Asian Nursing Research 12 (2018) 157e165

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Asian Nursing Research

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Invited Review Article

Transcultural Nursing: Current Trends in Theoretical Works

Eun-Ok Im,1 Yaelim Lee2, *,*
1
School of Nursing, Duke University, Durham, NC, USA
2
Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea

a r t i c l e i n f o a b s t r a c t

Article history: Purpose: To explore the current trends in theoretical works related to transcultural nursing through an
Received 7 August 2018 integrated literature review.
Accepted 20 August 2018 Methods: The literature on theoretical works related to transcultural nursing during the past 10 years
was searched through multiple databases and reviewed to determine themes reflecting the current
Keywords: trends in theoretical works related to transcultural nursing.
nursing research
Results: Through the review and analysis process, four themes reflecting the current trends in theoretical
nursing theory
works related to transcultural nursing were found: (a) purposes of exploring, defining and clarifying, and
transcultural nursing
reflecting; (b) various theorizing methods; (c) multiple sources of theorizing; and (d) clear linkages to
nursing practice and research.
Conclusion: Continuous efforts need to be made to further develop the theoretical works related to
transcultural nursing to reflect changes in this ever-changing nursing world.
© 2018 Korean Society of Nursing Science, Published by Elsevier Korea LLC. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Transcultural nursing has started from the mid 1950s [1]. Since
Leininger started her conceptualization of culture and development
of her transcultural nursing theory in 1960s [1], transcultural
nursing has become a major field of nursing. When the literature
during the past 10 years was roughly searched using the PubMed
database, more than 950 articles related to transcultural nursing
were retrieved. As the large number of articles indicates, trans-
cultural nursing is now considered as an important area of nursing
in research and practice.
Through many years of experiences in transcultural nursing, a
dozen of concepts and theories for transcultural nursing have been
suggested and used by many nursing scholars [2]. Many concepts
including cultural competence, cultural knowledge, cultural sensi-
tivity, and cultural brokerage have been developed and used [3].
Cultural competence has been suggested by many scholars as a
major component of nursing [4e6]. A number of articles have been
published on theoretical issues and scientific rigor in transcultural
nursing; specifically, many articles related to the equivalence of
concepts that do not exist in other cultures have been discussed
[7e9]. Also, several theorists proposed their own grand or middle-
range theories related to transcultural nursing [10e14].
* Correspondence to: Yaelim Lee, PhD, MSN, RN, Red Cross College of Nursing,
Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, Republic of
Korea.
E-mail address: ylcaregiver@gmail.com
*
ORCID: https://orcid.org/0000-0003-4200-8011
With drastic changes in nursing environments and subsequent
advances in nursing science, theoretical thoughts in transcultural
nursing have historically evolved in nursing history [15,16]. In
general, at every evolutionary step, there have been prominent
trends in the area of nursing theories [15,16]. Nursing once
emphasized conceptual frameworks and grand theories [15,16].
Then, nursing had hot discussions on metatheoretical issues related
to nursing [15,16]. With these trends and changes, theoretical
works related to transcultural nursing have also evolved. Trans-
cultural nursing started with grand theories and has moved with
concept development and analysis. Now, it is up to development of
the middle-range theories and situation-specific theories [13,17].
However, no specific article on the current trends of theoretical
works in transcultural nursing during the past 10 years was iden-
tified in literature searches through multiple databases, including
the PubMed, CINAHL, and PsycINFO.
The purpose of this article is to explore the current trends in
theoretical works related to transcultural nursing through an in-
tegrated literature review. First, a brief review of the theoretical
works that are being used in the field of transcultural nursing is
provided. Here, trends refer to “prevailing tendencies or in-
clinations” [18] and transcultural nursing meant “a nursing spe-
cialty created to answer the need for developing a global
perspective in the practice of nursing in a world of interdependent
nations and people” [19]. Then, the methods used to retrieve and
analyze the literature are concisely presented, and the themes
reflecting the current trends in theoretical works related to

