Cultural care in nursing was introduced by Madeleine Leininger in the mid-1950s to address patients’ cultural needs (Leininger 1988). Culture continues to shape people’s experiences of healthcare (Öner et al. 2023) as people often interpret healthcare according to their specific cultural beliefs (Shopo et al. 2023). Culture forms part of the children’s upbringing, and children are especially influenced by culture, as it shapes their worldview. It is important for the professional nurse to know the cultural beliefs and practices of the children they nurse (Dertli & Gunay 2022). Culture remains intrinsic to who people are and how they make healthcare decisions (Collins et al. 2025). It is therefore important for professional nurses to be sensitive to cultural practices to improve the quality of care and life (Öner et al. 2023).

Over the years, there has been an increase in cultural diversity owing to global migration. Professional nurses are exposed to patients from diverse cultural backgrounds. Professional nurses are expected to provide culturally sensitive nursing care (SANC 2022); however, they often lack the frame of reference to guide them in providing such care. The model, therefore, aims at assisting professional nurses to facilitate culturally sensitive nursing care throughout the children’s hospitalisation journey. Because of the increasing complexity of healthcare, including evolving cultural diversity, there is a need to develop new models to guide nursing practice (Andrews & Boyles 2019).

Cultural care models and frameworks have been developed over the years to address patients’ cultural care needs (Collins et al. 2025); however, they do not focus on the unique needs of the children. While these adult-focused models made significant contributions to the nursing practice regarding cultural care, they do not respond to the children’s unique developmental needs and the importance of the family’s involvement in the care of the child. The lack of a dedicated child-centred cultural care model limits professional nurses’ ability to facilitate holistic and inclusive care to children. Children need the presence of their mothers or primary caregivers during hospitalisation to provide familiarity similar to the home environment (Mabetha, De Wet-Billings & Odimegwu 2021). Literature suggests that cultural beliefs and practices influence the perceptions and choices of healthcare services (Mabetha et al. 2021). Mabetha et al. (2021) believes that the involvement of primary caregivers, including mothers, in the care of children has a positive influence on the children’s outcomes because their presence makes the children feel more secure and provides a sense of normalcy akin to the home environment. Despite this evidence, current models do not integrate primary caregivers’ involvement as a central component of paediatric nursing care. The model provides a guiding framework for professional nurses to deliver holistic care that is responsive to family dynamics and needs, children’s developmental stages and various cultural practices, which is its unique contribution to South African paediatric nursing. The model aims to incorporate the active and direct involvement of the mother or the primary caregiver in the child’s hospitalisation journey, recognising their indispensable role in the child’s well-being. In doing so, it not only facilitates holistic, culturally sensitive, child-centred nursing care, but it also promotes family- and community-centred care essential for a healthy ecosystem. The model also enforces collaboration between the healthcare professional, the family and the community.

Provision of culturally sensitive nursing care requires professional nurses to master the skills of cultural competence (Dertly & Gunay 2022), which is the ability to facilitate care within the patient’s context (Leininger 1988; Öner et al. 2023). The study answers the following research question: ‘What can be done to facilitate culturally sensitive nursing care for children?’ The model further aims to empower professional nurses with cultural competence skills. Campinha-Bacote (2002) identified five skills of cultural competence: cultural awareness, cultural knowledge, cultural skill, cultural encounter and cultural desire. The model provides professional nurses with guidelines to apply these skills to provide culturally appropriate and sensitive care.

Several theories guide the model. It is theoretically grounded in Leininger’s Culture Care Theory and Sunrise Model, as well as Campinha-Bacote’s Model of Cultural Competence. Dickoff, James and Wiedenbach (1968) and Chinn, Kramer and Sitzman (2022) provide the model with its structure and rigour. The model is tied together by the Ubuntu philosophy, highlighting mutual respect (Muhammad-Lawal et al. 2023) and the connectedness between the professional nurse and the recipients of care. Peplau’s Theory of Interpersonal Relationships (1997) provides the structural pathway for the children’s hospitalisation journey in three phases: relationship phase, working phase and termination phase. The three phases coincide with the patients’ admission, hospitalisation and discharge, respectively. During admission, which coincides with the relationship phase, the professional nurse leads the engagement and invites the mother to share cultural care expectations. This builds trust and brings them together to collaborate in care.

