Table of ContentsTRANSCULTURAL NURSING THEORY: SUNRISE
MODEL1Assumptions4SUNSHINE MODEL6Subconcepts8Three modes of nursing
care decisions and actions8THE ROLE OF A NURSE9REFERENCES11
List if figures Figure 1: Sunshine Model7
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TRANSCULTURAL NURSING THEORY: SUNRISE MODELTranscultural nursing
is a comparative study of cultures to understand similarities
(culture universal) and difference (culture-specific) across human
groups (Leininger, 1994). This care is intended to fit with or have
beneficial meaning and health outcomes for people of different or
similar cultural backgrounds.Early in her career,Madeleine
Leiningerrecognized the importance of the element of caring in the
profession of nursing. Through her observations while working as a
nurse, she identified a lack of cultural and care knowledge as the
missing component to a nurse's understanding of the many variations
required in patient care to support compliance, healing, and
wellness.Leininger's Culture Care Theory attempts to provide
culturally congruent nursing care through "cognitively based
assistive, supportive, facilitative, or enabling acts or decisions
that are mostly tailor-made to fit with individual, group's, or
institution's cultural values, beliefs, and lifeways." The intent
of the care is to fit with or have beneficial meaning and health
outcomes for people of different or similar culture
backgrounds.Culturally congruent care is possible when the
following occurs in the nurse-patient relationship: "Together the
nurse and the client creatively design a new or different care
lifestyle for the health or well-being of the client. This mode
requires the use of both generic and professional knowledge and
ways to fit such diverse ideas into nursing care actions and goals.
Care knowledge and skill are often repatterned for the best
interest of the clients. Thus all care modalities require
coparticipation of the nurse and clients (consumers) working
together to identify, plan, implement, and evaluate each caring
mode for culturally congruent nursing care. These modes can
stimulate nurses to design nursing actions and decisions using new
knowledge and culturally based ways to provide meaningful and
satisfying wholistic care to individuals, groups or
institutions."Leininger's model has developed into a movement in
nursing care called transcultural nursing. In 1995, Leininger
defined transcultural nursing as "a substantive area of study and
practice focused on comparative cultural care (caring) values,
beliefs, and practices of individuals or groups of similar or
different cultures with the goal of providing culture-specific and
universal nursing care practices in promoting health or well-being
or to help people to face unfavorable human conditions, illness, or
death in culturally meaningful ways."Leininger developed new terms
for the basic concepts of her theory. The concepts addressed in the
model are: Care, which assists others with real or anticipated
needs in an effort to improve a human condition of concern, or to
face death. Caring is an action or activity directed towards
providing care. Culture refers to learned, shared, and transmitted
values, beliefs, norms, and lifeways to a specific individual or
group that guide their thinking, decisions, actions, and patterned
ways of living. Culture Care is the multiple aspects of culture
that influence and help a person or group to improve their human
condition or deal with illness or death. Culture Care Diversity
refers to the differences in meanings, values, or acceptable forms
of care in or between groups of people. Culture Care Universality
refers to common care or similar meanings that are evident among
many cultures. Nursing is a learned profession with a disciplined
focus on care phenomena. Worldview is the way people tend to look
at the world or universe in creating a personal view of what life
is about. Cultural and Social Structure Dimensions include factors
related to spirituality, social structure, political concerns,
economics, educational patterns, technology, cultural values, and
ethnohistory that influence cultural responses of people within a
cultural context. Health refers to a state of well-being that is
culturally defined and valued by a designated culture. Cultural
Care Preservation or Maintenance refers to nursing care activities
that help people from particular cultures to retain and use core
cultural care values related to healthcare concerns or conditions.
Cultural Care Accomodation or Negotiation refers to creative
nursing actions that help people of a particular culture adapt or
negotiate with others in the healthcare community in an effort to
attain the shared goal of an optimal health outcome for patients of
a designated culture. Cultural Care Re-Patterning or Restructuring
refers to therapeutic actions taken by culturally competent nurses.
