or indigenous) knowledge often has rich care data
and needs to be explored. Generic care ideas need
to be appropriately integrated into the three modes
of action and decision for congruent care out-
comes. Both generic and professional care are inte-
grated together so the clients benefit from both
types of care.
The Sunrise Enabler was developed with the
idea to “let the sun enter the researcher’s mind” and
discover largely unknown care factors of cultures.
Letting the sun “rise and shine” is important and
offers fresh and new insights about care practices.
Generally, a wealth of new and unexpected nursing
care knowledge is discovered that has never been
known and used in present-day nursing and med-
ical services.
Current Status of the Theory
Currently, the theory of culture care diversity and
universality is being studied and used in many
schools of nursing within the United States and
other countries (Leininger & McFarland, 2002).
The theory has grown in recognition and value for
several reasons. First, the theory is the only nursing
theory that focuses explicitly and in depth on
discovering the meaning, uses, and patterns of
culture care within and between specific cultures.
Second, the theory provides comparative culture
care differences and similarities among and within
cultures. Thus, it has greatly expanded nurses’
knowledge about care so essential for nurses to
know and use in practices. Third, the theory has
a “built-in” and tailor-made ethnonursing nursing
research method that helps to realize the theory
tenets. It is different from ethnography and other
research methods. The ethnonursing method is a
qualitative method and is valuable in discover-
ing largely covert, complex, and generally hidden
care knowledge in cultures or subcultures. It was
the first specific research method designed so that
the theory and method fit together. This has
brought forth a wealth of new data. Quantitative
data methods were not helpful to find hidden
care data.
Fourth, the theory of culture care is the only the-
ory that searches for comprehensive and holistic
care data relying on social structure, worldview,
and multiple factors in a culture in order to get a
holistic knowledge base about care. The theory pre-
dicts the health and well-being of people and fo-
cuses on the totality of lifeways of individuals,
families, groups, communities, and/or institutions
related to culture and care phenomena. It gives a
comprehensive picture of care knowledge and often
in a historical and environmental context. Some
nurse researchers have studied care with limited
variables or in regard to medical symptoms and
diseases—an approach that is too limited and
fails to identify care beliefs and values from the in-
formants’ views. Discovering the totality of living
with a caring ethos in a culture has provided a
wealth of new knowledge about clients’ lifeworld
and care.
Fifth, the theory has both abstract and practical
dimensions. This characteristic helps nurse re-
searchers to discover what exists, or has the poten-
tial to be known and used for human caring and
health practices. What exists and does not exist is
important to discover, as is the potential for future
discoveries. Some theories deal only with abstract
phenomena, but this theory has both abstract and
practical realities.
Sixth, the theory of culture care is a synthesized
concept; integrated with the ethnonursing method,
it has already provided a wealth of many new in-
sights, knowledge areas, and valuable ways to work
with people of diverse cultures (5 books and 250
articles), showing different ways to care for cul-
tures. These transcultural nursing research findings
are the new knowledge holdings that support the
new discipline of transcultural nursing. These are
the “gold nuggets” to change or transform health
care to realize therapeutic outcomes for different
cultures. Several transcultural nursing studies have
been reported in the Journal of Transcultural
Nursingand other transcultural nursing books and
journals since 1980. They substantiate the theory
(Leininger, 1991, 1995, 1997a, 1997b).
Seventh, the theory and its research findings are
stimulating nursing faculty and clinicians to use
culture specific care appropriate and safe for cul-
tures. Thus, transcultural nursing knowledge is to
be used in clinical and community settings.
Nursing administrators in service and academia
need to be active change leaders to use transcultural
nursing findings. Nursing faculty members need to
promote and teach ways to be effective with cul-
tures (Leininger, 1998). Nurse consultants are usingCHAPTER 20 Madeleine M. Leininger’s Theory of Culture Care Diversity and Universality 319