St.

Paul University Dumaguete

Dumaguete City
Graduate School
MAN/MSN Program
SY 2016-2017, Second Semester

N 204 - Sociology and Anthropology (SOAN) with Transcultural Nursing

____________________________________________________________
A Research Output on Transcultural Nursing and Globalization of
Health Care and the Different Theoretical Perspectives of
Transcultural Nursing
__________________________________________________

Submitted to:
Erika Jane B. Yap, RN, MAN
Professor
Submitted by:
Peter A. Orlino, RN
Student

January 14, 2017

TRANSCULTURAL NURSING AND GLOBALIZATION OF HEALTH CARE

A. Definition, Nature, Rationale, and Importance of Transcultural Nursing

It has been over 6 decades since transcultural nursings foundress Dr. Madeleine M.
Leininger and thousands of other nurses across different cultures around the world were driven to
work thoroughly to establish transcultural nursing as a recognized area of academic study. It has
been noted how some women and men worked firmly to meet culturally congruent care. Dr.
Leininger articulated as she was contemplating on her philosophical thoughts: The nursing
world is in need of transcultural nursing to meet a changing world and changing health needs
it is new ideas, education, and practices that are essential to transform old practices and ideas
into new one (Leininger, in press).
Transcultural nursing has a historical origin of two worlds blending together: nursing and
anthropology. Founded by nurse-anthropologist Dr. Madeleine M. Leininger in the early 1950s,
transcultural nursing has provided grounds to guide nurses to grow cultural sensitivity for
appropriate, individualized clinical approaches and to develop a deeper appreciation of human
life and values.
It is believed that demography is destiny, demographic change is reality, and
demographic sensitivity is imperative. Providing culturally appropriate and thus competent care
in the 21st century will be a complex and difficult task for many nurses. A nurse who does not
recognize the value and importance of culturally appropriate care cannot possibly be an effective
care agent in this changing demographic society. When nurses consider race, ethnicity, culture,
and cultural heritage, they become more sensitive to clients. Indeed, there is a much variation
within certain races, cultures, or ethnic groups as there is across cultural groups. When the
informed nurse considers the significance of culture, clients are approached with a more
informed perspective (Giger and Davidhizar 3).
Transcultural nursing has been defined as a formal area of study and practice focused on
comparative human-care (caring) differences and similarities of the beliefs, values, and patterned
lifeways of cultures to provide culturally congruent, meaningful, and beneficial health care to
people. Today and in the future, cultures have the human rights to have their cultural values,

beliefs, and needs respected, understood, and appropriately used within any caring or curing
process, and so this necessitates that nurses are educated about culture and care phenomena. The
ultimate goal of transcultural nursing is to provide culturally congruent and competent care.
(Leininger, pp. 5-6).
B. Historical Development of Transcultural Nursing
Dr. Madeleine M. Leininger was the founder and leader of this new, specific cognitive
specialty in nursing. The first professional nurse with graduate preparation to complete a
doctorate in anthropology, Leininger took the culture construct from anthropology and care
from nursing and reformulated these two dominant constructs into culture care. Her pioneering
work began with her theory of cultural care diversity and universality, refined by 1975 with the
conceptual sunrise model. She divides the evolution of transcultural nursing into three eras:
1. Establishment of the field (19551975)
2. Program and research expansion (19751983)
3. Establishment of transcultural nursing worldwide (1983 to the present)
At the start in the mid-1950s, no cultural knowledgebase existed to guide nursing
decisions and actions to understand cultural behaviors as a way of providing therapeutic care.
Leininger wrote the first books in this field and coined the terms, transcultural nursing and
culturally congruent care. Leininger developed and taught the first university course in
transcultural nursing in 1966 at the University of Colorado. Programs and tracks in transcultural
nursing for masters and doctoral preparation were launched shortly after, in the early 1970s. In
recognition of her leadership, Leininger was honored as a Living Legend of the American
Academy of Nursing in 1998.
Today, transcultural nursing theory continues to expand and refine itself. Recent
educational and theoretical approaches in the field include the transcultural assessment model,
the model of heritage consistency, the model for cultural competence, the health care services
model, and advocacy for the application of transcultural nursing in clinical and community
contexts as well as a transcultural nursing assessment guide (Murphy).

