What are the three major theoretical tenets of Madeleine Leininger’s Theory of Cultural Care Diversity & Universality (aka Cultural Care Theory [CCT])?

3.1 Assignment
Week 3: Care or Caring Paradigm

Analyzing the Theory of Culture Care Diversity and Universality
Reading Study Guide: Chapter 17

Directions: Answer the following items in two to three sentences and submit your responses by Day 4. Possible Points: 20

1. What are the three major theoretical tenets of Madeleine Leininger’s Theory of Cultural Care Diversity & Universality (aka Cultural Care Theory [CCT])?

2. Summarize in your own words the major assumptions of Madeleine Leininger’s CCT?

3. The Sunrise Enabler Guide: When using the guide to provide client care, the nurse may begin anywhere on the Enabler. Where would you start? Why?

4. The phrase “nursing intervention” is not a part of Leininger’s CCT. Explain why. ,F
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Introducing the Theorist
ilfadel*inr r\’1. l*rnnrger ( 1925-2012) fcunded
the *qrrlCwide lie1d citra-qsculm:al nursrng, th’t
I ntern atio aa1’l’ran scuitural .\* urs in g Socier,v,
and the Jounal of Ttatts*ltwrat “\?rurrrg’
.Dr. Leininger abtair:eC her i”rltial nursing e’Jucation at St. ilrth*ny Sclmcl of }-ursing !n
Denrer, Cololado. She ea:ned her underqraduate deglee from Mt’ St. Scholastic College in
,{-tc1uson, Kansas; hcr master’s deqree in p*’-
chiatric and mental heahh nursing liorn the
Carhohc Unltersin’o: Amcricai and he: Phl)
in :ocial and cultural anthmpolag,,– at &e Uaiversiw +f Washington (Bo1’le Ei Glitrenberg
lli-nrichs, 2013), Dr. Lrininger:en’e,l as dean
at thr Unlversities of Washington and Utah,
rvhere she helped inititte md &rect the fust
doctoral prograrns in nursing and licilitated
the del’elopnrnt of mast*r’s degree programs
ir. nursing at,\r::crtcan and overseas instrtutions. Recognized as a Living Legtnd b1’the
Ameritan rtcadcn.iy of Nu sing and a dlstinsu-i:hed fe11o’w bl’the i\ustralian !{oval College
of Nursinq, shc sen’ed as a prolissor emcrita ia
the College nf Nursing at \lrayre Statc Universio and adiunct proi’essor at r}re Unlversiry
ofNebraska Ctllege oi\ursing’ 1)r’ Leiainger
passed at’av rt her home i;r Omaha, .r-e’*raska,
at the age cl87 on August 10, t012.
In rhe span ofhu prolilic career, Iladelaine
Leir.inqer publishtd 35 hooks’ rurorc approilrnatelv 3,00{l ‘articles (scme ol rthich wert
ner,er published), and qave more that 5,000
nrcsentations or nublic 1:rnrres tirroughout the
Linired Strtes a-qd abrcad, in adCiti*n to contribudng to flumerous bo,:ks and I’ideos llJor’le’
E+ Glittenberg Ilinr.lchs, 2013). Some ot her
11’gll-i(fltwrr books lnciude Euit Psltlsintrit
‘r’riri:. r”, 1. :;:r’
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304 !rr .L’.r:r 1′ ‘Oraxd Ta:tries obm& Cart ar Cari*4
Con*pts in Nursing (Leininger 6e’ llofung’
1960j; C,ering,’ Att Zssentini Human Nud
{i98lil Clare; The Essm* {Nursi*gand He*lrh-
(19fi,1); Care Di sutrtj atd {)us in Clininl an
Caxtmunig N*rsiilg {1983); Ethkai axd Marai
Dim*siais dCm t199}d); a*d Cultxre Carc
Dittrsi4 ani Utitttx*litl A Tbeary tiNursittg
i199ia, i0064). ^V#rsing artd intArepclapi: Tv;a
l*Zrftk to 8&rd i1970) ‘rvas the 6rst book to
bring together nursing and anthropolo*”‘lhe
lirrr booi. on transc’;.1tural nursing u’as Trrrnsuitura! NwsittX: Co*itp!s, Tbeari*s. and Pratliits
{i978, 1995,2002). llerbook Qildlitdtiu Rt’
st:xth fuIetbods in.Vlrirg i1985, 1998) rvas tire
fust published qualitative research methods
booh in nursing. ln 1981], l)r’ Leininger
iburded th,t Jaur*tt! tf Trensttbar*l Ntsing,
the iirst trsnsculru.rsl nursing .iournal in the
J)r. Lerninger conducted the first fie1d
stucly oi the Cadsup Akuna of rhe l-astern
l lignlands of tre’w Cuine* in rhe eadv 1960s
“ri**rr, ou to studY rnore th’ln culttres’ She
developed the fust nursing rescarch mcthod
called e/tra,rrttrsjrlg, use d b-v scholars in ntusing
and other disci.plines She lnitiated the idea or
rvor1,lv,’ide cenifitatitn of nurses prepa:ed
in transtularral nursing. “loda;-, Basic (uadergracluate) and Adranced igraduetei ctrdfiraiinr,, “r” availahle through the’I’mr,stultural
Nursing Socieq.
Overyiew of’the Theory
One of Dr, Leiningu’s ffcst .igflifi.tnt and
ulique contributions rvas the delelopment
of hzr etlN*u art ditersi4 arsi tttiztmali!1’tlse ‘
6ry, dso kaor.’n ls tl:e culture care thcon’
lC(“I), t’hich she int:oCuced in the carly
1960s to proriide cultulally congn:eat and
con:petent care (Leininger’ 199lb. 1995,
200641 }lcl’arland, 20i0). She beiieted that
trersctltural nursing cue cculd protide meaningful, theraneutlc health and healing outcomes. .’Xs she develaped the theolv, she
idtnrJied rra rscu-irural n:rsrng corlcccrs, principles, theories, and research-based knowiedge
to p.ride, chailenge, and explai-n mirsing practircs. Ihis *as a s:gr.:fica:rt ir:novation in nLlrsing and has heloed open the door in new
scientsc and iru:nar-stlc diraensirrns of t-aring
fo: nccrolc oi divrric anJ sir:ilrr lulture”
‘ih” ih*urr- ol.ull’rre care di’ersi’rv and ur’:’
-;ersalitl rra: ieq-rloped to estabiish a substar:uve
knottoCge bast to g,ride nurses L’r disrovery and
use ol tri”stu-ltural nursrng pracrices’ Iluring
the oost-World Wa; trl ;ieriod, Dr’ Leininger
,.ahled nurses n’ouid need raosculnual knos’lcduc and practiccr 😮 runctio:’ it’:th pcollt :t’
diu.rr. .ult t”t noddrride lLerninqcr’ I970′
1978]. Many’ntw immiqraflts and refugees
rver” crrmin! trr the Unrted States, ar:d tle
rarld ms lrecoming r-nore multic’:1tur:I
I-eininger held that cadcg far people of
**y .*Lir.u **s a critico-l and essential need’
1,ei;urses rnd other health proiesslonals urrt
not pr.p*.*d to meet tl’js glab*1 challen,qe’
Instead, nursinq and medicine were iocused on
using new rntdic*l tethnoLogies and ueatment
,egirnetr. ‘lle1* concentratcd on biomedical
srid,r’ of d;seascs and s1’r:rptoms. Shifting to
a ranscultur*l FersFertile was a n:;rjor but
criticallv netded changc.
this part ol the chapter Ftesents an
ove*’ieq’ oitbe iheon’ of culture rare diversirv
rnd uniltrsitlit-1′, along rvtth irs purposc, go’rls’
assumptions, theoretical tenets, Preditted
hunchcs, related general features’ and nev’est
features. ‘lhe next part ofthe chapter discusses
applications of the knot{edge in cliniral and
communin’senings’ Fo: a m*re in-deptl: disrussian of the theorist’s PersPeitiYds, L:onsult
the prlmarpliterature on the thcorv (Leicingsr,
1970, 1981, L9E9a, 1989b, 1990a, i990b,
1991a, 1995, 1997a, i998, J001, 2006a;
-Nlr!’arlaad, 201Si
Fsd:ors Leadi?tg t0 the Theary
L)r. Leininger’s maior mot.ivation lor rhe developn:ent of tit CC’l rvas the desile t* disrurer u*know’n or little-kaorvn knolvlcdge
abcut culturm and thtir core lalues, beliefs,
and needs. ‘lhe idea for the CC’f car”le to
her rthile shc was a clinical chrld nurse sFecialist in a child 6uidanee honre in a large
Slidv’esrern citv (Lcininger, 1970, 1991:,
1995, 2006r). ! ron: her ibcused obsersations
and dai1.r- nursing cxperience s t’irh the chil
dren in the hame, :he bernn.ie arrare that
thev rtert fiom manl’ cultulcs, diife:ing in
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wiit’tout put tist,.r’s prior permissi6n’ violuto” will be prosecuted’
Csm,ren 1T . Maaldtiat Lthtiager’s Ttsary ef Ca**re fja*Diorro4 ard Uxiwur’rry 305
their behaviors, nct:ds, responses, and care erDectxtions. ln the home ‘rerr roungsters u’ho
it.re Angla American, :\liican r\merican’
.Jervish i\merican, :\ppdachian, rnd manv
other lultures’ ‘I’htir parents responded to
them diflerently, anC their expectations c’:
cgre and &catnrent modes uere diflerent ‘I’he
realiry was a shwk to Leiningcr because sh*
l,r-as nol prepaled ta care tbr thildren of diversc cultures. Liker,l’ise’ nu.rses, phvsicians,
social lvorkers, and herlth proiessionals in the
sridarcc \cntc rvetc also not prep’r:ed to
,,,rprnJ ro iuch cu]rural ciiiicrenccs’
it ,ctn b.crtte evrdert that she r-cedeJ
cultural lcqou”ledge to be ireipful to the children. llel pEychiatric aad general nursing
rarc krrowledge and experiences lvere inadequate. Shc decidcJ to pursue doctoral in’:dt’
in anrh:opologv, \{rhilc in the ar:th’ropol’:grdoctoral ptogirnl, she discovered a rvealth
of pot.nri.-11r1 trlurble kncrvledge that would
bL: hclpiul iiun”. a::ur:lnq pcrspccrrve’
‘fo .*t* ior ch:ldren oI d:ver:e cultures and
link such knor,,*edge into nursin6 knorvledge
an,J practite ‘ras a mrior challenqc’ lt rrtrs
“rr.nti”I to incotnorate ncrl’ cultura] knolvledqe that ,u”ai beyand the traditional
nhvs:cal an.l ernotional nceds o: clierts
L.in,ng., *’r, ic:cerned about rvhether such
lca;ning rvor:ld be possibie, given nursing’s
traditional norrns and orientation to*’ard
medica.i kroi,ltedge
;\t that tlrne, she questioned what rnade
nursing a distinct rnd legrtimate prolissir:n’
She declared in the nid-1950s that care is (or
sheruld bri the essence and cenral domain 11′
nursing. 1}o*’ever, atcordin.q to Leini::ger,
rnanv nurtes resisred th.is ider because thel’
thought care tzs unlmpoftant, tm feminine,
t”o iuft, and t<io vague and that it *’ould
never explairi nursisg and be accepted ‘n,r
r:redirine (Leininger, 1970, 1977, f981′ 1984i’
\onctheless, Leininger firmly helC to the
tlaim and began to teach, srud,t, and *’rite
about ca-rrl as the essence of nursiftg, iis unique
and dominanr attribute ileiniager, 1970,
198i, 1988, 1?9ia,2ffi6al’ Ir*m both anduopol,rqicd atd nursir:g perspectlves, she hrld
i1r*t .rr” and cari*g wert basic and essentirl
human needs for huma-n growth, developrnent”
and sun’ival (Leininger, 1977- 1?81,2006*)’
Ser argued thtr u’hat hur-rans need is :rulnan
carj.ng’to sun’i,r’e tio:n birth to old age, when
ill oi’we}l. Nevertheiess, rare needed to be
specific and appropriate io cultures’
ller next step in the theotr lvas to tonceptualize selected t’-rltural lersper:rircs-and
transcultural nursing eoncepts derivcd from
anthro F olo fy-‘ She dere 1o ped as su mp tioc s
.ultt-rr. “*r*-io
est,lbhsh a kno*’ledge base for
the nerv ield of ranscu’lrurai nursing’ Sr-nthes:zing or interl’acing tulture carl into nursing
,*”s i real challtnge. (Leininqer, i976′ 1’78,
1?90a, 1990b, 199ia, 20064). tindings iiom
the the,rry could provide the knowledge to car*-
ibr peopie of t{:f}c:ent cultures” “lhc idea *i
proiiding carc was largeiv taken:br granted or
arrun ad-to he understood b-v nur;es, ‘-Lents’
and the public {Leininger, 1?81, i984)’ Yet
the meanieg ol”care” iiom the perspectile of
different ou-it n*, *ut unlslollrt to nulses aud
did not appear in the Lterature beibre the establishmeot ofLeininger’s theory in tht rarly
1?60s. Care kno*tedge had t+ be discotered
s’it1-. culturcs.