These actions help a patient to modify personal health behaviors
towards beneficial outcomes while respecting the patient's cultural
values.The theory's culturalogical assessment provides a holistic,
comprehensive overview of the client's background. The assessment
addresses the following: communication and language gender
considerations sexual orientation ability and disability occupation
age socioeconomic status interpersonal relationships appearance
dress use of space foods and meal preparation and related
lifewaysLeininger proposes that there are three modes for guiding
nurses judgments, decisions, or actions in order to provide
appropriate, beneficial, and meaningful care: preservation and/or
maintenance; accommodation and/or negotiation; and re-patterning
and/or restructuring. The modes have greatly influenced the nurse's
ability to provide culturally congruent nursing care, as well as
fostering culturally-competent nurses.Assumptions Leininger's model
makes the following assumptions:1. Care is the essence of nursing
and a distinct, dominant, and unifying focus.2. Caring is essential
for well-being, health, healing, growth, and to face death.3.
Culture care is the broadest holistic means by which a nurse can
know, explain, interpret, and predict nursing care phenomena to
guide nursing care practices.4. Nursing is a transcultural,
humanistic, and scientific care discipline and profession with the
central purpose to serve human beings worldwide.5. Caring is
essential to curing and healing. There can be no curing without
caring.6. Culture care concepts, meanings, expressions, patterns,
processes, and structural forms of care are different and similar
among all cultures of the world.7. Every human culture has lay care
knowledge and practices and usually some professional care
knowledge and practices which vary transculturally.8. Culture care
values, beliefs, and practices are influenced in the context of a
particular culture. They tend to be embedded in such things as
worldview, language, spirituality, kinship, politics and economics,
education, technology, and environment.9. Beneficial, healthy, and
satisfying culturally-based nursing care contributes to the
well-being of individuals, families, and communities within their
environmental context.10. Culturally congruent nursing care can
only happen when the patient, family, or community values,
expressions, or patterns are known and used appropriately, and in
meaningful ways by the nurse with the people.11. Culture care
differences and similarities between the nurse and patient exist in
any human culture worldwide.12. Clients who experience nursing care
that fails to be reasonably congruent with their beliefs, values,
and caring lifeways will show signs of cultural conflicts,
noncompliance, stresses and ethical or moral concerns.13. The
qualitative paradigm provides new ways of knowing and different
ways to discover the epistemic and ontological dimensions of human
care.The Culture Care Theory defines nursing as a learned
scientific and humanistic profession that focuses on human care
phenomena and caring activities in order to help, support,
facilitate, or enable patients to maintain or regain health in
culturally meaningful ways, or to help them face handicaps or
death.SUNSHINE MODELThe Sunshine Model is Leininger's visual aid to
the Culture Care Theory. The Model shows potential influences (not
causes) that might explain care practices related to historical,
cultural, social structure, worldview, environmental, and other
factors. As such it is a useful framework in helping you to
understand the needs and health requirements of your
patients/clients. Leininger incorporates within the model features
usually embedded or related to social structure such as religion,
kinship, politics, and economics. Gender, age and ethnic
information are embedded in family ties and specific norms and
practices. Whilst the model was developed initially as a conceptual
holistic research guide aimed at enabling researchers to identify
the theoretical aspects of transcultural nursing, for example how
other cultures experience pain, death and dying, bereavement and to
explain the nursing practices that stem from this, she also
describes how the model may be used in nursing assessment.
Leininger describes how nurses may tease out embedded practices
through careful questioning, active listening, patience, and
confirming what one sees and hears, believing that patients/clients
like to tell their story and are often pleased the nurse remains
interested in their world of telling and knowing.
