Nursing Theory

Madeleine Leininger’s Theory of Cultural Care: Background.

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Leininger’s Theory of Cultural Care began during the 1950s, when she developed a fascination with anthropology. While she was studying at the University of Cincinnati, she discussed this fascination and how it might influence her work as a professional nurse with visiting professor Margaret Mead (Munoz, 2012). Particularly, she was interested in acknowledging cultural differentiation factors in her nursing practice. She found many concepts that are pertinent to the discipline of nursing within anthropology. This fascination led to her work in the Eastern Highlands of New Guinea, where Leininger studied human behavior in two Gadsup villages to determing the convergence and divergence of human behavior in these locations. She received a national League of Nursing Fellowship for this work. This fascination blended into her studies, and she was the first professional nurse to receive a PhD in cultural and social anthropology in 1965. Madeleine Leininger aimed to use her newly acquired knowledge to blend nursing and anthropology (Munoz, 2011). Today, Leininger’s concept of “culturally congruent care” is the goal of the Theory of Culture care and is used globally as standard in the nursing profession.

This aim brought about the publication of her “Culture Care Diversity and Universality: A worldwide Theory of Nursing.” She is therefore regarded as the mother of transcultural nursing and the founder of the Transcultural Nursing society. In this capacity, Leininger has applied her theory by means of education, research, administration, and practice. In 1966, Dr. Leininger entered a position as Professor of Nursing and Anthropology at the University of Colorado. This was another first in the profession, where a joint appointment was awarded for a professor of nursing and a second discipline in the United States. From 1969, Leininger works as Dean, Professor of Nursing, and Lecturer in Anthropology at theh University of Washington’s School of Nursing. Her leadersip brough great recognition to the institution, where the University of Washington was recognized as the outstanding public institutionsal school of nursing in the United States.

From 1974 to 1980, Leininger served at the Utah College of Nursing as Dean, Professor of Nursing, Adjunct Professor of Anthropology, and Director of the Center for Nursing Research and the Doctoral and Transcultural Nursing Programs. She was also a pioneer in terms of her presidency at the American Associatoin of Colleges of Nursing, where she was the first full-time president. She was also one of hteh first members serving on the American Academy of Nursing in 1975. From 1981, she served in various capacities at Wayne State University, where she continued to receive a variety of awareds for her work, including the President’s Award for Excellence in Teaching and the Gersehenson’s Research Fellowship Award. Currently, Leininger is retired, but continues her work in the field of transcultural nursing. She has worked for more than 35 years to advance this theory and to act as a consultant and speaker on her theory, and she continues to do and remains in high demand for her expertise and work this to date.

The main phenomenon Leininger’s theory is concerned with is the apparent lack of effectiveness of health care in terms of providing the necessary care for culturally diverse populations. Noticing this when she started her career during the 1940s and 1950s, Leininger began to investigate ways in which to remedy this shortcoming. This in turn, as mentioned, above, led to the creation of her theory and the improvement of health care for populations in the United States and across the world.

Professional nursing today has benefited significantly from Leininger’s work, since nursing is primarily a caring profession. Those under her tutelage and care have both benefited from her work in terms of both receiving and giving healthcare. This accounts for her immense popularity among both professionals and recipients of healthcare in the United States and across the world.

In her work, Leininger contributed more than 400 scientific studies within the field of transcultural care (Sagar, 2012, p. 1). The Leininger Collection on Human Caring and Transcultural Nursing in the Archives of Caring and Nrusing at the Christine Lynn College of Nursing opened o April 16, 2010. These Archives contain Leininger’s life work, spanning some six decades of passionate research and practical application to her field.

Theory of Cultural Care: Description

When describing the theory in more detail, one might consider Madeleine Leininger’s theory of Cultural Care as a product of consciousness that is devoted to a world where constant change is recognized (Allauigan, 2011). The main aim of the theory, as stated above, is to meet the healthcare needs of diverse cultures. This is particularly important today, in a world where diversity and cultural integration is an increasing phenomenon across the world. As such, the theory was derived from Leininger’s experiences in hospitals, clinics, and communities.

