Population Health for Nurses · Transcultural Nursing

Cultural Models

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On this page 9 sections

In 30 seconds
Why this matters
The college version
Eli explains
Worked example
Key takeaway
Check yourself
Study tools
Sources & references

In 30 seconds

A cultural model (also called a framework or theory) organizes the near-infinite variety of cultural information into categories a nurse can use. Without a model, the nurse misses whole areas of a person's life. With a model, the nurse has a map — communication here, family roles there, beliefs about illness there — so nothing important is skipped.

Models taught in nursing fall into three kinds. Grand theories (Leininger's Culture Care Theory) explain culture and care as a whole. Assessment and competence frameworks (Giger–Davidhizar, Purnell, Campinha-Bacote) tell the nurse what to look at and build. Clinical communication tools (Kleinman's ) supply actual questions to ask. This topic walks through the most exam-relevant ones — and how to use them without turning them into stereotypes.

Why this matters

Models make assessment systematic. A framework prompts exploration of that would otherwise be forgotten — space and time, biological variation, death rituals — where misunderstandings and safety problems hide.
Models connect assessment to intervention. Leininger's three care modes are the clearest example: once the pattern is known, the model says whether to preserve, accommodate, or repattern it.
Models give the team a shared language. Documenting "per Giger–Davidhizar, the client's social organization includes…" tells the team what was assessed.
Models are classic exam content. The theory, six phenomena, twelve domains, five constructs, and Kleinman's questions appear routinely on nursing exams — as does the warning that a model misused as a group checklist becomes a stereotype.

The college version

Core Concepts

Leininger's Culture Care Theory and the Sunrise Model

The is the theory's visual map: a person's worldview and social structure dimensions — religion, kinship and family, politics, economics, education, technology, cultural values, ethnohistory — filter through the environmental context to shape the expressions of care the nurse observes. The nurse then acts through one of three modes:

: keep the client's cultural practices that support health — for example, honoring a family's tradition of having elders present during teaching.
: adjust the plan of care around the client's practices — for example, arranging meal times around fasting periods.
: work with the client to reshape a pattern that threatens health — for example, finding a culturally acceptable way to reduce a harmful dietary practice. Repatterning is negotiated, never imposed.

The Giger–Davidhizar Transcultural Assessment Model

Giger and Davidhizar organized cultural assessment around six cultural phenomena that exist in every culture but are expressed differently: communication (language, verbal and nonverbal style), space (comfort with distance and touch), social organization (family structure, roles, decision-making), time (orientation to past, present, or future), environmental control (beliefs about control over illness, use of traditional healers), and biological variations (differences with biological components). The model's key instruction: assess each phenomenon for the individual client — the phenomena are universal categories, not group descriptions.

The Purnell Model for Cultural Competence

Purnell's model is one of the most detailed organizing frameworks. It pictures culture at four levels — global society, community, family, and person — and lays out twelve domains: overview/heritage, communication, family roles and organization, workforce issues, biocultural ecology, high-risk behaviors, nutrition, pregnancy and childbearing, death rituals, spirituality, healthcare practices, and healthcare practitioner issues. Its size is a strength and a risk (a full twelve-domain assessment is a lot); in practice, nurses use the list as a menu and prioritize what is relevant.

Campinha-Bacote: competence as a process

Campinha-Bacote's model treats competence as a process, not an endpoint, made of five constructs:

Cultural awareness: examining your own biases and assumptions.
Cultural knowledge: learning about diverse worldviews and the conditions that affect different groups.
Cultural skill: conducting culturally relevant assessments and gathering data accurately.
Cultural encounters: seeking direct contact with people from other cultures — the experiences that correct stereotypes.
: the genuine motivation to engage with cultural difference — the construct that fuels all the others.

The model is remembered with the acronym ASKED (Awareness, Skill, Knowledge, Encounters, Desire). Exam memory hook: knowledge is not enough without desire — motivation must be present or the other constructs stall.

Kleinman's explanatory model

Arthur Kleinman's tool is a set of questions that elicit the client's explanatory model — their personal story of the illness: What do you call this problem? What do you think has caused it? Why did it start when it did? What does the illness do to you? How severe is it, and how long will it last? What do you fear most? What treatment do you think you should receive? The questions make the client the expert on their own experience and reveal where the client's understanding and the biomedical plan diverge — where negotiation must happen.

Using models well

Models are maps, not verdicts. They tell you where to look, not what you will find; the findings come from the individual.
Ask before assuming. A domain prompt is a question to ask, never a fact to fill in from a group label.
Combine models — for example, Purnell's domains to organize a community assessment, Kleinman's questions in a single home visit.
Document what you learn so the model's benefit — systematic, shareable information — is realized.