C. Global Factors that have significantly influenced the need for Transcultural Nursing

Leininger (1995) cites eight factors that influence her to establish transcultural nursing.
1. There was a marked increase in people within and between countries worldwide.
Transcultural nursing is needed because of the growing diversity that characterizes our
national and global populations.
2. There has been a rise in multicultural identities, with people expecting their cultural
beliefs, values, and lifeways to be understood and respected by nurses and other
healthcare providers.
3. The increased use of healthcare technology sometimes conflicts with cultural values of
clients, such as Amish prohibitions against using certain apnea monitors, IV pumps, and
other such health care technologic devices in the home.
4. Worldwide, there are cultural conflicts, clashes, and violence that have an impact health
care as more cultures interact with one another.
5. There was an increase in the number of people traveling and working in many different
parts of the world.
6. There was an increase in legal suits resulting from cultural conflict, negligence,
ignorance, and imposition of health care practices.
7. There has been a rise in feminism and gender issues, with new demands on health care
systems to meet the needs of women and children.
8. There has been an increase demand for community and culturally based health care
services in diverse environmental contexts (Andrews, Margaret M and Joyceen S Boyle).

THEORETICAL PERSPECTIVES OF TRANSCULTURAL NURSING

A. Culture Care Diversity and Universality (Madeleine Leininger)

The theory of Culture Care Diversity and Universality is the creative outcome of
independent thinking, a keen awareness of a rapidly changing world, and more than five
decades of using and refining the theory. The roots of the theory reflect the theorists early
and current nursing practice and draws upon the theorists experiences and creative thinking
relevant to nursing and health fields. It has been independently developed and soundly
constructed as a highly relevant theory to discover the care and health needs of diverse
cultures in hospitals, clinics, community settings, and her study of many cultures worldwide.
The theory has become a major caring theory with a unique emphasis on nursing as a means
to know and help cultures. Culturally based care factors are recognized as major influences
upon human expressions related to health, illness, wellbeing, or to face death and disabilities.
The theory has become meaningful as a guide to nurses thinking, practices, and research.
This process of envisioning and conceptualizing care is the essence of nursing. The theorist
postulates that human care is what makes people human, gives dignity to humans, and
inspires people to get well and to help others and further predicts there can be no curing
without caring, but caring can exist without curing (Leininger, 1984, 1988a; Leininger &
McFarland,2002).
Research focused on culture care as an interrelated phenomenon is crucial to help nurses
discover and identify new ways to understand and advance nursing, healing, and health care.
Leininger holds that care needs to become meaningful, explicit, and beneficial; it needs to be
conceptualized showing the interrelationships of care to culture and to different cultures the
transcultural nursing focus. Care is a powerful and dynamic force to understand the totality of
human behavior in health and illness. Action modes related to care that are culturally based and
maintained beneficial health outcomes are needed. Care needs to be understood and actualized in
diverse and specific cultural contexts.
Leininger holds that culture is the broadest, most comprehensive, holistic and universal
feature of human beings and care is predicted to be embedded in culture. Both need to be
understood to discover clients care needs. Caring is held as the action mode to help people of
diverse cultures while care is the phenomenon to be understood and to guide actions and

