You are on page 1of 9

Leininger’s Theory of Nursing:

Cultural Care Diversity and Universality


MADELEINE M. LEININGER, RN; PHD*

This paper is focused on the essential features of the nursing theory


of cultural diversity and universality. An overview of the essential
care
features is discussed to show how the theory was developed and how it
has evolved during the past three decades. The theory was initiated from
clinical experiences recognizing that culture, a wholistic concept, was
the missing link in nursing knowledge and practice. Through a creative
process of concept explication, reformulation, and resynthesis, the the-
ory of cultural care was set forth as a guide for the development of
nursing knowledge. The concept of culture was derived from anthropol-
ogy and the concept of care was derived from nursing. The theorist holds
that cultural care provides the broadest and most important means to
study, explain, and predict nursing knowledge and concomitant nursing
care practice. The ultimate goal of the theory is to provide cultural
congruent nursing care practices. The author contends that if one fully
discovers care meanings, patterns, and processes, one can explain and
predict health or well-being. The assumptions, definitions, and theoret-
ical explanations related to cultural care are presented with the sunrise
model to depict the major components of the theory.

One of the most exciting and important de- Since the early 1960s, nursing has been in
velopments in the history of nursing has been - an era of theory construction, refinement, and
the development of nursing theories to estab- systematic examination. Questions, such as
lish a sound basis for-the discipline of nursing the following, have been asked. What charac-
and to guide nursing practice. During the past terizes the essential nature and essence of
four decades, a cadre of nurse theorists has nursing? What constitutes the essential na-
been active focusing on the systematic study ture of nursing knowledge? What is different
of the nature and critical elements that char- about nursing knowledge compared with that
acterize the discipline of nursing. As a conse- of other health disciplines? These questions
quence, a number of different theories with and related ones have been central to the ad-
diverse conceptualizations of nursing have vancement of nursing as a discipline and
been developed and continue to be examined. profession.
Nursing theories have markedly stimulated As one of the early nurse theorists who be-
the intellectual, clinical, and research per- gan to develop the theory of cultural care di-
spectives of nurses requiring them to think versity and universality in the 1950s, the au-
anew about the nature and meaning of nurs- thor was interested in the nature of nursing
ing as a discipline and profession. This move- and how nursing differed from medicine in its
ment has led to critical positions and debates knowledge base and practice. The idea for the
among scholars of nursing about the core ele- theory began while studying the role of the
ments and epistemological bases of nursing clinical specialist in child psychiatric nursing
knowledge. It also encouraged nurses to shift in 1954 and while documenting the ways that
from the medical paradigm to a nursing para- care and nursing practice could accurately de-
digm. scribe and reflect nursing knowledge. The au-
thor firmly held to the position that care is the
Key Words: Cultural Care Theory. Leininger, Sunrise essence of nursing and the central, domi-
Model
nant, and unifying feature of nursing. Care
Received April 12, 1988 was viewed as a powerful means to help clients
Accepted May 30, 1988 recover from illnesses or unfavorable human
*
Wayne State University, Detroit, MI. life conditions (Leininger, 1978). Through in-
tense observation, it soon became clear to the
author that children of different cultural back-
grounds had different expectations and re-

152

Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on March 9, 2015


sponses to nurses as care providers. It was areas as they worked with clients from differ-
critical that clinical specialists recognize and ent cultural backgrounds. As students identi-
respond to these differences. Children of dif- fied cultural differences, they could see areas
ferent cultures were different and needed a of cultural conflicts between clients and
culturally based framework to guide their nurses that needed to be addressed. Transcul-
nursing care. Care and culture were inextric- tural nursing concepts and cultural care the-
ably linked together and could not be sepa- ory gave nurses an entirely new way to under-
rated in nursing care actions and decisions. stand individuals, families, and cultures. The
The theory of cultural care diversity and uni- focus on culture care differences and similar-
versality was born and it was the children who ities to describe, explain, and predict nursing
taught the author that the missing link in care outcomes was gradually viewed by nurses as
was culture. No longer could all children be essential to professional practice. These brief
treated alike nor could it be assumed that they historical ideas of the evolution of a theory
had similar needs. What constituted cultural help one to realize that theories with entirely
care diversities and universalities was the ma- new or different ideas take time, persistence,
jor domain to be explored anew as the basis and creative strategies to develop. Likewise, it
for sound nursing practice; thus, the theory takes time, education, and leadership to help
was conceived and developed in relation to a skeptics and potential followers to use the the-
perspective with social science roots. ory.
The author realized she had no background
in anthropology to understand culture and to
link culture with care. Knowledge of cultural
The Theorist’s View of the Nature and Definition
factors in nursing was absent. Moreover, there -