https://doi.org/10.1016/j.anr.2018.08.006
p1976-1317 e2093-7482/© 2018 Korean Society of Nursing Science, Published by Elsevier Korea LLC. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).
158 E.-O. Im, Y. Lee / Asian Nursing Research 12 (2018) 157e165
transcultural nursing are discussed. Finally, suggestions for future
development of transcultural nursing theories are proposed based
on the literature review.
An Overview of Theoretical Works in Transcultural Nursing
From the early stage of transcultural nursing, theories have been
an essential part of transcultural nursing. Under heavy influences of
anthropology and psychology, theorists began to determine the
theoretical basis of transcultural nursing and to define culture and
nursing care, nursing environments, nursing intervention, and
nurses' roles [10e14]. As mentioned previously, the central concepts
in transcultural nursing were culture, nursing, and environment.
During the time, several theories related to culture have been
adopted from other disciplines and used in nursing with some
modifications and refinements of the major and subconcepts of
existing theories from other disciplines. During the 1950s, 1960s,
and early 1970s, several theorists have developed theories that
could uniquely explain the concepts related to transcultural
nursing to provide an independent conceptual framework for
nursing education, practice, and research in transcultural nursing
[10,12,20].
During the late 1960s and 1970s, when metatheoretical dis-
cussions were made by nursing theorists [11,16], grand theories
including transcultural nursing theories were criticized for their
lack of explicated propositions and empirical testing [21]. Then, in
the mid 1970 to the 1980s, theorists began to discuss the necessity
of substantive theories in nursing and began to discuss the central
concepts in nursing [16]. From the 1980s and 2000s, all concept
analysis and concept development methods were suggested and
used [22]. During these periods, nursing scholars in transcultural
nursing also focused on their theoretical works on concept analyses
and concept development of central concepts related to trans-
cultural nursing [23e29].
From the 1990s, two new types of nursing theories were
introduced: middle-range theories and situation-specific theories
[17]. With the emerging middle-range theories in nursing in gen-
eral, several middle-range theories related to transcultural nursing
were proposed [16,30]. Also, a number of situation-specific theories
related to transcultural nursing were proposed during the same
period [31e38].
In recent years, with drastic advances in nursing research,
transcultural nursing scholars began to search for the theoretical
bases that could be easily operationalized into research in trans-
cultural nursing as in nursing in general [17]. At the same time, with
globalization and advances in nursing practice, transcultural
nursing also needs to find the theoretical bases that could be easily
translated into transcultural nursing practice. In the current stage
of nursing theories that is characterized as “diversity in thought”
[39], an increasing number of theories are suggested in many
different areas in nursing, including acute care, oncology, women's
health, pediatric, occupation health, community health, and so
forth. [40,41]. However, there has been no exploration on the cur-
rent trends in theoretical works related to transcultural nursing in
recent years.
Methods
To explore the current trends in theoretical works related to
transcultural nursing, an integrated literature review was con-
ducted using multiple databases including, the PubMed, CINAHL,
and Scopus databases. The databases were searched only for the
articles published during the past 10 years (2007e2018) because
this review aimed to explore the current trends. Initial searches
using the relevant keywords were conducted. Four articles were
retrieved from the databases using the keywords of “transcultural
nursing” and “grand theory.” Next, 10 articles were retrieved using
the keywords of “transcultural nursing,” “mid-range theory,” and
“middle-range theory.” When the keywords of “transcultural
nursing” and “situation specific theory” were used, seven articles
were retrieved. A total of 46 articles were retrieved using the
keywords of “transcultural nursing” and “grounded theory.” Finally,
with the keywords “transcultural nursing” and “concept analysis,”
an additional 56 articles were retrieved.
The resulting 123 articles retrieved from this initial search were
screened for duplicates, and six articles were excluded via this
process. Title and abstract reviews were conducted on the
remaining 117 articles, which resulted in the exclusion of eight
articles for which either the abstract or full text was inaccessible.
The remaining 109 articles were selected for full-text reviews.
However, six articles were excluded from the full-text reviews
because they were written in a language other than English. Two
articles were excluded because they consisted of the guidelines and
standards of culturally competent care rather than theoretical
works. Finally, additional 33 articles were excluded because they
did not address the topics of theory, concepts, or models at all. Thus,
a total of 68 articles were identified as eligible for full-text reviews.
The literature search and retrieval procedures are summarized in
Figure 1.
First, the eligible articles were classified by study design, country
where the study was conducted, and type of theory (e.g., grand
theories, middle-range theories, situation-specific theories, groun-
ded theories, and concept development/analysis). Next, individual
articles were reviewed to verify that they actually presented a
theory or a theoretical discourse. Those articles which actually
presented a theory/model/concept were reviewed in the aspects of
purpose of theorizing, types of theorizing, sources of theorizing,
checking and linkages to practice or research. The review categories
were selected based on the major components of the integrative
approach to theory development to explore the current trends in
theoretical works related to transcultural nursing [38,39].
The characteristics of the 68 reviewed studies are shown in
Table 1. Depending on the purposes of the theoretical works,
various methods were used [42]. The most frequently used
methods were the following: literature reviews (41.2%) and quali-
tative studies with interviews (33.8%). The majority were con-
ducted in the U.S. (47.1%), followed by Canada (7.4%), Australia
(5.9%), and the U.K. (4.4%). Two articles involved authors from
multinations [43,44]. The majority of the articles (58.8%) did not
specify the type of the theory or the level of the theory. Thirteen
(19.1%) articles specified their theorizing methods as concept ana-
lyses (19.1%), and eight (11.8%) identified their methods as groun-
ded theory methods. Although the terms of “thematic analysis” and
“content analysis” were not included in the keywords for the
literature searches, five (7.4%) articles specified their methods as
thematic analyses, and one (1.5%) article used both thematic and
content analyses. Among 68 reviewed articles, 47 (69.1%) imple-
mented theoretical discourses using theories and models as theo-
retical frameworks [45,46], conceptual frameworks [47,48], and
concepts underpinning the development of a study tool [49]. Only
the remaining 21 (30.9%) articles presented theories, models, or
concepts that they actually developed. Only these articles were
analyzed by purpose of theorizing, types of theorizing, sources of
theorizing, checking assumptions, and linkages to practice or
research (Table 2).
Results
Through the review and analysis process, four themes reflecting
the current trends in theoretical works related to transcultural
 E.-O. Im, Y. Lee / Asian Nursing Research 12 (2018) 157e165 159