During the hospital stay, which coincides with the working phase, there is a deeper connection between the professional nurse, the child and the mother. The professional nurse shows deep compassion through this collaboration. Throughout hospitalisation, the professional nurse engages with the recipients of care with trust and mutual understanding, and this brings them closer together for effective facilitation of culturally sensitive nursing care. In the final phase of the model – the termination phase, which coincides with discharge the professional nurse, the child and the mother together engage in a reflection of care. Peplau’s three phases of interpersonal relationships enhance cultural care by promoting meaningful engagement.

The research purpose was to develop, describe and evaluate a model to enable professional nurses to facilitate culturally sensitive practices for the nursing care of children at a children’s hospital. The study was conducted in two phases: descriptive phenomenology and model development. The model was developed in four steps: Step 1: Concept analysis; Step 2: Relationship statements; Step 3: Model development and description and Step 4: Model evaluation (Chinn et al. 2022).

A theory-generative, qualitative, exploratory, descriptive and contextual design was used to develop a model for professional nurses to facilitate culturally sensitive practices in nursing care for children at a children’s hospital. The study was conducted in two phases. In the first phase, a qualitative, exploratory, descriptive and contextual design was used to explore the experiences of professional nurses and mothers of sick children regarding culturally sensitive nursing care. These phenomenological experiences were used as a foundation to develop the model in the second phase. The second phase employed a theory-generative design.

The model is based on assumptions aligned with Madeleine Leininger’s Culture Care Theory, Campinha-Bacote’s Model of Cultural Competence and the Ubuntu philosophy. Leininger (2008) emphasises that caring is connected to culture because culture informs the individual’s healthcare expectations. Children’s perceptions and experiences of healthcare are shaped by their cultural beliefs and practices. Nurses are therefore expected to provide culturally appropriate and sensitive care for children from diverse cultural backgrounds (Tavallali 2025:75). The Culture Care Theory emphasises that, when healthcare is provided according to the cultural needs, the children develop lasting and trusting relations (Leininger 1988).

The model is based on seven assumptions summarised as follows:

Caring is culturally embedded, and this is based on Leininger’s view that care and culture are inseparable (Leininger 1997). Care, as conceptualised by Watson (2012), is defined as the foundation of nursing practice and is characterised by shared, meaningful moments between the professional nurses and the patients, including children. These shared moments are central to the facilitation of culturally sensitive practices for nursing care. It is during these moments that the professional nurse learns about the cultural beliefs and practices of the children, as well as their healthcare expectations. Respectful engagement enhances understanding, trust-building and mutual respect. Culture refers to the traditions and beliefs shared by individuals, families and communities.

Children’s healthcare experiences and cultural identities are shaped by their cultural backgrounds, and therefore, professional nurses must respond accordingly. The appropriate response requires professional nurses to be culturally competent. A culturally competent professional nurse has five skills of cultural awareness, cultural knowledge, cultural skill, cultural encounter and cultural desire (Campinha-Bacote 2002). The professional nurse clarifies their own values and becomes aware of various cultural beliefs and practices as they encounter children from diverse cultural backgrounds. Furthermore, the mothers mediate the children’s voices.

The professional nurse may initially lack cultural competence, which develops through reflection, education and encounters. This development is driven by the professional nurse’s awareness of skill gaps and commitment to learning. Ubuntu underpins the caring relationship and is the foundation of culturally sensitive nursing care. Ubuntu is seen through shared humanity, respect for human dignity and interconnectedness. Respectful engagement between the professional nurses and the mothers enhances mutual respect, understanding and the building of trust.

Structurally, the model is framed by the three-layer context that encloses the three phases of care and the outcome (Figure 1). The phases are inspired by Peplau’s Theory of Interpersonal Relationships: (1) the relationship phase, (2) the working phase and (3) the termination phase (Peplau 1997). These phases coincide with the patient’s hospitalisation journey. The relationship phase coincides with the admission process, the working phase with the hospitalisation stays and the termination phase with the patient’s discharge.

The model uses an African bead bracelet as a metaphor for the facilitation of culturally sensitive practices in nursing care. A metaphor is a figure of speech where a word is used to describe another unrelated word (Concise Oxford English Dictionary 2011) and to clarify processes (Steele, Baird & Davies 2022). Different colours of the African beads have been used to represent patients from diverse cultural backgrounds. The individual colours of the beads do not represent any specific cultural group; however, the differences among them serve to illustrate cultural diversity. The combination of the colours of the beads symbolises healing and protection (Jonauskaite & Mohr 2025). A combination of white, red, crystal and blue coloured beads is used.

