Foundress
- IT IS TIME TO CELEBRATE, REFLECT AND LOOK INTO THE FUTURE
- Dr. Madeleine M. Leininger
- Founder of Transcultural Nursing
- Leader in Human Care Theory and Research
October 2009
This is a very special occasion and time to welcome everyone to celebrate and to reflect on the tremendous achievements
since the Transcultural Nursing Society was established 35 years ago.[1] Time passes so quickly and we often do not take
time to reflect on our achievements over time and also to express our gratitude to leaders and staff in the Society. It is also
important to think about our progress and reflect on the future. In this message, I will highlight some of the noteworthy
accomplishments of the TCN Society the past 35 years. It is wise to reflect on the TCN Society’s impact on nursing and health
care. Most of all, we need to acknowledge some of the many outstanding members and leaders with their contributions
that made the TCN Society a full, active and outstanding organization. It is important to state this is not a historical account
of the Society but rather some major themes that have made the TCN Society so special and important to nurses and others
the past 35 years. As the founder and an active leader of transcultural nursing, I am in a unique position to reflect upon
some dominant themes of importance to members, colleagues, cultures and the Society at large. Such
achievements are important to recognize, not only for nurses but other health care personnel, public citizens and to many
interested world citizens. It is, therefore, time to celebrate, rejoice, and reflect upon some of these many achievements
and their impact on serving cultures, and helping nurses in local, regional, national and transnational areas in the world.
This is a also historical event to come together to reflect upon the ways the TCN Society has contributed to the health care
to many cultures for their health and well-being The TCN Society has had a major impact with beneficial services to improve
nursing and improve health care to diverse cultures in the world. But, at the outset, I believe we need to pause and
consider this important question: What might nursing and health services be like if transcultural nursing not been
established as a formal area of study, research and practice in nursing and health care services beginning in the late 1960’s
[2] As many of you know, the idea to establish and develop a new field of transcultural nursing was difficult when I began
this challenge in the late 1950’s. It was at this time that I identified that culture and care were the missing and significant
factors in nursing and health care services. Culturally-based care was not an integral part of health care services. This was
a major “cultural shock” to me, and a major and serious omission in nursing and in most health care services in the early
transcultural nursing era.[3] At that time I had just returned from three years of field research in a non-Western culture in
the Eastern Highlands of New Guinea focused on studying culture and care
relationships to well-being. It was the Gadsup people who clearly revealed to me the importance of culture and health
care. Culture and care were closely related to their health outcomes[4]. During the three-year period with the Gadsup, I
realized that nurses would have a difficult time serving these people unless prepared about the culture and their care
needs. I realized that nurses needed to be prepared to understand and help cultures receive care that fit their needs. So
when I returned to the United States, I was determined to establish a new field I called transcultural nursing to study and
help cultures in specific ways. I took the deanship position at the University of Washington School of Nursing to give
leadership to this new field and moved ahead with my ideas. I envisioned that if one million nurses were prepared in
transcultural nursing, they could make a great difference in the quality of care to cultures that were often avoided,
misunderstood and neglected due to cultural negligence and related problems. This meant nurses had to be prepared
about cultures and their care needs through formal courses and programs and with theory and research to guide their
practices. This was a great idea but also a major challenge to me. At this time (1960-1970) there were no faculty and nursing
students prepared in this area. Moreover, most nurses had not conceived or imagined such a new field. And yet, human
beings were born and raised in their cultures and their health and illness states were influenced by their culture. Why had
culturally-based care not been central to nursing education and practice? It was clear the faculty and students needed to
be educated to teach and practice transcultural nursing. I held to my belief that if you believe in something important to
