DISCUSSION ACROSS MODELS AND FUTURE OF TCN

- The author reviews one theory, five models, and one cultural assessment guide for their
applicability in nursing education, practice, and administration.
- Emphasizes the holistic nature of the reviewed theory, models, and guide compared to
traditional healthcare approaches.
- Advocates for a holistic perspective to enhance culturally congruent care in assessment,
planning, implementation, and evaluation.
- Highlights the integration of transcultural nursing concepts through scenarios, role plays, and
tables.
- Calls for a renewed dialogue among transcultural nursing theorists and model developers to
assess the evolution and clinical utility of these frameworks.
- Suggests revisiting evaluation criteria such as congruence, inclusivity, scope, and utility to align
with current healthcare practices.
- Encourages exploration of how these theories, models, and guide can be effectively
implemented in modern healthcare settings to shape nursing education, practice, and
administration.

1. Madeleine Leininger's Theory of Culture Care Diversity and Universality

-This model, often referred to as the "Sunrise Model," emphasizes understanding the cultural
beliefs, values, and practices of patients to provide culturally congruent care. It highlights the
interconnectedness of various cultural dimensions, including religious, financial, social,
technological, educational, legal, political, and philosophical aspects. The model encourages
nurses to consider both the universal and culture-specific aspects of care, promoting a holistic
approach.

Leiniger’s theory is depicted as the sunrise enabler to discover culture care, symbolic of hope to
generate new knowledge for nursing. The model shows factors such as (1) technoogical, (2)
religious and philosophical (3) kinship and social, (4) cultural values and lifeways, (5) political and
legal, (6) economic, and (7) educational, forming sunrays that influence individuals, families, and
groups in health and illness (Leininger, 1995, 2002, 2006).

-The model indicates the applicable ways in assessing and caring for individuals, families, groups,
communities, and institutions in various health systems.

2. Larry Purnell's Model for Cultural Competence

-This model views cultural competence as a developmental process, progressing through
four stages: unconscious incompetence, conscious incompetence, conscious competence, and
unconscious competence. It emphasizes the importance of continuous learning and self-
reflection to achieve cultural competence. The model incorporates both macro- and micro-
aspects of culture, encompassing global society, community, family, and the individual. It
highlights 12 domains of cultural influence, including religion, spirituality, education, technology,
and economics.

The Purnell Model is visually represented as a series of concentric circles, each representing a
different level of cultural influence:

 Global Society: The outermost circle represents the global society, recognizing the
interconnectedness of different cultures and the impact of globalization on individuals and
communities.
 Community: The second circle represents the community, acknowledging the influence of
community values, ethics, and goals on individual health beliefs and practices.
 Family: The third circle represents the family, emphasizing the importance of understanding
family structures, roles, and dynamics in shaping an individual's health beliefs and behaviors.
 Person: The innermost circle represents the individual, acknowledging the unique values,
beliefs, and experiences that shape each person's perspective on health and illness
The Twelve Cultural Domains
Within the innermost circle, the model identifies twelve cultural domains that represent key
aspects of cultural influence:

1. Overview/Heritage: This domain focuses on an individual's origin and cultural background,

including their history, traditions, and values.
2. Communication: This domain emphasizes the importance of understanding verbal and
nonverbal communication styles, including language, tone, and body language.
3. Family Roles and Organization: This domain explores the structure and dynamics of family
relationships, including gender roles, decision-making processes, and family support systems.
4. Workforce Issues: This domain focuses on the impact of work-related factors, such as
language barriers, on an individual's health and well-being.
5. Biocultural Ecology: This domain considers the biological and environmental factors that
influence health, including genetic predispositions, dietary habits, and environmental
exposures.
6. High-Risk Behaviors: This domain examines the prevalence and impact of high-risk
behaviors, such as alcohol consumption, within different cultures.
7. Nutrition: This domain explores dietary practices and beliefs, including food preferences,
cultural taboos, and the role of food in health and illness.
8. Pregnancy and Childbearing: This domain acknowledges the diverse cultural beliefs and
practices surrounding pregnancy, childbirth, and child-rearing.
9. Death Rituals: This domain recognizes the importance of understanding cultural beliefs and
practices related to death, dying, and bereavement.
10. Spirituality: This domain emphasizes the significance of spirituality in an individual's life,
including religious beliefs, practices, and the role of faith in health and healing.
11. Health Care Practices: This domain explores cultural beliefs and practices related to
healthcare, including attitudes towards healthcare providers, treatment preferences, and
access to healthcare services.
12. Health Care Practitioner: This domain acknowledges the influence of cultural beliefs and
values on the relationship between healthcare providers and patients.