Lcininger (1981. 1988, 1990a’ 1?91a,
1995) maintair:led that befare her rvork, thme
were no theories explicltly lbcused on care and
culrure in nursing environmelts, let alone
rcserrch studie, ro *plica:c care meanings
and plienarnena ln nursing. Theoretical
and practical mcanings ol rare n relatjon to
,p..ili. .r.,1tr.”u had not been sl:died, especi alh,’ iror:r a ccalparetive cultural perspectivl’
Leininger saw thc urgtnt need to develop a
rvhole nes’ bcd-r’ ci’ culrurallv trased care
knolr’ledge to suFF’otr tr.nscultural nursing
rare. Shitting nurses’ -.hrnking and attltudes
liorn rnedical svrnFtorlls, diseasts, snd rreatroents to that of knor’,’rng rultures and caring
values and catterns rras a majar task’ lJut
nursing necded an aPProFriare theorr’ ta
diucovsr cate, and Leininger htld that her theorv lvas “ihe cnly theory foculed on deveiopinq neu’ kno*’ledge ibr the discipliae +f
trrnscultural nut”ing” (Ltininger, 2S06a, p. 7.\
Iissential featuses of the CC’I and the rthnolursing reseilrch rnethcd rtere developed
andrior reri:ited throughout Leinirrger’s l-lte
ileininger, 2tl06a, 20 1 1),
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306 5rr t.-rr 1I’ Crattl Theilis ehtri C’rr’sr (]flritr{
Ratianale ibr Trons cu ltural Nursirg’
Signs andNeel
‘lhe sati,rnale lbr thange in nursing in A:rl*ica
and elser,there (Leininger, 1’70, i978, t98’1′
1989*, 19?0a, 1995) x:s based on the I’ollowing
L’Ihere rvere globrl nigations and inttractions of people l’r*m vim.ra11y eleiy plact in
the luorld due to modern electronics, Eansoortatio*. and communica*ian”lh*se peorle nceded scnsi:tlt ar.d appropriatc tarc’
jIh*r” ,r”r. s:g:rs ci cuhunl stresses anJ
cr:ltural conflicts as nu:$ts tried to rare
f,tr clients lrom diverse \{estern and
non-\\”estertr cultures.
3, ‘lhe.re rvere culnual indicaions ol <ansurncr itars artd resistance tn heaith
pcrsonr:tl rs thel’ uscd r-crr technolcgics
“,rd :,.rt*.rrt modes tl’.rt did not 5t thtir
clients’ I’alues a-nd l-ifewaYs.
4,’Ihere rve;e signs that some c[ens from
differtnt cu]tules r ere anqry, frustrated,
.qrrd ralsunderstood b1′ health personnel
ou’ing to ignorancc of ti-ie clients’ tultural
belicfs, ralucs. and *Puctatrons,
5. ‘lhere rvert srgns of;:risdiagnosis eld mistreat$ent of clients iiom diverse tulures
because health ptrsonnel did not understsnd the culrure ci the c[ent’
6,’lhere rr-ere signs that nurses, physician-<,
aad other professionai health personnel
rvere bccon-.ing quitc frustra;cd in lallng
f’or clients Jlor:r uniamiliar tulr’rres Culturc cilre facto.rs lvere largell’ misundersioad ol neglected.
/,’1here ra’rre siqns that consumers ol diflircnt cultures, rvhether in the horne,
Lospital, or clinir, t-ere heing trcated in
*’avs that did not satisfi’then: rnd this
irfiuelced thtir retovery’
8.’Ihere rrere rnanY signs of intercultural
confllcts and culrur:l pain among staff
that Ied to ttnsions,
9.’1he.re *”ere very few’health per:orinel of
dir-erse cultures tarlng tbr dients’
I S. Nurses *’e:e berglnning to ‘w’ork in 1’oreign
countries in the military or as srissionaries, and the.Y were har’lng gre ar difi;u1ty
understanding atd providhg appropriate
No palt of this book may be reproduced or transmitted
caring for clitnts of d-rverse ruirurcs’ ‘1he-r
rcma”laited ‘Jrat they did not understand
the iroples’ nceds,,ia1ues, a-ad iifervavs”
rtithaugh antluopclogists were clearlv etperts aboui cr,:ltures, rnar:-r’did not knofi’1vhat
i<i do rvith paticnrs’ nor *’ere the;* interested
in rrurses’work’ in nursing as a profession, or
in rhe studv oi human care phenornena in the
earlr 1950s. -\’lost anthroPologists in thcst
“*1i’d”v. were tar nrore interesttd in medrcal
dismses, archreological findings, and in phvsical and psvthologiial problerns oiculture l’or
th.** ,”ruonu ,r’rJ *”tr others, it sas tlearlr
evident in the 1960s that people +f dillertnt
cultures wert. not recei.ving rare tongmet:r wii’r
their cultural belieis and values (Leiniogt:r’
1?78, 1995i. I\iurses ald other health proi’essionals u;gent\ needed transcultlral knowledge a*d skills to work efrcierdy n’ir} pecple
of diverse cultures,
Leininger thcreible toak a leadership rcle
in the n*v lield she called #aarrzf urul nxrting’
She rlelired t;anscrrlrural nursing as an arca ct
studl’ and prscti.ce i’ocused on lulr:ral ca:e
(caring) valuer, bcliefs, and praitices of’partitulrr cJtures. llhe goal rvas m provide cr’ilturespecilic and tcngruent rare to ptople oldivelse
culrurcs {Lerningrr, i97S, 1984, 1995,20064J’
‘Ihe cenrral purpcse of trar:scultural nursing
rvas [o use research-based knorvledge to he]p
nurser &scover iare raluas and practices and
use this knolt-ledge ia sa:e, responsibie, and
n:eallngfi.r1 w*.vs to care for people ofdiJlerent
cultures.’fcday the CC’f hss led to a l’ealth
ofresesrrh-bascd knowledge to guide nulses
eld olher l^.te1th orotLssionals rn rhc carc oi
clients. tamili*s, and communities ol diJlerenr
cuhures or subcultures’
lifajar Tbe aretkal Tensts
In developiag the theorl– of rulrure cart dirersiq, md unlversalitl, Leininger identiied several predictil’r: tec€ts or premises as essential
fot nurses znd crhers to us*.
r\ plinciprl tenet u’as thrt r1-il-ers.ities and similarirics (or comrnonriiries) in culrnre care cxpressions, meanings, pltlelns, and practices
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*ltfrou, putf itfr”r’s prior permission Violators wil’l be prosecuted’
CH,r.r”rrk 17 . Jl”,adeldfue lalnirguri T*wqy af, Caltwr C*e llivrri+ *fld Unims/4 3fl7
rvauld be ibund rvithin c”lltures’ ‘lhis tt’net
rhallenges fturses to discover this knowiedge
so that n,:rses could use cultural data t* provide therapeutic our.ofiss. lt rvas pr*dict*d
thcm vv’oid bc a golci mine ol kno*’ledge il
flu.rses rYers patient *-nd persistent to distomr
care valucs and Pafterns within cultures, a Jimension chat nad b*en rnissing lion: traditional nursing. Ltininger rnaintained that
humaa t-reings are bnrn, live, and die *rth rheir
stecGc cuhural values and belleti, as vreltr as
with their historital and enr.ironmental contert, and that {aje is inporralt tbr therr survilal and rvell-bei*g. Leininger predicted tirat
dircolering tthlch eiements of care lt’ere culrurrl1y ,r:ir.rsal and rshich tqrrc dillirent
u,ouli drasticalll’ revolutionize lursing and
uId:nately tran siorm heal’,h-tare svste::rs and
practi.es (L*ininger, 1978, 1990a, 1990b,
r\nother major tcnei of the theon lras ihat
rvorldvi*v and social siruf,ture iattors-:uch
as techoalo6′ reiigioa {including sr:irltualiry’
and ph.rlosophl’), kinshiP {l’smlly ties), r-u1mr*1
values, beliefs, and liferval;s, political and 1ega1
factors, economic and educatianal iictors,
as rvell ar eihllclistolr, lang’:agc expressions’
envi.ronrnental tontxt, afld gcn+ric a-nd professional care-infl uente rvrvs indil’idu’lls,
ihnllies, groups, an#or ccmrnunlties tonsider
and deal s’ith he.rlth, rcli-being, rllness, healinq, disabilities, anC death (Leinlnger, 1995,
2ilO6a).’lhis brord and multiiaceted vierr provides a holitric pe$pe.ti.Ye ibr understanding
peoplc and grasping their rvorld aad environmeat s,ithin a historicd contexi l)atl liom
this irtlistic research -based kno’*’1edge gulde s
nurses in caring for th* health and r*e11-beiog
oi *re individual or to rrelp disa.bifld *r dving
clients :’ssm drfere[t cuiturff . Socia] stmcttral
factors inlluencing care ofpeopie liom difflerert culn:res provide nnv lnslghts for culturall-v
(cnqflrrlt car-e. Slster,atic sfudy bv nurss .rcu.”..h”r, rather than supenicial kncwledgt ol
culture is required to provide culru-rlll-v congruf,nt ca-re, ‘lhese fact’:rs, it:gether B’ith thc
histon oic’;ltures *nd ktowledge oftheir environnrental factorcr wst€ discovered to creste
tlre theory and to bring lbrth nerv inslghts a-nd
nerr kncrwi*dge. ‘lhere data disclose lvals that
clients can stay weil and prevent ill”nesses’ Indeed, to meer the theorv’s goai of making decisions ttlct provide cuirurally congruent caret
holistic culru*] Lnowledge must be discolrered
(Lrininger, 1991.a, 2006a).
