Chapter 1
Theoretical Foundations
of Transcultural Nursing
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Historical Origins of Transcultural
Nursing
• Transcultural nursing:
– Dr. Madeleine M. Leininger, nurse anthropologist
– Initial conception in the 1950s
– Formal creation as a specialty and new discipline within
the profession in the 1960s and 1970s
– Nurse scholars have generated a substantial and
important body of transcultural theoretical, research,
and evidence-based knowledge
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Historical Origins of Transcultural
Nursing (cont.)
• Anthropology:
The study of humans including their
– origins
– behavior
– social relationships
– physical and mental characteristics
– customs
– development through time and in all places in the world
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Historical Origins of Transcultural
Nursing (cont.)
• Transcultural nursing:
– Applies to more than merely
• panethnic minorities
• occupations or professions
• nonethnic cultures
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Historical Origins of Transcultural
Nursing (cont.)
• Transcultural nursing is a nursing specialty focused on the
comparative study and analysis of cultures and subcultures.
– It examines these groups with respect to their
• caring behavior
• nursing care
• health–illness values and beliefs
• patterns of behavior
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Historical Origins of Transcultural
Nursing (cont.)
• Transcultural nursing’s goal is to:
– develop a scientific and humanistic body of knowledge in
order to provide nursing care that is both
• culture-specific
• culture-universal
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Historical Origins of Transcultural
Nursing (cont.)
• Culture-specific refers to:
• particular values, beliefs, and patterns of behavior
that tend to be special or unique to a group and that
do not tend to be shared with members of other
cultures
• Culture-universal refers to:
• the commonly shared values, norms of behavior, and
life patterns that are similarly held among cultures
about human behavior and lifestyles
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Historical Origins of Transcultural
Nursing (cont.)
• Transcultural nursing requires:
– Sophisticated assessment and analytic skills
– Ability to
• plan
• design
• implement
• evaluate nursing care
• for individuals, families, groups, and communities
representing various cultures
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Historical Origins of Transcultural
Nursing (cont.)
• Transcultural nursing requires:
– That nurses be able to apply that knowledge to the
cultures of
• organizations
• institutions
• health and nursing agencies
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Question
Is the following question True or False?
Transcultural nursing has been formally considered a nursing
specialty since 2000.
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Answer
False
Rationale: Transcultural nursing was formally considered as
a specialty and new discipline within the profession in the
1960s and 1970s.
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The Importance of Transcultural Nursing
• Eight factors that affect transcultural nursing:
1. Marked increase in the migration of people
2. A rise in multicultural identities
3. The increased use of health care technology
4. Cultural conflicts, clashes, and violence
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The Importance of Transcultural Nursing
(cont.)
• Eight factors that affect transcultural nursing:
5. An increase in the number of people traveling and
migrating for work
6. An increase in legal suits resulting from cultural conflict,
negligence, ignorance, and imposition of health care
practices
7. A rise in feminism and gender issues
8. An increased demand for community and culturally
based health care services
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The Importance of Transcultural Nursing
(cont.)
• Transcultural nursing enables nurses to:
1. Communicate more effectively with clients from diverse
cultural and linguistic backgrounds
2. Assist those of various cultures with mental health
problems
3. Accurately assess the cultural expression of pain
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The Importance of Transcultural Nursing
(cont.)
•
Transcultural nursing enables nurses to:
4. Provide culturally appropriate interventions to prevent or
alleviate discomfort
5. Assess the for parent–child relationship that promote the
health and well-being of children
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Question
This is a multiple choice question.
Which outcome is most affected by effective transcultural
nursing of a culturally diverse client?
A. Pain assessment
B. Cost of nursing care
C. Respect of client’s rights
D. Preserving the client’s independence
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Answer
A. Pain assessment
Rationale: An individual’s perception and display of pain is
directly affected by cultural norms and behaviors. The other
options are universally held nursing responsibilities and not
directly impacted by an individual’s cultural beliefs or
values.
