University of South Dakota Honors Thesis: Culture Care in Medicine

This thesis, submitted to the University of South Dakota, examines the application of Leininger's Culture Care Theory to family medical history. The essay highlights the need to modernize the traditional approach to gathering patient medical information by integrating cultural considerations, as proposed by Leininger's theory and Sunrise Model. The author argues that globalization necessitates a patient-centered focus that respects and incorporates cultural backgrounds, especially regarding kinship and social factors, to improve healthcare outcomes. The paper explores the challenges of implementing Leininger's theory, emphasizing the importance of cultural competence in healthcare to address the diverse patient population. The conclusion stresses the significance of adapting to the changing demographics to ensure culturally sensitive and effective medical care. The essay provides an in-depth analysis of how the Theory of Culture Care can revolutionize healthcare by combining cultural integration and evidence-based practices.

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Honors Thesis Theses, Dissertations, and Student Projects
Spring 2019
Application of Leininger’s Culture Care Theory in Family MedicalApplication of Leininger’s Culture Care Theory in Family Medical
HistoryHistory
Avery Del Grosso
University of South Dakota
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Recommended CitationRecommended Citation
Del Grosso, Avery, "Application of Leininger’s Culture Care Theory in Family Medical History" (2019).
Honors Thesis. 43.
https://red.library.usd.edu/honors-thesis/43
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Application of Leininger’s Culture Care Theory in Family Medical History
By
Avery Del Grosso
A Thesis Submitted in Partial Fulfillment
Of the Requirements for the
University Honors Program
Department of Education
The University of South Dakota
May 2019

The members of the Honors Thesis Committee appointed
to examine the thesis of Avery Del Grosso
find it satisfactory and recommend that it be accepted.
Dr. Mejai Bola Avoseh
Professor of Educational Administration
Director of the Committee
Dr. Carole South-Winter
Assistant Professor of Healthcare Administration
Dr. Scott Breuninger
Honors Program Director

ABSTRACT
Application of Leininger’s Culture Care Theory in Family Medical History
Avery Del Grosso
Director: Mejai Bola Avoseh, Ph.D.
One of the very first interactions a patient has with medical staff is a one-on-one
interview to ascertain family medical history. However, the practice of recording pat
medical history has remained relatively unchanged for decades since the advent of
modern medicine. This begs a question of if there is a way to improve the current st
quo. Leininger’s Culture Care Theory and Sunrise Model implement both an innovati
and patient-centered focus that acknowledges and incorporates patients’ cultural
backgrounds into their healthcare plan. Combining Leininger’s Culture Care Theory w
the current process of recording family medical history will modernize a somewhat
antiquated aspect of modern healthcare, benefitting both patients and healthcare
professionals alike.
KEYWORDS: Leininger, Culture Care, Medical History, Globalization, Sunrise Model,

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TABLE OF CONTENTS
INTRODUCTION 1
FAMILY MEDICAL HISTORY 1
GLOBALIZATION 3
LEININGER’S THEORY OF CULTURE CARE (LTCC) 4
SUNRISE MODEL 5
THE FACTOR OF KINSHIP 7
WESTERN INDIVIDUALISM 8
INDIGINOUS COLLECTIVISM 9
LTCC AND FAMILY MEDICAL HISTORY 10
INCORPORATING LTCC INTO FAMILY MEDICAL HISTORY 11
CHALLENGES OF IMPLEMENTING LTCC 13
CONCLUSION 15
BIBLIOGRAPHY 17

1
INTRODUCTION
The technological boom of the 21st century has interconnected the world to a
unprecedented extent. The side effects of this interconnectedness can be seen in th
healthcare system. It is entirely plausible that a person may go from one side of the
to the other and find themselves in a hospital. Given the fact above, the United Stat
(U.S.) healthcare system must be able to adapt and accommodate patients of differe
cultures and worldviews. Madeleine M. Leininger created her Theory of Culture Care
Sunrise Model to address the challenge globalization has placed upon healthcare in
United States. There are seven key influences on Culture Care within the Sunrise Mo
one of which is Kinship and Social Factors. To the Western world, kinship may seem
straightforward, referring to direct family members or blood relatives. However, in
Eastern collectivist cultures, kinship takes on a much different meaning. Kinship can
made up of one’s direct family ties as well as neighbors, friends, and extended fami
Put into this context, this thesis seeks to elucidate how Leininger’s Culture Care The
can improve the current system of information regarding patient family medical hist
FAMILY MEDICAL HISTORY
According to the National Institute of Health, a family medical history is a reco
of health information about a person and their closest relatives. One’s medical histo
give clues to pathology, chronic illness, or potential risk factors for disease. Even so,
does not necessarily mean with certainty that a patient will develop a condition.
Typically, family medical history is collected via a self-disclosing questionnaire by th
patient or an interview with a medical professional. It is unclear precisely when reco
family medical history became common, standardized practice. However, the discov

