The Sunrise-Enabler Model

Effective care is the ultimate task of nurses. We are the members of the health team who have direct patient/client interaction and therefore it is through our knowledge & understanding of the values, customs, beliefs & practices our patients’ culture that we can provide effective care. A better way of understanding the factors that influence a person’s perception of well-being is the sunrise enabler of Madeleine Leininger. Leininger’s model of cultural care can be viewed as a rising sun. When using this model, the nurse can begin anywhere depending on the focus of nursing assessment. The model reflects influences of one’s worldview on cultural and structure dimensions. The cultural and social structure dimensions include technological, religious, philosophic, kinship, social, value and lifeway, political, legal, economic, and educational factors. Each of these identified systems affects health. These cultural and social structure dimensions in turn influences environment and language, wherein emphasis should be placed since this is where the patient/client find themselves such as home conditions, access to particular types of food and family access to transport. Environment and language influence the involved health systems – the folk, professional and nursing systems. The folk health system includes the traditional beliefs and practices on health care while the professional health systems are those practices we learned cognitively through formal professional schools of learning. The combination of the folk health system and the professional health system meets the biological, psychosocial, and cultural health needs of the patient/client.

These factors influence the patterns and expressions of caring in relation to the health of individuals, families, groups, and communities. To be able to make sound nursing care decisions and actions, these factors should be assessed properly and always be taken into consideration.

To achieve culture congruent care, nursing actions are to be planned in one of three modes: culture care preservation/maintenance, culture care accommodation/negotiation, or culture care repatterning/restructuring.

A research project on health and social practices regarding dengue in 2008 on three countries in Southeast Asia could be used as an example on how Leininger’s sunrise enabler can be applied on the community level. Some of the cultural and social factors that were assessed are as follows:

Cultural and Social Structure Dimensions


lack of awareness of first aid remedies and safety procedures on dengue prevention at home


community people view dengue as a bad omen

Kinship and Social

women are always the caregivers, thus more women are prone to psychological burden of caring for the sick member of the family

Cultural Values

health is of lesser priority; more priority is given to basic needs such as food

Political and legal

lack of policy programs by the local government regarding dengue prevention practices


more males acquire dengue since most of them are night shift and farms/plantation workers


low level of education is noted. Most are secondary level graduates, knowledge and comprehension on proper health practices on dengue prevention is low

Proper assessment of the cultural and social structure dimensions will lead to good planning and intervention, leading to a sustainable health care delivery to individual, families, or communities.


  1. wow um getting educated u no,thank u for the empowering piece of work

  2. Very impressive essay. May I use it in an essay that I am writing on Madeleine Leininger? It will be properly cited in APA format.

    Mark Harvey RN, BSN

  3. Its nice to read a useful article on "The Sunrise-Enabler Model". Some of points from this article are very helpful for me as I haven’t read them yet. health and fitness system is a bone of every society if your bone become week then you can't develop new methodologies and research in medical science.

  4. In accord with Dr. Leinenger's nursing AND anthropological work, below is a quote about my TrueTyme "whole picture of time" clock, described in detail at

    Dr. Roy Wagner, PhD, Prof. of Anthropology at the University of Virginia, USA ...

    "We live in sick times, and are all suffering from no longer being completed beings. Yale's clock is a working, self-involving, self-involuting yin yang that seems to help in a very 'funda-mental' way. By intently dwelling upon its cycles and counter-cycles you become the ultimate 'presentness' of all of nature around you: you merge with your environment, and its ever-changing absenses & presentnesses. Indeed as well as in theory, you become 'at one' with the sky, land and sea. And the ebbs and flows of the universe."

    If you agree with me that what our Better Tymes Project and our Better Tymes For Women one are doing and how are at least consistent with Dr. Leinenger's sunrise enabler model, I am hoping to begin a mutually worthwhile correspondence with many of you.

    Warmest regards, Yale S.Y. Landsberg, M.S., Charlotteville USA