Madeleine Leininger

Leininger's Theory of Nursing: Cultural Care Diversity and Universality

This paper is focused on the essential features of the nursing theory of cultural care diversity and universality. An overview of the essential features is discussed to show how the theory was developed and how it has evolved during the past three decades. The theory was initiated from clinical experiences recognizing that culture, a wholistic concept, was the missing link in nursing knowledge and practice. Through a creative process of concept explication, reformulation, and resynthesis, the the ory of cultural care was set forth as a guide for the development of nursing knowledge. The concept of culture was derived from anthropol ogy and the concept of care was derived from nursing. The theorist holds that cultural care provides the broadest and most important means to study, explain, and predict nursing knowledge and concomitant nursing care practice. The ultimate goal of the theory is to provide cultural congruent nursing care practices. The author contends that if one fully discovers care meanings, patterns, and processes, one can explain and predict health or well-being. The assumptions, definitions, and theoret ical explanations related to cultural care are presented with the sunrise model to depict the major components of the theory.

Culture Care Theory: A Major Contribution to Advance Transcultural Nursing Knowledge and Practices:

This article is focused on the major features of the Culture Care Diversity and Universality theory as a central contributing theory to advance transcultural nursing knowledge and to use the findings in teaching, research, practice, and consultation. It remains one of the oldest, most holistic, and most comprehensive theories to generate knowledge of diverse and similar cultures worldwide. The theory has been a powerful means to discover largely unknown knowledge in nursing and the health fields. It provides a new mode to assure culturally competent, safe, and congruent transcultural nursing care. The purpose, goal, assumptive premises, ethnonursing research method, criteria, and some findings are highlighted.

What Is Transcultural Nursing and Culturally Competent Care

Although transcultural nursing and culturally competent care had its origins in the mid-1950s, there are nurses and other health professionals who often seek clarification of these timely and important ideas. In this brief article, I will clarify these two interrelated ideas as the founder and coiner of the terms. Transcultural nursing has been defined as a legitimate and formal area of study, research, and practice, focused on culturally based care beliefs, values, and practices to help cultures or subcultures maintain or regain their health (wellbeing) and face disabilities or death in culturally congruent and beneficial caring ways (Leininger, 1970, 1978, 1995). Transcultural nursing is directed toward holistic, congruent (appropriate), and beneficial health care. It remains one of the most challenging and revolutionizing developments in health care as our world becomes globally multicultural. Transcultural nursing concepts, principles, and research findings are transforming nursing and medical systems and practices. Indeed, transcultural holistic and comparative perspectives are challenging nurses and other health care providers to think broadly and to reduce mechanistic and highly technical and impersonal actions that fail to help cultural clients. Ethical and moral factors become clearly evident as one works with clients of diverse cultures. Most important, transcultural nursing theories with a holistic and comparative perspective have led to culture-specific care. The Theory of Culture Care Diversity and Universality, which I developed in the mid-1950s, has been a major theory to advance the body of transcultural nursing knowledge (Leininger, 1978, 1991). The theory is focused on diverse and universal (common) dimensions of human caring worldwide and is based on my position that care is the essence, the central, dominant, and distinctive domain of nursing and transcultural nursing. The well-known Sunrise Model (Leininger, 1991) guides the researcher and clinician in using the theory to provide culturally congruent care to individuals, families, communities, and institutions. Hence, the construct of culturally congruent care was inherent and the goal of transcultural nursing. Simply, culturally congruent care means to provide care that is meaningful and fits with cultural beliefs and lifeways. From a professional perspective, it refers to the use of emic (local cultural knowledge and lifeways) in meaningful and tailored ways that fit with etic (largely professional outsiders’ knowledge) to help specific cultures, whether ill, disabled, facing death, or facing other human conditions. Because culture is focused on the total or holistic lifeways of human beings, religion (spiritual), kinship, politico-legal, education, technology, language, environmental context, and worldview are all considered. This knowledge is thoughtfully and selectively integrated with medical and nursing physical, psychological, and other knowledge to provide congruent care. To date, transcultural nursing theory and research-based knowledge with general concepts, principles, and practices are transforming nursing and health care in several places. Beneficial (health promoting) and satisfying outcomes are highly rewarding to transcultural nurses but are especially rewarding to consumers of transcultural nursing care. The Journal of Transcultural Nursing has provided evidence of such benefits over the past decade (1989-1999).

The Significance of Cultural Concepts in Nursing

This article was originally published in Minnesota League for Nursing, Vol. 10, No. 3, 3-12, in 1966, and in the Journal of Nursing Education (1967). It was reprinted in Transcultural nursing: Concepts, theories, and practices (1978) p. 121-134. It is one of the first transcultural nursing articles. It is held as a historical classic in transcultural nursing, and is frequently requested by nurses and other readers. The article has been slightly edited to improve readability.