Common Confusions

Do not confuse	With	Difference
Using a model	Following a script	A model prompts questions; a script presumes answers. The person, not the model, provides the content
A model's categories	Facts about a group	Categories (e.g., "time orientation") are things to ask about; filling them in from a group label is stereotyping
Explanatory model	Biomedical model	The explanatory model is the client's story; the biomedical model is the clinician's; both are needed and negotiated
Cultural knowledge	Cultural desire	Knowledge is information; desire is the motivation to use it. Campinha-Bacote treats desire as essential — knowledge alone can stall
The six phenomena	The twelve domains	Giger–Davidhizar's six phenomena and Purnell's twelve domains are different frameworks; exams may test either
One model for every situation	Choosing a fit	Models have different strengths — grand theory, assessment structure, or bedside questions; use the tool that fits the task

Eli explains

The same idea, in plain words

Explain it like I’m 10

A cultural model is like a map of a city you have never visited. The map does not tell you what the people there are like — it shows you the streets so you know where to look: the market, the temple, the school, the clinic. Giger and Davidhizar's map has six streets, Purnell's has twelve, and Kleinman's is a few questions that let the person draw their own map.

Worked example

A community health agency is expanding home visits to a neighborhood with several immigrant communities. Instead of sending nurses in cold, the planning team uses Purnell's model to structure a community profile — heritage, language, family organization, nutrition, healthcare practices, death rituals — built from interviews with community leaders and families and treated as a starting point, not a verdict.

On the first visit, Nurse Amara meets Mr. and Mrs. Chen, who care for Mrs. Chen's father at home. Using Kleinman's questions, she learns the family calls the condition a "slow decline" caused by years of hard labor and expects treatment to restore strength — a different picture than the discharge plan's "rehabilitation program." She also notices the family's time orientation is present-focused and the adult children decide collectively.

Amara does not argue. Using accommodation/negotiation, she reframes the exercises as "strength-building," includes all three adult children in teaching, and schedules visits when the family says. The models did not supply the answers — they made sure she asked the right questions.

Key takeaways

Leininger: Sunrise Model (worldview + social structure dimensions → environment → care expressions); three modes — preservation/maintenance, accommodation/negotiation, repatterning/restructuring.
Giger–Davidhizar: six cultural phenomena — communication, space, social organization, time, environmental control, biological variations. Assess each for the individual.
Purnell: four levels (global society, community, family, person) and twelve domains; a comprehensive menu, not a full checklist for every visit.
Campinha-Bacote: five constructs — awareness, knowledge, skill, encounters, desire; ASKED; competence is a process, never finished.
Kleinman: explanatory model questions reveal what the client calls the problem, believes caused it, fears, and expects as treatment.
Exam trap: models are organizing tools for individuals; using them to "fill in" facts about a group is stereotyping — the most commonly tested misuse.

Check yourself

6 review questions from the chapter. Try each one, then open the answer.

Name the three modes of Leininger's Culture Care Theory and give one example of each.
Show answer
Preservation/maintenance (keep a supportive practice, e.g., involving elders in teaching), accommodation/negotiation (adjust care around practices, e.g., scheduling around fasting), and repatterning/restructuring (work with the client to change a harmful pattern) — examples may vary.
What are the six cultural phenomena in the Giger–Davidhizar model?
Show answer
Communication, space, social organization, time, environmental control, and biological variations.
What does the acronym ASKED stand for in Campinha-Bacote's model, and why is cultural desire important?
Show answer
Awareness, Skill, Knowledge, Encounters, Desire. Cultural desire is genuine motivation to engage with cultural difference; it drives the other constructs, so knowledge without desire can stall.
What is the purpose of Kleinman's explanatory model questions?
Show answer
To elicit the client's explanatory model — what they call the problem, what they believe caused it, what they fear, and what treatment they expect — so care can be negotiated around the client's understanding.
How are Purnell's twelve domains best used in practice?
Show answer
As a menu: prioritize the domains relevant to the person and situation rather than completing all twelve every time.
Why is it wrong to "fill in" a model's categories using a person's group membership?
Show answer
Because models are organizing tools for individuals, not descriptions of groups; filling in categories from a group label replaces asking with assuming — stereotyping.

Keep learning

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Study toolsKey vocabulary

Key vocabulary

Sunrise Model: Leininger's diagram of factors shaping care: worldview, social structure dimensions, environment, care expressions
Cultural care preservation/maintenance: Keeping the client's cultural practices that support health
Cultural care accommodation/negotiation: Adjusting the plan of care around the client's practices
Cultural care repatterning/restructuring: Working with the client to reshape a health-threatening pattern
Domains: The twelve areas of life Purnell's model maps
Cultural desire: Genuine motivation to engage with cultural difference
Explanatory model: The client's own account of what is wrong and why

Sources & references

openstax.org — Population Health

This lesson was adapted from the open educational references above; their licenses and attributions are preserved. See Copyright & Licensing.

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