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Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Theories, Models, and Approaches

Larry Purnell, PhD, RN, FAAN



Cultural Theories, Models, and Cultural Theories, Models, and ApproachesApproaches

Leininger: First nurse cultural theorist from Leininger: First nurse cultural theorist from early 1950s. She states it is for nursing onlyearly 1950s. She states it is for nursing only

Campinha-Bacote: basic simple model without Campinha-Bacote: basic simple model without complex constructs but applicable to all complex constructs but applicable to all healthcare providers. Also has a Biblical based healthcare providers. Also has a Biblical based model.model.




Giger and Davidhizar: Nursing onlyGiger and Davidhizar: Nursing only Purnell: For all health care providers and is an Purnell: For all health care providers and is an

example of a complexity and holographic example of a complexity and holographic conceptual model with an organizing conceptual model with an organizing framework.framework.




Papadopoulous, Tilki, and Taylor Model for Papadopoulous, Tilki, and Taylor Model for Transcultural Nursing and Health Transcultural Nursing and Health

Andrews and Boyle Nursing Assessment Guide Andrews and Boyle Nursing Assessment Guide Spector’s Health Traditions ModelSpector’s Health Traditions Model




Ramsden's Cultural Safety Model Ramsden's Cultural Safety Model Jeffrey’s Teaching Cultural Competence in Jeffrey’s Teaching Cultural Competence in

Nursing and Health Care: Inquiry, Action, and Nursing and Health Care: Inquiry, Action, and InnovationInnovation



Leininger’s Theory of Cultural Care Leininger’s Theory of Cultural Care Diversity and UniversalityDiversity and Universality

www.madeleine-leininger.com

Leininger described the phenomena of cultural care Leininger described the phenomena of cultural care based on her experiences.based on her experiences.Began in the 1950s with her doctoral dissertation Began in the 1950s with her doctoral dissertation conducted in New Guinea conducted in New Guinea www.tcns.org and go to theories and then to the and go to theories and then to the Sunrise Enabler and her model is displayed as well as Sunrise Enabler and her model is displayed as well as publications.publications.



Transcultural NursingTranscultural Nursing "Transcultural nursing has been defined as a formal "Transcultural nursing has been defined as a formal

area of study and practice focused on comparative area of study and practice focused on comparative human-care (caring) differences and similarities of human-care (caring) differences and similarities of the beliefs, values, and patterned lifeways of cultures the beliefs, values, and patterned lifeways of cultures to provide culturally congruent, meaningful, and to provide culturally congruent, meaningful, and beneficial health care to people.“beneficial health care to people.“

Leininger and McFarland text, 3rd ed.,2002, pp5-6.Leininger and McFarland text, 3rd ed.,2002, pp5-6.



Leininger: Purpose and GoalLeininger: Purpose and Goal To discover, document, interpret, explain and predict To discover, document, interpret, explain and predict

multiple factors influencing care from a cultural multiple factors influencing care from a cultural holistic perspective.holistic perspective.

The goal of the theory was to provide culturally The goal of the theory was to provide culturally congruent care that would contribute to the health congruent care that would contribute to the health and well being of people, or to help them face and well being of people, or to help them face disability, dying, or death using the three modes of disability, dying, or death using the three modes of action.action.



Leninger: Theoretical TenetsLeninger: Theoretical Tenets Leininger’s tenets: Care diversities Leininger’s tenets: Care diversities

(differences) and universalities (differences) and universalities (commonalties) existed among cultures in the (commonalties) existed among cultures in the world which needed to be discovered, and world which needed to be discovered, and analyzed for their meaning and uses to analyzed for their meaning and uses to establish a body of transcultural nursing establish a body of transcultural nursing knowledge.knowledge.



Leininger: AssumptionsLeininger: Assumptions Care is essence of nursing and a distinct, dominant, Care is essence of nursing and a distinct, dominant,

central, and unifying focus. Some would say that central, and unifying focus. Some would say that caring is not unique to nursing. caring is not unique to nursing.