decisions. Culture and care together are predicted to be powerful theoretical constructs essential
to human health, wellbeing, and survival. In-depth knowledge of the specific culture care values,
beliefs, and lifeways of human beings within lifes experiences is held as important to unlock a
wealth of new knowledge for nursing and health practices.
Basic Theoretical Differences
Philosophically and professionally many questions about culture, care, and nursing have
been raised. In the past, many nurses viewed care linguistically as an important word to use in
teaching and practice, but very few could provide substantive knowledge or explain care within a
culture. It was then clearly evident that within nursing a troubling knowledge deficiency existed
for obtaining authentic, scientific, and accurate data about cultures and their care meanings,
expressions, and beneficial outcomes (Leininger, 1985). The theorist found care and culture had
been limitedly studied in nursing yet she predicted they would guide nursing in powerful ways.
In developing the theory, it became apparent to Leininger that the Theory of Culture Care would
be very different from other existing ideas or emerging nursing theories in several respects. First,
the central domain of the theory was focused on the close interrelationships between culture and
care. Second, the terms theories and models are often used in the same way but are different.
Theories should predict and lead to discovery of unknown or vaguely known truths or
interrelated phenomena, whereas models are mainly pictorial diagrams of some idea and are not
theories as they usually fail to show predictive relationships. There are different kinds of theories
used by different disciplines to generate knowledge; however, all theories (including the Culture
Care Theory) have as their primary goal to discover new phenomena or explicate vaguely known
knowledge (Leininger 1991a/b). Third, the Culture Care Theory is open to the discovery of new
ideas that were vague or largely unknown but with bearing on peoples culture care phenomena
related to their health and wellbeing. Leiningers theory focuses on culture care as a broad yet
central domain of inquiry with multiple factors or influencers on care and culture. Fourth, the
theorist values an open discovery and naturalistic process to explore different aspects of care and
culture in natural or familiar living contexts and in unknown environments. Fifth, Leininger has
developed a new and unknown research method different from ethnography, namely the
ethnonursing method, to systematically and rigorously discover the domain of inquiry (DOI) of
culture care. The ethnonursing method is designed as an open, natural, and qualitative inquiry

mode seeking informants ideas, perspectives, and knowledge, and did not control, reduce, or
manipulate culture and care as with quantitative methods.
The Culture Care Theory focuses on obtaining indepth knowledge of care and culture
constructs from key and general informants related to health, wellbeing, dying, or disabilities.
Leiningers theory differs markedly from other nursing theories as it does not rely upon the four
metaparadigm concepts to explain nursing of persons, environment, health and nursing. These
four concepts were too restrictive for open discovery about culture and care. Another major and
unique difference in Leiningers theory in comparison with other nursing ideas are the three
action modalities or decision modes necessary for providing culturally congruent nursing care.
These three theoretically predicted action and decision modalities of the culture care theory were
defined as follows (Leininger, 1991a/b; Leininger & McFarland, 2002).
1. Culture care preservation and-or maintenance referred to those assistive, supporting,
facilitative, or enabling professional acts or decisions that help cultures to retain, preserve
or maintain beneficial care beliefs and values or to face handicaps and death.
2. Culture care accommodation and-or negotiation referred to those

assistive,

accommodating, facilitative, or enabling creative provider care actions or decisions that

help cultures adapt to or negotiate with others for culturally congruent, safe and effective
care for their health, wellbeing, or to deal with illness or dying.
3. Culture care repatterning and-or restructuring referred to those assistive, supportive,
facilitative, or enabling professional actions and mutual decisions that would help people
to reorder, change, modify or restructure their lifeways and institutions for better (or
beneficial) health care patterns, practices or outcomes. (Leininger, 1991a/b, 1995;
Leininger & McFarland 2002).
These three modes based on research data are held to be essential for caring and are to be
used with specific research care data discovered from the theory. The theory challenges nurses to
discover specific and holistic care as known and used by the cultures over time in different
contexts. Leiningers theory directs nurse researchers toward discovering and using culturally
based or derived research care knowledge in nursing obtained from culture informants. To
achieve this goal, both emic [insider] and etic [outsider] knowledge are used to differentiate the
informants inside knowledge in contrast with the researchers or professional knowledge. Both
emic and etic data are studied as integral parts of the theory to obtain comparative and

