NURSING – PURNELL’S 12 DOMAINS OF CULTURAL ASSESSMENT
Cultural Group -African American –
Nursing – Purnell’s 12 Domains of Cultural Assessment
Introduction
Applying Purnell’s 12 Domains of Cultural Assessment Model to an African American cultural health issue provides a means for gathering data and formulating a culturally competent prevention strategy linked to the group’s common health risk aligned to cardio vascular disease (CVD). The following provides the profile according to Purnell’s model and the suggested application for creating a competent primary prevention strategy for CVD.
Purnell’s 12 Doman of Cultural Assessment Model
According to the National Association of School Nurses (2013) the model creates a circle made of 12 cultural domains. Global society is represented in the outer rim and the next is community, the third is family, the very inner rim is the individual, and the interior represents the 12 domains. The center remains empty representative of what unknown about the culture while the saw-toothed line is about the cultural consciousness beliefs.
The 12 Cultural Domains about African Americans
Heritage
Deeply rooted in the cultural heritage of African Americans aligned to slavery is food that continues today. Often given unwanted food sources from their masters African Americans developed a particular style of preparing food using large amounts of animal fats, salt, and sugar. Large amounts of salt as preservatives also pervaded in rural areas of America where African Americans continued many of the food preparation traditions as well as in the urban settings (Geyen, 2012).
Communication
Health issues are generally something not easily communicated among African Americans. Strong traditions remain that preclude more openness about health issues among families and communities. Still suspicious of clinicians, older African Americans remember past generations of African Americans experiences with health care scandals such as the Tuskegee experiments on African Americans (Geyen, 2012).
Family Roles
While African American culture is generally reflected along with the typical U.S. population, nonetheless African American family structures may extend including non-related people as family members. Often matriarchal African American families find more unmarried women than men and more educated women at the college level. Generally, found more conservative, older generations of African American family members adhere to traditional views assigned to gender roles. They hold respected positions in the family unit often providing childcare and as long as there are sons and daughters in the role of caretaker they are seldom institutionalized (Carteret, 2012).
Issues in the Workplace
Even with increased numbers of African Americans achieving higher education goals, the fact is African Americans remain overrepresented in dry cleaning, laundry, fabric mills, tobacco manufacture, smelters, agribusiness, and in hospital maintenance where they are exposed to toxic environments. The exposure includes, heat, pesticides, dust, noise, and toxic chemicals and is often exacerbated by both poverty living conditions and poor medical care (Hurley, 1995)
Bicultural Ecology
The bicultural ecology affecting African American health issues is partly genetic and also attributed to environments they live, racism, and socioeconomic status. While these are attributed to all people in similar environment, African Americans are particularly at risk (WebMD.com, 2016).
High-risk Behaviors
Core to high risk behaviors are cultural barriers connected to health disparities between African Americans compared to other racial groups and variations in high-risk lifestyle behaviors that include diet and lack of exercise (Geyen, 2012).
Nutritional Practices
As explained in the above about diet and food preparation African Americans generally consume too much fried foods, and use too much salt and sugar.
Childbearing
In the last decade, data shows African American women are 2.3 times more apt to not seek prenatal care in the 3rd trimmest of their pregnancy or they fail in receiving any kind of prenatal care leading to their infants dying four times as much from low birth weight and/or premature births as compared to white counterparts (Geyen, 2012).
End of Life Rituals/Spirituality
A large number of African Americans take a holistic view of death/dying having an understanding that birth and death remain part of a life cycle or continuum while it is not uncommon for older African Americans to hold that death is God’s will. This shows a tendency to believe in life support for as long as necessary. The use of cremation typically is avoided as well as donating organs. The general experience of spirituality is remains fundamental as reconciling death among African Americans who typically believe in the sanctity of life relying on the strength of both community and family during time of loss from death. The family-centered consensus holds value in decision-making and not uncommon relying on the strength of support from and given to extended family during this time with health and medical care givers understanding the desire to know of impending death so family and extended family living out of state can make arrangements to come say good bye (Geyen, 2012).
Healthcare Practices
Too many African Americans practice sedentary lifestyles often resulting in the early onset of chronic disease and the comorbidities associated with being overweight including diabetes, CVD, and premature death. Various beliefs, cultural practices, and reasons find numbers of African Americans lacking motivation for engaging in routine physical exercise as a means for turning around bad lifestyle choices affecting wellness (Geyen, 2012).
Attitudes Toward Healthcare Professionals
An initial and often continued attitude of suspicion toward health care providers proves especially problematic among the elderly African Americans making them reluctant to provide the necessary information in a healthcare setting to develop interventions and healthcare treatments (Carteret, 2012)
Intervention Plan
Working through community organizations and churches is an effective way for setting up educational programs for women and for families in the African American community about the health risks of CVD associated with poor life style choices including lack of exercise and diet. Helping the target community to understand that early intervention and diagnosis of high blood pressure, unhealthy cholesterol levels, poor diet choices, and the lack of exercise is a great part of CVD is a primary intervention that healthcare professionals including community nurses can develop for the African American community. Working in settings the target group feels comfortable and trusts such as churches, schools, and community centers is a key focus for successfully developing and carrying out an intervention program to first educate about the causes of CVD and help both individually and collectively create the necessary healthy lifestyle programs needed to address this serious health condition plaguing the African American community.
Conclusion
As posited in the above introduction and successfully applying Purnell’s 12 Domains of Cultural Assessment Model to an African American cultural health issue further allowed a better understanding from the data how to formulate a culturally competent prevention strategy linked to the group’s common health risk aligned to cardio vascular disease (CVD). The above academic medical learning exercise proved an invaluable example of how using such data gathering models for healthcare practices in addressing specific cultural needs of the diversity of the American population is an important tool having merit for the time put in to use it.
References
Carteret, M. (2011). Health Care for African American Patients/Families. Retrieved from
http://www.dimensionsofculture.com/2011/05/health-care-for-african-americanpatientsfamilies/
Geyen, D. J. (2012). Behavioral Changes for African Americans to Improve Health, Embrace Culture, and Minimize Disparities. ECI Interdisciplinary Journal for Legal and Social Policy. 2(1), 1-16. Retrieved from http://ecipublications.org/cgi/viewcontent.cgi?article=1015&context=ijlsp
Hurley, A. (1995). Environmental Inequalities: Class, Race, and Industrial Pollution in Gary, Indiana, 1945-1980. Chapel Hill, NC: University of North Carolina Press.
National Association of School Nurses. (2013). Purnell’s Model for Cultural Competence. Retrieved from https://www.nasn.org/ToolsResources/CulturalCompetency/PurnellModelforCulturalCompetence
Web MD.com (2016). Why 7 Deadly Diseases Strike Blacks Most. Retrieved from
http://www.webmd.com/hypertension-high-blood-pressure/features/why-7-deadly-diseases-strike-blacks-most
