Purnell Model for Cultural Competence

Last updated

The Purnell Model for Cultural Competence is a broadly utilized model for teaching and studying intercultural competence, especially within the nursing profession. Employing a method of the model incorporates ideas about cultures, persons, healthcare and health professional into a distinct and extensive evaluation instrument used to establish and evaluate cultural competence in healthcare. Although the Purnell Model was originally created for nursing students, the model can be applied in learning/teaching, management, study and practice settings, within a range of nations and cultures.

Contents

History and description

The Purnell Model for Cultural Competence was developed by Larry D. Purnell and Betty J. Paulanka, [1] as an outline to classify and arrange elements that have an effect on the culture of an individual. [2] The framework uses an ethnographic method to encourage cultural awareness and appreciation [3] in relation to healthcare. It offers a basis for individual's providing care to gain knowledge around concepts and features that relate to various cultures[ citation needed ] in anticipation of assisting the performance of culturally competent care in clinical settings. The model has been recognised as a way to integrate transcultural proficiency into the execution of nursing [ citation needed ] and in “primary, secondary and tertiary” [4] environments.

Cultural competence has been described as a process, which is constantly occurring and through which one slowly advances [5] from lacking knowledge to developing it. An individual begins as unconsciously unskilled [6] due to their absence of personal knowledge that they are lacking awareness about other cultures. Next, an individual becomes aware of their incompetence due to their acknowledgement that they have insufficient comprehension of other cultures. Individuals then become deliberately competent (through learning about others’ cultures) so that they are able to apply personalised interventions. Finally, individuals gradually become oblivious to their competence [6] due to their ability to instinctively provide patients with culturally competent care.

In multicultural societies, it is becoming essential for healthcare professionals to be able to provide culturally competent care due to the results of enhanced personal health, [7] as well as the health of the overall population. The greater the overall knowledge a health practitioner has about cultures, the better their ability is to conduct evaluations and in turn provide culturally competent suggestions to patients. Purnell's model requires the caregiver to contemplate the distinct identities of each patient and their views towards their treatment[ citation needed ] and care.

The Purnell Model

Illustration of the Purnell Model Diagram of the Purnell Model.png
Illustration of the Purnell Model

Purnell and Paulanka [1] proposed this model including four circles of varying sizes that are representative of the metaparadigms that are applied to nursing,[ citation needed ] as well as a twelve-part inner circle that illustrates the various “cultural domains”. [8]

Metaparadigm ideas (outer circles)

The outer circles of the model are interconnected metaparadigm ideas that relate to nursing, and are involved within the process of providing an individual with care. [9] The outermost (first) circle is used to represent the global society, [5] the second circle represents the concept of community, the third of family, and the innermost (fourth) circle illustrates the individual person.

Global society

Global society relates to observing the world as an interconnected whole [10] that consists of a range of individuals from various cultural and ethnic backgrounds. Concepts that are present and influence this unified world include globalisation forces and the rapid growth of communication technologies that impact upon how the global society is maintained. It is critical to consider a person's place within the diverse world community [11] as influencing forces on the global society can impact not only the civilisation, but also an individual's world outlook.

Community

Family group portrait of Mr and Mrs Young of Waterloo House, Waterford, 1913 Family group portrait of Mr and Mrs M Young and family of Waterloo House, Waterford, 1913.jpg
Family group portrait of Mr and Mrs Young of Waterloo House, Waterford, 1913

Community is included in the model, as a metaparadigm, as in the provision of culturally competent care; an individual's situation within a community must be addressed. Through considering a patient's sense of community, care providers acknowledge that different communities may have divergent values, ethics and goals. [12]

Family

An individual's relationship with their family is essential to consider in the deliverance of care. This is because each individual may want to differently consider/explain who constitutes family, and additionally the degree to which they want family members to be involved in their care may fluctuate. [13]

Person

Persons must be considered in the performance of culturally competent care, as each individual has their own sense of self, [14] values, beliefs and ideas. Due to every person having their own distinct way of relating to their environment, forming social relationships and communicating with others in their community [4] and broader society. Individual's beliefs and values may impact upon how they wish to be treated.

The domains (inner circle)

Passing on cultural heritage. 'Grandfather tells a story' Anker Grossvater erzahlt eine Geschichte 1884 Anker Grossvater erzahlt eine Geschichte 1884.jpg
Passing on cultural heritage. 'Grandfather tells a story' Anker Grossvater erzählt eine Geschichte 1884

The twelve inner pieces of the model are cultural domains that are composed of concepts that should be focused upon when evaluating patients. Each of the twelve domains should not be viewed as separate or diverse entities, instead it should recognised that they can influence and inform each other [15] and hence should be viewed as unified parts of a whole.

