Dr. Madeleine Leininger developed the Theory of Culture Care Diversity and Universality in response to observing differences in care needs among children from various cultures. The theory aims to provide culturally congruent nursing care using research to understand care values and practices within cultures. It identifies commonalities and differences between cultures and includes assumptions about the importance of culture and care. The Sunrise Model is used as a guide to understand factors influencing health. The theory remains widely used and has strengthened understanding of caring for diverse populations.

1. •Background, Education, Experience of the Theorist: Dr. Madeleine M. Leininger
•Service of Dr. Leininger
•Rationale for the transcultural nursing: signs & need
•Overview of the theory
•Factors leading to theory
•Theory includes; definition, purpose, goals, assumptions, major tenets
•The sunrise model
•Application of the theory – Metaparadigm
•Current status of the theory
•Strengths & weaknesses
•Summary
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2. Dr. Madeleine Leininger
PHD, LHD, DS, CTN, RN, FAAN, FRCNA
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Theory of Culture Care Diversity and Universality
& The “ Sunrise Model”

3. • Was born in Sutton , Nebraska in 1925 –july-13
• she was blended in terms of awareness culture.
• lived on a farm with two brothers and sisters.
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• Attended Sutton High School.
• Diploma nurse from St.Anthony’s school of nursing in Denver,
Colorado
• Obtained BSN in St. Scholastica college in Atchison in Kansas.
• Obtained MSN in Catholic University of America in Washington DC.
• Obtained PhD in Anthropology in University of Washington.

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• Dr. Leininger was the first professional nurse with a graduate
preparation to complete a PhD in social and cultural
anthropology at the university of Washington.
• Dr. Leininger is the founder of transcultural nursing.
• She brought nursing and anthropology together and coined the
term transcultural nursing as an essential formal area of study
and practice.

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• Her Culture Care Diversity & Universality theory was one of the earliest
nursing theories and it remains the only theory focused specifically on
transcultural nursing with a culture care focus.
• Her theory is used worldwide.
• Dr. Leininger served as dean and professor of nursing at the university
of Washington and Utah and she helped initiate and direct the first
doctoral programs in nursing.

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• She is a professor emeritus in the college of nursing at Wayne state university and
adjunct professor at the university of Nebraska ,college of nursing.
• She facilitated the development of master’s degree programs in nursing at
American and Overseas institutions.
• Dr.Leininger has written more than 30 books, Published more than 250 articles
and conducted More than 1200 public lectures throughout the United States and
abroad.

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• Developed in the mid-1950s and early 1960s
• Began when Dr. Leininger observed that children of different
culture required different needs.
• Providing care that is culturally congruent.
• Culture Care theory not only focuses on nurse-client interaction
but the focus also includes care for families, groups, communities,
cultures and institutions.

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She developed her theory of Transcultural Nursing by:
• Defining the ways on how people of different cultures can see their
nursing world
• Focusing on the people’s general beliefs and practices.
• Described her theory as “creative and systematic way of discovering
new knowledge”
• Increasingly relevant due to migration and diversity grows.

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• Broad theory :impact of culture on all aspects of human life.
• Focused :preservation and accommodations.
• Her belief that different cultures have both health practices that
are specific to one’s culture and prevailing patterns are common
across cultures led to the addition of terms “Diversity "and
“Universality” to the title of her theory.

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The theory
• Dr. Leininger, focuses on describing, explaining and predicting
nursing similarities and differences focused primarily on human care
and caring in human cultures.
• The Culture Care Diversity & Universality theory does not focus on
medical symptoms, disease entities or treatments.
• It is instead focused on those methods of approach to care that
means something to the people to whom the care is given.

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A combination of anthropology & nursing beliefs &
principles
• Leininger recognized that one of the most important contributions
of anthropology to nursing is the realization that health and illness
states are strongly influenced by culture.
• In fact, many nurse leaders hold that “it has been the most
significant breakthrough in nursing and the health fields in the
20th century and will be in greater demand in the 21st
century”(Leininger,1997).

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• Dr. Leininger established the first Caring Research Conference in
1978. She developed the theory of Culture Care with the ethno
nursing method.
• The ethno nursing method was the first nursing research method
and has been used for decades.
• She conducted the first transcultural nursing field study in early
1960s as she lived alone with the Gadsup of Eastern Highlands of
New Guinea.