contrasting care knowledge and are held as invaluable insights for nurses in caring for cultures.
The reader will find that the frequently used phrase nursing interventions is seldom used in the
Culture Care Theory or in transcultural nursing because it often refers to cultural imposition
practices which may be offensive or in conflict with the clients lifeways. Cultural imposition
practices are often destructive, ethnocentric, offensive, and lead to cultural pain and conflicts
(Leininger, 1991a/b, 1995).
Other Central Constructs in the Culture Care Theory
1. Care refers to both an abstract and-or a concrete phenomenon. Leininger has defined care
as those assistive, supportive, and enabling experiences or ideas towards others with
evident or anticipated needs to ameliorate or improve a human condition or lifeway
(Leininger, 1988a/b/c, 1991a/b, 1995a; Leininger & McFarland, 2002). Caring refers to
actions, attitudes and practices to assist or help others toward healing and wellbeing
(Leininger, 1988a/b/c, 1991a/b, 1995a; Leininger & McFarland, 2002). Care as a major
construct of the theory includes both folk and professional care which are a major part of
the theory and have been predicted to influence and explain the health or wellbeing of
diverse cultures.
2. Culture as the other major construct central to the theory of Culture Care has been
equally as important as care; therefore it is not an adverb or adjective modifier to care.
The theorist conceptualized culture care as a synthesized and closely linked phenomena
with interrelated ideas. Both culture and care require rigorous and full study with
attention to their embedded and constituted relationship to each other as a human care
phenomenon. Leininger has defined culture as the learned, shared, and transmitted
values, beliefs, norms, and lifeways of a particular culture that guides thinking, decisions,
and actions in patterned ways and often intergenerationally (Leininger, 1991a/b; 1997a).
Anthropologically, culture is usually viewed as a broad and most comprehensive means
to know, explain, and predict people lifeways over time and in different geographic
locations. Culture phenomena distinguish human beings from nonhumans but is more
than social interaction and symbols, more than ethnicity or social relationships. Culture
can be viewed as the blueprint for guiding human actions and decisions and includes
material and nonmaterial features of any group or individual.

3. The constructs emic and etic care are another major part of the theory. The theorist
wanted to identify differences and similarities among and between cultures. It is desirable
to know what is universal [or common] and what is different [diversities] among cultures
with respect to care. The term emic refers to the local, indigenous, or insiders cultural
knowledge and view of specific phenomena; whereas, etic refers to the outsiders or
strangers views and often health professional views and institutional knowledge of
phenomena (Leininger, 1991a/b).
4. Cultural and Social Structure Factors are another major feature of the theory. Social
structure phenomena provide broad, comprehensive, and special factors influencing care
expressions and meanings. Social structure factors of clients include religion
(spirituality); kinship (social ties); politics; legal issues; education; economics;
technology; political factors; philosophy of life; and cultural beliefs, and values with
gender and class differences. The theorist has predicted that these diverse factors must be
understood as they directly or indirectly influence health and wellbeing.
5. Ethnohistory is another construct of the theory that comes from anthropology; the theorist
has reconceptualized its meaning within a nursing perspective. The theorist defines
ethnohistory as the past facts, events, instances, and experiences of human beings,
groups, cultures, and institutions that occur over time in particular contexts that help
explain past and current lifeways about culture care influencers of health and wellbeing
or the death of people (Leininger 1991a/b; Leininger & McFarland, 2002).
6. Environmental context refers to the totality of an event, situation, or particular
experiences that gives meaning to peoples expressions, interpretations, and social
interactions within particular physical, ecological, spiritual, sociopolitical, technologic
factors in cultural settings (Leininger 1989, 1991a/b; Leininger & McFarland, 2002).
7. Worldview refers to the way people tend to look out upon their world or their universe to
form a picture or value stance about life or the world around them (Leininger 1991a/b;
Leininger & McFarland, 2002). Worldview provides a broad perspective of ones
orientation to life, people, or group that influence care or caring responses and decisions.
Worldview guides ones decisions and actions especially related to health and wellbeing
as well as care actions.
8. Culture Care Preservation and-or Maintenance, Culture Care Accommodation and-or
Negotiation, and Culture Care Repatterning and-or Restructuring have been defined
earlier.