Figure 1. Flow diagram for selection of the studies.

nursing were found: (a) purposes of exploring, defining and clari- Purposes of Exploring, Defining and Clarifying, and Reflecting
fying, and reflecting; (b) various theorizing methods; (c) multiple
sources of theorizing; and (d) close linkages to nursing practice and The purposes of theorizing were classified in three categories
research. These themes are presented as follows. based on the purpose statements of the articles: (a) “exploratory,”

Table 1 Characteristics of 68 Selected Studies.

Characteristics Number of studies (%)

Study design Primary Quantitative Descriptive Cross-sectional 6 (8.8%)

Correlational 3 (4.4%)
Experimental 1 (1.5%)
Qualitative Interview 23 (33.8%)
Ethnographic method 5 (7.4%)
Mixed-methods 2 (2.9%)
Secondary Review 28 (41.2%)
Study country Single country United States 32 (47.1%)
Canada 5 (7.4%)
Australia 4 (5.9%)
United Kingdom 3 (4.4%)
Countries with two studies Brazil, China, Tanzania, Thailand, Turkey
Countries with one study England, Ethiopia, Germany, Honduras, Japan, Mexico,
New Zealand, Saudi Arabia, South Africa, Sweden, Jordan, Israel
Multicountry involvement 2 (2.9%)
Theory type Grounded theory 8 (11.8%)
Modified grounded theory 1 (1.5%)
Concept analysis 13 (19.1%)
Thematic & content analysis 6 (8.8%)
Not specified 40 (58.8%)
Presentation of theory Theoretical discourse 46 (67.6%)
Actual presentation 22 (32.4%)

