Title of
theory
Culture Care Diversity and Universality
Cultural Competence Model
Author of
theory
Year theory
started
Madeleine Leininger
Larry Purnell
1950
1991
Reason for
developing
the theory
To provide knowledge on these factors so that “culturally
congruent care” will be acknowledged and delivered by
modifying health care to individuals, families and communities.
•
•
•
Sunrise Enabler Model
Name and
illustration of
the
theoretical
model
•
•
to learn concepts and characteristics of culture;
to define situations and understand the unique
ethno-cultural environment;
know the relationship of culture and health;
to facilitate culturally-sensitive care, and;
have basis for analysis of culture.
Purnell Cultural Competence Model
Assumptions
of the theory
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. Leininger’s 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.
1. All healthcare professions need similar
information about cultural diversity.
2. All healthcare professions share the
metaparadigm concepts of global society,
family, person, and health
3. One culture is not better than another culture
they are just different
4. Core similarities are shared by all cultures.
5. Differences exist within, between, and among
cultures
6. Cultures change slowly over time
7. The primary and secondary characteristics of
culture determine the degree to which one
varies from the dominant culture.
8. If clients are coparticipants in their care and
have a choice in health-related goals, plans,
and interventions, their compliance and health
outcomes will be improved.
9. Culture has a powerful influence on one's
interpretation of and responses to health care.
10. Individuals and families belong to several
cultural groups.
11. Each individual has the right to be respected for
his or her uniqueness and cultural heritage.
12. Caregivers need both cultural-general and
cultural specific information in order to provide
culturally sensitive and culturally competent
care.
13. Caregivers who can assess, plan, intervene,
and evaluate in a culturally competent manner
will improve the care of clients for whom they
care.
14. Learning culture is an ongoing process that
develops in a variety of ways, but primarily
through cultural encounters (Campinha-Bacote,
2004).
15. Prejudices and biases can be minimized with
cultural understanding.
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.
16. To be effective, health care must reflect the
unique understanding of the values, beliefs,
attitudes, lifeways, and worldview of diverse
populations and individual acculturation
patterns.
17. Differences in race and culture often require
adaptations to standard interventions.
18. Cultural awareness improves the caregiver's
self- awareness
19. When individuals of dissimilar cultural
orientations meet in a work or therapeutic
environment, the likelihood for developing a
mutually satisfying relationship is improved if
both parties in the relationship attempt to learn
about each other's culture.
20. Culture is not border bound. People bring their
culture with them when they migrate.
21. Professions, organizations, and associations
have their own culture, which can be analyzed
using a grand theory of culture.
Title of theory
Author of theory
Year theory started
Reason for
developing the
theory
The Process Of Cultural Competence In the Delivery
Of Healthcare Services: A Model Of Care
Transcultural Assessment Model
Josepha Camphina-Bacote
1991
• to become culturally competent, the health care
provider should integrate five processes including
cultural awareness, cultural knowledge, cultural
skill, cultural encounters and cultural desire
Cultural Competence in the Delivery of Health Care
Services Model
Joyce Newman Giger and Ruth Davidhizar
1988, 2002
• to create an assessment tool to be used by the
students and guide them in their communication
with culturally diverse patients.
Giger and Davidhizar’s Transcultural Assessment
Model
Name and illustration
of the theoretical
model
Assumptions of the
theory
1.
Cultural competence is a process, not an event.
Metaparadigm for the Model
2.
3.
4.
5.
Cultural competence consists of five constructs:
cultural awareness, cultural knowledge, cultural
skill, cultural encounters, and cultural desire.
There is more variation within ethnic groups than
across ethnic groups (intra-ethnic variation).
There is a direct relationship between the level of
competence of health care providers and their
ability to provide culturally responsive health care
services.
Cultural competence is an essential component
in rendering effective and culturally responsive
services to culturally and ethnically diverse
clients.
1. Transcultural nursing: A culturally competent practice
field that is client centered and research focused.
2. Culturally competent care: A dynamic, fluid,
continuous process whereby an individual, system, or
health care agency finds meaningful and useful care
delivery strategies based on knowledge of the cultural
heritage, beliefs, attitudes, and behaviors of those to
whom they render care (Davidhizar & Giger, 1998).
Cultural competence connotes a higher, more
sophisticated level of refinement of cognitive skills and
psychomotor skills, attitudes, and personal beliefs. To
develop cultural competency, it is essential for the
health care professional to use knowledge gained from
conceptual and theoretical models of culturally
appropriate care. Attainment of cultural competence can
assist the astute nurse in devising meaningful
interventions to promote optimal health among
individuals regardless of race, ethnicity, gender identity,
sexual identity, or cultural heritage.
3. Culturally unique individuals: An individual is
culturally unique and as such is a product of past
experiences, cultural beliefs, and cultural norms.
