Three Lenses for Culturally Congruent Care: Leininger's Sunrise Model, Campinha-Bacote's Process of Cultural Competence, and the LEARN Model
Student Name
Master of Science in Nursing Program, Aspen University
N512: Diverse Populations & Health Care
Instructor Name
Month Day, Year
Slide 2: Objectives
Describe Leininger's Culture Care theory and the Sunrise Model
Explain Campinha-Bacote's process of cultural competence as a self-assessment model
Apply the LEARN model, from medicine, to cross-cultural communication
Compare the three and use them together with one patient
Speaker notes: By the end of this presentation, the audience should be able to describe each model, explain what it adds to nursing practice, and use the three together. Two models come from nursing and one from family medicine, which shows that cultural care draws on more than one discipline. A single patient example runs through the later slides so the models can be seen working rather than only defined.
Slide 3: Why Cultural Models Matter
Good intentions do not replace method
Models tell the nurse what to assess and how to decide
They guard against stereotyping by focusing on the individual
They give teams a shared language
Speaker notes: Nurses care for patients whose beliefs about health, family, and illness differ from their own every day. Without a structured approach, care tends to follow the nurse's own cultural norms by default. Cultural models give the nurse questions to ask, factors to consider, and a way to make decisions that fit the patient. They also give a unit a common vocabulary for discussing cultural issues.
Slide 4: Leininger's Culture Care Diversity and Universality
Care is the essence of nursing, and care is shaped by culture
Diversity: care meanings and practices differ across cultures
Universality: some care values are shared across cultures
Goal: culturally congruent care for health and well-being
Speaker notes: Madeleine Leininger founded transcultural nursing and developed the theory of Culture Care Diversity and Universality. Her central claim is that care is the essence of nursing and that what counts as caring differs among cultures while also sharing common features. The goal of the theory is culturally congruent care, meaning care that fits the patient's values and lifeways and therefore supports health, well-being, or a meaningful death (Leininger, 2002).
Slide 5: The Sunrise Model
Graphic: the Sunrise Model, redrawn with its rising half-circle of factors
Seven cultural and social structure factors shape care
Technological, religious and philosophical, kinship and social, cultural values and lifeways, political and legal, economic, educational
Environmental context, language, and history surround them
Speaker notes: The Sunrise Model is the visual guide Leininger created to help nurses discover how culture shapes care. Its upper half shows cultural and social structure factors, including technology, religion and philosophy, family and social bonds, values and ways of living, political and legal systems, economics, and education, all set within environmental context, language, and history. These factors influence care expressions and patterns, which in turn affect health (Leininger, 2002).
Slide 6: Emic and Etic Knowledge
Emic: the insider's view, the patient's own meanings
Etic: the outsider's view, including professional knowledge
Both are needed for congruent care
The nurse learns the emic view by asking, not assuming
Speaker notes: Leininger distinguished emic knowledge, the insider's perspective held by the patient and their community, from etic knowledge, the outsider's perspective, including professional and scientific knowledge. Culturally congruent care blends the two. The nurse brings etic knowledge about disease and treatment but must learn the emic view of what the illness means and what care should look like from the patient and family.
Slide 7: Three Modes of Nursing Decisions
Preservation or maintenance: keep beneficial practices
Accommodation or negotiation: adapt care to fit cultural needs
Repatterning or restructuring: help change harmful practices respectfully
Choice depends on the practice's effect on health
Speaker notes: Leininger's theory gives three modes of nursing action. Where a practice helps or is harmless, such as prayer or family presence, the nurse keeps it in place; that is preservation or maintenance. Where care and culture pull in different directions, the nurse adapts, for example by scheduling medications around a fast; that is accommodation or negotiation. Where a practice causes harm, the nurse works with the patient to change it; that is repatterning or restructuring, done in partnership and with respect for the patient's values (Leininger, 2002).