Overview/heritage

This domain refers to concepts such as one's origin [5] that are vital in the aptitude of an individual in understanding both themselves and their patients.

Communication

This construct relates to the interactions an individual has been exposed to throughout their life and socialisation process, for example with family, peers and the wider community. It also conveys the importance of an individual's ability to provide verbal cues such as volume/tone [16] and non-verbal cues such as body language and eye contact. [17]

Family roles and organization

This domain refers to hierarchies and structures existent within families that may be dependent on gender or age, [18] which have the ability to influence not only family interactions but also the way in which an individual both communicates and acts.

Workforce issues

Pregnancy custom in China. Burying the placenta. "It was believed that placing the placenta in a pit in the doorway helped the child to become healthy, powerful, strong, wise and unafraid of strangers. " Burying the placenta, C16 Chinese painted book illustration Wellcome L0039985 Burying the placenta, C16 Chinese painted book illustration Wellcome L0039985.jpg
Pregnancy custom in China. Burying the placenta. "It was believed that placing the placenta in a pit in the doorway helped the child to become healthy, powerful, strong, wise and unafraid of strangers. " Burying the placenta, C16 Chinese painted book illustration Wellcome L0039985

Workforce issues denotes the way in which aspects present within a workplace such as language barriers, [5] may have an effect on an individual and their sense of being and belonging.

Biocultural ecology

The concept of biocultural ecology relates to disparities that exist between the diverse range of racial and cultural groups [5] such as biological variations, [20] which need to be considered to gain a greater understanding and appreciation for other cultures.

High-risk behaviours

High-risk behaviours like consumption of alcohol [16] are vital to consider as they exist within all cultures but the degrees to which they are used and subsequent impacts fluctuate.

Nutrition

Nutrition should be considered due to variations that exist between different cultures such as food intake and the values of certain foods. [21]

Pregnancy and childbearing

This concept is important for an individual to understand whilst providing culturally competent care due to the presence of diverse cultural beliefs about pregnancy. [22] There are also various practices and traditions that exist within ethnocultural groups [23] that need to be respected when providing care.

Death rituals

This domain is fundamental in the deliverance of culturally competent healthcare, as the care provider must recognise patients’ opinions towards death, and their customs towards occasions such as burial ceremonies. [5]

Spirituality

Spirituality is essential to consider in the acquisition of knowledge about others’ cultures and their practices, for example an individual's views and habits of prayer. [24]

Health care practices

This domain should be considered in the provision of culturally competent care, as practices like organ transplantation [22] require the comprehension of an individual's situation and necessity for care as well as cultural considerations.

Health care practitioner

This concept should be considered when providing an individual with care due to there being varying opinions and views that are existent among cultures, for example in relation to health care providers. [21]

Centre of model

The black circle featured in the centre of the diagram remains vacant to symbolise that which is still unknown. [5]

Pointed line

The line that is present under the circular figure is representative of the progressions and lapses, which occur to cultural proficiency, that are dependent on situations and occurrences [20] that individuals are confronted with.

Objectives

The Purnell Model for Cultural Competence seeks to accomplish multiple goals towards achieving cultural competence. The model was initially created with the objective of offering a guide in which healthcare professionals could use to aid them in acquiring knowledge about different cultures' ideas and features. The model has been proposed as an approach to help explain situations and occurrences that have the ability to influence the way individual's view culture universally in regards to historical viewpoints. [25] It is also intended to offer a way for social and ethnic data to be examined, through an outline that is representative of human attributes. The model is proposed as a basis for healthcare practitioners to understand patient's interactions and connections in relation to their cultural setting. The overall goal the model was created to attain is to enable the individuals providing care to do so in a way which is thoughtful and skilled, as to encourage consistency as a result of being aware of interdependent cultural features. [25]

Applications

Practice

The Purnell Model is intended for application in a range of settings/professions including: nursing, physiotherapy, sociology, social work, and in general medical practice. [4] Healthcare practitioners can employ the Purnell model in practice to aid in the provision of culturally competent care to patients. [26] The model can be applied to assist in the improvement and advancement of evaluation instruments, personalised healthcare plans and approaches to designing future strategies. [4] Purnell has noted himself, that the “Oncology Nurses Society” have utilised the framework to create their principles. [25]