Discol’€ring rulrural crrc knorvJedge rtquircs cntcring rhc cultural lvorld ro obscn’c,
Jisren, ar.d lalidatc idcas, ‘i’ranscultural nursing
is an immersion experience, not a “dip in a-ld
dip out” ntperleoce. No longer can nurses relv
only on iisgrr,ents of medica-l and psychologi–
ral kno*’ledge, Nurscs mrist become alvale ot
the social :tructrre. cultural histor.v, 1:rnguage
use , and the crrl:r,lnment in which pe oFle Lve
to uldsrstand cultural care expressions’ ‘fhus’
nr.lrses need to understand the phiiosophr- of
transcultural *ursing, tl:e culture t*-re theorl’,
end wals to discoue.r culture knc*’1edqe. Tra’nsr:ultural nursing ccurses and Eroqrarns are
csseniiai to provide the nccessa4′ ins truction
–l dlru rrrtlr(urrr!5, ^.–i^.i–
.rlnorher malor and preditted terret oithe theor;.: is that dl{ferences and rimilarities exist
betvceen the practices ,:i nr”* Icinds ol ci,e:
professional (etic) a.nd generic (emir, traditional, indigenous, or “ib1k”l Leininger, 1?91a,
2006a; .N'{cFarland, 2010)”Ihese diferences
influer:te the health, i11ness, and well-beng of
cLients. lilucidating these difierenccs identii’
q.lps in care, inxppropriate care’ and also benefir-ia.l care. Such findings influence the recoven’ (healingJ, health, and rrell-being of clienrs
ol dillbrent culrures. Xlarked dillcrenccs bet*een plenerit and professlonal care ideas end
acrions iead to sericus clienr-nurse coniicts,
por€ndf,l illnesses, ar:d even death (Leildager,
1978, ir95). Such ditl’erences musl be identi-
{ied ard resolved.
Leininger i.d*ntilied three t’a1t to attain and
ma.intain rrrlturally coegrueat care {Leir:inger,
1991a, 20054; iMc!-srlrnd, 2010). ‘Ihe tl-‘ree
m,:dalities postulated are (1i cu-ltr:e cart
presen’atj.oa and.ror r,:ainteaance, ti2) rultue
.”r* r..o*rnodrtior.r andlar negoriadon, and
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308 Si r t -i:r 1: ” Grpnd th*ries ebtfi Cift or Cstin{
i3) culrure carr restruclurir:g a*dlor repafterning (Leininger, 199ia, 1995, 2006a)’ these
thl*. mod*, iu*t” r’erv diiterent from traditional
nu:sing prar’ices, loutines, or inten’ention!’
‘liiey aie lbcused Dn rlrf,1ts to us€ iheorfliical dxta
crsativeil to f’aciLitrte ccngruent care tc ht
clients’ particuh: c’:ltural needs.’L’o arrive at
culturalll’aPPr$PriatL care, the nursc has to
draw on lrcsh cub,:re ean: researth and disco’jered ii-oorviedge froni the people alone rvith
ther:retica.l daia finCings. ‘Ihe care is tailored
to client needs. L*ininger believtd tirat routine inten’enlicns l+’ould not ahval’s be appropriare arJ iould leal to L’ulturai irnposition’
t”nsions. and cor:fllcts. -\ursti nceJ to shiti
iiorn relting on routile intenentions *nd
frorn ibursing oa slmptoms to emplo,r’ilg rartr
practices d.r:r’.d fron the cller.ts’ cuirure ar’d
iiom the rneon’, ‘lhcl’ necd to usr holistic care
knor.4edge ftorn ‘.he theorr as opp*:ed to
relying soleiy on rnedical data. i\’lost ir’:Por-
,rr.t ni’rli, tirey need to use borh generic and
professional care lindings. ‘lhis u’as a nerv
ih”U*rtg* but a rervarding cne t’or the’ nurse
and the client ilthoughr:iull-v donc, as it ibsters
nurse-client coilaboration. Examples of the
u:e of the three modalities can be lound in
several pubiished rources (l-tir:inge:, 1995,
19?9, 2002r }lc!’rrland et a1., 2011i \VehbetUamah, ?008a, 20il) and re presented in
rhe next part ofthis chaPter.
Use ol Lelninger’s theory has Ied to the discol’ery oi new k-inds ol tran;cultural nursing
knowledge. Cultur*l1y baserJ ca;e catr lreYenl
illnes: and mai.ntain t’rellness. .\tethods for
heiping ireoplt throughout tire Life crrle, iiorn
tirth tc death. havs been discoverd. Cultural
pafierns oi caling acd health rnrintenance
slong with er-nironrneatal xnd historical ilactors
,o* !*poarrnt, )lost important, ihe u:e ci
Lelninger’s thcoqt has helpcd unrover signlficant culrural differences and sirnilarities,
,rs: Paryo|e,
af the’Ihmry
cultural and care lactors iniluencing hurnaas
in heahh, sickness, aad dying and to therebv
advarce ar.d improte nurs.ing lrucdces’
the theory’s goal rs to discover gencric
ifi,lkl xr.d prot’c5sicnal care behcfs, eicressions,
and practires ihtt could be hcorporated into
collaboratite rlans oicarr de:igned to provide
culrurallt aFproFriate, sate, beneiiclJ, and
saris+’lng crre to people of diverse nr similar
.ulnri”s, to Fronrore their healrh and w*ilbeing, and to assist them ir: facirq dearh or
disabilldcs. ‘lhus. the ultimaie and primar.rsoi.l oirhe rheon’is to provide culrurallv congru.nt .”r* that i: tailor-madc ibr the Li’ewat’s
and ralues ofpcople (Lcin-:rger, 1991r’ 1995,
20il6a; l\’trclar1and, .\ilxer, Wehbt-Alanah, 6r
Burke, 2012)’
Leininger postulated sn’eral theoretical
assumpdons, or basic belieis, designed to assist rescarchers exploring \’Yestern and non-
\,Vestrrn c,.:-ltures (Lelninger, 1970, i977,
1981, 1984, 19!1a, 1?9tu,20064):
I. Cr.re is the essence and the cenrral
dominant, dlstinct, and uni$ing focus
^d.,,,.;.c vr.rgrJ.r.F,
2. I lumanistic and scientific cate are esscntia.l for human gro*th, rveil-being, health,
su*’lva], and to f’ace death and disabilities’
3. Carc (caring] is cssentlal to flr:ng or
healing, tbr *c.re can be nc curing t’ithout caring. flhis assumptioa ‘*’as hcld to
haye p:nt’ound relevance rrorldwide’)
4. Culture csre is the sl’nihesis of tw’c najor
constructs that guide the reserrclier to
disc*’er, explaln, and 3c{ouni f.rr health,
*ell-bcing, care expressions, and other
hurnan condltions.
5. Cul:u-rc croc crpreislons, nrc;rir.gs,
pf,tterfls, Prn.flsses, and structural iorrns
a-re diverse; bur sorne commanalides
(univtrsalities) exist anong and bet’weea
6, Culnrre care valucs, beliei’s, and pract.ites
s”re hiluenred by’aad enrbedded in me
+’orldr.ierv, social strucrure fectors (t,g., religion, phllos*phv ot iif*, hinship, politics,
Gaal, and
‘Ihis section discussrs some of the majcr assumFriDEs, definitions, and purposes of the
the,:n,’lF-e thto:v-* ortr:idirrg purpose ii tc
discover, d+cument, ana-ltzc, and identiry the
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wiihout pubtislier’s prior permissi;n Violators u’ill be prosecuted’
economics, tducation, techn*lo5-, and
rultura-1 raluss) and the ethnohistorical and
enrir*nfl1ental rontextt.
7, llvery culnrre has gtneric (1a,,*, ibl}’, naturalisti,:, n;t:nlr* emic) and usu,rLiv son:e
prolessional (ede) care tc be discovered
and used ibr culrur:1I1’congfllert care
Lo:flrucni and th.eraptut:” tart
orcurs u’hen culrure care values, ‘oe1ieii,
expressions, and patlPjns are explicidv
knorrn and used applopriateiy, sensitively’,
and n-reanin$tlly *’ith people oidiverse
or slrrilar cultures.