The first basis of the theory was developed during World War II. Many immigrants and refugees from a variety of cultures entered the United States and other countries across the world. The first phenomenon that Leininger became aware of was that recovery or health maintenance depended greatly upon the way in which healthcare was provided. This idea was reinforced in Leininger’s mind during the 1950s, when Leininger worked as a clinical specialist for mildly disturbed children. Because these children were from different cultures, Leininger became deeply aware of the inadequacy of current popular theories to address the needs of these children. This brought home to her the idea that more investigation was warranted into the problem and its potential solutions. One of her major challenges was professional resistance to her ideas, since there was not at the tie sufficient published work to support her thinking around the importance of culture in healthcare. With great effort, however, Leininger established herself as an icon in the field and the theory became one of the most important bases of ehealth care today (Allauigan, 2011, p. 1).

Leininger’s theory evolved into a model, known as the “sunrise enabler,” which functions on a practical level to determine and discover culture care, while also being symbolic of new hope and knowledge for excellence in nursing. The model includes seven “sunrays,” referring to the factors such as technological, religious and philosophical, kinship and social, cultural values and lifeways, political and legal, economic, and educational. All these factors form the sunrays that influence individuals, families, and groups in terms of promoting health and caring for those in an unhealthy state. Currently, the theory is used not only in nursing, but also in other health-related disciplines. It includes an assessment of the health care needs of individuals, families, groups, communities, and institutions within a variety of health systems.

When considering the type of reasoning used by the theory, one might argue that, at its initiation, the theory was created by inductive reasoning. Leininger observed various specific phenomena in terms of the way in which individuals from different cultures responded to healthcare, which was based on existing theories. She induced from this that the current theory was not sufficient to provide optimal healthcare and used her observations to arrive at theories that could be used to greater effect in healthcare.

Since inductive reasoning begins with observations of specific phenomena that can be applied to develop general theories, Leininger used inductive reasoning to develop her theory of transcultural nursing. Today, however, the theory is used to arrive in terms of deductive reasoning, which works the other way around. Deductive reasoning uses a general observation to arrive at a more specific conclusion. As such, Leininger’s model is used deductively to arrive at optimal ways for treating patients from different cultures. This also represents an effective way in which to determine the validity of a theory. While it is not always possible to arrive at accurate observations and conclusions using inductive reasoning, applying deductive reasoning to the created phenomenon tends to solidify the theory.

Hence the validity and accuracy of Leininger’s theory has been proven very effectively with the ability to apply both types of reasoning to it.

The theory has been refined over six decades (Sagar, 2012, p. 2). During this refining process, Leininger and others working with the theory have used its terms and phenomena with as much consistency as was warranted by its evolution. Today, the theory is used consistently across many healthcare disciplines throughout the world, providing a consistent method for caring for persons from different backgrounds.

The concepts are defined explicitly, providing a particular basis for identifying the specific cultural phenomena according to which health is to be evaluated and treated for each individual. Implicitly, the implication is that there must be a consistent sense of respect for cultural differentiation among individuals and that such differentiation is to be utilized not to discriminate but to promote respect.

Sagar (2012, p. 3) mentions that Leininger’s theory includes 11 assumptions. Some of these include that “care is the essence.. .and unifying focus of nursing,” that there are different expressions, meanings and patterns to “culture care” and that theya re divers, but also that there are some commonalities among them and the cultures involved, and also that every culture has some type of generic and professional care to discover and use in order to provide culturally congruent care. As such, the nurse is not to be only a “broker” or “mediator,” but an active participant in the culture and care an individual needs to become fully well.

As such, Madeleine Leininger has consistently taken into account and advocated for a holistic approach towards nursing care. She was one of the first to advocate for such an approach, long before it became popular to do so. As such, during the 1980s and 1990s, the reason for making “culture” and “care” the focus of theory development was the fact that they have been “missing” and “neglected” for far too long.