Learning/teaching

The Purnell Model is implemented within nursing programs through the inclusion of cultural outlines and has also been utilised to aid in the gathering of facts and statistics. [4] It has additionally been observed that the framework is employed within undergraduate educational settings and to guide in teaching how to appropriately evaluate a patient's wellbeing. [27] The model is recognised within the coursework for a bachelor's degree in nursing as an outline that can be incorporated into numerous programs. [28]

Administration

The model has been implemented to assist with employee training in several countries. [29] Administrators in several multicultural workplaces apply the model to encourage and endorse both recognition and acceptance of all staff members, non-dependent on their cultural and ethnic backgrounds. [4] The concept of workforce issues from within the model can be applied in professional settings, to benefit workplace culture and to find a solution to any complications that arise.

Research

Multiple individuals completing requirements for their studies (e.g., Masters and Doctorate) have applied the model in order to maintain an ethical approach to gathering information and conducting research. [4]

Strengths

The Purnell Model facilitates the potential to acquire information directly relevant to various cultures due to consideration given to each patient's circumstances. [30] Flexibility has been recognised as a critical quality of the model, as it is able to improve the prospective pertinence, of the model, to a range of settings like nursing. [31] The importance of the model is also acknowledged due to its ability to represent multiple outlooks on the world; that assist when providing individuals with culturally competent care. [32] The model has additionally been recognised to incorporate suppositions that are coherent in relation to the model's foundations, as well as containing well-defined explanations of the domains. [28]

Angela Cooper Brathwaite, who has conducted assessments on a variety of cultural competence models, has stated that the model is “comprehensive in content, very abstract, has logical congruence, conceptual clarity, demonstrates clinical utility and espouses the experiential-phenomenological perspective”. [32] The utilisation of a systems theory model is considered to be a beneficial quality of the framework, as well as the non-sequential scale provided to attain cultural competence. [33] Purnell's model is also perceived to have precision and coherence in reference to the clarity of the structure and its comprehensibility for intended users. [34]

Limitations/weaknesses

The Purnell Model does not account for the results that the provision of culturally competent care achieves/fails to achieve, in relation to the patient and their health. [35] This limitation results in a lack of authentication as to whether or not the model is successful in terms of the conduct of the care provider, and the consequences for patients. [35] The model's visual complexity can be seen as a limitation, as it may result in a lack of comprehension and diminish the model's function/value and its applicability. [28] As the framework is methodological, [36] it is considered to be quite abstract, which could detract from the model's utility in practice settings. [37] There is also a conceivable limitation in the instance that the model's material could be simplified beyond practical confines, so that the information provided/directed at an individual could mistakenly be used for an entire populace. [38] The intersecting concepts employed within the model can also be seen as a flaw, as only the minimum as to which is required to justify the concept should be used. [28]

Notes

Related Research Articles

<span class="mw-page-title-main">Telenursing</span>

Telenursing refers to the use of information technology in the provision of nursing services whenever physical distance exists between patient and nurse, or between any number of nurses. As a field, it is part of telemedicine, and has many points of contacts with other medical and non-medical applications, such as telediagnosis, teleconsultation, and telemonitoring. The field, however, is still being developed as the information on telenursing isn't comprehensive enough.

Nursing theory is defined as "a creative and conscientious structuring of ideas that project a tentative, purposeful, and systematic view of phenomena". Through systematic inquiry, whether in nursing research or practice, nurses are able to develop knowledge relevant to improving the care of patients. Theory refers to "a coherent group of general propositions used as principles of explanation".

<span class="mw-page-title-main">Nurse practitioner</span> Mid-level medical provider

A nurse practitioner (NP) is an advanced practice registered nurse (APRN) and a type of mid-level practitioner. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, formulate and prescribe medications and treatment plans. NP training covers basic disease prevention, coordination of care, and health promotion. One study found that although reasons for referrals to specialists are similar for both physicians and NPs, the quality of documentation in the referrals may be lower for NPs.

Cultural competence, also known as intercultural competence, is a range of cognitive, affective, behavioural, and linguistic skills that lead to effective and appropriate communication with people of other cultures. Intercultural or cross-cultural education are terms used for the training to achieve cultural competence.

