Theory of Culture Care Diversity

and Universality
By Madeleine M. Leininger

Gerald Ian Dela Cruz

Madeleine M. Leininger
Educational Background:

 1948 - Received her basic nursing education

at St. Anthony’s School of Nursing, Denver, Colorado

 1950 - Earned bachelor of science from Mount St. Scholastica

College (now known as Benedictine College), Atchison, Kansas

 1954 – had a master of science in psychiatric-mental health

nursing form the Catholic University of America, Washington,
DC

 1965 – a Ph.D. in cultural and social anthropology from the

University of Washington, Seattle.
 She is a Fellow in the American Academy of
nursing and holds honorary doctorates from
Benedictine College, the University of
Indianapolis, and the University of Kuopio,
Finland.

 1998 – she was named a “Living Legend” by the

American Academy of Nursing
Brief Background on the Formulation of the Theory

 In the 1940s Leininger recognized the importance of caring to nursing,

statements of appreciation for nursing care made by patients alerted her
to caring values and led to her longstanding focus on care as the
dominant ethos of nursing.

 While working as a clinical child nurse specialist

with disturbed children and their parents, she
observed recurrent behavioral differences among
the children, and finally concluded that these
differences had a cultural base.

 She identified a lack of knowledge of the children’s culture as the missing

link to understand the variations needed in care of clients.
 In the mid-1950s she declared that care is the essence and central
domain of nursing. She held that care and caring were basic and
essential human needs for human growth, development, and survival

 Leininiger built her theory of transcultural nursing on the premise

that the people of each culture can not only know and define the
ways which they experience and perceive their nursing care world
but also relate these experiences and perceptions to their general
health beliefs and practices.

 Transcultural Nursing – an area of study and practice focuses on

cultural care (caring) values, beliefs and practices of particular
cultures.
Overview of the Theory
 Leininger introduced her theory Culture Care Diversity and Universality in the early
1960s to provide culturally congruent and competent care.

 The Theory Culture Care Diversity and Universality was developed to establish a
substantive knowledge base to guide nurses in discovery and use of transcultural
nursing practices.

 During the post-World War II period, Leininger realized that nurses would need
transcultural knowledge and practices to function with people of diverse culture
worldwide because many new immigrants and refugees were coming to America,
and the world was becoming more multicultural.
 Culture Care or Culture Care
Diversity and Universality Theory:
belief that cultures have both health practices that are specific to one culture
and prevailing patterns that are common across cultures.

Purpose:
To discover, document, analyze, and identify the cultural and care factors
influencing humans in health, sickness, and dying and to thereby advance and
improve nursing practices

Goal:
To use research-based knowledge to provide culturally congruent, safe, beneficial,
and satisfying care to people of diverse or similar cultures for their health and well-
being or for meaningful dying.
Theory 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 belief 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
Orientational Theory Definitions
 Culture
 Care
 Culture Care
 Culture care diversity
 Culture care universality
 Professional care
 Generic (folk and lay) care
 Health
 Culture care preservation or maintenance
 Cultural care accommodation or negotiation
 Culture care repatterning or restructuring
 Ethnohistory
 Environmental context
 Worldview
 Kinship and social factors
 Religion and spiritual factors
 Political factors
 Technological factors
 Educational factors
 Economical factors
 Environmental factors
 Culturally congruent care
Major Theoretical Tenets

Leininiger identified several predictive tenets or premises as essential for nurses

and other to use:

1.Cultural care diversities and similarities or Commonalities that would be

found within cultures

• This tenet challenges nurses to discover this knowledge so that nurses could use
cultural data to provide therapeutic outcomes.

•Leininger has stated that human beings are born, they live, and they die with their
specific cultural values and beliefs, as well as with their historical and
environmental context, and that care has been important for their survival
and well-being
2. Worldview and Social Structure factor

• This includes religion (and spirituality), political and economical considerations,

kinship (family ties), education, technology, language expressions, the
environmental context, and cultural history – were important influences on health care
outcomes.

• This broad and multifaceted view provided a holistic perspective for

understanding people and grasping their world and environment within a historical
context.

• Data from this holistic research-based knowledge was predicted to guide nurses
for the health and well-being of the individual or to help disabled or dying clients
from different cultures.

•Nurses needed to become aware of the social structure, cultural history, language
use and the environment in which people lived in order to understand cultural
and care expressions.
3. Differences and Similarities between Professional and
Generic Care

• Elucidating the differences between these two kinds of care would

identify gaps in care, inappropriate care, and also beneficial care.

• Such findings would influence the recovery (healing), health, and well-
being of clients of different cultures.
Three Modalities

Leininger identified three new creative ways to attain and

maintain culturally congruent care to fit clients’ particular
needs:

• Culture care preservation or maintenance

• Culture care accommodation or negotiation
• Culture care restructuring or repatterning
The Sunrise Enabler: A Conceptual Guide
to Knowledge Discovery

 Leininger developed the sunrise enabler to provide a holistic and

comprehensive conceptual picture of the major factors influencing
Culture Care Diversity and Universality.

 The model can be a valuable visual guide to elucidating multiple

factors that influence human care and cultural lifeways of different
cultures.

 The enabler serves as a cognitive guide for the researcher to reflect

on different predicted influences on culturally based care.
 Example of Transcultural Nursing

 Daniel Saunders, 8 years old, has accompanied to the emergency

department by his mother and grandmother. He has had acute
abdominal pain for two days. The nurse notes that his mother defers
questions about Daniel to him or to his grandmother and that none of
the three respond immediately to question posed or comments made
by the staff or look directly at members of the staff. They sit close
together but do not touch one another. The physician wants to admit
Daniel for exploratory abdominal surgery. Daniel’s mother will not
sign the admission and surgical permission forms until his
grandmother has given her approval to do so. At his point, Daniel’s
grandmother takes a bag of cornmeal from her pocket and begins to
sprinkle it around Daniel.
 Nurse who lacks
transcultural knowledge
• views this family as strange and
suspicious
• lack of direct eye contact leads to
questions of what they are hiding
• mother appears indecisive
• family members don’t even seem to
much from each other since they do
not touch
• what is the deal with the cornmeal?
Nurse who have
transcultural knowledge
• recognize that this is a Navajo family
and the family members are
demonstrating typical characteristics
• Navajo culture is a matriarchial culture
whose members defer to the wisdom
of elders.
• Daniel is included in responses to
questions asked as a value of culture
is for the individual to speak for him or
herself
• lack of direct eye contact and pauses
after questions or statements are
made by another are indications of
respect and a degree of thought and
attention being given to the content of
the message
• Navajo family members demonstrate
their caring for one another through
being physically close, but not through
touching
 Nurse who lacks Nurse who have
transcultural knowledge transcultural knowledge
• Illness is viewed as a lack of or disturbance
of one’s harmony.
• Rituals, such as sprinkling the person with
cornmeal, are important to restore harmony
- nurse needs to note that it is important to
save the cornmeal to return it to the family
After Daniel’s surgery:
• nurse can anticipate that he will accept pain
relief
• it is also likely that as many relatives as are
available will want to visit – such family
support is another cultural value. Discharge
Instruction:
• b.i.d. antinbiotic - the timing of the
administration of his medication should be
tied to natural events such as sunup and
sundown rather than with meals or some
other activity.
• Navajo sense of time tends to be casual and
relative and meal times are likely to be
flexible.