

124
 Nursing Process
Assessment of Select Cultural Concepts
Communication
Space
Social Organization
Time
Environmental Control
Racial Groups

125
 Nursing Process
Selected Nursing Diagnoses
Communication, impaired
verbal
Social isolation
Disturbed personal identity
Risk for loneliness
Impaired adjustment
Decisional conflict
noncompliance

126
 Planning Client Outcomes

Knowing resources
Involve the client
Hot-cold, Ying-yang
Most effective care comes from involvement
of the the client.
Involve the client as early in the process as
possible .
Strive for the perfect balance
127
 Implementation

How do we make it

all fit

together? 128
 Role as Provider of Care

Nursing Interventions
Teaching
Safety
Communications
How we teach is just as
important as what we teach
our clients
Just as how we provide

the care is just as important as

how we provide that care

129
 Role as Provider of Care

Pharmacology
Modern medicine
Traditional medicine

130
Role as Provider of Care

Nutrition
Hot versus cold foods
Pica

131
 Dr. Leininger was the first
professional nurse with a PhD in
anthropology.

She brought nursing and

anthropology together and came
up with the term transcultural
nursing.

Her Culture Care Diversity &

Universality theory was one of the
earliest nursing theories and it
remains the only theory focused
specifically on transcultural
nursing. Her theory is used
worldwide.
(Leininger, 2006)
Description of the theory
The Culture Care Diversity and
Universality theory, according to
Dr. Leininger, focuses on
describing, explaining, and
predicting nursing similarities and
differences. It focuses primarily
on human care and their culture.

In addition, The Culture Care

Diversity & Universality theory
focuses on methods of approach
that takes care of patients and
their culture.

(Leininger, 2006)
 Research
Dr. Leininger developed her theory, Culture Care Diversity and Universality from a
Dr. Leininger d
combination of anthropology & nursing beliefs & principles

1985 she first published her theory in Nursing Science Quarterly

1988 - further explained her theory in same journal

1991 - published her book Culture Care Diversity and Universality: A Theory of Nursing

(Leininger, 2006)

Theory applied to nursing
Based on transcultural nursing model:

Transcultural nursing: is a learned branch of nursing that

focuses on the comparative study & analysis of cultures. They
apply these concepts to nursing and health-illness practices,
beliefs, and values.

Goal of Transcultural Nursing: is to provide care that is

congruent with cultural values, beliefs, and practices.
(Leininger, 1999)
Theorys Purpose & Goal
Purpose: to explicate
transcultural nursing
knowledge and practice

Goal: to identify ways to

provide culturally congruent
nursing care to people of
diverse or similar cultures

(Leininger, 2006)
The Sunrise Enabler
The theory includes an enabler. It serves as a
conceptual guide or cognitive map to
guide nurses in the systematic study of all
dimensions of the theory.

This map or guide is called the Sunrise

Enabler.

(Leininger, 2006)
(Leininger, 2006. pp25)
Applying theory in nursing practice
Knowledge of cultural diversity is essential for
nurses in order to provide appropriate care to
clients, families, and communities.

It also requires understanding of values,

beliefs, and practices of a clients culture.

Nursing actions must be culture-specific.

Culture Care theory not only focuses on nurse-

client interaction but the focus also includes
care for families, groups, communities, cultures
and institutions.

(Leininger, 1994)
CONCLUSION
We live in a cities/states that are rich in
diversity, and globalization has become a
fact of life, therefore, it is essential to
value diversity.

Nursing is a transcultural humanistic

profession with the central purpose of
serving individuals, groups, communities
and institutions worldwide.

If there is evidence of nurturing caring

behaviors with the use of culture-specific
care, there will be more signs of well
being and fewer signs of illness.

