Culture at Discharge and Presence at Midnight: Leininger's Culture Care Theory and Watson's Theory of Human Caring in Two Clinical Cases
Student Name
RN to BSN Program, Aspen University
N491: Concepts and Theories in Nursing
Instructor Name
Month Day, Year
Culture at Discharge and Presence at Midnight: Leininger's Culture Care Theory and Watson's Theory of Human Caring in Two Clinical Cases
Madeleine Leininger and Jean Watson both argued that caring is the essence of nursing, but they approached it from different directions. Leininger asked how care is understood and practiced across cultures and built a theory to guide culturally congruent care. Watson asked what happens between a nurse and a patient in a moment of genuine caring and built a theory around that relationship. This paper applies Leininger's theory to the discharge of a Somali-born man with diabetes shortly before Ramadan and Watson's theory to a woman awake and frightened on the night after a mastectomy. For each case it explains the theory, identifies the factors that shape care, describes how care is developed, and assesses the theory's strengths and limitations.
Leininger's Culture Care Theory
Leininger proposed that care is universal to human beings but that its meanings, expressions, and practices differ across cultures, and that nursing care is most beneficial when it is congruent with the patient's cultural values and lifeways (McFarland & Wehbe-Alamah, 2019). Her Sunrise Enabler directs the nurse to assess cultural and social structure factors, including religion, kinship, economics, education, and cultural values, and to consider how they interact with the professional health care system.
The theory offers three modes of nursing decisions and actions. Culture care preservation or maintenance supports practices that are beneficial; culture care accommodation or negotiation adapts care so that cultural practices and professional care can coexist; and culture care repatterning or restructuring helps a patient change a practice that is harmful, always with the patient's participation (Alligood, 2022). Those three modes turn assessment into a care plan.
Case One: A Discharge Before Ramadan
Mr. A. is a composite patient: a 64-year-old man, born in Somalia and settled in Minnesota two decades ago, with type 2 diabetes. He was admitted for a foot infection that required surgical debridement and intravenous antibiotics, and he is being discharged on a new regimen of basal insulin. Ramadan begins in eight days, and he tells the nurse he plans to fast, as he has every year. His adult daughter, who interprets when needed, is worried but says the decision is his.
Several cultural and social structure factors bear directly on his discharge plan. Religion is central: fasting from dawn to sunset during Ramadan is a pillar of his faith and a source of spiritual meaning and community. Kinship shapes decisions, with his daughter and his imam likely to be consulted. Economic and practical factors matter too, including the timing of meals at the evening meal that breaks the fast and before dawn, and access to follow-up care during the month. A discharge plan that tells him simply not to fast, or that ignores Ramadan altogether, is likely to be set aside.
Developing Culturally Congruent Care for Mr. A.
Using Leininger's three modes, the nurse begins with preservation: acknowledging the importance of fasting and asking what Ramadan means to him rather than treating it as a problem. Accommodation and negotiation come next. International practical guidelines for diabetes and Ramadan classify people with a recent acute illness, including infection needing hospitalization, as very high risk and advise against fasting, while also recognizing that many people fast regardless and recommending individualized plans for them (Hassanein et al., 2017). The nurse shares that assessment honestly, notes that Islamic teaching exempts the sick from fasting, and suggests that he discuss this with his imam and his daughter. The nurse also arranges a visit with the diabetes team before Ramadan.
If Mr. A. decides to fast after that conversation, the plan shifts to negotiation and, where needed, repatterning. The guidelines recommend adjusting basal insulin, typically reducing the dose on fasting days, checking blood glucose frequently, and breaking the fast if glucose falls below 70 mg/dL or rises above 300 mg/dL (Hassanein et al., 2017). The nurse teaches him and his daughter to check glucose during the day, explains that testing does not break the fast, and writes the thresholds in both English and Somali. Foot care teaching is timed around meals, and a follow-up call is scheduled for the first week of Ramadan. Care is congruent when he leaves with a plan he intends to follow and that keeps him safe.
Strengths and Limitations of Leininger's Theory
The theory's great strength is that it gives nurses a structure for cultural assessment and a practical set of decisions, and its focus on the patient's own values helps prevent the discharge plan that is correct on paper and ignored at home. Its research method, ethnonursing, has produced a large body of culture care studies (McFarland & Wehbe-Alamah, 2019). Its limitations are the time a full Sunrise assessment requires on a busy unit and the risk that nurses use cultural knowledge as a checklist of group traits rather than a starting point for asking an individual. Mr. A.'s decision about fasting was his own, and a nurse who assumed it from his background would have been as wrong as one who ignored it.
Watson's Theory of Human Caring
Watson describes caring as the moral ideal of nursing and the transpersonal caring relationship as its core. A caring occasion occurs when a nurse and a patient come together with their unique life histories and create a moment in which both are changed; the nurse attends to the whole person, not only the diagnosis (Watson, 2008). Watson organized practice around ten caritas processes, which include practicing loving-kindness, being authentically present, cultivating sensitivity to self and others, developing a helping and trusting relationship, and allowing the expression of positive and negative feelings.
Interprofessional clinicians at a children's hospital interviewed about human caring described it in the terms of the caritas processes, speaking of loving-kindness toward patients, colleagues, and themselves and of faith and hope in their work (Wei & Watson, 2019). The study suggests that the language of the theory matches how clinicians already experience caring, which supports its use in practice.
