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# Madeleine Leininger's transcultural nursing and culturally congruent care

- Fundamental

Leininger taught that care must fit the person's culture: the nurse learns their values and practices and decides with them what to keep or change.

Updated Nov 12, 2026

## Key points

- Culture care is universal, but its forms are diverse.
- Goal: culturally congruent care that fits the person's values and lifeways.
- Sunrise Model: a map of the cultural and social factors that shape care.
- Three modes of nursing decisions: preserve or maintain, accommodate or negotiate, repattern or restructure.
- Emic = the insider's view of a culture; etic = the outsider's view.

## What it is

Madeleine Leininger, a US nurse who also trained in anthropology, founded transcultural nursing in the 1960s. Her theory of culture care diversity and universality holds that care exists in every culture (universality) but takes different forms in each (diversity). The aim is culturally congruent care: care that fits the person's values, beliefs and ways of life. To assess, she proposed the Sunrise Model, which maps the factors that shape care: worldview, religion and philosophy, kinship and social ties, cultural values and lifeways, politics and law, economics, education and technology. She studied cultures from the insider's view (emic) and the outsider's view (etic).

## Key points

- Preserve or maintain: support practices that are helpful or harmless (a prayer, a family member at the bedside).
- Accommodate or negotiate: adapt care to fit a practice (timing of meals around a religious fast, with safety checks).
- Repattern or restructure: help the person change a practice that harms health, with respect and explanation.
- Sunrise factors include technology, religion and philosophy, kinship and social ties, values and lifeways, politics and law, economics and education.
- It moves beyond the nurse–patient pair to families, communities and institutions.

## What it is for

- Strength: the theory most clearly reaches context at family, community and institutional levels.
- Strength: its graphic model is easy to use in assessment.
- Limit: critics say it rests on Eurocentric ideas of health and illness.
- Limit: it risks treating cultures as static and assuming all members of a group respond the same way.

## Step by step

- Ask the person and family how they understand the illness and how they usually care for it — this is the emic view.
- Explore the Sunrise factors that matter: beliefs, family, work, money, schooling, home remedies — so the context is known.
- Sort each practice: helpful, harmless or harmful — this decides the mode of action.
- Decide with the person whether to preserve, accommodate or repattern each practice — decisions are shared.
- Build the plan into their routines and language — care that fits is more likely to be followed.
- Evaluate whether care was acceptable to the person and safe.

## Leininger and the metaparadigm

| Concept | How Leininger sees it |
| --- | --- |
| Person | A cultural being, part of a family and community, with their own values and care practices |
| Environment | The cultural, social and environmental context: worldview, social structure, history and language |
| Health | Wellbeing defined and lived according to each culture |
| Nursing | A transcultural discipline that gives care congruent with the person's culture |

## In nursing practice

- Example: a patient in home palliative care in Bogotá drinks herbal teas and prays for relief. The nurse keeps the prayer (preserve), checks the teas with the team (negotiate) and explains the risk of an unsafe product (repattern).
- A Colombian ethnographic study of home palliative care used Leininger's theory to describe such beliefs and practices.
- In a Colombian public university, Leininger's theory was taught in undergraduate public health nursing.

## Common mistakes

- Assuming that everyone from a region or group shares the same beliefs.
- Dismissing home remedies without asking what they are and why they matter.
- Imposing changes instead of negotiating them with the person and family.
- Leaving culture for a single question on the admission form.

## Test yourself

Think of the answer, then tap the question to see it.

## What is culturally congruent care?

Care that fits the person's cultural values, beliefs and ways of life, which is the goal of Leininger's theory.

## What are Leininger's three modes of nursing decisions and actions?

Preserve or maintain, accommodate or negotiate, and repattern or restructure cultural care practices.

## What is the Sunrise Model used for?

To assess the cultural and social factors that shape a person's care, such as beliefs, family, economics, education and technology.

## What is the difference between the emic and the etic view?

The emic view is the insider's view of a culture; the etic view is the outsider's view.

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## Connections

## Related 1

- [Culturally competent care in practice](https://durgical.com/en/nursing/culturally-competent-care-in-practice/)

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Cultural beliefs-practices of palliative home care patients from Leininger's theory approach](https://pmc.ncbi.nlm.nih.gov/articles/PMC11623961/) (Revista Cuidarte (PubMed Central), 2023); [Breast Ironing from the Perspective of Transcultural Nursing by Madeleine Leininger: A Narrative Review](https://pmc.ncbi.nlm.nih.gov/articles/PMC11678159/) (Nursing Reports (PubMed Central), 2024); [Where and how does fundamental care fit within seminal nursing theories: A narrative review and synthesis of key nursing concepts](https://pmc.ncbi.nlm.nih.gov/articles/PMC7540068/) (Journal of Clinical Nursing (PubMed Central), 2020); [Enseñanza de la salud pública en la formación del pregrado de enfermería en una universidad colombiana](https://www.redalyc.org/journal/5763/576364220013/576364220013.pdf) (Revista de la Facultad de Medicina, Universidad Nacional de Colombia (Redalyc), 2019).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/madeleine-leininger-s-transcultural-nursing-and-culturally-congruent-care/