4. Culturally sensitive environments: Culturally diverse
health care can and should be rendered in a variety of
clinical set- tings. Regardless of the level of care,
primary, secondary, or tertiary knowledge of culturally
relevant information will assist in planning and
implementing a culturally competent treatment regime.
5. Health and health status: Health and health status is
based on culturally specific illness and wellness
behaviors. An individual’s cultural beliefs, values, and
attitudes all contribute to the overarching meaning of
health for each individual.
Title of theory
Author of theory
Year theory started
Reason for
developing the theory
Name and illustration
of the theoretical
model
Cultural Competence and Confidence (CCC) Model
Bureaucratic Caring Theory
Marianne R. Jeffreys
2004
• to interrelate concepts that explain, describe,
influence, and/or predict the phenomenon of
learning (developing) cultural competence and
incorporates the construct of TSE (confidence) as
a major influencing factor
Cultural Competence and Confidence Model
Marilyn Anne Ray
1981
• To illustrate caring as not only humanistic, ethical,
spiritual, social, cultural and educational but also as
part of the structural. Political, economic, legal and
technological characteristics of a complex
organization.
Holographic Theory of Bureaucratic Caring
Assumptions of the
theory
1. Cultural competence is an ongoing,
multidimensional learning process that integrates
transcultural skills in all three dimensions
(cognitive, affective, and practical), involves
transcultural self-efficacy (confidence) as a major
influencing factor, and aims to achieve cultural
congruent care.
2. Transcultural self-efficacy is a dynamic construct
that changes over time and is influenced by
formalized exposure to culture care concepts
(transcultural nursing)."
3. The learning of transcultural nursing skills is
influenced by self-efficacy perceptions
(confidence).
4. The performance of transcultural nursing skill
competencies is directly influenced by the
adequate learning of such skills and by
transcultural self-efficacy perceptions.
5. The performance of culturally congruent nursing
skills is influenced by self-efficacy perceptions and
by formalized educational exposure to
transcultural nursing care concepts and skills
throughout the educational experience.
6. All students and nurses (regardless of age,
ethnicity, gender, sexual orientation, lifestyle,
religion, socioeconomic status, geographic
location, or race) require formalized educational
experiences to meet culture care needs of diverse
individuals."
7. The most comprehensive learning involves the
integration of cognitive, practical, and affective
dimensions.
8. Learning in the cognitive, practical, and affective
dimensions is paradoxically distinct yet
interrelated."
9. Learners are most confident about their attitudes
(affective dimension) and least confident about
their transcultural nursing knowledge (cognitive
dimension)."
1. Nursing is holistic, relational, spiritual, and ethical
caring that seeks the good of self and others in
complex community, organizational, and
bureaucratic cultures. Dwelling more deeply with the
nature of caring reveals that the foundation of
spiritual caring is love. Through knowledge of the
inner mystery of the inspirational life within, love
calls forth a responsible ethical life that enables the
expression of concrete actions of caring in the lives
of nurses. As such, caring is cultural and social.
Transcultural caring encompasses beliefs and
values of compassion or love and justice or fairness,
which find significance in the social realm, where
relationships are formed and transformed.
Transcultural caring serves as a unique lens through
which human choices are seen, and understanding
in health and healing emerges. Thus, through
compassion and justice, nursing strives toward
excellence in the activities of caring through the
dynamics of complex cultural contexts of
relationships, organizations, and communities
2. A person is a spiritual and cultural being. Persons
are created by God, the Mystery of Being, and they
engage co-creatively in human organizational and
transcultural relationships to find meaning and
value
3. Health provides a pattern of meaning for
individuals, families, and communities. In all human
societies, beliefs and caring practices about illness
and health are central features of culture. Health is
not simply the consequence of a physical state of
being. People construct their reality of health in
terms of biology, mental patterns, characteristics of
their image of the body, mind, and soul, ethnicity
and family structures, structures of society and
community (political, economic, legal, and
technological), and experiences of caring that give
meaning to lives in complex ways. The social
organization of health and illness in society (the
10. Novice learners will have lower self-efficacy
perceptions than advanced learners."
11. Inefficacious individuals are at risk for decreased
motivation, lack of commitment, and/ or avoidance
of cultural considerations when planning and
implementing nursing care.
12. Supremely efficacious (overly confident)
individuals are at risk for inadequate preparation in
learning the transcultural nursing skills necessary
to provide culturally congruent care.
13. Early intervention with at-risk individuals will better
prepare nurses to meet cultural competency.
14. The greatest change in transcultural self-efficacy
perceptions will be detected in individuals with low
self-efficacy (low confidence) initially, who have
then been exposed to formalized transcultural
nursing concepts and experiences.
healthcare system) determines the way that people
are recognized as sick or well. It determines how
health professionals view health and illness, and
how individuals view health and illness. Health is
related to the way that people in a cultural group or
organizational culture or bureaucratic system
construct reality and give or find meaning