Madeleine Leininger
The Cultural Component
Grace Argentino
Kristen Argo
Madeleine M. Leininger
"...first nurse anthropologist and
founded the discipline of transcultural
nursing, the ethnonursing qualitative
research methodology, the Council on
Nursing and Anthropology with the
American Anthropological
Association/Society for Applied
Anthropology, the Transcultural
Nursing Society, and the Journal of
Transcultural Nursing" (Ray, 2013,
Madeleine M. Leininger
Origins of Nursing Model
After an extensive three year study in New Guinea,
Leininger realized there was an association between
culture and health care. The healthcare industry was
not prepared to effectively meet the cultural needs
of individuals and their families due to a lack of
knowledge and understanding of cultural values.
This became the motivating factor in her quest to
establish the discipline of transcultural nursing.
Madeleine M. Leininger
Origins of Nursing Model
Her studies led to the development of the Theory of
Culture Care Diversity and Universality, laying the
foundation for the transcultural nursing movement.
Her goal was to provide the necessary tools to
provide culturally congruent care that integrated the
patient's cultural beliefs and values to produce
results that were both effective and satisfying to the
Leininger's Theory
Information and Concepts
"There are certain basic concepts, or ideas, that are
essential to an understanding of professional nursing
practice; they are the building blocks of nursing. These
concepts are person, environment and health.
Everything professional nurses do is in some way
related to one of these basic inter-related concepts..."
(Chitty & Black, 2011, p. 272).
Madeleine Leininger's culture care theory encompasses
all four global concepts while emphasizing the need to
incorporate the patient's cultural beliefs into their care.
Theory of Culture Care
Diversity and Universality
"...states that care is the essence of nursing and the
dominant, distinctive, and unifying feature of
nursing. Human caring varies among cultures in its
expression, processes, and patterns" (Potter & Perry,
2009, p.50).
Leininger's Sunrise Model
"...demonstrates the inclusiveness of culture in
everyday life and helps to explain why cultural
assessment needs to be comprehensive...assumes
that cultural care values, beliefs, and practices are
fixed in the cultural and social structural dimensions
of society, which include environmental context,
language, and ethnohistory" (Potter & Perry, 2009,
Sunrise Enabler
The Four Global Concepts
Leininger's theory defines health as a "state of wellbeing 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" (Taber's Cyclopedic Medical
Encyclopedia, 2013).
The Four Global Concepts
Chitty and Black (2011) infers that people are
"systems with human needs" (p. 274).
Leininger's theory delves into the realm of each
person's human needs based on their cultural beliefs.
The Four Global Concepts
Ethnohistory is defined as "past facts, events,
instances, experiences of individuals, groups,
cultures, and institutions that are primarily people
centered (ethno) and which describe, explain, and
interpret human lifeways within particular cultural
contexts and over short or long periods of
time"(Taber's Cyclopedic Medical Encyclopedia,
Leininger's cultural care theory recognizes the
importance of ethnohistory and how it helps define
a person and their needs.
The Four Global Concepts
The environmental concept of Leininger's theory is
"the totality of an event, situation, or particular
experiences that give meaning to human
expressions, interpretations, and social interactions
in particular physical, ecological, sociopolitical,
and/or cultural settings" (Taber's Cyclopedic
Medical Encyclopedia, 2013).
The Four Global Concepts
The goals of nursing practice developed by
Madeleine Leininger are "to improve and to provide
culturally congruent care to people that is beneficial,
will fit with, and be useful to the client, family, or
culture group healthy lifeways; to provide culturally
congruent nursing care in order to improve or offer
a different kind of nursing care service to people of
diverse or similar cultures". (Taber's Cyclopedic
Medical Encyclopedia, 2013)
The Four Global Concepts
Madeleine Leininger states "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" (Clarke,
McFarland, Andrews & Leininger, 2009, p. 235).
Relationship of Concepts
Every human being is a unique individual with different
needs and characteristics. Their environments, views on
health and health care and beliefs all differ. The four
global concepts necessary for effective patient care are
not stand alone ideals. They interact with each other and
constantly change the balance regarding a person's
The concept of culturally congruent nursing combines
the four concepts with an emphasis on cultural
understanding to promote the health and well-being of
the patient.
Madeleine M. Leininger
Interpretation and Inferences/Implications and Consequences
As stated by the philosophy and values of
Transcultural Nursing (TCN)
"Human care/caring is defined within the context of
culture. Culturally competent care can only occur
when culture care values are known and serve as the
foundation for meaningful care" (Transcultural
Nursing Society, 2013).