9. Culturally Congruent Care refers to culturally based care knowledge, acts and decisions
used in sensitive and knowledgeable ways to appropriately and meaningfully fit the
cultural values, beliefs, and lifeways of clients for their health and wellbeing, or to
prevent illness, disabilities, or death (Leininger, 1963, 1973b, 1991a/b, 1995; Leininger &
McFarland, 2002). To provide culturally congruent and safe care has been the major goal
of the Culture Care Theory.
10. Care Diversity refers to the differences or variabilities among human beings with respect
to culture care meanings, patterns, values, lifeways, symbols or other features related to
providing beneficial care to clients of a designated culture (Leininger, 1995, 1997a;
Leininger & McFarland, 2002).
11. Culture Care Universality refers to the commonly shared or similar culture care
phenomena features of human beings or a group with recurrent meanings, patterns,
values, lifeways, or symbols that serve as a guide for care givers to provide assistive,
supportive, facilitative, or enabling people care for healthy outcomes (Leininger, 1995).
Care Theory:
1. Culture care expressions, meaning, patterns, and practices are diverse and yet there are
shared commonalities and some universal attributes.
2. The worldview, multiple social structure factors, ethnohistory, environmental context,
language, and generic and professional care are critical influencers of cultural care
patterns to predict health, well-being, illness, healing, and ways people face disabilities
and death.
3. Generic emic [folk] and professional etic health factors in different environmental
contexts greatly influence health and illness outcomes.
4. From an analysis of the above influencers, three major actions and decision guides can
lead to providing ways to give culturally congruent, safe, and meaningful health care to
cultures. The three culturally based action and decision modes are: a) culture care
preservation and /or maintenance; b) culture care accommodation, negotiation; and, c)
culture care repatterning and-or restructuring. Decision and action modes based on
culture care are key factors to arrive at congruent and meaningful care. Individual, family,
group or community factors are assessed and responded to in a dynamic and participatory
nurse client relationship (Leininger 1991a/b, 1993b, 2002; Leininger & McFarland,
2002).

Theoretical Assumptions:
1. Care is the essence and the central dominant, distinct, and unifying focus of nursing.
2. Humanistic and scientific care is essential for human growth, wellbeing, health, survival, and
to face death and disabilities.
3. Care (caring) is essential to curing or healing for there can be no curing without caring. (This
assumption was held to have profound relevance worldwide.)
4. Culture care is the synthesis of two major constructs which guides the researcher to discover,
explain, and account for health, wellbeing, care expressions, and other human conditions.
5. Culture care expressions, meanings, patterns, processes and structural forms are diverse but
some commonalities (universals) exist among and between cultures.
6. Culture care values, beliefs, and practices are influenced by and embedded in the worldview,
social structure factors (e.g. religion, philosophy of life, kinship, politics, economics, education,
technology, and cultural values) and the ethnohistorical and environmental contexts.
7. Every culture has generic [lay, folk, naturalistic; mainly emic] and usually some professional
[etic] care to be discovered and used for culturally congruent care practice.
8. Culturally congruent and therapeutic care occurs when culture care values, beliefs,
expressions, and patterns are explicitly known and used appropriately, sensitively, and
meaningfully with people of diverse or similar cultures.
9. Leiningers three theoretical modes of care offer new, creative, and different therapeutic ways
to help people of diverse cultures.
10. Qualitative research paradigmatic methods offer important means to discover largely
embedded, covert, epistemic, and ontological culture care knowledge and practices.
11. Transcultural nursing is a discipline with a body of knowledge and practices to attain and
maintain the goal of culturally congruent care for health and wellbeing.

B. Cultural Care Assessment for Congruent Competency practices (Purnell)

Purnell Model for Cultural Competence by Larry Purnell

The Purnell Model for Cultural Competence comprises of 12 culture domains. In the figure
below:

the Outer Rim represents global society;

the Second Rim represents community;
the Third Rim represents family;
the Inner Rim represents person;
the Interior depicts 12 domains;
the Center is empty, representing what we do not yet know about culture; and
the Saw-Toothed Line represents concepts of cultural consciousness.

Concepts of Cultural Consciousness

Variant cultural characteristics: age, generation, nationality, race, color, gender, religion,
educational status, socioeconomic status, occupation, military status, political beliefs, urban
versus rural residence, enclave identity, marital status, parental status, physical characteristics,
sexual orientation, gender issues, and reason for migration (sojourner, immigrant, undocumented
status)
Unconsciously incompetent
Not being aware that one is lacking knowledge about another culture
Consciously incompetent
Being aware that one is lacking knowledge about another culture
Consciously competent
Learning about the clients culture, verifying generalizations about the clients culture,
and providing culturally specific interventions

Unconsciously competent
Automatically providing culturally congruent care to clients of diverse cultures
12 Cultural Domains

