Most facilities have a standard tool. Many tools are based on Madeleine Leininger’s theory of Cultural Care. Leininger’s theory is founded on the idea that cultural heritage and customs are important to each group. Leininger’s Cultural Care Diversity and Universality Theory and the Sunrise model, which arose from the theory, started the revolution of defining cultural care and the use of cultural care concepts in the nursing assessment process. The Sunrise model uses Leininger’s Culture Care Diversity and Universality Theory components that focus on patient care in a global environment and is multifaceted to include the culture’s characteristics in an interdependent relationship (Leininger, 2002).
It is imperative that healthcare providers understand these customs and can care for each patient individually to preserve the cultural atmosphere. This level of care translated into transcultural patient care, and several models of care were developed, including Giger and Davidhizar, and Purnell.
Giger and Davidhizar's Transcultural Assessment Model is based on six data collection areas (Giger, 2014). The model centers on the idea that although cultures are different in characteristics, they share fundamental factors.
- Communication- what language is spoken? How is silence used? Notice pronunciation of words. What non-verbal forms of communication are used?
- Space- what is personal space? Notice body movements during conversations.
- Social Organization- Note gender and sexual orientation, geography, socioeconomic status, ethnicity, family role, religion, age and life cycle status.
- Time- How is time used, how important is time, is there more focus on past, present, or future?
- Environmental controls- What are current health practices? What is the definition of health and illness?
- Biological variations- physical dimensions, genetic susceptibility to disease, nutritional preferences, social support, coping structure.
- Cultural uniqueness- Place of birth, race, length of time in this country
The Purnell Model for Cultural Competence is an assessment tool used in primary, secondary, and tertiary care. The model has its roots in biology, anthropology, sociology, economics, geography, political science, pharmacology, nutrition, communication, family development, and social support (Purnell, 2008). Concepts from each discipline are reflected in the domains used in the model. It is conceptualized as a circle, with society being the outer ring, community the second ring, family the third ring, and the inner ring is the person. There are 12 domains in the Purnell Model that are used as guides in the assessment. These are (Purnell, 2008):
- Heritage- origin, residence, economics, topography, politics, education, occupation
- Communication- language, dialects, time, names, touch, facial expression, body language, spatial distancing, volume, tone, eye contact
- Family role and organization- structure, gender, roles, child-rearing, social status, roles of child and elderly
- Workforce- language barriers, autonomy, dominant culture, secondary culture
- Biocultural ecology- biological and physical characteristics
- High-risk behaviors – safety, alcohol, and drug
- Nutrition – common foods, rituals, limitations, health promotion
- Pregnancy and child-rearing - fertility practices, view on pregnancy and child-rearing, birthing, postpartum
- Death- rituals, bereavement
- Spirituality – religion, the meaning of life, prayer, spirituality
- Healthcare practices - traditions, responsibility for health, self-medication, rehabilitation, beliefs, barriers
- Healthcare practitioner – perceptions, folk practices, gender healthcare status
The model is based on the assumption that all healthcare providers need the same information. The assessment is based on four factors of how the person functions in each of the following factors: global society, family, personal practice, and health practices. Further, it is assumed that all cultures have similar core components, but each culture has specific variations that can change over time. The model also assumes that health care providers understand the importance of culture in the assessment and care of each patient.