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
July 13, 1925-August 10, 2012