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With any theory the theorist formulates assumptions to guide the research as a basis for the theory and draws upon the theorist's conceptual and philosophical perspectives. The theoretical assumptive premises of the theory of Culture Care Diversity and Universality Theory areas follows:
As we approach the twenty-first century, nurses will need to be prepared in transcultural nursing with substantive knowledge and skills to function in a multicultural world. Nurses will be expected to understand the purpose, knowledge domains, essential skills, and the historical evolution of transcultural nursing which is an area of formal study and practice in nursing focused on comparative holistic cultural care, health, and illness patterns of individuals and groups with respect to differences and similarities in cultural values, beliefs, and practices. The goal of transcultural nursing is to provide culturally congruent, sensitive, and competent nursing care to people of diverse cultures.
Components of the theory of Culture Care Diversity and Universality and the Sunrise Model have been under development since the 1940s. As early as 1969. Leininger published an article entitled Ethnoscience: A Promising Research Approach to Improve Nursing Practice (Image. 1969). There are many versions of Leininger's model. although few publications were available on the theory of cultural care until a major article was published in Nursing and Health Care in 1985. Leininger underwent rigorous preparatory work in concept analysis and model development before publishing and continues to research. publish, and seek publications internationally for the Journal of Transcultural Nursing (Summer 1989, Vol. 1 No. 1).
Development of the concepts of care and caring was a necessary first step in the evolution of Leininger's theory. A unique feature in developing the Culture Care Theory was the use of an inductive research method called ethnonursing to define and discover culture care. The theory was developed from the qualitative paradigm or perspective in order to elicit the meanings, understanding, characteristics and attributes of culture care from culturally diverse populations. This is a markedly different approach from the traditional quantitative paradigm in which researchers focus on testing predetermined hypotheses and specific variables that are primarily the interest of the researcher. With the qualitative paradigm, the researcher uses orientational rather than operational definitions. Orientational definitions tend to facilitate a discovery method to uncover phenomena or a broad domain of inquiry and may change according to what the researcher discovers.
As early as 1970, Leininger identified the words care and caring in a major publication as important nursing elements. Care refers to 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. Caring is defined as 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. The other major orientational definitions for Leininger's theory are defined below.
In 1991, Leininger defined the following terms to serve as guideposts to discover phenomena bearing upon culture care.
Leininger needed an inductive theory to research her conceptual framework and thus defined theory as patterns or sets of interrelated concepts, constructs, expressions, meanings, and experiences that describe, explain, predict and account for some phenomena or domain of inquiry through an open creative, and naturalistic discovery process (Leininger, 1991). This definition would facilitate studying culture care using a naturalistic discovery process and lead to in-depth descriptions, as well as ways to understand explain, interpret, and even predict nursing phenomena through patterns and themes.
According to Leininger, the purpose of culture care theory is to discover, through open naturalistic inquiry culture care diversities and universality in order to generate nursing knowledge for the discipline and profession of nursing. The goal of the theory is to provide culturally congruent nursing care that is tailored to fit the client's cultural values, beliefs, and lifeways. Leininger theorized that if nursing care was not culturally congruent, a host of conflicts and problems would occur that would delay recovery, prevent wellness, or could even lead to unexpected death.
Leininger theorized about differences between generic and profession caring. She conceptualized that there were two kind of caring that existed in every culture mat needed to be discovered and identified for their comparative uses in nursing. Generic care is seen as the prototype of care which includes local home remedies and folk care. On the other hand, professional care was conceptualized to be different from generic care in that it was defined as cognitively learned, practiced, and transmitted knowledge learned through formal and informal professional education nursing schools.
In theorizing about generic and professional care. Leininger predicted that generic care i.e.; naturalistic, local, spiritual, alternative, folk, and familiar home care practices differ considerably from professional care. If professional and generic care practices did not reasonably fit together, this would influence client recover}, health, and well-being. The goal is to link and synthesize generic and professional care knowledge to benefit the patient. Leininger proposed that world view social structure, language, ethnohistory and environmental context as previously defined would greatly influence both generic and professional care beliefs and practices. Knowledge of generic and professional care of individuals, families, groups, institutions, and communities was essential to provide professional nursing care. In general, she maintained that with the theory of culture care there would be some similarities (commonalties or universities) along with the differences (diversities) among cultures with regard to culture care meanings, patterns, expressions, functions (uses), structural features, and practices. These similarities and differences needed to be made known in order to arrive at a holistic perspective of human care with specific cultures.
Leininger also postulated that specific care expressions or patterns such as presence, respect, support enabling, compassion, and other care constructs could be powerful factors for the nurse to use to help people remain healthy. She predicted that if caring meanings and patterns were known and used in nursing, health ways would prevail: if non-caring expressions existed, one would find unfavorable, unhealthy care practices. These culture care constructs were seen to be the essence of what nursing is or should be and are meant to help nurses provide meaningful nursing care. Gradually, care constructs across cultures are being discovered and understood to guide professional nursing education care practices.
Leininger's Sunrise Model symbolizes the rising of the sun (care). The model depicts a full sun with four levels of foci. Within the circle in the upper portion of the model are components of the social structure and world view factors such as: religion, kinship, economics, technology, cultural values, language, ethnohistory and environmental factors that are predicted to explain and influence care expressions, patterns, and practices leading to holistic health and well being. In the lower half of the model, individuals, families, groups, communities, and institutions in diverse health systems such as; generic or folk systems, and professional systems are depicted as influencing nursing care decisions and actions. Culturally congruent nursing care is depicted as the result of:
Also included in the model are levels of abstraction and analysis from which care can be studied at each level. Various cultural phenomena are studied from the micro middle, and macro perspectives leading to culturally appropriate nursing decisions. Leininger's model has served as the prototype for the development of other culturally specific nursing models and tools.