Leininger’s Theory of Culture Care Diversity The Theory of Culture Care Diversity and Universality, developed by Madeline Leininger, is a significant contribution to the field of nursing, blending the disciplines of nursing and anthropology. Conceived in the mid-1950s, this theory arose from Leininger’s observations as a clinical nurse specialist working with children and families from diverse cultural backgrounds. The lack of cultural understanding in nursing care led her to explore a new approach to nursing, one that integrates cultural sensitivity into caregiving practices (George, 2001). This theory provides a comprehensive framework for delivering culturally congruent care that respects the diverse beliefs, values, and practices of individuals from different cultural backgrounds.
Leininger as a Professional Nurse
Madeline Leininger was the first professional nurse to earn a doctorate in anthropology, and she is credited with founding the field of transcultural nursing. She coined the term “culturally congruent care,” which refers to nursing care that is consistent with the client’s cultural values, beliefs, and practices. According to Leininger, culture care is the broadest and most holistic means of understanding, explaining, interpreting, and predicting nursing care phenomena to guide nursing practices (Leininger, 2001a).
Culturally congruent care is effective and meaningful only when the nurse incorporates the culture care values, expressions, or patterns of the client—whether an individual, family, group, or community—into the care provided. Transcultural nursing, therefore, focuses on acquiring and applying knowledge about specific and diverse cultures to help clients maintain or regain well-being, face death, manage disabilities, or cope with chronic illnesses in ways that align with their cultural beliefs and lifestyles (Leininger, 1995, 2001b).
Purpose of the Theory
The primary purpose of Leininger’s theory is to identify and understand both the diversities and universalities of human care. The ultimate goal is to provide culturally congruent care that improves health outcomes. Leininger first published her theory in 1985, with subsequent revisions in 1988, 1991, 1995, and 2001, each time refining the conceptual definitions and theoretical assumptions (Leininger, 2001a).
The theory’s development has continually sought to clarify how nurses can provide care that is not only culturally sensitive but also effective in meeting the unique needs of patients from various cultural backgrounds. By bridging the gap between nursing care and culture, Leininger aimed to make care more holistic, comprehensive, and beneficial for all patients.
Components of the Theory
Leininger’s theory is visually represented through the Sunrise Model, which serves as a cognitive map for studying culturally congruent care. The model highlights several key components, including:
- Worldview: The way individuals or groups perceive the world and construct a view of their lives and surroundings. It is influenced by cultural and social structure dimensions such as technology, religion, kinship, politics, economics, education, and other interrelated factors.
- Environmental Context: The totality of an event or experience that gives meaning to human expressions, social interactions, and interpretations within specific physical, sociopolitical, ecological, and cultural settings.
- Ethnohistory: The past events, experiences, and facts that are people-centered and help describe, explain, and interpret human lifeways within a particular cultural context.
- Generic Care System: The folk or lay knowledge and skills that are culturally learned and transmitted, used to provide assistive, supportive, or enabling acts for others.
- Professional Care System: Health, illness, and wellness-related knowledge and practice skills that are formally taught, learned, and transmitted.
Theoretical Modes of the Theory
Leininger’s theory includes three theoretical modes:
- Cultural Care Preservation and/or Maintenance: This mode involves supporting or preserving patients’ cultural beliefs and practices to help them maintain well-being, recover from illness, or face death in a culturally appropriate way.
- Cultural Care Accommodation and/or Negotiation: This mode focuses on working with clients to negotiate and accommodate care practices that are acceptable to both the client and healthcare provider. It aims to achieve the best health outcomes while respecting cultural preferences.
- Cultural Care Repatterning or Restructuring: This mode involves helping clients modify their cultural practices when these are harmful or not conducive to health, while still respecting the clients’ cultural values and beliefs.
Leininger’s theory utilizes both emic (indigenous or folk care) and etic (professional care) perspectives to provide a comprehensive approach to culturally congruent care. The theory acknowledges the importance of understanding both the unique cultural values (diversity) and the commonalities (universality) in care practices across different cultures.
Versatility of the Theory
Leininger’s Theory of Culture Care Diversity and Universality is highly versatile and applicable across various settings. The theory defines health as “a state of well-being that is culturally defined, valued, and practiced, reflecting the ability of individuals or groups to perform their daily role activities in culturally expressed, beneficial, and patterned lifestyles” (Leininger, 2001a, p. 48). The theory emphasizes that care is essential for healing, health, and well-being, making it the central and unifying feature of nursing (Leininger, 1985a, 1995, 2001a).
Leininger presented nursing as a transcultural, humanistic, and scientific profession dedicated to serving human beings worldwide. She argued that while other nursing theories also consider health, person, nursing, and the environment, care is the essence of nursing. Care involves “concrete phenomena related to assisting, supporting, or enabling experiences or behaviors toward others to improve a human condition or lifestyle” (Leininger, 2001a, p. 46).
Scope of the Theory
The Theory of Culture Care Diversity and Universality is broad and comprehensive in scope, addressing nursing care from a multicultural and worldview perspective. It demonstrates generality and applicability across different cultural contexts and healthcare settings. Leininger developed the ethnonursing research method to systematically explore the theory’s purpose, goals, and principles through a naturalistic, predominantly emic open inquiry discovery approach (Leininger, 2001a).
Ethnonursing research focuses on studying nursing care beliefs, practices, and values as perceived and known by particular cultures through their experiences and belief systems. Over the past 40 years, Leininger’s theory has been applied in studies across approximately 100 different cultures (Leininger, 2001b). Her work, including around 27 books and 250 articles on transcultural nursing, has significantly narrowed the knowledge gap between nursing care and culture.
The Journal of Transcultural Nursing, founded by Leininger, has been a major source for disseminating caring constructs and culture care information. This theory has significantly contributed to establishing transcultural nursing as a formal area of study, research, and practice.
Conclusion
Leininger’s Theory of Culture Care Diversity and Universality has made a profound impact on nursing by highlighting the importance of culturally congruent care. This theory has provided a comprehensive framework for understanding and addressing the diverse cultural needs of patients, thereby enhancing the quality of care provided. By recognizing the cultural factors that influence health and healing, Leininger’s theory has guided nurses worldwide in delivering care that is respectful, effective, and meaningful to patients from all cultural backgrounds.
As Leininger predicted, transcultural nursing, with a focus on human care diversity and universality, continues to evolve as a foundational framework in the field of nursing. The theory’s emphasis on culturally congruent care has led to significant advancements in nursing practice, teaching, and research, ensuring that care is both scientifically sound and culturally appropriate.