Table 2 Twenty one Studies with Actual Presentations of Theory/Model/Concept.
Authors (published year)
Saftner, Martyn, Momper,
Loveland-Cherry, &
Low (2015) [54]
€r,
Pergert, Ekblad, Enska
€ rk (2008) [53]
& Bjo
Huang, Yates, & Prior
(2009) [51]
Sobel & Metzler Sawin
(2016) [50]
Somerville (2007) [55]
Liu (2012) [64]
al-Omari & Pallikkathayil
(2008) [56]
160
Theory/model/concept Purpose of theorizing Types of theorizing Sources of theorizing Checking assumption Presentation of Linkages to practice or
theory/model/concept research
Framing sexual risk Exploratory Grounded theory Primary data (interview of Yes Figure presented Practice: supports
behavior (Glaser's methodology) 20 urban American Indian culturally responsive
girls) Extending existing practice with urban
theory (Bronfenbrenner's American Indian girls
ecological model) Research: guides the
future study
Protecting professional Exploratory Grounded theory Primary data (interview of No Figure presented Practice: prepare nurses
composure: strategies (Glaser's methodology) 12 nurses in Swedish when encountering
used by nurses when their pediatric care) situation
professional preparedness of overwhelming emotional
is overridden by family expressions when
members' emotional caring for families
expressions with foreign background
Research: expands
through future
studies on understanding
E.-O. Im, Y. Lee / Asian Nursing Research 12 (2018) 157e165
the underlying reasons for
phenomenon
Concept of Exploratory Grounded theory Primary data (interview of No Figure presented Practice: helps understand
accommodating cultural seven Australian oncology the process of
needs nurses) how nurses accommodate
cultural needs. Hospital
policy:
emphasized the needs
for developing
policy, guidelines on
cultural care.
Theoretical model of Exploratory Grounded theory Primary data (interview of No Figure presented Practice: provided a
culturally competent care 26 Hispanic men and list of nursing
with Hispanic patients women) actions provided for
culturally
competent care Research:
emphasized
further studies
of emerged themes
were suggested
The theory of Exploratory Modified grounded Primary data (interview of No Figure presented Practice: emphasized
cross-cultural endeavor theory 10 palliative care nurses in the needs of further
in palliative care nursing U.K.) education and
supports on cross-cultural
care Research: two research
questions suggested
Self-efficacy among Exploratory Concept analysis Secondary data (31 articles No Figure presented Practice: helps
Chinese elderly with DM (Walker and Avant's) and dictionaries) nurses for caring
Chinese elderly with
diabetes by understanding
of key elements
of the model Research:
serves as a theoretical basis
for intervention or scale
development studies
Concept of psychological Define & Concept analysis Secondary data (scholarly Yes No figure presented Practice/research: benefits
acculturation clarification (Walker and literature and dictionaries) Antecedents, defining from clarifying the
Avant's) attributes, and dimensions of acculturation
consequences of
psychological
acculturation presented
Table 2 (continued)

Authors (published year) Theory/model/concept Purpose of theorizing Types of theorizing Sources of theorizing Checking assumption Presentation of Linkages to practice or
theory/model/concept research

Baker (2011) [60] Concept of acculturation Current knowledge Concept analysis ( Secondary data (113 Yes No figure presented Practice/research: provided
Morse's) literature review) A new theoretical a list of suggestions for
definition of current limitation and
acculturation assumptions on
including acculturation that needs to
multidimensional be addressed before
concepts presented applying to practice
settings
Dudas (2012) [63] Cultural competence Current knowledge Concept analysis Secondary data (30 articles) No No figure presented Practice: supports nurses to
(Rodgers and Knafl's) Three dimensions of achieve cultural
cultural competence competence Research:
(awareness, attitudes, suggested future studies on
behaviors) and tools to measure cultural
related concepts competence

E.-O. Im, Y. Lee / Asian Nursing Research 12 (2018) 157e165

were identified
Foronda, Baptiste, Cultural humility Current knowledge Concept analysis Secondary data (62 articles) No No figure presented Practice/research: firm
Reinholdt, & Ousman (Rodgers and Knafl's) Attributes, understanding of the
(2016) [61] antecedents, concept will benefit
consequences of achieving better care
cultural humility
presented
Foronda (2008) [62] Cultural sensitivity Current knowledge Concept analysis Secondary data (63 No No figure presented Practice/research: serves
(Rodgers and Knafl's) documents) Attributes, antecedents, as a bases for theory
consequences of generation and nursing
cultural sensitivity practice in multicultural
presented settings
Plummer & Molzahn Attributes of Define & Concept analysis Secondary data (26 articles) Yes Figure presented Practice: helps nurses to
(2009) [57] quality of life clarification (Morse's) better understand the
concept of quality of life
Research: suggested more
studies on exploring the
quality of life
Savage, van der Wal, & Child vulnerability based Exploratory Concept analysis Primary data (interview of No Figure presented Practice: the most
Tjallinks (2013) [65] on views of rural (Walker and Avant's) 32 participants, survey of vulnerable children can be
Tanzanian villagers 80 participants) identified from the model
Serafica (2011) [59] Acculturation in Filipino Define & Concept analysis Secondary data (20 articles) No Figure presented Practice: helps understand
Immigrants Within Health clarification (Walker and Avant's) Filipino immigrants and
Context provides adequate
interventions Research:
serves as the first step of
developing comprehensive
acculturation instruments
Siatkowski (2007) [66] Acculturation in the Define & Concept analysis Secondary data (28 articles) No No figure presented Practice: contributes in
Hispanic population clarification (Walker and Avant's) Attributes, achieving the goal of
antecedents, eliminating health
consequences, disparities of Healthy
case studies, and People 2010 Research:
empirical referents future study suggested for
of acculturation
(continued on next page)

