Instructions
The Purnell Model for Cultural Competence
Health disparities are well documented and are often found in racial and ethnic minority groups (Betancourt et al., 2003). Additionally, the minority groups experiencing poorer health status is expected to grow within the United States (Betancourt, et al., 2003). There are many reasons that contribute to disparities in quality of care including socioeconomic disadvantage, lower levels of education, higher rates of occupational hazards, variations in patient’s health beliefs, values, preferences, and behaviors (Betancourt, et al., 2003). Due to these observations, multiple cultural competence models have been developed. The four prominent models for cultural competence include the Leininger Sunrise Model, Giger and Davidhizar Transcultural Assessment Model, Campinha-Bacote Model of Cultural Competence in healthcare delivery, and the Purnell model for cultural competence (Albougami, 2016). The Purnell model is the focus of this discussion and is summarized below.
The Purnell model for cultural competence can be described as a circular, multilevel organizational framework. The purpose of the framework is to assist all types of healthcare professionals in learning and understanding culture, including their own, in order to provide culturally holistic care. This framework was developed in 1998 and although fundamentally the same, has been updated, revised, and clarified. There are four rims within the circular model, layering one upon the other. The outer rim represents the global society, the second rim represents community, the third rim represents family, and the inner rim represents the individual (Purnell, 2003). In the center of the circle is a dark spot representing unknown phenomena. There are twelve constructs that aid in assessing the cultural attributes of the individual, family, or community. These twelve domains are depicted inside the circle resembling pizza slices. The constructs include heritage (origins, residence, topography, economics, politics), communication (language, dialects, eye contact, facial expressions.), family role and organization (head of household, gender roles, extended family), workforce issues (autonomy, language barriers, etc.), biocultural ecology (skin color, heredity, genetics), high-risk behaviors (tobacco and alcohol use, physical activity), nutrition (meaning of food, common dishes, health promotion), pregnancy (fertility practices and beliefs, birthing, postpartum), death rituals, spirituality (religious practices, meaning of life, prayer), health-care practices (focus on heath care, traditional practices, mental health barriers), and health-care practitioners (perceptions of practitioners and gender and health care) (Purnell, 2003).
One of the goals for an advanced practice nurse is to be able to provide excellent, patient-centered care. To deliver this type of care, it is important to develop cultural competence. A culturally competent practitioner can formulate a better relationship, communicate more effectively, and successfully eliminate health disparities with the patient. In fact, Pacquiao (2007) described multiple benefits from culturally competent practitioners including greater use of preventative asthma medication by parents for their children, improved experience and patient satisfaction scores, and increased cancer screening among African Americans. Providing culturally competent care leads to effective, comprehensive, and respectful healthcare delivery to patients.
References
Albougami, A. (2016). Comparison of four cultural competence models in transcultural nursing: a discussion paper. International Archives of Nursing and Health Care, 2(4). https://doi.org/10.23937/2469-5823/1510053
Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2003). Defining Cultural Competence: A practical framework for addressing Racial/Ethnic disparities in health and health care. Public Health Reports. https://doi.org/10.1093/phr/118.4.293
Pacquiao, D. F. (2007). The relationship between cultural competence education and increasing diversity in nursing schools and practice settings. Journal of Transcultural Nursing, 18(1_suppl), 28S-37S. https://doi.org/10.1177/1043659606295679
Purnell, L. D. (2003). Transcultural Health Care: a culturally competent approach. http://ci.nii.ac.jp/ncid/BA89406100
Peer 2
Cultural Competence
Cultural competence is crucial for providers to be knowledgeable about to effectively and efficiently prepare healthcare interventions and treatment plans that respect the patient’s cultural differences. Lack of knowledge of a patient’s cultural beliefs and values can result in serious adverse outcomes such as threats to life and quality of care for all individuals (Purnell, 2014). The advanced practice nurse can strengthen patient trust, communication, and have effective treatment outcomes by improving cultural awareness through resources, language assistance, and clinics that provide support to both patients and practitioners of all entities (Cocoziello, 2023). When patients feel that their healthcare provider is culturally competent, they will access care when problems first arise which helps to reduce length of stay, decrease complications, and reduce overall costs (Purnell, 2014).
The Purnell Model for Cultural Competence is relevant to the advanced practice nurse because culture has a powerful influence on one’s interpretation and response to health care. The Purnell Model can be used by all healthcare providers to help become consciously competent. The model starting from outward to inward consists of a global society, community, family, and the individual person. Within the individual persons circle are 12 divided pieces that represent the individual’s beliefs regarding communication, family roles and organization, workforce issues, biocultural etiology, high-risk behaviors, nutrition, pregnancy, death rituals, spirituality, health-care practices, healthcare providers, and overview of heritage and location. Learning about a patient’s cultural data can provide the health care provider with instruction for the best way to approach treatment options by either adopting, modifying, or rejecting healthcare interventions that will respect the patient’s cultural differences. The advanced practice nurse will need to ask open-ended questions that will not only increase the patients trust with the practitioner but will help the practitioner identify the need for additional health screenings such as if the patient has lived in overcrowded or unsanitary conditions, the patient may need to be screened for tuberculosis or respiratory diseases. Knowing the educational level of a patient and understanding what their culture values as important learning styles or whether their cultures educational programs emphasized theory or practical application can help navigate the advanced practice nurse to determine the best approach to teaching the patient about a disease or importance of adherence to a medication. Other considerations the advanced practice nurse should be aware of are barriers to health care. Barriers include but are not limited to availability, accessibility, affordability, accountability, adaptability, acceptability, awareness, attitudes, approachability, alternative practices and practitioners, additional services, and literacy. With literacy, language is the largest barrier to healthcare and the advanced practice nurse can alleviate this problem by reaching out to an ethnic agency, a church for assistance, and involving professionals from the same ethnicity to help obtain culturally responsive care (Purnell, 2014).
Cultural competence learning should start early rather than later, it is not something that can be taught in one class, it is something that is developed over time and requires practice, receptiveness, readiness, and dedication (Lee et al., 2022). Educating oneself about different cultures and their beliefs is an ongoing process, cultures can change over time, and working with diverse groups helps to increase knowledge and minimize prejudices and biases by having a better cultural understanding. Showing respect, cultural awareness, and cultural sensitivity to a patient’s cultural beliefs and values will strengthen the relationship, improve patient outcomes and treatment compliance.
References
Cocoziello, N. (2023). Navigating the healthcare system with cultural competence. Journal of Nurse Life Care Planning, 23(2), 27–29.
Lee, V. W. P., Lai, D. W. L., & Ruan, Y.-X. (2022). Receptivity and readiness for cultural competence training amongst the social workers in Hong Kong. British Journal of Social Work, 52(1), 6–25. https://doi.org/10.1093/bjsw/bcaa191
Purnell, L. (2014). Transcultural health care: A culturally competent approach. (4th ed.). Philadelphia: F.A. Davis Co.