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Models of Transcultural Care - Cultural Competence

Leininger’s Model

Leininger's Cultural Care Diversity and Universality Theory and the Sunrise Model are perhaps the most written about to date. (Sources: Reynolds & Leininger, 1993)

The theory draws from anthropological observations and studies of culture, cultural values, beliefs and practices. It derives from nursing and anthropological concepts and methods of enquiry. Some concepts are described as they pertain to the theoretical development. The orientational definitions are explained. Leininger has defined concepts as they apply to nursing. The development of the theory of transcultural nursing is based on the defining and re-defining of concepts to give them a focus that emphasise the essence of care in its cultural context, with both the culture specific and universal issues being considered. Leininger claims that the theory of cultural care diversity and universality is holistic.

Leininger considers cultural blindness, culture shock, culture imposition, ethnocentrism and cultural relativism as barriers to developing knowledge about other’s culture.

The model has been used in a wide range of nursing specialisms.

As many of the concepts are abstract in nature together with the layered way in which it is constructed, the theory is complex and requires an understanding of how these interrelate. Many of these concepts are prefixed by the adjective ‘cultural’, pointing to the emphasis placed by Leininger on the cultural perspective. The theory is holistic and seeks to encompass both the diversity and universality of concepts in nursing care. This is because Leininger also recognises the comparative aspects of caring within and between cultures, hence the acknowledgement of similarities as much as differences in caring in diverse cultures. The broad concepts and their qualitative dimensions make the theory relatively comprehensive and applicable in some contexts of multicultural care settings. The theory of transcultural nursing has been researched using the qualitative approach. The rigour of the approach has been demonstrated primarily through the criteria of credibility and confirmability of data in the studies. The theory has implications for how we assess, plan, implement and evaluate care of people from diverse cultural backgrounds. (A detailed critical overview can be found in Marriner-Tomey,1994, Chapter 28, pp. 423-444).

The model with its emphasis on cultural sensitivity and cultural congruence has been criticised on the grounds that it assumes that knowledge of different cultures will improve care and services (Culley, 1996, Culley 1997, Culley 2000). The culturalist approach fails to account for the structural and political aspects of the inequalities of minority ethnic people (Mulholland, 1995). And, by focusing on cultural differences and deficits, makes the culture the problem, and gives rise to a 'victim blaming' stance. The cultural analysis is based on the notion of cultural differences as cultural deficits, and may reinforce stereotypes, and perpetuate the power distance between care professionals and patients. From the perspective of cultural safety, the power relationship between the patient and the care professional is an important one , and it has been argued that not to take into account the structural and political issues that affect people from minority ethnic groups is to diminish and disempower, making the care less than culturally safe (Coup, 1996).

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