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• Dr. Leininger wrote the first books on
transcultural nursing.
• She developed and launched the first
undergraduate and graduate courses and
programs in transcultural nursing beginning
in the 1970s.
• Dr. Leininger established and was the first
editor of the Journal of Transcultural
Nursing

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• Dr. Madeleine Leininger has received many outstanding awards and
honors and has been nominated for the Nobel Prize for her
significant and worldwide breakthrough encouraging health
disciplines to study and practice transcultural health care.
• She introduced as the “Margaret Mead of the health field” and
“new Nightingale”

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The Leininger Sunrise Model
represents the structure of culture
care theory by describing the
relationship between anthropological
and nursing beliefs and principles.
This map or guide is called the Sunrise
Enabler.
Dr. Leininger’s sunrise model

17. She introduced in the early 1960s to provide culturally congruent and
competent care (Leininger, 1991b, 1995).
She believed that transcultural nursing care could provide meaningful,
therapeutic health and healing outcomes.
As she developed the theory, she identified transcultural nursing concepts,
principles, theories, and research-based knowledge to guide, challenge, and
explain nursing practices.

18. This was a significant innovation in nursing and has helped open the door to
new scientific and humanistic dimensions of caring for people of diverse and
similar cultures.
The Theory of Culture Care Diversity and Universality was developed to
establish a substantive knowledge base to guide nurses in discovery and use of
transcultural nursing practices.

19. At this time, during the post–World War II period, Dr. Leininger realized
nurses would need transcultural knowledge and practices to function with
people of diverse cultures worldwide (Leininger, 1970, 1978).
Many new immigrants and refugees were coming to America, and the world
was becoming more multicultural.
Leininger held that caring for people of many different cultures was a critical
and essential need, yet nurses and other health professionals were not
prepared to meet this global challenge.

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Instead, nursing and medicine were focused on using new medical
technologies and treatment regimens.
They concentrated on biomedical study of diseases and symptoms.
Shifting to a trans-cultural perspective was a major but critically
needed change.

21. A frequent question often posed to Dr. Leininger is, “What led you to develop your theory?”
Her major motivation was the desire to discover unknown or little known knowledge about
cultures and their core values, beliefs, and needs.
The idea for the Culture Care Theory came to her while she was a clinical child nurse
specialist in a child guidance home in a large Midwestern city (Leininger, 1970, 1991a, 1995).
From her focused observations and daily nursing experiences with the children in the home,
she became aware that they were from many different cultures, differing in their behaviors,
needs, responses, and care expectations.

22. The reality was a shock to Leininger, as she was not prepared to care
for children of diverse cultures.
Likewise, nurses, physicians, social workers, and health professionals
in the guidance home were also not prepared to respond to such
cultural differences.
It soon became evident that she needed cultural knowledge to be
helpful to the children.

23. Her psychiatric and general nursing care knowledge and experiences
were woefully inadequate.
She decided to pursue doctoral study in anthropology.
While in the anthropology program, she discovered a wealth of
potentially valuable knowledge that would be helpful from a nursing
perspective.
To care for children of diverse cultures and link such knowledge into
nursing thought and actions was a major challenge.

24. • At that time, she had questioned what made nursing a distinct and
legitimate profession.
• She declared in the mid-1950s that care is (or should be) the essence
and central domain of nursing.
• Many nurses resisted this idea, because they thought care was
unimportant, too feminine, too soft, and too vague, and that it would
never explain nursing and be accepted by medicine (Leininger, 1970,
1977, 1981, 1984).

25. •Leininger firmly held to the claim and began to teach, study, and write about
care as the essence of nursing, its unique and dominant attribute (Leininger,
1970, 1981, 1988, 1991a).
• From both anthropological and nursing perspectives, she held that care and
caring were basic and essential human needs for human growth, development,
and survival (Leininger, 1977, 1981).
•She argued that what humans need is human caring to survive from birth to old
age, when ill or well.

26. • Nevertheless, care needed to be specific and appropriate to
cultures.
•Her next step in the theory was to conceptualize selected cultural
perspectives and transcultural nursing concepts derived from
anthropology.
•She developed assumptions of culture care to establish a new
knowledge base for the new field of transcultural nursing.
•Synthesizing or interfacing culture care into nursing was a real
challenge.

