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Transcultural Assessment Nursing Paper.

Transcultural Assessment Nursing Paper.

Reducing health disparities and achieving equitable health care are vital objectives for the United States healthcare system. Cultural competence is viewed as a “foundational pillar for reducing disparities through culturally sensitive and unbiased quality care” (Agency for Health Care Research and Quality, 2014, p. 1). Culturally competent care respects diversity, while considering factors such as language, communication styles, attitudes, beliefs, and behaviors that attribute to health and wellness (Agency for Health Care Research and Quality, 2014).Transcultural Assessment Nursing Paper. The purpose of this paper is to suggest the use of a framework to help student nurses understand cultural awareness and to stimulate through self-reflection their examination of values and actions promoting culturally competent care.

Standards for Culturally Competent Care in 
Nursing Education
The nursing profession has supported the importance of culturally driven health care. The Commission on Collegiate Nursing Education (CCNE, 2008) suggests that diversity education in nursing programs is the first step in preparing a nursing workforce that can provide compassionate, culturally safe care to diverse individuals and populations. The National League for Nursing (NLN) states that nursing faculty must make preparing competent and culturally safe student nurses a priority in curriculum design and implementation (2012).

Most nursing programs have heeded the call for culturally competent nurses and address this importance in college and program mission statements or course outcome statements. Additionally, accrediting bodies and approval boards such as the American Association of Colleges of Nursing (AACN, 2008) and the NLN (2012) have expectations that culturally sensitive care is included in curricula. Despite the call, there is conflicting and limited research to help us determine which are the best methods to teach cultural diversity to the next generation of nurses. Transcultural Assessment Nursing Paper.



Student nurses’ perceptions of cultural diversity are frequently influenced by society’s definitions of these topics. These are often related to shared patterns of values and learned behaviors that have transferred over time. Student nurses’ ideas are based on multiculturalism and celebration of diversity, as well as discouragement of discrimination and increased acceptance; but these societal definitions and personal values can mislead nursing students to accept culture as merely differences in practices or beliefs. These misunderstandings encourage student nurses to assume that groups can be objectively categorized or defined by a particular essence or practice instead of culture being defined as a dynamic and complex process. Student nurses recognize cultural world views at large but fail to appreciate specific social, historical, religious and ethnic experiences that play a unique role in determining the cultural needs of each individual (Vandenberg & Kalischuk, 2014).

The Transcultural Assessment Model: Six Dimensions
The Transcultural Assessment Model was developed in response to student nurses’ need to assess and design care for culturally diverse patients (Giger & Davidhizar, 2002). This model provides a framework that can be incorporated into nursing education curricula. The model assesses differences between individuals in cultural groups by inquiring about six cultural dimensions: communication, time, space, social organization, environmental control, and biological variations. This assessment framework can be utilized by student nurses to facilitate the design and delivery of sensitive care (Giger & Davidhizar, 2002). Transcultural Assessment Nursing Paper.

Cultural awareness involves individuals exploring their own cultural and professional backgrounds while scrutinizing personal bias and understanding diversity issues in health care delivery (Sarafis & Malliarou, 2013). Cultural awareness is enhanced when student nurses use reflection to evaluate and understand their own values related to the Transcultural Assessment Model criteria (Thorpe & Loo, 2003). By reflecting on each of the dimensions, nursing students gain insight into more complete cultural care practices. Student nurses can understand and apply the dimensions more holistically if they have assessed each dimension in their own lives and formulate plans for culturally competent care through the use of ponder/focus questions (McClimens, Brewster, & Lewis, 2014).

For student nurses to deliver safe, culturally competent care, a mutual understanding of the patient’s cultural needs must be achieved through communication. Communication, verbal and non-verbal, account for a large portion of the cultural disconnect between student nurses and their patients (Momeni, Jirwe, & Emami, 2008). Transcultural Assessment Nursing Paper.When communication barriers were present, patients often expressed concerns and fears of being misunderstood as well as a strong sense of insecurity during interactions with nursing staff (Cioffi, 2003). Nursing students may ask themselves these questions and formulate possible solutions: “Have I ever been misunderstood, either through spoken words or body language?” and “Have I ever been treated differently related to mental health or learning disabilities?”

To understand individualistic views of culture, student nurses must assess patient views about passage of time, points in time, and duration of time. Many countries and cultures are oriented with a focus on the past. These cultures value tradition and doing things as their predecessors have done. This can lead to reluctance in accepting new technology or treatments. Some cultures stress the present and may seem relatively unconcerned with the future. These individuals may disregard preventative measures and may show up late or miss appointments (Giger & Davidhizar, 2004). Student nurses may question their personal and cultural views related to time: “Is the past, present, or future most important to me?” and “How does my view of time reflect in my personal heath choices?”

