Purnell’s Model for Cultural Competence
Introduction
The modern health care faces multiculturalism and diversity challenges that arise due to cultural differences of the health care professionals and among the clients. As such, various initiatives and strategies have become necessary to inculcate cultural sensitivity or competence among health care professionals. Healthcare organizations face the challenges pose by multicultural diversity as well as ethnic and racial disparities among the service providers (Campinha, 2011). Therefore, they are avidly adopting various strategies to address this issue. They develop statements, initiatives, and standards to encourage health care professionals to become culturally competent.
Purnell’s Model has been proposed for health care organizations to spur cultural competence among health care professionals in various settings. It forms a critical framework for encouraging cultural sensitivity by increasing cultural knowledge to ensure that health professionals are culturally competent (Purnell, 2014). This paper will review Purnell’s model for cultural competence by examining the characteristics of the 12 domains of cultural assessment with reference to Native Americans as one of the cultural group. The paper will also select a health risk common to Native Americans as a selected cultural group and formulate culturally competent primary prevention strategies using assessment data.
12 domains of Purnell’s Model for cultural assessment and description of Native Americans in each group
Culture is defined in the Purnell’s Model as a combination of behavioral patterns, customs, values, arts, beliefs, and any other social transmission of human characteristics that guide their decision making. The model describes cultural competence as a process in which health care professionals move from not being aware of others’ cultures to conscious competence that enables them to provide health care that is culturally congruent to culturally diverse clients. Purnell’s Model for Cultural Competence is a circle with three major rims. The outmost one represents the global society, the second one represents the community, and the third one represents the person. The circle is interiorly divided into 12 wedges that describe the 12 cultural domains as well as their characteristics (Purnell, 2014). These cultural constructs form the basic framework of the Purnell’s Model.
Overview/heritage
This domain encompasses various concepts relating to inhabited localities, current residence of the cultural group, the topography, how the topography affects the origin and the current residence of the group, the value placed on education by the group, politics, economics, and causes of emigration for the cultural group. The Native American women have unique experiences, particularly when giving birth. These experiences are influenced negatively or positively by the health care they receive. The Native Americans are affected by political and socio-cultural factors, which exert negative effects on cultural identity, education, health, and traditional values. According to the recent research, there has been an increase in the number of Native American women requiring healthcare services (Manson et al., 1997). Thus, the application of Purnell’s Model is relevant to overcome various barriers like people’s belief in traditional spiritual systems of healing that hamper the provision quality health care.
Communication
Communication is another domain for cultural assessment, which covers various concepts relating to dialects and dominant language used by a particular cultural group. It also encompasses various paralanguage variations like intonations, the willingness to share personal experiences, facial expressions, emotional closeness, and other communication variables. The Native American culture is characterized by various communication barriers due to adherence to their cultural values and other culture-related factors that affect the effective provision of health care. Most Native Americans are reluctant when it comes to the expression of pain using various communication skills (Manson et al., 1997). Thus, Purnell’s Model is needed in this to help the caregivers to adapt to various interventions that meet the varying health needs of the Native Americans.
Family roles and organization
This domain covers issues relating to household heads as well as the gender roles. Additionally, this domain embodies childbearing practices, family roles, children’s developmental tasks, and the roles of members of extended family and aged people. The family and individuals’ statuses, as well as other community aspects such as sexual orientation, divorce, childless marriage, and single parenting, are also covered by this domain. The culture of Native Americans gives minimal attention to various parenting characteristics. The parenting strategies and styles vary among families. This makes it difficult to generalize the family characteristics.
Workforce issues
This domain is concerned with issues of language barriers, acculturation, and autonomy. Communication barrier is a big issue among the Native Americans. In order to provide health care that is culturally sensitive, effective communication is mandatory (Hunt, 2016). Health services are supposed to be offered in language understandable by the Native Americans. However, the culture of Native Americans is characterized by significant cultural differences that lead to miscommunication, misdiagnosis, and consequently improper treatment. Native Americans are found to be poor when it comes to the expression of pain. This may lead to health care providers concluding that a patient is not experiencing any pain. The American Society is also characterized by serious acculturation that results in people adopting others’ cultural values (Manson et al., 1997). Therefore, Purnell’s Model is relevant to cultivate the sense of cultural competence and promote the efficiency of health care provision.