human beings, that some time and in some place this goal could become a reality. With my father’s German heritage and
my Irish mother’s background, I was supported by this belief. It was my father’s determination and my mother’s love of
humor, music, and to remain positive if things were tough in any pursued goal. My mother taught me to sing and laugh
when work became difficult, discouraging or very difficult. These virtues helped sustain me in my goal to develop
transcultural nursing. As many of you know from my books and publications, beginning with the first transcultural nursing
book in 1978, I began by identifying some basic transcultural nursing concepts, principles and potential practices for the
new field of nursing. These concepts and principles became the basic and fundamental ingredients of transcultural
nursing helped nurses to study and come into the new field. Gradually and slowly, these ideas with many examples of
potential transcultural nursing practices began to be assimilated by nurses. It was the nurses who had been in military
service or missionary work, and nurses functioning in community settings with clearly different or “strange beliefs and
practices” that helped nurses to grasp the idea of transcultural nursing. It was these interested nurses who came to take
transcultural nursing courses at the University of Washington in the early 1970’s. As Dean at the University of Washington
School of Nursing in 1969, I also helped faculty become interested in transcultural nursing and by 1978, transcultural
nursing was launched in the school. I well remember Beverly Horn as the brave and venturesome nurse to become the first
nurse wanting to be prepared in transcultural nursing. Dr. Horn today is our Executive Administrator of the Global
Transcultural Nursing Office and she continues to make tremendous contributions to transcultural nursing. She was also
President of the TCN Society. While Dr. Horn was taking courses and completing them, she became the first nurse to do a
major transcultural nursing research study of studying the Mackelshoot people in Washington State. She focused on her
interest in maternal child caring. It is important to state here that Professor Dorothy Crowley, an excellent faculty member,
was very interested to explore caring with me in a seminar on Human Caring as the Essence of Nursing and Health.
Professor Crowley and Dr.Horn became valuable leaders to support transcultural nursing. These faculty held that culture
and care were essential to nursing. I held that care was central and the essence of transcultural nursing which I had
emphasized in my beliefs, teaching, research and writing. Gradually,transcultural nursing became a reality with many
community field studies and mentored clinical practices by nurses. This was most encouraging as many nurses at this time
were wed to curing, medical symptoms and learning many medical diagnoses. Nurses were following the cultural norms of
medicine’s beliefs and practices and only a few nurses envisioned that nursing could be a strong, powerful, and
independent discipline with transcultural nursing. By the mid 1970’s, there was a core of prepared and enthusiastic nurses
who were eager to make transcultural nursing a reality and they were most helpful to help other nurses value and envision
transcultural nursing. In 1974, it was time to establish the Transcultural Nursing Society. These interested nurses and
others were sharing their ideas, questions, interests and experiences with each other. It was a very wise step to launch the
TCN Society as nurses needed to come together to learn, share and support each other in the new field. In 1974, the first
conference focused on transcultural nursing occurred in Hawaii with a large attendance, including deans, some physicians
and other interested people. It was a highly successful conference. Since 1974, the attendance at the annual Transcultural
Nursing Conferences has grown in number, interest and colleagueship. As the membership and interest grew with the
TCN Society at annual conferences, more nurses became interested in transcultural nursing as a legitimate and important
area of study, research and practice. Moreover, clients of diverse cultures were gradually receiving transcultural nursing as
their first experience with transcultural nurses. Soon transcultural nursing became institutionalized in schools of nursing,
hospitals, community health agencies and public health services. Transcultural nursing had become a legitimate
educational reality at the University of Washington by 1975 with the support ofmembers of the TCN Society. By 1987 and
early in the 1990’s many outstanding transcultural nurses were teaching and practicing transcultural nursing. Several faculty
and their students were beginning to transform nursing and health care in community agencies and hospitals.