Care is essential for well being, health, growth, Care is essential for well being, health, growth, survival, and to face handicaps or death.survival, and to face handicaps or death.

Culturally based care is the broadest means to know, Culturally based care is the broadest means to know, explain, interpret, and predict nursing care explain, interpret, and predict nursing care phenomena to guide nursing care decisions and phenomena to guide nursing care decisions and actions.actions.



Leininger AssumptionsLeininger Assumptions Nursing is a transcultural humanistic and scientific Nursing is a transcultural humanistic and scientific

care to serve individuals, groups, communities, and care to serve individuals, groups, communities, and institutions worldwide.institutions worldwide.

Caring is essential to curing and healing for there can Caring is essential to curing and healing for there can be no curing without caring.be no curing without caring.

Cultural care concepts meanings and expression Cultural care concepts meanings and expression patterns of care vary transculturally with diversity patterns of care vary transculturally with diversity and universality.and universality.



Leininger AssumptionsLeininger Assumptions Every human culture has generic care knowledge and Every human culture has generic care knowledge and

practices and some professional care knowledge that practices and some professional care knowledge that vary transculturally.vary transculturally.

Culture care values, beliefs, and practices are Culture care values, beliefs, and practices are influenced by the (rays of the sun see the Model).influenced by the (rays of the sun see the Model).

Beneficial, healthy, and satisfying culturally based Beneficial, healthy, and satisfying culturally based care influences the health and well-being of care influences the health and well-being of individuals, families, groups, and communities within individuals, families, groups, and communities within the cultural context.the cultural context.



Leininger AssumptionsLeininger Assumptions Culturally congruent care can only occur when Culturally congruent care can only occur when

individuals’, groups’, and communities’ patterns are individuals’, groups’, and communities’ patterns are known and used in meaningful ways.known and used in meaningful ways.

Culture care differences and similarities between Culture care differences and similarities between professionals and clients exist in all human cultures professionals and clients exist in all human cultures worldwide.worldwide.

Culture conflicts, imposition practices, cultural Culture conflicts, imposition practices, cultural stresses, and pain reflect the lack of professional stresses, and pain reflect the lack of professional care to provide culturally congruent care.care to provide culturally congruent care.



Leininger’s Sunrise Enabler to Leininger’s Sunrise Enabler to Discover Culture CareDiscover Culture Care

To view the model go to:http://leiningertheory.blogspot.com/



Leininger Orientational Theory Leininger Orientational Theory DefinitionsDefinitions

Cultural Care Preservation or Maintenance: all is well with the Cultural Care Preservation or Maintenance: all is well with the patient so encourage to continue what has been donepatient so encourage to continue what has been done

Cultural Care Accommodation or Negotiation: Needs some Cultural Care Accommodation or Negotiation: Needs some change. What is acceptable weight from the patient’s change. What is acceptable weight from the patient’s perspective perspective

Cultural Care Repatterning or Restructuring: Practices are Cultural Care Repatterning or Restructuring: Practices are deleterious to overall health and need restructured: sexually deleterious to overall health and need restructured: sexually promiscuous and has not been practicing safe sex promiscuous and has not been practicing safe sex



Cultural Competence in the Delivery of Cultural Competence in the Delivery of Healthcare Services: A culturally Healthcare Services: A culturally

Competent Model of CareCompetent Model of Care Dr. Josepha Campinha-Bacote but cannot Dr. Josepha Campinha-Bacote but cannot

display her model. Go to display her model. Go to http://www.transculturalcare.nethttp://www.transculturalcare.net



Process of Cultural CompetenceProcess of Cultural Competence Cultural Competence is a process not an event.Cultural Competence is a process not an event. The process consist of five inter-related constructs: The process consist of five inter-related constructs:

Cultural desire, cultural awareness, cultural Cultural desire, cultural awareness, cultural knowledge, cultural skills, and cultural encounter.knowledge, cultural skills, and cultural encounter.

