Erickson, H.C., Tomlin, E.M., & Swain, M.A.P. (1983).

Modeling and role modeling: A theory and paradigm for nursing. Englewood Cliffs, NJ: Prentice Hall. MADELEINE LEININGER'S THEORY DIVERSITY AND UNIVERSALITY OF CULTURE CARE

A grand theory focusing on the discovery of human care diversities and universalities and ways to provide culturally congruent care to people. The concepts of the theory are:

1.

Care abstract and concrete phenomena related to assisting, supporting, or enabling experiences or behaviors toward or for others with evident or anticipated needs to ameliorate or improve a human condition or lifeway.

2.

Caring the actions and activities directed toward assisting, supporting, or enabling another individual or group with evident or anticipated needs to ameliorate or improve a human condition or lifeway or to face death.

3.

Culture the learned, shared, and transmitted values, beliefs, norms, and lifeways of a particular group that guide thinking, decisions, and actions in patterned ways; encompasses several cultural and social structure dimensions: technological factors, religious and philosophical factors, kinship and social factors, political and legal factors, economic factors, educational factors, and cultural values and lifeways.

4.

Language word usages, symbols, and meanings about care.

5.

Ethnohistory past facts, events, instances, experiences of individuals, groups, cultures, and institutions that are primarily people centered (ethno) and that describe, explain, and interpret human lifeways within particular cultural contexts and over short or long periods of time.

6.

Environmental context the totality of an event, situation, or particular experiences that give meaning to human expressions, interpretations, and social interactions in particular physical, ecological, sociopolitical, and/or cultural settings.

7.

Health a state of well-being that is culturally defined, valued, and practiced, and which reflects the ability of individuals (or groups) to perform their daily role activities in culturally expressed, beneficial, and patterned lifeways.

8.

Worldview the way people tend to look out on the world or their universe to form a picture of or a value stance about their life or the world around them.

9.

Cultural care the subjectively and objectively transmitted values, beliefs, and patterned lifeways that assist, support, or enable another individual or group to maintain well-being and health, to improve his or her human condition and lifeway, to deal with illness, handicaps, or death. The two dimensions are: Cultural care diversitythe variabilities and/or differences in meanings, patterns, values, lifeways, or symbols of care within or between collectivities that are related to assistive, supportive, or enabling human care expressions. Cultural care universalitythe common, similar, or dominant uniform care meanings, patterns, values, lifeways, or symbols that are manifest among many cultures and reflect assistive, supportive, facilitative, or enabling ways to help people.

10. Care systems

the values, norms, and structural features of an organization designed for serving people's health needs, concerns, or conditions. The two types of care systems are: Generic (emic) lay care systemtraditional or local indigenous health care or cure practices that have special meanings and uses to heal or assist people, which are generally offered in familiar home or community environmental contexts with their local practitioners. Professional (etic) health care systemprofessional care or cure services offered by diverse health personnel who have been prepared through formal professional programs of study in special educational institutions.

11. Culturally congruent care

culturally based care knowledge, acts, and decisions used in sensitive and knowledgeable ways to appropriately and meaningfully fit the cultural values, beliefs, and lifeways of clients for their health and well being, or to prevent illness, disabilities, or death. The three modes of culturally congruent care are: Culture care preservation and/or maintenance refers to assistive, supportive, facilitative, or enabling professional acts or decisions that help cultures to retain, preserve, or maintain beneficial care beliefs and values or to face handicaps and death.

Culture care accommodation and/or negotiation refers to assistive, accommodating, facilitative, or enabling creative provider care actions or decisions that help cultures to adapt to or negotiate with others for culturally congruent, safe, and effective care for their health, well being, or to deal with illness or dying. Culture care repatterning and/or restructuring supportive, facilitative, or enabling professional decisions that would help people to reorder, restructure their life ways and institutions for better care patterns, practices, or outcomes. refers to assistive, actions and mutual change, modify, or (or beneficial) health

12. Cultural and social structure factors

Factors that influence expressions and meanings of care, including gender and class differences in religion or spirituality, kinship or social ties, politics, legal issues, education, economics, technology, philosophy of life, and cultural beliefs and values.

Nursing practice is directed toward improving and providing culturally congruent care to people. A practice methodology for the Theory of Culture Care Diversity and Universality is as follows: Goals of Nursing Practice are: to improve and to provide culturally congruent care to people that is beneficial, will fit with, and be useful to the client, family, or culture group healthy lifeways; to provide culturally congruent nursing care in order to improve or offer a different kind of nursing care service to people of diverse or similar cultures. Clients include individuals, communities, and institutions. families, subcultures, groups,

Culturalogical Assessment The nurse maintains a holistic or total view of the client's world by using the Sunrise Model and Enablers to guide assessment of cultural beliefs, values, and lifeways. The nurse is aware that the client may belong to a subculture or special group that maintains its own values and beliefs that differ from the values and beliefs of the dominant culture. The nurse shows a genuine interest in the client and learns from and maintains respect for the client. The nurse asks open-ended questions and maintains the role of an active listener, learner, and reflector. The nurse shares professional knowledge only if the client asks about such knowledge. he nurse begins the assessment with such questions as: What would you like to share with me today about your experiences or beliefs, to help you keep well? Are there some special ideas or ways you would like nurses to care for you? The nurse gives attention to clients' gender differences, communication modes, special language terms, interpersonal relationships, and use of space and foods.

Nursing Judgments, Decisions, and Actions Nursing practice requires the coparticipation of nurses and clients working together to identify, plan, implement, and evaluate the appropriate mode(s) of culturally congruent care. Nursing decisions and actions encompass assisting, accommodating, supporting, facilitating, and enabling. Nurse and client select one or more mode of culturally congruent care. Culture Care Preservation and/or Maintenanceused when professional decisions and actions are needed to help clients of a designated culture to retain, preserve, or maintain care beliefs Culture Care Accommodation and/or Negotiationused when professional decisions and actions are needed to help clients of a designated culture adapt to or negotiate with others for care. Culture Care Repatterning and/or Restructuringused when professional decisions and actions are needed to help clients of a designated culture to reorder, change, modify, or restructure their life ways and institutions. Clinical Protocols Specific nursing practices or clinical protocols are derived from the findings of research guided by the Theory of Culture Care Diversity and Universality. The research findings are used to develop protocols for cultural-congruent care that blends with the particular cultural values, beliefs, and lifeways of the client, and is assessed to be beneficial, satisfying, and meaningful to the client. Professional nursing care, learned in formal educational programs, builds upon the generic care given by naturalistic lay and folk care givers. The curriculum emphasizes transcultural nursing knowledge, with formal study about different cultures in the world, as well as culture-universal and culture-specific health care needs of people and nursing care practices. Transcultural nurse generalists are prepared at the baccalaureate level for the general use of transcultural nursing concepts, principles, and practices. Transcultural nurse specialists, who are prepared at the doctoral level, have in-depth understanding of a few cultures and can function as field practitioners, teachers, researchers, or consultants. Certification is awarded by the Transcultural Nursing Society to nurses who have educational preparation in transcultural nursing or the equivalent and who demonstrate basic clinical competence in transcultural nursing. Leininger, M.M., & McFarland, M.R. (2006). Culture care diversity and universality: A worldwide nursing theory (2nd ed.). Boston: Jones and Bartlett.