Transcultural Theories and Models

Transcultural Nursing

the study and practice of nursing care that considers how a person's culture affects health, illness, caring, and healthcare decisions.

- Recognizes cultural diversity

- Assesses the patient's cultural beliefs and practices

- Respects the patient's values and preferences

- Incorporates safe cultural practices into care

- Identifies potentially harmful practices

- Negotiates differences between cultural preferences and medical recommendations

- Provides care that is safe, ethical, clinically appropriate, and culturally meaningful

Characteristics of a transculturally competent nurse

Cultural Competence

ability to provide effective care within the patient's cultural context. Develop the knowledge, skills, awareness, attitudes, and willingness needed to provide effective care across cultures.

Cultural Humility

An acknowledgement of one's own barriers to true intercultural understanding. Includes lifelong self-reflection and learning from patients, acknowledging limitations and biases, recognizing power differences, and being open to correction

Culture

the learned and shared patterns of values, beliefs, norms, knowledge, practices, behaviors, symbols, and meanings that influence how people understand and interact with the world.

Learned, Shared, Dynamic, Transmitted, Adaptive, Not deterministic

6 important characteristics of culture

Race

A group of human beings distinguished by physical traits, blood types, genetic code patterns or genetically inherited characteristics.

Ethnicity

Identity with a group of people that share distinct physical and mental traits as a product of common heredity and cultural traditions.

Ethnocentrism

occurs when a person evaluates another culture according to the standards of their own culture and assumes their own culture is Normal, Correct, Better, or Superior

Cultural Relativism

means attempting to understand a belief or behavior within the cultural context in which it exists, rather than immediately judging it using one's own cultural standards.

Cultural Stereotyping

an oversimplified assumption that members of a particular cultural group have the same beliefs, behaviors, values, and practices

Culture and care → Cultural assessment → Cultural competence → Culturally congruent care → Health equity

The Progression in Transcultural Nursing:

Culture and Care

Recognize that culture influences beliefs, values, behaviors, communication, health practices, and responses to illness and healthcare.

Cultural Assessment

Explore the patient's cultural beliefs, practices, values, family structure, communication patterns, and healthcare preferences.

Culturally Congruent Care

Adapt nursing interventions to respect and integrate the patient's cultural beliefs and practices while maintaining safety and evidence-based care.

Health Equity

Reduce cultural barriers and disparities, strengthen trust and communication, improve patient participation, and promote fair and equitable care for all.

Dr. Madeleine Leininger

Mother of Transcultural Nursing

Culture Care Diversity and Universality Theory

Has two core assumptions that caring is the essence of nursing and that diversities and commonalities exist between cultures. Attempts to provide culturally congruent nursing care through "cognitively based assistive, supportive, facilitative, or enabling acts or decisions that are mostly tailor-made to fit with individual, group's, or institution's cultural values, beliefs, and lifeways." The intent of the care is to fit with or have beneficial meaning and health outcomes for people of different or similar culture backgrounds.

Cultural Diversity

The varying cultural differences, meanings, and patterns in care among different groups.

Cultural Universality

The common, shared care or health-seeking behaviors found across different human cultures

The Sunrise Enabler Model

Represents hope for generating new nursing knowledge. A visual diagram that helps nurses analyze how worldview, social structures, religion, politics, and language influence an individual's health and care.

Technological factors

Religious and philosophical factors

Economic factors

Educational factors

Kinship and social factors

Cultural values, beliefs, and ways of life

Political and legal factors

Seven Influencing Factors (Sunrays) that affect health and illness:

Preservation/Maintenance

Accommodation/Negotiation

Repatterning/Restructuring

Three Action Modes for Culturally Congruent Care

Preservation/Maintenance

Ethnonursing mode of action (Leininger's model) in which patients fully implement their cultural health practice.

Accommodation/Negotiation

Adapting care plans to fit a patient's cultural habits without compromising health.

Repatterning/Restructuring

Mutual modification of nursing actions by nurse and client to promote better health outcomes

Larry Purnell (1991)

Developed the Model for Cultural Competence

Purnell Model for Cultural Competence (PMCC)

Provides a framework for cultural assessment and helps healthcare providers understand how culture affects healthcare beliefs, behaviors, and practices. Promotes culturally congruent, sensitive, and competent healthcare. Has 12 wedge-shaped cultural domains surrounded by 4 concentric rims. Widely used in nursing education and clinical practice. Helps nurses avoid assumptions and provide care that respects the patient's cultural beliefs and practices.