9. the three modes of care ofier iherapeutic
rvrvs tc lielp people of di*rsc cu-ltures”
I 0, QuaLitative research paradigrnfl dc meihods
olier imponant rneans to discover largelv
embeddcd, covtrt, epistemic, and ontolcgical cultule care knoutLedge and practices’
! l.’fran:cultural nursing is a discipline wlth
a bodv uf kno*’ledge a*d pracdces to atrain and ndntain the goal cf culrurally
rongrrelt tase lcr health rnd rvej-i-beinq
(Lcininqcr, 200/ra, PP. 1 8-l 9)
fo encouragSe discotery of qualitadve knolrledge, Leininger u:ed orientational (not operational) definltions for her rheor-1″, to a-l1olv the
researther to discern pr*viousl,v unknoll’n phenorr.cra or rdcas. Or;enta:ional tcrrts aLIow
dis.’ose!. and are usuallv congruent *’ith the
cLlent 1ifewt1n.’lhe,v are irnportant in using the
qrialitative ethnonursing discovery mtthcd,
,ihi.h ir i’octsed on how people understand
and *peritnce theirr’;orld usiag cultural
knorviedge and lilirral: (Leininger, 19S5,
1991a, 199?b, 1997c, 2002, 2006a).’l.hc lbllorving are se.lect eramPles:
1, Cultara,”lhe learned, shared, and transmitted salues, beiiefs, norrns, and lifiwars of a
particular Eloup a\at guides thek rhjnkinS,
decislons, and aciions in patterned t:a1s
and ofren intergereiadonalit (Ltining*r,
20064, p. 13),
?. Carr, lhose rssistive, supportive, a-ad
enabiing -;xperiences or ide*t torvard
*thers t’ith evidtnt cr mticiPated needs to
ameliorate or improle a human condidon
or }}’erva;,’. C*.riag reiers to aitions, ittirudes, md pra:tices to assist or help otFiers
torrard healing and *’ell-being (Lelninger,
2006.t, p. l2J. Care is both an rbsttact ind
a toncreta Phenomtnon,
3, Cttlturt *.rrr: SublecivelY and objtctiveiy
iearntd and trrnsraited va1u”t. 6sliei-c, and
patterned liierval:s that assist, suPpsrt,
i”.ilrtrr., or eaahle another individual or
flroup to maintairr rveii-treing and health,
t i*p.ut. rheir i:u:rnan conditic’n a-‘)d
ilii:rvry, or to deal *’rth i11ness, handicaps,
or desth (Leininger, i991a, P, 47)’
4, Ctltart Ccre Drt’erri{“: ‘Ihe diJferenrcs or
‘r.ariabilitier *nrong human beings u’ith
rf;soefi io culfi:re rarc meanings, patterns’
vatrues, liinray’s, s1-mtro1s, or other features
related to pror-i&ng beneiir-ie} care !o
cLcnts oi a designated.-ulture (Leialnger,
200i:a, p. 16).
5, C*llure Carc L”r,trsrrs*litt’:'”Ihe common],v
shared o: similar culrure care phenornerra
iLarure s *ihunan btings with recurrerrt
meanings, patterns, values, lifertra,vs, or
s1’mbo1s tFrat sen’e as a Euidt fbr cuegivers
to prorid e assistil’e, supPa.tive, facilitativt,
or enabLlng peoole care for healthv outiomcs (Leirunger.2006a, : 16)
6. I}ar!:xi*nat {etril rare: lbrma1 and exa}icir
cognidvei-v learned protessional care luro*’ledge and practices obtained gener*ll1′
rhrciugh educaticnai insdurions”Ihe1′ are
taught to nurses and cthels to prulide assisdve, sugpcrire, tnabling, or ihcilitatire
acts lbr or to anorher lndiridual or group
in order to i.rnprove their heaith, pr*’ent
ilhesses, or to htlp utth dling cr other
h.uman cotdltions {Leinlngrr,2006a. p. llJ’
7, Gm*ir (erxa) tmt: ‘lhe learned and transnrined lav, indigenous, traditinnal, or lccal
ibik kno*’1edge antl practices to provide
assisti’r,c, supportil’el enabling, rnd faciLLtailve acts for or t*rl’rrd others rr’iih efidelt
or anticipeteri health needs in order to
irnprove rreJl-being or to help rvith dfing
oi *ther human conditior:l {Leininger,
2006a, p. 14).
rvithout publisner’s prior permission Violators will be prosecuted’
310 -st l r ;;: f ” Cratd Thttriet abrul Cart or Cairig
S, Calture rdre Plt\t/’i!atiafr a*l/’ar maixlt
rsarr,’ those assistil’e, supportive, iacilitaiive, or enabling professionrl acts cr
dcc:sions ihat h.elp culrures to rcrain,
lrcscn’e. or r::entain benefrtial tare beii*ii .nd ‘a.lucs
or to rate hanilcaps and
deafi (Leininger,1006a, ::’ 8)’
*, Culture ure *i*mmtdatbn attdlat fit1arid’
lrr:’lhcse assi:tiw, arcomnrodating, ticilitatire, or enabling crcative protider care
ections or decisicns tlat trcilitate adaptation to or negotiadon rr-ith others for culturallr, congment. saJ’e. and eflective care
for ‘heir health, te11-being, or to deal with
illness or dJing (Leinineer,2006a, p’ 8)’
10, Culturr idre repilllerflifig *ailet rt$r*tlarilg.”IF.osc asiistive, support:r’e, facditative, or enabling proi’essicnal acdons and
mltua] decisiolLs that help people to reorder, change, rnodi[‘. or r€EtructuJe
ti:eir iilbrtals and instirutions fo: better
(or benefici.xl) h*a-lth-care Pafterns, pra’-
tires, or cuicofiles {Leinlnger, 2006a,
p. 8). ‘lhese safterfls sre muuaLlv cstablished benveen caregil’ers and teceivers’
11, Ethnth:irtry: ‘lhe pasr facts, cre nts, instances, and experiences ofhuman Leings,
groups, cultures, and institutions thar
occal orer time in pa-rticular contexts
that help expiain past and cjlruent lii’trvals
about culture eare influencers of health
and *’e1l-bei,rg or tlic Ceath of people
(Lcrninger. 20i”rt,r, P. i5).
12, Enriranmtnlal taatext:’lb-e rotaliq’ cf
f,tr event, siruadofi, or Farticular exFcrieace that grves r:reaning to people’s
expressions, intrrpretations, and rocial
inter*ctions within particular 6eopirlsical’
etologrcal, spirirual, socicpolitical, and
technoioglcal iactor: ia specifit culural
scttrngs (l,eininqcr, 2il06a’ :. 15)’
13, Worldtiru: ‘lhe rvav people tend to look
out ol thei-r u’orld or the.k uniycrse io
form a !:icture cr r.alue srante about life
or rhe wor1d around them {Leinlagel,
2006r, p. 15).
14. Ctiltwa! antl sorial strutturerkLJors: religion
(spirin:alitr’); kinship (sacial ties); oolitics;
legal issues; educationl ecorrofii.csi techndog,,’; polltica1 iactors; philosophy of
No part of this book may be reproduced or transmitted
liill and cxitural beliei! and ralues rvith
gendcr and class dirt’crencr. ‘.lhe rhcorist
i^s credicted thst *Iese diverse lactors
must be understood as they dircctly or
indkect\’ iniluence health and rvell-being
(Lelning*r, 2006a, P. 14).
15. Culruralli toztgt#r:rrl rarr.’ Culturallv based
care knowledge, rcts, and decision: used
in scnsitive and knoil’ledgeable waJ’s to
aocropriatclv and mtanrngrull)’ ti: rhe
.uirursi talu.s, bel-iefi, and lifeu’avs of
cLents t’or th*ir health and rre11-being,
D{ ro prcvefit illness, disabiljties, or deatl:
{Lelninger, 2006a, P. 15J
The Sunrise Enabler; A ConcePtval
Guide to Knawledge Disrcaery
Leininger developed the sunrise enabler
(I’is. 17-L) to provide a holistic and con:pr*-
h*nsive conreprual picn:re o{‘the maior ihctors
influtncing culture care dirersirr and unil’ers,rli+* (Lelninger, i995, :997b: Ltininger &
-\’tci’arhnd, 2002.2006). lhc r.cdel car’ bc a
va.luablc visual guide tn elucidadng n:ultiple
lictors that ln$uence human care and iii’e*’a-vs
rf diffirent culrures, ‘lhe enabler scrl’es as 3
cognitiuc guide tbr tl”e rescrriher to refltct on
diiicrent prcdicted inB.uences on tulturalli”
brsed care.
‘lhe sunrise enabler can also be used as a
r.sluable aid in culzura} and health-care assessment ol clienrs. As thc rcsearil’.cr uscs thc
madel the diil’erent iictcrs aiert hirrr or her to
find culture care phrnomena, Cender, scxual
orle*tation, race. c1ass, and biornedical conditinns are studied as part oi the thtorv. ‘Ihese
detern:inanrs tend to be embedded in the
worldr.ierl’and social selrlctttre and rake tlme
to r:.cognize, Care values and beliefs als usuallY
lodged inio cnvironmcnt, religion, kinship,
and da:1v lite F,iiterrls, ‘lhe nurse can begin tht discovelr at aav
place in the enatrler ard loLlolv the informant’s
ideas and experientes about crre. lfone starts
in the upper pan of the enrbler, onc needs to
reilect on all aspects dtpicted to otrtain hoiistic
or total tart data, Silrne nurses start ri’ith
gerr:it ald prol*ssional tare then lor:k at hr:rv
r”i-igb”, N.oflomi.s, anri othcr lnfluences affect
theie care rirodes. Onc a1*’a1’s moves lvith the
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*,litrout puUtirner’s prior permission Violators will be prosecuted’
f,:HA!,r’r:rt1?’Madelrinel*iningxtlhtorTtf1*ltwef,re&iaem$uxdUritwraiiry 311
Cultural Care
Culturai Care Preser’-ationlMaintenance
Culture. Care Accommudation,’hregotiation
Cdtt {+ llnilr.rr$s, culture carc Repattcming’Resrructuring
6 rlf . I*hitlSer 2004
Culturally Congruent Care foi ltealth, l1’ell-being or Dying
I ‘ ‘ L.elrritL;lrr’s surise crlabltr lo riisqorqr cu.ltut ruc f ;V ‘L.irin’qrJtl/-ld7
ini’nrmants’, rather than the resercher’s, inter- nrocess, &e nr:rse holds h’is or her ol’n’ etic
cst and story. llexibfir-v in using rhe enablec tiases in check so that tLre int’or’:ant’s ldeas
prDmotes a tctal or holistic viern lf .rre. will come fr:nh, rather than the researchm’s’
‘Ihe three transculru.ral clrc decisicns lod ‘l”ranscultural nurses a.re ment:.red in rvays to
actions (in tire lor+er part of the figure) are lery r+’i’.hhold theg biases or $’ishes and to enter the
importr.at to keep :r mind’ Nursi’ng decisions clientt unridviex”
*ctiofls are studied until o!]e ,e*1i,es the ‘Ihe nurse begirrs the s:ud,v bl’ rrrakng
carr nreded.. “Ihr nurse disroTers rrith thc in- expiicrt a specilic donrair tfixquiry. !’or tr.attfc,rmant the rppropriate decisions, acrions, or ple, tire rcse ‘lrcher may foms on a iiomain ol
il;, f”a .*r*l ‘ihrorghout this discovery inquin such ss “cullure care ‘;f Mtxican
z/\ lnflucrces ‘\
Care ExPnssions
Faltems & Prattittr
Ilolirdic Health I lllns$ / I)€sth
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without publisher’s prior permission. Violators will be prosecuted’
312 !r t: t ,rr:. V ‘ Llrand Th*ties a’icti trt or Caing
.t\rrr(ri.an rnothets csJing lor their lhildrerr i’rr
their home.” Lverv lvord in the donlain strteErent i* L’r1Pofiant and st’,rdie d with the suruise
cnabls and the theory tenets. the nuse ot researcher n:ia,v h.x!€ hunches about the domain
and care, but until all dara hrl’e been studied
rvith the theory teners, she or ht ca-rinoi Fro’!e
them. lnfor:nrn15′ 1’lqrvpollls’ cxpelitncci,
and acti,:rs are irl1,1i documeatcd. Generall1,
informants select *fiat the.v hke to lalk xbout
limt, and the nursdresearttier r{romrnodates
theb interest cr stcries ahout care. l)uring ir-
,lcfth srdCy oi rht domrrr ol lr,quiry. all zrcas
.ithr sunr:se cnlblcr arc ider.tified a-nd tonfurned s’ith the intbrmanrs. ‘Ihe inibrrnanrs
becorne ritlr’e Px.ttiripants thrcughout thcdis-
.o1,cry process in such a u”a1’as to feel comfbrtable a-nd rvilling to share the.ir idtas.