The Center of the Model: The Unknown

The Purnell Model includes a black circle in the center, representing the unknown. This symbolizes
the ongoing process of learning and understanding different cultures, acknowledging that there
will always be more to discover and appreciate.

3. Josepha Campinha-Bacote's Process of Cultural Competence in the Delivery of Healthcare

Services
- This model emphasizes the importance of cultural desire, the intrinsic motivation to
engage in the process of cultural competence. It outlines five key elements: cultural awareness,
cultural knowledge, cultural skill, cultural encounter, and cultural desire. The model encourages
nurses to actively seek out opportunities to learn about and interact with diverse cultures, fostering
a deeper understanding and sensitivity.

1. Cultural Awareness:
This component involves recognizing one's own cultural biases, prejudices, and assumptions. It
requires self-reflection and an understanding of how one's own cultural background influences
perceptions and interactions with others
2. Cultural Knowledge:
This component involves acquiring knowledge about different cultures, including their beliefs,
values, health practices, and communication styles. It requires a commitment to learning about
diverse populations and understanding how cultural factors influence health and illness.

3. Cultural Skill:
This component involves developing the ability to effectively communicate and interact with
patients from diverse cultural backgrounds. It includes acquiring skills in language interpretation,
cultural assessment, and culturally sensitive communication.Healthcare providers must be able to
adapt their communication and care delivery to accommodate cultural differences.

4. Cultural Encounter:
This component involves engaging in meaningful interactions with people from diverse cultures. It
requires actively seeking out opportunities to learn from and interact with individuals from different
backgrounds

5. Cultural Desire:
This component involves having a genuine interest in understanding and respecting diverse
cultures. It requires a commitment to providing culturally competent care and a willingness to go
beyond the minimum requirements to provide culturally sensitive and effective care.

4.Giger and Davidhizar's Transcultural Assessment Model

-This model focuses on assessing and intervening from a transcultural perspective,
recognizing the individual as a unique cultural being. It examines six cultural phenomena of
human diversity: communication, space, time, social organization, environmental control, and
biological variations (Dowd, Davidhizar, & Giger, 1998). The model provides a structured
framework for understanding and addressing cultural differences in these areas, enabling nurses
to tailor care to individual needs.
-The Giger and Davidhizar (2008) model has five metaparadigms:
 ”transcultural nursing and culturally diverse nursing;
 Culturally competent care;
 Culturally unique individuals;
 Culturally sensitive environments;
 Health and health status based on culturally specific illness and wellness behavior

 Biological Variations- physical characteristics such as stature and skin and hair color;
enzymatic and genetic presence of disease; susceptibility to illness; and psychological coping
 Environmental Control- health practices, values, and views on health and illness, including
how one’s behavior affected one’s health.
 Space
 Time
 Social Organzation
 Communication

5.Rachel Spector's Health Traditions Model

-This model highlights the importance of understanding the patient's health beliefs and
practices, including traditional healing methods. It encourages nurses to incorporate these beliefs
into the care plan.

1. Cultural Competency: The model emphasizes the importance of cultural competency,

which involves understanding and respecting the cultural beliefs and practices of patients.
This requires healthcare providers to develop cultural awareness, knowledge, and skills to
effectively interact with diverse populations.
2. Cultural Care: The model highlights the importance of providing culturally congruent care,
which means tailoring healthcare interventions to align with the patient's cultural beliefs
 and practices. This involves respecting the patient's values, beliefs, and traditions and
incorporating them into the care plan.
3. Health: The model defines health as a holistic concept encompassing physical, mental,
and spiritual well-being. It recognizes that health is influenced by a multitude of factors,
including cultural background, family history, and environment.
4. Healing: The model acknowledges the role of traditional healing practices in restoring
health. It encourages healthcare providers to understand and respect the use of traditional
medicine, rituals, and therapies alongside conventional medical treatments.

6.Andrews and Boyle's Transcultural Nursing Assessment Guide

-This guide provides a comprehensive framework for assessing cultural factors that may
influence patient care. It covers a wide range of areas, including communication, spirituality,
health beliefs, and family structure.
-Andrews and Boyle emphasize that cultural knowledge is the foundation for a cultural
assessment. They believe that this knowledge, combined with the nurse's critical thinking skills,
provides the basis for delivering culturally competent care.

1. Before the Assessment

 Know the key topics to address: This includes understanding the cultural domains relevant
to the individual's background, such as communication, family roles, nutrition, and
spirituality.
 Know how to address these topics without offending the patient and family: This involves
being sensitive to cultural norms and avoiding language or behaviors that may be
perceived as disrespectful.
 Determine if you'll need an interpreter: This is crucial for ensuring effective communication
and understanding, particularly when language barriers exist.
 Identify a patient confidante who may help bridge the cultural gap: This can be a family
member, friend, or community leader who can provide insights into the individual's cultural
background.
 Interview other providers who know the patient to obtain relevant information: This can help
gather information about the individual's health history, cultural practices, and any previous
interactions with the healthcare system.
 Select a strategy for gathering data: This could involve a formal interview, an informal
conversation, or observation of the individual's behavior and interactions.