Quality of Life from a Transcultural Nursing Perspective

The author presents research findings derived from Leiningers theory of culture care diversity and universality bearing upon quality of life. She holds that since quality of life is culturally constituted and patterned, it needs to be studied and understood from a transcultural nursing perspective in order to advance nursing as a discipline and profession. Five major cultures are presented to illustrate culturally constituted dominant care patterns related to quality of life. These comparative data reflect more diversity than universality among the cultures. The author encourages nurse researchers to move beyond present-day overemphasis on individualism and to discover dominant transcultural care values and patterns of emic and etic knowledge focused on quality of life, health, and well-being.

Transcultural care principles, human rights, and ethical considerations.

During the past three decades, the author has developed and used some general principles to guide transcultural instruction, practice and research. These principles were developed from my transcultural care theory, research studies and direct clinical experiences, consultation and general writings on the subject [Leininger 1967, 1970, 1973, 1976, 1978, 1979, 1980, 1981, 1984a, 1984b, 1988, 1989, 1990]. The principles include some assumptive premises with regard to universal and diverse considerations of human beings with the importance to know and respect the cultural rights of people in order to provide meaningful, satisfying and appropriate culture care to people. Through the years, a number of nursing students, faculty, and clinicians have used these principles, rights and ethical considerations to guide them in their thinking and to protect clients human and ethical rights. Since many nurses frequently request copies of these statements for teaching, consultation and clinical work, they are published below with this intent in mind.

Transcultural Nursing Society Position Statement on Human Rights

In 2006, the Transcultural Nursing Society created a business plan with a firm commitment to social change and the support of human rights. One of the primary goals of the plan was to seek recognition from the United Nations as a Human Rights Organization. As a first step in articulating this goal, the board of trustees of TCNS tasked a small group of Transcultural Nursing Scholars to develop a position statement. This article is the culmination of the collaborative task forces efforts to define how TCNS seeks the fulfillment of human rights for people of all cultures worldwide.

Transcultural Nursing Care Values, Beliefs, and Practices of American (USA) Gypsies

This ethnonursing qualitative investigation was focused on the domain of culture care values, expression and meanings of selected American Gypsies. The purpose of the study was to explicate culture care American Gypsy lifeways in order to help nurses understand this largely unknown culture, and to offer guidelines for providing culturally congruent nursing care. Leiningers theory of Culture Care Diversity and Universality was the appropriate theory to use for this study, along with the ethnonursing research method to generate emic and djtij grounded data. Findings substantiated that the world view, ethnohistory, religion (moral code), kinship and cultural values, and generic folk practices were powerful influencers of Gypsy lifeways and supported culture congruent nursing care. Ethnohistorical facts strongly buttressed the cultural values, norms, and moral codes for culture specific care practices. Several Gypsy culture specific and dominant care meanings, expressions, and actions were confirmed and made credible from raw data and thematic analysis. They were: 1) protective in-group caring; 2) watching over and guarding against Gadje; 3) facilitating care rituals; 4) respecting Gypsy values; 5) alleviating Gadje harassment; 6) remaining suspicious of outsiders; and 7) dealing with purity and impurity moral codes and rules. Culture specific and congruent care generated from Leiningers theory with the three predicted modes were identified to guide nursing decisions and actions.

Some anthropological issues related to community mental health programs in the United States.

This paper presents some major anthropological issues related to community mental health programs and centers in the United States. The author discusses reasons why a truly community-centered approach has not been fully developed and implemented in many centers. Emphasis is given to the importance of understanding current cultural and social forces affecting the patients illness and the need to incorporate these sociocultural data into existing mental health programs. The paper is based upon the authors practice and consultant role with several community mental health programs and should be useful to designers and evaluators of future mental health progress.This paper presents some major anthropological issues related to community mental health programs and centers in the United States. The author discusses reasons why a truly community-centered approach has not been fully developed and implemented in many centers. Emphasis is given to the importance of understanding current cultural and social forces affecting the patients illness and the need to incorporate these sociocultural data into existing mental health programs. The paper is based upon the authors practice and consultant role with several community mental health programs and should be useful to designers and evaluators of future mental health progress.

Caring Some Reflections on the Impact of the Culture Care Theory by McFarland & Andrews and a Conversation With Leininger

This column is the first of two with a special focus on the construct of caring. In this dialogue, two Leininger scholars together address the questions related to the global impact on practice and the contribution of the model to scientific development in nursing. Then, in a special conversation, nurse theorist Madeleine Leininger offers her view of the impact of her work as well as some of her early experiences.