Cultural Competence: Ray’s Theory of Transcultural Caring Dynamics in Nursing and Health Care to Guide Reflective Analysis for Self-Awareness
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Abstract
Introduction: The aim of this article is to present the theoretical model with a description of Ray’s Theory of Transcultural Caring Dynamics in Nursing and Health Care with supporting transcultural nursing phenomena and global health care data.
Methods: The theory was developed from knowledge of nursing, transcultural nursing, complexity science, and cultural anthropology.
Results: The theory and model are significant resources to address contemporary issues of culture, human-environment integrality, cultural diversity, migration patterns in the global community, minority health, the social determinants of health, and the need for increasing cultural awareness, communitarian ethics, reflective analysis, and competency of health care professionals in the delivery of competent cultural health care for improved health, healing, and a peaceful death. The paper points out that the central emphasis of the theory and model, essence of caring, transcultural ethics, transcultural context, and universal sources (spirituality) highlight the opportunity for transcultural awareness, seeking understanding and cultural choice. This multidimensional aspect of the model illuminates both patient’s/family’s and provider’s cultures and values, and the environment, and acknowledges the criticality through reflection of the cultural impact on mutual choices for health care outcomes and quality of life.
Conclusion: This theory and contemporary knowledge about the changing world community, migration patterns, social determinants of health (SDOH), transcultural caring science and its dynamics provide opportunities for nurses and physicians to enact effective transcultural health care aligned with the unique cultural needs of each patient and their family.
Keywords:
transcultural caring dynamics, communitarian ethics, organizations, spirituality, migration, cultural awareness, reflective analysis, transcultural inter-professional competency
Article Details
How to Cite
MARTIN, Mary Brigid; RAY, Marilyn A..
Cultural Competence: Ray’s Theory of Transcultural Caring Dynamics in Nursing and Health Care to Guide Reflective Analysis for Self-Awareness.
Medical Research Archives, [S.l.], v. 14, n. 5, may 2026.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/7387>. Date accessed: 23 june 2026.
doi: https://doi.org/10.18103/mra.v14i5.7387.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Leininger MM.Transcultural nursing and globalization of healthcare: Importance, focus and historical aspects. In Leininger MM and McFarland MR, eds, Transcultural Nursing: Concepts, Theories, Research & Practice (ed., pp. 3–44). McGraw Hill; 2002.
2. Wehbe-Alamah H, McFarland M. Leininger’s Transcultural Healthcare: Concepts, Theories, Research & Practice. McGraw Hill; 2026;3.
3. Boniol M, Kunjumen T, Nair TS, Siyam A, Campbell J, Diallo K. The global health workforce stock and distribution in 2020 and 2030: a threat to equity and ‘universal’ health coverage? BMJ Global Health. 2022;7(6):e009316. doi:10.1136/bmjgh-\\-009316
4. Social Work Action. International Federation of Social Workers. Accessed April 30, 2026. https://www.ifsw.org/social-work-action/
5. Krogstie R. Facing failure: Lessons from research on marginalized populations in an unstable political culture. Published November 17, 2025. Accessed April 30, 2026. https://nursology.net/2025/11/17/facing-failure-lessons-from-research-on-marginalized-populations-in-an-unstable-political-culture/