Slide 8: Campinha-Bacote's Process of Cultural Competence
Cultural competence as a process of becoming, not a state of being
Five constructs: awareness, knowledge, skill, encounters, desire
Mnemonic: ASKED
Applies to individuals and organizations
Speaker notes: Josepha Campinha-Bacote describes cultural competence as an ongoing process in which the nurse continually strives to work effectively within the patient's cultural context. Her model rests on five linked constructs, each carrying the word cultural and listed here in the order of the ASKED mnemonic: awareness, skill, knowledge, encounters, and desire. The mnemonic ASKED helps nurses ask themselves questions about each construct (Campinha-Bacote, 2002).
Slide 9: The Five Constructs
Graphic: five overlapping circles labeled with the constructs
Awareness: examine one's own biases and background
Knowledge: learn about health beliefs, disease patterns, treatment responses
Skill: collect cultural data and perform culturally based assessments
Encounters: direct interactions with people from other cultures
Desire: the motivation to want to engage
Speaker notes: Cultural awareness is self-examination of one's own culture and biases. Cultural knowledge includes health-related beliefs, disease incidence, and differences in responses to treatment. Cultural skill is the ability to collect relevant cultural data and perform a culturally sensitive assessment. Cultural encounters are direct interactions that refine beliefs and prevent stereotyping. Desire, wanting to engage instead of merely complying, supplies the energy for the other four (Campinha-Bacote, 2002).
Slide 10: Using the Model for Self-Assessment
Awareness: What biases do I bring to this patient?
Knowledge: What do I know, and what might I be assuming?
Skill: Can I conduct a cultural assessment?
Encounters: How many direct interactions have I had?
Desire: Do I want to engage, or am I complying?
Speaker notes: The ASKED questions turn the model into a self-assessment tool. Before caring for a patient from an unfamiliar background, the nurse can ask whether they have examined their own biases, what they know and what they may be assuming, whether they have the skills to assess this patient, how much direct experience they have, and whether they genuinely want to engage. Honest answers identify where learning is needed.
Slide 11: The LEARN Model, a Non-Nursing Framework
Developed in family medicine by Berlin and Fowkes (1983)
A framework for cross-cultural communication in clinical encounters
Focuses on explanatory models: how the patient understands the illness
Useful to any clinician, including nurses
Speaker notes: The LEARN model was developed by two family physicians as a teaching framework for cross-cultural health care. It is not a nursing theory, but it fits nursing well because it structures a conversation in which the clinician's and the patient's explanations of an illness are compared and reconciled (Berlin & Fowkes, 1983). It focuses on communication, which the other two models assume but do not script.
Slide 12: The Five Steps of LEARN
Listen with sympathy to the patient's view of the problem
Explain the clinician's view
Acknowledge differences and similarities
Recommend treatment
Negotiate agreement
Speaker notes: The five steps are listen, explain, acknowledge, recommend, and negotiate. The clinician begins by listening to the patient's perception of the problem, then explains their own perception, acknowledges where the two views agree and differ, recommends treatment, and negotiates a plan that the patient can accept. Negotiation may include incorporating traditional practices that are not harmful (Berlin & Fowkes, 1983).
Slide 13: Comparing the Three Models
Graphic: comparison table of focus, origin, and best use
Leininger: what cultural factors shape care, and what to do
Campinha-Bacote: how the nurse develops competence
LEARN: how to talk through differences in one encounter
Speaker notes: The three models answer different questions. Leininger's theory tells the nurse which cultural and social factors to assess and offers three modes of action. Campinha-Bacote's model focuses on the nurse's own development and gives questions for self-assessment. The LEARN model gives a concrete sequence for a conversation. Used together, they cover the patient, the nurse, and the encounter between them.
Slide 14: Case Example, the Patient
Composite patient: 68-year-old Mexican American woman with new type 2 diabetes
Prefers Spanish; lives with her daughter's family
Believes the illness came from a severe fright after her husband's death
Uses nopal cactus and prayer; worried about insulin
Speaker notes: To show the models working together, consider a composite patient: a 68-year-old Mexican American woman recently diagnosed with type 2 diabetes. She prefers Spanish, lives with her daughter's family, and believes her illness began after a severe fright when her husband died. She eats nopal cactus to lower her sugar, prays daily, and is afraid that insulin causes blindness because a relative lost her sight after starting it.
