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

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

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

8. 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

9. 9

10. 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

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

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

13. 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.

14. 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.

15. 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.

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

17. 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

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

19. Domain: Workforce Issues
Acculturation
Autonomy
Language barriers

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

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

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

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

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

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

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

27. 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

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

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

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