Reflecting on my working years as a staff nurse, it feels as though I have practiced blindly; especially when I think of the adage, theory without practice is meaningless but practice without theory is blind. It was not until I started learning about an abundance of theories and applying them to everyday nursing practice, that was I really begun to understand a nurse’s values, beliefs, thoughts, as well as the health and welfare of patients in my care. Nursing theories and a plethora of other theories can define and enrich nurses everyday practice and afford us the opportunity to be creative in choosing a variety of practice methods and techniques to improve the quality of nursing care and patient outcomes. Theories illuminate the path for nurses and set the foundation for the development of professional practice.

Dr. Madeleine Leininger, founder of the field of transcultural nursing in the mid-1960s, provides a holistic framework which can offer a comprehensive and holistic picture to reflect the totality of knowing people in their lifeways or culture. The purpose of Dr. Leininger’s culture care, diversity, and universality theory is to explain transcultural nursing knowledge and practice. The goal of Dr. Leininger’s theory is to identify ways of providing culturally sensitive nursing care to people from diverse cultures. The foundation of the theory is that cultures exhibit both diversity and universality. Dr. Leininger defined diversity as the perceiving, knowing, and practicing of patient care in differing ways, and universality as commonalities of care. She defines a culture as a group’s values, beliefs, norms, and the life practices which are learned, shared, and handed down from one generation to the next. In this way, cultures guide the thinking, decision making, and actions of specific populations.

The key concepts of Dr. Leininger’s culture care, diversity, and universality theory make for a powerful tool in providing culturally competent care to many populations of patients. This theory places the patient at the focus of practice so that it becomes satisfying to the nurse and patient when the patient receives full attention from the nurse. Dr. Leininger’s culture care theory also provides a reflective aspect which allows the nurse to self- reflect; thus, becoming aware of their own values and the ways in which they may be imposing those values on patients. Dr. Leininger believed that it is critical for nurses to remain culturally competent providers as they are the ones who provide the most direct patient care. As such, nurses must understand how to work effectively within a diverse cultural atmosphere. For example, teenagers are a diverse social group with their own beliefs, values, attitudes, expectations, and behaviors. If the nurse recognizes the adolescent is shy, the nurse will want to take extra steps in establishing a caring relationship.

Understanding that health is created and lived by people within the setting of their everyday lives—where they interact, learn, play, work, socialize, and love, should not be underestimated when planning interventions. The function of nursing is to connect with the patient at a human, one-to-one level. The goal of nurses who are skilled in transcultural nursing should be the belief that it is the human right of every culture to have their beliefs, values, and practices understood and respected by those providing care. Dr. Leininger once stated, to paraphrase, nurses who are not prepared in transcultural nursing will be handicapped especially with the demographic shift of cultural diversity in this country. Furthermore, nursing practice cannot be ethical unless the culture and beliefs of the client are taken into consideration. Potential harmful complications, such as creating misdiagnosis and unnecessary suffering, can result from nurses who are not prepared to provide culturally competent care.

Can you pinpoint a nursing theory or other theories that underpin your nursing practice? Share your comments.


Donnelly, P. L. (2000). Ethics and cross-cultural nursing Journal of Transcultural Nursing 11(2), 119-126. doi: 10.1177/104365960001100206

Leininger, M. M., & McFarland, M. R. (2002). Transcultural nursing, concepts, theories, research and practice. (3 ed.). Omaha, NE: McGraw-Hill Professional.

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