161
Table 2 (continued )
Authors (published year)
Tjale & Bruce (2007) [52]
Rukwong, Chirawatkul,
& Markovic (2007) [67]
Papadopoulos et al.
(2017) [43]
Ho & Chiang
(2015) [69]
Im, Lee, & Chee
(2011) [68]
Lovering (2012) [58]
Note. DM ¼ diabetes mellitus.
Theory/model/concept
Concept of holistic
nursing care
Suk-Sam-Bai (quality of life
perceptions)
Compassion in nursing
practice
Motivated psychosocial and
behavioral adaptation
Factors Influencing the Use
of Internet Cancer Support
Groups model
Crescent of Care nursing
model
Purpose of theorizing Types of theorizing Sources of theorizing
Exploratory Concept analysis Secondary data (77
(Rodgers and Knafl's) references)
Exploratory Thematic and content Primary data (interview of
analysis 16 disabled Thailand
women and notes of
observations)
Exploratory Thematic analysis (Braun Primary data (survey of
and Clarke's) 1,323 respondents from 15
countries)
Exploratory Not specified Secondary data (25 studies)
Exploratory Not specified Primary data (preliminary
quantitative study
presented in other article)
Secondary (systematic
review presented in other
article)
Define & clarification Not specified Secondary data (based on
the study presented in
other article, literature
review)
162
Checking assumption Presentation of Linkages to practice or
theory/model/concept research
in the Hispanic the development of
population presented acculturation scale
No No figure presented Practice: applying
Attributes, knowledge from the model
antecedents, helps holistic nursing care
consequences, and practice
related concepts
to holistic nursing
care presented
No Figure presented Practice: provides
comprehensive
perspectives for middle-
aged women with disability
No Figure presented Practice: provided
understanding of
internationally shared
concept of nursing
E.-O. Im, Y. Lee / Asian Nursing Research 12 (2018) 157e165
compassion Research:
future studies on exploring
cultural differences in
compassion, country-
specific research
Organization:
organizational culture
necessary for nursing
compassion
No Figure presented Practice: suggested
strategies for timely
resilience Research: future
studies necessary on
migrant nurses
Yes Figure presented Practice: provides better
care by incorporating
cultural factors from the
model when caring Asian
Americans Research:
suggested for future studies
with larger sample size and
instruments measuring the
use of Internet Cancer
Support Groups
No Figure presented Practice: helps guide care
for Arab Muslim patients
Education: helps guide
nursing education and
improves images of the
Arab world
 E.-O. Im, Y. Lee / Asian Nursing Research 12 (2018) 157e165
(b) “defining and clarifying”, and (c) “reflecting.” Among 21
selected studies, 12 (57.1%) described exploratory purposes of
theorizing by using phrases of “to explore” [50], “to investigate”
[51], “to examine” [52], or “to gain knowledge” [53]. For example,
the framing sexual risk behavior model was presented with the
purpose of exploring the lesser known phenomenon of an urban,
adolescent American Indian young female's sexual risk behaviors
[54]. Also, the theory of Cross-Cultural Endeavor in Palliative Care
Nursing was developed with the purpose of investigating how
palliative care nurses care for people from diverse cultural back-
grounds [55].
Five (23.8%) studies aimed at defining and clarifying the con-
cepts by using phrases of “to define” [56], “to enhance clarity” [57],
or “to present a detailed explanation” [58]. For example, the
Acculturation in Filipino Immigrants within Health Context model
was presented to clarify the definition of and the concepts related
to acculturation in this population [59]. The concept of psycho-
logical acculturation was presented to define the concept and
further discuss its implications in nursing practice [56].
Four (19.0%) articles showed theorizing to reflect the current
knowledge in the specific areas. The terms used in the purpose
statements included the following: “to provide a current under-
standing” [60], “to provide a current definition” [61], and “to un-
cover the current meaning” [62]. The current concepts of Cultural
Competence [63], Cultural Humility [61], and Cultural Sensitivity
[62] were presented in these studies.
Various Theorizing Methods
Among 21 selected articles, four [50,51,53,54] used the groun-
ded theory approach; one [55] used the modified grounded
approach; 11 [52,56,57,59e66] used concept analyses; two [43,67]
used both thematic and content analyses; and three [58,68,69] did
not specify the types of methods used for theorizing. Among four
articles that used the grounded theory methodology, two specified
their use of Glaser's methodology [53,54]. The article used the
modified grounded theory did not provide its reference for the
method nor did it mention in which part of the grounded theory
method the modification was made [55]. About a half of the studies
that used concept analyses followed the Walker and Avant's
concept analysis method [56,59,64e66], the Rodgers and Knafl's
method [52,61e63], and the Morse's method [57,60]. One of the
two articles that used thematic analyses [43] specified the use of
