Transcultural Caring Dynamics in Nursing and Health Care

Contributor: Marilyn (Dee) Ray
September 20, 2018

Author: Marilyn (Dee) Ray, RN, PhD, CTN-A, FAAN. Colonel (Ret.), United States Air Force Nurse Corps

Exemplars –

Year First Published – 1989

© 2018 Marilyn (Dee) Ray

Major Concepts

The Dimensions of the Theory are the following:

Essence of caring –  (the action of compassion and love as the mediating force to guide moral caring behavior and facilitate right action within the dynamics of culture. caring beliefs and values, transcultural caring ethics (moral foundations of respect for persons, cultural rights), transcultural context, and universal sources (religious/spiritual dimensions)

Transcultural Caring Ethics – (the ethical knowledge of respect, fidelity, integrity, beneficence, human rights, cultural rights, the rights of nature and so forth that shapes moral caring experience that facilitates transcultural ethical caring;

Transcultural Context  – illuminates the person in the sociocultural context, including political, economic, technological, legal, ecological and health care systems–the diverse identities and personal/ethnic/cultural/multicultural values, beliefs and attitudes about relationships, symbols, rituals guiding transcultural experience in social, communal, health care organizations and global cultural systems;

Universal Sources –  highlight select religions and/or spiritual relationships and beliefs and the universal mind, and identify how standards of spiritual and religious traditions shape transcultural caring experience.

Transcultural Caring Awareness, Understanding and Choice –  the center of this dynamic model which illuminates the process of transcultural caring inquiry–the processes of knowledge of transcultural caring, seeking understanding, evidence, and cultural competence–the dynamics of the essence of caring, transcultural caring ethics, transcultural context, and universal sources to facilitate the making of responsible, mutual choices by incorporating tools of assessment and evaluation for transcultural communicative spiritual-ethical caring in health, healing, well-being, dying and peaceful death.


An explanatory, representational, and operational theoretical/conceptual model which is a guide for transcultural caring behavior in given nursing and health care cultural situation/s.

Brief Description

The theoretical model considers transcultural caring to be an integral mode of being, thinking, and doing in the framework of caring, transcultural caring ethics, transcultural context (social-cultural phenomena), and universal sources (religions or spirituality). These are the creative transcultural forces (four dimensions of the theory) that constitute the foundation for personal awareness, understanding and choice-making.

The fundamental assumptions of this theory are:

a. Transcultural consciousness (awareness, seeking to understand, critical reflection) engenders an appreciation of both cultural diversity and the reality of sharing a common humanity.

b. Sociocultural (social and cultural knowledge are the foundation to ways of knowing (personal, ethical, empirical, aesthetic);

c. Caring (caring is the essence of nursing, and integral with all ways of knowing, and the Totality, Simultaneity and Unitary-Transformative paradigms of nursing);

d. Complex caring dynamics (transcultural caring is integral with the sciences of complexity with a focus on self- reflection, relational transcultural caring complexity, relational self-organization, and transcultural caring knowledge-in-process).

The theoretical model was developed to facilitate answering the following questions about caring for self and persons in diverse cultures/communities:

