The demographic profile of the countries suggests that countries are rapidly becoming heterogeneous, multicultural societies. So it is imperative that nurses develop an understanding about culture and its relevance to competent care. Transcultural nursing represents and reflects the need for respect and acknowledgement of the wholeness of all human beings. It is essential to remember that regardless of race ethnicity or cultural heritage, every human being is culturally unique. Professional nursing care is culturally sensitive, culturally appropriate and culturally competent

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TRANSCULTURAL NURSING
INTRODUCTION
The demographic profile of the countries suggests that countries are rapidly becoming
heterogeneous, multicultural societies. So it is imperative that nurses develop an understanding
about culture and its relevance to competent care. Transcultural nursing represents and reflects the
need for respect and acknowledgement of the wholeness of all human beings.
It is essential to remember that regardless of race ethnicity or cultural heritage, every human being
is culturally unique. Professional nursing care is culturally sensitive, culturally appropriate and
culturally competent.
TERMINOLOGIES
 CULTURE- It represents the nonphysical traits, such as values, beliefs, attitudes and
customs, shared by a group of people and passed from one generation to next.
 TRANSCULTURE- Extending through all human cultures or involving, encompassing, or
combining elements of more than one culture.
 CULTURAL VALUES – They are unique individual expressions of a particular culture
that have been accepted as appropriate overtime.
 ETHNITHCITY – It refers to group whose members share a common social and cultural
heritage that is passed on to successive generations.
 DIVERSITY – It refers to the fact or state of being different
 CULTURAL IMPOSITION- It is the tendency to impose one’s cultural beliefs values
and patterns of behavior on a person or persons from different cultures
 CULURAL SHOCK- It is a disorder that occurs in response to transition from one culture
setting to another.
FOUNDER OF TRANSCULTURAL NURSING: Dr. Madeleine Leininger

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CONCEPT OF TRANSCULTURAL NURSING
According to Stokes (1991): Nursing as a profession is not “culturally free” but rather is “culturally
determined”. Transcultural nursing is providing client centered culturally competent care to clients
from various ethnic and cultural backgrounds.
DEFINITION
Transcultural nursing as a substantive area of study and practice focused on comparative cultural
care values, beliefs and practices of individuals or groups of similar or different cultures.
Madeleine Leininger
A humanistic and scientific onset of formal study in nursing, which is focused upon differences and
similarities among cultures with respect to care, health and illness based upon the people’s cultural
values, beliefs and practices and to use this knowledge to provide culture specific nursing care.
Transcultural nursing represents an effort by the nurses from all cultural backgrounds and clinical
areas to camel together and defined concepts that enable them to develop the knowledge and skills
needed to provide culturally sensitive care.
PURPOSE OF DEVELOPING TRANSCULTURAL PRACTICES
 Nurses are central in providing culturally competent healthcare.
 Combining the knowledge and patterns of Transcultural advancements result in improved
nursing care.
 To make growing awareness and acceptance of diversity and willingness to maintain and
support ethnic and cultural heritage.
 Increasing awareness among the consumers of what constitutes competent and sensitive
health care.
 Nursing profession continues to value holistic and comprehensive approach to provide care.
NURSING IN A DIVERSE HEALTH CARE SYSTEM
Nursing in a diverse health care system aims to bridge the gap between clients of varied cultural
backgrounds. Nurses should foster the inclusion of health promoters in selected healthcare settings.

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American nurses association’s position statement on cultural diversity in nursing practice
emphasizes that nurses at all levels of practice must understand how culture affects definitions of
health and illness, notion of illness causation, delivery of care and interactions with health care
providers
In 1992 and American Academy Of Nursing Expert Panel Report included general
principles to be used in preparing nursing graduates who are sensitive to cultural diversity and
global health care needs the panel members reviewed nursing models that can enhance the delivery
of culturally appropriate care and guide nursing research, practice and education.
Leininger wrote that nurses are not prepared to work effectively with people from different
cultural backgrounds and that as shortage exists of masters and doctoral prepared Transcultural
nurses to teach in schools of nursing.
CULTURE AND HEALTHCARE
 Perceptions of health and illness are shaped by cultural factors.
 Due to cultural shaping, individuals vary in health care behavior, health status and health
seeking attitude.
MODELS OF TRANSCULTURAL NURSING
 To help develop, test and organize the emerging body of knowledge in Transcultural
nursing, it is necessary to have a conceptual framework from which various theoretical
statements that can emerge.
 There are two models that widely used in the field
- Leininger Sunrise Model
- The Giger and Davidhizar: Trans cultural assessment model
- Campinha Bacote model of cultural competence in healthcare diversity
LEININGER’S THEORY OF TRANSCULTURAL NURSING
 Dr.Leininger was the first professional nurse with a graduate preparation to complete a PhD
in Anthropology.