27. The new Theory of Culture Care Diversity and Universality had to be soundly
and logically developed(Leininger, 1976, 1978, 1990a, 1990b, 1991a).
Before her work, there were no theories explicitly focused on care and culture in
nursing environments, let alone research studies to explicate care meanings and
phenomena in nursing (Leininger, 1981, 1988, 1990a, 1991a, 1995).
Theoretical and practice meanings of care in relation to specific cultures had not
been studied, especially from a comparative cultural perspective.

28. 1. There were increased numbers of global migrations of people from
virtually every place in the world due to modern electronics,
transportation, and communication. These people needed sensitive
and appropriate care.
2. There were signs of cultural stresses and cultural conflicts as nurses
tried to care for strangers from many Western and non- Western
cultures.

29. 3. There were cultural indications of consumer fears and resistance to
health personnel as they used new technologies and treatment
modes that did not fit their values and life ways.
4. There were signs that some clients from different cultures were
angry, frustrated, and misunderstood by health personnel owing to
ignorance of the clients’ cultural beliefs, values, and expectations.

30. 5. There were signs of misdiagnosis and mistreatment of clients from unknown
cultures because health personnel did not understand the culture of the client.
6. There were signs that nurses, physicians, and other professional health
personnel were becoming quite frustrated in caring for cultural strangers.
Culture care factors of clients were largely misunderstood or neglected.

31. 7. There were signs that consumers of different cultures, whether in
the home, hospital, or clinic, were being treated in ways that did not
satisfy them and this influenced their recovery.
8. There were many signs of intercultural conflicts and cultural pain
among staff that led to tensions.

32. 9. There were very few health personnel of different cultures caring
for clients.
10. Nurses were beginning to work in foreign countries in the military
or as missionaries, and they were having great difficulty
understanding and providing appropriate caring for clients of diverse
cultures. They complained that they did not understand the peoples’
needs, values, and lifeways.

33. • Definition
• Purpose
• Goals
• Assumptions
• Major tenets
• Conceptual models

34. Leininger had defined transcultural nursing as an area of study and
practice focused on cultural care (caring) values, beliefs, and practices of
particular cultures (Leininger, 1978, 1984, 1995).
to provide culture specific and congruent care to people of diverse
cultures
was to use research-based knowledge to help nurses discover care
values and practices and use this knowledge in safe, responsible, and
meaningful ways to care for people of different cultures.

35. Leininger identified 09 assumptions,
1.Care is essential for human growth, development, and survival and for
facing death or dying.
2. Care is essential to curing and healing; there can be no curing without
caring.
3. The forms, expressions, patterns, and processes of human care vary
among all cultures of the world.

36. 4. Every culture has generic (lay, folk, or naturalistic) care, and most also
have professional care practices.
5. Culture care values and beliefs are embedded in religious, kinship,
social, political, cultural, economic, and historical dimensions of the
social structure and in language and environmental contexts.
6. Therapeutic nursing care can occur only when culture care values,
expressions, and/ or practices are known and used explicitly to provide
human care.

37. 7. Differences between caregiver and care receiver expectations need
to be understood in order to provide beneficial, satisfying, and
congruent care.
8. Culturally congruent, specific, or universal care modes are essential
to the health or well-being of people of all cultures.
9. Nursing is essentially a transcultural care profession and discipline.

38. 1. Commonalities
2. Worldview and social structure factors
3. Professional and generic care

39. A major tenet was that cultural care diversities and similarities would be found within cultures.
◦ Human beings are born, live, and die with their specific cultural values and
beliefs.
◦ Cultural care is important for their survival and wellbeing.
◦ Transcultural nursing is missing from the traditional nursing.
◦ It is a challenge for nurses to discover transcultural nursing knowledge.
That’s why Leininger predicted elements of care were culturally universal and applications are
different.

40. This is another major tenet of the theory.
•Multiple factors are important and influence on health care outcomes.
•Multifaceted view provides a holistic perspectives for understanding people
and grasping their world.
•Nurses needed to become aware of the social structure and different cultures.
•Therefore nurses should have holistic cultural knowledge.

42. •Differences between two kinds of care were also predicted to influence the
health and well being of clients.
•Ideas and actions could lead to nurse client conflicts, potential illnesses and even
death.
•Such differences needed to be identified and resolved.
•Therefore cultural congruent care is very important as nurses.

53. •Currently, the theory of culture care diversity and universality is being
studied and used in many schools of nursing within the United States and
other countries .