Humans vary greatly in their comfort level related to personal space. Some of these spatial concerns are related to personal preferences, while others are a reflection of cultural principles. Student nurses must be aware of their patients’ comfort level related to body distance during conversation, proximity to family members, perception of space, eye contact, and personal and cultural touch practices (Giger & Davidhizar, 2004). Student nurses may question, “What is my personal comfort level related to touch, eye contact, and conversational distance?” and “Can I identify a situation where I was made uncomfortable by another individual related to my personal space?”  Transcultural Assessment Nursing Paper.

Social Organization
Humans often learn and adopt cultural beliefs through social organization. Individuals from culturally diverse backgrounds will all manifest different degrees of acculturation into the beliefs of their dominant culture. In some circumstances, cultural values stem from the opinion of elders or patriarchs, while others place value on position in family. In this context, student nurses need to factor in geography, socioeconomic status, religious affiliation, gender and sexual orientation, as well as age and life cycle status (Giger & Davidhizar, 2004). Student nurses could self-evaluate by pondering these questions: “What role do my parents and family member play in my beliefs?” and “Have my cultural views changed related to my current stage of life?”

Environmental Control
Environmental control can be explained in the patient’s ability, within their cultural system, to plan activities that control their environment as well as their perception of personal control over factors in the environment (Giger & Davidhizar, 2004). Examples of assessment factors which play a role in environmental control are locus of control, folk medicine, and health beliefs. Student nurses need to understand that these issues play an extremely vital role in the way patients define illness and wellness, utilize health care resources and respond to health associated experiences (Eggenberger, Grassley, & Restrepo, 2006). Transcultural Assessment Nursing Paper.Questions that student nurses might ponder are: “Am I superstitious and do I believe that I am in complete control of my health and wellness?” and “What non-medical/alternative methods do I believe in and utilize to obtain health?

Biological Variation
When assessing a patient’s cultural underpinnings, biological variations need to be evaluated carefully to avoid stereotypes and discrimination. These factors include race, body structure, genetic variations, nutritional preferences and psychological characteristics (Davidhizar, & Giger, 2008). Nursing examples include diseases related to specific ethnic groups as well as rural versus urban health. Student nurses must remember the uniqueness of individuals and that a person’s association with an ethnic group does not mean that the individual patient will follow the socially accepted definition of his/her biological foundation (Vandenberg & Kalischuk, 2014).  Transcultural Assessment Nursing Paper.Questions that a nursing student might reflect upon with patients are: “What is an accepted stereotype related to your ethnic group that is not true about you?” and “What health care practice do you not participate in that most of your ethnic group does?”

As a challenging health care environment results from new technologies, scientific advances, and cultural diversity, today’s student nurses are faced with uncertainty, unknown boundaries and unfamiliar practice questions. It is crucial that student nurses understand their personal values, culture, and biases, as well as those of their occupation through knowledge and reflection of cultural assessment tools. This reflection will foster cultural awareness and promote competent practices that will allow student nurses to give safe, patient centered care (Leduc & Kotzer, 2009). Nursing curriculum that integrates cultural care theories and conceptual frameworks across the curriculum will give graduate student nurses the tools needed to tackle the challenge of reducing health disparity in the United States (AACN, 2008). Facilitating cultural competency through reflective awareness, empathy, active listening techniques, and appropriate theoretical frameworks can assist health care providers in delivering culturally safe care (Institute for Health Care Improvement, 2014). Transcultural Assessment Nursing Paper.