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 She brought nursing and anthropology together and coined the term “Transcultural nursing”
as an essential formal area of study and practice.
 Her culture care diversity and universality theory was one of the earliest nursing theories
and it remains the only theory focused specifically on Transcultural nursing with a culture
care focus. Her theory is used worldwide.
THE SUNRISE ENABLER
 The theory includes an enabler (Dr Leininger prefers it not be called a model) that serves as
a conceptual guide or cognitive map to guide nurses in the systematic study of all
dimensions of the theory.
KEY CONCEPTS OF THEORY
 Cultural diversity: The differences or variations among and between different cultures.
 Cultural universality: the similarities of different cultures. Main aim is to discover
similarities and differences about care and its impact on the health and wellbeing of groups.

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 Generic care (or folk care): Remedies passed down from one generation to another within a
particular culture often administered by the mother or medicine man or woman
THREE ELEMENTS (OR CARE DECISIONS AND ACTIONS) TO
PROVIDE CULTURALLY CONGRUENT CARE
1. Culture care preservation/maintenance: It occurs when nursing care preservations or
maintenance is used to enable people of particular culture to retain or preserve relevant care
values so that they can maintain their well being, recover from illness or face handicaps
and/or death.
2. Culture care accommodation/negotiation: It involves the actions and decisions that help
people in a culture to adapt or negotiate with others for a beneficial or satisfying health
outcome with professional care providers.
3. Culture care repatterning/ restructuring: It is used to help clients change or modify their
healthcare patterns to provide a way of life more beneficial or healthier while still respecting
their cultural pattern or beliefs.
THE GIGER DAVIDHIZAR TRANSCULTURAL ASSESSMENT MODEL
 The model was developed in 1988 in response to the need for nursing students in an
undergraduate program to assess and provide care for patients that were culturally diverse.
 Giger and Davidhizar have identified six cultural phenomena that vary among cultural
groups and affect health care.

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 The model includes:
- Transcultural Nursing
- Culturally Competent Care
- Culturally unique individual
- Culturally sensitive environments
- Health and health status.
 Communication: It adopts the entire world of human interaction and behavior.
Communication establishes a sense of commonality with others and permits the sharing of
information, messages in the form of ideas and feelings. Communication is means by which
culture is shared. Both verbal and nonverbal communications are learned in one’s culture.
Communication often presents the most significant problem in working within cultural
groups. The essential elements of communication are: vocabulary, rhythm, style, volume,
and use of touch, context of speech (emotional tone), kinesics, and body posture.
 Space: Space refers to distance and intimacy techniques utilized when relating verbally or
nonverbally to others. All communication occurs in the context of space. According to Hall,
there are four distinct zones of interpersonal space: intimate, personal, social and
consultative, and public. Rules concerning personal distance vary from culture to culture.
Personal space is an extension of the body and is in addition referred to as outer space where
as inner space refers to personal space of awareness.
 Social organization: Social organization refers to the manner in which a cultural group
organizes itself around the family group. Family group is the most influential social
organization. Family structure and organization, religious, values and beliefs, and role
assignments, may all relate to ethnicity and culture. Mother saw the reason for the disease as

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the God’s destiny. She believed that recovery or deterioration process of the child was
dependent upon God’s will. She states that this disease is an exam of their lives.
 Time. Time is very important aspect of interpersonal communication. Cultural groups can
be past, present, or future oriented. Those individuals who focus on the past, attempt to
provide tradition and have little motivation for formulating future goals. Other individuals
are present-time orientated and if the present task is viewed as the most important, the
people in the culture tend to be unappreciative of the past and do not plan for the future.
Individuals with future time orientation plan and organize present activities to achieve future
goals. Preventive health care needs some future-time orientation because preventive actions
are motivated by a future reward. Also cultures relate to time in terms of clock time vs.
social time. Some groups relate on the basis of social time.
 Environmental control. Environmental control refers to the ability of the person to control
nature and to plan and direct factors in the environment that affect them. If persons come
from a cultural group in which there is less belief in internal control (feeling that one does
have some control) and more in external control (feeling that one does not have control),
there may be a fatalistic view in which seeking health care is viewed as useless.
 Biological variations. Biological differences, especially genetic variations, growth and
developmental patterns, body systems, racial anatomical characteristics, skin and hair
physiology, disease prevalence, and resistance to disease. It is a well-known fact that people
differ culturally. Less known and understood are the biological differences that exist among
people in various racial groups.
CAMPINHA BACOTE’S MODEL OF CULTURAL COMPETENCE IN
HEALTHCARE DELIVERY
 The Process of Cultural Competence in the Delivery of Healthcare Services are cultural
awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire.
 Cultural Awareness: Cultural awareness is the self-examination and in-depth exploration
of one’s own cultural and professional background. This process involves the recognition of
one’s biases, prejudices, and assumptions about individuals who are different. Without being
aware of the influence of one’s own cultural or professional values, there is risk that the
health care provider may engage in cultural imposition.

