Table of Contents

TRANSCULTURAL NURSING THEORY: SUNRISE MODEL..................................................1

Assumptions................................................................................................................................4
SUNSHINE MODEL......................................................................................................................6
Subconcepts.............................................................................................................................8
Three modes of nursing care decisions and actions.................................................................8
THE ROLE OF A NURSE..............................................................................................................9
REFERENCES..............................................................................................................................11

List if figures
Figure 1: Sunshine Model................................................................................................................7

TRANSCULTURAL NURSING THEORY: SUNRISE MODEL

Transcultural 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 Leininger recognized 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 lifeways

Leininger 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 wellbeing 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 MODEL
The 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.
Subconcepts
Generic (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 actions
a. 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 NURSE
1.
2.
3.
4.
5.

Determine the client's cultural heritage and language skills.

Determine if any of his health beliefs relate to the cause of the illness or to the problem.
Collect information that any home remedies the person is taking to treat the symptoms.
Nurses should evaluate their attitudes toward ethnic nursing care.
Self-evaluation helps the nurse to become more comfortable when providing care to clients

from diverse backgrounds

6. Understand the influence of culture, race &ethnicity 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 wellness
8. 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=w
Leininger, 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=sunris
e%20enabler%20picture&f=false

Leininger, 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=xyHHQ8sHiboDBmiVqyZD
0RJ7kH0#v=onepage&q=leininger's%20transcultural%20nursing%20theory&f=false
Weblinks
http://nursing-theory.org/nursing-theorists/Madeline-Leininger.php
http://nursingtheories.weebly.com/madeleine-m-leininger.html