Transcultural nursing concepts, principles and practices were becoming incorporated into care of cultures. Although I could
identify many nurse leaders, teachers and mentors, one can find their names in my History of Transcultural Nursing.[5] I
viewed this early period (1970-1978) as the New and Primary Transcultural Nursing Era in nursing as transcultural nursing
concepts and practices were beginning to transform nursing from the past practices to the education and practice of
providing culturally congruent care, the goal of transcultural nursing and health care. This was the era when many nurses
were eager to share their experiences with other nurses. The TCN Society and transcultural nursing grew in size and
interest. This was the time when a number of nurses were working in other countries or “foreign” institutions. For example,
Muriel Larson had been bringing nursing students to Greece and teaching these students transcultural nursing directly with
the cultures in highly successful ways. Likewise, Dr. Akram Omeri and Dr. Elizabeth Cameron-Traub were teaching
transcultural nursing in Australia. Carol and Carolyn Bloch were also functioning and demonstrating transcultural nursing
in a large hospital in California with Hispanic clients. Many other nurses prepared in transcultural nursing were active in
teaching and demonstrating transcultural nursing practices with different cultures such as Frances Wenger with the Old
Order Amish, Gennie Kinney and Kay Daub with the Hawaiians and Pacific Islanders. In 1990, the Executive Officers and
Board of Trustees of the TCN Society established the Global TCN Office at Madonna University. Donna Barnes was the first
Secretary and was of great help to the organization. Frances Wenger, as President of the TCN Society, had the first office in
the new wing of the Global Office. This Global Office was conceived by the TCN Society. To date, it has had a significant
impact to nurture and communicate with nurses worldwide. With the excellent and competent leadership of Dr. Beverly
Horn, as Executive Director, and Lisa Dobson, the Administrative Officer of the Global Office, the Global Office has been
most successful and effective to help nurses in the United States and many other countries to support and maintain
transcultural nursing. Lisa Dobson, with her financial skills and astute administrative talents has been an outstanding
Director and facilitator of the Office. Most importantly, Dr. Margaret Andrews was successful to obtain a grant from the
HRSA Fund of one million dollars over a three-year period (2008-2011). This grant was supported by the TCN Society in
partnership with Madonna University. It is unique and has been of tremendous help to the Global Office, the Directors,
staff and many members of the Society. The members of the TCN Society are most grateful for this grant and for the
outstanding leadership of Dr.Beverly Horn and Lisa Dobson. These leaders have been live and a dynamic force to make the
Global TCN Office successful and effective. Indeed, the leaders and staff at the Office have been truly outstanding over the
past nearly twenty years and have worked closely with the TCN Society. Besides the TCN Society, there have been other
major factors that have been important to establish and maintain transcultural nursing. These factors can only be
identified briefly. First, the Journal of Transcultural Nursing was launched in 1986. It was extremely difficult to obtain a
publishing company for the Journal. I contacted 20 publishing companies but none were interested because “they never
heard of transcultural nursing and medicine had not approved it.” These incredible statements led me to contact Dr.
Michael Carter, Dean of the University of Tennessee School of Nursing. Dr. Carter was of tremendous help to get the Journal
published and I served as the first editor. Later Marty Douglas was appointed official editor and Sage Publishing Company
became the publishers of the Journal. The Journal was supported by the TCN Society. It has had a tremendous impact
locally, regionally, nationally and internationally to disseminate transcultural nursing research, theory, activities and
practices worldwide. In addition, John Vanderlaan, a computer/internet expert, played a major role to make transcultural
nursing known worldwide with frequent information about the TCN Society, members, research and news items of
members. John was of great assistance to spread transcultural nursing worldwide. He supported feedback communication
from nurses in transcultural nursing worldwide. Research and the work of many nurses in the Society were shared by John’s
creative internet services. In 2007, John Vanderlaan received the Leininger Breakthrough Award for creating and
disseminating transcultural nursing knowledge worldwide. Another major achievement of the Society was to establish
certification of transcultural nurses. This was important to assure the public, nurses, and citizens that nurses were
knowledgeable and skilled to provide culturally congruent care. Most recently, certification examination and policies have
been updated and refined by the TCN Society under the chairmanship of Dr. Marilyn McFarland. This work was done to
make certification available worldwide and to revise the criteria for applicants. Dr. Marilyn McFarland, our first prepared
and certified transcultural nurse gerontologist, has served as Chairperson of the Committee. She has worked closely with a
core of with competent TCN committee and Societal members. Currently, the new certification process is now available to
nurses worldwide with electronic and reliable methods to evaluate the candidates. The TCN Society, through support and
contributions of its members, has offered several awards to help nurses pursue graduate preparation, research and
theoretical preparation in transcultural nursing. These awards have markedly helped increase the number of nurses
prepared in transcultural nursing and for certification and leadership roles. These awards have been of great help to
nurses within the United States and from other countries to become prepared, knowledgeable and competent in
transcultural nursing, and ready for certification. The Transcultural Nursing Conferences sponsored yearly by the TCN
Society the past 35 years have been a tremendous means for transcultural nurses to come together and share their
research, theory and practices with each other and to often have several papers published in the Journal of Transcultural
Nursing. Each year as the members come to these conferences saying how they are stimulated and refreshed by these
conferences. The presenters are major leaders and all papers are generally grounded in theory, research and practices.