Agency for Health Care Research and Quality (2014). Improving cultural competence to reduce health disparities for priority populations. Retrieved from
American Association of Colleges of Nursing (2008). Cultural competency in baccalaureate nursing education. Retrieved from
Cioffi, R. N. (2003). Communicating with culturally and linguistically diverse patients in an acute care setting: Nurses’ experiences. International Journal of Nursing Students, 40(3), 299–306. Transcultural Assessment Nursing Paper.
Commission on Collegiate Nursing Education. (2008). Standards for accreditation of baccalaureate and graduate degree nursing programs. Washington, DC: Author. Retrieved from
Davidhizar, R., & Giger, J. N. (2008). Understanding ethnopharmacology: Implications for cultural relativism. Journal of National Black Nurses’ Association, 19(1), 63–68.
Eggenberger, S. K., Grassley, J., & Restrepo, E. (2006). Culturally competent nursing care for families: Listening to the voices of Mexican-American women. The Online Journal for Issues in Nursing, (11)3. Retrieved from
Giger, J. N., & Davidhizar, R. E. (2002). The Giger and Davidhizar Transcultural Assessment Model. Journal of Transcultural Nursing, 13(3), 185–188. doi: 10.1177/10459602013003004
Giger, J. N., & Davidhizar, R. E. (2004). Transcultural nursing: assessment and intervention (4th ed.). St. Louis: Mosby. Transcultural Assessment Nursing Paper.
Institute for Health Care Improvement (2014). Health disparities collaboratives. Retrieved from
Leduc, K., & Kotzer, A. M. (2009). Bridging the gap: A Comparison of the professional nursing values of students, new graduates, and seasoned professionals. Nursing Education Perspectives, 30(5), 279–284.
McClimens, A., Brewster, J., & Lewis, R. (2014). Recognizing and respecting patients’ cultural diversity. Nursing Standard, 28(28), 45–52.
Momeni, P., Jirwe, M., & Emami, A. (2008). Enabling nursing students to become culturally competent: A documentary analysis of curricula in all Swedish nursing programs. Scandinavian Journal of Caring Sciences, 22(4), 499–506.
National League for Nursing (2012). The scope of practice for academic nurse educators. New York, NY: Author.
Sarafis, P. A., & Malliarou, M. M. (2013). Cultural self-efficacy of baccalaureate nursing students in a Greek university. Iranian Journal of Nursing & Midwifery Research, 18(6), 446–450.
Thorpe, K., & Loo, R. (2003). The values profile of nursing undergraduate students: Implications for education and professional development. Journal of Nursing Education, 42(2), 83-90.
Vandenberg, H., & Kalischuk, R. G. (2014). Conceptualizations of culture and cultural care among undergraduate nursing students: An exploration and critique of cultural education. Journal of Cultural Diversity, 21(3), 99–107. Transcultural Assessment Nursing Paper.