(Leininger, 2006)
 References
Leininger, M. M.& McFarland, R. M. (2006). Culture care diversity and Universality, A world wide Nursing
theory (2nd ed). (pp1-50). Jones and Bartlette Publishers.
http://books.google.com/books?
id=NmY43MysbxIC&pg=PA24&dq=sunrise+enabler+picture&lr=#v=onepage&q=s
unrise%20enabler%20picture&f=false

Leininger, M. M. (1994). Nursing Education and International Perspective. Teaching and Learning
Transcultural Nursing. (pp 207-225). Juta & Co, Zebra Publications.
http://books.google.com/books?hl=en&lr=&id=tHq0pWamh1oC&oi=fnd&pg=PA207&dq=leininger%27s+tr
anscultural+nursing+theory&ots=wyJJ6fqy5b&sig=xyHHQ8sHiboDBmiVqyZD0RJ7kH0#v=onepage&q=leini
nger's%20transcultural%20nursing%20theory&f=false

Leininger, M. M.(1999). What is Transcultural Nursing and Culturally Competent Care. J Transcult Nurs 1999;
10; 9. http://tcn.sagepub.com/cgi/reprint/10/1/9.pdf
 CLIENT-NURSE-ENVIRONMENT DYNAMICS
Discuss the historical
Explain the key
backgrounds of concepts and
Leiningers Theory propositions
of Culture Care and relevant to the
above
Neumans Systems theories/models
Model; Discuss the strengths
Discuss the major and limitations of
the above
assumptions of the theories/models;
Theory of Culture and
Care and the Describe a personal or
Systems Model work that will
illustrate the key
concepts of
Leininger and
Neuman models.
 Some of the previous nursing theories you
studied in the previous modules on man as a
biological system, a behavioral composite
and an organism with stages of
development.
The other modules discussed nursing
theories that highlighted one-to-one client-
nurse relationships which depicted persons
as interactive beings.

Page 143
Two particular theories, those of Madeleine
Leininger and Betty Neuman, considered all these
dimensions simultaneously and comprehensively
within a cultural and systems perspectives.
They viewed the environment as encompassing
family, society, culture, healthcare professionals,
significant others, as well as the socio-economic
and social conditions surrounding the client.
Page 144
 Neuman asserted that man is in constant
interaction with their environment and that any
change occurring in one affects the other.

Leininger stated that culture guides a particuas

grouos thinking, decisions and actions in patterned
ways

Page 145
LEININGERS THEORY OF CULTURE CARE
Madeleine Leininger introduced the concept that
care and health practices have cultural dimensions.
Although I cited indigenous cultures as examples, in
this modern day and age, nurses encounter different
kinds of clients in different health care settings.

Page 146
 There may be instances perhaps, that in your
interactions with your clients, you found some of
them difficult, demanding, or passive. You must
have felt exasperated with the way these clients
behaved and reacted even to your tender loving
care. You must have asked, who really is causing
the problem here the client or myself, the
caregiver? Am I being aware of the cultural needs of
my clients? You, as a nurse, should be especially
aware of the cultural aspects of nursing care
because you have constant and more direct
interactions with clients compared toother members
of the health care team.
Page 147
 For many years, studies have been conducted
along this line with the purpose of helping
nurses work more effectively with clients from
different cultures. The work of Leininger on
human care theory was a result of extensive
studies of many cultures, both western and
non-western

Page 148
 HISTORICAL BACKGROUND OF LEININGERS
THEORY OF CULTURE CARE

How was the theory

of Culture Care
developed?

Page 149
In the historical account that you are about
to read, you will be amazed at how
Madeleine Leininger devoted her career to
studying the cultural dimensions of human
care and caring.
Her theory was developed through insights
from personal experiences, extensive
readings in anthropology, and in-depth
studies of the caring behavior and values of
selected cultures.

Page 150
 PERSONAL
Leininger EXPERIENCES
first realized the importance of culture
care to nursing practice in the mid-1940s. She was
then young graduate staff nurse in a large general
hospital in the United States.
While providing care, she received different
remarks and comments from her patients regarding
the care that she provided and realized that there
were differences in the way patients responded to
her care giving practices. She thought that being
sensitive to their responses was important to
human care.