There is therefore great emphasis on an appropriate assessment of cultural factors when individuals, families, groups, and institutions are receiving healthcare in order to make such care culturally congruent (Sagar, 2012, p. 4). Such an assessment should occur in five phases:

1) Recording observations using all five senses; 2) paying close attention and listening for phenomena such as generic folk practices; 3) identifying patterns and narratives; 4) synthesis of themes and patterns; and 5) development of a culturally care plan with the assistance of the client.

The main relationship among concepts to identify therefore involves the fact that the overall theory of respect and understanding of cultural phenomena is divided into specific actions, each designed to move towards a greater understanding of said culture. These, in turn, are used to arrive at a specific plan of care for the optimal health of the individuals or groups involved. Hence, there is a generic beginning, followed by specific steps, finally to arrive at a healthcare plan that is specifically designed for the recipients from a specified cultural background.

In this way, Leininger’s theory provides for the inclusion of specific cultural phenomena and concerns within the healthcare field.

Theory Evaluation

Explicit beliefs behind Leininger’s theory include the fact that culture is a vitally important component of optimal healthcare. Without the awareness of the specific cultural phenomena that influences an individual’s perception and experience of healthcare, optimal care cannot be provided. Explicitly, therefore, Leininger believes that culture has a direct influence on an individaul’s or group’s experience of healthcare, and that this influences the quality and success of overall health management for the individuals or groups involved.

The implication of this is that all nurses need a basic sense of respect for individual cultural phenomena and the ability of these to influence optimal health care. The lack of such holistic respect would detract from the quality of health care provided.

According to Masters (2014), the four metaparadigm concepts of nursing include person, environment, health, and nursing. Leininger’s theory includes at least three of these, which are the person, health, and nursing. The environment appears to be somewhat neglected in favor of interpersonal factors and how these relate to the health of the individual. In terms of the person, the individual or group’s personal sense of culture is thoroughly evaluated and determined. These are assumed to have a direct effect on how the person feels about and perceives his or her own sense of health. In terms of nursing, a plan is derived from the investigation of a person’s sense of culture and health and the interaction of these. As such, the “nursing” component is a derivation of the components that relate to the individual culture of the person. In other words, there is an interaction among person, health, and nursing in order to provide an optimal component of care for the individual or group in question.

Having developed over several decades, the theory has gained a significant sense of clarity. From the beginning of her investigations, Leininger has strived towards clarity and lucidity. This has also been the case in her leadership and teaching, both professions requiring significant lucidity in order to be effective. Hence, throughout its evolution, the theory has gained a significant sense of clarity that all nurses and nursing students can apply to their practical work with patients. It is consistent throughout nursing practice in the world today.

Theory Application

Leininger’s theory will guide nursing actions in terms of practice, education, informatics, and administration. In practice, for example, I will apply the theory in my own practice by being adamantly respectful of all cultures represented by the clients who come to me for healthcare. I will then use this respect as a basis for my investigation into specific cultural factors that would influence my client’s perceptions of health care and his or her specific needs in this regard.

In education, Sagar (2012, p. 5) notes that it is vitally important to include cultural awareness as part of a nurse training program. Because of the many social and cultural differentiations in each country across the world today, one can no longer ignore the cultural component of health care. In fact, it has become one of the most vital elements to help those in need of care.

In terms of informatics, I believe it remains highly necessary to continue the good work Leininger has started by consistently developing the theory towards ever greater excellence, according to new phenomena and challenges being identified. Hence, both theoretical and practical research will continue to be important actions in this regard.

Administratively, nurses need an administration process that provides them with sufficient tools to positively and effectively identify cultural phenomena within health care. All nurses working with culturally diverse patients must do so towards the greatest effect for both the client and the process involved.


Alluaigan, D. (2011). Theory Development and Historical Background. Retrieved from: http://nursingtheories.blogspot..html

Masters, K. (2014) Role Development in Professional Nursing Practice. Barlington, M.A.: Jones & Bartlett.

Munoz, D.N. (2011) Biography of Leininger. Retrieved from:

Sagar, P.L. (2012). Transcultural Nursing Theory and Models: Application in Nursing Education, Practice, and Administration. Retrieved from: