Transcultural Nursing Theory by Madeleine Leininger

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Within the rapid growth of modern society, the health care industry keeps serving as the critical element of its members and system in general. Hence, its innovative approaches to public health should be focused on “recognizing and embracing cultural diversity as if of utmost importance to all healthcare providers today” (Busher Betancourt, 2016, p.1). However, such an approach is vital in the nurse’s scope of care. As a rule, the education of the nursing students barely addresses the importance of perceiving and understanding different cultures, although they inevitably engage with patients from all backgrounds in everyday nursing practice. With that said, Madeleine Leininger’s theory appears to be a useful contribution to nursing education and has provided new insight into the clinical setting.

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An Overview of the Nursing Theory

The Transcultural Nursing Theory (TNT) or Culture Care Theory (CCT) is a concept of cultural values and beliefs within a nursing field founded by Madeleine Leininger. According to Ayiera (2016), the CCT is based upon the clinical experience considering that the aspect of culture was a missing link in the nursing care practice. The core principle of the theory implies understanding and acceptance of everybody’s background since it might be a determining factor in one’s health status. Hence, cultural competence is a crucial concept to pursue in the nursing practice to provide patients with improved and satisfactory health care. Leininger’s theory developed into a nursing discipline as a fundamental approach to nursing practice and a better understanding of health care delivery.

Model’s Efficacy in Nursing Practice

The Transcultural Nursing Theory pursues “discovering, documenting, knowing, and explaining the interdependence of care and culture phenomena with differences and similarities between and among cultures” (Kasper & Zoucha, 2019, p. 3). The CCT’s goal is to provide culturally congruent care that contributes to the health and well-being of people or to help them address disabilities, dying, or death with the aid of three modes of culture care decisions and actions. The efficiency of Leininger’s theory lies in its purpose to “better define the expectations of the nurse-patient relationship” (Busher Betancourt, 2016, p. 2). The nurse is the one responsible for providing care and engaging with a patient for the majority of his or her time receiving care. As nurses immerse themselves in cultural education and adopt care that addresses patient’s cultural expectations, they implement a culturally congruent nursing process. The TNT is effective in transforming the caregivers’ practice that was previously less concentrated on patient diversity.

Application of the TNT in Practice

By analyzing the transcultural theory by Madeleine Leininger, a nurse practitioner will attain culturally-specific knowledge, which will result in improved patient treatment with a sense of open-mindedness. Within hectic nursing everyday work, many situations might pose cultural challenges to the nurse. Therefore, it is essential to consider the fundamental role of communication and accommodation to gain insight from the patient on his cultural background. Eventually, a nurse will be able to appreciate diverse cultures and apply past experiences to future patient care. With that said, by providing culturally congruent care that is respectful towards various cultural beliefs, values, and practices, one might obtain the moral and ethical responsibility in terms of professional care.

The Four Metaparadigm Concepts and the CCT

The Transcultural Nursing Theory, or CCT, aims at obtaining a comprehensive knowledge of the care issue that concerns the cultural expectations of the patients. Such an approach examines a nursing practice within the notions of health, well-being, disabilities, and dying. Compared to other fellow theorists of the 1950s and 1960s, Leininger’s theory and methodology are focused on the qualitative paradigm. Furthermore, McFarland & Wehbe-Alamah (2015) state that it was used to “tease out largely unknown data about culture care” (p. 19). Therefore, the theory development is based upon the four metaparadigm concepts of person, environment, health, and nursing in order to explain nursing.

Leininger’s Concern with the Metaparadigm Concept

The four metaparadigm concepts were negatively viewed by nursing theorist while developing the transcultural theory. With regard to the critical concerns about the metaparadigm concept, Leininger’s approach is based on the modified perception of the nursing discipline that is primarily focused on care and culture. As defined by a theorist herself, nursing is a “learned humanistic and scientific profession which is focused on human care phenomena and activities” (McFarland & Wehbe-Alamah, 2015, p. 20). Nursing means to “assist, support, or enable individuals or groups to maintain or regain their well-being in culturally meaningful and beneficial ways or to help people face handicaps or death” (McFarland & Wehbe-Alamah, 2015, p. 20). As such, the CCT highlights care and culture as they were the missing phenomena in the metaparadigm concept.

