Theory Transcultural

Nursing

Istianna N
 Basic Concepts

 Transcultural Nursing—the study of the

lifeways and patterns of persons of various
cultures including their healthcare practices and
nursing’s role in that culture.
 Cross Cultural Nursing—the study of the
lifeways and patterns of persons of various
cultures from an anthropological perspective that
is being applied to nursing.
 Concepts (Cont’d)
 International Nursing—
the exchange of nurses between 2 or
more nations/cultures.
 Culture—the patterns and lifeways that guide a
group of people’s worldview and decision-
making.
 Cultural Imposition—a situation where one
culture forces their values and beliefs on another
culture or subculture.
 Concepts (Cont’d)
 Acculturation—the process of adapting or
modifying the patterns and lifeways of an
adopted culture as a result of contact with another
group or individual.

 Assimilation—the process of accepting some

of the cultural practices or traits of the prevailing
culture into one’s own daily activities.

 Refugee—a person who flees from

persecution, invasion, or political danger.
 Concepts (cont’d)
 Values—something regarded as desirable,
worthy, or right, as a belief, standard, or moral
precept.
 Beliefs—a tenet or body of tenets; doctrine; creed.
 Ethnocentrism—the universal tendency of
human beings to think that their ways of thinking,
acting, and believing are the only right, proper, and
natural ways. It can be a major barrier to
providing culturally conscious care.
 Concepts (Cont’d)
 Generalization—usually an oversimplification
made about behaviors of an individual or large
group.
 Stereotyping—to make a person possess or
believe to possess characteristics or qualities that
typify a particular group.
Cultural Competence in Nursing
 Developing an awareness of one’s own existence,
sensations, thoughts, and environment without
letting it have an undue influence on those from
other backgrounds.
 Demonstrating knowledge and understanding of
the client’s culture.
 Accepting and respecting cultural differences.
 Adapting care to be congruent with the client’s
culture.
 4 Levels of Cultural Competence

 Unconscious incompetence—not being aware

that one is lacking knowledge about another
culture.
 Conscious incompetence—being aware that
one is lacking knowledge about another culture.
 Conscious competence—learning about the
client’s culture, verifying generalizations about
the client’s culture, and providing culturally
specific interventions.
 Unconscious competence—automatically
providing culturally congruent care to clients of a
diverse culture.
 What is YOUR goal
re: Cultural Competence??

 Through this course

we hope that you will
desire to strive for
CONSCIOUS
COMPETENCE
regarding your
client’s culture when
you practice.
 Nursing Theorists in
Transcultural Nursing
 Madeleine Leininger—the founder
of Transcultural Nursing.
Dr. Leininger studied anthropology in the 1950’s and
early 60’s. She earned her PhD in Cultural
Anthropology. She then decided that nursing was
constantly dealing with the lifeways and patterns of
peoples of many backgrounds and that in caring for
these persons, nurses needed to be sensitive to the
unique needs of all peoples. She felt strongly that
we should NOT impose our views on others
whenever possible.
 Contributions of Madeleine Leininger
(July 13, 1925-August 10, 2012)
to the Development of Transcultural Nursing
from the TCNS website: www.tcns.org

Date Contribution
1954 Leininger noticed and studied the cultural differences in
the perception of care
1965 Leininger earned a doctorate in cultural anthropology
[Univ. of Washington]
1965- Leininger offered first courses and telelectures offered in
1969 Transcultural Nursing [Univ. of Colorado School of Nsg]
Est. 1st PhD nurse-scientist program combining anthro-
pology and nursing[Univ. of Colorado School of Nsg]
1973 !st Academic Dept. in Transcultural Nursing est’d [Univ.
of Washington, School of Nsg]
1974 Transcultural Nursing Society(TNS) est’d as the official
organization of transcultural nursing.
1978 First advanced degree programs [Master’s & Doctoral]
est’d [Univ. of Utah School of Nursing]
1988 Transcultural Nursing Society(TNS)—initiated
certification examinations: Certified Transcultural
Nurse
1989 Journal of Transcultural Nursing (JTN)—1st published
as official publication of the TNS; Leininger is
founding editor. The goal of the JTN is to disseminate
transcultural ideas, theories, research findings, and/or
practice experiences.

1991 Dr. Leininger published Culture Care Diversity and

Universality: A theory of Nursing in which she
outlines her theory [Culture Care Diversity and
Universality and the Sunrise Model] and its research
implications.