2. During the Assessment

 Be aware of the environment: Observe the individual's surroundings and identify any
cultural cues or symbols that may provide insights into their beliefs and practices.
 Look around: Pay attention to the individual's appearance, clothing, and personal
belongings, as these can offer clues about their cultural background.
 Assess verbal and nonverbal communications: Observe the individual's communication
style, including their language, tone, body language, and eye contact.

The Twelve Cultural Domains of the Guide

-Andrews and Boyle's guide outlines twelve cultural domains that provide a comprehensive
framework for assessing cultural influences on health:

1. Cultural Affiliations: This domain explores the individual's cultural group(s) and their level of
identification with those groups. It also considers their place of birth, past residences, and
any potential impact of recent relocation.
 2. Values Orientation: This domain focuses on the individual's attitudes, values, and beliefs
about life events, health, illness, and healthcare providers. It also examines their views on
body image, illness stigma, work, leisure, education, and change.
3. Cultural Sanctions and Restrictions: This domain explores the individual's cultural group's
rules and regulations regarding emotional expression, spirituality, religious beliefs, modesty,
gender roles, sexuality, and death rituals.
4. Communication: This domain examines the individual's primary language, fluency in English,
preferred language for communication, and use of nonverbal communication. It also
considers the need for an interpreter and any preferences regarding the interpreter's
gender, age, or cultural background.
5. Health-Related Beliefs and Practices: This domain explores the individual's beliefs about the
causes of illness, ideal body image, self-image, and health promotion practices. It also
considers their religious affiliation, reliance on cultural healers, and perceptions of
biomedical healthcare providers and nurses.
6. Nutrition: This domain examines the individual's dietary practices and beliefs, including food
preferences, cultural taboos, and the role of food in health and illness. It also considers the
influence of religious beliefs and practices on their diet.
7. Socioeconomic Considerations: This domain explores the individual's social support network,
the roles of family members in health and illness, and the influence of socioeconomic status
on their lifestyle, living conditions, and access to healthcare.
8. Organizations Providing Cultural Support: This domain examines the influence of ethnic or
cultural organizations on the individual's access to healthcare and their overall well-being.
9. Educational Background: This domain explores the individual's highest level of education
and its impact on their knowledge of the healthcare system, their ability to understand
written materials, and their preferred learning style.
10. Religious Affiliation: This domain examines the influence of the individual's religious beliefs
and practices on their health and illness, including their views on life events, healing rituals,
and the role of religious representatives.
11. Cultural Aspects of Disease Incidence: This domain considers the prevalence of specific
genetic or acquired conditions and socioenvironmental diseases within the individual's
cultural group. It also examines their resistance to certain diseases.
12. Biocultural Variations: This domain explores the individual's distinctive physical features,
anatomical variations, and any impact these variations may have on their physical
examination. It also considers their growth and development characteristics and their
cultural perceptions of aging.

The Future of TCN in Nursing Education

Sagar's vision for the future of Transcultural Nursing in nursing education is ambitious and
multifaceted. She advocates for a shift from simply integratingTranscultural Nursing concepts into
existing curricula to creating a more comprehensive and culturally responsive learning
environment. This vision encompasses several key elements:

 TCN Content: Integration of Concepts Versus Separate Courses: Sagar argues that
Transcultural Nursing should not be treated as a separate subject but rather integrated into
all aspects of nursing education. This approach ensures that cultural competence
becomes a core competency for all nurses, regardless of their specialization.
 Cultural Competence Among Nursing Students: Sagar emphasizes the importance of
fostering cultural competence among nursing students. This includes developing their
cultural awareness, knowledge, skills, and sensitivity to diverse cultural perspectives.
  Faculty Preparation in TCN: Sagar recognizes the need for ongoing professional
development and training for nursing faculty in Transcultural Nursing. This ensures that
educators are equipped to effectively integrate Transcultural Nursing concepts into their
teaching and create a culturally responsive learning environment.
 Nontraditional and Minority Students: Sagar highlights the importance of creating an
inclusive and welcoming environment for nontraditional and minority students in nursing
education. This includes addressing potential barriers to access and ensuring that diverse
perspectives are represented in the curriculum.
 Learning TCN at a Distance: With the increasing popularity of online learning, Sagar
emphasizes the need to adapt Transcultural Nursing education for distance learning
environments. This includes developing innovative strategies for fostering cultural awareness,
knowledge, and skills in virtual settings.

