that caring for people of many different cultures
was a critical and esssential need, yet nurses and
other health professionals were not prepared to
meet this global challenge. Instead, nursing and
medicine were focused on using new medical tech-
nologies and treatment regimes. They were focused
on studying biomedical diseases and symptoms.
Shifting to a transcultural perspective was a major
change but a critical need.
This part of the chapter presents an overview
of the Theory of Culture Care Diversity and
Universality, along with its purpose, goals, assump-
tions, theoretical tenets, predicted hunches, and re-
lated general features of the theory. The next part of
the chapter discusses applications of the knowledge
in clinical and community settings. For more in-
depth reading of the theorist’s perspectives, readers
should consult primary literature on the theory
(Leininger, 1970, 1981, 1989a, 1989b, 1990a, 1990b,
1991, 1995, 1997, 1998, 2002, and 2004).
FACTORS LEADING TO THE THEORY
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 to develop
the Culture Care Theory came to her while she was
functioning as a clinical child nurse specialist in a
child guidance home in a large Midwestern city
(Leininger, 1970, 1991, 1995). From her focused
observations and daily nursing experiences with
the children, she became aware that the children in
the guidance home were from many different cul-
tures. Children were different in their behaviors,
needs, responses, and care expectations. In the
home were children who were Anglo-Caucasian,
African American, Jewish American, Appalachian,
and many other cultures. The children’s parents
responded to the children differently, and their ex-
pectations of care and treatment modes were dif-
ferent. The reality was a cultural shock to Leininger
as she was not prepared to care for children of di-
verse cultures. Likewise, nurses, physicians, social
workers, and health professionals in the guidance
home were also not prepared to respond to such
cultural differences. Because of this cultural shock,
she felt helpless to care for the children and their
parents. It soon became evident that she needed
cultural knowledge to be helpful to the children.
Her psychiatric and general nursing care knowl-
edge and experiences were woefully inadequate.
She decided to pursue doctoral study in anthropol-
ogy. While in the anthropology program, she dis-
covered a wealth of potentially valuable knowledge
that would be helpful within a nursing perspective.
To care for children of diverse cultures and link
such knowledge into nursing thought and actions
was a major challenge. It was essential to incorpo-
rate new cultural knowledge into nursing. It was
knowledge that went beyond the traditional physi-
cal and emotional needs of clients. Leininger was
concerned whether it would be possible to incorpo-
rate such new knowledge, given the traditional
norms of nursing and its orientation toward
medical knowledge.
At that time, she had questioned what made
nursing a distinct and legitimate profession. She de-
clared in the mid-1950s that care is (or should be)Care is (or should be) the essence and
central domain of nursing.the essence and central domain of nursing.
However, many nurses resisted this idea, because
they thought care was not important and was too
feminine, too soft, and too vague and that it would
never explain nursing and be accepted by medicine
(Leininger, 1970, 1977, 1981, 1984). Nonetheless,
Leininger firmly held to the claim and began to
teach, study, and write about care as the essence of
nursing as its unique and dominant attribute
(Leininger, 1970, 1981, 1988, 1991). From both an-
thropological and nursing perspectives, she held
that care and caring were basic and essential human
needs for human growth, development, and sur-
vival (Leininger, 1977, 1981). She argued that what
humans need is human caring to survive from birth
to old age, when ill or well. 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 in order to
establish a new knowledge base for the new field of
transcultural nursing. Synthesizing or interfacing
culture care into nursing was a real challenge. The
new Theory of Culture Care Diversity and Univer-
sality had to be soundly and logically developed
(Leininger, 1976, 1978, 1990a, 1990b, 1991). For-
mulating such cultural care knowledge was essen-
tial to support the new discipline of transculturalCHAPTER 20 Madeleine M. Leininger’s Theory of Culture Care Diversity and Universality 311