1. Global Society - broad influences such as worldwide trends and globalization.

2. Community - influences from the person's community and social environment.

3. Family - family roles, values, beliefs, and practices.

4. Individual - the person's unique cultural characteristics and experiences.

4 rims of the PMCC

Overview/Heritage

Communication

Family Roles & Organization

Workforce Issues

Biocultural Ecology

High-Risk Behaviors

Nutrition

Pregnancy & Childbearing

Death Rituals

Spirituality

Healthcare Practices

Healthcare Providers

12 cultural domains of the PMCC

Marianne Jeffreys

Developed the Cultural Competence and Confidence Model (CCC)

Jeffreys' Cultural Competence and Confidence Model (CCC)

Explains how nurses develop cultural competence and confidence when caring for patients from cultures different from their own.

Transcultural Self-Efficacy (TSE)

The core mechanism of the model, defined as a person's perceived confidence in learning or performing transcultural skills. Grounded in Bandura's social cognitive theory

Cognitive, Practical, Affective

3 Learning dimensions of CCC

Campinha-Bacote's Process of Cultural Competence in the Delivery of Healthcare Services (PCCDHS)

views cultural competence as an ongoing process, rather than something a healthcare professional simply "has."

Cultural Awareness (Know yourself)

Cultural Knowledge (Learn about others)

Cultural Skill (Know how to assess)

Cultural Encounters (Interact with others)

Cultural Desire (want to learn)

5 Constructs of the PCCDHS

Campinha-Bacote's Biblically Based Model of Cultural Competence in the Delivery of Healthcare Services.

integrates the principles of cultural competence with Christian/Biblical values. It emphasizes that healthcare providers should recognize and respect patients' cultural and spiritual beliefs while providing compassionate, ethical, and holistic care. Emphasizes values such as love, compassion, respect, humility, service, and treating every person as having inherent worth.

Imago Dei

Latin for "image of God," which refers to the fact that God created man in his own image and likeness. Key concept in BBMCCDHS which provides a theological foundation for culturally competent care: understanding and respecting cultural differences is part of honoring the God-given dignity of every individual.

Joyce Newman Giger and Ruth Elaine Davidhizar

Developed the Transcultural Assessment Model

Giger & Davidhizar's Transcultural Assessment Model (TAM)

help nurses assess culturally diverse patients and provide culturally appropriate care. It is based on the work of Leininger, Spector, Orque et al., and Hall. It focuses on 6 areas that can influence how a person experiences health and healthcare

1. Biological Variations

2. Environmental Control

3. Time

4. Social Orientation

5. Space

6. Communication

The 6 Cultural Phenomena of TAM which are connected and overlap with one another. By understanding these six areas, the nurse can avoid making assumptions and provide care that fits the patient's culture and individual needs.

Joyceen S. Boyle and Margaret M. Andrews

Developed Transcultural Nursing Assessment Guides

Boyle & Andrews: Transcultural Nursing Assessment Guides

developed practical assessment guides to help nurses understand culture and provide culturally congruent care. Unlike models such as Purnell or Giger-Davidihizar, schools can use the guides without adopting a specific transcultural nursing model.

1. Transcultural Nursing Assessment Guide for Individuals and Families (TCNGIF)

2. Transcultural Nursing Assessment Guide for Groups and Communities (TCNAGGC)

3. Guide for Healthcare Organizations and Facilities

3 main assessment guides by Boyle and Andrews, depending on what is being assessed:

Biocultural variations & disease

Communication

Cultural affiliations

Cultural sanctions & restrictions

Developmental considerations

Economics

Educational background

Health beliefs & practices

Kinship & social networks

Nutrition

Religion & spirituality

Values orientation

the 12 categories of Transcultural Nursing Assessment Guide for Individuals and Families which help nurses perform a cultural and physical assessment of individuals and families.

Family & kinship systems

Social & life networks

Political/government systems

Language & traditions

Worldviews, values & cultural norms

Religious beliefs & practices

Health beliefs & practices

Healthcare systems

the 8 categories of Transcultural Nursing Assessment Guide for Groups and Communities. Used when assessing larger groups or communities, rather than just one patient or family.

Environmental context

Language & ethnohistory

Technology

Religious/philosophical factors

Social factors

Cultural values

Political/legal factors

Economic factors

Education

9 areas of the Guide for Healthcare Organizations and Facilities. This guide looks at the organization itself and whether it can provide culturally competent care. It aims to to help healthcare organizations become culturally competent environments, not just individual nurses.

Rachel E. Spector

nursing scholar known for developing the Heritage Assessment Tool and the Health Traditions Model (HTM), which help nurses understand how cultural heritage influences health beliefs and practices.

Spector's Heritage Traditions Model / Health Traditions Model (HTM)

a transcultural nursing model that explains how a person's cultural heritage and personal health traditions influence how they maintain, protect, and restore health. It was developed by incorporating Giger and Davidhizar's six cultural phenomena.

A balance within the person and between the person and the outside world. This balance involves the three dimensions from Physical, Mental, Spiritual

Spector views health as:

Maintaining health

Protecting health

Restoring health

Spector's model focuses on three major aspects of health traditions: