MADELEINE LEININGER’S

CULTURE CARE DIVERSITY AND UNIVERSALITY

Madeleine Leininger: Transcultural Nursing Theory. (2019, September 11). [Illustration]. Nurses Labs.
https://nurseslabs.com/wp-content/uploads/2014/08/Leininger-Sunrise-Model.png
 A Conceptual Model of Nursing developed by Madeleine M. Leininger to depict the
components of the Culture Care Diversity and Universality theory of nursing, named from the
form of its graphic appearance.
Each culture has a world view and cultural and social structure, which are learned
through language and environment contexts. These contexts include technological factors,
religious and philosophical factors, kinship and social factors, cultural values and beliefs,
political and legal factors, educational factors and economic factors. All of these language and
environmental contexts influence the care and health patterns and expressions of individuals,
families, groups, and institutions; all of the latter participate in diverse health systems, which
include both folk and professional systems. The nursing subsystem spans both the folk system
and the professional system. To provide culture-congruent care, nurses use knowledge gained
through analysis of the components of the model to make nursing care decisions based on
cultural care preservation/maintenance (deliverative-
assistive or facilitative decisions that include methods of preserving or maintaining lifeways or v
alues beneficial to the client), cultural care accommodation/negotiation (cognitiveassistive decisi
ons that take into account the cultural beliefs, values, and practices of the client), or cultural care 
repatterning/restructuring (assistive or facilitative decisions that combine several different aspect
s of the client's culture in a way that is beneficial or meaningful to the client).

MARGARET NEWMAN’S
HEALTH AS EXPANDING CONSCIOUSNESS
FIGURE 23-1  Nurse and patient coming together and moving apart in process recognition, insight, and
transformation. (From Newman, M. A. [2008]. Transforming presence: The difference that nursing makes.
Philadelphia: F. A. Davis.)
 Newman emphasizes the primacy of relationships as a focus of nursing, both nurse-client
relationships and relationships within clients’ lives (Newman, 2008). During dialectic nurse-
client relationships, clients get in touch with the meaning of their lives through identification of
meanings in the process of their evolving patterns of relating (Newman, 2008). “The emphasis of
this process is on knowing/caring through pattern recognition” (Newman, 2008, p. 10). Insight
into these patterns provides clients with illumination of action possibilities, which then opens the
way for transformation (Newman, 1990a).
Nurses facilitate pattern recognition in clients by forming relationships with them at
critical points in their lives and connecting with them in an authentic way. The nurse-client
relationship is characterized by “a rhythmic coming together and moving apart as clients
encounter disruption of their organized, predictable state” (Newman, 1999, p. 228). She states
that the nurse will continue to connect with clients as they move through periods of
disorganization and unpredictability to arrive at a higher, organized state (Newman, 1999). The
nurse comes together with clients at these critical choice points in their lives and participates
with them in the process of expanding consciousness. The relationship is one of rhythmicity and
timing, with the nurse letting go of the need to direct the relationship or fix things. As the nurse
relinquishes the need to manipulate or control, there is greater ability to enter into this
fluctuating, rhythmic partnership with the client (Newman, 1999). Newman has diagrammed this
nurse-client interaction of coming together and moving apart through the processes of
recognition, insight, and transformation. Nurses are seen as partners in the process of expanding
consciousness, and are transformed and have their lives enhanced in the dialogical process
(Newman, 2008). As facilitator, the nurse helps an individual, family, or community to focus on
patterns of relating (M. Newman, personal communication, 2004). Thus, the nursing process is
one of pattern recognition.
FIGURE 23-2  Parallel between Newman’s theory of expanding consciousness and Young’s stages of human
evolution. (From Newman, M. A. [1990]. Newman’s theory of health as praxis. Nursing Science Quarterly, 3[1],
37–41.)

As the theory evolved, Newman developed a synthesis of the pattern of movement, space,
time, and consciousness (M. Newman, personal communication, 2004, 2008). Time was not
merely conceptualized as subjective or objective, but was also viewed in a holographic sense (M.
Newman, personal communication, 2000). According to Newman (1994), “Each moment has an
explicate order and also enfolds all others, meaning that each moment of our lives contains
all others of all time” (p. 62).

Space, time, and movement later became linked with Newman’s (1986) assertion that the
intersection of movement-space-time represented the person as a center of consciousness.
Further, this varied from person to person, place to place, and time to time. Newman (1986) also
emphasized that the crucial task of nursing is to be able to see the concepts of movement-space-
time in relation to each other, and consider them all at once, recognizing patterns of evolving
consciousness.
In Health as Expanding Consciousness (Newman, 1986, 1994), Newman’s theory
encompassed the work of Young’s spectrum of consciousness (Young, 1976). She saw Young’s
central theme as one in which self and universe were of the same nature. This essential nature
could not be defined but was characterized by complete freedom and unrestricted choice at both
the beginning and the end of life’s trajectory (Newman, 1986).
Newman established a corollary between her model of health as expanding consciousness and
Young’s conception of the evolution of human beings. She explained that individuals came into
being from a state of consciousness, and that they were bound in time, found their identity in
space, and, through movement, learned the “law” of the way that things worked; they then made
choices that ultimately took them beyond space and time to a state of absolute consciousness
(Newman, 1994).
REFERENCES

sunrise model. (n.d.) Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and

Allied Health, Seventh Edition. (2003). Retrieved November 21 2020 from https://medical-
dictionary.thefreedictionary.com/sunrise+model
Brown, J.W., & Alligood, M.R. (2004). Realizing Wrongness: Stories of older wife caregivers.
Journal of Applied Gerontology, 23(2), 104-119