Figure 1: Sunshine Model
Cultural congruent (nursing) care is defined as those
cognitively based assistive, supportive, facilitative, or enabling
acts or decisions that are tailor-made to fit with individual,
group, or institutional cultural values, beliefs, and lifeways in
order to provide or support meaningful, beneficial, and satisfying
health care, or well-being services.SubconceptsGeneric (folk or
lay) care systems are culturally learned and transmitted,
indigenous (or traditional), folk (home-based) knowledge and skills
used to provide assistive, supportive, enabling, or facilitative
acts toward or for another individual, group, or institution with
evident or anticipated needs to ameliorate or improve a human life
way, health condition (or well-being), or to deal with handicaps
and death situations.Professional care system(s) are defined as
formally taught, learned, and transmitted professional care,
health, illness, wellness, and related knowledge and practice
skills that prevail in professional institutions usually with
multidisciplinary personnel to serve consumers.Care as a verb is
defined as actions and activities directed toward assisting,
supporting, or enabling another individual or group with evident or
anticipated needs to ameliorate or improve a human condition or
lifeway or to face death.Three modes of nursing care decisions and
actionsa. Cultural care preservation is also known as maintenance
and includes those assistive, supporting, facilitative, or enabling
professional actions and decisions that help people of a particular
culture to retain and/or preserve relevant care values so that they
can maintain their well-being, recover from illness, or face
handicaps and/or death.b. Cultural care accommodation also known as
negotiation, includes those assistive, supportive, facilitative, or
enabling creative professional actions and decisions that help
people of a designated culture to adapt to or negotiate with others
for a beneficial or satisfying health outcome with professional
care providers.c. Culture care repatterning, or restructuring
includes those assistive, supporting, facilitative, or enabling
professional actions and decisions that help a client(s) reorder,
change, or greatly modify their lifeways for new, different, and
beneficial health care pattern while respecting the client(s)
cultural values and beliefs and still providing a beneficial or
healthier lifeway than before the changes were coestablished with
the client(s). (Leininger, 1994)THE ROLE OF A NURSE1. Determine the
client's cultural heritage and language skills.2. Determine if any
of his health beliefs relate to the cause of the illness or to the
problem.3. Collect information that any home remedies the person is
taking to treat the symptoms.4. Nurses should evaluate their
attitudes toward ethnic nursing care.5. Self-evaluation helps the
nurse to become more comfortable when providing care to clients
from diverse backgrounds6. Understand the influence of culture,
race ðnicity on the development of social emotional
relationship, child rearing practices & attitude toward
health.7. Collect information about the socioeconomic status of the
family and its influence on their health promotion and wellness8.
Identify the religious practices of the family and their influence
on health promotion belief in families.9. Understanding of the
general characteristics of the major ethnic groups, but always
individualize care.10. The nursing diagnosis for clients should
include potential problems in their interaction with the health
care system and problems involving the effects of culture.11. The
planning and implementation of nursing interventions should be
adapted as much as possible to the client's cultural background.12.
Evaluation should include the nurse's self-evaluation of attitudes
and emotions toward providing nursing care to clients from diverse
sociocultural backgrounds.13. Self-evaluation by the nurse is
crucial as he or she increases skills for interaction. .
REFERENCES Leininger, M. (1997). Transcultural nursing research
to tranform nursing education and practice: 40 years.Image: Journal
of Nursing Scholarship,29(4), 341+. Retrieved from
http://0go.galegroup.com.mel.org/ps/i.do?id=GALE%7CA20125511&v=2.1&u=lom_accessmich&it=r&p=AONE&SW=wLeininger,
M. M.& McFarland, R. M. (2006). Culture care diversity and
Universality, A world wide Nursing theory (2nd ed). (pp1-50). Jones
and Bartlette Publishers.
http://books.google.com/books?id=NmY43MysbxIC&pg=PA24&dq=sunrise+enabler+picture&lr=#v=onepage&q=sunrise%20enabler%20picture&f=falseLeininger,
M. M. (1994). Nursing Education and International Perspective.
Teaching and Learning Transcultural Nursing. (pp 207-225). Juta
& Co, Zebra Publications.
http://books.google.com/books?hl=en&lr=&id=tHq0pWamh1oC&oi=fnd&pg=PA207&dq=leininger%27s+transcultural+nursing+theory&ots=wyJJ6fqy5b&sig=xyHHQ8sHiboDBmiVqyZD0RJ7kH0#v=onepage&q=leininger's%20transcultural%20nursing%20theory&f=falseWeblinkshttp://nursing-theory.org/nursing-theorists/Madeline-Leininger.phphttp://nursingtheories.weebly.com/madeleine-m-leininger.html