The beads are assembled along a strong cord to create a bracelet, symbolising the facilitation process. The professional nurse selects the beads symbolising mobilisation and utilisation of resources for cultural care. The child and the mother join the professional nurse in selecting the beads symbolising collaboration, an essential aspect of culturally sensitive nursing care. The strong cord symbolises the difficulty of the facilitation process, necessitating trust, respect, understanding, compassion and care during the process. Assembling the beads requires careful selection of different beads. The facilitation process is driven by communication. The selection of the beads represents cultural assessment during the relationship phase; assembling the beads into a bracelet symbolises cultural care facilitation during the working phase; and the wearing of the beautifully made bracelet, the termination phase, requires effective communication and collaboration between the professional nurse, the child and the mother. This metaphor as an agent of change (Steele et al. 2022) symbolises the transformation of care to be more inclusive and sensitive to diverse cultural beliefs and practices.

Different colours have been used in the model’s structure to convey distinct cultural meanings (Jonauskaite & Mohr 2025). The context of the model is three layered, with the layers coloured orange, yellow and red, progressing from the outer to the inner layer. These colours represent the emotional tones of the hospital context. Orange represents the hospital as a healing environment (Jonauskaite & Mohr 2025). Yellow represents happiness, symbolising hope for successful facilitation of cultural care. Red symbolises the passion and commitment with which the professional nurse engages with the child and the mother in the ward. While the hospital is associated with negative emotions, the orange, yellow and red colours of the context show its positive side of hope for healing (Alzahrani 2021). The child and the mother join the family and the community represented by the white colour, embracing the outcome of healing (Ulusoy, Olguntürk & Aslanoğlu 2020). The facilitation process occurs in three phases, described next.

Ethical clearance was obtained from the University of Johannesburg’s Research Ethics Committee (REC-821-2020), and the healthcare facility provided written permission for the study to be conducted. The fundamental ethical principles of autonomy, non-maleficence, beneficence and justice were adhered to throughout the study (Dhai & McQuoid-Mason 2020). Informed consent was obtained from all the participants prior to participating in the study, with the understanding that they could withdraw anytime without penalty.

The termination phase is the last phase of the patient care journey and is realised when the goals have been achieved at the point of discharge. Effective facilitation of culturally sensitive practices for nursing care results in positive professional outcomes, including enhanced job satisfaction, strengthened cultural competence, reduced frustration and increased cultural desire for the professional nurse. For the child, the termination phase is associated with improved clinical outcomes and greater levels of satisfaction, while the mother experiences a sense of relief, reassurance and overall satisfaction with the cultural care provided to the child.

The professional nurse becomes confident in cultural competence skills and desires subsequent encounters to further engage in and apply these skills. There is increased job satisfaction and the desire to contribute to the development of others. Facilitation occurs through a feedback loop across the model; therefore, should there be a relapse, the professional nurse is able to revisit the process at the appropriate phase. There is an improved quality of care and greater satisfaction for the child, the family and the larger community. They feel respected and understood. The hospital stay potentially becomes shorter because of improved cooperation and trust. Through gaining trust in the healthcare system, the community utilises the healthcare services with trust.

The model was evaluated by nursing theory experts in qualitative research and theory generation. The demographics of the experts are provided in Table 4. The model evaluation sought the experts’ critical reflections on five aspects: (1) clarity, (2) simplicity, (3) generality, (4) accessibility and (5) importance of the model (Chinn et al. 2022).

The feedback reflected high levels of clarity and perceived importance, with constructive suggestions to improve accessibility and universality. The model is believed to be clear:

The feedback also highlighted the simplicity of the model as expressed by one expert:

With respect to the applicability of the model, one expert commented as follows:

One expert highlighted the model’s importance by saying:

The model is said to be accessible within the healthcare and cultural context:

Overall, the experts agreed that the model demonstrated conceptual clarity, practical simplicity, theoretical generality and contextual accessibility. The model integrated theoretical and regulatory representation, colour coding and the strong underpinning by Ubuntu philosophy.

The model needs to be used effectively to realise the desired outcomes. Evaluation of the model led to the development of the following guidelines for its operationalisation.

The study had three major limitations, namely sample limitation, researcher bias and implementation of the model. Professional nurses were sampled in the study, thereby excluding the enrolled nurses and enrolled nursing assistants. The experiences of these nursing categories have not been explored. The study was conducted at one children’s hospital; therefore, the experiences of the professional nurses and the mothers from the other children’s hospital and other hospitals with paediatric units have not been explored. In addition, even though the guidelines for the implementation of the model have been developed, the model has not been implemented. It is therefore recommended that future research should focus on including other categories of nurses, using stratified sampling strategies to include other hospitals providing paediatric care and the implementation of the model.