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CHAPTER 22 Madeleine M. Leininger 423

theory is that the construct of care has been critical
Use of Empirical Evidence to human growth, development, and survival for
For more than 6 decades, Leininger has held that care human beings from the beginning of the human spe-
is the essence of nursing and the dominant, distinctive, cies (Leininger, 1981, 1984a). The second reason is to
and unifying feature of nursing (1970, 1981, 1988a, explicate and fully understand cultural knowledge
1991b; Leininger & McFarland, 2002a, 2006). She has and the roles of caregivers and care recipients in dif-
found that care is complex, elusive, and embedded in ferent cultures to provide culturally congruent care
social structure and other aspects of culture (1991b; (Leininger, 1991b, 1995c, 2002a, 2002b, 2002c). Third,
Leininger & McFarland, 2006). She holds that different care knowledge is discovered and can be used as
forms, expressions, and patterns of care are diverse, essential to promote the healing and well-being
and some are universal (Leininger, 1991b; Leininger & of clients, to face death, or to ensure the survival of
McFarland, 2002a, 2006). Leininger (1985a, 1990b) human cultures over time (Leininger, 1981, 1984a,
favors qualitative ethnomethods, especially ethnonurs- 1991b). Fourth, the nursing profession needs to sys-
ing, to study care. These methods are directed toward tematically study care from a broad and holistic cul-
discovering the people-truths, views, beliefs, and pat- tural perspective to discover the expressions and
terned lifeways of people. During the 1960s, Leininger meanings of care, health, illness, and well-being as
developed the ethnonursing method to study transcul- nursing knowledge (Leininger, 1991b, 1995c, 2002a,
tural nursing phenomena specifically and systemati- 2002b, 2002c). Leininger (1991b, 1995c, 2002a, 2002b,
cally. The method focuses on the classification of care 2002c) finds that care is largely an elusive phenome-
beliefs, values, and practices as cognitively or subjec- non often embedded in cultural lifeways and values.
tively known by a designated culture (or cultural repre- However, this knowledge is a sound basis for nurses
sentatives) through their local emic people-centered to guide their practice for culturally congruent care
language, experiences, beliefs, and value systems about and specific therapeutic ways to maintain health, pre-
actual or potential nursing phenomena such as care, vent illness, heal, or help people face death (Leininger,
health, and environmental factors (Leininger, 1991b, 1994). A central thesis of the theory is that if the
1995c; Leininger & McFarland, 2002a, 2006). Although meaning of care can be fully grasped, the well-being
nursing has used the words careand caringfor more or health care of individuals, families, and groups can
than a century, the definitions and usage have been be predicted, and culturally congruent care can be
vague and used as clichés without specific meanings to provided (Leininger, 1991b). Leininger (1991b) views
the culture of the client or nurse (Leininger, 1981, care as one of the most powerful constructs and the
1984a). “Indeed, the concepts about caring have been central phenomenon of nursing. However, such care
some of the least understood and studied of all human constructs and patterns must be fully documented,
knowledge and research areas within and outside of understood, and used to ensure that culturally based
nursing” (Leininger, 1978, p. 33). care becomes the major guide to transcultural nurs-
With the transcultural care theory and ethnonurs- ing therapy and is used to explain or predict nursing
ing method based on emic (insider views) beliefs, a practices (Leininger, 1991b).
person gets close to the discovery of people-based To date, Leininger has studied several cultures in
care, because data come directly from people rather depth and has studied many cultures with undergradu-
than the etic (outsider views) beliefs and practices of ate and graduate students and faculty using qualitative
the researcher. An important purpose of the theory is research methods. She has explicated care constructs
to document, know, predict, and explain systemati- throughout cultures in which each culture has different
cally through field data what is diverse and universal meanings, cultural experiences, and uses by people of
about generic and professional care of the cultures diverse and similar cultures (Leininger, 1991b, 1995c;
being studied (Leininger, 1991b). Leininger & McFarland, 2002a, 2006). New knowledge
Leininger (1984a, 1988a) holds that detailed and continues to be discovered by transcultural nurses in
culturally based caring knowledge and practices the development of transcultural care practices with
should distinguish nursing’s contributions from those diverse and similar cultures. In time, Leininger (1991b)
of other disciplines. The first reason for studying care contends, diverse and universal features of care and