The Conceptual Model of the CCT

The conceptual models determine the perspective and produce evidence on the phenomenon on the specific issue. The nursing conceptual models deal with extensive metaparadigm concepts of human beings, health, nursing, and environment. As mentioned above, the basic nursing conceptual model is incomplete for defining nursing. As a result, two significant concepts of care and culture were included as the essence and the central dominant of nursing. A conceptual map for generating nursing knowledge about teaching culture care using the CCT can be applied to nurse educators in various contexts. The map highlights the core aspects with the use of the CCT model situated within the constructivist qualitative paradigm, as well as the ethno-nursing research.

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By conceptualizing the theory, one might define a basic theoretical tenet, which is described by Alligood (2018) as “care diversities and universalities” that co-exist among cultures (p. 347). The second theoretical tenet implies worldviews and social structure factors. These include religion, economics, education, technology, politics, kinship, ethnohistory, environment, language, and generic care and professional care factors that impact the culture care meanings, expressions, and patterns in different cultures. Therefore, a theory is based on findings from the social structure, generic care, professional practices, and other aspects that promote culturally based care for patients. They should be thoroughly examined, assessed, and implemented in the dynamic nurse-client interrelation.

Evidence-Based Examples of the CCT

Leininger’s theory was used as a framework for designing teaching modules that enable a transcultural education to healthcare providers, as well as staff personnel. Furthermore, it contributed to the project on increasing the medical personnel knowledge about cultures the health industry usually faces. The CCT maintained a systematic approach for the implementation of culturally congruent care with the use of social structure dimensions and modes of care action and decision that is demonstrated in the Sunrise Enabler. Moreover, the John Hopkins Nursing Evidence-Based Practice Model (JHNEBP) is the practical model for applying evidence-based research into clinical practice (McFarland, & Wehbe-Alamah, 2015). Ultimately, the combination of the CCT and the JHNEBP, together with a didactic module, connected several elements that contributed to the development of a pilot program for cultural assessment and staff education, as the core of the cultural competence. There is also a number of transcultural models and guides that were impacted by the Leininger’s CCT.


The Transcultural Nursing Theory addresses both general practice and specialty and aims at providing culturally coherent nursing care. This can be achieved when both the nurse and the patient creatively invent a new care lifestyle for the well-being and health of the patient. It was the first theory directed toward discovering and applying culturally based research care knowledge in nursing that was gathered through cultural informants. The CCT has a worldwide implementation and value since it influenced the development of other modified disciplines. The following analysis of the theory, its conceptual model, incorporation with the four metaparadigm concepts, and the evidence-based examples facilitate a better understanding of the CCT and, hence, its successful implementation in the nursing practice.


Alligood, M. (2018). Nursing theorists and their work (9th ed.). St. Louis, MO: Elsevier.

Ayiera, F. (2016). Essential features of the transcultural nursing theory by Madeleine Leininger. Norderstedt, Germany: GRIN Verlag.

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Busher Betancourt, D. (2016). Madeleine Leininger and the transcultural theory of nursing. The Downtown Review, 2(1), 1-7.

Kasper, C., & Zoucha, R. (2019). Annual review of nursing research, Volume 37: Transcultural and social research. New York, NY: Springer Publishing Company.

McFarland, M., & Wehbe-Alamah, H. (2015). Leininger’s culture care diversity and universality: A worldwide nursing theory (3rd ed.). Burlington, MA: Jones & Bartlett Publishers.

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NursingBird. "Transcultural Nursing Theory by Madeleine Leininger." July 16, 2022.