of a Theory
were no other professional nurses with grad-
uate preparation in anthropology. Anthropol- Before a theory can be understood, the the-
ogy was not a part of nursing curricula nor orist’s views in general must be known. Cur-
part of the thinking of nurse theorists and rently, the literature abounds with ideas from
educators in those early days. This reality led nurse theorists who have been educated to
the author to doctoral preparation in anthro- view a theory as &dquo;a set of interrelated concepts,
pology in order to develop the theory in a definitions, propositions or hypotheses with
knowledgeable way. The need for the new field specified and measurable relationships to pre-
of transcultural nursing to prepare nurses to dict and control phenomena under study&dquo;
function in a multicultural world became (Polit and Hungler, 1983, p. 101). This tradi-
clear. As the first nurse anthropologist with tional definition of a theory (and its variants)
doctoral preparation in cultural anthropology, is derived from the elements and criteria used
the author developed knowledge and research in a quantitative paradigm. The theory re-
for the new field of transcultural nursing with quires rigid operational definitions of specified
a focus on cultural care theory (Leininger, relationships among a priori variables that can
1970, 1978). It took time and in-depth study be controlled, measured, and verified in pre-
to link culture and care into a meaningful cise ways. This perspective of theory is only
relationship. The theory of cultural care diver- one way to view theory and it can seriously
sity and universality was difficult to formulate limit the discovery of phenomena that are un-
because there was so much to understand known, vaguely known, or that cannot be es-
about different cultures in the world and nurs- tablished as operationally defined variables
ing’s perspectives of cultural phenomena. At prior to a research investigation. The author
the same time, the need arose to develop was committed to discovery of the epistemo-
courses and programs in transcultural nursing logical sources of nursing knowledge related
so that the theory could be appropriately used. to cultural care with its inherent meanings
There were few nurses interested in anthro- and characteristics as the goal of the theory.
pology in those days; nurses were deeply in- The concept of care had not been studied from
volved in medical tasks and the physical and different cultural viewpoints, and thus an
technical needs of clients. Gradually, tran- open approach was essential to discover the
scultural nursing and cultural care made unknown attributes of care from a compara-
sense to some nurses. The author’s firm con- tive cultural perspective. A qualitative ap-
viction about the importance of transcultural proach was imperative to identify, describe,
nursing led her to prepare a cohort of nurses and account for unknown aspects of cultural
to try the ideas espoused in the theory. care. Indeed, there was a critical need for the-
As nurses became prepared in transcultural ories that would lead to the discovery of the
nursing, the theory became meaningful to people’s emic (local or insider’s) views of the
more practicing nurses. Transcultural nurses meanings, symbols, patterns, and expressions
and others began using the cultural care the- of cultural care and nursing from a wholistic
ory with enthusiasm. Likewise, nursing stu- perspective. The open ethnographic or anthro-
dents’ began to use the theory in the clinical pological qualitative approach was selected to