1995 Dr. Leininger published Transcultural Nursing—

Concepts, Theories, Research & Practices as a text
for undergraduate and graduate nursing students.
2001+ Dr. Leininger continued to teach a graduate level
Transcultural Course at the Univ. of Northern
Colorado. She guest lectured internationally at age 77!!
 Leininger’s Theory
 She developed the “SUNRISE MODEL” as a basis
for assessment and research in nursing.

This model remains as a standard in Transcultural

Nursing Theory.

 Dr. Leininger also developed the ETHNONURSING

Method for conducting Transcultural Research.
While it is considered by Dr. Leininger to be
Qualitative, it has certain attributes that make it
somewhat Quantitative as well.
 Leininger’s Theory (cont’d)
 Note that the model looks like a Sunrise and the
Worldview encompasses everything that makes
people who they are.

 The 7 Cultural and Social Structure

Dimensions are the large areas that nurses need
to learn about through interview and living among
the people of different cultures.

 Below the Individuals, Families, Groups,

Communities, & Institutions are the Diverse
Health Systems that all persons deal with in
various ways.
 How to Provide
Culturally Congruent Care:
 Leininger suggests 3 approaches to plan
and implement Culturally Congruent Care.
 The first is Cultural Care
Preservation/Maintenance where we look
at what we as nurses can do to preserve and
maintain the cultural practices of an
individual or family while receiving safe,
holistic care somewhere in the Healthcare
Delivery System.
 How to Provide
Culturally Congruent Care: (cont’d)
 The second approach is Cultural Care
Accommodation/Negotiation where we
look at what we as nurses can do to
accommodate the patient and negotiate with
the patient within the healthcare
environment in order to provide culturally
congruent care while he/she is in the
Healthcare Delivery System.
 How to Provide
Culturally Congruent Care: (Cont’d)

 The third approach is Cultural Care

Repatterning/Restructuring where we
look at what we as nurses need to do with
the patient and family to repattern or
restructure their lifeways in order to
promote healing and wellness, always
being cognizant of the cultural influences
that affect why they do what they do in
their life experience.
 Josepha Campinha-Bacote
 In 1991, Campinha-Bacote developed her own
Transcultural Theory entitled “Culturally
Competent Model of Care”.

 She did much research in the African-American

population.

 Her model looks like this:

“Culturally Competent Model of Care”

Updated 8/2005

There is a
new model
available on
her website
 Geiger and Davidhizer Model
 Joyce Newman Geiger and Ruth
Davidhizer were inspired to develop a
culturally competent assessment tool by
their nursing students at Bethel College in
Mishawaka, IN. Dr. Davidhizer just passed
away in 2007.
 The Transcultural Assessment Model was
developed and researched in 1990.
The Giger and Davidhizar’s Transcultural
Assessment Model
Model shows:
The client, a unique cultural being, in the
center. It is important to remember that the
client is culturally unique and as such is a product
of past experiences, cultural beliefs and cultural
norms. Cultural expressions vary but it is that
which give an individual a unique identity.

Cultural heritage consistency: This theory

analyzes the degree to which people identify with
the dominant and traditional cultures . Its
essential elements are: culture, ethnicity, and
religion

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1. Culture –
represents non-physical traits,
such as values, attitudes, beliefs,
customs shared by a group of
people and passed from generation
to the next. Culture is also the sum
f beliefs, practices, habits, likes
dislikes, norms, customs and
rituals learned from the family
during the ears of socialization.
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2. Ethnicity –
is a sense of identification associated
with a cultural group’s common social
and cultural heritage. Ethnicity is
indicative of the following
characteristics a group may share in
some combination:
i. Common geographic origin
ii. Migratory status
iii. Race
iv. Language and dialect
v. Religious faith or faiths
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2. Ethnicity – cont…
vi. Ties that transcend kinship,
neighborhood, and community boundaries
vii. Shared traditions, values, and symbols
viii. Literature, folklore, and music
ix. Food preferences
x. Settlement and employment patterns
xi. Special interest with regard to politics
in the homeland and in the United States
xii. Institutions that specifically serve and
maintain the group

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Religion –
“the belief in a divine or superhuman
power or powers to be obeyed and
worshipped as the creator(s) and ruler (s)
of the universe; and a system of beliefs,
practices and ethical values.
It is not possible to isolate the aspects of
culture religion, and ethnicity that shape a
person’s worldview. Each is a part of the
other, and all three are united within the
person. Therefore, when religion is
discussed, culture and ethnicity must
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The Six Cultural Organizing Phenomena

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Culturally diverse nursing must take into
account six cultural phenomena that vary
but are evident in all cultural groups and
affect health care. These have been
identified by Giger & Davidhizar, 1999,
and Engebertson & Headley(2000), as:
(1)environmental control,
(2)biological variations,
(3)social organization
(4)Communication,
(5)space, and
(6)time orientation.

