Early in her career, Madeleine Leininger recognized the importance of the element
of caring in the profession of nursing. Through her observations while working as
a nurse, she identified a lack of cultural and care knowledge as the missing component
to a nurse's understanding of the many variations required in patient care to support
compliance, healing, and wellness.
Leininger's Culture Care Theory attempts to provide culturally congruent nursing care
through "cognitively based assistive, supportive, facilitative, or enabling acts or
decisions that are mostly tailor-made to fit with individual, group's, or institution's
cultural values, beliefs, and lifeways." The intent of the care is to fit with or have
beneficial meaning and health outcomes for people of different or similar culture
Culturally congruent care is possible when the following occurs in the nurse-patient
relationship: "Together the nurse and the client creatively design a new or different
care lifestyle for the health or well-being of the client. This mode requires the use
of both generic and professional knowledge and ways to fit such diverse ideas into nursing
care actions and goals. Care knowledge and skill are often repatterned for the best
interest of the clients. Thus all care modalities require coparticipation of the nurse
and clients (consumers) working together to identify, plan, implement, and evaluate
each caring mode for culturally congruent nursing care. These modes can stimulate nurses
to design nursing actions and decisions using new knowledge and culturally based ways to
provide meaningful and satisfying wholistic care to individuals, groups or institutions."
Leininger's model has developed into a movement in nursing care called transcultural
nursing. In 1995, Leininger defined transcultural nursing as "a substantive area of
study and practice focused on comparative cultural care (caring) values, beliefs, and
practices of individuals or groups of similar or different cultures with the goal of
providing culture-specific and universal nursing care practices in promoting health or
well-being or to help people to face unfavorable human conditions, illness, or death in
culturally meaningful ways."
Leininger developed new terms for the basic concepts of her theory. The concepts addressed in the model are:
Care, which assists others with real or anticipated needs in an effort to
improve a human condition of concern, or to face death.
Caring is an action or activity directed towards providing care.
Culture refers to learned, shared, and transmitted values, beliefs, norms,
and lifeways to a specific individual or group that guide their thinking, decisions,
actions, and patterned ways of living.
Culture Care is the multiple aspects of culture that influence and help a
person or group to improve their human condition or deal with illness or death.
Culture Care Diversity refers to the differences in meanings, values, or
acceptable forms of care in or between groups of people.
Culture Care Universality refers to common care or similar meanings that
are evident among many cultures.
Nursing is a learned profession with a disciplined focus on care phenomena.
Worldview is the way people tend to look at the world or universe in creating a personal view of what life is about.
Cultural and Social Structure Dimensions include factors related to spirituality,
social structure, political concerns, economics, educational patterns, technology,
cultural values, and ethnohistory that influence cultural responses of people within
a cultural context.
Health refers to a state of well-being that is culturally defined and valued by a designated culture.
Cultural Care Preservation or Maintenance refers to nursing care activities
that help people from particular cultures to retain and use core cultural care
values related to healthcare concerns or conditions.
Cultural Care Accomodation or Negotiation refers to creative nursing actions
that help people of a particular culture adapt or negotiate with others in the
healthcare community in an effort to attain the shared goal of an optimal health
outcome for patients of a designated culture.
Cultural Care Re-Patterning or Restructuring refers to therapeutic actions
taken by culturally competent nurses. These actions help a patient to modify
personal health behaviors towards beneficial outcomes while respecting the
patient's cultural values.
The theory's culturalogical assessment provides a holistic, comprehensive overview of the client's background. The assessment addresses the following:
communication and language
ability and disability
use of space
foods and meal preparation and related lifeways
Leininger proposes that there are three modes for guiding nurses judgments, decisions,
or actions in order to provide appropriate, beneficial, and meaningful care: preservation
and/or maintenance; accommodation and/or negotiation; and re-patterning and/or restructuring.
The modes have greatly influenced the nurse's ability to provide culturally congruent nursing
care, as well as fostering culturally-competent nurses.
Leininger's model makes the following assumptions:
Care is the essence of nursing and a distinct, dominant, and unifying focus.
Caring is essential for well-being, health, healing, growth, and to face death.
Culture care is the broadest holistic means by which a nurse can know, explain, interpret, and predict nursing care phenomena to guide nursing care practices.
Nursing is a transcultural, humanistic, and scientific care discipline and profession with the central purpose to serve human beings worldwide.
Caring is essential to curing and healing. There can be no curing without caring.
Culture care concepts, meanings, expressions, patterns, processes, and structural forms of care are different and similar among all cultures of the world.
Every human culture has lay care knowledge and practices and usually some professional care knowledge and practices which vary transculturally.
Culture care values, beliefs, and practices are influenced in the context of a particular culture. They tend to be embedded in such things as worldview, language, spirituality, kinship, politics and economics, education, technology, and environment.
Beneficial, healthy, and satisfying culturally-based nursing care contributes to the well-being of individuals, families, and communities within their environmental context.
Culturally congruent nursing care can only happen when the patient, family, or community values, expressions, or patterns are known and used appropriately, and in meaningful ways by the nurse with the people.
Culture care differences and similarities between the nurse and patient exist in any human culture worldwide.
Clients who experience nursing care that fails to be reasonably congruent with their beliefs, values, and caring lifeways will show signs of cultural conflicts, noncompliance, stresses and ethical or moral concerns.
The qualitative paradigm provides new ways of knowing and different ways to discover the epistemic and ontological dimensions of human care.
The Culture Care Theory defines nursing as a learned scientific and humanistic profession
that focuses on human care phenomena and caring activities in order to help, support,
facilitate, or enable patients to maintain or regain health in culturally meaningful
ways, or to help them face handicaps or death.
The Sunshine Model is Leininger's visual aid to the Culture Care Theory.