153

Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on March 9, 2015


discover the unknown, subtle, or less objective theory is an imaginative grouping of knowl-
facts of care, as well as the subjective dimen- edge, ideas and experiences that are repre-
sions, and to explicate patterned expressions sented symbolically and seek to illuminate a
of cultural care within naturalistic contexts given phenomenon&dquo; (p. 1). Steven’s (1979) def-
and without use of predetermined (a priori) inition of theory further supports Watson’s in
variables. that she states &dquo;a theory is a statement that
Thus, the author made a bold break from purports to account for or characterize some
the view in nursing that a theory must be phenomenon&dquo; (p. 1).
tested through explicit preconceived or etic In general, a theory is effective if it can
(researcher’s or outsider’s) views about vari- discover, explain, interpret, and predict a phe-
ables to prove something. This latter philo- nomenon. different ways to define
There are
sophical and theoretical stance would not per- and use theories; there is
no one right way to
mit a full and accurate account of clients’ generate, test, analyze, and evaluate theories.
knowledge about care. Theories tested through More scientists are beginning to use qualita-
the scientific method with the rigid proce- tive approaches for inquiry to expand knowl-
dures, rules, and controlled conditions of logi- edge, especially in the human sciences (Capra,
cal positivism eventually gave way to the an- 1983; Leininger, 1985a; Reason & Rowan,
thropological, a theory- and knowledge-gener- 1981).
ating mode of open inquiry (Leininger, 1985a).
The author’s definition of theory is different
from current mainstream nurse theorists but
most congruent with anthropology and tran- Conceptualization of the Theory of Cultural Care
scultural nursing. The author believes that the The theorist of cultural care holds that care

discovery of care as a concept in nursing was is the essence of nursing and provides dis-
a
stifled until the use of the qualitative. ap- tinctconcept to describe, explain, and predict
proach, with the research methods of ethnog- nursing (Leininger, 1984, 1988b). Care should
raphy and phenomenology, became known to be central to nursing paradigms or metapara-
nurses (Leininger, 1985a). In addition, some digms and supported by the concepts of health
nurses devalue the concept of care because and environmental contexts. The author re-
they have not studied it in depth as a theory jects the idea that nursing and person explain
and as a phenomenon to be explained in its nursing, for one cannot explain nor predict the
own right (Leininger, 1986; Deers, 1988). same phenomenon one is studying. Nursing is
Some nurse leaders cannot envision care as a the phenomenon to be explained. Moreover,
theoretical concept in its own right as a phe- person, per se, is not sufficient to explain
nomenon to be studied, but rather see it as a nursing as it fails to account for groups, fam-
concrete action or practice (Lundh, Soder, & ilies, social institutions, and cultures. Nursing
Waerness, 1988). is not only concerned with person as an indi-
This leads to the author’s definition of the- vidual concept but includes groups, collectivi-
ory as sets of interrelated knowledge with ties, and institutions. It is ironic that some
meanings and experiences that describe, ex- nurses fail to recognize care in the metapara-
plain, predict, or account for some phenome- digms of nursing, or as the crucial dimension
non (or domain of inquiry) through an open, to explain and predict as a theoretical phenom-
creative, and naturalistic discovery process. enon. Only a few theorists, such as Watson
This perspective is critical to discover, account (1985) and Orem (1980) focus on care as im-
for, confirm, and explain unknown or vaguely portant or central to nursing, a phenomenon
known phenomena. It is essential to the de- to be explained and predicted. However, in the
velopment of nursing knowledge to document past decade, more nurses are beginning to fo-
and describe new insights and possibilities not cus on care and there are more research stud-
yet known or explicated. The use of inductive ies, publications, and writings specifically on
strategies to get to people (emic) truths, reali- the care phenomenon than at any time in the
ties, and other life-death knowledge about hu- past history of nursing. For example, before
man conditions is essential. The theory of cul- the 1970s, there were less than 30 nursing
tural care diversity and universality is con- articles, very few research studies, and vir-
gruent with methods that support the tually no books specifically directed to the
discovery of &dquo;people truths&dquo; in human living study of the care phenomenon per se, whereas
contexts rather than methods that follow the in 1987, there were more than 500 nursing
researcher’s preconceived views. The theory articles and 28 books by nurses addressing
can guide researchers to discover naturalistic care research, theory, and clinical findings in
inquiry patterns and expressions of cultural the United States (Leininger, in press).
care within diverse environmental contexts The author’s conceptualization of the theory
and social structures. of cultural care was derived from anthropology
Watson’s (1985) definition of theory lends with new formulations made within nursing
support to the author’s. She states that &dquo;a care perspectives. Her philosophy of nursing,

