The Purnell Model for Cultural Competence

This chapter presents the Purnell Model for Cultural Competence, its organizing framework, and the assump- tions upon which the model is based. In addition, American cultural values, practices, and beliefs are presented to assist non–native American health-care providers to understand American ways. The American references are meant to describe, not prescribe or predict, behaviors and practices. Although the authors recognize that Canada and Mexico are part of North America, American, as used in this chapter, refers to the dominant middle-class values of citizens of the mainland United States. Owing to space limitations, this chapter deals not with the objective culture—arts, literature, humanities, and so on—but rather with the subjective cul- ture. Many Americans are not aware of the subjective culture because they identify differences as individual personality traits and disregard political and social origins of culture. Many view culture as something that belongs only to for- eigners or disadvantaged groups. However, when Americans travel abroad, their host country inhabitants many times stereotypically identify them as Americans because of their values, beliefs, attitudes, behaviors, speech patterns, and mannerisms. Some feel that Americans are “fun lovers” and that, for some Americans, violence is a way of life. However, “the right to bear arms” is guaranteed by the Constitution. Most likely, the United States is not any more violent than, or even as violent as, many other societies, but American media coverage may be better than other countries, thereby giving the impression that the United States is more violent than it actually is. Accordingly, these stereotypes are not always accurate or desirable. The Purnell Model for Cultural Competence

Western academic and health-care organizations stress structure, systematization, and formalization when

studying complex phenomena such as culture and eth- nicity. Given the complexity of individuals, the Purnell Model for Cultural Competence provides a comprehen- sive, systematic, and concise framework for learning and understanding culture. The empirical framework of the model can assist health-care providers, managers, and administrators in all health disciplines to provide holis- tic, culturally competent therapeutic interventions; health promotion and wellness; illness, disease, and injury prevention; health maintenance and restoration; and health teaching across educational and practice settings. The Purnell Model for Cultural Competence

The purposes of this model are to

1. Provide a framework for all health-care providers to learn concepts and characteristics of culture.

2. Define circumstances that affect a person’s cul- tural worldview in the context of historical per- spectives.

3. Provide a model that links the most central rela- tionships of culture.

4. Interrelate characteristics of culture to promote congruence and to facilitate the delivery of con- sciously sensitive and competent health care.

5. Provide a framework that reflects human charac- teristics such as motivation, intentionality, and meaning.

6. Provide a structure for analyzing cultural data. 7. View the individual, family, or group within

their unique ethnocultural environment. The Purnell Model for Cultural Competence

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Assumptions Upon Which the Model Is Based The major explicit assumptions upon which the model is based are

1. All health-care professions need similar infor- mation about cultural diversity.

2. All health-care professions share the metapara- digm concepts of global society, family, person, and health.

3. One culture is not better than another culture; they are just different.

4. Core similarities are shared by all cultures. 5. Differences exist within, between, and among

cultures. 6. Cultures change slowly over time. 7. The primary and secondary characteristics of

culture (see Chapter 1) determine the degree to which one varies from the dominant culture.

8. If clients are coparticipants in their care and have a choice in health-related goals, plans, and interventions, their compliance and health outcomes will be improved. The Purnell Model for Cultural Competence

9. Culture has a powerful influence on one’s inter- pretation of and responses to health care.

10. Individuals and families belong to several sub- cultures.

11. Each individual has the right to be respected for his or her uniqueness and cultural heritage.

12. Caregivers need both culture-general and culture-specific information in order to provide culturally sensitive and culturally competent care.

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13. Caregivers who can assess, plan, intervene, and evaluate in a culturally competent manner will improve the care of clients for whom they care.

14. Learning culture is an ongoing process that develops in a variety of ways, but primarily through cultural encounters (Campinha- Bacote, 2006). The Purnell Model for Cultural Competence

15. Prejudices and biases can be minimized with cultural understanding.

16. To be effective, health care must reflect the unique understanding of the values, beliefs, attitudes, lifeways, and worldview of diverse populations and individual acculturation patterns.

17. Differences in race and culture often require adaptations to standard interventions.

18. Cultural awareness improves the caregiver’s self-awareness.

19. Professions, organizations, and associations have their own culture, which can be analyzed using a grand theory of culture.

20. Every client encounter is a cultural encounter.

Overview of the Theory, the Model, and Organizing Framework The Purnell model has been classified as holographic and complexity theory because it includes a model and orga- nizing framework that can be used by all health-care providers in various disciplines and settings. The model is a circle, with an outlying rim representing global society, a second rim representing community, a third rim repre- senting family, and an inner rim representing the person (Fig. 2–1). The interior of the circle is divided into 12 pie- shaped wedges depicting cultural domains and their con- cepts. The dark center of the circle represents unknown phenomena. Along the bottom of the model, a jagged line represents the nonlinear concept of cultural con- sciousness. The 12 cultural domains (constructs) provide the organizing framework of the model. A box following the discussion of each domain provides statements that can be adapted as a guide for assessing patients and clients in various settings. Accordingly, health-care providers can use these same questions to better under- stand their own cultural beliefs, attitudes, values, prac- tices, and behaviors. The Purnell Model for Cultural Competence

MACRO ASPECTS OF THE MODEL

The macro aspects of this interactional model include the metaparadigm concepts of a global society, community, family, person, and conscious competence. The theory and model are conceptualized from biology, anthropol- ogy, sociology, economics, geography, history, ecology, physiology, psychology, political science, pharmacology, and nutrition as well as theories from communication, family development, and social support. The model can be used in clinical practice, education, research, and the administration and management of health-care services or to analyze organizational culture. The Purnell Model for Cultural Competence

Phenomena related to a global society include world communication and politics; conflicts and warfare; nat- ural disasters and famines; international exchanges in education, business, commerce, and information tech- nology; advances in health science; space exploration; and the expanded opportunities for people to travel around the world and interact with diverse societies. Global events that are widely disseminated by television, radio, satellite transmission, newsprint, and information technology affect all societies, either directly or indirectly. Such events create chaos while consciously and uncon- sciously forcing people to alter their lifeways and worldviews.

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Think of a recent event that has affected global society, such as conflict or war, health advances in technology, or recent travel and possible environ- mental exposure to health problems. How did you become aware of this event? How has this event altered your views and other people’s views of worldwide cultures The Purnell Model for Cultural Competence

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