Nursing

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Purnell Model for Cultural Competence

Larry Purnell, PhD, RN, FAAN

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Purnell Model: Assumptions

All healthcare professions need much of the same information about cultural diversity and share the metaparadigm concepts of global society, community, family, person, and health.
One culture is not better than another culture; they are just different.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Purnell Model: Assumptions

There are core similarities shared by all cultures.
There are differences within, between, and among cultures.
Cultures change over time, but slowly.
Culture has powerful influences on one’s interpretations and responses to health care.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Purnell Model: Assumptions

If clients are co-participants in care and have a choice in health-related goals, plans, and interventions, health outcomes will be improved.
Variant cultural characteristics determine the degree to which people vary from their dominant culture beliefs, values, and practices.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Purnell Model: Assumptions

Individuals and families belong to several cultural groups, usually known as subcultures.
Each individual has the right to be respected for his or her unique differences and cultural heritage.
Caregivers who can assess, plan, and intervene in a culturally competent manner will improve the care of clients for whom they care.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Purnell Model: Assumptions

Caregivers know themselves better by learning about their own cultures.
Professions, organizations, and associations have their own cultures.
Healthcare teams can benefit from a Model and Organizing Framework that is useable by all healthcare disciplines.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Variant Cultural Characteristics

Nationality
Race
Color
Gender
Age
Religious affiliation
Educational status
Socioeconomic status
Occupation
Military experience
Political beliefs
Urban versus rural residence
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Variant Cultural Characteristics

Marital status
Parental status
Physical characteristics
Sexual orientation
Gender issues
Length of time away from the home country
Reason for immigration—sojourner, immigrant, undocumented status
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Metaparadigm Concept: Global Society

Seeing the world as one large community of multicultural people
Evidence of global society
What happens in other parts of the world affects each community
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

ClickerCheck

What determines a person’s adherence with his/her dominant culture?

Metaparadigm concepts

Variant characteristics

Global society

Cultural worldview

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Correct Answer

Correct answer: B

Variant cultural characteristics determine the degree to which a person adheres to his/her dominant cultural beliefs and practices.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Metaparadigm concept: Community

A group or class of people having a common interest or identity living in a specified locality but can be an online community as well now
What happens in the community has an effect on the family.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Metaparadigm concept: Family

Two or more people who are emotionally involved with each other
They may, but not necessarily, live in close proximity to each other.
What affects the individual, affects the person.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Metaparadigm concept: Person

A human being, one who is constantly adapting to his or her environment biologically, physically, socially, or psychologically
Person is defined differently in other cultures.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Domain: Overview/Heritage

Origins
Residence
Topography
Economics
Politics
Education
Occupation
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Domain: Communication

Dominant language and dialects
Contextual use of the language
Paralanguage—volume and tone
Temporality—time—and spatial distancing
Use of touch
Eye contact and facial expressions
Greetings and name format
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Domain: Family Organization

Head of household
Gender roles
Goals and priorities
Developmental tasks
Roles of the aged and extended family
Social status
Alternative lifestyles
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Domain: Workforce Issues

Acculturation
Autonomy
Language barriers
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Domain: Biocultural Ecology

Biological variations
Skin color
Heredity
Genetics
Endemics
Drug metabolism
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Domain: High-Risk Behaviors

Tobacco
Alcohol
Recreational drugs
Physical activity
Safety
Sexual behavior
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Domain: Nutrition

Meaning of food
Common foods
Rituals
Deficiencies
Limitations
Health promotion
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Domain: Pregnancy and Childbearing

Fertility practices
Views toward pregnancy
Pregnancy beliefs
Birthing practices
Postpartum
Prescriptive, restrictive, and taboo practices
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Domain: Death and Dying

Death rituals during the dying process
Post mortem practices
Bereavement
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Domain: Spirituality

Religious practices
Use of prayer
Meaning of life
Individual strength
Spirituality and health
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

ClickerCheck

Contextual aspect of cultural communication includes

Dominant language

Dialects

Explicit versus implicit communication

Translation versus interpretation

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Correct Answer

Correct answer: C

Contextual use of a language is concerned with the number of words used to express a thought. High-contexted communication uses fewer words to express a thought.

Low-contexted communication uses a lot of words to express a thought

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Domain: Health-care Practices

Focus of health care
Traditional practices
Magicoreligious beliefs
Responsibility for health
Self-medication practices
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Domain: Health-care Practices

Responses to pain
Sick role
Mental health
Rehabilitation
Chronicity
Blood transfusion
Transplantation
Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Domain: Health-care Practitioners

Perceptions of practitioners
Folk practitioners
Gender and health care
Status of healthcare providers
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