The key and pivotal construct is cultural desire.The key and pivotal construct is cultural desire. There is more variation within a cultural group than There is more variation within a cultural group than

across cultural groups.across cultural groups.



Process of Cultural CompetenceProcess of Cultural Competence There is a direct relationship between healthcare There is a direct relationship between healthcare

professionals level of cultural competence and their professionals level of cultural competence and their ability to provide culturally responsive health care.ability to provide culturally responsive health care.

Cultural competence is an essential component in Cultural competence is an essential component in delivering effective and culturally responsive care to delivering effective and culturally responsive care to culturally diverse clients.culturally diverse clients.



Cultural DesireCultural Desire

. . . Cultural desire is defined as the motivation . . . Cultural desire is defined as the motivation of the healthcare professional to “want to” of the healthcare professional to “want to” engage in the process of becoming culturally engage in the process of becoming culturally competent; not the “have to”.competent; not the “have to”.



Concepts Cultural awareness is the self-examination and in-depth Cultural awareness is the self-examination and in-depth

exploration of one’s own cultural background.exploration of one’s own cultural background. Cultural knowledge is the process of seeking and obtaining a Cultural knowledge is the process of seeking and obtaining a

sound educational base about culturally diverse groups.sound educational base about culturally diverse groups. Cultural Skills is the ability to collect relevant cultural data Cultural Skills is the ability to collect relevant cultural data

regarding the client’s presenting problem as well as regarding the client’s presenting problem as well as accurately perform a culturally based physical assessment.accurately perform a culturally based physical assessment.

Cultural encounter is the process which encourages the Cultural encounter is the process which encourages the healthcare professional to directly engage in face-to-face healthcare professional to directly engage in face-to-face interactions with clients from culturally diverse backgrounds.interactions with clients from culturally diverse backgrounds.



The Giger and Davidhizar The Giger and Davidhizar Transcultural Assessment ModelTranscultural Assessment Model

Dr. Joyce GigerDr. Joyce GigerDr. Ruth Davidhizar (deceased)Dr. Ruth Davidhizar (deceased)



Giger and Davidhizar AssumptionsGiger and Davidhizar Assumptions

The Giger and Davidhizar Transcultural Model The Giger and Davidhizar Transcultural Model postulates that each individual is culturally postulates that each individual is culturally unique and should be assessed according to unique and should be assessed according to the six cultural phenomena.the six cultural phenomena.



Giger and Davidhizar CommunicationGiger and Davidhizar Communication

Communication embraces the entire world of Communication embraces the entire world of human interaction and behavior. human interaction and behavior. Communication is the means by which culture Communication is the means by which culture is transmitted and preserved. Both verbal and is transmitted and preserved. Both verbal and non-verbal communication are learned in non-verbal communication are learned in one’s culture.one’s culture.



Giger and Davidhizar Giger and Davidhizar SpaceSpace

Space refers to the distance between Space refers to the distance between individuals when they interact. All individuals when they interact. All communication occurs in the context of space.communication occurs in the context of space.

Zones of personal space: intimate, personal, Zones of personal space: intimate, personal, social, and consultative and public. Rules social, and consultative and public. Rules concerning personal distance vary from concerning personal distance vary from culture to culture.culture to culture.



Giger and Davidhizar Giger and Davidhizar Social OrganizationSocial Organization

Social organization refers to the manner in Social organization refers to the manner in which a cultural group organizes itself around which a cultural group organizes itself around the family group. Family structure and the family group. Family structure and organization, religious values and beliefs, and organization, religious values and beliefs, and role assignments may all relate to ethnicity role assignments may all relate to ethnicity and culture.and culture.



Giger and Davidhizar Giger and Davidhizar TimeTime

Time is an important aspect of interpersonal Time is an important aspect of interpersonal communication. communication.

Cultural groups can be past, present, or Cultural groups can be past, present, or future oriented. future oriented.

Preventive health requires some future time Preventive health requires some future time orientation because preventative actions are orientation because preventative actions are motivated by a future reward. motivated by a future reward.