6. Ray M. Transcultural Caring Dynamics in Nursing and Health Care (1st ed.).F. A. Davis; 2010.
7. Ray M. Transcultural Caring Dynamics in Nursing and Health Care (2nd ed.).F. A. Davis; 2016.
8. Ray M. Ray’s theory of transcultural caring dynamics in nursing and health care: A significant cultural resource. International Journal for Human Caring. 2024; 28(3): 61-68. http:dx.doi.org/10.20467/IJHC:2022-0048
9. Ray M. (2021). Evolution of Ray’s theory of bureaucratic caring. International Journal for Human Caring. 25(3), 159-175. https://doi.org/10.20467/HumanCaring-D20-00043
10. World Migration Report 2024. International Organization for Migration. Accessed April 30, 2026. https://worldmigrationreport.iom.int/msite/wmr-2024-interactive/
11. What are Health Disparities? National Institutes of Health. Published February 25, 2026. Accessed April 30, 2026. https://www.nimhd.nih.gov/about/what-are-health-disparities
12. Scholz N. Addressing Health Inequalities in the European Union – Concepts, Action, State of Play. In-Depth Analysis. Brussels, Belgium: Parliamentary Research Service. Published February 2020. Accessed April 30, 2026. PE 646.18 URL: https://www.europarl.europa.eu/thinktank/en/document/EPRS_IDA(2020)646182
13. Operational framework for monitoring social determinants of health equity. World Health Organization. who.int. Published January 18, 2024. Accessed April 30, 2026. https://www.who.int/publications/i/item/9789240088320
14. Pacquiao DF, Maxwell JB, Ludwig-Beymer P, Stievano A, Sagar P, Purnell L, Daub K. Integration of population health, social determinants, and social justice in transcultural nursing and culturally competent care: White paper by the Scholars Education Interest Group. Journal of Transcultural Nursing. 2023; 34(3): 75-177. doi:10.1177/10436 596231163878
15. The Universal Declaration of Human Rights. United Nations. un.org. Accessed April 30, 2026.
16. Tang C, Tian B, Zhang X, Zhang K, Xiao X, Simoni JM, Wang H. The influence of cultural competence of nurses on patient satisfaction and the mediating effect of patient trust. Journal of Advances in Nursing. 2019; 75(4).749-759. doi: 10.1111/jan.13854
17. Social Determinants of Health. AACN Essentials Tool Kit: Domains & Concepts. Accessed April 30, 2026. https://www.aacnnursing.org/essentials/tool-kit/domains-concepts/social-determinants-of-health
18. Nour N, Stuckler D, Ajayi O, Abdellah M. Effectiveness of alternative approaches to integrating SDOH into medical education: A scoping review. BMC Medical Education. 2023; 23: 18. https://doi.org/10.1186/s12909-022-03899-2
19. Rosa WE, Dossey BM, Koithan M, Kreitzer MJ, Manjrekar P., Meleis A, Mukamana D, Ray M, Watson, J. Nursing theory in the quest for the Sustainable Development Goals. Nursing Science Quarterly. 2020; 33(2):178-182. doi:10.1177/0894318420903495
20. Wehbe-Alamah H. The Ethnonursing Research Method: Major features and enablers. In McFarland M, Wehbe-Alamah H. eds, Transcultural Nursing Concepts, Theories, Research and Practice. McGraw-Hill Education; 2018; 57-84.
21. Wehbe-Alamah H, McFarland M. Leininger’s Ethnonursing Research Method: Historical retrospective and overview. Journal of Transcultural Nursing. 2020; 31(4): 337–349. https://doi.org/10.1177/1043659620912308
22. Wehbe-Alamah H, McFarland M. Leininger’s Transcultural Healthcare: Concepts, Theories, Research & Practice. McGraw Hill; 2026;3.
23. Boykin A, Schoenhofer S. Nursing as Caring: A Model for Transforming Practice. Jones & Bartlett Learning; 2001: 40.
24. Parse RR. Human becoming: Parse’s theory of nursing. Nursing Science Quarterly. 1992; 5(1): 35–42. https://doi.org/10.1177/089431849200500109
25. Ray M, Turkel M. Caring as emancipatory nursing praxis: The theory of relational caring complexity. Advances in Nursing Science. 2014; 37(2), 132-146. https://doi.org/10.1097/ans.0000000000000024
26. Davidson AW, Ray MA, Turkel MC. Nursing, caring, and complexity science : for human-environment well-being.; 2011. http://lghttp.48653.nexcesscdn.net/80223CF/springer-static/media/samplechapters/9780826125873/9780826125873_chapter.pdf.