A clinical nurse specialist (CNS) is an advanced practice nurse who can provide advice related to specific conditions or treatment pathways. According to the International Council of Nurses (ICN), an Advanced Practice Nurse is a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. Clinical Nurse Specialists are registered nurses who have had graduate level nursing preparation at the master's or doctoral level as a CNS. They are clinical experts in evidence-based nursing practice within a specialty area, treating and managing the health concerns of patients and populations. The CNS specialty may be focused on individuals, populations, settings, type of care, type of problem, or diagnostic systems subspecialty. CNSs practice autonomously and integrate knowledge of disease and medical treatments into the assessment, diagnosis, and treatment of patients' illnesses. These nurses design, implement, and evaluate both patient–specific and population-based programs of care. CNSs provide leadership in the advanced practice of nursing to achieve quality and cost-effective patient outcomes as well as provide leadership of multidisciplinary groups in designing and implementing innovative alternative solutions that address system problems and/or patient care issues. In many jurisdictions, CNSs, as direct care providers, perform comprehensive health assessments, develop differential diagnoses, and may have prescriptive authority. Prescriptive authority allows them to provide pharmacologic and nonpharmacologic treatments and order diagnostic and laboratory tests in addressing and managing specialty health problems of patients and populations. CNSs serve as patient advocates, consultants, and researchers in various settings.

<span class="mw-page-title-main">Madeleine Leininger</span>

Madeleine Leininger was a nursing theorist, nursing professor and developer of the concept of transcultural nursing. First published in 1961, her contributions to nursing theory involve the discussion of what it is to care.

Transcultural nursing is how professional nursing interacts with the concept of culture. Based in anthropology and nursing, it is supported by nursing theory, research, and practice. It is a specific cognitive specialty in nursing that focuses on global cultures and comparative cultural caring, health, and nursing phenomena. It was established in 1955 as a formal area of inquiry and practice. It is a body of knowledge that assists in providing culturally appropriate nursing care.

<span class="mw-page-title-main">Nursing</span> Health care profession

Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses can be differentiated from other healthcare providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialties with differing levels of prescription authority. Nurses comprise the largest component of most healthcare environments; but there is evidence of international shortages of qualified nurses. Nurses collaborate with other healthcare providers such as physicians, nurse practitioners, physical therapists, and psychologists. There is a distinction between nurses and nurse practitioners; in the U.S., the latter are nurses with a graduate degree in advanced practice nursing, and are permitted to prescribe medications unlike the former. They practice independently in a variety of settings in more than half of the United States. Since the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.

Ambulatory care nursing is the nursing care of patients who receive treatment on an outpatient basis, ie they do not require admission to a hospital for an overnight stay. Ambulatory care includes those clinical, organizational and professional activities engaged in by registered nurses with and for individuals, groups, and populations who seek assistance with improving health and/or seek care for health-related problems. The American Academy of Ambulatory Care Nursing (AAACN) describes ambulatory care nursing as a comprehensive practice which is built on a broad knowledge base of nursing and health sciences, and applies clinical expertise rooted in the nursing process.

Workplace safety in healthcare settings is similar to the workplace safety concerns in most occupations, but there are some unique risk factors, such as chemical exposures, and the distribution of injuries is somewhat different from the average of all occupations. Injuries to workers in healthcare settings usually involve overexertion or falling, such as strained muscles from lifting a patient or slipping on a wet floor. There is a higher than average risk of violence from other people, and a lower than average risk of transportation-related injuries.

<span class="mw-page-title-main">Cultural sensitivity</span> Knowledge, awareness, and acceptance of other cultures

Cultural sensitivity, also referred to as cross-cultural sensitivity or cultural awareness, is the knowledge, awareness, and acceptance of other cultures and others' cultural identities. It is related to cultural competence, and is sometimes regarded as the precursor to the achievement of cultural competence, but is a more commonly used term. On the individual level, cultural sensitivity is a state of mind regarding interactions with those different from oneself. Cultural sensitivity enables travelers, workers, and others to successfully navigate interactions with a culture other than their own.

Clinical peer review, also known as medical peer review is the process by which health care professionals, including those in nursing and pharmacy, evaluate each other's clinical performance. A discipline-specific process may be referenced accordingly.

The Clinical Care Classification (CCC) System is a standardized, coded nursing terminology that identifies the discrete elements of nursing practice. The CCC provides a unique framework and coding structure. Used for documenting the plan of care; following the nursing process in all health care settings.