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of genetics and heritability most likely spurred the widespread examination of family
history in medicine.
The concept of family medical history is not a novel one. Humanity has had th
idea that things can be passed down from parents to children for centuries. A relativ
recent example of this concept is the discovery of hemophilia in Queen Victoria’s fam
in the 19th and 20th centuries. Coined as “Royal Disease”, hemophilia was known to be
spreading through royal bloodlines, but nobody quite knew the mechanisms behind
or why. The conclusion of the human genome project in 2003 was a pivotal moment
where our understanding of human genetics increased exponentially, and the
underpinnings of family heredity began to be truly be unraveled. Even then, it took
another six years for Tsarevich Alexei, Rogaev et al. to discover in 2009 that Royal
Disease was hemophilia B. In light of the aforementioned historical context, medical
family history occupies a peculiar, yet universally important place in history and in o
everyday lives. With the advent of modern genetic research, medical professionals c
now identify risk factors for disease and pathology long before they manifest themse
within a patient.
The way in which medical professionals collect family medical history is
typically through a self-reporting questionnaire or a one-on-one interview with their
patients. This process has not changed notably since the conclusion of the human g
project. The most drastic change to the family history collection process has most lik
been the incorporation of technology such as computers, patient databases, and onl
charting. Such changes have increased the ease of use and access to patient medic
history for both patients and physicians, but the core process remains the same for

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patient that may find themselves in the U.S. healthcare system. In short, family med
history is a standardized process which is applied in the same fashion for every patie
regardless of circumstances. One consequence of viewing patient family history thro
a standardized lens is that progressive changes in patient demographics are not
accommodated for. But what is responsible for such sweeping changes in patient
demographics such that healthcare has fallen behind? I propose the answer lies with
globalization.
GLOBALIZATION
Leininger’s Theory of Culture Care is predicated upon the concept of a globaliz
world. For Leininger’s Theory of Culture Care to be fully understood, globalization m
first be clarified. Globalization has been around for centuries, even going as far back
the Renaissance (Mittelman 5). Globalization refers to the increasing transnational a
transcultural circulation of goods, people, ideas, money, and information around the
world driven most notably by the rapid expansion of technology in the twenty-first
century (5). Highlighting the effect globalization has upon the U.S., the U.S. Census
Bureau documented that in 1998 there was a total of approximately 26 million forei
born U.S. residents which comprised 9 percent of the total U.S. population (Riche 16
However, the 2010 U.S. Census reports that approximately 13% of the U.S. populati
now foreign-born residents (Grieco et al. 2). Put into the context of healthcare, this 4
change represents the possibility of millions more patients in the U.S. healthcare sys
from a wealth of different global cultures.
Along with political, economic, and educational institutions, hospitals are also
place where globalization’s effects converge. However, the healthcare industry is un