Giger and Davidhizar Environmental Giger and Davidhizar Environmental ControlControl

Environmental control refers to the ability of Environmental control refers to the ability of the person to control nature and to plan and the person to control nature and to plan and direct factors in the environment that affect direct factors in the environment that affect them.them.



Giger and Davidhizar Giger and Davidhizar Biological VariationsBiological Variations

Biological differences, especially genetic Biological differences, especially genetic variations, exist between individuals in variations, exist between individuals in different racial groups. different racial groups.



Boyle and Andrews Culturological Boyle and Andrews Culturological AssessmentAssessment

Biocultural variations and cultural aspects of the Biocultural variations and cultural aspects of the incidence of diseaseincidence of disease

CommunicationCommunication Cultural affiliations Cultural affiliations Cultural sanctions and restrictionsCultural sanctions and restrictions Developmental considerationsDevelopmental considerations EconomicsEconomics Educational backgroundEducational background



Boyle and Andrews Culturological Boyle and Andrews Culturological AssessmentAssessment

Health related beliefs and practicesHealth related beliefs and practices Kinship and social networksKinship and social networks Nutrition Nutrition Religion and spiritualityReligion and spirituality Values orientation Values orientation



Ramsden Cultural SafetyRamsden Cultural Safety "the effective nursing practice of a person or a "the effective nursing practice of a person or a

family from another culture, as determined by family from another culture, as determined by that person or family", while unsafe cultural that person or family", while unsafe cultural practice is "any action which diminishes, practice is "any action which diminishes, demeans or disempowers the cultural identity demeans or disempowers the cultural identity and wellbeing of an individual" (Nursing and wellbeing of an individual" (Nursing Council of New Zealand (NCNZ). Council of New Zealand (NCNZ).



Ramsden Cultural SafetyRamsden Cultural Safetyhttp://culturalsafety.massey.ac.nz/RAMSDEN%20THESIS.pdfhttp://culturalsafety.massey.ac.nz/RAMSDEN%20THESIS.pdf

Assumes that nurses and the culture of nursing is exotic to Assumes that nurses and the culture of nursing is exotic to people people

Gives the power of definition to the person served Gives the power of definition to the person served Concerned with human diversity Concerned with human diversity Focus internal on nurse or midwife, exchanges power, Focus internal on nurse or midwife, exchanges power,

negotiated negotiated A key part of Cultural Safety is that it emphasises life chances A key part of Cultural Safety is that it emphasises life chances

rather than life stylesrather than life styles



Papadopoulos, Tilki, and TaylorPapadopoulos, Tilki, and TaylorCultural AwarenessCultural Awareness

Self awarenessSelf awarenessCultural identityCultural identityHeritage adherenceHeritage adherenceEthnocentricityEthnocentricityStereotypingStereotypingEthnohistoryEthnohistory



Papadopoulos, Tilki, and TaylorPapadopoulos, Tilki, and TaylorCultural KnowledgeCultural Knowledge

Health beliefs and behavioursHealth beliefs and behavioursAnthropological, Sociological,Anthropological, Sociological,Psychological and Biological understandingPsychological and Biological understandingSimilarities and differencesSimilarities and differencesHealth InequalitiesHealth Inequalities



Papadopoulos, Tilki, and TaylorPapadopoulos, Tilki, and TaylorCultural SensitivityCultural Sensitivity

EmpathyEmpathyInterpersonal/communication skillsInterpersonal/communication skillsTrustTrustAcceptanceAcceptanceAppropriatenessAppropriatenessRespectRespect



Papadopoulos, Tilki, and TaylorPapadopoulos, Tilki, and TaylorCultural CompetenceCultural Competence

Assessment skillsAssessment skillsDiagnostic skillsDiagnostic skillsClinical SkillsClinical SkillsChallenging and addressing prejudice, Challenging and addressing prejudice,

discrimination, and inequalitiesdiscrimination, and inequalities

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