The real chal.lengc is to f<rtus tare meanin6s, beliei!, r”:luer, and ptartices related to
inlorm,rnts’culturas so that subtle and obvious difi*rences rnd sirnilarities about care are
ide nti:ied among key and gener.ql infurmants’
“lhe differeaces anC similariti*s ate imPortant
ro docurnent with rhe theor,”-‘ If inforn:ants
ask abour the researcher’s vielr.s, the latter
must be ctrehllly and sp*rse\ shared”l-he resea:clre: keeps in rrunti that some inibrmants
may s’anr tl please the researcher b1′ talkir:g
about profcssional n-redicines a:rd treatments’
Prolesiional ideas, hou’ever, oiien cloud ar
mask the cl-ient’s reil interests and l’iet’s’ 1t
this occu.rs, rhe researchttr must be dert to
such tendrncies and ketp the lbcus oa the informant’s idtrss arid on ihe dorniin of inquirl
studitd. Tire inlbrmani’s kno*’1edge is rlwr’vs
kcpt cerrtral to the discovery prccess abuui
.ultur. .”t*, heelth, and rte11-being. trfthe researcher finds some factors unfarniliar, such
as kinship, etonornics, and p+lidcai aad other
consider*tions depictcd in tle r:r<,’dei, the
researcher should listtn attentiYel-t- to ihe
informant’s ideas. Obtaining insight into
thr i.l1’ormarrt’s e;:ric (insider’s) vitws, belieis,
and pnctices is cenual ts str-idvlng the theon’
{Lcrninger, 198-i, 1991a’ 1995, 11}9/b;
Leininser flc MtFa-r1and, 2002, 2t106).
‘lhroughout the sr’:dv and use ofthe thecry,
the rneanings, cxpressians, and patterns of
No part of this book may be reproduced or transmitted
culturall.v bascd care are inportant’ -lhe n”rse/
researchcr lisirns rrtentively tp informants’
accounts about care and then docun:errts tle
idear. What inforrr.ants ko’nv and practice
aboui care or caring in thek culrure is signifira!!t. lJocurrenting ideas from rhe informents’
emir l’icrvpoint ir essential to aJri\:c xt atcuratil
cultura.lh based carc. Unlinour: iarc nea-rings,
such as tie conc€Fts of protertion, respect,
1ove, and matl’olirer care concepts’ need to be
tersed out and explored in depth, as the!’are
the ke.yu’ords acd idcas in understanding crre’
Such care meanlngs rnd expressions are nct allvays readiiy’ knolvnl inibrrnaats ponder care
meanings and are chcn surprised that nurses
are focused on care instead oi medicai s1’n:ptoms. Sanletiroes intbrm;rnrs maYbe relurtant
to share ideas ahout social structuler religion,
and economlts or politics, as thev i’ear thfse
idear ma.-v not be xccePted or unCerstood bv
health prrsoar:el. Generic folk or iadige*cus
knorvledge often has rich care data mrd needs
to be exdored. Gcteric care ideas nee d tn be
approp:iately integnteC ir.to the threc trarri”ttritl moties oi decisians and actions i’or
cuhdralll’ co[IJr”uent c are outiomcs. Generic
and prot’essional care rre integrated so that tle
clients benefit iiom both fipes o{ caru.
‘lhe sunrise enabler rsas developed wlth
the idea to “iet the sun efliet lhe reseatcher’s
rnind’ ,qnd discover largeir unkn’:*’n care
lictors oicultures’ Letting the sun “rise anu{
shrne” is importsnt and ct’ers iresh insights
abcut care pracrices. A recent metasynthtsis
oif4 doctcral dissertations using Leinlnger’s
CLIT and tht eth:roaursing research method
ied to the discoyeri- of lnterpretive and cxplanarory culr,rre care findings, neq’ th*oretical
formulaticns, and evldence-based retommendadons to guide nursing practice ([lc]’*riand
et a1.,201i).
Newest,ldilition ta tbe Thrlry
In the sumnrsr o12011, Dr. Leininqer inrroduced rc/ldd’rrditrve t$e Ls a new cale consaF:ct,
r+’hich she ofiered as *re nert phast in the srolutionan’development ci CC’ll. She n’raintained that diverse cultur&1 values, belieis,
expressions, actions, and practices *’rthit a
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Cl{li,f ER 1? . .l&rdelrfue Imnirugrt Ifutoy of Caltwe ilaw]}ivro4r *xd Uxiwro,liy 313
familv, a group, an insiilrition’ or nthc.r unit
mal prtscnt wth sltratiot:s in uhith conflitts
r:rav arise. She oroposed collaboradve circ e! a
*.L, .. * rrr”,*g* t* resoive diifelences end
f rovide culntral.l’ cor.gruent cere
Lcinir’.ge: ritfine,l the iollaborrtive care
aDEroach as thasc ualues, n:eantngs, expres-
,ion*, .-d acricns by ir-ibrn:ar.ts thst rerrca’l a
desire an,l a pla-n to w,:rk rvitl’l cthers in order
ro identih’, attain, and maintaln hcaith and
*,el1-treing and to resolve conillcts ‘I}ris care
r-otrsrruct las been published b;.. Ilclarland
and \ilehhe-“\1’rrnah (Mc!’adand & trtrehber’Uanrah,2015).
Carrent Status ofthe Theory
Currentll, the theory ol rulture cr-re ditersiq’
md univeaalirycontinues tobe studied md used
in manl rchools of nursing rvithln ”]re Unit+d
States and in tther countries, such as L€baroli,
jordaa, SauCi rtabia, ‘faiwan, Ci-Jna, Japan,
and !’inland (l-*ninger & Mcl’arland, 2002,
2006; lVehhc-;\hmal Ec Mclarland; 2012)’
lnterdiscipli-naq’ health personnel a:e b*cominq
ir:c;easingil’ alvare of transnlirural nursing conrepts thai help them in rhei-r work Serenl disciplines including dentistlr, medicine, social
rvlrh and pharrnac.v hare reoorted using th’e
culruratll’congruent care theorv or teaching it in
the.ir prug;a:ns {}lc} x1and, .201 1).
fh” th.otr- of culrure care rriLi ;emsin cf
globa1 inrerest and srgnificance as nurses and
other heaith-care prclessi+nals cofltlnue tc
e:;plore cultures and their cre needs and practices’ivorlds’ide, Transtulrural nursing concepts, printiples, theort, and Sndings rnust
becc,me ii:iIy incorporatcd into professionrl
areas cf teaching, practice, consultation, and
research.. \\tren this occu.rs, one can anticlpate
trte transculiural hea-lth Frattires and c+lcorrita nt bene{its’ Llnqucstio nablv, tne theorl’
rrill continue tr grow in relevrrrte and use as
our worid bccomes more intenselv mulricu-ltural. Iursts aed crher hcalth proiLssionais art
expetted io prc,vide culruraliv f,Dngruent c’1rs
r+ people of direrse cultures.
.Ihe theory, alcng
s.ith maty translulrural nursing colceprs.
prlac!+lts, and research f,ndings, u’iil conrinue
to prore indispensable.