Biocultural ecology
In this domain, the concepts of skin color, genetics, drug metabolism, and biological variations are covered. The American culture comprises of various races due to immigration. The intermarriage between the Native Americans and the immigrants has produced an interracial society with diverse cultural values. The society values cultural interrelations and discourages autonomy.
High-risk behavior
This domain embodies the issues of high-risk behaviors such as alcoholism, recreational drugs, tobacco, health safety, and physical activities. The main characteristic of the Native Americans that is covered in this domain is alcohol abuse, which is quite pervasive among the Native Americans. Alcohol abuse is in one of the major causes of high mortality rates among different American tribes.
Nutrition
This domain covers the common food types among different cultural groups. The Native American culture is characterized by consumption of a wide variety of foods where some foods are consumed for specific purposes like health promotion. Additionally, specific food is consumed during illness.
Pregnancy
Children in the American culture are viewed as the property and responsibility of parents. The dominant culture of Native Americans has strong pregnancy beliefs where families are expected to raise tribal children.
Death rituals
This domain covers the issues of bereavement and death rituals. The Native Americans tend to incorporate traditional death rituals in their funeral services.
Spirituality
This domain is concerned with how various cultural groups use religious practices to give life specific meaning. The Native American society believes in some spiritual system of healing. This tends to compromise the professionalism of health care providers.
Health care practices
This entails how cultural competence emphasizes care whether acute or preventive. It is also concerned with individuals’ responsibility for their health, donation, organ transplantation, and beliefs concerning biomedical and traditional health practices. The major feature of this domain that is associated with Americans is their perception of mental illness. Mentally ill persons receive special treatments in various life aspects such as employment, health care, and education.
Health care practitioners
This entails the perception of the society about the status and use of traditional care, magic- religious, and allopathic treatment methods. It also encompasses the issue of the gender of the health care professionals. The Native American culture is characterized by a mix of traditional beliefs and the use of the modern biomedical treatment methods.
How I would use my assessment data to formulate culturally competent primary prevention strategies for alcohol abuse as a health risk among Native Americans
The abuse of alcohol has been found to be a pervasive problem among the Native Americans. Among the users of alcohol, the mortality rates approximate to 465% higher than mortality rates in the entire population. This shows that alcohol contributes to nearly one- third of all deaths among the Native Americans. Thus, preventive strategies would be needed to curb this problem. Alcohol poses a serious health risk among consumers. Using the assessment data, I would classify all the cultural practices carried out by Native Americans to identify the practice in which the use of alcohol is most necessary and inevitable as well as the type and amount of alcohol needed for that cultural practice to invading violently into peoples’ culture. I would also assess the relevance of the practice to the society and review its history. The next step would involve educating the community on the health risk associated with excessive alcohol consumption without referring to a particular cultural group to maintain cultural sensitivity.
References
Campinha, J. (2011). Delivering Patient-Centered Care in the Midst of a Cultural Conflict: The Role of Cultural Competence. Online Journal Of Issues In Nursing, 16(2), 1. doi:10.3912/OJIN.Vol16No02Man05
Hunt, D. D (2016). Cultural competence in nursing practice. Retrieved August 28, 2016, from http://nursing.advanceweb.com/Continuing-Education/CE-Articles/Cultural-Competence-in-Nursing-Practice-2.aspx
Manson, S. M., Bechtold, D. W., Novins, D. K., & Beals, J. (1997). Assessing psychopathology in American Indian and Alaska Native children and adolescents. Applied Developmental Science, 1(3), 135-144.
Purnell, L. (2014). The Purnell model for cultural competence. Retrieved August 28, 2016 from http://files.midwestclinicians.org/sharedchcpolicies/Policies_Forms/Cultural%20Competency/PURNELL%27S%20MODEL.pdf