Page 151
During that time, many nurses like her
believed that caring meant spending time
with patients and listening to their stories
about themselves, their families, work and
home life.
During the mid-1950s, while working as a
psychiatric clinical nurse specialist in a child
guidance home, she observed recurrent
behavioral differences among children she
looked after for. She concluded that these
differences in the way they played, ate, slept,
and interacted were rooted in their culture.
Page 152
On the other hand, she identified in the staff a lack
of knowledge of the childrens cultures as the
reason why nurses were unable to respond
appropriately to the childrens behavior and
expressed needs. This time, she recognized the
need to develop nursing strategies that would
incorporate different cultures, patterns and life
ways.
Toward this end, Leininger pursued doctoral studies
at the University of Washington, focusing on
cultural anthropology.

Page 153
In 1978, Leininger defined Transcultural
Nursing as:
a learned subfield or branch of nursing
which focuses upon the comparative study
and analysis of cultures with respect to
nursing and health-illness practices, beliefs,
and values with the goal to provide
meaningful and efficacious nursing services to
people according to their cultural values and
health-illness context.

Page 154
The term TRANSCULTURAL means across all
world cultures. It applies to the evolving
knowledge and practices related to this new
field of study and practice.
According to her, transcultural nursing theory
and ethnoscience methods allow one to
discover and learn about peoples views and
practice of caring.

Page 155
According to her, transcultural nursing
theory and ethnoscience methods allow one
to discover and learn about peoples views
and practice of caring.
Ethnomethods use people-centered data
sources that focus on emic (insiders
views), views, as opposed to the
researchers etic (outsiders views).

Page 156
 Leininger clarified that her Culture Care
Theory was not just an application of
anthropological concepts to nursing.
She explained that while the roots of culture
are discussed mainly in anthropology, and
concepts of care are discussed largely in
nursing, the theory was developed to
discover that will serve mainly the discipline
of nursing.

Page 157
 Well, you may be thinking that this mission
that Leininger decided to undertake was
easy.
But according to her, it took tremendous
leadership skills to introduce anthropological
insights in nursing, and in the process
develop a Culture Care Theory.

Page 158
 First, there were no nurses who had interest
in conceptualizing the actual or potential
relationship between anthropology and
nursing.
Second, after formulating and disseminating
some ideas and hunches related to her
theory, there were still very few nurses
interested in such strange idea in nursing.

Page 159
She realized that nurses realied too heavily
on biophysical and psychological
explanations with virtually no awareness
of how culture could influence nursing and
nursing care.

Page 160
 Challenged as she was to continue developing
her theory, she envisioned helping nurses to
discover new knowledge and different
perspectives of nursing. Leininger encouraged
mane students and faculty to pursue
graduate studies in anthropological nursing
practice.

Page 161
 She saw nursing in the 21st century as multi-
cultural because of the global changes that
would bring people closer to each other due
to changes in social, cultural, political, health
care, and technological forces.

Page 162
 LEININGER THEORY OF CULTURAL CARE
In this section of the module, you will have a
glimpse of what Leininger wanted to
emphasize in her theory.
She called her theory Culture Care Diversity
and Universality.

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 According to her, the purpose of the Culture
Care Theory is to discover human care
similarities (universality) and differences
(diversity) in relation to world view, social
structure and other dimensions.
The goal of the theory is to improve and
provide culturally congruent care that is
beneficial, fitting, and useful to the client,
family or culture group.

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 In conceptualizing the theory, Leininger held
this as the central tenet: CARE is the
essence of nursing, and its central, dominant
and unifying focus.
She stated that culture care would provide a
distinctive feature by which to know,
interpret, and explain nursing as a discipline
and profession.

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 Leininger theorized that all cultures of the
world had folk, indigenous and naturalistic
lay care systems and that some people were
exposed to professional health care systems.
Folk and professional health care systems
greatly influenced individual or group access
to quality care in favorable or less favorable
ways.
She further stated that what was similar or
different between folk and professional
systems was yet to be discovered.

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 To support her theory, she formulated several
assumptive premises which included:
Human caring is a universal phenomena, but the
expressions, processes, structural forms, and
patterns of caring vary among cultures.
Caring acts and processes are essential for human
birth, development, growth, survival, and peaceful
death.
Care has a biophysical, cultural, psychological,
social, and environmental dimension, and the
concept of cultural provides the broadest means to
know and understand care.
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 Nursing is a transcultural phenomenon as
nurses interact with clients, staff, and other
groups, and requires that nurses identify
and use intercultural nurse-client and system
data.
Care behaviors, goals, and functions vary
transcultural because of the social structure,
worldview, and cultural values of people
from different cultures.
Self and other care practices vary in
different cultures and in differences folks
and professional care systems.
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 The identification of universal and non-
universal folk and professional caring
behaviors, beliefs, and practices is essential
to discover the epistemological and
ontological base of nursing care knowledge.