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 Cultural Knowledge: Cultural knowledge is the process of seeking and obtaining a sound
educational foundation about diverse cultural and ethnic groups. In obtaining this knowledge
base, the health care provider must focus on the integration of three specific issues: health-
related beliefs and cultural values, disease incidence and prevalence, and treatment efficacy.
Obtaining cultural knowledge about the client’s health-related beliefs and values involves
understanding their worldview. The client’s worldview will explain how he/ she interpret
his/her illness and how it guides his thinking, doing, and being.
 Cultural Skill: Cultural skill is the ability to collect relevant cultural data regarding the
client’s presenting problem as well as accurately performing a culturally based physical
assessment. This process involves learning how to conduct cultural assessments and
culturally based physical assessments.
 Cultural Encounters: Cultural encounter is the process that encourages the health care
provider to directly engage in cross-cultural interactions with clients from culturally diverse
backgrounds. Directly interacting with clients from diverse cultural groups will refine or
modify one’s existing beliefs about a cultural group and will prevent possible stereotyping
that may have occurred. It also involves an assessment of the client’s linguistic needs. Using
a formally trained interpreter may be necessary to facilitate communication during the
interview process
 Cultural Desire: Cultural desire is the motivation of the health care provider to want to,
rather than have to, engage in the process of becoming culturally aware, culturally
knowledgeable, culturally skillful, and familiar with cultural encounters. Cultural desire
involves the concept of caring.

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ASSUMPTIONS ABOUT TRANSCULTURAL NURSING
 Nursing is a Transcultural phenomenon because nursing practices involve at least two
persons, generally having different cultural orientation and lifestyles.
 Caring is a universal phenomenon, however, the forms and manifestations of caring vary
among cultures.
 Therapeutic nursing is largely culturally determined, culturally based and culturally
validated.
 Members of a given culture have their own caring practices, which are frequently unfamiliar
to nurses from other cultures.
RECENT STUDIES REGARDING TRANSCULTURAL NURSING
1) Experiences of Nigerian Internationally Educated Nurses Transitioning to United
States Health Care Settings (APRIL 2018)
2) Vietnamese American Women’s Beliefs and Perceptions About Breast Cancer and
Breast Cancer Screening: A Community-Based Participatory Study
3) Social and Cultural Barriers to Women’s Participation in Pap Smear Screening
Programs in Low- and Middle-Income Latin American and Caribbean Countries: An
Integrative Review (JANUARY 2018)
4) Cultural Aspects of End-of-Life Care Planning for African Americans: An
Integrative Review of Literature (JAN 2018)
5) The experience of nurses in care for culturally diverse families: A qualitative meta-
synthesis (2016)
OBSTACLES ENCOUNTERED IN TRANSCULTURAL NURSING
 Barriers related to cultural competence can be grouped into two categories.
1. Those related to providers
- These arise when individual providers lack of knowledge of their
patient’s cultural practices and beliefs or when provider’s beliefs
differ from those of their patient’s.
2. Those related to systems
- Exist because most facilities haven’t been designed for cultural
diversity, favoring instead a one-size-fits-all approach to care.
Limitations in personnel or materials may hinder a facility’s ability
to adjust care to the various ways people approach death and dying.
Some settings such as ICU may be unable to accommodate certain
needs.

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 It requires extensive time and effort to acquire an understanding of the whole social
structure of culture and the place of healthcare in the culture.
 People who enter a new culture, including healthcare workers, generally experience feeling
of discomfort and uncertainty.
 Consciously or unconsciously, healthcare workers have frequently forced their own cultural
views about health on persons with different beliefs and values.
CONCLUSION
Nurses need to be aware of and sensitive to the cultural needs of clients. The practice of
nursing today demands that the nurse identify and meet the cultural needs of diverse groups,
understand the social and cultural reality of the client, family, and community, develop
expertise to implement culturally acceptable strategies to provide nursing care, and identify
and use resources acceptable to the client.
BIBLIOGRAPHY
1) Hamric and Hanson’s ‘Advance Nursing Practice: An integrative approach’. Elsevier.6th
edition.
2) Navdeep Kaur Brar, H C Rawat ‘Text Book of Advance Nursing Practice’.
3) Samta Soni ‘Text Book of Advance Nursing Practice’. Jaypee Publications.
4) Kathryn A Blair, Michaelene P Jansen ‘Advanced Practice in Nursing’. 5th edition.
5) Lucille A Joel ‘Advanced Practice Nursing Essentials for role development’.3rd edition.
6) Shebeer.P.Basheer, S. Yaseen Khan ‘A Concise Text Book of Advanced Nursing Practice’.
Emmess.2nd edition.
7) Journals.sagepub.com
8) https://www.ncbi.nlm.nih.gov
9) https://www.nursingald.com
10) https://ovid.com
11) https://sciencedirect.com
12) Austinpublishinggroup.com/nursing/full text/nursing
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