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1. ENVIRONMENTAL CONTROL – refers
to the ability of members of a particular
group to plan activities that control
nature or direct environmental factors.
 Plays an extremely important role in the
way patients respond to health-related
experiences, including the ways in which
they define health and illness and seek
and use health care resources and social
supports.
Examples of environmental control
systems: complex traditional health and
illness beliefs, the practice of folk medicine,
the use of traditional healers, etc.
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2. BIOLOGICAL VARIATIONS – The several ways in
which people from one cultural group differ biologically
(i.e., physically and genetically) from other cultural groups
constitute their biological variations. These are:

Body built and structure – specific bone structure and

structural differences between groups. Example: smaller
stature of Asians
Skin color, including variations in tone, texture, healing
abilities, and hair follicles. Example: African Americans –
dark skinned; Europeans – light skinned
Jewish and Islamic Americans, etc. Common nutritional
disorder, lactose intolerance, is found among Mexicans.
Africa, Asian, and Eastern European Jewish Americans

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3. SOCIAL ORGANIZATION –
refers to the ways in which groups determine rules of
acceptable behavior and role of individual members.
Family unit (nuclear, single parent, extended, blended)
Children learn their cultural responses to life events from
the family and its ethnoreligious group through
socialization.
Gender – gender roles vary according to cultural
context:
patriarchal structure – husband/father is the dominant
person (Latino, Hispanic and traditional Muslim families
matriarchal structure – the wife is responsible for child
care and household maintenance whereas the father’s role
is to support and protect the family members.
Lifestyle – alternative lifestyles. Example: homosexual
couples and communal groups
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Social organization also prescribes behavior
for such significant events as birth, death,
child rearing, and illness.

Nurses must demonstrate respect for

client’s lifestyles even when they differ
from theirs by:
Being aware of own tendency to be
ethnocentric
 Being sensitive to client’s needs
especially those expressed non-verbally
Use self-awareness to determine the
impact of own beliefs and values

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4. SPACE (PROXEMICS) –
The area around a person’s body, surrounding
environment, and objects within that
environment; affects people’s behaviors and
attitudes toward the space around themselves.
 Territoriality refers to the behavior and
attitude people exhibit about an area they have
claimed and defend or react emotionally when
others encroach on it.

 Both personal space and territoriality are

influenced by culture, thus different
ethnocultural groups have varying norms related
to the use of space.
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 Space and related behaviors have different
meanings in the following zones:

Intimate zone – extends up to 1 ½ feet.

Acceptable only in private places because this
distance allows adults to have the most bodily
contact for perception of breath and odor,
Personal distance – extends from 1 ½ to 4 feet.
This is an extension of the self that is like a
“bubble” of space surrounding the body. At this
distance the voice may be moderate, body odor
may not be apparent, and visual distortion may
have disappeared.

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Social distance – extends from 4 to 12 feet.
This is reserved for impersonal business
transactions. Perceptual information is much
less detailed.

Public distance – extends 12 feet or more.

Individuals interact only impersonally.
Communicator’s voices must be projected, and
subtle facial expressions may be lost.

Use of personal space varies among individuals

and ethnic groups. The extreme modesty
practiced by members of some cultural groups
may prevent members from seeking preventive
health care. 36
5. Time Orientation (Temporal Relationships)
– refers to viewing of time in the present, past
or future; varies among different cultural
groups. Most cultures include all three time
orientation, but one orientation is more likely
to dominate the cultural perspective.
Examples:
American culture – future oriented; time is a
highly valuable resource: do not waste time,
“time is money”
German culture – past-oriented society,
where laying a proper foundation by providing
historical background information can enhance
communication
Central American culture – present oriented
Asian, Latin countries – punctuality is not
taken seriously 37
Communication –
Language differences possibly play
the most important obstacle to
providing multicultural health care
because clients come from all over
the world and they affect all
stages of the patient caregiver
relationship. to, and evaluate our
experience.

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 In Summary

 You have been introduced to several theorists in

Transcultural Nursing other than the author of
your text.
 I hope you have been inspired to learn more
about cultures in order to be a
CULTURALLY CONSCIOUS
COMPETENT NURSE 