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Transcultural Nursing Theory

Dr. Madeleine Leininger became interested in anthropology on the 1950s, and it was the blending of this discipline with nursing that led to the Transcultural Nursing Theory. The theory was the first of its kind and addressed what Leininger felt was the missing component in nursing.

Transcultural nursing refers to the cultural factors that influence the nurse-patient relationship. Because this aspect of nursing had never been addressed, a theory was needed that could study this type of care. Leininger sought to provide patient care that was in accord with the cultural beliefs and values of patients or groups. She also discussed the meaning of caring. The theory has been defined as a middle range theory although its holistic approach applies to a wide range of nursing applications.

Basic Concepts

  • Caring is the helping of others with their real or expected needs. This serves to improve areas of concern or helps patients face peaceful deaths.
  • Caring is defined as an action taken to provide care.
  • Culture refers to the values, beliefs and life patterns that guide patients' and group's ways of thinking, actions and lifestyles.
  • Cultural care refers to the many aspects of a particular culture that influence patients' and group's abilities to improve their health conditions and cope with illness and death.
  • Cultural care diversity is the difference in values and perception of acceptable ways of care between different groups of people.
  • Cultural care universality refers to common beliefs that are present between many cultures.
  • Nursing is a learned profession that has its focus on care.
  • Cultural and social structure refers to the many factors that influence patients' responses within the context of culture. Included are social mores, religion, political beliefs, educational levels and ethnohistory.
  • Health is defined as the state of well-being that is considered normal by a particular culture.
  • Cultural care maintenance refers to those activities of nursing care that assist patients and groups improve their health while remaining true to their cultural values.
  • Cultural care accommodation refers to nursing activities that are a result of negotiation and arrive at the shared goal of the most advantageous health outcome.
  • Cultural care restructuring refers to healing actions that are instituted by culturally informed nurses or families. These actions allow patients to adjust their behaviors while adhering to their cultural beliefs and values.
There are several philosophical assumptions of the nursing theory that add clarity, meaning and depth.


  • Caring is the spirit and primary focus of nursing.
  • The spirit of caring is necessary for facing sickness and death and also for healing and growth.
  • Culture care forms a holistic framework by which to guide nursing care practices.
  • Nursing's primary purpose is to serve people in health, sickness and dying.
  • There is no healing without the giving and receiving of care.
  • All cultures share both similar and different concepts of culture care.
  • Nurses must be aware of the folk remedies, care practices and professional knowledge of each culture. It is only by identifying and discussing these factors with patients that culturally agreeable care can take place.
  • Cultural care values and beliefs are influenced by many factors such as religion, economics, education, social structure, political views and the environment.
  • Culture-based nursing improves the welfare of patients and groups.
  • Culturally favorable nursing care can only happen when the nurses providing care are knowledgeable with the culture and its values and patterns.
  • If nursing care does not agree with patients' cultural beliefs and values, the patients will experience stress and conflict and will exhibit noncompliance.
Culturally aware nurses realize that culture affects the nurse-patient relationship. They educate themselves and ask patients about their cultural practices and preferences. Whenever possible, they integrate the patients' cultural needs into the nursing care plan. They respect cultural differences and realize that these differences are an important nursing concern.

The strengths of the system include improved decisions in the clinical setting. Nurses develop cultural sensitivity and a deeper appreciation of human values. A weakness is that sometimes outcomes can be misinterpreted or resistance is met, and nurses question their effectiveness. The theory does not focus on symptoms of disease or treatments.

Dr. Leininger provided a visual aid to her theory called the Sunshine-Enabler Model. It can be seen at http://n207b.blogspot.com/2010/07/sunrise-enabler-model.html. Using this model, the theory can be seen as a rising sun with the various factors that affect cultural care as part of the sun. Three interconnected circles below the sun show how nursing care is related to folk systems and professional systems. This graphic makes it easier to understand the theory as a whole.

Publications related to the Transcultural Nursing Theory

Dr. Leininger was a prolific writer and most of her papers and documents are archived at various universities. A description of these archives can be found at http://www.madeleine-leininger.com/en/archives.shtml.

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