27. Ray M. A study of caring within an institutional culture. [Dissertation], University of Utah, College of Nursing, Salt Lake City, Utah. Dissertation Abstracts International (University Microfilms, No. 81-27-787); 1981.
28. Koszalinski R, Wilson C, Schaefer AM. Underpinning human health outcomes of harmful algal bloom Exposure Research: An analysis of the relationship and Applicability of the Bureaucratic Caring Theory. Scandinavian Journal of Caring Sciences. 2026; 40(1):e70199. doi:10.1111/scs.70199
29. Egan M. The ‘godfather’ of AI reveals the only way humanity can survive super intelligent AI. CNN Business. Published August 13, 2025. Accessed April 30, 2026. https://www.cnn.com/2025/08/13/tech/ai-geoffrey-hinton
30. Coyoca G, Ray M. A Nursing Research review of the application of the Phenomenological Caring Inquiry Methodology. Medical Research Archives. 2025;13(10). doi:10.18103/mra.v13i10.6963
31. Martin MB. Perceived discrimination of Muslims in health care. Journal of Muslim Mental Health. 2015;9(2):41-69.
32. Johns C. Becoming a Reflective Practitioner (7th ed.). Wiley; 2025.
33. Tseng T-J. Ray M. Wu CJ. Examining nursing students’ learning through reflective analysis using Ray’s transcultural caring dynamics in nursing and health care theory. British Medical Education. 2025; 25(559): 3-8. https://doi.org/10.1186/s12909-23-07123-9
34. Martin MB, Ray M. Enhancing the role of the transcultural healthcare provider in the global environment. In Wehbe-Alamah H, McFarland M, eds. Leininger’s Transcultural Healthcare: Concepts, Theories, Research & Practice. McGraw Hill; 2026.
35. Leininger M. Leininger’s acculturation health care assessment tool for cultural patterns in traditional and non-traditional life ways. Journal of Transcultural Nursing. 1991; 2(2):40-42. www.ncbi.nlm.nih.gov/pubmed/20432395
36. Coyoca GS, Tuppal C, Ray M. Eliciting the Theory of Meaning on Self-Care for Nurses: Application of Ray’s Caring Inquiry. The Technician. 2025; 37(1). doi:10.62071/apjsi.v37i1.760
37. Poudel B. Ray M. Consciousness: Humanoid robots and caring in nursing from multicultural perspectives. International Journal for Human Caring. 2019; 23(2): 185-195. https://dx.doi.org/10.20467/1091-5710.23.2.185
38. Ray M. Illuminating the meaning of caring: Unfolding the sacred art of divine love. In M. Roach, ed. Caring from the heart: The Convergence of Caring and Spirituality. Paulist Press;163-178.
39. Betancourt JR. Cultural competence and medical education: many names, many perspectives, one goal. Academic Medicine. 2006;81(6):499-501. doi:10.1097/01.acm.0000225211.77088.cb Martin 2015
40. Adeani IS, Febriani RB, Syafryadin S. Using Gibbs Reflective Cycle in making reflections of literary analysis. Indonesian EFL Journal. 2020;6(2): 139. doi:10.25134/ieflj.v6i2.3382
41. Newman M, Smith M, Dexheimer Pharris M, Jones D. The focus of the discipline revisited. Advances in Nursing Science. 2008; 31(1): E16-E27. doi:10.1097/01.ANS.0000311533.65941.f1
42. Brottman MR, Char DM, Hattori RA, Heeb R, Taff SD. Toward cultural competency in health care: A scoping review of the diversity and inclusion education literature. Academic Medicine. 2019;95 (5):803-813. doi:10.1097/acm.0000000000002995
43. Leininger M. The phenomenon of caring. Part V. Caring: the essence and central focus of nursing. Nurs Res Rep. 1977;12(1):2-14.