  1. Do you believe that you are a cultural/multicultural being? What is meant by the term, the multicultural self?
  2. What is the meaning of caring to you?
  3. Do you have a perspective about transcultural caring?
  4. What are the social-cultural determinants of health?
  5. How do the beliefs, values, attitudes, and behaviors that make up your experience affect how you give or receive care?
  6. How does a person’s culture, including one’s own, affect health, illness, healing, caring, dying and death?
  7. Does nursing have a culture? If so, what are the dominant characteristics?
  8. Do other disciplines/professions, such as, medicine, psychology, and social work have specific cultures? What are the dominant characteristics?
  9. How does a health care organization (cultural/transcultural context) in which you practice or supports student experiences convey its values, and what are they?
  10. How do the organizations in which you work or that supports student experiences, understand cultural diversity and encourage culturally competent caregiving?
  11. What does transcultural ethics mean to you?
  12. What is the meaning of think globally, act locally?
  13. What do human rights, cultural rights, environmental rights/rights of nature, rights of space (cosmos), and social justice mean to you?
  14. How do political decisions (governance structure related to power and authority), legal (policies, standards of practice), economic (insurance, budget choices, and financial management), and technological factors (non-human resources, including EHR, social media) influence/affect health, illness, healing or population, including, immigrant or refugee patient care?
  15. What is meant by race, cultural identity/identities/pan-identity in the contemporary world?
  16. How can you communicate better with someone of a different culture? What does it mean to seek understanding of another’s language, cultural symbols and rituals; how may they be honored in health care environments?
  17. How do the economics of health, including a particular health care system play a role in the provision of health care to culturally diverse people? What is the meaning of health in your nation-state? Is nurse caring considered a value-added concept in organizations?
  18. How would you help patients, families find the cultural and material resources to improve their health?
  19. How do beliefs about spirituality contribute to your values and beliefs, and interactions toward people with diverse cultural beliefs?
  20. What does spirituality have to contribute to being culturally relevant in patient care?
  21. What culturally relevant spiritual practices are supported by the organization within which you practice?
  22. How can you assess your progress toward transcultural caring competence (accountability and responsibility)?
  23. What does patient choice mean to you in terms of the practice of transcultural nursing?
  24. How do you as a cultural/multicultural being negotiate for self, others, including staff or faculty in the context of daily life? How would you deal with cultural/transcultural conflict?
  25. How do you perceive vulnerable people negotiating for their health and well-being in multicultural/contextual environments and your role?
  26. What does peaceful death mean to you in terms of health and healing, and how do you convey transcultural caring for your patients /families of diverse cultures?
  27. How does awareness and knowledge of this Transcultural Caring Dynamics in Nursing and Health Care Theory and framework help create transformation to a transcultural caring environment in the workplace or in Colleges/Schools of Nursing?

The dynamics of meaning of culture and transcultural caring awareness and understanding of relational caring experiences for health, healing, and well-being are the essence of this theory. The five dimensional theoretical/conceptual model of Ray’s, “Transcultural Caring in Nursing and Health Care” illuminates knowledge/information for understanding how each individual is a “cultural/multicultural being,” including nurses as care givers or nursing administrators or educators, and how cultures/culture groups influence one another through transcultural caring relationships, individually and collectively in local and global environments.

©2018 Marilyn (Dee) Ray

©2018 Marilyn (Dee) Ray

Primary Sources 

Ray, M.A. (1989). Transcultural caring: Political and economic caring visions. Journal of Transcultural Nursing, 1, 17-21.

Ray, M.A. (1994). Transcultural nursing ethics: A framework and model for transcultural ethical analysis. Journal of Holistic Nursing, 12, 251-264.

Ray, M. (2010). Transcultural caring dynamics in nursing and health care (1st ed.). Philadelphia, PA: F. A. Davis.

Ray, M. (2016). Transcultural caring dynamics in nursing and health care (2nd ed.). Philadelphia, PA: F. A. Davis.


“Real world” exemplars of transcultural caring experiences are presented at the end of each chapter in Section 1, and in Chapters 7-26 in Section 2 of the book to help master transcultural/multicultural assessment, caring behaviors, and responsible culturally relevant choice-making.

An Instructor Guide (included in 2010 edition of book) with learning tools and examination questions and powerpoints written by Drs. Anne Vitale and Marilyn Ray is available from F. A. Davis Company to facilitate both in-class and on line instruction.


Ray, M. (2016). Transcultural caring dynamics in nursing and health care (2nd ed.). Philadelphia, PA: F. A. Davis.

Ray, M. (2010). Transcultural caring dynamics in nursing and health care. Philadelphia, PA: F. A. Davis.

Vitale, A. & Ray, M. (2010). Instructor guide.   Philadelphia, PA: F. A. Davis.

Ray, M. (1998). Complexity and nursing science. Nursing Science Quarterly, 11, 91-93.