It is not intended for domains to stand alone, rather, they affect one another.
1. Overview/heritage
Concepts related to country of origin, current residence, and the effects of the topography of
the country of origin and current residence, economics, politics, reasons for emigration,
educational status, and occupations.
2. Communication
Concepts related to the dominant language and dialects; contextual use of the language;
paralanguage variations such as voice volume, tone, and intonations; and the willingness to share
thoughts and feelings. Nonverbal communications such as the use of eye contact, facial
expressions, touch, body language, spatial distancing practices, and acceptable greetings;
temporality in terms of past, present, or future worldview orientation; clock versus social time;
and the use of names are important concepts.
3. Family roles and organization
Concepts related to the head of the household and gender roles; family roles, priorities, and
developmental tasks of children and adolescents; child-rearing practices; and roles of the ages
and extended family members. Social status and views toward alternative lifestyles such as
single parenting, sexual orientation, child-less marriages, and divorce are also included in the
domain.
4. Workforce issues
Concepts

related

to

autonomy, acculturation,

assimilation,

gender

roles,

communication styles, individualism, and health care practices from the country of origin.

5. Bicultural ecology

ethnic

Includes variations in ethnic and racial origins such as skin coloration and physical
differences in body stature; genetic, heredity, endemic, and topographical diseases; and
differences in how the body metabolizes drugs.
6. High-risk behaviors
Includes the use of tobacco, alcohol and recreational drugs; lack of physical activity; nonuse
of safety measures such as seatbelts and helmets; and high-risk sexual practices.
7. Nutrition
Includes having adequate food; the meaning of food; food choices, rituals, and taboos; and
how food and food substances are used during illness and for health promotion and wellness.
8. Pregnancy and childbearing
Includes fertility practices; methods for birth control; views towards pregnancy; and
prescriptive, restrictive, and taboo practices related to pregnancy, birthing, and postpartum
treatment.
9. Death rituals
Includes how the individual and the culture view death, rituals and behaviors to prepare for
death, and burial practices. Bereavement behaviors are also included in this domain.
10. Spirituality
Includes religious practices and the use of prayer, behaviors that give meaning to life, and
individual sources of strength.
11. Health care practices
Includes the focus of health care such as acute or preventive; traditional, magico-religious,
and biomedical beliefs; individual responsibility for health; self-medication practices; and views
towards mental illness, chronicity, and organ donation and transplantation. Barriers to health care
and ones response to pain and the sick role are included in this domain.

12. Health care practitioner

Concepts include the status, use, and perceptions of traditional, magico-religious, and
allopathic biomedical health care providers. In addition, the gender of the health care provider
may have significance. The major focus: is to identify culture care beliefs, values, patterns,
expressions, and meanings related to the clients needs for obtaining or maintaining health or to
face acute or chronic illness, disabilities, or death.
In cultural care assessment the nurse goes beyond assessment of physical, psycho. ,
social, and mental aspects to include or tap the holistic or totality living and functioning
dimensions. Nurses are taught in Trans- cultural nursing to use liberal arts and other broad areas
of knowledge to get a realistic and accurate picture of people and their health needs or concerns

Purposes of a culture care assessment:

1.

To discover the clients culture care and health patterns and meanings in relation to the

clients worldview, life ways, cultural values, beliefs, practices, context, and social structure
factors.
2.

To obtain holistic culture care information as a sound basis for nursing care decisions and

actions.
3.

To discover specific culture care patterns that can be used to make differential nursing

decisions that fit the clients values and life ways and to discover what professional knowledge
can be helpful to the client.
4.

To identify potential areas of cultural conflicts, clashes, and neglected areas resulting

from emic and etic value differences between clients and professional health personnel
5.

To identify general and specific dominant themes and patterns that need to be known in

context for culturally congruent care practices.

6.

To identify comparative cultural care information among clients of different or similar

cultures, which can be shared and used in clinical, teaching, and research practices.
7.

To identify both similarities and differences among clients in providing quality care.

8.

To use theoretical ideas and research approaches to interpret and explain practices for

congruent care and new areas of Trans- cultural nursing knowledge for discipline users.
The sunrise model serves as a guide to cultural assessment. The major areas for assessment
are the following:
1.