Braun and Clarke's (2006) framework for inductive thematic
analyses.
Multiple Sources of Theorizing
Twelve (57.1%) studies used only the secondary data as the
sources of theorizing. While some of the articles used dictionaries
and articles [56,64], the majority of the works relied on the liter-
ature. Although some did not mention the details of literature being
included in theorizing [56,58], the number of articles included in
the theorizing process ranged between 20 [59] and 113 [60]. Seven
(33.3%) articles used only the primary data for theorizing process.
One article [43] used the data from a survey, and four articles used
the data from interviews [50,51,54,55]. Others combined the data
from a survey [65] and notes from observation [67] with their
interview data for theorizing. Both the primary and secondary data
were the sources of theorizing in two articles [54,68]. For example,
for presenting the Factors Influencing the Use of Internet Cancer
Support Groups model, quantitative data from a preliminary study
and results from a systematic review were used for theorizing [68].
Only one article [54] claimed that the presented theory stemmed
from a pre-existing model.
163
Among 21 articles, only five (23.8%) checked and described
their assumptions of the theory/model/concepts presented
[54,56,57,60,68]. For example, Saftner et al. (2015) described the
assumptions made to develop their grounded theory; Baker (2011)
described the assumptions in the definitions and the theory related
to acculturation, and Im, Lee, and Chee (2011) described the as-
sumptions of the presented model itself.
Clear Linkages to Nursing Practice or Research
Fourteen (66.7%) articles provided actual figures/illustrations of
the theory/model/concept that they were presenting. The remain-
ing seven articles described the findings from theorizing through
presenting a new theoretical definition of a concept [60], di-
mensions of a concept [63], or the antecedents, attributes, conse-
quences, and related concepts of the studied concepts
[52,56,61,62,66]. All 21 articles described the linkages to nursing
practice. The implication for nursing practice was mainly focused
on a firm understanding of the presented theory/model/concept to
help prepare nurses for better nursing care [54,61,64]. Some studies
provided detailed strategies for nursing practice. For example, they
provided a list of nursing actions for culturally competent care [50]
and a list of suggestions for current limitations and assumptions on
acculturation that need to be addressed before applying the
concept to nursing practice [60].
Sixteen (76.2%) articles described the linkages to nursing
research. The implication for nursing research included suggesting
the theory/model/concept presented in the study as a theoretical
basis for future research [54,62], as well as a guide for future in-
terventions or scale development studies [59,63,64,66]. Also, the
studies emphasized the need for expansion of the theory/model/
concept through future research [50,53] and the need to explore
the same concept in larger studies [68] or in other populations and
settings [43,69]. Somerville (2007) provided specific research
questions for future studies.
Linkages to the hospital policy were also made for a study on
concepts of accommodating cultural needs [51]. The need for
developing policies and guidelines for cultural care was suggested
as well [51]. In addition, the linkages to health organizations were
made in an article on compassion in nursing practices, emphasizing
the needs for organizational culture that would promote nursing
compassion [43]. The linkages to education were made in an article
that presented the Crescent of Care nursing model, which was
intended to help guide nursing education and improve images of
the Arab world [58].
Discussion
This integrated literature review provided an overview of the
current trends in theoretical works related to transcultural nursing.
The theoretical works related to transcultural nursing obviously
had purposes of exploring, defining and clarifying, and reflecting
nursing phenomenon related to transcultural nursing. The theo-
rizing process of the theoretical work related to transcultural
nursing also involved various theorizing methods and multiple
sources for theorizing. The theoretical works clearly provided im-
plications for future research and practice.
These trends in the theoretical works in transcultural nursing
are consistent with those observed in nursing theories in general
[70]. Im and Chang (2012) indicated that the current theoretical
works in nursing tended to develop and refine specific concepts,
develop middle-range theories that focused on specific concepts,
and develop instruments to specifically target individual concepts
of theories and connect theories to specific areas of nursing prac-
tice. They also indicated the coexistence of all types of theoretical
164 E.-O. Im, Y. Lee / Asian Nursing Research 12 (2018) 157e165
works, the close linkages to nursing research, and international
collaborative efforts made for the development of the theoretical
works. In general, the findings of this review agree with the pre-
