Where it came from
The culture care theory (formally, the theory of culture care diversity and universality) was developed by Madeleine Leininger (1925–2012), a nurse and anthropologist. In the mid-1950s, working as a psychiatric nurse at a child guidance home in Cincinnati, she was struck by how differently children from various cultural backgrounds ate, played, slept, and accepted help. Nothing in her nursing education had prepared her for those differences—a gap she called cultural ignorance.
To close it, Leininger studied anthropology at the University of Washington, earning her PhD in 1965 after fieldwork among the Gadsup people of the Eastern Highlands of New Guinea—she's often cited as the first professional nurse with a doctorate in anthropology. She founded the Transcultural Nursing Society in 1974, launched the Journal of Transcultural Nursing in 1989, and brought the theory together in Culture Care Diversity and Universality: A Theory of Nursing (1991).
Diversity and universality
Like Watson, Leininger saw caring as the essence of nursing, but she stressed that caring gets its meaning from culture. Some care values and practices differ from culture to culture (diversity); others are shared across humanity (universality). The wider the gap between generic, or emic, care that people learn within their culture and the professional, or etic, care that health systems provide, the more conflict, dissatisfaction, and nonadherence follow. That's why nurses need to understand how worldview, religion and philosophy, kinship and social ties, cultural values and lifeways, politics and law, economics, education, and technology shape care.
The Sunrise Enabler (often called the Sunrise model) lays those factors out like a rising sun. It starts with cultural and social structure at the top, moves through individuals, families, and groups and the folk and professional systems, and ends with nursing decisions at the bottom—serving both as an assessment map and as the guide to her research method, ethnonursing.
Three modes of nursing action
To deliver culturally congruent care, Leininger proposed three kinds of decisions: culture care preservation/maintenance (keep practices that support health), accommodation/negotiation (find common ground between cultural and professional care), and repatterning/restructuring (work with the patient to change harmful practices). A new mother who follows postpartum customs of avoiding cold water and cold foods can usually keep them; scheduling medication around a religious fast is accommodation; replacing a folk remedy that carries infection risk is repatterning.
Why it matters now
With growing immigrant and multilingual patient populations, cultural competence is a baseline skill. Interpreter services, attention to diet and faith, and respect for family-centered decision-making all trace back to Leininger. Walking through the Sunrise factors one by one when planning care for a patient from another culture helps keep important pieces from slipping through the cracks.
Strengths and limitations
Leininger brought culture into nursing systematically for the first time, reshaped nursing education and research worldwide, and left a distinctive qualitative method in ethnonursing. Critics note that the Sunrise model is sprawling and hard to use quickly at the bedside, and that treating culture as fixed categories can reinforce stereotypes. Individual variation within any culture is always large.
See also
Nursing theory · Watson's theory of human caring · Nightingale's environmental theory · Peplau's interpersonal relations theory
FAQ
- Is culture care theory the same as transcultural nursing?
- Transcultural nursing is the field Leininger founded; culture care theory is its central theory.
- What do emic and etic mean?
- Emic is the insider's view—how people within a culture understand care. Etic is the outsider's or professional view.
Sources reviewed: 2026-10-26
References
- Leininger, M. M. (Ed.). (1991). Culture Care Diversity and Universality: A Theory of Nursing. New York: National League for Nursing Press.
- Leininger, M. M. (1978). Transcultural Nursing: Concepts, Theories, and Practices. New York: Wiley.
- McFarland, M. R., & Wehbe-Alamah, H. B. (2018). Leininger's Transcultural Nursing: Concepts, Theories, Research, and Practice (4th ed.). New York: McGraw-Hill Education.
- Alligood, M. R. (Ed.). (2021). Nursing Theorists and Their Work (10th ed.). Elsevier.