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when compared to similarly globalized institutions. For example, healthcare is unive
across all countries and cultures. Furthermore, healthcare is intertwined with politica
social, historical, and religious factors in every global society. The convergence of al
aforementioned factors and globalization into the U.S. healthcare infrastructure pose
problem to physicians, challenging them to provide culturally sensitive treatment fo
rapidly diversifying patient population. Leininger’s Theory of Culture Care attempts t
equip physicians and other healthcare professions with the tools and knowledge
necessary to address this problem.
LEININGER’S THEORY OF CULTURE CARE (LTCC)
In the United States, concerted efforts are being made in the last two decades
order to implement better cultural awareness in the healthcare field. Often referred
“Cultural Competence”, Leininger, a nursing theorist, from Omaha, NE, published h
Theory of Culture Care in 1995 to revolutionize healthcare by incorporating, “cognit
based assistive, supportive, facilitative, or enabling acts or decisions that are mostly
tailor-made to fit with individual's, group's, or institution's cultural values, beliefs, an
lifeways" (McFarland and Wehbe-Alamah 5). In other words, Leininger’s Theory of
Culture Care (LTCC) seeks to standardize healthcare in such a way that would be
appropriate, respectful, and decent for everyone that may find themselves in a glob
healthcare system regardless of their culture of origin. LTCC encompasses many asp
of culture such as religion, technology, education, politics, etc. The factors that LTCC
influence, in turn, influence how healthcare systems address their patients’ needs. A
Albougami confirms in an analysis of LTCC, “These factors, along with language and
social environment, significantly affect the services delivered by systems, whether

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traditional or professional.” (Albougami 1). Traditional medicine and traditional
healthcare systems refer to systems that treat afflictions through herbal and spiritua
means (Neba 133), whereas professional healthcare systems treat patients using lea
knowledge and evidence-based practices (Albougami 1). What LTCC suggests is
combining traditional medicine’s cultural integration along with professional healthc
objectivity to produce a healthcare system, which not only treats the patients’ symp
using evidence-based science but also respect the patients’ cultural beliefs, values,
concerns.
While it is clear that LTCC functions as a whole to incorporate culture into
healthcare, what exactly does the term “Culture Care” mean? At the time LTCC was
created, Leininger believed that the predominant theories of healthcare are much to
restrictive, introducing the Theory of Culture Care as a much more open and explora
approach to both culture and care. When Leininger created LTCC, the current trend
healthcare was towards standardization, where healthcare procedures are nearly ide
for everybody. Leininger coined the term Culture Care to embody the movement aw
from standardization and towards personalization of healthcare. More specifically,
Culture care refers to meaningful and therapeutic healthcare practices that are cultu
based (Leininger 9). Culture acts as a guide by which humans act and make decision
including material and nonmaterial aspects of a group or individual (Leininger 6). In
way, culture is inseparable from healthcare. Insofar as culture acts as a guide by wh
humans base their actions, then it follows that culture has ubiquitous influence over
nearly all aspects of life which includes patient-physician interactions in a healthcare
setting. Leininger makes the claim that it is this very nature of culture is the basis fo

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it should not be buried beneath standardization, but rather be brought to the forefro
healthcare.
SUNRISE MODEL
Leininger’s Sunrise Model (Fig. 1) is a visualization of her Theory of Culture
Care in the shape of a sunrise or half-circle.

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Fig. 1. Leininger, Madeleine M., and Marilyn R. McFarland. Culture Care Diversity an
Universality: a Worldwide Nursing Theory. 2nd ed., Jones and Bartlett, 2006.
The two-sided arrows throughout the Sunrise Model represent two regions interactin
with one another. At first glance, the Sunrise Model appears to have two-sided arrow
going between every level. This is quite deliberate, as it depicts the codependency o
various factors of LTCC. Each factor in the Sunrise Model affects all other factors aro
it. The Sunrise Model begins with an individual’s overarching worldview. A person’s
worldview encompasses the entirety of the Sunrise Model, indicating that it is the
foundation by which a person frames their healthcare experiences. Below “Worldvie
is “Cultural & Social Structure Dimensions”. The dimensions of Social Structure and
Culture envelopes the rest of the Sunrise Model much like “Worldview” does, convey
that it unilaterally affects all aspects of Leininger’s Sunrise Model. The wedges that
constitute the bulk of the Leininger’s Sunrise Model are labeled: technological factor
religious and philosophical factors, kinship and social factors, cultural values - belief
and lifeways, political and legal factors, economic factors, and educational factors. E
of these factors interact with one another to produce a complex system of reciproca
interactions. At the very bottom of the Sunrise is “Holistic Health/Illness/Death”, whi
takes the culmination of all the previous factors and relationships and relates them
healthcare. In essence, the Sunrise Model visually demonstrates how Leininger’s Cu
Care Theory links culture to healthcare.
THE FACTOR OF KINSHIP
Next are the kinship factor of Leininger’s Theory and Sunrise Model. In short,
kinship refers to familial ties that an individual experiences. This is different from fam