Purnell Model for Cultural Competence
The demographics of the American population are increasingly changing due to a growth in the proportion of persons collectively termed as ethnic minority. It is expected that by the year 2020, 35% of the American population will consist of ethnic minorities (Barrow, 2010). This increase in diversity is expected in the background of long-standing variations in the health status of persons from culturally diverse backgrounds (Barrow, 2010). These variations have been attributed to lack of cultural competence amongst healthcare professionals. Consequently, acquisition of cultural competence for health workers had been prioritized. A number of models for guiding cultural competency amongst multidisciplinary healthcare team members across a variety of settings have been proposed. Purnell’s model of cultural competence is one such model: it helps health professionals understand the concept of cultural competence and provides a process for achievement of this competence (Rose, 2013, p. 54).
Purnell’s model of cultural competence consists of a schematic combined with an organizing framework. It was first developed in 1991 as a clinical assessment tool. In 1992, the schematic, metaparadigm concepts, and scale for cultural competence were added. The model was conceptualized from multiple theories, a research base garnered from administrative, communication, family development and organizational theories as well as discipline knowledge in anthropology, nutrition, pharmacology, physiology, anatomy amongst others (Purnell, 2002). The model comprises of two sets of factors denoted as the macro and micro aspects. The macro aspects are the metaparadigm concepts that are universal to all cultures and healthcare professionals. These macro aspects are global society, community, family, and person. The micro aspects are the model’s 12 domains/ constructs. The theory also has explicit assumptions about healthcare providers and care recipients (Purnell, 2005).
Diagrammatically, Purnell’s model is organized into concentric circles. The macro aspects constitute the four outlying rims while the micro aspects constitute the inner circle. The four outermost concentric circles consist of the global society, community, family, and person moving inwards. The inner circle section is divided into 12 pie-shaped wedges. Each wedge represents a cultural domain and its related concepts. The 12 domains do not stand alone but are affected and related to each other. Each domain has a separate table called the organizing framework (Purnell, 2005). The tables contain a number of questions that healthcare providers can utilize to assess an individual or a group. The inner most circle of the schematic is empty. This section represents unknown aspects of a cultural group. Both the outer lying rims and inner circle form segments of a whole. At the bottom of the schematic is an erose. The erose represents the concept of cultural consciousness and relates to healthcare providers and organizations. Purnell conceptualized the process of gaining cultural competence as a non-linear process consisting of four levels: unconscious incompetence, conscious incompetence, conscious competence, and unconscious competence. Since the model is conceptualized from a broad perspective, it is applicable to all healthcare-related professions and across different care settings (Purnell, 2005).
The 12 domains of culture in Purnell’s model are overview/heritage, communication, family roles and organization, workforce issues, biocultural ecology, high-risk behaviors, nutrition, pregnancy and childbearing practices, death rituals, spirituality, healthcare practice, and healthcare practitioner. These domains influence healthcare diversity in a myriad of ways. The first domain, overview, influences issues such as conditions that patients in a certain cultural group are likely to be predisposed to on account of their country of origin and current residence. Communication, the second domain, influences the manner in which healthcare workers create rapport and disclose information to patients (Purnell, 2005). For instance, the Pakistani community shields family members from bad news and thus do not inform terminally ill patients of their diagnosis. Family roles and organizations influence health-related issues such as decision making and child rearing practices. Workforce issues impact on individual and community healthcare practices. Biocultural ecology creates variances in terms of endemic, genetic, and hereditary conditions and drug metabolism. High-risk behaviors accepted in a culture influence the health risks members of a community are exposed to. Nutrition influences the prevalence of nutrient-related conditions in a community and use of foods to promote health and wellness. Pregnancy and child bearing practices influence birthing and family planning choices as well as pregnancy behaviors. Death rituals influence end-of-life decision making and manner of grieving. Spirituality influences individual and family coping mechanisms in diseases and illness. Healthcare practices influences individual responses to pain, adoption of the sick role, self-medication practices, and views towards illnesses. Healthcare practitioner status shapes individual and community views towards healthcare professionals, traditional healers, and gender of healthcare workers. In effect, they influence patient-health worker relationships (Purnell, 2005).
In my practice, I will use Purnell’s model as a framework for providing culturally competent care to patients and clients. I will apply the model’s organizing framework in carrying out assessments and planning nursing interventions for patients drawn from different cultures. The domains of the model allow a more in-depth and focused analysis (Rose, 2013, p. 54). The model can thus provide useful insights into a patient’s cultural needs in every domain. In so doing, it will help me provide individualized care using approaches that respect the culture of clients/patients. The expected outcome is that my patients will participate in their own care.
In summary, an increase in the diversity of the American population has prompted health professionals to consider cultural variations in the provision of healthcare. This paper has described the theory and organizing framework of Purnell’s model of cultural competence. Further, it has discussed how the model’s 12 domains influence diversity in healthcare. Lastly, it has discussed how the model can be applied when working with different cultures.
References
Purnell, L. (2002). The Purnell model for cultural competence. Journal of Transcultural Nursing, 13(3), 193-196.
Purnell, L. (2005). The Purnell model for cultural competence. The Journal of Multicultural Nursing and Health, 11(2), 7-17.
Rose, P. R. (2013). Cultural competency for the health professional. Burlington, MA: Jones & Barlett learning.