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History of Transcultural Nursing
• Leininger’s Conceptual Framework:
– Sunrise Model
• based on the concept of cultural care that guides
nursing judgments and activities to provide
culturally congruent care
– Theory of Culture Care Diversity and Universality
• focuses on describing, explaining, and predicting
nursing similarities and differences focused
primarily on human care and caring in human
cultures
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History of Transcultural Nursing (cont.)
• The three modes of nursing decisions and
actions:
– culture care preservation and/or maintenance
– culture care accommodation and/or negotiation
– culture care re-patterning and/or restructuring
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History of Transcultural Nursing (cont.)
• Other Models:
– Giger and Davidhizar Transcultural Assessment
Model—six cultural phenomena are:
• communication
• time
• space
• social organization
• environmental control
• biological variations
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History of Transcultural Nursing (cont.)
• Other Models:
– Purnell Model for Cultural Competence
• An organizing framework of 12 domains
• Identifies the primary and secondary characteristics
of culture, which determines an individual’s cultural
heritage including:
• beliefs
• values
• practices
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History of Transcultural Nursing (cont.)
• Other Models
– Andrews/Boyle Transcultural Nursing Assessment
Guide:
• provides a comprehensive and practical overview of
key assessment areas
• provides the foundation for culturally competent care
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History of Transcultural Nursing (cont.)
• Other Models
– Campinha-Bacote Model of Cultural Competence
in the Delivery of Healthcare Services:
• Five encompassing concepts that depict the process
for developing cultural competence:
• cultural awareness
• cultural knowledge
• cultural skill
• cultural encounter
• cultural desire
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Question
Is the following question True or False?
Dr. Madeleine M. Leininger authored both conceptual
frameworks, the Theory of Culture Care Diversity and
Universality and the Sunrise Model.
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Answer
True
Rationale: Dr. Madeleine M. Leininger is credited with
authoring both of these conceptual frameworks related to
transcultural nursing.
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Critical Analysis of Transcultural Nursing
• Major criticisms:
– Ambiguous terminology
– Lacks clarity in describing key concepts
– Failure to recognize the relationship between
knowledge and power
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Critical Analysis of Transcultural Nursing
(cont.)
• Major criticisms:
– Inattention to the complexities associated with
prejudice, discrimination, and racism
– Failure to address bias, prejudice, discrimination, and
social injustice
– Fostering stereotyping
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Critical Analysis of Transcultural Nursing
(cont.)
• Major criticisms:
– Failure to consider the variations within cultures that
influence the ways in which people express their
cultural orientation
– Basing models on the assumption that understanding
one’s own culture and the culture of others creates
tolerance and respect for people from diverse
backgrounds
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Standards for Transcultural Nursing
• The standards for transcultural nursing were
developed to:
– Foster excellence in transcultural nursing practice
– Provide criteria for the evaluation of transcultural
nursing
– Create a tool for teaching and learning
– Increase the public’s confidence in the nursing
profession
– Advance the field of transcultural nursing
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Standards for Transcultural Nursing
• The eight standards for transcultural nursing:
1. Theoretical foundations of transcultural nursing
2. Cultural information gathering
3. Caring and healing systems
4. Cultural health patterns and caring practices
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Standards for Transcultural Nursing
(cont.)
• The eight standards for transcultural nursing:
5. Health care planning
6. Evaluation
7. Research
8. Professional development
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Question
This is a multiple choice question.
Which nursing action addresses a commonly held
criticism of transcultural nursing?
A. Speaking to a client in their native language
B. Requesting a dietary consult to address cultural diet
requests diet
C. Not assuming all members of a culture share all beliefs
D. Allowing the family to perform cultural rituals
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Answer
C. Not assuming all members of a culture share all beliefs
Rationale: A criticism of transcultural nursing is its
tendency to foster stereotypes.
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Certification
• Transcultural nursing certification:
– Sets apart those professional nurses who have:
• Achieved a level of understanding of diverse cultures
• Clinical experiences to provide knowledgeable and
competent care to clients of diverse cultural
backgrounds
• Skills to assess and implement care that is
congruent with the values, beliefs, and life ways of
the clients being served
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