54. The theory has grown in recognition and value for several reasons.
1. It is the only nursing theory that focuses explicitly and in depth on
discovering the meaning, uses, and patterns of culture care within and
between specific cultures.
2. The theory provides a comparison of culture care between and within
cultures.
3. The theory has a built-in and tailor-made ethnonursing nursing research
method that helps to realize the theory tenets.

55. 4.The theory of culture care is the only theory that searches for
comprehensive care on multiple factors in a culture to construct a
holistic knowledge base about care.
5. The theory has both abstract and practical dimensions.
6. The theory of culture care is a synthesized concept; integrated with the
ethnonursing method, it has already provided a wealth of many new
insights showing different ways to care for people of diverse cultures.

56. 7. The theory and its research findings are stimulating to use safe,
appropriate, culture-specific care in clinical and community settings.
The theory is frequently used to conduct culturally congruent health
care assessments.
Interdisciplinary health personnel are becoming aware of transcultural
nursing concepts which help them in their work.

57. 8. Informants are often very pleased to have their culture understood and
to have care made to fit their values and beliefs, a most rewarding
benefit of the theory.
9. Users of the theory are thinking reflectively and valuing it. The theory
encourages the researcher or clinician to discover culture from the
people and to let them be in control of their ideas and their accounts.

58. 10. Nurse researchers who have been prepared in transcultural nursing
and have used the theory and method.
11. Nurses who have used the theory and findings over time often speak
of how much they have learned about themselves, new cultures, and,
caring values and practices.

59. Strengths
•Recognition of the importance of culture and its influence on everything.
•This theory was tested by a number of people in a variety of settings and
cultures.
•The Sunrise enabler provides guidance for the areas in which information
is needed.
Weakness/ Limitations
•Limited graduate nurses are academically prepared for culture care
nursing.

60. •The purpose of the culture care theory (along with the ethnonursing
method) has been to discover culture care with the goal of using the
knowledge to combine generic and professional care.
•The goal is to provide culturally congruent nursing care using the three
modes of nursing actions and decision making(Leininger, 1991b, 1995).

61. •The clinical use of the three major care modes
culture care preservation or maintenance
culture care accommodation or negotiation
culture care repatterning or restructuring

62. The Theory of Culture Care Diversity and Universality is one of the most
comprehensive yet practical theories to advance transcultural and general
nursing knowledge is essential to improve care to people. Nursing
students and practicing nurses have the strongest advocates of the
culture care theory (Leininger, 2002).

63. Dr. Leininger’s sunrise model is a visual guidance for the theory. This is
also helpful to decision making in cultural congruent care using 03
modalities.

64. The theory is useful to nurses and to nursing and to professionals in other
disciplines such as physical, occupational, and speech therapy, medicine,
social work, and pharmacy.
Health care practitioners in other disciplines are beginning to use this
theory, because they also need to become knowledgeable about and
sensitive and responsible to people of diverse cultures who need care.

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66. •Leininger, M. (1978). Transcultural nursing: Concepts, theories, and practices. New York: John Wiley & Sons.
•Leininger, M. (1984). Care: The essence of nursing and health. Thorofare, NJ: Slack.
•Leininger, M. (1995). Transcultural nursing: Concepts, theories, research, and practice. Columbus, OH: McGraw Hill College
Custom Series.
•Leininger, M. M. (2002). Part I: The theory of culture care and the ethnonursing research method. In:
M. M. Leininger & M. R. McFarland (Eds.), Transcultural nursing: concepts, theories, and practice
(3rd ed., pp. 71–98). Sudbury, MA: Jones and Bartlett.
•Leininger, M. (1991b). The theory of culture care diversity and universality. In: M. Leininger (Ed.), Culture care diversity and
universality: A theory of nursing (pp. 5–68). New York: National League for Nursing Press.
•Leininger, M. (1989a). Transcultural nursing: Quo vadis (where goeth the field)? Journal of Transcultural Nursing, 1(1), 33–45.
•Leininger, M. (1989b). Transcultural nurse specialists and generalists: New practitioners in nursing. Journal of Transcultural
Nursing, 1(1), 4–16.
•Leininger, M. (1990c). Ethnomethods: The philosophic and epistemic basis to explicate transcultural nursing
knowledge. Journal of Transcultural Nursing, 1(2), 40–51.
•Leininger, M. (1997a). Overview and reflection of the theory of culture care and the ethnonursing research
method. Journal of Transcultural Nursing, 8(2), 32–51.