Madeleine Leininger
NCM 100 | Theoretical Foundations of Nursing
OUTLINE:
I. Credentials and Background
of the Theorist
II. Theoretical sources
III. Use of Empirical Evidences
IV. Major Concepts and
Definitions
V. Major Assumptions
VI. Logical Form
1) The Observation-
Participation-
2) Reflection Enabler Domain
of Inquiry Enabler
3) Semi-structure Inquiry
Guide Enabler to Assess
Culture Care and Health
4) Acculturation Health
Assessment Enabler for
Cultural Patterns in
Traditional or Non-
traditional Lifeways
VII. Acceptance by the NUrsing
Community
VIII. Critique of the Work
IX. Abbreviations
X. References
XI. Appendix
LEGEND:
Black for Powerpoint red for audio blue
for book
THEORY OF CULTURE CARE
DIVERSITY AND UNIVERSALITY
CREDENTIALS AND BACKGROUND OF
THE THEORIST
● The founder of transcultural nursing
and a leader in transcultural nursing
and human care theory.
● She was the first professional nurse
with graduate preparation in nursing to
hold a PhD in cultural and social
anthropology.
● She served as an instructor, staff nurse,
and head nurse on a medical surgical
unit and opened a new psychiatry unit
while director of the nursing service at
St. Joseph's Hospital in Omaha,
Nebraska
● In 1954, Leininger obtained her
master's degree in psychiatric nursing
from the Catholic University of America
in Washington DC
● While working at a child guidance home
in the Cincinatti, Leininger discovered
that the staff lacked understanding of
cultural factors influencing the behavior
of children
● During the 1950's and 1960's
Leininger identified common areas of
theory interests and research foci
between the disciplines of nursing and
anthropology
● She found anthropology so fascinating
that she believes that it should be an
area of focus for all nurses.
AGRESAN, ALVEZ, ANACTA, BAÑEZ, BEDUA, CASTIL, CHAVEZ
WEEK# 7
Date (11/10/2022) | Ms. Mate
● Leininger undertook an ethnographic
and enthnonursing study while living
with the Gadsup people in Papua New
Guinea for 2 years
● She observed the unique culture of the
people noting a number of differences
between western and non-western
● Her theory is focused on transcultural
nursing, meaning the nurse must know
the culture of the patient. To provide
holistic care, the nurse must have an
idea what culture the patient has.
● Very futuristic
● Back in the 1950s, anthropology was
not popular but she saw its potential to
be applicable in nursing.
● From being a psychiatrist nurse, she
shifted to transcultural nursing.
(Why the sudden shift?
- She discovered/realized that
psychoanalytical are not effective at all
especially to children)
● Anthropology - study of society
● She immersed herself in the Gadsup
culture and observed the differences
between their culture and the Western
culture.
THEORETICAL SOURCES
● Leininger described transcultural
nursing as a major area of nursing
focused on the comparative study and
analysis of diverse cultures and
subcultures worldwide with respect to
their caring values, expressions and
health illness belief and patterns of
behavior
PURPOSE
o To discover human care
diversities universalities in
relation to worldview, cultural
and social-cultural dimension
o To discover ways to provide
culturally congruent care for
people of different or similar
cultures to maintain their health
or wellbeing or to face death
o Congruent care - the same care
that the healthcare professional
has.
GOAL
o To Improve and to provide
culturally congruent care to
people that is beneficial and will
fit with and useful to the client,
family or cultural group.
● Leininger distinguished between
transcultural nursing and cross- cultural
nursing.
● Transcultural nursing is where
nurses are prepared and committed to
 Madeleine Leininger
NCM 100 | Theoretical Foundations of Nursing
develop knowledge and practice
transcultural nursing
● Cross cultural nursing refers to
nurses who used applied or medical
anthropological concepts instead of
developing transcultural theory and
research based practices
● Leininger developed her theory of
culture care diversity and universality
based on the belief that people of
different cultures can inform and are
capable of guiding professionals to
receive the kind of care they desire or
need from others
● According to Leininger, the theory of
culture care diversity and universality
has several distinct features, different
from those other nursing theories
● She believes that if the patient is active
in its plan of care, the nursing
professional will be effective.
● Difference between goal and purpose;
Goal - more specific than purpose and
is somehow related to purpose
Purpose - broader and deeper
USE OF EMPIRICAL EVIDENCES
● Leininger held that care was the
essence of nursing and the dominant,
distinctive and unifying feature of
nursing
● Care is complex, elusive, and often
embedded in social structure and other
aspects of the culture.
● The first reason for studying the culture
care theory is that the construct of care
has been critical to the growth,
development and survival of human
beings
MAJOR CONCEPTS AND DEFINITIONS
● Care and Caring
o Care refers to the abstract and
manifest phenomenon with
expressions of assistive,
supportive, enabling, and
facilitation ways toward or about
self or others.