Nurses often state that these conferences are “most uplifting and renew their interest to gain new knowledge in
transcultural nursing.” Learning from other transcultural nurses is encouraged and especially
from nurses caring for diverse cultures. The conference proceedings and research papers are an inspiration to the
attendees. Moreover, many of the conferences are held in different countries to accommodate travelers and to stimulate
global thinking and practices and encourage membership. Papers are generally focused on providing culturally congruent
care. Several keynote addresses and research papers are published in the Journal of Transcultural Nursing and/or
published in diverse publications or on-line. Attendees repeatedly say, “It is so rewarding to meet nurses worldwide and
to learn of their teaching and practices”. Learning about transcultural nursing in diverse cultures and subcultures in the
United States and in other lands has been of much interest to the attendees. New transcultural nursing relationships often
occur. Transcultural nurses also learn about transcultural nursing leadership working in Western and non-Western
cultures with students and colleagues. Muriel Larson, Cheryl Leuning, and many other nurses from other countries have
become role models to demonstrate their leadership from countries such as in Greece, Finland, Canada, Australia, Asia,
Africa and many other places. Great success stories are often shared among the attendees to help them in their teaching
and research practices. In the late 1950’s while pursuing a PhD in cultural and social anthropology at the University of
Washington (Seattle) and while helping to establish PhD Nurse Scientist Programs with Dr. Fay Abdellah, I began to
develop my Theory of Culture Care Diversity and Universality.[6] This was a great challenge for me as it was the first nursing
theory focused on discovering and explicating culture care phenomena and from transcultural nursing caring perspectives.
By 1963-1966, the Theory of Culture Care had been well formulated and was being systematically examined by transcultural
nurses in the United State and a few other countries. I had used the Culture Care Theory while conducting field research in
New Guinea and with several United States cultures and subcultures. The goal of the theory was to discover ways nurses
and other health care providers could provide culturally congruent care, as the goal of the theory. This phrase I coined in
1960 and is now being used at the Federal and State levels and in other countries. Most importantly and simultaneously, I
developed the Ethnonursing Research Method which was a qualitative research method. Qualitative research methods
were limitedly used in nursing. However, several qualitative methods as ethnonursing were so essential to tease out in-
depth care knowledge about dominant culture care meanings and expressions in cultures. The Theory and the
Ethnonursing Research Method with five enablers were unique to explicate culture care phenomena and have been used
by many members of the TCN Society and by nurses worldwide the past thirty year and with other professions. The Theory
and Method with five Enabler Guides and three distinct and unique modalities to guide nurses’ decisions and actions in
order to provide culturally congruent care, They have been well received and used in research with cultures. Both the Theory
and the Method have been major contributions supported by the TCN Society. Several grants have helped develop, affirm
and establish transcultural nursing as a discipline. Establishing transcultural nursing as a discipline has long been a
major goal of the Founder. It has been a significant achievement that has been declared by many nurse leaders such as
Professors Andrews, Clarke, McFarland, Wenger, and many other leaders as “the first area in nursing to have achieved
discipline status.” This has been a noteworthy achievement. Transcultural nursing as a discipline has been largely
achieved based on theory, research methods and findings that have had beneficial outcomes to clients of diverse cultures.