viously reported trends in nursing theories in general. However, the
interpretation of these findings needs to be carefully made because
only the articles published in refereed journals during the last
10 years were reviewed. Subsequently, theoretical works that have
been published in the forms other than refereed journal articles
were missing in this review/analysis. Also, as noted, the criteria for
the review were limited to the components of theorizing suggested
by Im (2005).
This article suggests the following implications for future
theoretical development in transcultural nursing based on the
findings of the review/analysis. First of all, the theoretical works in
transcultural nursing need to continuously aim at multiple pur-
poses as noted in this review. Nursing phenomena in transcultural
nursing are evolving with advances in technologies, transportation,
and communication. Subsequently, many nursing phenomena that
were taken for granted have changed by time and place as well as
by culture. Thus, the theoretical works in transcultural nursing
need to reflect these changes by exploring, defining and clarifying,
and adequately reflecting the changing phenomena.
Second, as noted previously, only few articles clearly described
the level of theory/model/concept that was presented in the arti-
cles. Only the articles that presented theories from grounded the-
ory approaches or the findings from concept analyses clearly
described the methods used for theorizing in their works. Among
68 articles that were reviewed, more than a half of the articles did
not provide information on the methods used for their theorizing
process. Most of the 21 articles actually presented a theory/model/
concept that was developed using a concept analysis or grounded
theory approach. For future theoretical works related to trans-
cultural nursing, the methods used for theorizing need to be
specified and described in detail to provide a concrete ground for
the theoretical works.
Third, most of the theories/models/concepts presented in the
reviewed articles were developed from a single source of secondary
data, such as a literature review. For a comprehensive and balanced
understanding of nursing phenomena, the use of multiple sources
for theorizing has been highly recommended [71]. Only two articles
in this review indicated the use of two sources for theorizing
[54,68]. Moreover, the theoretical works that were developed
based on literature reviews tend to use a wide range of numbers of
articles in their analysis and synthesis; some even did not report
the number of articles that they reviewed. Also, the inclusion and
exclusion criteria for selection of articles were rarely reported. For
future theoretical works in transcultural nursing, multiple sources
of theorizing need to be used while providing further details on the
sources of theorizing.
Finally, the trials to link the theoretical works in transcultural
nursing to nursing practice and research need to be continued. As
mentioned, with changes in nursing phenomena involved in
transcultural nursing, the theoretical works need to provide di-
rections for nursing practice and research that appropriately and
adequately reflect the changes in nursing phenomena. Subse-
quently, the efforts to link the theoretical works to nursing practice
and research as well as those to link the changes in nursing phe-
nomenon to the theoretical works need to be continued.
Conclusion
This integrated literature review explored the current trends in
theoretical works related to transcultural nursing published in the
past 10 years. The findings suggest that the trends were generally
consistent with the previously reported trends in nursing theories
in general. The theoretical works related to transcultural nursing
clearly defined the purposes of theorizing; used various theorizing
methods; used different theorizing sources, mostly secondary data;
and clearly explained the linkages to nursing practice, research,
hospital policy, health organizations, and education. Based on the
findings, four implications for future theoretical development in
transcultural nursing were suggested: (a) the need to continuously
aim at multiple purposes of theorizing, (b) the need to clearly
describe the level of theory/model/concept in the study, (c) the
need to use multiple sources for theorizing, and (d) the need to
continuously describe the linkage of theoretical works to nursing
practice and research.
Considering its definition and history, transcultural nursing has
always been on the front line of dealing with global changes in
nursing phenomena. Transcultural nursing is “a specialty created to
answer the need for developing a global perspective in the practice
of nursing in a world of interdependent nations and people.” [72]
Efforts must be continuously made to further develop the theo-
retical works related to transcultural nursing to reflect the changes
in this ever-evolving nursing world and to provide culturally sen-
sitive and competent nursing care.
Conflicts of interest and source of funding
No conflict of interests has been declared by the authors.
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