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CHAPTER 22 Madeleine M. Leininger 427

study the diverse elements or components of the theory, generally used in quantitative studies. These tools are
and to make culturally congruent clinical assessments. often viewed as unnatural and [are] frightening to cul-
Selected information is offered here to introduce the tural informants” (Leininger, 2002c, p. 89).
reader to Leininger’s creative work of evolving theory 1. The observation participation reflection enabler
and Sunrise Enabler over time. The Sunrise Enabler is used to facilitate the researcher in entering and
symbolizes the rising of the sun (care) (Leininger, remaining with informants in their familiar or natu-
1991b, 1995c; Leininger & McFarland, 2002a, 2006). ral context during the study. The researcher gradu-
The upper half of the circle depicts components of the ally moves from the role of observer and listener,
social structure and worldview factors that influence transitioning to that of participant and reflector
care and health through language, ethnohistory, and with the informants. By moving slowly and politely
environmental context. These factors also influence the with permission, the researcher does not disrupt
folk, professional, and nursing system(s), which are the and therefore is able to observe what is naturally
middle part of the model. The two halves together form occurring in the environment or with the people.
a full sun, which represents the universe that nurses 2. With the stranger to trusted friend enabler, the nurse
must consider to appreciate human care and health researcher is able to learn much about oneself and
(Leininger, 1991b, 1995c; Leininger & McFarland, the people and culture being studied. The goal with
2002a, 2006). According to Leininger, nursing acts as this guide is to become a trusted friend as one moves
a bridge between folk (generic) and the professional from distrusted stranger to trusted friend and differ-
system. Three kinds of nursing care and decisions and ent attitudes, behaviors, and expectations can be
actions are predicted in the theory: Culture Care pres- identified. This process is essential for the researcher
ervation or maintenance, Culture Care accommodation to become trusted such that honest, credible, and
or negotiation, and Culture Care repatterning or in-depth data may be discovered from informants.
restructuring (Leininger, 1991b, 1995c; Leininger & 3. The domain of “inquiry enabler” is a process used by
McFarland, 2002a, 2006). nurse researchers in each study to clearly establish
The Sunrise Enabler depicts human beings as in- the researcher’s interest and area of focus. The
separable from their cultural background and social domain of inquiry is a “succinct tailor made state-
structure, worldview, history, and environmental con- ment focused directly and specifically on Culture
text as a basic tenet of Leininger’s theory (Leininger, Care and health phenomena” (Leininger, 2002c,
1991b, 1995c; Leininger & McFarland, 2002a, 2006). p. 92), stating questions or ideas related to the focus
Gender, race, age, and class are embedded in social of the study, its purpose, and goals.
structure factors and are studied. Biological, emo- 4. The acculturation health assessment enabler is an-
tional, and other dimensions are studied from a holis- other important guide used with the method. It is
tic view and are not fragmented or separate. Theory essential when studying cultures to assess the
generation from this model may occur at multiple extent of the informants’ acculturation as to
levels from the micro range (small-scale specific indi- whether they are more “traditionally or nontradi-
viduals) to study groups, families, communities, or tionally oriented in their values, beliefs, and general
large-scale phenomena (several cultures). Leininger lifeways” (Leininger, 2002c, p. 92). This enabler is
has also developed several enablers to facilitate study- used for both cultural assessments and ethnonurs-
ing phenomena using the four phases of qualitative ing research studies.
data analysis. Most importantly, qualitative criteria
are used to analyze the data; they are credibility, con- Acceptance by the Nursing Community
firmability, meaning-in-context, saturation, repat-
terning, and transferability (Leininger, 1995c, 2002c). Practice
Leininger has developed four other enablers to assist Leininger identifies several factors related to the slow-
nurse researchers in their use of the ethnonursing ness of nurses to recognize and value transcultural
method. “Enablers sharply contrast with mechanistic nursing and cultural factors in nursing practices and
devices such as tools, scales, measurement instru- education (Leininger, 1991b; Leininger & McFarland,
ments, and other impersonal objective distancing tools 2006). First, the theory was conceptualized during the