Why is the theory of culture care diversity important in the delivery of nursing care for all patients?

Overview of Leininger’s Culture Care Theory

The construct of culture in Leininger’s theory borrows its meaning from anthropology. Culture is the “learned, shared, and transmitted knowledge of values, beliefs, norms, and lifeways of a particular group that are generally transmitted intergenerationally and influence thinking, decisions, and actions in patterned or certain ways” (Leininger, 2002a, p. 47). Culture can be discovered in the actions, practices, language, norms or rules for behavior (values and beliefs), and in the symbols that are important to the people. As Leininger has stated, culture is learned and then passed down from generation to generation.

The most significant effect of Leininger’s theory has been on the construct of caring in relation to nursing practice (Clarke, et al., 2009, p. 234). The goal of the culture care theory (CCT) is to provide culturally congruent nursing care, which refers to “culturally based care knowledge, acts, and decisions used in sensitive and knowledgeable ways to appropriately and meaningfully fit the cultural values, beliefs, and lifeways of clients for their health and wellbeing, or to prevent illness, disabilities, or death” (Leininger, 2006, p. 15). As a companion to her theory Leininger developed enablers to guide nurses in gathering relevant assessment data or conducting a culturalogical assessment. The culturalogical assessment consists of a comprehensiveholistic overview of the client’s background including communication and language, gender and interpersonal relationship customs, appearance, dress, use of space, food preferences, meal preparation, and other lifeways. Leininger’s theory is applicable in the nursing care of clients from racially and ethnically diverse backgrounds as well as the culture care needs of individuals or groups belonging to cultures and subcultures identified on the basis of sexual orientation (lesbian, gay, bisexual, transgendered groups); ability or disability (the deaf or hearing impaired or blind or visually impaired); occupation (nursing, medicine, or the military); age (youth, adolescents, elders); or socioeconomic status (poverty or affluence; homelessness).

A key construct of Leininger’s theory is cultural diversity which refers to differences that can be found among and between different cultures. By recognizing variations, the nurse can avoid stereotyping or assuming that all people will respond positively or in the same way to the standards or routines in nursing care. Another construct is that of cultural universality, which refers to the commonalities that exist in different cultures. These ideas led to an important goal of the theory—that is, “to discover similarities and differences about care and its impact on the health and well-being of groups” (Leininger, 1995c, p. 70). Nurses are familiar with professional care, and a construct of generic care is introduced. Generic care or folk care includes remedies passed down from generation to generation within a particular culture. Leininger (1995c) stated, “Interfacing generic and professional care into creative and meaningful nursing may well unlock the essential ingredients for quality healthcare” (p. 81).

Two other constructs of importance in the theory of culture care diversity and universality are culture-specific care and culturally congruent care.

• Culture-specific care refers to care resulting from the identification and abstraction of care practices from a particular culture that lead to the planning and application of nursing care to “fit the specific care needs and life ways” of a client from that culture (Leininger, 1995c, p. 74).

• Culturally congruent care is a major goal of the theory (Leininger, 2006). This refers to “culturally based care knowledge, acts, and decisions used in sensitive and knowledgeable ways to appropriately and meaningfully fit the cultural values, beliefs, and practices of clients for their health and wellbeing, or to prevent illness, disabilities, or death” (p. 15, 2006).

Leininger (2002b) postulated three modes of care actions and decisions for guiding nursing care so nurses in diverse practice settings can provide beneficial and meaningful care that is culturally congruent with the values, beliefs, practices, and worldviews of clients. The three modes of culture care are (a) preservation and/or maintenance; (b) accommodation and/or negotiation; and (c) repatterning and/or restructuring. These modes have substantively influenced the ability of nurses to provide culturally congruent nursing care and thereby fostered the development of culturally competent nurses. Nurses practicing in large urban centers typically care for clients from hundreds of different cultures or subcultures. Leininger’s culture care theory provides practicing nurses with an evidence-based, versatile, useful, and helpful approach to guide them in their daily decisions and actions regardless of the number of clients under their care or complexity of their care needs.

Dr. Leininger developed the ethnonursing research method for nurse researchers to study and advance nursing phenomena from a human science philosophical perspective with the qualitative analytical lens of culture and care (Leininger, 1995 a,b,c; 2002a,b, 2006a; Leininger & McFarland, 2002, 2006). The method was developed with the theory of culture care diversity and universality to study the nursing dimensions of culture care that include care phenomena, research enablers, and the social structural factors (e.g., kinship and social; cultural values, beliefs, and lifeways; religious and philosophical; economic; educational; political/legal systems; technological; and, environmental context, language, and ethnohistory) and three modes of care action and decision (Leininger & McFarland, 2002, 2006; Ray, Morris, & McFarland, 2012).

Recently the ethnonursing method has been proposed for use in other health care disciplines. McFarland, Wehbe-Alamah, Wilson, and colleagues (2011) developed the meta-ethnonursing research method after analyzing and synthesizing 23 dissertations conceptualized with the theory of culture care diversity and universality using the ethnonursing research method. Using the CCT as a guide, culture care action and decision meta-modes were discovered that were focused on providing culturally congruent nursing care among cultural groups (McFarland, Mixer, Wehbe-Alamah, et al., 2012). Discovering data from these meta-modes supported the translational research component of Leininger’s culture care theory and the meta-ethnonursing method. Translational research or implementation science is the foundation for research utilization as evidence-based practice (Ray, et al., 2012). This new meta-ethnonursing method promotes overall expansion and conceptual development of culture care in general for further explication, substantiation, and evolution of Leininger’s theory of culture care diversity and universality and the ethnonursing research method (McFarland, et al., 2012).