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CHAPTER 22 Madeleine M. Leininger 425

The universality of care reveals the common nature studying culturally based care for individuals, fami-
of human beings and humanity, whereas diversity lies, and groups. These factors are studied, assessed,
of care reveals the variability and selected, unique and responded to in a dynamic and participatory
features of human beings. nurse-client relationship (Leininger 1991a, 1991b,
2002b; Leininger & McFarland, 2002a).
Theoretical Assertions
Tenets are the positions one holds or the givens that the Logical Form
theorist uses with a theory. In developing the Culture Leininger’s theory (1995c) is derived from anthropol-
Care Theory, four major tenets were conceptualized ogy and nursing but is reformulated to become trans-
and formulated (Leininger, 2002c, 2006): cultural nursing theory with a human care perspective.
1. Culture Care expressions, meanings, patterns, and She developed the ethnonursing research method and
practices are diverse, and yet there are shared com- has emphasized the importance of studying people
monalities and some universal attributes. from their emic or local knowledge and experiences
2. The worldview consists of multiple social structure and later contrasting them with the etic (outsider)
factors (e.g., religion, economics, cultural values, beliefs and practices. Her book, Qualitative Research
ethnohistory, environmental context, language, Methods in Nursing (Leininger, 1985a) and related pub-
and generic and professional care), which are criti- lications (Leininger, 1990b, 1995c, 2002c; Leininger &
cal influencers of cultural care patterns to predict McFarland, 2006) provide substantive knowledge about
health, well-being, illness, healing, and ways people qualitative methods in nursing.
face disabilities and death. Leininger is skilled in using ethnonursing, ethnog-
3. Generic emic (folk) and professional etic care in raphy, life histories, life stories, photography, and
different environmental contexts can greatly influ- phenomenological methods that provide a holistic
ence health and illness outcomes. approach to study cultural behavior in diverse envi-
4. From an analysis of the previously listed influencers, ronmental contexts. With these qualitative methods,
three major actions and decision guides were pre- the researcher moves with people in their daily living
dicted to provide ways to give culturally congruent, activities to grasp their world. The nurse researcher
safe, and meaningful health care to cultures. The inductively obtains data of documented descriptive
three culturally based action and decision modes and interpretative accounts from informants through
were the following: (1) Culture Care preservation observation and participation explicating care as a
or maintenance, (2) Culture Care accommodation major challenge within the method. The qualitative
or negotiation, and (3) Culture Care repatterning or approach is used to develop basic and substantive
restructuring. Decision and action modes based on grounded data-based knowledge about cultural care
culture care were predicted as key factors to arrive at to guide nurses in their work. Although other meth-
congruent, safe, and meaningful care. ods of research such as hypothesis testing and experi-
Leininger has maintained that documentation mental quantitative methods can be used to study
of these tenets was necessary in order to provide transcultural care, the method of choice depends
meaningful and satisfying care to people, and they are upon the researcher’s purposes, the goals of the study,
predicted to be powerful influencers on culturally and the phenomena to be studied. Creativity and
based care. These factors needed to be discovered experience of the nurse researcher to use different
directly from the informants as influencing factors research methods to discover nursing knowledge are
related to health, well-being, illness, and death. The encouraged. However, Leininger holds that qualita-
modes set forth in the four tenets are Culture Care tive methods are important to establish meanings and
preservation or maintenance; Culture Care accom- accurate cultural knowledge.
modation and negotiation; and Culture Care repat- Leininger developed the Sunrise Enabler (Figure
terning or restructuring. The researcher draws upon 22–1) in the 1970s to depict the essential components
findings from the social structure, generic and profes- of the theory. She has refined the sunrise, and thus the
sional practices, and other influencing factors while evolved enabler is more definitive and valuable to