Care is largely culturally derived and

requires culturally based-knowledge and
skills for satisfying and efficacious nursing
practices.

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 There can be no curing without caring but
there can be caring without curing. (The
statement means that curing activities must
go with caring activities. As Leininger sais,
care is the nurses way of being with and
helping people. Caring can be done not only
in illness states but also wellness conditions
in order to improve the human health
condition.)
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 THE SUNRISE MODEL
Leininger viewed her models as the rising of
the sun. The upper half of the circle
depicts components of the socio-cultural
structure and worldview factors that
influence care and health through language
and environment.

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 These factors influence folk, professional, and
nursing systems which are in the lower half of the
model.
The nursing subsystem ast as a bridge between folk
and professional health systems.
Through the three types of nursing care decisions
and actions, it is possible to provide culture
congruent care that is beneficial, satisfying, and
meaningful to people.
These nursing decisions and actions are: CULTURE
CARE PRESERVATION, CULTURAL CARE
ACCOMODATION, AND CULTURAL REPATTERNING.

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 The arrows on the model indicate influences
which flow in different areas and across
major factors.
The factors are closely interrelated to each
other, very much like a view of the total
functioning of human beings.
The dotted lines indicate an open world or an
open system of living.
Do you find the model helpful in capturing
the essential dimensions or components of
the theory?

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Culture care preservation or maintenance to
those assistive, supportive, facilitative, or
enabling professional actions and decisions
that help individuals preserve or maintain
favorable health and caring lifeways.
A good example is promotion of breastfeeding
practices. Another is maintaining the
involvement of families/relatives in caring for
the client.

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Cultural care accommodation or negotiation
refers to those culturally based assistive,
supporting, facilitative, or enabling
professional actions and decisions that help
people of a particular culture adapt to, or
negotiate with others, a beneficial or
satisfying health outcome.

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 We can cite as an example the training of
hilots or traditional birth attendants on the
use of sterile technique in delivering babies.
We can also consider nurses action as
negotiation when she advises a client about
the positive and negative aspects of seeking
help from an indigenous spiritual healer.

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Culture care restructuring or repartterning
refers to those assistive, supportive,
facilitative, or enabling professional actions
and decisions that help people change or
modify their life ways to accommodate new
or different health care patterns that are
culturally meaningful and satisfying to them.
For example, a client who is a chronic smoker
can work together with a nurse so that the
former will stop smoking for his own health
and well-being.

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 Leiningers Sunrise Model guides nurses in
discovering knowledge about culture-specific care
practices that can be used to improve nursing care.

In using this model, you may work either from the

top or bottom depending on the scope of your
interest or inquiry. You may want to begin
exploration by focusing your study on the care of
individuals or groups in hospitals or homes (lower
part of the Model.)
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Then you gradually move the exploration
upward to include specific culture. Finally,
you move on to discover large scale
phenomena including the worldview, cultural,
and social structural dimensions of several
cultures.
Let me illustrate this by an example:

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You may be interested in discovering the caring ways
of the Aetas of Zambales in Central Luzon.
Specifically, you may want to explore their childbirth
practices. Then yo may want to expand your study to
include other Filipino indigenous cultures such as the
Mangyans of Southern tagalo and the Tinguians of
Northern Luzon, or the Subanons and Maranaws od
Mindanao because you want to discover similarities
and differences in childbirth folk beliefs, practices, and
taboos. If you are interested in doing large scale
study, then you would look into bigger aspects of life
economy or production, social structure and political
organization and how these factors influence their
health, well-being, and caring practices.