Applications *f
the Theorv
‘Ihe p,:rpose ,:f this Part of th* chapter is to
preser:r the implications fbl aursinfl Prartice ot
it . CCt’ a.’rd related eihnonutsing reseuch
fin&ngs, ,F1any r:ursing theories are rather abs’uact and do not I’otus or how practicing
lu:ses eight use tl:e reseerh lindings related
tc a theory. 1L:*’ever’ rvith the CC1′, along
r*’rth the ethno[ursiflg met]rod, there is a budtin means I’or disccvering and confirming data
with informants in order to rnake Pracricai
nursing actitrns s’nd detisions meanindll rnd
culzurallr’ congruent {Leioinser, 2002)’l
I-eilrnger purposelirllv aroided uslng the
phrasc nrrring inlm-slicrt because this term
ofter, implies to tlients frora dirtbrenl culru:es
that the nr:rse is lmposing his or |rer (etic]
vicws, rth.ich n:41’not be helpiui. Instcad, ttre
term lursing adians and detiiastttvas used, but
als.art with the clients hclpilg to arrive at
r,q’hai.ver scilons $r Cecisions r+’ere planned
anJ tnrplencntcJ. Lhe lare nodcs fir t:rh thc
clje.::ts’ or peoples’ life’*r-rt aud rre borh thera.peuric anJ satis$iag fbr thtm. ‘1he nurse iafl
drarv on scientfic and evldence-based nursing’
medical, and other icrou’iedge rvitir each care
l)ata collected itorn the upper and lo*’er
parts of rie suruise cnabler prol’ide cult’le care
Lor”ledge for rhe nurse and +ther rese*”rr-hers
to discorer and cstabLsh usei’ul*’a1s t’r provide
qualin’ care ptacticcs, Acttve panicipato.ry i:rvolvement’cvlth. clirnts is essendrl to arrive at
cularrallv congruent cate lvith one or all oithe
th;ee action modes to meet clients’ care needs
in rheir particular ewironmental context’s’ ‘1he
use ofrhese modes in nursing cart is one ofth’e
[:ost treaiive and reluardirrg teanrres oi transcultural and general c.ussing practice rrith
clients of dir-erse culrures. [,]sing Lrininger’s
cart modes in clinical Frractlct sho$s respect to
clients’belieii, values, and expressions ald establlshes a panncrship bet$een health-care
lFai ddiriond iltirrotios ubour trIe lJ:hmilu*iag
ldwrch bluhod p1e*e 1p to banus *ngter cottttt
ruilalrk al FA $a*it hrtp:,{davisplus’ildaviacom
l’r’iifrnut put listter’s prior permission’ Violators will be prosecuted
No part olthis book may be reproduced or transmitted
314 Sr., r:ir: \’ ‘ Gratd 1Tesni-‘ atu$ Cere cr C*titg
prov’ider: and clients ta ensure sai’e, beneitent,
and culturalh’congruent care (l{cl-arland 8r
Eipperle, 2008). ‘}i
is most iupcrranr {and a shlft in ru*ng)
ta irref,:11,v ibcus on the hoiistic &mensiotls,
as depicted in tie sunrise enablcr, to arriw at
rherapeutit culture care pracdces. “{‘-11
the factors in the sunrise enablcr must be considered
rc arrive .qt iult’.:railv ccngruent s:art’ ‘Ihese
lnclude rvorldview; technological, religious’
kinship, political-leg’aI, economrc, and eCucationrl iactorsi culrural vdues and lileuays;
enl’iromte nt al co nre*t, langoage, and et}:nolistory: and generic (ioll’) and professional
care pracdces ileiainger, 2002, 2006*l’ Llare
g”reiat”d irom the CC’l’ urll beccrne sal’e,
iorrgr,rtn,, me*ningful, and beneficial rc
clients only when the nurse in clinical prartice
becomes ful11′ alvale of and explicitlr uses
knorr,ledge generated ilom ttre theon and ethnonursing met’hcd, rl’hether irr a communitl’,
hon-re, orlnstitutional c ontext.’Ihe C C’I, used
with the ethnocurslng raethod, is a pou’erful
E-leans J”or exploring ne’,+’di:ecdons and practices i-ri nursinq. trncorsor’ttinq culrurt-speri6c
care irlto dienr tare is essential to ihe pracdre
of proitssional carc rnd to licensure ls reEI\-
t*r*d nrrr”r, Culture-speci{ic care is the safe
rtre&ns ;o ensure culnrrall-v based holirtic care
that lits rne client’s cultur-a ma-ior challenge
lbr nur:es *nd ,:ther healdr-crre prcfessionals
*’ho practice :r.rd prol’ide ser’:rcei ia ali heshhcare sertings,
The {Jse of Cukare C*te Research
(}ver the p*st -q de.ades, Dr. Leininger and
odler research colleagues have used the CCI’
and the ethnonursing metiod to tbcus on the
care rrieaninqs and cxperiences of 10C culzuses
{Leininger, :002). they discovered 187 care
construrts in Western and non-Western cultures benvetn 1989 and 1998 (Leininger,
1998a, 1998b). Leinitger listed the Li most
domlnalt construcls oi carc in priorlt-v ra-‘rkirrg:, with tf ie nosr urrive*al or fiequenth- di-tcocered lirst: reiptct forl’1bout. concerrt
for/abouE, afiefl tion to (details)iin anticipation
of; helping*assisting or ihcilltaiive acts; sciiYe
helping; pr{:sence {being ph.vsicallv there);
,.rndersianding {heliei!, values, liiertal’s, ald
cnvironmcntaL)i connectednessl protection
(gender reJated)i tcuching; and comibrt measures {Leininger, 2006b; Stcf’arland’ 2002)’
‘Ihese care consffucts are the most critical and
ifiportant uqil’ersal or ro11ln]o3 {indiags to
consider in nursing praciice, hut care diversities rvill also be ibund and nrust bc considered’
‘lhc rvavs in rvh.ch culture care is apaiied and
used ia soetifit culrures rviii refle’:t both sir:rilaritles *nd difierences arnong and rtithin
ditTerent cultures.
i\*ct, nl.o erhoon’,usitrg smdies art rsielved
rvith focus on the {inding:, u’hich have implications for nurring Practice,
C u ltur e C arc af Tradi tiona I
Muslims in the Midwestet?t
1n 2005, the the*ry’c,irulture care dirqrsitv a-tld
unlversahty and the tthnonursing researth
method lvffe used ro guide a study of th* cu-lture crre of tradi.tional Stryian Musiin:s in the
Midrrestern Linit*d Srat*s {Wehbe-iUanra-h,
:008b, 201i). ‘Ihe domain af inquiry for ‘jris
etinooursing sruCy rABs the gentrit and the
protessional care meanings, beliefs’ and praciices ,”14t*d to health and illness oftraditlcnai
Srtran .\lus1ims living ia selerel urbrn cotrurunlties 1n the -trtidrvestem Unired States. ‘Ihe
purpose ofthis Etudl lt?s to discover, d+stribe,
a,nd anallze the *ffttt of rvorldvierv, cul::’.ual
contsxt, terhnologic*l, religicu:’ poi-itical, educadonal, and eronomic i.retors on the traditional Svrian ;\lus)ims’ generic and proi’tssionai
care memings, beliefs, cnd praidces”Ihr gcai
rvas to provide practicing nurses and other
health-care prol’iders u’ith know’ledge that can
be turned lnto trre actions and decision: that
facilitate the prorisiotl al cu1rural1,v congrxsnt
care to tradltlonal Syrian Muslims li’.’ing in
sl’nilar {ontaxts i\\’ehbe-A1am*h, 2011).
Findings from thrs grudY retealed that the
worldtiew of traditional S,vrian Muslims is
deeph, en:bedded in *re lslamic religion and
the lrrian culture. Life is vieweJ as a t€st iiom
Cod ald a journcJ’in which one must aftemFl
to dc as manv good deeds as possib’le .lcd to
behave in a rlghteous wav rvheihfr condllcting
bu:iness, taking c:re ofhouseu’ork, or engaging
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Ci{d?,r}:n 17 ‘ i{sdej,r’ze Isizirgv’r ‘Ihmry of *tttt*e D*e Diwti* *nd th1ifltrffiSry 3 15
in an1’other regul*r daily acrivig’ Kinship *nd
f*r*iLrl r”lrtio.thips are rreasured’ Socializine
rrlth f*rLily members and friends rre considered in:paitant aspectri ci Strian lilbrva1″ Visitltions and telephone ,-onl’ersati*ns as well as
!’:ida1′ prayer corgregations are rnajor sccial
activities tc,r Sy:ians. ln S1:ian }lusiirn :oriet1,
lhe n.ran ry5rita1!- assurnes the role ol the
breadrtinner, whertas rhe rromln takes on
other responsibilities, such as managing the
h’.usehold and rrising the thiiCren {Wehbe-
Some or the discorered traditional culmrai
beliel’s and practlces included^ modesq, generous hospltalig+, segregation olmen and rvomen
during social evenis surh as r+’eddlng partirs
and dicner indrations, *’cariag oia coar orjr/”
Srrd over tlothes 1’or rvome n ‘*’hen in public,
caring ibr older familv ntembers *’ithin the
home seting, as u’e}1 as risiring, pravrng fbr,
and cool:ing for the sick’ ‘l*orr*al *’ery-da.v acricns rvere considered h,v manf inlbrmants as
acts ofrvorship. Engagine in rcLlgious pracdccs
such as pravcr and Qr-r’ar: reci:ation or ;nelrrorization wlas reported as a source oi phl:ical,
spirirual, eclotional, and mental supFort by
nufilorous lnfotmanis’ Religious b’eliefs lvere
deterrnined tc plav an important role in a person’s decision-making inl’oit’lng abortion, sterilization, autopsY, orgrn donation, binh
conrrol, and other signi{icant health issues
{\’VchLe-rtr1amah, 1008a).
Cxing uus described as being considerate
oicther people’s irelings and respecting rheir
bcliefs, Enpathv, s1’mFathy’ sensitivit), unseliishness, an*! understanding were other
qua.Itier u:ed to describe caring, Caring can be
expressed b1’checking orr others, being availabie to &em, olfering tF.em he1p, cooking
he:dthy ibod, and keeping a clcan bodr- and a
hlgienic envirc*ment. Llring can additionallv
be exempliiied bv rvirhnolding a diagnosis.
o-nC/or prognosis iiom a patient especialll if
an impendiirg death w* exp+cted anii b1’bu1r’-
ing the dead with 24 hours oltheir passing’
Caricg anribures oinu.rses u’err identified as
srniting, responding quicklv to the needs c’f
s:ck patients, loving &e nursir,S profession and
role, and respecting the patient’l culture
(trVehbe-;Uanah, 200Sb).
A plethora ai generii cr folk pratticcs were
discoi,ered and induded some th’tr art tteneiicial to health and c*iers rvith potentrallv
harrnful ramiiicarions’ One suth example is
the consumption of ra*’ liver, which is rich in
iron and is used to treat anerrlia or iron deficierrcl’. Another ex*mpl+ is treating head llce
b1 pouring gasoline over the sc:1p anC massaging !r inro the hu. I’cik practices that arc ben-
.irti.1to health inciudtd eating ir moderation,
exercising, rrd takltg vitamin C when treating
a cold (Weh.bc-:llamah. ]008b).
Such information can be turned into culrura11,r’ congruent decisious and actions that
ean ltr!paet clitical lrattice tLr*ugn the application of Lelnir:ger’s r-ulrurc care modes’
-{ccordingly, nurses aad other health-care
prootders ian prestn’e andlor maintain the cu-1-
iural beliei’s, e-xpressioas, aad practices cftraditional S1’rian r\luslirns bv respectilg the nttd
for rnodestv and seeregation and assigning
same-sex health-care providers lvhcnel’er possible. ‘lhe culrural belieland prartice ot visiting
thc sick can be rccommodated bl ensouraging
a large uumber of *sitors within the hospital
set*ng \tith the negotiadon of having onl1- a
fr* oLitott in the parient’s roorq at a time ‘lhe
harnfirl iblk prartices ofusing gasoline to treat
head lice and consuming ra\f iil’Er to treat anemia can be repattcrned x’nd/or restructllred
through eduration eiramifications aad discussion of heahLicr altt’matives
trffiHffiffiffi T
:\ i\’iiddlc Ilastern patiert in labor identi&ed
as }lrs. Sarah Isiam has iust been adrnitted
to the obstetrics iloor. She is acccn:panied
bv her husband and is dressed in icqrse clothing that covers all *fher bodv except ibr irer
frc” ,nd hands” She belongs ro the S1uslim
faith and rrears a hcad cover, }1er husband
r€quEsts that orlly temale health-eare
pror,iders {1lCPs} be assigned to his rviie.