The Theory has been a significant development to establish the unique discipline knowledge which have been supported
by the TCN Society for transcultural nursing as a discipline. A recent article by Andrews, Clarke, Leininger and McFarland2
attest to this fact and transcultural nursing as a discipline. It is also important to state that the Theory and Research
Method have led to many new discoveries about largely unknown cultures and nursing care knowledge as the findings are
often breakthroughs in nursing and health care. Many transcultural nursing publications, transcultural nursing articles,
books and reports reveal these findings and uses of findings. Since 1975, the Theory and Ethnonursing Research Method
have guided many faculty, undergraduate and graduate students in their thinking and in research studies. It has been most
encouraging to find transcultural nurses eager to study Western and non-Western cultures and also subcultures with the
Theory. In addition, other disciplines are now discovering and using the Culture Care Theory and Ethnonursing Research
Method in their professional work, such as dentists, physicians, religious groups, economists, educators, ethicists and
many other groups are using the theory and the method. Some of these interdisciplinary groups have become interested
and active to work with transcultural nurses and the Society. Accordingly, TCN Society members have been active to
influence interdiscipline transcultural nursing knowledge, principles and methods since 1986 with different colleagues in
regional and transnational locations. These members promote the goal of transcultural nursing and use of the Theory of
Culture Care and the Ethnonursing Method to provide culturally congruent care. The latter phrase I coined in the late 1950’s
as the goal of transcultural nursing and of the Culture Care Theory. Providing culturally congruent care is today commonly
heard at federal meetings in the United States and many agencies and organizations as well as overseas and are often
cited as a mandate to provide quality care to cultures. Transcultural nursing continues to have a significant impact in
health care to provide care to diverse cultures and is influencing worldwide cultures. This is commendable and a marked
change from 50 years ago before the TCN Society and the transcultural field were established. It is also important to state
that members of the TCN Society have recently written and published a Human Rights Document as a guide to help reduce
world conflicts and provide social and cultural justice. It is a guide for the United Nations and that it will be adopted by the
UN members. Such publications and many others of the TCN Society members have been most helpful to promote culturally
congruent care and discipline status, and have helped to promote world peace, and to reduce intercultural world conflicts,
stresses and wars. Such contributions have been noteworthy the past 35 years since the Society was established. One
would be remiss not to mention that there are many nurses functioning as transcultural nurses in other countries. These
nurses remain active members of the Society and have promoted culturally-based care. The noteworthy leadership of Dr.