Slide 15: Applying Leininger
Sunrise factors: kinship, religion, cultural values, economics
Preserve: prayer, family involvement, nopal as part of meals
Accommodate: involve the daughter in teaching; adapt the meal plan
Repattern: address the insulin fear gently with accurate information
Speaker notes: Using the Sunrise Model, the nurse assesses kinship, religion, values, and economics. Prayer and family involvement can be preserved. Nopal, which is a food, can remain in her diet within a plan that accounts for its effect. Care can be accommodated by including her daughter and adapting traditional meals. Her fear of insulin is a belief the nurse can gently repattern by explaining that diabetes, not insulin, damages the eyes.
Slide 16: Applying Campinha-Bacote
Awareness: Am I dismissing susto as superstition?
Knowledge: Learn about susto and common beliefs about insulin
Skill: Use a qualified interpreter and a cultural assessment
Encounters and desire: Engage with her family and community
Speaker notes: Applying the ASKED questions, the nurse checks whether they are inclined to dismiss her explanation of the illness, known as susto or fright, as superstition. They learn what susto means to her and why insulin is feared in some communities. They use a qualified interpreter rather than her grandchildren, and they approach the encounter with genuine interest rather than a checklist.
Slide 17: Applying LEARN
Listen: 'What do you think caused your diabetes?'
Explain: high blood sugar and how it harms the eyes and kidneys
Acknowledge: both views agree that stress and grief affect health
Recommend and negotiate: start with metformin and meal changes; revisit insulin later
Speaker notes: The LEARN conversation begins by asking what she believes caused her illness and listening without correction. The nurse practitioner then explains high blood sugar in simple terms, acknowledges that grief and stress do affect health, and recommends a plan. Negotiation might begin with oral medication and meal changes she can accept, with a promise to revisit insulin if it is needed, keeping trust intact.
Slide 18: Conclusion
Leininger: assess culture and choose preserve, accommodate, or repattern
Campinha-Bacote: keep developing awareness, knowledge, skill, encounters, desire
LEARN: structure each conversation around both explanations
Together: congruent care for the patient, growth for the nurse
Speaker notes: Each model contributes something different. Leininger's theory guides what to assess and how to decide. Campinha-Bacote's model keeps the nurse's own development in view. The LEARN model turns good intentions into a conversation that respects the patient's explanation while delivering safe care. Using them together helps the nurse provide care that fits the patient and keep growing in the process.
References
Berlin, E. A., & Fowkes, W. C., Jr. (1983). A teaching framework for cross-cultural health care: Application in family practice. Western Journal of Medicine, 139(6), 934-938.
Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing, 13(3), 181-184. https://doi.org/10.1177/10459602013003003
Leininger, M. (2002). Culture care theory: A major contribution to advance transcultural nursing knowledge and practices. Journal of Transcultural Nursing, 13(3), 189-192. https://doi.org/10.1177/10459602013003005
How this N 512 Module 2 example is structured
N512 Module 2 typically asks for at least 15 content slides plus title, objectives and references presenting two nursing cultural theories or models and one non-nursing theory, one of them Leininger's Sunrise Model or Culture Care theory, one a self-assessment model and one a communication model, with three graphics and detailed speaker notes with APA citations. Aspen revises courses, so follow your classroom's prompt. This example gives each model definition and application slides, compares them in a table and applies all three to one patient.
N512 Module 2 questions, answered
What does N512 Module 2 usually ask for?
A presentation of at least 15 content slides, plus title, objectives and references, on two nursing cultural models and one non-nursing model: Leininger's theory or Sunrise Model, a self-assessment model and a communication model, with three graphics and detailed speaker notes.
What are Leininger's three modes of nursing action?
Keeping helpful practices (preservation or maintenance), adapting care so culture and treatment fit together (accommodation or negotiation) and helping change harmful practices (repatterning or restructuring). The nurse chooses among them based on whether a cultural practice helps, is neutral or harms the patient's health.
What does LEARN stand for?
Listen, Explain, Acknowledge, Recommend and Negotiate. Berlin and Fowkes developed it in family medicine as a framework for cross-cultural clinical conversations.
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