Case Two: Midnight After a Mastectomy
Ms. L. is a composite patient: a 45-year-old teacher on the first night after a left mastectomy for breast cancer. At midnight she is awake with her call light on. She says she needs nothing, but she is crying, and she has not looked at her dressing. The nurse has four other patients. The task-focused response would be to check her pain score, offer medication, and move on.
Instead the nurse applies Watson's processes. She sits down at eye level rather than standing at the door, which communicates authentic presence. She names what she sees, that Ms. L. seems upset, and waits, allowing negative feelings to be expressed. Ms. L. says she is afraid to see her body and afraid of telling her daughters. The nurse does not rush to reassure; she asks what would help. They agree that tomorrow, with her husband present, the nurse will help her look at the incision, and that tonight they will focus on rest. The nurse dims the lights, repositions her, gives the ordered analgesic, and returns twenty minutes later as promised. The encounter took about ten minutes, and both people left it changed.
Developing Care From Watson's Theory, and Its Strengths and Limitations
Care developed from Watson's theory is planned around the relationship as well as the tasks. For Ms. L., the plan includes a consistent nurse where possible, a scheduled time to view the incision with support, an offer of a visit from a breast cancer survivor volunteer, and attention to the healing environment of her room. Evaluation asks not only whether pain is controlled but whether she feels able to face the next step.
The theory's strengths are its insistence on the human meaning of illness and its reminder that presence is a nursing intervention. Its limitations are that its concepts are abstract and difficult to measure, which has made outcome research harder than for more concrete theories, and that nurses under heavy workloads may see it as an ideal rather than a practice. The case suggests that the second limitation is partly a matter of framing: a caring occasion does not require an hour, only a nurse willing to stop.
Conclusion
The two cases also show that the theories can work together in a single patient's care. Mr. A. will need presence as much as a culturally negotiated plan when he learns what fasting may cost him, and Ms. L.'s recovery will depend on cultural factors, such as how her family understands cancer and body image, that Leininger's assessment would bring to light. A nurse who carries both frameworks into every encounter is better prepared than one who reaches for a theory only after a problem appears.
Leininger and Watson offer complementary guidance. Leininger's theory helped the nurse see that Mr. A.'s discharge plan had to account for Ramadan and produced a negotiated plan that respected his faith while protecting his safety. Watson's theory helped the nurse see that Ms. L.'s call light was a request for presence and produced a plan built around the relationship. Both theories insist that the patient's meaning, cultural or personal, is part of the clinical picture, and both show that attending to it changes what a good plan of care looks like.
References
Alligood, M. R. (2022). Nursing theorists and their work (10th ed.). Elsevier.
Hassanein, M., Al-Arouj, M., Hamdy, O., Bebakar, W. M. W., Jabbar, A., Al-Madani, A., Hanif, W., Lessan, N., Basit, A., Tayeb, K., Omar, M., Abdallah, K., Al Twaim, A., Buyukbese, M. A., El-Sayed, A. A., & Ben-Nakhi, A. (2017). Diabetes and Ramadan: Practical guidelines. Diabetes Research and Clinical Practice, 126, 303-316. https://doi.org/10.1016/j.diabres.2017.03.003
McFarland, M. R., & Wehbe-Alamah, H. B. (2019). Leininger's theory of culture care diversity and universality: An overview with a historical retrospective and a view toward the future. Journal of Transcultural Nursing, 30(6), 540-557. https://doi.org/10.1177/1043659619867134
Watson, J. (2008). Nursing: The philosophy and science of caring (Rev. ed.). University Press of Colorado.
Wei, H., & Watson, J. (2019). Healthcare interprofessional team members' perspectives on human caring: A directed content analysis study. International Journal of Nursing Sciences, 6(1), 17-23. https://doi.org/10.1016/j.ijnss.2018.12.001
How this N 491 Module 6 example is structured
N491 Module 6 typically asks for an APA paper of about 1,500 to 1,750 words analyzing two case studies, one through Leininger's culture care theory and one through Watson's caring theory, covering cultural factors in discharge planning, why the theories matter, how care is developed and each theory's strengths and limitations, with outside sources plus the textbook. Aspen revises courses, so your classroom's cases and rubric are what count. This example gives each theory the same four-part treatment in parallel, grounds the discharge plan in international diabetes and Ramadan guidelines, shows caring as specific behaviors, and closes by comparing the two cases.
N491 Module 6 questions, answered
What does N491 Module 6 usually ask for?
Commonly an APA paper analyzing two case studies, one with Leininger's culture care theory and one with Watson's transpersonal caring theory, addressing cultural factors in discharge planning, why each theory matters, how care is developed and each theory's strengths and limitations, in about 1,500 to 1,750 words with two outside references plus the textbook.
What are Leininger's three modes of nursing care decisions?
Culture care preservation or maintenance, culture care accommodation or negotiation, and culture care repatterning or restructuring. The sample uses all three in order to build a discharge plan, which is a clear way to show you can apply the theory rather than only define it.
How do I show Watson's theory in a care plan?
Translate the caritas processes into behaviors you can describe: sitting down, naming the feeling, waiting, returning when promised, arranging support. The sample does this in a ten-minute night encounter, which also answers the common criticism that caring theory is too idealistic for a busy unit.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.