● Generic Care
o It refers to the learned and
transmitted lay, indigenous,
traditional or local folk
knowledge and practices to
provide assistance, supportive,
enabling, and facilitative acts for
● Professional Care
o It refers to formal and explicit
cognitively learned professional
care knowledge and practices
obtained generally through
educational institutions.
AGRESAN, ALVEZ, ANACTA, BAÑEZ, BEDUA, CASTIL, CHAVEZ
WEEK# 7
Date (11/10/2022) | Ms. Mate
● Culture
o Refers to learned, shared, and
transmitted values, beliefs,
norms, and lifeways of a
particular culture that guide
thinking, decisions, and actions
in patterned ways.
● Culture care
o Refers to the synthesis of the
two major constructs, care and
culture, that guide researcher to
discover, explain, and account
for health, well-being, care
expression, and other human
conditions.
● Culturally congruent care
o Refers to culturally based are
knowledge, acts, and decisions
used in sensitive, creative, and
meaningful ways to
appropriately fit the cultural
values, beliefs, and lifeways of
clients for their health and
well-being, or to prevent or face
illness disabilities, or death.
● Culture care diversity
o Refers to the variabilities or
differences in culture care
beliefs, meanings, patterns,
values, symbols,
lifeways,symbols, and other
features among human beings
related to providing beneficial
care for clients from a
designated culture.
● Culture care universality
o Refers to commonly shared or
similar culture care phenomena
features of human beings pr
group with recurrent meanings,
patterns, values, symbols, or
lifeways that serve as a guide
for caregivers to provide
assistive, support facilitative, or
enabling people care for healthy
outcomes.
● Worldview
o Refers to the way people tend to
look out on their world or
universe to form a picture or
value stance about life or the
world around them.
● Cultural and Social Structures
Dimension
o refers to the dynamic, holistic,
and interrelated patterns of
structured features of a culture.
● Environmental Context
o refers to the totality of an event,
situation, or particular
experience that gives meanings
to people’s expressions,
interpretations, and social
interactions.
● Ethnohistory
 Madeleine Leininger
NCM 100 | Theoretical Foundations of Nursing
o The sequence of past facts,
events, instances, or
experiences of human beings,
groups, cultures, or institutions
over time in particular contexts
that help explain past and
current lifeways about culture
care influencers affecting the
health and well-being, disability,
or death of people.
● Emic
o refers to local, indigenous, or
the insider cultural knowledge
and views about specific
phenomena
● Etic
o refers to the outsider or stranger
views or institutional/system
knowledge and interpreted
values about cultural
phenomena
● Health
o a state of restorative well-being
that is culturally constituted,
defined, valued, and practiced
by individuals or groups that
enables them to perform their
daily lives.
● Culture Care Preservation and/or
Maintenance
o refers to those assistive,
supportive, facilitative, or
enabling professional actions
and decisions that help people of
a particular culture to retain,
preserve, or maintain
meaningful care beliefs and
values for their well-being, to
recover from illness, or to deal
with handicaps or dying.
● Culture Care Accommodation and/or
Negotiation
o refers to those assistive,
accommodating, facilitative, or
enabling creative professional
care actions and decisions that
help people of a designated
culture to adapt to or negotiate
with others for culturally
congruent, safe, effective care
for meaningful, and beneficial
health outcomes.
● Culture Care Repatterning and
Restructuring
o refers to the assistive,
supportive facilitative, or
enabling professional actions
and decisions that help clients
reorder, change, or modify their
lifeways for beneficial healthcare
patterns, practices, or
outcomes.
MAJOR ASSUMPTIONS
● Major assumptions of the theory of culture
car diversity and universality presented
AGRESAN, ALVEZ, ANACTA, BAÑEZ, BEDUA, CASTIL, CHAVEZ
WEEK# 7
Date (11/10/2022) | Ms. Mate
here were derived from Leininger’s
definitive works on the theory and
subsequent evolutionary changes:
○ Care is the essence and the central
dominant, distinct,and unifying focus of
nursing.
○ Humanistic and scientific care is
essential for human growth, well-being,
health, survival, and to face death and
disabilities.
○ Care (caring) is essential to curing or
healing for there can be no curing
without caring (this assumption was held
to have profound relevance worldwide).
○ change, or modify their lifeways for
beneficial healthcare patterns, practices,
or outcomes (McFarland & Wander
Alamah, 20156, p. 161.
○ Culture care is the synthesis of two
major constructs (culture and care) that
guide the researcher to discover,
explain, and account for health,
well-being, care expres-sions, and other
human conditions.
○ Culture care expressions, meanings,
patterns, processes, and structural
forms are diverse, but some
commonalities (universalities) exist
among and between cultures.
○ Culture care values, beliefs, and
practices are influenced by and
embedded in the worldview, social
structure factors (e.g., religion,