<span class="mw-page-title-main">Holistic nursing</span> Medical care practice

Holistic nursing is a way of treating and taking care of the patient as a whole body, which involves physical, social, environmental, psychological, cultural and religious factors. There are many theories that support the importance of nurses approaching the patient holistically and education on this is there to support the goal of holistic nursing. The important skill to be used in holistic nursing would be communicating skills with patients and other practitioners. This emphasizes that patients being treated would be treated not only in their body but also their mind and spirit.. Holistic nursing is a nursing speciality concerning the integration of one's mind, body, and spirit with his or her environment. This speciality has a theoretical basis in a few grand nursing theories, most notably the science of unitary human beings, as published by Martha E. Rogers in An Introduction to the Theoretical Basis of Nursing, and the mid-range theory Empowered Holistic Nursing Education, as published by Dr. Katie Love. Holistic nursing has gained recognition by the American Nurses Association (ANA) as a nursing specialty with a defined scope of practice and standards. Holistic nursing focuses on the mind, body, and spirit working together as a whole and how spiritual awareness in nursing can help heal illness. Holistic medicine focuses on maintaining optimum well-being and preventing rather than just treating disease.

Genetics nursing is a nursing specialty that focuses on providing genetic healthcare to patients.

<span class="mw-page-title-main">Cultural competence in healthcare</span> Health care services that are sensitive and responsive to the needs of diverse cultures

Cultural competence in healthcare refers to the ability for healthcare professionals to demonstrate cultural competence toward patients with diverse values, beliefs, and feelings. This process includes consideration of the individual social, cultural, and psychological needs of patients for effective cross-cultural communication with their health care providers. The goal of cultural competence in health care is to reduce health disparities and to provide optimal care to patients regardless of their race, gender, ethnic background, native languages spoken, and religious or cultural beliefs. Cultural competency training is important in health care fields where human interaction is common, including medicine, nursing, allied health, mental health, social work, pharmacy, oral health, and public health fields.

An acute care nurse practitioner (ACNP) is a registered nurse who has completed an accredited graduate-level educational program that prepares them as a nurse practitioner. This program includes supervised clinical practice to acquire advanced knowledge, skills, and abilities. This education and training qualifies them to independently: (1) perform comprehensive health assessments; (2) order and interpret the full spectrum of diagnostic tests and procedures; (3) use a differential diagnosis to reach a medical diagnosis; and (4) order, provide, and evaluate the outcomes of interventions. The purpose of the ACNP is to provide advanced nursing care across the continuum of health care services to meet the specialized physiologic and psychological needs of patients with acute, critical, and/or complex chronic health conditions. This care is continuous and comprehensive and may be provided in any setting where the patient may be found. The ACNP is a licensed independent practitioner and may autonomously provide care. Whenever appropriate, the ACNP considers formal consultation and/or collaboration involving patients, caregivers, nurses, physicians, and other members of the interprofessional team.

The role of spirituality in health care has received significant research attention due to its benefits for patients and health care professionals. Integrating spirituality in healthcare can enhance healthcare professionals' ability to communicate effectively with patients and families. It can also have a positive impact on the health and well-being of patients due to its potential to enhance patients' ability to cope with illness and achieve better physical and mental health outcomes. As per 2014, more than 70 medical schools in the United States offer courses on spirituality and medicine. The Association of American Medical Colleges has co-sponsored, with the National Institute for Healthcare Research, four conferences, on curricular development in spirituality and medicine since 1997.

Creative Health Care Management (CHCM) is a private U.S. corporation, which provides consultation and training in the health care sector. CHCM is based in Bloomington, Minnesota. Founded in 1982 by Marie Manthey, it was originally called Creative Nursing Management. The name change to CHCM was in recognition of the systemic nature of change.

A nurse scientist is a registered nurse with advanced education and expertise in nursing research. These professionals play a critical role in advancing nursing knowledge, improving patient care, and shaping the future of the nursing profession. Highly educated and specialized, nurse scientists conduct research to generate new knowledge about nursing care, employing a deep understanding of nursing theory, research methodologies, and clinical practice. Nurse scientists are essential contributors to the development of new nursing interventions and practices. Their skills extend beyond academic settings and these advanced nurses work in hospitals, research institutes, and community organizations. Through their efforts, nurse scientists have a profound impact on the quality of healthcare, contributing significantly to the improvement of patient care and the overall advancement of the nursing profession. They possess advanced qualifications, typically holding a Ph.D. in nursing or a related field, demonstrating expertise not only in research principles and methodology but also in-depth content knowledge within a specific clinical area. The primary focus of the role is to provide leadership in the development, coordination and management of clinical research studies; provide mentorship for nurses in research; lead evaluation activities that improve outcomes for patients participating in research studies; contribute to the overall health sciences literature. Nurse scientists have been regarded as knowledge brokers. They participate in nursing research.

References

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.