Culturally congruent care: putting the puzzle together.

This article presents the 3-D puzzle model of culturally congruent care, defines the levels and constructs employed by this model, presents some assumptions, and lays out some basic propositions as a foundation for further work. There are many extant frameworks and theories of culture and cultural competence in nursing and health care; the model presented here draws heavily from prior work and is an attempt to present a synthesis of concepts and processes in a new way. The ideas presented here build particularly on pioneering work in transcultural nursing by Leininger. Leininger's work specifically focuses on the use of qualitative methods to understand the ways in which culture influences nursing care from an emic, or insider, perspective. The 3-D puzzle model extends Leininger's work to include concrete articulations of constructs relevant to design and implementation of intervention strategies for teaching and measuring competency among nurses and other providers.