Cultural values, beliefs, and practices.

2.

Religious, philosophical, and spiritual beliefs.

3.

Economic factors.

4.

Educational factors.

5.

Technological views.

6.

Kinship and social ties.

7.

Political and legal factors.

Principles for culturalogical assessment

1.

TO show a genuine and sincere interest in the client as one listens to and learns to and

learns from the client.

2.

To give attention to gender or class differences, communication modes (with special

language terms), and interpersonal space.

3.

The nurse need to remain fully aware of ones own cultural biases and prejudices. If not

aware about she will fall in a (cultural blindness)

4.

To remain an active listener to fit client expectations and create a climate that is trusting

so that the client feels it is safe and beneficial to share ones beliefs and life ways.
Transcultural communication modes
The nurse should understand the many verbal and nonverbal modes of many diverse
cultures. This is an imperative today in this multicultural world. Nurses should speak at least two
languages today. Body language expressions are forms of communication and are culturally
patterned. Kinesics is the term that refers to body movements communication modes, which

include posture, facial expressions (smile or anger), gestures, eye contact, and other body
features.
Proxemics: it refers to the use and perception of interpersonal or personal space in socio cultural
interactions. Finally, within the many areas of Tran cultural communication, a few pointers need
to be given about the use of interpreters to get accurate assessments. The interpreter should know
the clients cultural language and knows the culture. ("Cultural Care Assessment for Congruent
Competency Practices")
Leiningers short culturalogical assessment guide:
Phase 1: Record observation of what you see, hear or experience with clients (includes dress and
appearance, body condition features, language, mannerisms and general behavior, attitudes, and
cultural features).
Phase 2: Listen to learn from the client about cultural values, beliefs, and daily (nightly)
practices related to care and health in the clients environmental context. Give attention to generic
(home or folk) practices and professional nursing practices.
Phase 3: identify and document recurrent client patterns and narratives (stories) with client
meanings of what has been seen, heard or experienced.
Phase 4: Synthesize themes and patterns of care derived from the information obtained in phase
1, 2, 3.
Phase 5: Develop a culturally-based client-nurse care plan as co-participants for decisions and
actions for culturally congruent care.
Caring rituals important to assess:
In doing culture care assessments there are special areas bearing on caring patterns and healing
that provide valuable information.
1.

Eating rituals

2.

Daily and nightly ritual care activities

3.

Sleep and rest ritual patterns

4.

Life cycle rituals are especially crucial because they demonstrate patterns of caring for

health, as well as illnesses and generic folk life ways

5.

Nurse and hospital rituals

Standards for culturally competent and congruent care

1.

Consumers of diverse cultures have a right to have Tran cultural care standards used to

protect and respect their generic (folk) values, beliefs, and practices and to have health personnel
incorporate.
2.

Nurses assessing and providing care to diverse culture or subcultures have a moral

obligation to be prepared in Transcultural nursing to provide knowledgeable, sensitive, and

research-based care to the culturally different.
3.

Cultural assessment and practices need to demonstrate the use of Tran cultural nursing

concepts, principles, theories, and research findings and competencies to ensure safe, congruent,
and competent practices.
4.

Nurses as caregivers have an ethical, morale, professional obligation and responsibility to

study, understand, and use relevant research-based Transcultural care for safe, beneficial, and
satisfying client or family outcomes.
5.

Providing culturally competent and congruent care should reflect the caregivers ability to

assess and use culture-specific data without biases, prejudices, discrimination, or related negative
outcome
6.

Nurses caring for clients of diverse cultures should seek to provide holistic care that is

comprehensive and takes into account the clients worldview and includes ethno history, religion
(or spiritual), morale/ ethical values, specific cultural care beliefs and values, kinship ties.
7.

Nurses demonstrating cultural competence and congruent care maintain an open,

learning, flexible attitude and desire to expand their knowledge of diverse cultures and caring life
ways.

8.

Nurses with Transcultural competencies show evidence of being able to use local,

regional, and national resources for beneficial care outcomes.

9.

