Introduction to

Transcultural Nursing

Why should we study it??

WELCOME to Cultural and Spiritual

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Table 1. Guidelines for the Practice of Culturally Competent Nursing Care.
Guideline Description
1. Knowledge of Cultures
 Nurses shall gain an understanding of the perspectives, traditions, values, practices, and
family systems of culturally diverse individuals, families, communities, and populations
they care for, as well as knowledge of the complex variables that affect the achievement of
health and well-being.
2. Education and Training in Culturally Competent Care
 Nurses shall be educationally prepared to provide culturally congruent health care.
Knowledge and skills necessary for assuring that nursing care is culturally congruent shall
be included in global health care agendas that mandate formal education and clinical
training, as well as required ongoing, continuing education for all practicing nurses.
3. Critical Reflection
 Nurses shall engage in critical reflection of their own values, beliefs, and cultural
heritage in order to have an awareness of how these qualities and issues can impact
culturally congruent nursing care.
4. Cross-Cultural Communication
 Nurses shall use culturally competent verbal and nonverbal communication skills to
identify client’s values, beliefs, practices, perceptions, and unique health care needs.
Culturally Competent Practice
 Nurses shall utilize cross-cultural knowledge and culturally sensitive skills in
implementing culturally congruent nursing care.
6. Cultural Competence in Health Care Systems and Organizations
 Health care organizations should provide the structure and resources
necessary to evaluate and meet the cultural and language needs of their diverse
clients.
7. Patient Advocacy and Empowerment
 Nurses shall recognize the effect of health care policies, delivery systems, and
resources on their patient populations, and shall empower and advocate for their
patients as indicated.
 Nurses shall advocate for the inclusion of their patient’s cultural beliefs and
practices in all dimensions of their health care.
8. Multicultural Workforce
 Nurses shall actively engage in the effort to ensure a multicultural workforce
in health care settings. One measure to achieve a multicultural workforce is
through strengthening of recruitment and retention efforts in the hospitals,
clinics, and academic settings.
9. Cross-Cultural Leadership
 Nurses shall have the ability to influence individuals, groups, and systems to
achieve outcomes of culturally competent care for diverse populations.
 Nurses shall have the knowledge and skills to work with public and private
organizations, professional associations, and communities to establish policies
and guidelines for comprehensive implementation and evaluation of culturally
competent care.
10. Evidence-Based Practice and Research
 Nurses shall base their practice on interventions that have been systematically
tested and shown to be the most effective for the culturally diverse populations
that they serve. In areas where there is a lack of evidence of efficacy, nurse
researchers shall investigate and test interventions that may be the most effective
in reducing the disparities in health outcomes.

Douglas MK1, Rosenkoetter M, Pacquiao DF, Callister LC, Hattar-Pollara M,

Lauderdale J, Milstead J, Nardi D, Purnell L. . (2014). Guidelines for implementing
culturally competent nursing care. Journal of Transcultural Nursing, 25(2):109-21. doi:
10.1177/1043659614520998. Epub 2014 Feb 18. Retrieved August 12, 2016.
 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 1st 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]
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.

Resource: http://www.madeleine-leininger.com/cc/overview.pdf
Retrieved on 3/14/2017
from
http://www.tcns.org/Theor
ies.html
 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.
 Leininger’s Theory (cont’d)
 Generic or Folk Systems are the
everyday remedies an individual, family or
group may use to promote wellness and
healing. Some examples might include:

 Chicken Soup
 Chamomile Tea or other Herbal teas
 Voodoo
 Sacrifices of birds or animals
to the spirits
 Prayer
 Curandero

Nurses need to assess in all these areas to

plan safe, effective care.
 Leininger’s Theory (cont’d)
Professional Systems are different depending
upon the Health Care Delivery System of that culture.
Whether there is socialized medicine, private insurance,
communal healthcare, poor economic support vs. great
wealth, all contribute to the influence of the utilization of
Professionals to prevent illness, heal illness, and promote
health and wellness.
Nursing must collaborate within the healthcare
delivery system to plan and implement safe, effective,
culturally competent care.
 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 has continued to evolve in her model development through
her research. Her newest 2010 model emphasizes the
importance of ‘cultural encounters’ to increase cultural
awareness, knowledge, skill, and desire.
 She did much research in the African-American
population.
 Her 2002 model is visually inspirational
“Culturally Competent Model of Care”
http://www.transculturalcare.net/
 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.
 Geiger and Davidhizer Model
Communication
Culturally Unique Individual

Space

Social Organization
Biological Variations

Time
Environmental Control
Giger, J. N., & Davidhizar, R. (2002). Culturally competent care: emphasis on understanding the people of
Afghanistan, Afghanistan Americans, and Islamic culture and religion. International Nursing Review, 49(2), 79-86.
doi:10.1046/j.1466-7657.2002.00118.x
 In Summary

 You have been introduced to several theorists in

Transcultural Nursing other than the author of
your text. Next, we will explore the Purnell and
Paulanka Model in greater depth as it will be the
basis for your Cultural Presentations.
 I hope you have been inspired to learn more
about cultures in order to be a
CULTURALLY CONSCIOUS
COMPETENT NURSE 