Introduction Cultural competency is currently taken for granted in nursing theory and practice. However, cultural competency was not always normative. Madeline Leininger was the first nursing theorist, practitioner, and scholar to distinguish transcultural nursing as a unique means of providing top quality of care. The underlying principle of transcultural nursing, also known as ethnonursing, is applying anthropological and sociological principles to nursing practice. Contemporary nursing practice is culturally competent at its core primarily because the principles of Leininger’s nursing theory have become fully incorporated into education and professional practice.

Leininger: Describing the Theorist

Born in Nebraska, USA, Leininger recognized the importance of caring as a fundamental principle of the profession of nursing (“Madeline Leininger’s Culture Care,” n.d.). Leininger received several collegiate degrees, the first of which was a nursing diploma in 1950 from St. Anthony’s School of Nursing in Denver, during which time she worked in a children’s home and realized the importance of shifting away from the colonial and xenophobic approach towards one based on cultural competency (Busher Betancourt, 2015).

Her initial nurse education was followed by a Bachelor’s of Science from St. Scholastica (Benedictine College) in Kansas in 1954, followed by a Master’s in psychiatric and mental health nursing from Catholic University of America in Washington, D.C. in 1965, finally receiving the PhD in cultural and social anthropology from t he University of Washington in Seattle in 1965 (“Madeline Leininger’s Culture Care,” n.d.). Leininger was the first to put forth the concept of transcultural nursing: the concept of adapting nursing practices to be more culturally relevant.

Classification

Nursing theories are classified from levels of generality or abstraction,...

Metatheories are the most abstract, followed by grand nursing theories, middle range theories, and finally, practice theories that have daily relevance in the day-to-day operations of healthcare workers (McEwen & Wills, 2014). A metatheory is a paradigm, or a “theory about a theory,” (McEwen & Wills, 2014, p. 37). A grand theory is not as comprehensive in scope as a metatheory but is similarly as unspecific. Middle range theories become more specific and have specific relevance for nursing practice, administration, and public policy. Finally, practice theories are situation specific (McEwen & Wills, 2014). The practice theories are those that nurses work with each and every day. Transcultural nursing theory is a grand theory but one that has application to middle range and practice applications in healthcare.
Assumptions and Metaparadigms

The most fundamental assumption of Leininger’s (1988) transcultural nursing theory is that culture is a ‘missing link in nursing knowledge and practice,” as well as being a “wholistic concept” that is fully relevant to evidence-based nursing (Leininger, 1988, p. 152). One of the ways that transcultural nursing theory is fully integrated into nursing practice as a metaparadigm is related to the concepts of health, wellness, illness, and healing. Culture impacts the ways individual people think about what constitutes health, wellness, and illness. Likewise, culture impacts ne’s attitudes towards healthcare, interventions, treatments, and the role of doctors, nurses, and other healthcare workers. As Leininger (1994) herself points out in her extensive writings, transcultural nursing reveals the nuances of emic and etic knowledge, which are in turn linked to “quality of life, health, and well-being,” (p. 22). Etic knowledge is that which is developed by outsiders, or those who may be academic or professional…