Related Publications

Ray, M. (2016). Transcultural caring dynamics in nursing and health care (2nd ed.).
Philadelphia: F.A. Davis Company. (Print and E-book,

Ray, M. (2010). Transcultural caring dynamics in nursing and health care (2nd ed.).
Philadelphia: F.A. Davis Company. (Print Book with Instructor Guide. )

Martin, M. & Ray, M. (2018). Enhancing the role of the transcultural nurse in the global environment. In M. McFarland & H. Wehbe-Alamah (Eds.). Transcultural nursing: Concepts, theories and practices (4th ed.)(pp. 209-309). New York: McGraw-Hill Education.

Ray, M., Morris, E. & McFarland, M. (2013). Ethnonursing method of Dr. Madeleine Leininger. In C Beck (ed.). Routledge International Handbook of Qualitative Research (pp. 213-229). London: Routledge.

Ray, M. (2013). Caring inquiry: The esthetic process in the way of compassion. In M. Smith, M. Turkel & Z. Wolf (Eds.), Caring in nursing classics: An essential resource (pp. 339-345). New York: Springer Publishing Company.

Ray, M. (2010). Creating caring organizations and cultures through communitarian ethics. Journal of the World Universities Forum, 3 (6), 41-52. (2010 Finalist for the International Award for Excellence for Publication in Journal)

Ray, M. (2007). Technological caring as a dynamic of complexity in nursing practice. In A. Barnard & R. Locsin (Eds.), Technology and nursing: Practice, concepts and issues (pp. 174-190). New York: Palgrave Macmillan.

Ray, M. (2001a). Transcultural assessment. In S. Koch & S. Garratt (Eds.). Assessing older people: A practical guide for health professionals (pp. 35-47). Sydney: MacLennan & Petty.

Ray, M. (2001b). Complex culture and technology: Toward a global caring communitarian ethics of nursing. In R. Locsin (Ed.), Advancing technology, caring, and nursing (pp. 41-52). Westport, CT: Auburn House.

Ray, M.A. (2000). Transcultural assessment of older adults. In S. Garratt & S. Koch (Eds.), Assessing older adults: A workbook. Melbourne, Australia: MacLennan and Petty.

Ray, M. (1999). The foundations of caring for deacony. In R. Ryökäs & K. Kiessling (Eds.), Spiritus-Lux-caritas.  Deaconal Institution of Lahti, Lahti, Finland (pp. 225-236). Saarijavi, Finland: Gummerus Printing. [Translated into German. Germany: University of Heidelberg, 1999).

Ray, M.A. (1995). Transcultural health care ethics: Pathways to progress (pp. 3-9). In J. Wang (Ed.), Health Care and Culture. Morgantown, West Virginia: West Virginia University.

Ray, M. (1994). Transcultural nursing ethics: A framework and model for transcultural l ethical analysis. Journal of Holistic Nursing, 12(3), 251-264.

Davidson, A. & Ray, M. (1991). Studying the human-environment relationship using the science of complexity. Advances in Nursing Science, 14(2), 73-87.

Ray, M. (1990). Phenomenological method for nursing research. In N. Chaska (Ed.), The nursing profession: Turning points (pp. 173-179). St. Louis: The C. V. Mosby Company.

Ray, M. (1989). Transcultural caring: Political and economic caring visions. Journal of Transcultural Nursing, 1(1), 17-21.


Marilyn (Dee) Ray (1938 – )

Photo credit: Lifetouch Church Directories – directories@lifetouch .com.

Dr. Ray is Professor Emeritus at Florida Atlantic University, Christine E. Lynn College of Nursing, Boca Raton, Florida, USA. She is a retired Colonel in the United States Air Force Reserve, Nurse Corps (USAFR NC) serving for 32 years. She holds a diploma in nursing from St. Joseph Hospital, School of Nursing, Hamilton, Canada; Bachelor and Master of Science degrees in Nursing from the University of Colorado, Denver, Colorado; Master of Arts in Anthropology from McMaster University, Canada; Doctor of Philosophy in Nursing with a specialty in Transcultural Nursing from the University of Utah, Salt Lake City, Utah. Ray has held faculty positions at the University of San Francisco, University of California San Francisco, McMaster University, the University of Colorado, and the Christine E. Lynn Eminent Scholar, and Professorial positions at Florida Atlantic University and the University of Colorado, and Visiting Scholar, Virginia Commonwealth University.