Transcultural nursing has been integrated into modern nursing education due to the increased heterogeneity of patient populations.
As more people from a variety of cultures and with a variety of
ethnicities now utilize healthcare facilities, nurses need to be aware of their varying perceptions and levels of tolerance for healthcare. Transcultural Assessment Nursing Paper.
This situation can lead to departures from the practice norms that would otherwise direct patient care, thus opening up a wide array of options regarding treatments and follow-ups. Decision making in patient care involves many important considerations, including patients’ attitudes and how they will react to treatment advice [1-3].
For these reasons, the adaptability of nursing professionals is crucial,
particularly when it comes to cultural diversity, because this issue can affect the quality of service provided to patients.
Nurses should have sufficient information about different cultural backgrounds and customs to be able to conduct holistic
In addition, certain culture-related concepts are particularly
relevant to healthcare and nursing [15]. These include culture, race,
ethnicity, and cultural competence. Culture refers to a set of beliefs,
assumptions, values, and norms that a group of individuals largely
observe and transfer across generations [16]. Ingram defined culture
as a learned worldview demonstrated by a group of individuals that
is transferred socially [17]. Transcultural Assessment Nursing Paper.Culture affects the beliefs, values, norms, and behaviors of individuals, and it is reflected in language, food,
dress, and social institutions. Culture can significantly affect various aspects of human life, including health and preferences for managing health conditions. Multicultural trends are emerging in numerous countries due to globalization and mass immigration [17].
Each culture has distinct characteristics and therefore,
individuals belonging to different cultures can differ considerably.
These differences must be respected and each individual treated as a
unique human being. Indeed, even people belonging to the same race
may differ culturally. Transcultural Assessment Nursing Paper.Race is a social classification based on physical
characteristics like skin color [16]. It can also serve as an identifying
trait of a culture. Similarly, ethnicity indicates cultural membership
based on people having similar cultural characteristics that have led to
a common history. Ethnicity tends to remain with people throughout
their lives [16].
Cultural competence refers to a set of culturally congruent
practices, behaviors, and policies that allow nursing professionals to
deliver high-quality services in a variety of cross-cultural scenarios
[16]. Cultural competence is an essential requirement in nursing.
Culturally congruent healthcare does not aim to facilitate patient
care for ethnic or racial minority groups only; rather, the objective
is to improve healthcare delivery by considering differences in age,
gender, religion, and socioeconomic status [18].
Healthcare professionals, especially nurses, should make an effort
to understand and learn about different cultures. Understanding a
patient’s religious and cultural background can be highly beneficial
in delivering healthcare. This understanding may cause healthcare
professionals to evaluate their own cultural and religious beliefs,
which may in turn influence their practices [19]. Transcultural Assessment Nursing Paper.Such cultural
awareness denotes an individual’s self-awareness of his or her own
cultural background, differences, and biases. Acculturation, on the
other hand, signifies the process of learning about a new culture.
Nurses should adapt to different cultures by making modifications to
their nursing practices [20].
Evolution of Transcultural Nursing
Leininger uncovered a core concept of care during her early
education; this concept later became her motivation to specialize in
transcultural nursing specifically [9]. She explained this concept as a
fundamental nursing component based on her experience and positive
feedback from patients. During her work at a child-guidance home,
she experienced a cultural shock, leading her to realize that a lack
of understanding regarding cultural diversity could explain recurrent
behavioral patterns in some children. She recognized a major deficit
in understanding differential patient demands in the context of care
and wellness. She maintained that the quality of nursing education
suffered due to the absence of training in cultural diversity, the result
being a disconnect between patient and nurse. Transcultural Assessment Nursing Paper.
The theorist’s identification of this problem shaped a new
paradigm in nursing care, leading to the advent of transcultural
nursing [9]. Leininger defined transcultural nursing as an area of
study that focuses on comparative cultural care based on the beliefs,
practices, and values of care-seeking patients. Its main purpose is
to provide both universal and culture-based nursing practices that
promote well-being and health. Additionally, it aims to help patients
overcome illness in a culturally intelligent and responsive manner
Models of Transcultural Nursing
Transcultural nursing models provide nurses with the foundation
required for gaining knowledge about different cultures during
healthcare delivery. The models are under continual development
and they guide nursing practice all over the world. Hence, this paper
focuses on the four particularly significant models.
Leininger Sunrise Model
The Leininger Sunrise Model represents the structure of culture
care theory by describing the relationship between anthropological
and nursing beliefs and principles [9]. Nurses use this model when
making cultural evaluations of patients. The model connects the