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 From 1960 to 1990, Leininger and other
nurse studied 54 cultures in Western and
Non-western societies. They were able to
identify 172 care constructs with specific
meanings, usages, and interpretations which
can guide nursing actions and decisions. The
studies revealed in general that:

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1. Emic culture care knowledge from western
and non-Westerm cultures showed more
differences than similarities in culture
values, usage and meanings,
2. The social structure and worldview of
Western and Non-Western cultures strongly
influenced care practices leading to health
or well-being.

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3. Major differences existed between the
clients cultural care knowledge (emic
viewpoint) and that of professional nurses
and other health personnel (etic viewpoint)
in hospital contexts,; and
4. Culture care differences between the client
and health personnel gave rise to conflicts,
stresses, noncompliance, and slower client
recovery.

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 Other theories generated by studies
conducted by Leininger and several graduate
Transcultural students reveal the following:
1. Nursing care decisions or actions that reflect
the use of the clients cultural care view
values, beliefs, and practices were positively
related to clients satisfaction with care
received.

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3. High dependency of the clients upon technological
nursing care activities were closely related to
cultural care that reflected decreased personalized
care actions.
4. Religion and kinship care factors were more
resilient to change than technological factors.
5. Self-care practices were evident in cultures that
value individualism and independence; other care
practices were evident in cultures that support
human interdependence.

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STRENGTHS AND
LIMITATIONS

Page 186
 A major strength of Leiningers Theory is the
recognition of the importance of culture in
providing nursing care. Unlike other nursing
theorists who held that person, nursing,
health, and environment are the basic
concepts in nursing, Leininger focused o care
as the central aspect of nursing.

Page 187
 She asserted that the use of the term
PERSON may be controversial particularly in
non-western cultures because the concepts
of family or institutions are more important
and meaningful to them.
She stated that there are disciplines such as
the humanities and the sciences which
already focus on man or person.

Page 188
 She further stated that while the concept of
ENVIRONMENT is important in nursing, it is not
really unique to the profession. She likewise
believed that the concept of HEALTH is not distinct
to nursing becaue many disciplines and fields have
studied health.
The theory is useful and applicable to both
individuals and groups of clients because the goal
is the same - rendering culture-specific care.
The Sunrise Model can be used as a guide for the
study of any culture or for the comparative study of
several cultures.

Page 189
 While the theory does not provide specific directions
for nursing care, it provides guidelines for the
gathering of knowledge, and a framework for
decision-making that would be great benefit to the
client.
Leininger did not use the term NURSING
INTERVENTION because the she believed that the
term communicates some sort of interference or
imposition on peoples cultural practices.
Even the term NURSING PROBLEMS is not part of
her vocabulary for the reason that nursing problems
may not necessarily be the peoples problems; or
the problems may be viewed differently by people of
different cultures.

Page 190
 If the theory can be applied in planned
nursing experiences, it can help nurses
become culture-sensitive health care
professionals.
However, as Leininger herself pointed out
there are only few nurses who are
academically prepared to conduct
transcultural investigations, the results of
which can contribute to the increasing
knowledge about transcultural care.

Page 191
 Some critics of Leininger believe that her focus on
culture omits other variables such as class and
gender differences which can be sources of conflict
and stress within a society and among people.
Another comment is that culture-specific nursing
care may divert attention from the uniqueness of
the individual.
Wilkins suggested that nurses should use cultural
awareness. Sensitivity and a good knowledge base
in asking the right questions so they can make a
realistic and proper assessment of the needs of each
of the individual.

Page 192
 SUMMARY
The major concepts of Leiningers Theory are
culture, culture care, culture care diversity
and universality, worldview, social structure,
environmental; context, folk health system,
professional, culture care, preservation,
culture care accommodation, culture care
repartterning. These concepts and their
interrelationships provide the basis for the
sunrise of The Theory.

Page 193
 The Sunrise Model presents of focus which
move from the cultural and social structure
through individuals, families, groups, and
institutions in diverse health care systems in
which nursing care decisions and actions can
involve culture care preservation,
accommodation and repartterning.

Page 194
 Leininger said that cares are those care
patterns, values, and behaviors that are
common across cultures. Care diversities are
those patterns and processes that are unique
or specific to an individual, family, or cultural
group. A basic tenet of Leiningers theory is
that human beings are inseparable from their
cultural background and the society which
they belong.

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