philosophy of life, kinship, politics,
economics, education, technology, and
cultural values) and the ethnohistorical
and environmental contexts.
○ • Every culture has generic lay, folk,
naturalistic; mainly emic) and usually
some professional (etic) care to be
discovered and used for culturally
congruent care practices.
○ Culturally congruent and therapeutic
care occurs when culture care values,
beliefs, expressions, and patterns are
explicitly known and used appropriately,
sensitively, and meaningfully with people
of diverse or similar cultures.
○ Leininger's three theoretical models of
care offer new, creative, and different
therapeutic ways to help people of
diverse cultures.
○ The ethnonursing research method and
other qualitative research paradigmatic
methods offer important means to
discover largely embedded, covert,
epistemic, and ontological culture care
knowledge and practices.
○ Transcultural nursing is a discipline with
a body of knowledge and practices to
attain and maintain the goal of culturally
congruent care for health and
well-being.
NCE
LOGICAL FORM
 Madeleine Leininger
NCM 100 | Theoretical Foundations of Nursing
● Leininger also developed several other
enablers to assist nurse researchers in
their use of the ethnonursing method:
o The Observation- Participation-
o Reflection Enabler Domain of
Inquiry Enabler
o Semi-structure Inquiry Guide
Enabler to Assess Culture Care
and Health
o Acculturation Health Assessment
Enabler for Cultural Patterns in
Traditional or Non- traditional
Lifeways
● Used 2 methods/enablers to define her
theory
● Developed in 1970s and refined in 2006
● THE OBSERVATION-
PARTICIPATION-REFLECTION
ENABLER
➔ used to facilitate the researcher
to enter and remain with
informants in their familiar and
natural context during the
study
➔ From being an observer, they
transition gradually to become
a participant.
● STRANGER TO TRUSTED FRIEND
ENABLER
➔ The nurse researcher is able to
learn much about themselves
and the people and culture
being studied.
➔ The goal with this guide is to
move from a distrusted
stranger to become a trusted
friend.
● THE DOMAIN OF INQUIRY
ENABLER
➔ Is a statement made by nurse
researchers when guided by the
culture care theory and using
the ethnonursing method to
clearly focus his or her are of
study
➔ It comprises questions or ideas
related to the focus, purpose
and goals of the study
● SEMI-STRUCTURED INQUIRY
GUIDE ENABLER TO ASSESS
CULTURE CARE AND HEALTH
➔ Developed with open-ended
questions to assist the nurse In
discovering and understanding
the different cultural
dimensions
● ACCULTURATION HEALTH
ASSESSMENT ENABLER FOR
CULTURAL PATTERNS IN
TRADITIONAL OR
NONTRADITIONAL LIFEWAYS
AGRESAN, ALVEZ, ANACTA, BAÑEZ, BEDUA, CASTIL, CHAVEZ
WEEK# 7
Date (11/10/2022) | Ms. Mate
➔ It is essential when studying
cultures to assess the extent of
the informant's acculturation,
whether they are more or less
traditionally or nontraditionally
oriented to their values, beliefs
and general lifeways
ICAL EVIDENCES
ACCEPTANCE BY THE NURSING
COMMUNITY
● Practice
o Leininger identified several
o factors associated with
reluctance by nursing to
recognize and value
transcultural nursing
▪ Many nurses weren’t familiar
with anthropology in 1960s
▪ Many clients were reluctant to
demand in meeting their
cultural needs from their HC
providers
▪ Until the 1990s the journals
about transcultural nursing
were often rejected because
editors didn’t know the value
of it
o In the 21st century, transcultural
nursing education became more
imperative for all nurses
worldwide
● Education
o After the world’s first master’s
and doctoral program in
transcultural nursing were
approved and implemented in
1977 at the University of Utah.
Many nurses have become
specifically prepared for
transcultural nursing.
o With the heightened public
awareness of health care costs,
diverse cultures and human
rights worldwide, there is a
much greater demand to provide
holistic, high quality and
comprehensive care.
● Research
o Nurses worldwide use this
culture care theory in practice,
research, education and
administration
o This theory is the only one in
nursing focused specifically on
culture care and has specific
methods to study culture and
care practices
ICAL EVIDENCES
CRITIQUE OF THE WORK
● Clarity
o The culture care theory has a
broad, holistic, comprehensive
perspective of individuals,
families, cultures and
communities and population
 Madeleine Leininger WEEK# 7
NCM 100 | Theoretical Foundations of Nursing Date (11/10/2022) | Ms. Mate

● Simplicity APPENDIX
o We need to decipher the
problem we are facing. Then we
can solve problems and quickly Figure: Leininger’s Sunrise Enabler
generate as many new ideas as
possible
● Generality
o It demonstrates the criterion on
generality because it is a
qualitative oriented theory that
is broad, comprehensive and
worldwide in scope
● Importance
o Providing culture-specific,
culturally congruent care is a
vital, necessary and established
goal in contemporary nursing

END OF TRANSCRIPTION

REFERENCES

● Nursing Theorists and Their

Work 9th ed
● Nursing Theorists and Their
Works 10th ed

ABBREVIATIONS

Abbrev – abbreviation
TFN – Theoretical Foundations of
Nursing

AGRESAN, ALVEZ, ANACTA, BAÑEZ, BEDUA, CASTIL, CHAVEZ