44. Watson J. Nursing: The Philosophy and Science of Caring. Little, Brown & Company; 1979.
45. Watson, J. Metaphysics of Watson Unitary Caring Science. Springer; 2025.
46. Hsu L, Hsieh S. Testing of a measurement model for baccalaureate nursing students’ self‐evaluation of core competencies. Journal of Advanced Nursing. 2009; 65(11): 2454-2463. doi:10.1111/j.1 365-2648.2009.05124.x
47. De-María B, López-González MA. Cultural competence interventions in European Healthcare: A scoping review. Healthcare. 2024;12(10):1040. doi:10.3390/healthcare12101040
48. MacAskill W. Chua WJ. Woodall H. Pinidiyapathirage J. Beyond the written reflection: A systematic review and qualitative synthesis of creative approaches to reflective learning amongst medical students. Perspectives on Medical Education. 2023;12(1): 361–371. Doi: https://doi.org/10.5334/pme.914
49. Casement P. On Learning from the Patient. Taylor & Francis;1985.
50. Ray M, Locsin R. Toward an adequate understanding of phenomenological and hermeneutic-phenomenological nursing research. Editorial. Nursing and Health Science. 2023; 25: 3-8. doi:10.1111/nhs.13015
2. Wehbe-Alamah H, McFarland M. Leininger’s Transcultural Healthcare: Concepts, Theories, Research & Practice. McGraw Hill; 2026;3.
3. Boniol M, Kunjumen T, Nair TS, Siyam A, Campbell J, Diallo K. The global health workforce stock and distribution in 2020 and 2030: a threat to equity and ‘universal’ health coverage? BMJ Global Health. 2022;7(6):e009316. doi:10.1136/bmjgh-\\-009316
4. Social Work Action. International Federation of Social Workers. Accessed April 30, 2026. https://www.ifsw.org/social-work-action/
5. Krogstie R. Facing failure: Lessons from research on marginalized populations in an unstable political culture. Published November 17, 2025. Accessed April 30, 2026. https://nursology.net/2025/11/17/facing-failure-lessons-from-research-on-marginalized-populations-in-an-unstable-political-culture/
6. Ray M. Transcultural Caring Dynamics in Nursing and Health Care (1st ed.).F. A. Davis; 2010.
7. Ray M. Transcultural Caring Dynamics in Nursing and Health Care (2nd ed.).F. A. Davis; 2016.
8. Ray M. Ray’s theory of transcultural caring dynamics in nursing and health care: A significant cultural resource. International Journal for Human Caring. 2024; 28(3): 61-68. http:dx.doi.org/10.20467/IJHC:2022-0048
9. Ray M. (2021). Evolution of Ray’s theory of bureaucratic caring. International Journal for Human Caring. 25(3), 159-175. https://doi.org/10.20467/HumanCaring-D20-00043
10. World Migration Report 2024. International Organization for Migration. Accessed April 30, 2026. https://worldmigrationreport.iom.int/msite/wmr-2024-interactive/
11. What are Health Disparities? National Institutes of Health. Published February 25, 2026. Accessed April 30, 2026. https://www.nimhd.nih.gov/about/what-are-health-disparities
12. Scholz N. Addressing Health Inequalities in the European Union – Concepts, Action, State of Play. In-Depth Analysis. Brussels, Belgium: Parliamentary Research Service. Published February 2020. Accessed April 30, 2026. PE 646.18 URL: https://www.europarl.europa.eu/thinktank/en/document/EPRS_IDA(2020)646182
13. Operational framework for monitoring social determinants of health equity. World Health Organization. who.int. Published January 18, 2024. Accessed April 30, 2026. https://www.who.int/publications/i/item/9789240088320
14. Pacquiao DF, Maxwell JB, Ludwig-Beymer P, Stievano A, Sagar P, Purnell L, Daub K. Integration of population health, social determinants, and social justice in transcultural nursing and culturally competent care: White paper by the Scholars Education Interest Group. Journal of Transcultural Nursing. 2023; 34(3): 75-177. doi:10.1177/10436 596231163878
