expressed, beneficial, and patterned ways
(Leininger, 1993, 1995, p. 106).
9.Culture care preservation or maintenance: Refers
to those assistive, supporting, facilitative, or en-
abling professional actions and decisions that
help people of a particular culture to retain
and/or preserve relevant care values so that
they can maintain their well-being, recover
from illness, or face handicaps and/or death
(Leininger, 1991, p. 48).
10.Culture care accommodation or negotiation:
Refers to those assistive, supporting, facilita-
tive, or enabling creative professional actions
and decisions that help people of a designated
culture to adapt to, or to negotiate with, others
for beneficial or satisfying health outcomes
(Leininger, 1991, p. 48).
11.Culture care repatterning or restructuring:
Refers to those assistive, supporting, facilita-
tive, or enabling professional actions and deci-
sions that help clients reorder, change, or
greatly modify their own lifeways for new, dif-
ferent, and beneficial health-care patterns
while respecting the client(s)’ cultural values
and beliefs to provide beneficial and healthy
lifeways (Leininger, 1991, p. 49). (These pat-
terns are mutually established between care
givers and receivers.)
12.Ethnohistory:Refers to past facts, events, in-
stances, and experiences of individuals, groups,
cultures, and institutions that have been pri-
marily experienced or known in the past and
which describe, explain, and interpret human
lifeways within a particular culture over short
or long periods of time (Leininger, 1991, p. 48).
13.Environmental context:Refers to the totality of
an event, situation, or particular experience
that gives meaning to human expressions, in-
terpretations, and social actions in particular
physical, ecological, sociopolitical, and/or
cultural settings (Leininger, 1991, p. 48).
14.Wo r l dv i e w :Refers to the way in which people
tend to look out on the world or their universe
to form a picture or value stance about their
life or the world around them (Leininger, 1991,
p. 47).
15.Kinship and social factors:Refers to family in-
tergenerational linkages and social interactions
based on cultural beliefs, values, and recurrent
lifeways over time.
16.Religion and spiritual factors:Refers to the
supernatural and natural beliefs and practices
that guide individual and group thoughts and
actions toward the good or desired ways to
improve one’s lifeways.
17.Political factors:Refers to authority and power
over others that regulates or influences an-
other’s actions, decisions, or behavior.
18.Technological factors: Refers to the use of elec-
trical, mechanical, or physical (nonhuman)
objects used in the service of humans.
19.Education factors:Refers to formal and infor-
mal modes of learning or acquiring knowledge
about specific ideas or diverse subject matter
domains or phenomena.
20.Economic factors:Refers to the production, dis-
tribution, and use of negotiable material or
consumable productions held valuable to or
needed by human beings.
21.Environmental factors:Refers to the totality of
factors within one’s geographic or ecological
living area.
22.Culturally congruent care:Refers to the use of
culturally based care knowledge and action
modes with individuals or groups in beneficial
and meaningful ways to assist or improve one’s
health and well-being or to face illness, disabil-
ities, or death (Leininger, 2002).
The above definitions are called orientational
rather than operational, in order to permit the re-
searcher to discover unknown phenomena or
vaguely known ideas. Orientational terms allow dis-
covery and are usually congruent with the client
lifeways. They are important in using the qualitative
ethnonursing discovery method, which is focused
on how people know, understand, and experience
their world using cultural knowledge and lifeways
(Leininger, 1985, 1991, 1997a, 1997b, 1999, 2000).The Sunrise Enabler:
A Conceptual Guide to
Knowledge DiscoveryThe sunrise enabler (Figure 20–1) was developed
by Leininger to provide a holistic and comprehen-
sive conceptual picture of the major factors influ-
encing Culture Care Diversity and Universality
(Leininger, 1995, 1997a; Leininger & McFarland,
2002). The model can be a valuable conceptual vis-
ual guide to discover multiple factors influencing316 SECTION III Nursing Theory in Nursing Practice, Education, Research, and Administration