The Future of TCN in Nursing Practice

Sagar envisions a future where Transcultural Nursing is deeply embedded in nursing practice,
transforming how nurses care for diverse patient populations. This vision encompasses several key
elements:

 Cultural Assessment: Sagar emphasizes the importance of conducting thorough cultural

assessments as an integral part of patient care. This involves understanding the patient's
cultural beliefs, practices, and values, as well as their preferred communication styles and
decision-making processes.
 Culturally Congruent Care: Sagar advocates for providing culturally congruent care, which
means tailoring care plans to align with the patient's cultural beliefs and practices. This
ensures that care is respectful, sensitive, and effective for each individual.
 Intercultural Communication: Sagar recognizes the crucial role of intercultural
communication in providing culturally competent care. This involves developing effective
communication skills that bridge cultural differences and enhance understanding between
nurses and patients.
 Addressing Health Disparities: Sagar highlights the need for nurses to actively address
health disparities that disproportionately affect certain cultural groups. This involves
understanding the social, economic, and environmental factors that contribute to these
disparities and advocating for policies and practices that promote health equity.
 Collaborative Care: Sagar emphasizes the importance of collaborative care, involving
patients, families, and other healthcare professionals in the decision-making process. This
ensures that care is culturally sensitive and aligned with the patient's needs and
preferences.


The Future of TCN in Nursing Administration

Sagar envisions a future where Transcultural Nursingis central to nursing administration, shaping
policies, practices, and organizational culture to promote equity and inclusivity in healthcare. This
vision encompasses several key elements:

 Leadership Development: Sagar emphasizes the need for developing culturally competent
nursing leaders who can championTranscultural Nursing principles within their organizations.
This includes providing training and mentorship opportunities to equip leaders with the
knowledge, skills, and sensitivity to promote cultural responsiveness.
 Policy and Practice: Sagar advocates for developing and implementing policies and
practices that promote cultural sensitivity and equity in healthcare. This includes addressing
health disparities, ensuring access to culturally appropriate care, and promoting culturally
competent communication.
  Diversity and Inclusion: Sagar highlights the importance of creating a diverse and inclusive
workforce that reflects the communities served. This involves recruiting and retaining nurses
from diverse backgrounds, promoting cultural understanding and sensitivity, and fostering a
welcoming and equitable work environment.
 Community Engagement: Sagar emphasizes the need for nursing administrators to engage
with their communities to understand their cultural needs and preferences. This involves
building relationships with community leaders, participating in community events, and
seeking input from diverse stakeholders.
 Research and Evaluation: Sagar advocates for conducting research and evaluating the
impact of Transcultural Nursing initiatives in nursing administration. This involves measuring
the effectiveness of programs, identifying areas for improvement, and disseminating best
practices to promote continuous learning and improvement.

Embracing a Transformative Future of Transcultural Nursing

Sagar envisions a future where Transcultural Nursing is not just a niche area but a fundamental
aspect of nursing practice. This vision encompasses several key elements:

 Integration into Nursing Education: Transcultural Nursing should not be treated as a

separate subject but rather integrated into all aspects of nursing education. This ensures
that cultural competence becomes a core competency for all nurses, regardless of their
specialization.
 Culturally Competent Nursing Practice: Nurses should conduct thorough cultural
assessments, provide culturally congruent care, and utilize effective intercultural
communication skills to bridge cultural differences and enhance understanding between
nurses and patients.
 Transcultural Nursing in Nursing Administration: Nursing administrators should champion
Transcultural Nursing principles within their organizations by developing culturally
competent leaders, implementing policies and practices that promote cultural sensitivity
and equity, and creating a diverse and inclusive workforce.
 Community Engagement: Nursing administrators should engage with their communities to
understand their cultural needs and preferences, building relationships with community
leaders, participating in community events, and seeking input from diverse stakeholders.
 Research and Evaluation: Sagar advocates for conducting research and evaluating the
impact of Transcultural Nursing initiatives to measure the effectiveness of programs, identify
areas for improvement, and disseminate best practices.

References:

Sagar, P.L., 2011, Transcultural Nursing Theory and Models.,ISBN: 9780826107480

4.8: Transcultural Nursing Care Models. (2021, July 3). Medicine LibreTexts.
https://med.libretexts.org/Bookshelves/Nursing/Nursing_(Ulutasdemir)/04%3A_Transcultural_
Nursing/4.08%3A_Transcultural_Nursing_Care_Models
 In partial fulfillment of the requirement for the subject NCM 120, LEC

DISCUSSION ACROSS MODELS AND

FUTURE OF TCN

SUBMITTED BY:

Baliquid, Yvonne pearl a.

Submitted to:
Judith l. saingan, rn

Date of submittion:

November 7, 2024