Purnell Model for Cultural Competence Larry Purnell, PhD, RN, FAAN

Purnell Model: Assumptions All healthcare professions need much of the same information about cultural diversity and share the metaparadigm concepts of global society, community, family, person, and health. One culture is not better than another culture; they are just different.

Purnell Model: Assumptions There are core similarities shared by all cultures. There are differences within, between, and among cultures. Cultures change over time, but slowly. Culture has powerful influences on one’s interpretations and responses to health care.

Purnell Model: Assumptions If clients are co-participants in care and have a choice in health-related goals, plans, and interventions, health outcomes will be improved. Variant cultural characteristics determine the degree to which people vary from their dominant culture beliefs, values, and practices.

Purnell Model: Assumptions Individuals and families belong to several cultural groups, usually known as subcultures. Each individual has the right to be respected for his or her unique differences and cultural heritage. Caregivers who can assess, plan, and intervene in a culturally competent manner will improve the care of clients for whom they care.

Purnell Model: Assumptions Caregivers know themselves better by learning about their own cultures. Professions, organizations, and associations have their own cultures. Healthcare teams can benefit from a Model and Organizing Framework that is useable by all healthcare disciplines.

Variant Cultural Characteristics Nationality Race Color Gender Age Religious affiliation Educational status Socioeconomic status Occupation Military experience Political beliefs Urban versus rural residence

Variant Cultural Characteristics Marital status Parental status Physical characteristics Sexual orientation Gender issues Length of time away from the home country Reason for immigration—sojourner, immigrant, undocumented status

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Metaparadigm Concept: Global Society Seeing the world as one large community of multicultural people Evidence of global society What happens in other parts of the world affects each community

ClickerCheck What determines a person’s adherence with his/her dominant culture? Metaparadigm concepts Variant characteristics Global society Cultural worldview

Correct Answer Correct answer: B Variant cultural characteristics determine the degree to which a person adheres to his/her dominant cultural beliefs and practices.

Metaparadigm concept: Community A group or class of people having a common interest or identity living in a specified locality but can be an online community as well now What happens in the community has an effect on the family.

Metaparadigm concept: Family Two or more people who are emotionally involved with each other They may, but not necessarily, live in close proximity to each other. What affects the individual, affects the person.

Metaparadigm concept: Person A human being, one who is constantly adapting to his or her environment biologically, physically, socially, or psychologically Person is defined differently in other cultures.

Domain: Overview/Heritage Origins Residence Topography Economics Politics Education Occupation

Domain: Communication Dominant language and dialects Contextual use of the language Paralanguage—volume and tone Temporality—time—and spatial distancing Use of touch Eye contact and facial expressions Greetings and name format

Domain: Family Organization Head of household Gender roles Goals and priorities Developmental tasks Roles of the aged and extended family Social status Alternative lifestyles

Domain: Workforce Issues Acculturation Autonomy Language barriers

Domain: Biocultural Ecology Biological variations Skin color Heredity Genetics Endemics Drug metabolism

Domain: High-Risk Behaviors Tobacco Alcohol Recreational drugs Physical activity Safety Sexual behavior

Domain: Nutrition Meaning of food Common foods Rituals Deficiencies Limitations Health promotion

Domain: Pregnancy and Childbearing Fertility practices Views toward pregnancy Pregnancy beliefs Birthing practices Postpartum Prescriptive, restrictive, and taboo practices

Domain: Death and Dying Death rituals during the dying process Post mortem practices Bereavement

Domain: Spirituality Religious practices Use of prayer Meaning of life Individual strength Spirituality and health

ClickerCheck Contextual aspect of cultural communication includes Dominant language Dialects Explicit versus implicit communication Translation versus interpretation

Correct Answer Correct answer: C Contextual use of a language is concerned with the number of words used to express a thought. High-contexted communication uses fewer words to express a thought. Low-contexted communication uses a lot of words to express a thought

Domain: Health-care Practices Focus of health care Traditional practices Magicoreligious beliefs Responsibility for health Self-medication practices

Domain: Health-care Practices Responses to pain Sick role Mental health Rehabilitation Chronicity Blood transfusion Transplantation

Domain: Health-care Practitioners Perceptions of practitioners Folk practitioners Gender and health care Status of healthcare providers