concepts of the theory with actual clinical practices, while offering
a systemic approach to identifying values, beliefs, behaviors, and
community customs. The model encompasses numerous aspects
of culture: religious, financial, social, technological, educational,
legal, political, and philosophical dimensions. These factors, along
with language and social environment, significantly affect the
services delivered by systems, whether traditional or professional.
Traditional healthcare systems are based on conventional beliefs
related to health, whereas professional systems rely on learned
knowledge, evidence-based practice, and research [13]. The nursing
profession considers patients’ physical, spiritual, and cultural needs.
A thorough understanding of these needs facilitates the achievement
of desired clinical outcomes. Moreover, Leininger’s model helps
healthcare professionals to avoid the stereotyping of patients [13]. To
accomplish such goals, the model utilizes three concepts: culture care
maintenance/preservation, culture care negotiation/accommodation,
and culture care restructuring/repatterning. Cultural preservation
refers to nurses’ provision of support for cultural practices, such as
employing acupressure or acupuncture for anxiety and pain relief
prior to medical interventions. Transcultural Assessment Nursing Paper.Similarly, cultural negotiation refers
to the support provided to the patients and their family members in
carrying out cultural activities that do not pose threats to the health
of the patients or any other individual in the healthcare setting.
Finally, cultural restructuring refers to nurses’ efforts to deliver
patient-centered care by helping patients modify or change their
cultural activities. Cultural restructuring is suggested only when
certain cultural practices may cause harm to the patient or those in
the surrounding environment. These concepts can inform nurses in
achieving their ultimate goals [16].
Giger and Davidhizar Transcultural Assessment Model
This model emphasizes the importance of considering every
person as unique in his or her culture [10]. According to Giger and
Davidhizar, there are six dimensions common to every culture:
communication, space, social organization, time, environmental
control, and biological variation [10]. The first dimension is
communication, which is the holistic process of human interaction
and conduct. The use and preservation of communication takes
several forms – verbal, nonverbal, and written – and differs in terms
of expression, language and dialect, voice tone and volume, context,
emotional implication, facial expression, gestures, and body language. Transcultural Assessment Nursing Paper.
Language can become a barrier to quality healthcare due to simple
misunderstandings and failure to communicate as intended. The
second dimension is space, which is the distance maintained between
interacting individuals; this “personal space” differs according to
individuals’ cultural backgrounds. The concept of space involves three
other behavioral patterns: attachment with objects in the environment,
body posture, and movement in the setting [10]. It is important to
observe tact and to avoid overstepping boundaries with respect to
these aspects of interaction, because doing so can cause patients
unnecessary anxiety. The third dimension is social organization,
which is how certain cultures group themselves in accordance with
family, beliefs, and duties. This dimension requires nurses to remain
aware that patient conduct can be influenced by factors like sexual
orientation, acknowledgement and utilization of titles, and decisionmaking regulations. An awareness of this dimension can help nurses
avoid being perceived as being derogatory or disrespectful. The fourth
dimension is time, which is similar to social organization in terms of
influence. Time is subdivided into whether the group is clock-oriented,
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like most Westerners, or socially oriented. The clock-oriented group
is fixated on time itself, and individuals with this orientation seek to
keep appointments so as not to be seen as ill-mannered or offensive. Transcultural Assessment Nursing Paper.
The behavior of socially oriented groups emphasizes the here and
now. Such individuals understand time as a flexible spectrum defined
by the duration of activities; an activity does not begin until the
preceding event has ended. The fifth dimension is environmental
control, which implicates how the person perceives society and its
internal and external factors, such as beliefs and understandings
regarding how illness occurs, how it should be treated, and how
health is uplifted and maintained. The sixth and last dimension is
biological orientation. Races vary biologically due to differences in
DNA, and some races are more prone to certain diseases than others.
Other notable elements of this model are a deeper understanding of
pain tolerance and deficiencies and predilections in nutrition [21,22].
Purnell Model for Cultural Competence
The Purnell model focuses on providing a foundation for
understanding the various attributes of a different culture, allowing
nurses to adequately view patient attributes, such as incitement,
experiences, and notions about healthcare and illness [11]. This
model is presented in a diagram with parallel circles that represent
aspects of global society as well as the community, family, and person.
The Purnell model includes twelve domains: overview or heritage,
communication, family roles and organization, workforce issues,
bio-cultural ecology, high-risk behaviors, nutrition, pregnancy, death
rituals, spirituality, healthcare practices, and healthcare professionals
[11]. Purnell considered these domains to be important in evaluating
the traits and characteristics of various ethnic groups. The model can