154

Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on March 9, 2015


with care inherent to the nature of nursing, is versal, yet the beliefs, values, and practices
based on extensive clinical nursing experi- vary, with some universal features. The cul-
ences, readings, and anthropological ideas of tural theory is held to be the broadest and
care
Homo sapiens with cultures that have sur- most wholistic guide to study human beings
vived through time. People are born, live, be- with their lifeways, cultural values and be-
come ill, and die within a cultural belief and liefs, symbols, material and nonmaterial
practice system, but are dependent upon hu- forms, and living contexts.
man care for growth and survival. Such ideas Finally, the author has predicted three dom-
and others required in-depth study and analy- inant modes to guide nursing decisions and
sis. It was a creative challenge to select, syn- actions in order to provide cultural congruent
thesize, and reconstruct knowledge from an- care. They are (a) cultural care maintenance
thropology and nursing to develop the theory or preservation, (b) cultural care accommoda-
of cultural care. It required in-depth under- tion or negotiation, and (c) cultural care re-
standing of different cultures of the world and structuring and repatterning (Leininger,
social structures. The language usages, sym- 1985a). The creatively designed nursing deci-
bols, and meanings about care in diverse cul- sions and actions will be congruent with the
tures had to be understood in order to derive lifeways of individuals, families, or groups as
the essences and patterns of cultural care. a basis to support the goal of cultural con-
Conceptualizing cultural care diversities and gruent care. If the latter goal of the theory is
universalities was important to establish what met, clients will find that nursing care reason-
is similar and different about care within and ably fits with or is similar to cultural beliefs,
among cultures. The author believes that the values, and lifeways. Cultural congruent nurs-
ultimate goal of cultural care theory is to pro- ing care is, therefore, predicted to provide
vide culturally congruent nursing care. Thus, meaningful, satisfying, and beneficial care to
the theory was derived from the disciplines of clients. In sum, the purpose of the theory is to
anthropology and nursing and constructed to describe, account for, interpret, and predict
fit nursing’s distinct and essential perspective cultural congruent care in order to attain the
about generic and professional care worldwide ultimate goal of the theory, namely, to provide
(Leininger, 1970, 1978, 1985a, 1988a). quality care to clients of diverse cultures that
is congruent, satisfying, and beneficial to
them.
Transcultural nursing concepts and
cultural

care theory gave nurses an


entirely new way to understand Assumptive Premises of the Theory
individuals, families, and cultures.
Several assumptive premises have been
identified related to the theory (Leininger
The author predicts that a continued in- 1979, 1985b). They are as follows.
depth analysis and systematic documentary 1. Care is essential for human growth, well
study of the care phenomenon will lead to a being, and survival and to face death or
full explication of the essences and the epis- disabilities.
temological roots of nursing care knowledge to 2. There are diverse and universal forms,
guide nursing decisions and practices. Com- expressions, patterns, and processes of hu-
man care that exist transculturally.
parative studies of cultural care patterns, val-
ues, and practices will greatly enrich and ex- 3. Care is the essence of nursing and the dis-
tend nursing knowledge, especially emic per- tinct, dominant and unifying feature of
spectives. Such knowledge should be valuable nursing.
4. Culture care is the broadest means to know,
to guide nurses in keeping people well and
explain, account for and predict nursing
preventing illnesses and disabilities and to care phenomena and to guide nursing care
support the well-being statuses of individuals, practices.
families, and cultures. Professional care based 5. Knowledge of meanings and practices de-
on generic care will be a powerful means to rived from world views, social structure fac-
promote health (or well-being) and to preserve tors, cultural values, environmental context,
healthy ways of life for people of diverse and and language uses are essential to guide
similar cultures. nursing decisions and actions in providing
With this theory, the author predicts that cultural congruent care.
cultural care knowledge and practices will 6. Cultures have folk and professional care val-
ues, beliefs, and practices that influence
have meaningful functions and structural pat-
cultural care practices in Western and non-
terns derived from the cultural values, world Western cultures.
views, social structures, and environmental 7. Care is essential to curing; however, there
contexts of diverse cultures. Folk and profes- can be no curing without caring, but there
sional care practices are predicted to be uni- can be caring without curing.