15. The Universal Declaration of Human Rights. United Nations. un.org. Accessed April 30, 2026.
16. Tang C, Tian B, Zhang X, Zhang K, Xiao X, Simoni JM, Wang H. The influence of cultural competence of nurses on patient satisfaction and the mediating effect of patient trust. Journal of Advances in Nursing. 2019; 75(4).749-759. doi: 10.1111/jan.13854
17. Social Determinants of Health. AACN Essentials Tool Kit: Domains & Concepts. Accessed April 30, 2026. https://www.aacnnursing.org/essentials/tool-kit/domains-concepts/social-determinants-of-health
18. Nour N, Stuckler D, Ajayi O, Abdellah M. Effectiveness of alternative approaches to integrating SDOH into medical education: A scoping review. BMC Medical Education. 2023; 23: 18. https://doi.org/10.1186/s12909-022-03899-2
19. Rosa WE, Dossey BM, Koithan M, Kreitzer MJ, Manjrekar P., Meleis A, Mukamana D, Ray M, Watson, J. Nursing theory in the quest for the Sustainable Development Goals. Nursing Science Quarterly. 2020; 33(2):178-182. doi:10.1177/0894318420903495
20. Wehbe-Alamah H. The Ethnonursing Research Method: Major features and enablers. In McFarland M, Wehbe-Alamah H. eds, Transcultural Nursing Concepts, Theories, Research and Practice. McGraw-Hill Education; 2018; 57-84.
21. Wehbe-Alamah H, McFarland M. Leininger’s Ethnonursing Research Method: Historical retrospective and overview. Journal of Transcultural Nursing. 2020; 31(4): 337–349. https://doi.org/10.1177/1043659620912308
22. Wehbe-Alamah H, McFarland M. Leininger’s Transcultural Healthcare: Concepts, Theories, Research & Practice. McGraw Hill; 2026;3.
23. Boykin A, Schoenhofer S. Nursing as Caring: A Model for Transforming Practice. Jones & Bartlett Learning; 2001: 40.
24. Parse RR. Human becoming: Parse’s theory of nursing. Nursing Science Quarterly. 1992; 5(1): 35–42. https://doi.org/10.1177/089431849200500109
25. Ray M, Turkel M. Caring as emancipatory nursing praxis: The theory of relational caring complexity. Advances in Nursing Science. 2014; 37(2), 132-146. https://doi.org/10.1097/ans.0000000000000024
26. Davidson AW, Ray MA, Turkel MC. Nursing, caring, and complexity science : for human-environment well-being.; 2011. http://lghttp.48653.nexcesscdn.net/80223CF/springer-static/media/samplechapters/9780826125873/9780826125873_chapter.pdf.
27. Ray M. A study of caring within an institutional culture. [Dissertation], University of Utah, College of Nursing, Salt Lake City, Utah. Dissertation Abstracts International (University Microfilms, No. 81-27-787); 1981.
28. Koszalinski R, Wilson C, Schaefer AM. Underpinning human health outcomes of harmful algal bloom Exposure Research: An analysis of the relationship and Applicability of the Bureaucratic Caring Theory. Scandinavian Journal of Caring Sciences. 2026; 40(1):e70199. doi:10.1111/scs.70199
29. Egan M. The ‘godfather’ of AI reveals the only way humanity can survive super intelligent AI. CNN Business. Published August 13, 2025. Accessed April 30, 2026. https://www.cnn.com/2025/08/13/tech/ai-geoffrey-hinton
30. Coyoca G, Ray M. A Nursing Research review of the application of the Phenomenological Caring Inquiry Methodology. Medical Research Archives. 2025;13(10). doi:10.18103/mra.v13i10.6963
