Leininger's Theory of Culture Care Diversity and Universality

Background of the Theorist

Dr. Madeleine Leininger was a remarkable woman who was one of the early nursing theorists
and the first to introduce the concept of transcultural nursing. She also introduced the
discussion of what it means to care.
Madeleine Leininger was born on July 13, 1925 in Sutton, Nebraska. She lived in a farm with her
four brothers and sisters, and graduated from Sutton High School. After graduation from Sutton
High she was in the U.S. Army Nursing Corps while pursuing a basic nursing program. It was due
to her aunt who suffered from congenital heart disease that led her to pursue a career in
nursing.

Assumptions
1. Care is essential for human growth, development, and survival and for facing death or
dying.
2. Care is essential to curing and healing; there can be no curing without caring.
3. The forms, expressions, patterns, and processes of human care vary among all cultures
of the world.
4. Every culture has generic (lay, folk, or naturalistic) care, and most also have
professional care practices.
5. Culture care values and beliefs are embedded in religious, kinship, social, political,
cultural, economic, and historical dimensions of the social structure and in language
and environmental contexts.
6. Therapeutic nursing care can occur only when culture care values, expressions, and/
or practices are known and used explicitly to provide human care.
7. Differences between caregiver and care receiver expectations need to be understood in
order to provide beneficial, satisfying, and congruent care.
8. Culturally congruent, specific, or universal care modes are essential to the health or
well-being of people of all cultures.
9. Nursing is essentially a transcultural care profession and discipline.

Major Concepts
The purpose of Leininger’s theory is to generate knowledge related to the nursing care of
people who value their cultural heritage and lifeways.
Major concepts of the model are culture, culture care, and culture care differences (diversities)
and similarities (universals) pertaining to transcultural human care. Other major concepts are
care and caring, emic view (language expressions, perceptions, beliefs, and practice of
individuals or groups of a particular culture in regard to certain phenomena), etic view (universal
language expression beliefs and practices in regard to certain phenomena that pertain to several
cultures or groups), lay system of health care, professional system of health care, and culturally
congruent nursing care.

The goal for application of Leininger’s theory is to provide culturally congruent nursing care
to persons of diverse cultures. A central tenet of the theory is that it is important for the nurse
to understand the individual’s view of illness. Also, the focus is on recognizing and
understanding cultural similarities and differences and using this information to positively
influence nursing care and health. The theory has been widely used for research, and findings
are appropriate for nurses in any setting who work with individuals, families, and groups
from a cultural background different from the nurse’s.

SUNRISE MODEL

Leininger also identified three new creative ways to attain and maintain culturally congruent
care . The three modalities postulated were:
1. culture care preservation or maintenance
2. culture care accommodation
3. culture care restructuring or repatterning
Leininger prefers not to use the phrase “nursing intervention,” because this term often
implies to clients from different cultures that the nurse is imposing his or her (etic) views,
which may not be helpful. Instead, the term “nursing actions and decisions” is used, but
always with the clients helping to arrive at whatever actions or decisions are planned and
implemented. The modes fit with the clients’ or peoples’ lifeways and yet are therapeutic and
satisfying for them. The nurse can draw upon scientific nursing, medical, and other
knowledge with each mode.
Data collected from the upper and lower parts of the sunrise enabler provide culture care
knowledge for nurse researchers to discover and establish useful ways to provide quality
care practices.
It is most important (and a shift in nursing) to carefully focus on the holistic dimensions, as
depicted in the sunrise enabler, to arrive at therapeutic culture care practices. All the factors
in the sunrise enabler must be considered to arrive at culturally congruent care.