155

Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on March 9, 2015


8. Nursing is a transcultural phenomenon re- a picture or value stance about their life
quiring knowledge of different cultures to and the world about them.
provide care that is congruent with the 8. Social structure refers to the dynamic na-
clients’ lifeways, social structure, and envi- ture of interrelated structural or organi-
ronmental context. zational factors of a particular culture (or
society) and how these factors function to
give meaning and structural order, includ-
Theoretical Definitions of Orientation Related to ing religious, kinship, political, economic,
the Theory educational, technological, and cultural
factors.
As discussed above, operational definitions 9. Environmental context refers to the total-
are inappropriate in research with an open ity of an event, situation, or particular ex-
discovery theory, for the researcher seeks perience that gives meaning to human
emic knowledge derived from people and en- expressions, including social interactions
vironmental contexts as the epistemological and physical, ecological, emotional, and
and ontological sources of cultural care knowl- cultural dimensions.
10. Folk health (well being) system refers to
edge. The researcher has no desire to manip- traditional or local indigenous health care
ulate, control, or use tightly defined ideas or
or cure practices that have special mean-
variables that have been pre-selected before a
study begins, but instead uses an inductive ings and uses to heal or assist people,
which are generally offered in familiar
mode to generate ideas or fresh knowledge and home or community environmental con-
to get accurate views and experiences. Orien- texts with their local practitioners.
tation definitions may be used and altered as 11. Health refers to a state of well-being that
one studies a culture in order to fit the people’s is culturally defined, valued, and practiced
frame of reference and their world views and and which reflects the ability of individuals
other ideas derived firsthand from them. The (or groups) to perform their daily role activ-
informants’ definitions and interpretation ities in a culturally satisfactory way.
may replace the researcher’s usage in time.
12. Professional health system refers to
The following terms have been used as provi- professional care or cure services offered
sional guides to inductive or deductive acqui- by diverse health personnel who have been
sition of data (Leininger, 1978, 1985b).
prepared through formal professional pro-
grams of study in special educational insti-
1. Culture refers to the learned, shared, and tutions.
transmitted values, beliefs, norms, and life 13. Cultural care preservation or mainte-
practices of a particular group that guides . nance refers to those assistive, supportive,
thinking, decisions, and actions in pat- or actions and deci-
enabling professional
terned ways. sions that clients of a particular cul-
help
2. Care (noun) refers to phenomena related to ture to preserve or maintain a state of
assisting, supportive, or enabling behavior health or to recover from illness and to face
toward or for another individual (or group) death.
with evident or anticipated needs to amel- 14. Cultural care accommodation or negotia-
iorate or improve a human condition or tion refers to those assistive, supporting,
, lifeway. or enabling professional actions and deci-
3. Caring (verb) refers to actions directed to- sions that help clients of a particular cul-
ward assisting, supporting, or enabling an- ture to adapt to or negotiate for a beneficial
other individual (or group) with evident or or satisfying health status or to face death.

anticipated needs to ameliorate or improve 15. Cultural care repatterning or restructur-


a human condition or lifeway. ing refers to those assistive, supportive, or
4. Cultural care refers to the cognitively enabling professional actions or decisions
known values, beliefs, and patterned that help clients change their lifeways for
expressions that assist, support, or enable new or different patterns that are cultur-
another individual or group to maintain ally meaningful and satisfying or that sup-
well-being, improve a human condition or port beneficial and healthy life patterns.
lifeway, or face death and disabilities.
5. Cultural care diversity refers to the vari-
ability of meanings, patterns, values, or The Sunrise Model: Conceptual Components of
symbols of care that are culturally derived the Theory
by humans for their well-being or to im-
~

prove a human condition and lifeway or to The sunrise model was developed and re-
face death. fined over the past three decades to provide a
6. Cultural care universality refers to com-
mon, similar, or uniform meanings, pat-
gestaltic view of the major and interrelated
terns, values, or symbols of care that are components of the theory. The model (Fig. 1)
is not the theory per se but a conceptual pic-
culturally derived by humans for their well- ture to depict the components of the theory to
being or to improve a human condition and
lifeway or to face death. study how these components influence the
7. World view refers to the way people tend care and health status of individuals, families,
to look upon the world or universe to form groups, and sociocultural institutions. It is a

