Nursing Research: Leininger’s Theory of Culture Care Diversity and Universality

The Theory of Culture Care Diversity and Universality is derived from the disciplines of nursing and anthropology. Madeline Leininger conceptualized the theory in the mid-1950s while working as a clinical nurse specialist with disturbed children and their
families (George, 2001). Troubled by the lack of knowledge available to help nurses understand the variations in care required for people from different cultures, Leininger set out to establish a new direction for nursing and to bridge the knowledge gap between nursing care and culture (Leininger, 2001a).


Leininger was the first professional nurse to earn a doctorate in anthropology. She is credited with establishing transcultural nursing and coining the term “culturally congruent care” (Leininger, 2001a). According to Leininger, culture care is the broadest holistic means of knowing, explaining, interpreting, and predicting nursing care phenomena to guide nursing practices. Culturally congruent care is beneficial care and occurs only when the culture care values, expressions, or patterns of the client (individual, group, family, or community) are known and used in appropriate and meaningful ways by the nurse.
Thus, transcultural nursing focuses on comparative care knowledge of specific and diverse cultures that helps clients regain and maintain their well-being, and face death, dis-abilities, or chronic illnesses in ways that are beneficial to them and fit with their beliefs, values, and lifeways (Leininger, 1995,2001b).
Leininger established the theory of culture care to account for and explain much of the phenomena related to transcultural nursing. The purpose of the theory is to discover human care diversities and universalities while the goal of the theory is to improve and provide culturally congruent care. Leininger first published the theory in 1985 with subsequent publications of revisions in 1988, 1991, 1995, and 2001 (Leininger, 2001a). With each publication of the theory, the conceptual definitions have evolved to higher levels of clarity, as has the nature of the underlying theoretical assumptions and statements.
The components of the theory are depicted in the Sunrise Model. The Sunrise Model is designed to function as a cognitive map for the study of culturally congruent care. Even though Leininger provides orientational definitions for the concepts in the model, she discourages the use of operational definitions in the study of culture care (Leininger, 2001a). Leininger supports exploring and discovering the essence of care for a particular culture, and puts forth the theory of culture care worldwide as necessary research for epistemic knowledge for the profession of nursing. The theory has three theoretical modes: cultural care preservation and/or maintenance, cultural care accommodation and/or negotiation, and cultural care repatterning or restructuring (Leininger). The three modes were developed based on Leininger’s experiences with using culture care knowledge to assist clients in several Western and non-Western cultures. According to Leininger, the modes are care centered and use both emic (generic or folk care) and etic (professional care) knowledge.
In Leininger’s theory, culture care diversity points to the differences in meanings, values, patterns, and lifeways that are related to assistive, supportive, or enabling human care expressions within or between collectives, while culture care universality points to the common, similar, or dominant uniform care meanings (Leininger, 1995, 2001a). World-view is the way people look at the world and form a picture about their lives and the world.

According to the tenets of the theory, this world view is defined by cultural and social structure dimensions that involve dynamic patterns of a particular culture that include technological, religious, philosophical, kin-ship, social, political, economic, and educational interrelated factors as well as culture values and lifeways. The environmental context is the totality of an event or experience and gives meaning to human expressions, social interactions, and interpretations in particular physical, sociopolitical, ecological, and/or cultural settings. Ethnohistory refers to past facts, experiences, and events that are primarily people-centered and describe, ex-plain, and interpret human lifeways within a particular cultural context. Generic care system refers to folk or lay knowledge and skills that are culturally learned and transmitted and used to provide assistive, supportive, or enabling acts for another individual. Professional care system refers to health, illness, and wellness-related knowledge and practice skills that are formally taught, learned, and transmitted. In the Theory of Culture Care Diversity and Universality, Leininger orientationally defines health as “a state of well-being that is culturally defined, valued, and practiced, and which reflects the ability of individuals (or groups) to perform their daily role activities in culturally expressed, beneficial, and patterned lifeways” (Leininger, 2001a, p.48). Care is described as being essential to curing, healing, health, well-being, and survival. Care is also presented as the dominant and unifying feature of nursing, and one of the most important concepts of transcultural nursing (Leininger, 1985a, 1995, 2001a). Nursing is presented as a transcultural humanistic and scientific profession and discipline whose central purpose is to serve human beings worldwide. Leininger asserts that even though the concepts of health, person, nursing, and environment are supported by nursing theorists as the major elements under consideration in the practice of nursing, care is the essence of nursing and includes “concrete phenomena related to assisting, supporting, or enabling experiences or behaviors toward or for others with evident or anticipated needs to ameliorate or improve a human condition or lifeway” (Leininger, 2001a, p. 46). The Theory of Culture Care Diversity and Universality is broad, comprehensive, and worldwide in scope, demonstrating the criterion of generality, and addressing nursing care from a multicultural and worldview perspective. The ethno nursing research method was designed to systematically explore the purpose, goal, and tenets of the theory through a naturalistic and predominantly emic open-inquiry discovery approach (Leininger, 2001a). Ethnonursing focuses on the study of nursing care beliefs, practices, and values, cognitively perceived and known by a particular culture through their experiences, beliefs, and value systems. Over the past 40 years, Leininger’s theory of culture care has become well-known and valued; studies have been conducted in approximately 100 cultures using the culture care theory (Leininger, 2001b). Leininger has published approximately 27 books and 250 articles on transcultural nursing and human caring, and the Journal of Transcultural Nursing, which was founded by Leininger, has been a major source for dissemination of caring constructs and culture care information. The knowledge gap between nursing care and culture has narrowed and clients worldwide are realizing the benefits of culturally congruent care. There is a wealth of new generic and professional culture care knowledge available to guide transcultural nursing teaching and practices. The theory has contributed significantly to soundly establishing the field of transcultural nursing as a formal area of study, research, and practice, and Leininger predicts that “by the year 2010, transcultural nursing with a human care diversity and universality focus will become the arching framework of nursing” (Leininger, 2001a, p. 414).