31. Martin MB. Perceived discrimination of Muslims in health care. Journal of Muslim Mental Health. 2015;9(2):41-69.
32. Johns C. Becoming a Reflective Practitioner (7th ed.). Wiley; 2025.
33. Tseng T-J. Ray M. Wu CJ. Examining nursing students’ learning through reflective analysis using Ray’s transcultural caring dynamics in nursing and health care theory. British Medical Education. 2025; 25(559): 3-8. https://doi.org/10.1186/s12909-23-07123-9
34. Martin MB, Ray M. Enhancing the role of the transcultural healthcare provider in the global environment. In Wehbe-Alamah H, McFarland M, eds. Leininger’s Transcultural Healthcare: Concepts, Theories, Research & Practice. McGraw Hill; 2026.
35. Leininger M. Leininger’s acculturation health care assessment tool for cultural patterns in traditional and non-traditional life ways. Journal of Transcultural Nursing. 1991; 2(2):40-42. www.ncbi.nlm.nih.gov/pubmed/20432395
36. Coyoca GS, Tuppal C, Ray M. Eliciting the Theory of Meaning on Self-Care for Nurses: Application of Ray’s Caring Inquiry. The Technician. 2025; 37(1). doi:10.62071/apjsi.v37i1.760
37. Poudel B. Ray M. Consciousness: Humanoid robots and caring in nursing from multicultural perspectives. International Journal for Human Caring. 2019; 23(2): 185-195. https://dx.doi.org/10.20467/1091-5710.23.2.185
38. Ray M. Illuminating the meaning of caring: Unfolding the sacred art of divine love. In M. Roach, ed. Caring from the heart: The Convergence of Caring and Spirituality. Paulist Press;163-178.
39. Betancourt JR. Cultural competence and medical education: many names, many perspectives, one goal. Academic Medicine. 2006;81(6):499-501. doi:10.1097/01.acm.0000225211.77088.cb Martin 2015
40. Adeani IS, Febriani RB, Syafryadin S. Using Gibbs Reflective Cycle in making reflections of literary analysis. Indonesian EFL Journal. 2020;6(2): 139. doi:10.25134/ieflj.v6i2.3382
41. Newman M, Smith M, Dexheimer Pharris M, Jones D. The focus of the discipline revisited. Advances in Nursing Science. 2008; 31(1): E16-E27. doi:10.1097/01.ANS.0000311533.65941.f1
42. Brottman MR, Char DM, Hattori RA, Heeb R, Taff SD. Toward cultural competency in health care: A scoping review of the diversity and inclusion education literature. Academic Medicine. 2019;95 (5):803-813. doi:10.1097/acm.0000000000002995
43. Leininger M. The phenomenon of caring. Part V. Caring: the essence and central focus of nursing. Nurs Res Rep. 1977;12(1):2-14.
44. Watson J. Nursing: The Philosophy and Science of Caring. Little, Brown & Company; 1979.
45. Watson, J. Metaphysics of Watson Unitary Caring Science. Springer; 2025.
46. Hsu L, Hsieh S. Testing of a measurement model for baccalaureate nursing students’ self‐evaluation of core competencies. Journal of Advanced Nursing. 2009; 65(11): 2454-2463. doi:10.1111/j.1 365-2648.2009.05124.x
47. De-María B, López-González MA. Cultural competence interventions in European Healthcare: A scoping review. Healthcare. 2024;12(10):1040. doi:10.3390/healthcare12101040
48. MacAskill W. Chua WJ. Woodall H. Pinidiyapathirage J. Beyond the written reflection: A systematic review and qualitative synthesis of creative approaches to reflective learning amongst medical students. Perspectives on Medical Education. 2023;12(1): 361–371. Doi: https://doi.org/10.5334/pme.914
49. Casement P. On Learning from the Patient. Taylor & Francis;1985.
50. Ray M, Locsin R. Toward an adequate understanding of phenomenological and hermeneutic-phenomenological nursing research. Editorial. Nursing and Health Science. 2023; 25: 3-8. doi:10.1111/nhs.13015