be depicted with a frame representing global society and an outer
circle signifying community. The second circle signifies family, and
the innermost circle depicts the individual [23]. Transcultural Assessment Nursing Paper.
The first domain is culture and heritage, which includes the
country of derivation, the geographical influence of the original
and present home, political affairs, economics, educational status,
and profession. The second domain comprises important notions
relevant to communication, such as primary language and dialects,
circumstantial effectiveness and convenience of the language,
paralinguistic differences, and nonverbal communication. The third
domain, family roles and organization, involves who heads the
household in terms of gender and age. The organization of the family
is affected by goals and priorities, developmental tasks, social status,
and alternative lifestyles. The fourth domain is workforce issues,
including acculturation, autonomy, and the presence of language
barriers. The fifth domain includes factors of bio-cultural ecology,
which encompass observable differences with respect to ethnic and
racial origins, like skin color and other physical variations. The
sixth domain is high-risk behaviors, such as using tobacco, alcohol,
or recreational drugs. This domain also includes physical activity
and levels of safety or precautions taken. The seventh domain is
nutrition. Depending on their place of origin, individuals or groups
are accustomed to certain foods and draw meaning from the foods
they eat. Food consumption associated with certain rituals may affect
health. Some ethnic groups suffer from certain nutritional limitations
and deficiencies. The eighth domain is pregnancy. Pregnancy is
viewed differently, because there are a myriad of beliefs accompanying
this life phase. The act of birthing and the postpartum period involve
certain practices that need to be taken into consideration when
dealing with a particular ethno-cultural group. The ninth domain is
death rituals. Perceptions of death differ from culture to culture in
terms of how death is accepted, what rituals are performed, and how
one should behave following a death. The tenth domain is spirituality,
which includes religious practice, use of prayer, individual strength,
the meaning of life, and how spirituality relates to health. The
eleventh domain reflects healthcare practices. This domain includes
the responsibility for health and the barriers that must be overcome
to achieve successful health outcomes. Healthcare practices include
traditional practices, magical religious practices, chronic-disease
treatment and rehabilitation, mental-health practices, and the roles
of the sick. The twelfth and final domain, healthcare professionals,
involves the perceptions and roles of traditional and folk healthcare
practices [24]. Transcultural Assessment Nursing Paper.
Campinha-Bacote Model of Cultural Competence in
Healthcare Delivery
Campinha-Bacote first developed her model, known as “cultural
competency in the delivery of healthcare services,” in 1998, revising
it in 2002 [12]. The model considers cultural competence not as
a consequence brought about by certain factors, but as a process.
The concept of cultural competence can be defined as a process in
which the nurse attempts to achieve greater efficiency and the ability
to work in a culturally diverse environment while caring for the
patient, whether an individual, a family, or a group [12]. To achieve
cultural competence, a nurse must undertake a process of developing
the capacity to deliver efficient and high-quality care, a process that
encompasses five components. The first involves cultural awareness,
a process in which healthcare professionals consciously acknowledge
their own cultural backgrounds, which helps them avoid biases
toward other cultures. The second component is cultural skill, defined
as the ability to obtain the necessary information from patients via
culturally-appropriate conduct and physical assessment. Transcultural Assessment Nursing Paper.The third
component is cultural knowledge, a process in which healthcare
professionals open their minds to understand variations in cultural
and ethnic traits as they relate to patient attitudes toward illness and
health. The fourth component is cultural encounter during which
stereotyping is avoided through the interaction between healthcare
professionals and members of different cultures. During this process,
overreliance on conventional views is discouraged. The fifth and last
component is cultural desire, which is the driving force for becoming
educated, skilled, competent, and aware of culture; it also presumes a
willingness to have transcultural interactions [25].
Discussion across Models
Transcultural nursing models have played a significant role
in forming the basic foundations of nursing practice. Despite their
positive contributions, the transcultural models have been criticized
for their limitations and failure to acknowledge certain issues related
to the educational and practical components of transcultural nursing
[8]. For example, the Leininger model has been critiqued for failing
to acknowledge political and structural processes. Critics have argued
that it focuses exclusively on cultural diversity, biases, conventional
views, and the inequity between nurses and patients. According to
these critiques, the model also failsto acknowledge that cultural
diversity needs to go beyond between group differences and be
understood from the perspective of differences among individuals from the same culture, due to varying socioeconomic backgrounds, age groups, and types of communities. Conversely, the model has been praised for its clear and simple way of evaluating professional and societal cultures [3]. Transcultural Assessment Nursing Paper.



