to be discovered in order to create the theory and to
bring new insights and new knowledge. This data
would also disclose ways clients would remain well
and prevent illnesses. Indeed, holistic cultural
knowledge needed to be discovered, rather than
small pieces of medical knowledge, in order to
make decisions in arriving at culturally congruent
care, which was the theory’s goal (Leininger, 1991).
Discovering cultural care knowledge would ne-
cessitate entering the cultural world to observe, lis-
ten, and validate ideas. Transcultural nursing is an
immersion experience not a “dip in and dip out”
experience. No longer could nurses rely only on bits
and pieces of partial or fragmented medical and
psychological knowledge. Nurses needed to become
aware of the social structure knowledge, cultural
history, language uses, and environmental factors
in which people lived. It was these factors that were
important to understand cultural and care expres-
sions. Thus, nurses had to be taught the philosophy
of transcultural nursing, the culture care theory,
and how to discover culture knowledge. It was the
transcultural nursing courses and programs that
provided such instruction and mentoring.
Professional and Generic Care
Another major and predicted tenet of the theory
was that there were care differences and similarities
with regard to two kinds of care, namely profes-
sional and generic (traditional or indigenous folk),
and their practices (Leininger, 1991). These differ-
ences were also predicted to influence the health
and well-being of clients. These differences would
identify gaps in care, inappropriate care, and also
beneficial care. Such findings would influence the
recovery (healing), health, and well-being of clients
of different cultures. Marked differences between
generic and professional care ideas and actions
could lead to serious client-nurse conflicts, poten-
tial illnesses, and even death (Leininger, 1978,
1995). These differences needed to be identified
and resolved.
Three Modalities
Leininger also identified three new creative ways to
attain and maintain culturally congruent care
(Leininger, 1991). The three modalities postulated
were (1) culture care preservation or maintenance,
(2) culture care accommodation or negotiation,
and (3) culture care restructuring or repatterning
(Leininger, 1991, 1995). These three modes were
very different from traditional nursing practices,
routines, or interventions. They were focused on
ways to use theory data creatively to facilitate con-
gruent care to fit clients’ particular cultural needs.
To arrive at culturally appropriate care, the nurse
had to draw upon fresh culture care research and
discovered knowledge from the people, along with
theory data findings. The care had to be tailored to
or fit the client needs. Leininger believed that rou-
tine interventions would not always be appropriate
and could lead to cultural imposition, cultural ten-
sions, and cultural conflicts. Thus, nurses had to
shift from relying on routine interventions and
from focusing on symptoms to care practices de-
rived from the clients’ culture and from the theory.
They had to use holistic care knowledge from the
theory and not medical data. Most importantly,
they had to use both generic and professional care
data. This was a new challenge but a rewarding one
for the nurse and the client if thoughtfully done.
Examples of the use of the three modalites contain-
ing theory findings are in several published sources
(Leininger, 1995, 1999, 2002) and are presented in
the next part of this chapter.
Since this theory has been used, new kinds of
transcultural nursing knowledge have been forth-
coming. Culturally based care has been discovered
to prevent illness and to maintain wellness. Ways to
help people throughout the life cycle (birth to
death) have been discovered. Cultural patterns of
caring and health maintenance have also been dis-
covered, with environmental and historical factors.
Most importantly, cultural differences and simula-
rities have been discovered with the theory.THEORETICAL ASSUMPTIONS: PURPOSE,
GOAL, AND DEFINITIONS OF THE THEORY
This next section discusses some of the major as-
sumptions, definitions, and purposes of the theory.
The theory’s overriding purpose was to discover,
document, analyze, and identify the cultural and
care factors influencing human beings in health,
sickness, and dying and to thereby advance and
improve nursing practices.
The theory’s goal was to use research-based
knowledge in order to provide culturally congru-
ent, safe, and beneficial care to people of diverse or
similar cultures for their health and well-being or
for meaningful dying. This goal of arriving at cul-
turally congruent care was predicted to promote314 SECTION III Nursing Theory in Nursing Practice, Education, Research, and Administration