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.
History and description The Purnell Model for Cultural Competence was developed by Larry D. Purnell and Betty J. Paulanka, as an outline to classify and arrange elements that have an effect on the culture of an individual. The framework uses an ethnographic method to encourage cultural awareness and appreciation in relation to healthcare. It offers a basis for individuals providing care to gain knowledge around concepts and features that relate to various cultures 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 and in “primary, secondary and tertiary” environments. Cultural competence has been described as a process, which is constantly occurring and through which one slowly advances from lacking knowledge to developing it. An individual begins as unconsciously unskilled 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 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, 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 and care.
The Purnell Model
Purnell and Paulanka proposed this model including four circles of varying sizes that are representative of the metaparadigms that are applied to nursing, as well as a twelve-part inner circle that illustrates the various “cultural domains”.
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. The outermost (first) circle is used to represent the global society, 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 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 as influencing forces on the global society can impact not only the civilisation, but also an individual's world outlook.
Community
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.
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.
Person Persons must be considered in the performance of culturally competent care, as each individual has their own sense of self, 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 and broader society. Individual's beliefs and values may impact upon how they wish to be treated.
The domains (inner circle)
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 and hence should be viewed as unified parts of a whole.
Overview/heritage This domain refers to concepts such as one's origin 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 and non-verbal cues such as body language and eye contact.
Family roles and organization This domain refers to hierarchies and structures existent within families that may be dependent on gender or age, which have the ability to influence not only family interactions but also the way in which an individual both communicates and acts.
Workforce issues
Workforce issues denotes the way in which aspects present within a workplace such as language barriers, may have an effect on an individual and their sense of being and belonging.
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