Madeleine M. Leininger
Interpretation and Inferences/Implications and Consequences
Nurses must critically reflect on their own values
and beliefs, and determine the impact it has on
providing culturally congruent care. Gaining
knowledge of different cultural beliefs and values
will enable nurses and other healthcare providers to
plan appropriate care, beneficial to the patient's
health and well-being.
Madeleine M. Leininger
Interpretation and Inferences/Implications and Consequences
A set of 12 universal standards for providing
cultural nursing care were developed by members of
the Transcultural Nursing Society and the Expert
Panel for Global Nursing and Health of the
American Academy of Nursing. They can be found
through the following link listed below in Table 1,
on page 258.
Madeleine M. Leininger
Interpretation and Inferences/Implications and Consequences
Without Leininger's influence in the development of
transcultural nursing, individuals, families, groups,
and institutions might not have their needs met due
to the lack of understanding of how cultural
differences influences health and health patterns.
Misunderstandings may be conveyed as insults, rude
behavior, or a sign of disrespect. A lack of
understanding may cause reluctance in an
individual's choice to return for future care.
Evaluation of Transcultural Nursing
There are many nursing theories regarding patient care
and well-being which have similar or overlapping
Madeleine Leininger's theory is unique as it is "the only
nursing theory focused explicitly on culture care as the
dominant domain of nursing inquiry. The theory is a
holistic, culturally based care theory that incorporates
broad humanistic dimensions about people in their
cultural life context" (Leininger, 2007, p. 9).
Evaluation of Transcultural Nursing
"It is also unique in its incorporation of social
structure factors, such as religion, politics,
economics, cultural history, lifespan values, kinship,
and philosophy of living; and geo-environmental
factors, as potential influences of culture care
phenomena" (Leininger, 2007, p. 9).
Evaluation of Transcultural Nursing
"Another unique feature of the culture care theory was
the focus on emic and etic care knowledge. Emic
knowledge comes directly from cultural informants as
they know and practice care with their values and
beliefs in their unique cultural contexts. Emic
knowledge was the natural, local, indigenous root care
values. In contrast, etic care knowledge was derived
from outsider views of non-local or non-indigenous care
values and beliefs such as those of professional nurses"
(Leininger, 2007, p.10).
Evaluation of Transcultural Nursing
Madeleine Leininger's theory of transcultural
nursing falls into the description of the four
global concepts as every aspect is incorporated
into the care of the patient.
While the theory itself is broad, it can be
utilized in any area in the health field. Society
continues to become more and more diverse
and people in every culture need health care at
some point in their lives.
Evaluation of Transcultural Nursing
While other theories have not been generated from
this model, there has been a significant increase in
transcultural nursing over the decades.
Evaluation of Transcultural Nursing
"Culturally congruent care has become a soughtafter goal today and a mantra for many health
organizations and professions, nationally and many states and countries, it has
become a goal and an expected norm of healthcare
services" (Leininger, 2007, p. 9).
Theory in Practice
The practice of transcultural nursing has increased
globally since Madeleine Leininger first presented it
decades ago.
Today's communities are becoming more ethnically
diverse and the need to understand the beliefs and
values among the different cultures is becoming
more important. Once an understanding and
acceptance exist, caregivers can begin to provide
culturally congruent care that is more effective for
their patients.
Theory in Practice
"Nurses who work in other countries, particularly
developing nations, face two significant moral
concerns: how to interface with established cultural
norms and how to handle the novel ethical
dilemmas that arise from practicing in a different
culture. The standard ways of making decisions,
used in one’s own culture, are challenged and often
require greater cultural sensitivity and ethical
reflection" (Crigger & Holcomb, 2007, p. 70).
Theory in Practice
"Before the authors engaged in health care efforts in
Honduras, they considered how to approach a culture in
which they had little knowledge...Four ways of thinking
about service and the people served were formed. They are
revealing ignorance, reverencing the culture, refraining
from harm, and reducing biomedical and cultural
ethnocentricity" (Crigger & Holcomb, 2007, p. 72-73).
Revealing ignorance pertains to the fact that anyone outside
of a culture may learn how to work with, communicate with
and treat people from said culture, but they will never be
“of” that culture.
Theory in Practice
"...after more than 10 years of involvement in Honduras,
the authors have limited understanding of the culture. But
they realize that the Honduran culture makes perfect sense to
the Honduran people they encounter. The authors accept the
fact that they are in a dynamic process of piecing together an
understanding of the culture and who these people truly are.
