The Culture Assessment Models in the Nursing Practice

History and Background

These days’ international medical tourism is developing rapidly in the world. Foreigners may find themselves in the unfamiliar ambiance in clinics when the accident happened on vacation, during a stay on a work or student visa when applying for help from migrants. It is more difficult for someone who has a disease overseas as foreign cultural traditions are mixed with medical rules and norms. Nurses need to be aware of cultural diversity, various approaches towards different groups of patients regarding their origins, and the ability to speak the nonnative language. There are two culture assessment models that can be observed in terms of their implication into the nurse work process are The Sunrise Model by Madeleine Leininger and the Giger and Davidhizar Transcultural Assessment Model.

The person who first drew attention to the ethnic and cultural characteristics of patient care of different nationalities, races, and religions, was an American nurse Madeleine Leininger. Leininger was a member of the Royal College of Nursing of Australia. Her teaching activities were awarded state and public awards, such as the President’s Award for Excellence in Teaching, the Board of Governors’ Distinguished Faculty Award, and the Gershenson’s Research Fellowship Award (Ray, 2016). Madeline introduced transcultural care into nursing practice. Madeleine created the Sunrise Model, illustrating the interconnection of cultural concepts. Features of the patients’ thinking are determined by their cultural values, beliefs, habits, superstitions, and lifestyle of an individual or group, which a nurse should understand (Ray, 2016). Cultural features shape the language and characteristics of communication, understanding gender roles, attitude towards disability, occupation, age, social and economic status, and relations in society and between family members.

To study the specifics of the mentality and communicative behavior of the cultural community, Giger and Davidizar propose to consider six sociocultural parameters being specific to each cultural group and affecting intercultural communication. These elements are environmental control, biological variations, social organization, communication, space, time orientation (Giger & Haddad, 2020). The model of Leininger focuses on the application of culturally congruent nursing. It has led to the idea of transcultural competence, and the primary purpose of it is to provide specific and universal methods of nursing care to maintain the health and people’s well-being from the standpoint of cultural differences. However, Giger and Davidhizar concentrate on individuality, avoiding uniting all people in the cultural group. Every patient is culturally unique from the six perspectives.

Strengths and Weaknesses

The Sunrise Model

Concerning the Sunrise Model of Madeleine Leininger’s, there are several positive outcomes of its implementation in the healthcare system. Firstly, nurses pay particular attention to a patient’s physical, mental, and cultural needs during the healing process. For instance, when Japanese nurses talked about a Russian patient yearning for brown bread. Especially for his sake, several times a week, brown bread was brought from the Russian diplomatic mission. Due to the awareness of customs, traditions of the patient’s culture, it facilitates the treatment and quick recovery.

Secondly, according to Leininger, the disease changes a person and changes itself under the influence of the person’s physiology and mental characteristics. There should be particular attention on the environment: the use of space and methods of cooking, hair, and jewelry. Creating the proper ambiance might help to diminish the course of a disease. Finally, historically, when traditional medicine had been formed, it began to inspire confidence. Consequently, when the medical community is fond of other people’s experience, abandoning the traditions and achievements, the credibility gap is formed. In every human culture, knowledge and experience are accumulated related to health and illness.

The Giger and Davidhizar Transcultural Assessment Model

One of the strengths of the Giger and Davidhizar Assessment Model is emphasis on the language and communication. Communicative features are manifested in various languages, verbal and non-verbal behavior, speech expressiveness, and silence. The language barrier between different cultures is one of the most severe communication problems. In healthcare, communication is complicated by the presence of medical terminology, technical terms, slang, abbreviations, and idioms (Giger & Haddad, 2020). Besides, each communicative community has its verbal communication standards, for example, choice of words, volume, and speed of speech, the directness of expression, permissible degree of emotionality.

Secondly, the most common form of communication in a medical setting is dialogue, in most cases, between a healthcare provider and a patient. A comprehensive analysis of 6 phenomena in regard to the healthcare system in the United States confirms how important it is to overcome the barriers and successful communicative competence (Giger & Haddad, 2020). Finally, one of the advantages is the factor of the patients’ perception of health and treatment issues. One of the elements of this model is environmental control which includes existing systems of traditional beliefs regarding health and treatment, traditional medicine practices, and seeking help from a spiritual healer. Using this model, medical staff can understand the way of creating convenient treatment processes for patients.


Both models have similar disadvantages. It is complex to validate the cultural competence of the nurse’s healthcare as there is no measurement of the medical professionals’ behavior and the outcomes of clinical treatment. Furthermore, both sophisticated and practical require transcultural nursing knowledge and appropriate research methods to illustrate the phenomena (Wehbe-Alamah, 2018). For instance, the Sunrise Model shows multiple interrelationships of approaches and diversity of critical theories and relationships, especially social structure factors (Wehbe-Alamah, 2018). To be implemented correctly, it also requires elemental anthropological knowledge and considerable transcultural nursing knowledge. The Transcultural Assessment Model demands a critical systematic study of cultures in all their displays, leading to a comprehension of their diversity and the destruction of stereotypes.


In a multinational state, communicative conflicts in the healthcare sector are often based on ignorance of the participants’ cultural and national features. These problems are universal and result from either a language barrier, misunderstanding of non-verbal signals, violation of the conventions of cultural etiquette, or ethnocentrism and discrimination. The best choice for implementation is the Giger and Davidhizar Assessment Model.

Traditionally, cultures differ in the degree of expressiveness of speech. For example, Americans of European descent monitor the tone of voice and value restraint in expressing their emotions. By contrast, African Americans are more verbal and value emotionality in a conversation or argument, expressing displeasure loudly at the slightest discomfort or pain. Due to this fact’s ignorance, the loudness and dynamism of their speech can be interpreted as aggressiveness by more restrained white staff (Ray, 2016). This knowledge would be beneficial for medical services consequently to improvement of patient satisfaction (Ray, 2016). Moreover, it takes into account the peculiarities of the national and sociocultural mentality of representatives of different habits and to study aspects of the cultural behavior of the group with which communication occurs.


The first recommendation to improve the models’ application is to create a system for monitoring patient satisfaction in healthcare institutes and develop detailed guidelines. Besides, it is necessary to conduct an analytical report on the results of observation, followed by the formation of an information-analytical data bank. Medical staff should be informed about the results of a study, presenting the results of monitoring at meetings, conferences of healthcare facilities. Moreover, it would be useful to increase medical effectiveness by conducting seminars, improving the personal-professional and ethical-deontological qualities of medical workers, thereby improving the efficiency of medical care.


Giger, J. N., & Haddad, L. (2020). Transcultural Nursing-E-Book: Assessment and Intervention. (8th ed.). Elsevier Health Sciences.

Ray, M. A. (2016). Transcultural Caring Dynamics in Nursing and Health Care. FA Davis.

Wehbe-Alamah, H. B. (2018). Leininger’s culture care diversity and universality theory: Classic and new contributions. Annual Review of Nursing Research, 37(1), 1-23. doi:10.1891/0739-6686.37.1.1

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