156

Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on March 9, 2015


Figure 1. Sunrise model to depict dimensions of cultural care diversity and universality: A theory of nursing.

wholistic conceptualization to help the re- ponents of the theory. The researcher is free
searcher systematically study the theory’s di- to start the discovery process according to per-
verse components, such as world view, social sonal interest regarding care. The nature, pat-
structure factors, cultural values and beliefs, terns, meanings, and characteristics of care
and folk and professional health systems, and can be systematically investigated. The model
how these components interface with each should not be used from a casual, linear, or
other in a gestaltic perspective. Thus, the re- positivistic perspective, but rather with the
searcher is able to see the whole conceptual goal to discover the essence, meanings, and
picture of the theoretical components. patterned expressions of generic and profes-
As the researcher uses the model, one can sional care. Because this base of care knowl-
focus on specific areas, such as the individual, edge is still relatively unknown, the author
family, group, or institution and study care supports qualitative ethnomethods to obtain
phenomena in relation to the different com- grounded knowledge derived from key and

157

Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on March 9, 2015


general informants about the different com- researcher’s etic a priori viewpoints. These
ponents depicted in the model and from the emic care constructs are invaluable to explain,
theoretical statements presented earlier. Teas- develop, and guide nursing actions and deci-
ing out illusive and embedded ideas from social sions, and they give clues to ways clients ex-
structure, world view, and cultural beliefs pect to receive culturally congruent care. How
about care is a difficult and important chal- these care constructs influence the health or
lenge. With an open inquiry manner, inform- well-being of individuals, families, groups, or
ants are encouraged to share their ideas and institutions in different cultures is of major
experiences about care and its relationship to importance in establishing the substantive
different components of the theory and to ex- knowledge of nursing.
plore the meanings of care to predict or explain Throughout the inductive discovery process,
health or well-being states. the researcher describes and documents di-
To study the tenets of the theory, the re- verse and common features about care with
searcher moves to discover the nature, pat- informants of a particular culture. Findings
terns, and expressions of cultural care and from each culture study are contrasted with
health in diverse folk and professional health findings from other studies to identify both
systems. The nursing system in cultures is a universal and diverse patterns and themes
major part of the professional system. The folk among cultures. Care concepts, such as stress
health system of different cultures is an ex- alleviation, trust, involvement with touch,
tremely rich source of data from which to gain stimulation, comfort, engrossment, tender-
an understanding of care and health practices. ness, and empathy, may be similar or differ-
For example, the author has identified a num- ent. In keeping with qualitative methods, the
ber of folk health beliefs and practices impor- researcher uses criteria such as confirmation,
tant to clients, but often these practices are in credibility, saturation, recurrence, and others
conflict with nurses’ professional modes of to evaluate the findings in light of the theory
believing and acting (Leininger, 1988b, in (Leininger, 1985a).
press). As one studies these systems, it is im-
portant to ask about non-caring beliefs and
practices in both the folk and professional By use of the theory, nurses will
systems to fully understand care and health discover different
practices. Keen observation with an open ex- perspectives about
care.
ploratory posture is essential to discover the
similarities among cultures so that universal
care features as well as differences can be
identified within folk and professional health Cultural care theory is used primarily to gen-
systems. erate grounded and substantive data about
In the sunrise model, there are three modes care meanings, patterns, experiences, and
proposed for making nursing decisions and other aspects of care. It is used to generate
taking actions for cultural congruent care. new or to gain different insights
knowledge
These modes are usually identified from and about of diverse cultures. By use of the
care
acted upon using data that have been derived theory, not only will nurses discover different
from a comprehensive study of individuals, perspectives about care, but they will realize
families, and groups. These grounded and sub- there differences and commonalities in
are
stantive data derived from key and general caring for clients using culturally based data
informants, observations, participatory expe- to guide nursing care practices. It is also pos-
riences, and other research strategios provide sible to develop hypotheses from qualitative
important information to determine which findings of the theory or to conduct quantita-
mode of decision would be most appropriate, tive research studies on cultural care. Exam-
beneficial, or satisfying to the clients. ples of hypotheses, questions, themes and re-
As the researcher uses the theory in an open lated areas have been presented previously
inductive or empirically derived way to obtain (Leininger, 1978, 1985b, 1988a, 1988b).
first hand emic data from different informants From the first transcultural care study in
in their natural and familiar environmental the eastern highlands of New Guinea in the
contexts, one can identify themes and pat- early 1960s by the author to the present day
terns of differences and similarities about (including studies of 52 cultures, 30 of those
care. Gentle and sensitive probing is needed to studied with other researchers), the findings
discover the subtle meanings and interpreta- have been extremely informative and packed
tions of care, such as comfort, succorance, with detailed cultural descriptions and emic
attention, presence, and many other care con- interpretations of the care phenomenon. For
structs still so limitedly known in their full example, these studies reveal that a) cultural
meanings and uses in nursing. The inform- care has more diverse than similar meanings,
ants’ emic knowledge and experiences are far and the patterns of care expression have major
more important for grounded data than the implications for building an extensive body of

