Theory of Culture Care Diversity and Universality


Nursing is the practice of autonomous and collaborative care for sick or healthy individuals, families, and communities. The roles of nurses range from recording patients’ medical history and symptoms to performing diagnostic tests, administering medication, monitoring patients’ health, and providing support and advice to the patient. When attending to hospitalized children, nurses should respect and protect the family’s dignity while providing excellent care to the child. I, Dr. Madeline Leininger, found out that nurses and specialists do not recognize the critical role of culture in healing, caring, and healthcare treatment practices. Culture and care are essential dimensions that are missing in nursing and healthcare services, and I find this disturbing and a topic worth exploring.

Basis for Development of the Theory

Healthcare practitioners should understand and respond therapeutically to clients from different cultures. The demand for healthcare in hospitals has gradually increased as more people seek professional care, hence the need to understand people’s cultural backgrounds. The gap between culture and care has motivated me to develop a new discipline of transcultural nursing because of the need to integrate care, culture, and health knowledge into nursing. Understanding other people’s cultures increases personal growth and opens up diverse opportunities.

Culture refers to people’s or society’s ideas, customs, and social behavior. In nursing, culture awareness facilitates communication between nurses and patients, and this also helps nurses acknowledge the differences in patients from various cultures (Kaihlanen, 2019). Nurses major in taking care of patient’s needs, so a good relationship between the two is essential. Understanding the patient’s culture helps the nurse bond with the patient and increases the patient’s willingness to adhere to the nurse’s recommendations. As a clinical mental health specialist in a child guidance center, I developed a theory relating culture and care in nursing which led to the birth of the Theory of Culture and Care Diversity and Universality.

History and Development of the Theory

Immigrants increased the population in the US, which increased the demand for health care. During World War II, many immigrants from diverse cultures left their native homes and moved into the United States (Gordon, 2019). While at work, I saw the challenges in caring for children and discovered that limited research had been done about care within specific cultures. I also tried to use psychoanalytic and other mental health ideas to help World War II patients, but the practices were inadequate in helping immigrants from different cultural backgrounds, which increased my interest in pursuing the importance of understanding culture and how to apply it in the nursing profession.

My main aim was to comprehend different cultures and the theories related to caring and culture. Seeing that I had limited knowledge of culture and care, I decided to pursue a Ph.D. in anthropology and became the first professional nurse to hold a Ph.D. in social and cultural anthropology (Alligood, 2022). Pursuing my PhD, I developed the Theory of Culture Care Diversity and Universality, focusing specifically on nursing care and health. My theory was a new way to discover caring ways to help people. I envisioned that knowledge of transcultural care would transform nursing and health care in education and practice worldwide.

Relationship Between Culture and Care

Culture is the broadest, most holistic, most comprehensive, and universal feature of human beings, and care was predicted to be embedded in culture. I find it crucial that both culture and care must be understood for a patient’s needs to be discovered. Cultural care factors are behaviors, attitudes, communication styles, language, and beliefs, and understanding these factors increases the chances of the nurse journeying through the patient’s healthcare plan effortlessly. Health practitioners must also understand the patient’s view on religion, gender roles, and health beliefs. All these factors helped me realize that culture influences people’s beliefs and practices related to illnesses, well-being, and disabilities.

Care in nursing involves being attentive, open, respectful, and treating the patient as a person. Compassion, conscience, and commitment enhance caring in nursing and help the nurse deliver effectively. The patients feel the warmth and openness of the nurse, which increases their confidence in the health care service they are receiving. Envisioning and reconceptualizing care as the essence of nursing from a holistic care perspective is a critical way of understanding people effective communication, trust, and respect are crucial qualities of a nurse (Landis, 2022). I believe that care gives meaning to nursing, healing, well-being, or helping people face disabilities and death.

Caring gives dignity to people and inspires them to get better and help others. It is also quite evident that there can be caring without curing while curing without caring is difficult. Care is explicit, meaningful, powerful, and dynamic, and it helps understand the totality of human behavior within the health context. Integrating care and culture has led to beneficial health outcomes and helped people in diverse cultures to heal, recover, and face death and disabilities. Transcultural care has proved therapeutic and safe for people of diverse and similar cultures.

Research Examining the Theory

The absence of care in nursing demonstrated limited nurses’ interest in studying care as a nursing phenomenon. I, therefore, examined why care and culture were excluded from nursing. Nurses needed to provide care to diverse cultures but could not achieve that due to a lack of a base of cultural care research knowledge. My theory, therefore, aided research in nursing and eased the nursing profession into introducing care and culture as part of nursing phenomena.

The environment also had to be examined as it indicates the geographical location of patients. The environment also regards cultural care and health’s spiritual, social, and technological aspects, giving clues on meanings and patterns of living for groups, families, and individuals. When nurses have environmental insights about their patients, they can understand their living means and extend care to them. Patients get a better experience from nurses who understand their cultural backgrounds.

The Theory in Practice

The Culture Care Theory (CCT) has provided insights into nursing research, practice, and education. The theory has also guided translational research projects introducing culture care into nursing. Bhattacharya et al. (2019) utilized the Theory of Culture Care Universality to expand healthcare providers’ cultural awareness and integrate cultural assessment into the documentation of all clinical encounters. The integration between culture and care was used to guide clinical staff in working together to develop instructional materials, enhancing the delivery of healthcare services and patient satisfaction.

McFarland and Wehbe-Alamah (2019) also used Leininger’s theory in their undergraduate, graduate, and international nursing courses. The nursing faculties are still encouraged to address professional, generic, and cultural care modes in making decisions and to advocate for their inclusion in clinical care planning. Mixer (2020) conducted research that integrated the culture care theory into the context of nursing education. Mixer’s research discovered nursing faculty practices that support teaching students to provide cultural care within their profession.


The Culture Care Diversity and Universality theory has been used widely in practicing nursing and in education. Schools have embedded the theory in the nursing faculty to ensure their students learn the importance of culture and care in nursing practice. Hospitals and other institutions have used the theory to ensure patients get the best care and follow the health practitioner’s recommendations. Areas holding people from diverse cultures can now enjoy proper healthcare procedures as their cultures are considered during treatment.


Alligood, M. R. (2022). Nursing theorists and their work. Elsevier.

Bhattacharya, S., Kumar, R., Sharma, N., & Thiyagarajan, A. (2019). Cultural competence in family practice and Primary Care Setting. Journal of Family Medicine and Primary Care, 8(1), 1. Web.

Gordon, L.W. (2019). Asian immigration since World War II. In Immigration and U.S. Foreign Policy (pp. 169–191). Routledge.

Kaihlanen, A. M., Hietapakka, L., & Heponiemi, T. (2019). Increasing cultural awareness: qualitative study of nurses’ perceptions about cultural competence training. BMC nursing, 18, 38. Web.

Landis, T., Godfrey, N., Barbosa-Leiker, C., Clark, C., Brewington, J. G., Joseph, M. L., Luparell, S., Phillips, B. C., Priddy, K. D., & Weybrew, K. A. (2021). National Study of Nursing Faculty and Administrators’ perceptions of professional identity in nursing. Nurse Educator, 47(1), 13–18. Web.

McFarland, M. R., & Wehbe-Alamah, H. B. (2019). Leininger’s theory of Culture Care Diversity and universality: An overview with a historical retrospective and a view toward the future. Journal of Transcultural Nursing, 30(6), 540–557. Web.

Mixer, S.J., Fornehed, M.L.C. (2020). People of Appalachian Heritage. In: Purnell, L., Fenkl, E. (Eds.) Textbook for Transcultural Health Care: A Population Approach (pp. 217–250). Springer.

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