Nurses with Transcultural competencies demonstrate leadership skills to work with other

nurses and interdisciplinary colleagues who need help to provide culturally safe and congruent
client practices, thus preventing cultural imposition, cultural pain offenses, cultural conflicts, and
many other negative and destructive outcomes.
10.

Nurses with Trans cultural competencies are active to defend, uphold, and improve care

to clients of diverse cultures and to share their research findings and competency experiences in
public and professional arenas ("Cultural Care Assessment For Congruent Competency
Practices").

C. Cultural CARE Assessment (Capinha Bacote)

Cultural competence is a process of becoming culturally competent, not being culturally
competent.
Dr. Campinha-Bacote
The Process of Cultural Competence in the Delivery of Healthcare Services, is a culturally
conscious model of healthcare delivery that defines cultural competence as the process in which
the healthcare professional continually strives to achieve the ability and availability to effectively
work within the cultural context of a client (family, individual or community). It is a process of
becoming culturally competent, not being culturally competent. This model of cultural
competence views cultural awareness, cultural knowledge, cultural skill, cultural encounters and
cultural desire as the five constructs of cultural competence. Cultural encounter is the pivotal
construct of cultural competence that provides the energy source and foundation for ones
journey towards cultural competence. (Bacote, Dr. Capinha)
1. Clinical We provide direct and indirect consultation regarding clients with health care
and mental health issues related to their cultural and/or ethnic background.
2. Administrative We provide agencies with consultation, training and presentations
regarding such administrative issues as organizational cultural competence, recruitment
and retention of minorities, and cultural diversity in the workforce.
3. Research We provide consultation on research grants, demonstration projects, and
proposals in the areas of cultural competency and the delivery of culturally responsive
healthcare services and cultural competence in the health professions.
4. Educational We conduct workshops, seminars and presentations on various topics of
cultural competence in health care and mental health, as well as provide in-service
education to clinicians and other healthcare providers on cultural competence. (Bacote,
Dr. Capinha)

REFERENCES

A. PRINTED BOOK:
Andrews, Margaret M and Joyceen S Boyle. Transcultural Concepts in Nursing Care. 1st ed.,
Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2008.

Giger, Joyce and Ruth Elaine Davidhizar. Transcultural Nursing: Assessment and Intervention.
5th ed. St. Louis, Missouri: Mosby Elsevier, 2008. Print.

Leininger, M., & McFarland, M.R. (2002). Transcultural Nursing: Concepts, theories,
research, & practice (3rd ed.). New York: McGraw Hill Medical Publishing Division.

Leininger, M. Transcultural Nursing: Concept, Theories, And Practices, New York: John
Wiley & Sons, 1978.. 1st ed. Columbus, Ohio: Greyden Press, 1994. Print.
Leininger, M. (Ed.). (1985). Qualitative research methods in nursing. New York: Grune &
Stratton.

Purnell, L. (2002). The Purnell model for cultural competence. Journal of Transcultural Nursing,
13(3), 193-197.

B. JOURNAL ARTICLE:
Leininger, M.M. (1991). Second reflection: Comparative care as central to transcultural nursing.
Journal of Transcultural Nursing, 3(1), 2.

Leininger (in press). The evolution of transcultural nursing with breakthroughs to discipline
status. Journal of Transcultural Nursing.

C. WORLD WIDE WEB ADDRESS:

Bacote, Dr. Capinha. "The Process Of Cultural Competence In The Delivery Of Healthcare
Services". Transcultural C.A.R.E Associates, 2017, http://transculturalcare.net/the-process-ofcultural-competence-in-the-delivery-of-healthcare-services/.

Bacote, Josepha Campinha. "The Process Of Cultural Competence In The Delivery Of

Healthcare
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Murphy, Sharon. "Mapping The Literature Of Transcultural Nursing". Pubmed Central (PMC),
2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1463039/.

Pacquiao, Dula. "Ethics And Cultural Diversity- A Framework For Decision Making". 2017,
https://practicalbioethics.org/files/members/documents/Pacquiao_17_3_4.pdf.

Spector, Rachel. Cultural Diversity in Health and Illness". Journals.Sagepub.Com, 2017,

http://journals.sagepub.com/doi/pdf/10.1177/10459602013003007.

"The Giger and Davidhizar Transcultural Assessment Model

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