‘I’hr turse pruvitles cuituralhl congrutnt care
ro fhls familv using Leiuinger’s culture tsre
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316 !r.r: r -irr V ‘ Crsnd’Ihtcries absul Cttre or Carinq
F$etri*B {k,FW&s jyj*
:\cccrding to this theoii–, the worldyieli’
oi everv human beine is aflbcted b,v cu1rural
and soci”l sgucrural dirn*lsions, including but
not iimited to culzural va-1ues, beliefs, and liie –
rrnys, r-nd kinship, so{ial and reiiglous farrors’
‘lhtreibre. proltssional nursing ctre must incorsorate an u*.derstanding of these belieis
*.j pr*.o.”r’ rls a resuft, the nurse procecd-s
bv conJuctrng a cJlmraf assessmer’t to identL+-
irr.oortrnr n*,1. ,nd prohibitions rhat need to
bc add-ressed in the plan ofcare.’1he nurse be*
srns br’*plaining thai she rvould iike to ask
io lcrn rbout how to brst care foI
t’h. .1i.nt and her ts.mllv.’lhc cu}’.xal a;sessn’reni rereals tht fbllorvicg:
‘ -Nlcdesn* aad prirarl are important values
to.Mrs. and Mr. 1slm and should bc prcsen’td $’hcne1’er possibic, according to ‘-‘:1-
tural and religious teachings. Ihe couple
explains th*t this can be achiered bv assigninq san:e-set I lCPs md trv preventing
*”1* *dio’id*u-lt {ron’, tttering thc Patient’s
room rvrtl’.out fi:st obt.rinrng pcrrr:ssior’ to
do sr..
‘ Pork-d*riveC products induding gelatin ue
prohlbited in lsiam and therei’ore should
be exduded *om diet a-ad medirations’
‘1he cougle uplains thatJe.lio and geJrtinencapsulate-d medications contaia 6elatin
and should be ar-cided’
‘ :! special praycr needs tc be *’hispered b1’
the ilthtr in rhc nelvborrls ears aJier birrhthe couple reque-rts thar the ner*’L’orn be
har:ded to the father as sooa as possible
aftrr birth to l’aciLitatr this practice.
‘ tr/isiu.tion hy lirnily members and iiiends is
to be *pected fb1lowin6 birth. The couple informs r’cu that they ergfct at least 30 r{sitors’
‘ Smoking the wattr pip* is a comrnon
cuitrra-1 practice and is olten caried in tht
Fresente ofchildren. Itr. Islam smokes
the uate.r pi.=e m’lce a dw.
ilaving identilied important culmrql xnd
religicus valucs, Prallices’ needs, rnd prohibiions, the nurse oroceeds to deveJop .1 culRtrai}l’ congruent plan of care using Leiringels
Cuiture rare modes:
Culturc tare Presewrtion and./or
‘ ‘lhe nurse includes a note in the electronic
health record absut identilied cultural and
reJigious rnlucs, oracdces, needs, rnd prohibitions. ‘Ihis r-i1l assisr rvith conrirruitl’of
rulturall,v congruent cxre’
” ‘Ihe nurse is female; therei’ore shc is able to
cue ibr;\’lrs. ls1am.
‘ ‘Ihe nrirse places a sign at }1rs. Isiam do’or
that reads: “No males aliou’ed x”ithour
.;lhe obstcticrar: rnd a-11 nurs!ng stalfattending the birrh sre iniormed tbout the
in:portant prtctlce ofhanding tlc nelryborn
to the t’ather *’itlin minutes of blrrh. ‘ihe
father recltcs the pmlcr in *re babv’s tals’
‘Ihe nurse attends the bkth and ensures
that this happecs.
Culrure care rccornmodation andr’or
. ‘Ihe lurte alranqes lbr kitthen stait lo prol’lde vegetarlan Je}-lo I’ersus animal-dcrlled
‘ ‘lhe nurse alranges for mtdicr’tions to tre
ordered er dispensed in tablet versus gelcap
‘ ‘1he nurse negotiates t’ith the iar.’rily to
haqe l”isitors coile et different tlmes, *zit in
lrdti:rg rocm, aad r-isit il nunrbers ol f or
3 at a time,
Culture care restructuring aftd/or
. ‘fhe nurse educates the clitnt and her
husband sbo’:t dangers associated rqith
smoking and secondhaad smoking inhalation implications is;hg nsrtborn. Sh* adlises the discontinuation olthis practit’e’
(Alternativelt, th.e nurse negotiaies rrith
IUr Islart to oalll smoke cutdoors and cur
down to onte a day.)
Llpon discharge, 51r. and }Irs. lslam thank
i*u, ih. nursc, for providing thcm *’ith the
best tare they have n’er receired in a \\iestern
health-care setting.
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f,rrA:”rr*r 1? . &rclclr ine Leitingx\ Tkcmy af caf,’Jrre cer* Diwtsiry a*d llni|M*liry 3L7
‘Ihe purpose of the CC’I and the ethnonursi;rg mesod is to dise over culrure care L”lo11’1-
edge and to cot:rbine generic and prol’essional
car. ‘Ihe goal is to proride culturallv congru–
ent nursing care uslng the th.ree modes ol
nursinq actions anC dtcisions thflt att ilcarin$rl, -“afe, aad beneiicial to periole oisimiiar
,rJ dir.tt* cuitr:es lvarldwide {Leinlngtr,
1991b, 19r5, 2006a).’Ihe clinical use of the
three major ca.re modes (culrure care preservatiofi and,/or rnxintenance: culturt crre accomrnodation and,/or negoriationl and culture
.i.re reFf,tterring and/or restructuring) tt1’
*urses to guide nurslrg iudgments, dccisionr,
and actions is essenrlal in crder to prortde ruiruraI1y congruent care rhrl is benefrcial, sarishing. and mean:nftul to the ptocle nurses
cen-c. ‘lhc srud:es oresented Lcre substantiarc
rhat thc three modes rre care-centered and
are bascd on ihe use of gcneric care (emic)
kncwledge along rvith plrllssional cart (etic)
krou’IeCge obtrir:rd from researth using the
CCT along rl’irh the ethronursing method’
“lhis chapter has reviewed onlv a small sel*ction oi tl’re culture care findings iiorn ethnonursirg research studies conducted over the
past 5 decxdes. “lhere is a*’esltl ofadditionsl
iindings olinterest to Ptatticing nurses *ho
care for clirnts cf a1l ages frnm diverse and
sirnila-r cuitural groups in manl’ di{erent insriturional and communirv contexts arc’uad
the *’orld, tr{cre in-dep;h cu}ure care finil*
ings, along r+’ith the use oi the three mcdes,
can ire iDund tn the Jotntti q!’Tratstullural
.\irriag (1?89-2013), in the OttlircJotrual of
Cvkrtrai Cow1ttttt* in Nuttitg a*i Healthtart
{u*”lr’.OjCC^\II.org) *nd in the qumerous
Itr+yle,J., 6cGtttenbug i iiridrs, j” (2613). Sladeiei*e
tr+inisger, PhS, i,!dD, lili. !’S”CA’ t-A-An-r A smrbnm.J+mal afT*t*l.r*el Mwirg, }41]’ 5.
Lxininpt, &1. {1!?0’1 . i'{*itg etd m$rry*lag1: Tw
wr!& re &!nnd. Nw Yorlr WihY
Lsisi*ge{, }i, i1+76}. ‘Iwo1turuI nursiss Prc#ns s
midsg eiulleflEE. ‘trbc&**it*x Nw, 515\, &-d.
books and articles lvrittrr: b,r’ I)r. -\’ladeleine
Leinlnger and resea-rchers using her theorr”
and method. Nruses in clinical practite can
reier to researcir studles and doctolal dissertations conceprualiztd u’rthin the CC’I’ for rdditlonal detailed nursing iraplicatioas ior
clients i’ronr diverse cukures iLeininger &
-&lrFarland, 2002; *\{cl’ariand et ai., 2011)’
‘Ihe theory ,;i culture care diversig and universaiiqv is one of tire rnost cornprehensive vet
pracdcal theories to advance ranscultural lqd
g*nerai nursing knowledge a’itl: concomitant
r+.a1-r tb; pra.ticirg nruses to establish or iln-
,ror. .*i* to peopic. Nursing srudentt and
practicing nurses have remaineC the strongest
*duo.rt”i olrtre CCT (Leininger, ?002), -Ihe
theory- focuses on a long-neglerted a-rea in
nursinq practice-culturr care-that is most
relevant to our rnultlcultural world.
the tlreory oi’tulture rare diversiry md universalit,v.is depicred in the sunliie enabler as a
risieg sun. lLs ri:ua-l ntiaPhor is particularh’
apt. ‘lhe fumre of the CC’ll shines brightly indeed because it is hoiistic and comprehcnsivel
and it faciiitates discct’ering tare related to
dircrse and similar culturcs, contextB, aad lges
olpeople in lran:iiiar and naturalistic *’a1:.’Ihe
theory is usefi:l to nurses and nursing as w’ell
as tc proi’essionals in other d:sciplines sueh as
phvsical, ocrupatiooalr and speech thertpl’,
nledirine, social *’ork, and pharrnaq” I lealthrare pracriioners in other disciplines are
beginni.ng to use this ttreorv berause thtv also
n””d to b”.or:re knot’ledgeable about and
sensitive nnd responsible to people of direrse
cult:res rvho need care il-einlnger.3002;
illcl’arland, 201 1],
l*inirger, I1. f 9?fl” Cuiag:’ilw esre and moual
lomr of amit5, .Vrritgfiam&Fo*ada*im Bgrr,
tz\Llt L-!+
Lsi{ir$s, M. {1978}, fffierr}641 e&5ir$- fla,r+},i
rAmt, aadfruc*er Nm Ydc lviht’
f*i*ingu, M. {1881}, Cm;g,’dr ara tia! $umaa tud.
‘.tho:cfw, Hj: $ladc
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No part of this book may be reproduced or transmitted
31f, 5[c rtnil< v ‘ Granl Theori* a&*ui Carr ar (erirg
Leinisgtr, t\{” {19S4}, 6au Sr arae a/*ai;g uad
,iw/r*.’Ihcref*e, r$r Sladr
Ixi,qi{ger, l{” {il85}. gffiir}erttw Erffi} tutM iE
n*rirg 1pf. ff-;3;. *rhodo, $L: Cme 8cS*atrua’
L*iflirutr;M: (1988). Crt: Ditouttl onduw in diakd
aar! ammairy ouairs. l)ffiir’ -t1I: \Yayne Sate
UnireEiq Preslxinlnes, Iri, (1989t), “frumulrual nwing QLo red\
(wtrw gtrth rhe 6etd!}.lomsl a[T’tariltwul
&ksrhS, ,{{$,33-45.
