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
Technological	lack of awareness of first aid remedies and safety procedures on dengue prevention at home
Religious	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
Economic	more males acquire dengue since most of them are night shift and farms/plantation workers
Educational	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.