Akram Omeri and Dr. Elizabeth Cameron Traub in Australia and the great leadership of Dr. Gennie Kinney and Dr. Kathryn
Daub to establish transcultural nursing in Hawaii and in the Pacific Island Region have been laudatory and significant
contributions. The work of nurses in the Scandinavian countries, in Japan, Taiwan, South Africa and other places has also
been commendable. As I stated at the beginning, this is not a full history of the importance and many contributions of the
TCN Society, but mainly to highlight and refresh our memories of some major achievements with the TCN Society the past 35
years. These contributions help us to realize that the TCN Society and its members have been highly significant to many
cultures. They are the springboard for the Society to move forward in this century and future centuries as transcultural
nursing becomes fully recognized and, integrated into health care practices worldwide. In looking into the future, one can
anticipate that the TCN Society will grow in membership worldwide. The Society and the Global Office will continue to serve
many nurses and health care providers in the United States and globally.[7] One can predict that the TCN Society will
remain an active organization to promote transcultural health care to many diverse cultures and subcultures and with
interdiscipline colleagues worldwide. The Society will continue with theory-based research to improve, reform, modify and
serve diverse and similar cultures. As the Founder of the transcultural nursing field, I anticipate that the TCN Society and its
members will remain active to discover the universality (or commonalities) of transcultural nursing care and respect and
will support diversities worldwide. When this occurs, the TCN Society will greatly expand its members with new Global TCN
Centers to support worldwide goals. This will be an exciting global era for the TCN Society members who will remain active
participants and recipients of the continued benefits of the Society. One can also anticipate many additional
developments (too numerous to mention here) will occur and stimulate new and all established members to be creative
and persistent leaders in transforming quality of care to cultures and world citizens. Indeed, the future seems highly
promising as the TCN Society continues its active leadership to provide culturally congruent care to all cultures. In this last
section it is appropriate to express our sincere thanks and deep gratitude to all the past leaders, members, Presidents,
and Board of Trustees, staff and especially our very capable and competent Executive and Administrative Officers of the TCN
Society and to Madonna University for Global TCN Office and for their tremendous help. The Society has been especially
grateful for the Madonna University Presidents, Deans and Officers as they have been most supportive of transcultural
nursing for the past 35 years and we are most grateful to them. We must also thank our Divine Leader, God, for His
guidance and help through the years. What a special blessing. We are especially thankful that the transcultural nursing
field was established and has grown through the past 50 years. As the Founder, this has been rewarding to witness in my
life span and has been a privilege and honor to be a part of this important cultural movement. To witness the growth of
transcultural nursing to serve people of diverse cultures has been highly rewarding. Most of all, it has been a great joy to
know and work with TCN members through this 35-year span of time. I was privileged to know many of you personally, your
families, your interests and your talents through special occasions and in my teaching and research. I thank God daily for
your friendship, your help and commitment to know and support transcultural nursing and the TCN Society. Thank you
sincerely for your contributions to the TCN Society and to make transcultural nursing a truly great and recognized discipline
with the desire to serve to humankind worldwide. Let us express a powerful and loud “THANK YOU” to all contributors and
let us go forward with enthusiasm to continue so that transcultural nursing will grow worldwide. We will know and
experience cultures as an integral part of our world and uphold my original motto (1960): “That we will become one united
world culture for unity, good health, peace and goodwill for all cultures in the world as we become one world with many
cultures.”
[1] Leininger M. and McFarland, M. (2006). Culture Care Diversity and Universality: A Worldwide Theory of Nursing. 2nd
edition. New York: Jones & Bartlett
[2] Clarke, P., McFarland, M., Andrews, M., Leininger, M. (2009). Caring: Some reflections on the impact of the Culture Care
Theory by McFarland & Andrews and a conversation with Leininger. Nursing, Scientific Quarterly, Vol. 22, No. 1. July 2009
[3] Leininger; M. (1995). Transcultural nursing: Concepts. theories. research. and practices (1st. ed. originally published in
1978, New York: John Wiley & Sons). Reprinted. Columbus, OH: Greyden Press. (1995). First definitive publication on
Transcultural Nursing
[4] Leininger, M., & McFarland, M. (2002). Transcultural nursing: Concepts, theories, research and practices (3rd ed.). New
York: McGraw Hill Book, Inc.
[5] The evolution of transcultural nursing with breakthroughs to discipline status. 2007. On at www.madeleineleininger.
com/resources
[6] Leininger, M. (1991). Culture care diversity and universality: Theory of nursing. New York: National Leaguefor Nursing
[7] Leininger, M. (1988). Transcultural Health and Nursing in the Twenty-first Century. Paper presented at Thomas Jefferson
University, Philadelphia, Pennsylvania. March 10, 1988.
Dr. Leininger’s recent articles may be found at: http://www.madeleine‐leininger.com/resources
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