Lcininfltr, I!1. {1989b). TruorrnorC rNrE }pEcidisu
*ig”ncj”*, Jlev Pffrition€s in rusiog’ Jmrl
a{ Tdntftlrurl! buuffiag, l(1}, a-16′
Leiriltp, ${. {1990e). Trrmulrunl rusing A wwldwiJe nw*iry t* adrm nusiug krot’lcdgt and
rrattie*” trJ. &lcClwiexy Se &{. ilm, {tds’), Cr
MJ i6s itr ilmif,g- St. lsua MO: t’ V’ ils*I’
I*inires, i{. {19qfi}), Culnre: ‘itt onspituou* triar
in* tint t* u*detrrand ethicd gfid fisn1dimm*ioils
oiirwm e&e, In I!I- L*id*ger (*id”], -5*tua/*rri
dref din#!in# sf wt’ Ilelroir, Ml: Vy’rwe Sane
Uoiffiirv !ts.
LeinlrrEs, &1. {1990d), gr*iird#/Md d#r’rnad *r
ar* I3euoir, Silr W*3ee Se{e Uniffiity tsrffi’
l*inin*e, M, {1991E). GdJaB rffi d#Js*’ #/#i{e
@lirj:,i rI,fdr’4l&ftin6- Nru Yuk iradmal
Legut t-e l\using Prcse.
L*inineer, -\’1. (1991b)-‘fhc theuy of culturc rue
dirtsis md univssaliry. lo -\4. I*irnngs (Ed ),
Cu&s{ trrs /r:E#ir} ead ****m/iry::f r*enry o1{
rming {pp. 5-68}’ Nw YorL Hatiooa! Lmgue
for Nusirrg Fem,
Liinn)s#, xf , (19951- Tmwnntval tnj,g: (hrcfit’
tAilt, t*ed:, aadTrwne Colmbul, OI i:
McCqs-Hili tntleYP Curtm Suier’
t*inio*er, -V. (1997r). Otmi* and refl*tion of the
.leon of culue rx md dre eLhoonudng rwmh
oedrcd-,Iamo!{?rmor*we/,i!tr,”trd! *U)’ 3?-51′
I*itir:qw, &s. {1997bi” Owrim ol rhe rhmr-r *f cu1-
tur; ff rviih rhe $hnonusbg rswch metlud’
/axmef gf ?roaw/ruarlnrrrr’ag’ S(I)’ 3!-53′
Leininmr, IU, (199?c) Trosulrual runing rrewch to
ranrlbrm nmilg eduBcios atrd Pscticer 40 vffE’
Imgt: Jwal a$’fw;ieg S.ea,nm6ip, 39{d}’ 3;11-347′
arrieg. DaYton, {)l’l: Gr+den Prug
Leiniofs]ll1 (199sb}. fueia! ru*ch rPonr Dominert
cdue cm iuic) reingr md pncrkt fiodLrge
ft*n l*ininss’$ thesrJ”J*aa/ 9f lra*miJlrd
,\ererdd’ 9(?)”i-H7′
l*icinger, M. 0002)’ Fr.rt Il’Ih* thewy of ohu* se
md the ettrnonmi*g re*rch merhod’ ln F{‘ }’t’
fsintgs &${, li, M*’attesd {Edg’}’ ?ienffi&{ral
Eniar: ondplr, riarr:, aadSrwtrr {3rd ed’

pf. 7r:?8). Sudbury,IItu.lones ud Buden.
i.aritsSs, &{. {1fi06e), Culture cre dirmity 8d ffiiwraliry tluory aad nnlutict of ttm e&m*uring
oed:od, ln .\{. ${. lxinioSrr Ea M. B’ hl’c}’lduri
{{dc.), Sslr&rediiffi i4 tl xxi*ncli4: d *tr*Jwdc
aatl*g rtutry, (}nd ed., g9. l-ar)’ $udbry, l'{A
Jnrm rnd Sotlex.
Lsiaiags, $1′ {?06b}. E&nmu*inlp A re*arclr
*urL*tr *tth
m rtudy dre Li)€o{y of mlele
w. In M. S{. Leiflinger &’Sf I McFsisd
nmrrs rlwry i.:nd id., pp. a3-$1]’ Sud&ur,r, *tr!
jom md B’rtl*ttLciniats, Il. (20091- lt is tiw to ub6’e*’ ry&t ud
l*i intc tfu fr,twc Retriwcd on Jarruary 9, ?013
liun tt u ii’Lqnrinr*1?'{m!ng 3ukttr’website at
hrrp r//tw,ut*.o4i&’oundrex-hsni
Lehiogu, .&1. (201i)- lri+inger’s reflarim on dre
on piog &th* ptrtotire m r*sdr Tls Ot&rc
Jawat e{ Cxhtaal Conattfr* in Nn;fr4 dod
Hutthti*, r(2), 1-l3 hgtpl/Me ojcsh’or8/
Leiaia*tr, M., & I lo,ling, C (1960) BB:’c f $rbio trit
ffir.r,r, ia r*r;xA. Phrlad*.lph.it LiPpbcort’
LeiilnA;, &L ${-. & }k}’arland, M, 1l (Ed+. {2002}’
TruEr’vlr#}! nfflin#: c’tr4’B’ i’Bd’n4′ dildP8{Iia
(3rd ed.). Irtrv YaL. IlcGnw-iii.ll’
Lai*iagu, M,, Sc Mc5slmd, St’ {204}}’ Tmart*tmJ
a*iirg; C+**p*, ;*riu rssro4 mlgron’e Ftd *d^)’
Hw fsk :vlc{.imv-}liE, Chinrue {-loed*’Irmsladoil Co!+right 200? by Wu-m llook lnc’ (llook
r*uhrcd into CtrlnseJ.
Leiaiafiet, lr{. M* SrslcFrtrcnd, !r{ & {Iirtg”i {’00*}’
C#:m a1miry # m*?mdiryrJ uod&ri* aerirg
rion (2nd d ). Sudbury, -N{.& Joret md Buden’
-lrcftrI;d, fi{. R. {2002}. Pm lI: Selected reseffi}:
fndiqs from the ruire ffi6 *Es{‘. In 1l{‘ M’
Leltitgr f*14- IL rllcFriend {Ed*)! ftensailstd/
w*1a11: futttptt, t&6ffi, drlptrdsrd {3rd Bd-,
FP. ,9-tr16J. Nsv Yorh- &!c{iruw-l’!i}l’
ldciufsnd- I’,{, F- {3010}, }f#eleiro lxiai*ger: Crltw w rhmry *f fivenlty sd mivtselity’ Ifl JL
1’t.’Ioney ScM. R Alligord {Edr’), ‘Virniag;i}ar
nifJ ed/’k#{sl {Ith ed” 9p’ rt5+-479′ uattl
rer{siom frcm 1fi0$ ed-}, lir. t*uis, }d(}: E:lss{er
$trc!-ulurd, i’1″ it, {}011).Sradr:et*re l&oryardo
loal rt rlr fid{fr t’at trilaw&ral mring- Keytore
rddre* plwtei u the 3?rh./ruua] Confsencc cf
rhe Inrcrmrimal Sxiety of ‘froruItural lrusiog,
Lae l’egar, tiY.
Hc$’slm{I\1.11., {rElpprle, M’ K’ (3ffiS)’ Cuitue
cm tlrmry: .{ p*pwd pmrtire r}rrory guide ftr
oiffi practitionus ia primry tut wttiAgr’ Cmtmjrer,lr rVorot,fJ*aef/r rir Jurrrufm rYmi:tg
Itc&rgr” .At{l-?}. 4E-dl,
Msl-uiard, &1, R’, Mixs, S,J’, Wehhe,Almrh, fI,
{n*ulq H- {}0UJ’ Eih*omshg; A qudit*ire rea*ch msrbei Ii)r iU di*ripEtw. &eJie ls’#M’i’MJ
Jm! al Qualintite tutctbcd’, ) I \31, 259-279′
Uniwsity *1 Alherrq Cmdr.
ndcp.ulmd, i{, 8., EtlVehbe-Alamrh,. l{‘ E, (}s15),
llhe &tsry pf cuhure lE€ diwsiry md uit’trn:irr’
Ir &tc!’erimd rnd Wehbe-A}ffih {Ed*}. dr}ffi
t#t di%*ri t! and nitwaliry, ]{ uodri*id-t *miag
pzuNTED By: bf1a0ldt8104fec@placeholder.17527.edu. printing is for personal, private use only. No part of this book may be reproduced or transmitted
wiihout publisher’s prior pemrission. Violators will be prosecuted
Cudi’rl:r{ 17 . Madetrine Leiniagt’t Tbwry of,Cu*tre C*rcDiwrsiry ead l/niwrcJitl 319
rhuy (3ad ed., Ch 1, pp. 1-31i. Sudbury, MAr’loru
*d lltrt16tt.
Mc!”ulmd, M’, $fehbe-.S,1mah- Ii., Wilesn,Itd’, &
Ys*m, IL F*11]’ Synopeis of fi*diage dic*xed
J,lr;, , a.*+t;u. orta*1mrhe*is of doctoral &srcruioro guiLhd by dw Cukm Cm’lheorv wirh
uw ol’rhe rtlrnoomilg rewch neihod’ Odirc
,y’mo{ $C*lrrr/ Cofifd/scc ir,Vffiieg {fi{
H*klxa#,.!{Z}, 2d-39′ l{etriwedt}oru hnp:y’1
w’.ff !ru31{ompetcle-pr+iecloryrojcmL/
\?c!&rAlmatr, il, {30flSai. 8ri’}ging gffii€ md pmfmrioaal cut putimr fuc Mutlir perimts tlr*ug1r
the m of Leiningpr’g P:lture cm mde c ‘ dldnttdlom.r n&ro, rrtl-2J. 83-97.
W€tibc-Aktreh, 1{- {2008b). Ca{rm mrc o/S,s’iua
Muliw in dE *fidlktm #.5,{‘ ??cgrrm} md
Mtsimal braltb rcfr lrtitfs, frlnr! io&’ ild pr@titil
ttstiaa Msiifl oad in1lnuidr lo F*ric’
i”riu*.I”n, Cc*ny: \’DM Vcdrg Dr’ fuluihr
Welk-Aiu$h, i{. {i011}-‘lhe mr gf tultw e*:e
th*or1 with $prm Musllrm in the |{id-wctsn
Uriled liele- A#iw,p*nilaf Cukud (rnlesmu
;n NffiiftI&il{} ll#kbe*, I(31, t-1X’ llatrised f!ffi
Wehb{-Aimah, ! 1., & Mc!’ulud, !1- (20U) T’r
Tdwex *{twl apxiext, Podium prmmtation
ai tlu 3$rh.jLlrrual CsrI’erema ofthe Tnucultural
I’iurog $oricry. Orlando’ F’lorida

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