158

Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on March 9, 2015


nursing knowledge; b) cultural care constructs tural factors in all aspects of human care serv-
illusive and often embedded in cultural
are ices will be imperative. Comparative studies of
values, kinship, religious systems, and envi- care from diverse cultures will be essential to
ronmental contexts; c) care meanings and advance nursing knowledge and practices.
interpretations require knowledge of local lan- Nurses will need research findings to deal with
guage usages; d) marked differences exist be- care differences and similarities in nursing
tween Western and non-Western cultures re- practices. Both micro- and macro-scale care
garding care values, patterns, and practices theories will be used as nurses expand their
with signs of considerable conflicts, stresses, world view about different nursing and health
and non-caring practices between care givers _ care systems worldwide in order to be effective
and receivers of these different cultural ori- practitioners, researchers, and educators in
entations ; and e) technological nursing prac- other cultures.
tices tend to increase distance between client In the future, the author predicts even
and nurse in care relationships. Many other greater interest in human care theories and
findings have been generated from the 52 cul- use of research findings as personalized care
tures that have been studied and will be pre- becomes a highly competitive and economi-
sented elsewhere. Largely emically derived cally valued &dquo;product&dquo; by consumers and pro-
data are being used to guide culturally con- viders of quality health care services. Quality
gruent care practices for clients of diverse cul- health care will become a marketable item
tures using the projected three modes of nuxs- with favorable positive cost benefits as it is
ing decision and action patterns depicted in now being promoted in commercial busi-
Figure 1. nesses. Nursing is in a unique and enviable
position to demonstrate quality care based on
in-depth knowledge about the meanings and
Current and Future Uses of the
Theory experiences related to healing clients and pro-
viding effective health care promotion services
During the past decade, the theory has been to the well, sick, disabled, or dying. Ethical
used by an increased number of nurses in the cultural values of care in diverse cultures and
United States and abroad. The present gener- environmental contexts have yet to be fully
ation of nursing students are enthusiastic explicated and understood in nursing. The the-
users of the theory as they realize the critical ory of cultural care diversity and universality,
problems in working with clients from many Watson’s theory of existential care (1985) and
strange cultures in the United States and over- Parse’s theory of man-living-health ( 1981 ) are
seas. They also know they will be working with some examples of highly promising new theo-
more diverse clients as the health care world ries calling for alternative research ap-
becomes even more multicultural. This theory proaches to knowledge generation and confir-
has relevance and significance for nurses in ’mation. These theories are sufficiently broad
all cultures to reduce nurse burnout, cultural in scope to lead to the identification of knowl-
shock, marked ethnocentrism, and many edge specific to cultures. Most importantly,
other nursing conditions and practices. these theories, with the use of naturalistic
Nurses from many different cultures in the inquiry modes such as ethnonursing, phenom-
world are becoming critical of nursing theories enology, and others, are getting to the well-
that do not fit their cultural ideologies, beliefs, spring of the critical and essential nature of
and values as recently noted in the literature nursing knowledge. By the early part of the
(Leininger, 1978, 1984, 1988b; Lundh, Soder, 2lst century, there will be many nurses focus-
& Waerness, 1988). As a theorist who fre- ing on human care and nursing with the the-
quently visits and consults with nurses in ory of cultural care diversity and universality
many different places in the world, the author remaining the most meaningful and broadest
listens to these concerns and hears the value means to study people worldwide within dif-
of cultural care theory. The theory is broad ferent temporal, spatial, contextual, and mul-
enough to incorporate nursing care ideas and tidimensional perspectives. The use of anthro-
specific enough to develop culture-specific pological and transcultural care knowledge is
care world wide. The theory is unique as a essential for accurate reliable health care.
guide to research to obtain in-depth knowledge
of particular cultures and of professional nurs- References
ing’s culture care patterns and themes. The Capra, F. (1983). The turning point. New York: Bantam.
interest in care as a central domain of nursing Deers, D. (1988). Editorial: On clinical scholarship (again).
to guide nursing care decisions and actions is Image: Journal of Nursing Scholarship, 20 (1), 2.
growing world wide with evidence to establish Leininger, M. (1970). Nursing and anthropology: Two
care as nursing’s major and fundamental worlds to blend. New York: Wiley.