Integrating cultural competence models are a beneficial
addition to nursing curricula and clinical training in undergraduate
and graduate nursing programs [26-28]. Numerous studies have
investigated how these models can be integrated effectively into
nursing curricula. Kardong-Edgren and Campinha-Bacote assessed
the effectiveness of four nursing programs’ curricula in producing
culturally competent graduates [29]. Two of these programs had
adopted models advocated by transcultural-nursing theorists, such
as Campinha-Bacote and Leininger. One of the other programs
used an approach that integrated concepts from various models. The
remaining program involves a free-standing course with no specific
model used. According to the study’s results, graduating nursing students scored in the culturally aware range, as measured by the\ Campinha-Bacote’s Inventory for Assessing the Process of Cultural
Competency among Healthcare Professionals-Revised (IAPCC-R) questionnaire, regardless of which program they attended [29].
This finding is consistent with Noble and Rom’s study that
employed the Campinha-Bacote model and an adaptation of the
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IAPCC-R questionnaire to evaluate an educational intervention’s
effectiveness in strengthening the cultural competence of nursing
students in Israel [30]. Nobel and Rom found that cultural knowledge
among the students was low because they lacked an understanding of
how cultural knowledge can be integrated with nursing interventions
and applied in patient care. They also reported that employing a cultural competence program significantly enhances the level of cultural awareness among students, a realistic goal for undergraduate nursing students. Nobel and Rom also note that it may be more appropriate for faculty to expect a high level of cultural competence to occur after graduation [30]. Nobel and Rom also suggested that the usefulness of this approach was enhanced by allowing faculty who had experience with culturally competent care to share their expertise with faculty who were deficient in this respect [31,32]. Transcultural Assessment Nursing Paper.
The nursing program based on the Giger-Davidhizar transcultural
assessment model was an appropriate guide for faculty to impart the
skills necessary for culturally responsive and competent care with
respect to six healthcare phenomena [10]. This simple and modern
elaboration of the Leininger model is used to assess and strengthen nurses’ acknowledgment of cultural diversity. Giger and Davidhizar
take an approach that is different than Lininger’s Sunrise Model,
arguing that not every individual of the same culture or ethnicity behaves in the same manner. First developed in 2004, the model is used to help undergraduate nursing students provide and assess health care for individuals from varying cultural backgrounds. The current version of the model sets a framework that enables nurses
to assess culture’s role in health and illness. It can also serve as an academic and clinical framework for developing cultural competence [21].
In addition, the Purnell model is a framework that can be
employed to incorporate transcultural competence into nursing
practice [11]. Lipson and Desantis noted that the Purnell model often
is used in undergraduate communication and health assessment
programs [22]. This model can be used by all healthcare professionals
in both their practice and academic development. Transcultural Assessment Nursing Paper.As a result, the
model represents an organizing framework that utilizes precise
questions and provides a helpful format for assessing culture in
clinical settings. Flexibility is one of the strongest features of the Purnell model, enhancing its applicability in various healthcare contexts. Moreover, the model’s healthcare framework allows nurses to learn the different characteristics and concepts of cultural diversity.
The model interlinks historical elements and their influence on a
person’s international cultural perspective and elaborates on the chief
relationships of culture, thus allowing culturally competent care [22].
The model’s framework encourages nurses to consider and reflect on the unique characteristics of every patient, including their views of illness, motivation, and healthcare. Finally, the model’s structure facilitates the analysis of cultural data, allowing nurses to cater to families, groups, and individuals in terms of their respective cultural uniqueness using various communication strategies [24].
Critical Appraisal of Transcultural Models
Brathwaite compared several transcultural nursing models using the following criteria: comprehensiveness, logical congruence, conceptual clarity, level of abstraction, clinical utility, and perspective [33]. Only the Campinha-Bacotecultural-competence process model met all of Brathwaite’s criteria. Brathwaite’s review indicated that the Campinha-Bacote model incorporates five components (cultural awareness, cultural skills, cultural knowledge, cultural encounters, and cultural desire) that build upon one another in a logical progression, providing concise outcomes for interventions, a clear description of processes, and an immediate clinical benefit in optimizing patient care planning. Furthermore, the nursing literature indicated that the Campinha-Bacote model is the one most often used as a framework
for research and is frequently cited. In addition, several authors have
indicated that Campinha-Bacote model is suitable as a framework for
incorporating cultural competence into their practice [6,34,35]. Transcultural Assessment Nursing Paper.
Despite the criticisms of some transcultural nursing models, they
remain a significant part of nursing education and practice. Nurses
can benefit from the Leininger model by learning a simple method
of exploring professional and societal culture [9]. Additionally, Giger
and Davidhizar’s six components can enhance their understanding
of the processes of observation and reflection [10]. On the other
hand, the major assumptions of the Purnell model for cultural
competence and their associated framework involves drawing on a
broader perspective, which makes them applicable to all healthcare
environments and practice disciplines [11]. Finally, the CampinhaBacote model holds more immediate appeal, because it helps in
addressing cultural competence with respect to healthcare delivery
Establishing Best Practice Standards in Cultural Competence
Nursing Education. In order to establish quality nursing care,
optimum standards for both local and global settings need to
be developed in the nursing profession [36]. Nursing requires a