With their work in Honduras, each exposure to the culture
brings them closer to understanding" (Crigger & Holcomb, 2007,
p. 74).
Theory in Practice
"Failure to acknowledge and work with the existing culture
and its health care system is identified as a barrier to
work in other cultures. Many of the major public health issues
encountered in Honduras were beyond the abilities of the authors
to change. Although health care providers can encourage
changes and educate the people with whom they work, they
do not have the ability to implement the sweeping
social changes needed to address significant public health
issues. The authors had to accept the public health limitations
in the country and at the same time respect the culture
for the services that were provided" (Crigger & Holcomb, 2007,
p. 73).
Theory in Practice
"Cultures can adopt external ideas too quickly, and
it can be harmful. On the other hand, cultures may
resist adopting and be harmed by not adopting a
view quickly enough" (Crigger & Holcomb, 2007,
p. 74).
Nurses must be able to blend cultural ideals whether
the patient has come to them in a hospital setting
foreign to them or if the nurse has chosen to practice
in a country with different cultural backgrounds
than they are used to.
Theory in Practice
Standards for culturally competent nursing care can
be found in The Journal of Transcultural Nursing at
the following link:
Madeleine M. Leininger
Madeleine Leininger's theory of culture care diversity
and universality was a groundbreaking step in nursing
care. Transcultural nursing is a vital component in
nursing care worldwide due to the increase in
immigration and the vast differences in every culture.
"The nursing outcome of culturally congruent care is
health and well-being for the patient" (Chitty & Black,
2011, pg. 316) which is what we should all be striving
for as professional nurses.
Case Study
"A 70-year-old Hmong mother and her 45-year-old son came to a large
hospital to get help with “mother’s pains.” The son was culturally obligated to
remain with his mother at all times. The mother did not speak English and
relied on her son for everything. The mother had several cultural amulets she
wore on her neck and wrist for spiritual protection. The staff nurse quickly
removed the amulets as “they were dirty strings.” The mother cried
immediately and pleaded to her son to return these objects to her for
protection. She refused medications and was viewed by the staff nurses as
“uncooperative and resistant'"(Leininger, 2003, p. 157).
What would you have done differently if you were the nurse caring for this
Case Study
The nurse is caring for a Middle Eastern postpartum
patient who gave birth to a son the day prior. The
woman barely speaks English, and is surrounded by her
mother-in-law and sister. The new mother is sleeping
and the mother-in-law is changing the baby. Upon
entering the room, you are told "she rest" by the
grandmother. How would you plan interventions that
are culturally sensitive to the Middle Eastern culture,
understanding it is customary in the patient's culture for
the mother-in-law to take over care of the infant during
the first few months of life?
Chitty, K., & Black, B. (2011). Professional nursing: Concepts & challenges (6th ed.).
Maryland Heights, MO: Saunders Elsevier
Clarke, P., McFarland, M., Andrews, M., and Leininger, M. (2009). Caring: Some
reflections on the impact of the culture care theory by McFarland & Andrews and a
conversation with Leininger. Nursing Science Quarterly, 22, 233-239. doi:
Crigger, N., and Holcomb, L. (2007). Practical strategies for providing culturally
sensitive, ethical care in developing nations. Journal of Transcultural Nursing, 18, 7076. doi: 10.1177/1043659606294198
Douglas, M. K., Uhl Pierce, J., Rosenkoetter, M., Callister, L. C., Hattar-Pollara, M.,
Lauderdale, J., ...Pacquiao, D. (2009) Standards of practice for culturally competent
nursing care: A request for comments. Journal of Transcultural Nursing, 20 (3), 257269. doi: 10.1177/1043659609334678
Leininger, M. (2007). Theoretical questions and concerns: Response from the theory
of culture care diversity and universality perspective. Nursing Science Quarterly, 20,
9-13. doi: 0.1177/08943184062967841
Leininger, M. (2003). Founder's focus: Transcultural nursing makes a big outcome
difference. Journal of Transcultural Nursing, 14, 157. doi:
Madeleine Leininger. (2013). In Taber's Cyclopedic Medical Dictionary online.
Retrieved from
Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing (7th ed.). St. Louis,
Missouri: Mosby Elsevier.
Ray, M. A., (2013). Madeleine M. Leininger 1925-2012. Qualitative Health Research,
23 (1), 142-144. doi:10.1177/10497323 12464578
Transcultural Nursing Society. (2013). Philosophy/values. Retrieved from

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