knowledge base. Leininger, M. (1978). Transcultural nursing concepts,


theories and practices. New York: Wiley.
As nurses function in today’s world and Leininger, M. (1979). Transcultural nursing. New York:
even more so by the 21st century, multicul- Mason.

159

Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on March 9, 2015


Leininger, M. (1984, December). Transcultural nursing: Leininger, M. (in press). Ethnocare and ethnohealth of
An essential knowledge and practice field for today. The ten cultures in urban environmental contexts. Detroit:
Canadian Nurse, pp. 41-45. Wayne State University Press.
Leininger, M. (1985a). Qualitative research methods in Lundh, U., Soder, M., & Waerness, K. (1988). Nursing
nursing. Orlando, FL: Grune and Stratton. theories: A critical review. Image: Journal of Nursing
Leininger, M. (1985b). Transcultural care diversity and Scholarship, 20(1), 40.
universality: A theory of nursing. Nursing and Health Orem, D. (1980). Nursing concepts of practice. New York:
Care, 6(4), 209-212. McGraw-Hill.
Leininger, M. (1986, July). Care facilitation and resistance Parse, R. R. (1981). Man-living-health: A theory of nurs-
factors in the culture of nursing. Topics in Clinical ing. New York: Wiley.
Nursing, 8, 1-12. Polit, D., & Hungler, B. (1983). Nursing research: Princi-
Leininger, M. (1988a). Caring: An essential human need. ples and methods. (2nd ed.). Philadelphia: Lippincott.
Detroit: Wayne State University Press. (Reprinted with Reason, P., & Rowan, J. (1981). Human inquiry: A source
original work published (1981) by Slack Pub. Inc., Tho- book of new paradigm research. New York: Wiley.
rofare, NJ). Stevens, B. J. (1979). Nursing theory: Analysis, appli-
Leininger, M. (1988b). Care: The essence of nursing and cation, evaluation. Boston: Little, Brown.
health. Detroit: Wayne State University Press. (Re- Watson, J. (1985). Nursing: Human science and human
printed with original work published (1984) by Slack care: A theory of nursing. Norwalk, CT: Appleton-Cen-
Pub. Inc., Thorofare, NJ. tury-Crofts.

160

Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on March 9, 2015