Purnell Model for Cultural Competence

The Purnell Model for Cultural Competence is a model for teaching and learning about intercultural competence, which is a range of cognitive, affective, and behavioral skills that allow for effective and appropriate communication between people of different cultures. Developed for used within the nursing profession, the Purnell Model for Cultural Competence combines various ideas tied to cultures, people, health care, and health professionals to create an effective evaluation instrument that can be used to both establish and evaluate competence in hospitals and other healthcare settings. It is composed of twelve distinct cultural domains, including overview/heritage, communication, family roles and organization, workforce issues, bicultural ecology, high-risk behaviors, pregnancy and childbearing, death rituals, spirituality, healthcare practices, and healthcare practitioner. Since its creation, the Purnell Model for Cultural Competence has also been adapted for use in an array of non-healthcare settings in various countries and cultures around the world.

Background

The Purnell Model for Cultural Competence was introduced by nursing professor and healthcare expert Larry D. Purnell and Betty J. Paulanka in 2002. Purnell’s breakthrough model hinges on the importance of cultural competence. In his 1998 book Transcultural Health Care: A Culturally Competent Approach, Purnell defined cultural competence as “developing an awareness of one’s own existence, sensations, thoughts, and environment without letting it have an undue influence on those from other backgrounds; demonstrating knowledge and understanding of the client’s culture; accepting and respecting cultural differences; [and] adapting care to be congruent with the client’s culture.”

In health care, cultural competence is a critical part of the care process. Specifically, culturally competent health care involves recognizing a patient’s individual needs, including his or her language, customs, beliefs, and perspectives. For nurses, physicians, and other healthcare providers, cultural sensitivity is an essential part of treating patients and ensuring that they receive the care they need in an appropriate manner that meets their individual needs. In the United States, the need for cultural competence in health care has only increased over time. As the American population has grown more ethnically and racially diverse, the need to provide medical care with the distinct cultural needs of each individual patient in mind has risen as well. For that reason, incorporating cultural competence training into the broader educational curriculum for those studying to enter the medical field as physicians, nurses, or other types of healthcare professionals is a necessity. To that end, a number of cultural competence models meant to aid the incorporation of cultural competence training into medical education programs have been developed since the mid-twentieth century. In addition to the Purnell Model for Cultural Competence, some of these models include Leininger’s Sunrise Model, the Transcultural Assessment Model, and the Model of Cultural Competence in Healthcare Delivery. These models all offer healthcare professionals a roadmap to use when providing effective medical care in culturally diverse environments. Among these various models, the Purnell Model for Cultural Competence offers perhaps the most comprehensive approach to cultural competence in medicine that has yet been developed.

Overview

The Purnell Model for Cultural Competence is an organizing framework originally meant to be used by student nurses as a clinical assessment tool. As a whole, the model consists of both the underlying organizing framework and a visual schematic. The visual schematic depicts the model as a series of four concentric circles. The outermost circle represents global society, the second circle represents community, the third ring represents family, and the fourth ring represents the person. The area inside the concentric circles is divided into twelve wedges depicting various cultural domains and their associated concepts. Within the model, each domain is related to and affected by the rest. The center of the model is left empty as a representation of the unknown as aspects of the cultural group being examined. A saw-tooth line found underneath the model represents the concept of cultural consciousness and may be seen as relating to either the healthcare provider or broader healthcare organizations.

The twelve domains lie at the heart of the Purnell Model for Cultural Competence. Within the model, these domains flow from general phenomena to specific phenomena. As applied to the person being assessed, the concepts within the overview/heritage domain relate to country of origin, current place of residence, the effects of the topography of the country of origin and current place of residence, politics, economics, educational status, occupations, and reasons for emigration.

The communication domain includes concepts related to the person’s dominant language and dialect; their contextual use of the language; their use of paralanguage variations like vocal tone, volume, and intonation; and their willingness to share their thoughts and feelings. It also includes the person’s use of nonverbal language like body language, facial expressions, eye contact, touch, and spatial distancing practices; their preference for acceptable greetings; temporal worldview orientation; their perception of clock versus social time; and their preference in the use of names.

The family roles and organization domain includes concepts related to who is perceived as the head of the household; the specific roles of other family members, especially children, elders, and extended family; child-rearing practices; and views on alternative lifestyles as pertains to issues such as sexual orientation, single-parenthood, divorce, and childless marriages.

The concepts within the workforce issues domain relate to matters like autonomy, gender roles, ethnic communication styles, individualism, assimilation, and healthcare practices from the person’s country of origin.

The bicultural ecology domain includes concepts related to variations in ethnic and racial origins, such as skin color or differences in how the body metabolizes drugs.

The high-risk behavior domain includes concepts tied to the person’s use of dangerous drugs or non-use of safety devices like seatbelts.

The concepts within the nutrition domain related to issues like the person’s access to an adequate food supply, their cultural understanding of food, and their views on the use of food as a means of promoting health and wellness.

The concepts within the death rituals domain relate to how the person and his or her culture view death and the death rituals he or she observes.

The spirituality domain includes concepts related to the person’s religious beliefs.

The healthcare practices domain includes concepts related to the person’s views on health care and any potential cultural barriers to health care.

Finally, the healthcare practitioner domain relates to the person’s use and perception of healthcare providers and the status of health care providers within the person’s culture.

Bibliography

Albougami AS, et al. “Comparison of Four Cultural Competence Models in Transcultural Nursing: A Discussion Paper.” International Archives of Nursing and Health Care, vol. 2, no. 4, 1 July 2016.

“Developing Culturally Sensitive Healthcare Systems.” Duquesne University, 6 Apr. 2020, onlinenursing.duq.edu/blog/developing-culturally-sensitive-healthcare-systems. Accessed 30 Oct. 2024.

“A Guide to Culturally Competent Nursing Care.” Alvernia University, 2 Feb. 2017, blog.diversitynursing.com/blog/a-guide-to-culturally-competent-nursing-care. Accessed 30 Oct. 2024.

“Providing Cultural Competency Training for Your Nursing Staff.” Minority Nurse, 15 Feb. 2016, minoritynurse.com/providing-cultural-competency-training-for-your-nursing-staff. Accessed 30 Oct. 2024.

Purnell, Larry. “The Purnell Model for Cultural Competence.” Journal of Transcultural Nursing, vol. 13, no. 3, July 2002, pp. 193–196.

Purnell, Larry D. Transcultural Health Care: A Culturally Competent Approach. F.A. Davis Company, 2012.