distinct approach, one that involves reaching successful endpoints
of traditional education and strategies necessary to achieve such
goals. Salminen et al. point out the significance of acknowledging the
demonstration of competency categories [37]. Transcultural Assessment Nursing Paper.
They offer recommendations for dealing with the future challenges
pertaining to nursing education. For instance, they recommended requiring competency courses for nursing students and practicing nurses in their academic curricula and continuing education workshops, respectively. These courses and workshops may include subject-specific content, learning strategies, and assessments for acquired learning. In addition, successfully addressing the needs of culturally diverse populations ultimately requires the combination of theoretical research and clinical practice [38]. Ensuring the provision of high-quality nursing education is guided by local, national, and international guidelines that lead to universal standards of culturally sensitive healthcare practice to disseminate knowledge by means of cross-cultural activities and encourage the understanding of diverse populations [39].
This paper discussed the transcultural nursing models of Leininger, Giger and Davidhizar, Purnell, and Campinha-Bacote.
No particular model was deemed superior to the others; all four have made and can make significant contributions to nursing education and practice. Leininger developed her model to bring about the practice
of culturally congruent nursing. Her research gave rise to the concept of transcultural competence in nursing. Giger and Davidhizar focuses on the individual, not just the cultural group, seeing each individual as culturally unique from the perspective of the six dimensions. Purnell created a diagrammatic representation containing twelve cultural domains, which determine variations in values, beliefs, and practices of an individual’s cultural heritage. Campinha-Bacote defines cultural competence as a process instead of merely an endpoint. Overall, the Campinha-Bacote model is sufficiently comprehensive to guide empirical research and the development of educational interventions.
The model’s five components can be used to strengthen the cultural
competence of nurses practicing in countries all over the world.
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3. Higginbottom GMA, Richter MS, Mogale RS, Ortiz L, Young S, et al. (2011)
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8. Raman J (2015) Improved health and wellness outcomes in ethnically/
culturally diverse patients through enhanced cultural competency in nurse
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nursing. National League for Nursing Press, New York, NY.
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intervention (5th edn) Mosby, St. Louis, MO.
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12. Campinha-Bacote J (2002) The Process of Cultural Competence in the
Delivery of Healthcare Services: a model of care. J Transcult Nurs 13: 181-
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transcultural nursing knowledge and practices. J Transcult Nurs 13: 189-192.
14. Engebretson J, Mahoney J, Carlson ED (2008) Cultural competence in the
era of evidence-based practice. J Prof Nurs 24: 172-178. Transcultural Assessment Nursing Paper.
15. Lowe J, Archibald C (2009) Cultural diversity: the intention of nursing. Nurs
Forum 44: 11-18.
16. Martin ML, Jensen E, Coatsworth-Puspoky R, Forchuk C, Lysiak-Globe T,
et al. (2007) Integrating an evidenced-based research intervention in the
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17. Ingram R (2011) Using Campinha-Bacote’s process of cultural competence
model to examine the relationship between health literacy and cultural
competence. J Adv Nurs 7: 695-703.
18. Narayanasamy A, White E (2005) A review of transcultural nursing. Nurse
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19. Munoz CC, DoBroka CC, Mohammad S (2009) Development of a
multidisciplinary course in cultural competence for nursing and human
service professions. J Nurs Educ 48: 495-503.
20. Hearnden M (2008) Coping with differences in culture and communication in
health care. Nurs Stand 23: 49-57.
21. Davidhizar R, Giger JN, Hannenpluf LW (2006) Using the Giger-Davidhizar
Transcultural Assessment Model (GDTAM) in providing patient care. J Pract
Nurs 56: 20-25.
22. Lipson JG, DeSantis LA (2007) Current approaches to integrating elements
of cultural competence in nursing education. J Transcult Nurs 18: 10S-20S.
23. Albarran J, Rosser E, Bach S, Uhrenfeldt L, Lundberg P, et al. (2011)
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24. Purnell L (2005) The Purnell model for cultural competence. Journal of
Multicultural Nursing & Health 11: 7-15.
25. Campinha-Bacote J (2011) Delivering patient-centered care in the midst of a
cultural conflict: the role of cultural competence. Online J Issues Nurs 16: 5.
26. Caffrey R, Neander W, Markle D, Stewart B (2005) Improving the cultural
competence of nursing students: Results of integrating cultural content in the
curriculum and an international immersion experience. J Nurs Educ 44: 234-
27. Cuellar NG, Brennan AM, Vito K, de Leon Siantz ML (2008) Cultural
competence in the undergraduate nursing curriculum. J Prof Nurs 24: 143-
28. Sumpter DF, Carthon JM (2011) Lost in translation: student perceptions of
cultural competence in undergraduate and graduate nursing curricula. J Prof
Nurs 27: 43-49.
29. Kardong-Edgren S, Campinha-Bacote J (2008) Cultural competency of
graduating US Bachelor of Science nursing students. Contemp Nurse 28:
30. Noble A, Nuszen E, Rom M, Noble LM (2014) The effect of a cultural
competence educational intervention for first-year nursing students in Israel.
J Transcult Nurs 25: 87-94.
31. Grant LF, Lentzring TD (2003) Status of cultural competence in nursing
education: A literature review. Journal of Multicultural Nursing and Health 9:
32. Kardong-Edgren S, Bond ML, Schlosser S, Cason C, Jones ME, et al. (2005)
Cultural attitudes, knowledge and skills of nursing faculty toward patients of
four diverse cultures. J Prof Nurs 175-182. Transcultural Assessment Nursing Paper.
33. Brathwaite AE (2005) Evaluation of a cultural competence course. J Transcult
Nurs 16: 361-369.
34. Almutairi AF, McCarthy A, Gardner GE (2015) Understanding cultural
competence in a multicultural nursing workforce: Registered nurse’s
experience in Saudi Arabia. J Transcult Nurs 26: 16-23.
35. Beer J, Chipps J (2014) A survey of cultural competence of critical care
nurses in Kwa-Zul Natal. South African Journal of Critical Care 30: 50-54.
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