Purnells model

CULTURAL COMPETENCY

1. PURNELLS’ MODEL ON CULTURAL COMPETENCY

2. GLOBAL SOCIETY

3. COMMUNITY

4. FAMILY

5. PERSON

6. 12 Inner aspects of the model: Overview/Heritage Communication Family Organization Workforce Issues Biocultural Ecology High-risk health behaviors Nutrition Pregnancy Death Rituals Spirituality Health-care practices Health-care practitioners

7. OVERVIEW/HERITAGE Country of Origin Current Residence The effects of the Topography of country of origin and current residence on health Economics Politics Reasons for Migration Education Status Occupations

8. Dominant Language Dialects Contextual use Volume/Tone Spatial Distancing Eye Contact Facial Expressions Greetings Temporality Time Name Touch

9. FAMILY ROLES and ORGANIZATIONS The head of the household Gender roles Family goals and priorities Developmental tasks of children and adolescents Roles of ages Roles of extended family members Individual and social status in the community Acceptance of alternative lifestyle

10. WORKFORCE ISSUES Autonomy Acculturation Assimilation Gender roles Ethnic communication style Individualism Health care practices from the country of origin

11. BIOCULTURAL ECOLOGY Skin color Body type Disease that are genetic, heredity, topographic, or endemic How the culture metabolizes drugs

12. HIGH-RISK BEHAVIOR Drug use Alcohol use Nicotine use Dangerous behaviors Use of safety equipment's Degree of sedentary lifestyle Consumption of unhealthy food

13. NUTRITION Availability of food Rituals and taboos associated with food The meaning of food to the culture How food is used in sickness and in health

14. PREGNANCY and CHILDBEARING PRACTICES Fertility practices Labor and delivery practices Practices that are considered taboo, prescriptive or restrictive during pregnancy Labor and postpartum

15. DEATH RITUALS How death is viewed Preparation for death Burial practices Bereavement practices

16. SPIRITUALITY Practices that gives strength and meaning of life Religious practices How prayer is used

17. HEALTH CARE PRACTICES Does the culture seek preventative or acute treatment? Magicoreligious and healthcare beliefs Traditional practices Individual responsibility for health Self medicating practices Views towards issues such as: Organ donations Mental illness Rehabilitation How pain is expressed The sick role Barriers to health care

18. HEALTH CARE PRACTITIONERS Type of practitioners the culture uses Traditional or Folk Biomedical Does gender of the practitioner comes in to play

19. CONCEPTS OF CULTURAL CONSCIOUSNESS Unconsciously incompetent Consciously incompetent Unconsciously competent Consciously competent

20. All healthcare disciplines require the same information regarding cultural diversity. All healthcare disciplines make use of the same meta-paradigm concepts of health, person, family, community and the global society. There is no culture that is better than the other; instead, they are merely different. There are core similarities across all cultures. There are differences within, between and among cultures. Cultures are subject to change gradually in a society that is stable; The following are the major assumptions of the Purnell’s model for cultural competence:

21. The level to which a culture differs from the dominant culture is determined by the secondary and primary characteristics of culture. If patients are co-participants in health care and are given the choice in selecting health-related interventions, plans and goals, then, there will be an improvement in health outcomes. Culture exerts a significant impact on a person’s interpretation of healthcare and how he/she responds to care. Families and individuals fit in numerous cultural groups. Each person deserves to be respected for his/her cultural heritage and uniqueness. Caregivers require both specific and general cultural information in order to offer care that is both culturally competent and sensitive.

22. Assessments, plans and interventions that are culturally competent tend to improve patients’ care. Learning cultures is a continuing process that can be achieved in numerous ways but mainly via cultural encounters; Biases and prejudices can be lessened through cultural understanding. Effectiveness of care can be improved through reflecting on distinctive understanding of the life ways, beliefs, and values of individual acculturation patterns and diverse populations. Cultural and racial differences need the adaptations of the standard interventions. Cultural awareness tends to improve the self-awareness of the caregiver. Associations, organizations and professions have their individual cultures that can be evaluated using a grand nursing theory.

23. In this regard, a health care provider who is culturally competent tends to be aware of his/her thoughts, existence, environment and sensations and does not let these factors influence the patient receiving care. Cultural competence entails adapting care in a way that it is consistent with the patients, culture.

24. The purnell’s model for cultural competence originated out of education and practice The 12 domains comprising the organizing framework are briefly described along with the primary and secondary characteristic of culture, which determines variations in values, belief and practices of an individual’s cultural heritage. All healthcare providers in any practice setting can use the model, which make it especially desirable in today’s team-oriented healthcare environment. The model has been used by nurses, physician and occupational therapist in practice, education, administration and research in Australia, Belgium, Canada, Central America, Great Britain, Spanish. Although the model is 4 years old, it shows promise for becoming a major contribution to transcultural nursing and healthcare.

25. When I am making my report on this model, I can say that it really fit me even if I am in the school setting. > As a School Nurse I deal with 1300 students , who came from different tribe. When there are accidents that happen. I always observe the student and as to what tribe does he/she belong, because my next step depends as to what tribe they belong. In the province where I work you must be aware of the cultural practices of each club. When a student is wounded and blood is seen, Anticipate that sometimes conflict can arise. I also talk to them using the dialect that they are using because sometimes they are not comfortable talking to their teachers even me as their school nurse. Some students who enter the clinic and seek for help, when I asked them if they informed their parents just take their silence and sometimes make an alibi. Some of the students especially those who came from the barrio doesn’t go at the hospital for check-up because they lack the money needed.

26. Sometimes I always hear from them that they go to a “quack Doctor” and have a hilot . The province have a lot of cultural practices that can hardly remove, everything was still strong, as a nurse its really hard to enter into situation when conflict has already arises. Sometimes accidents are normal because high school students especially grade 7 are playful. Sometimes they are not aware that they are already hurting each other. Some parents are not open-minded. In my area, this theory help me to be more sensitive, especially in the future. I can understand my patients easily and communicate even in a simple gestures. Not every patients express their emotions or talk to us abruptly, some of them just shut their mouth and look at us. This model alone when used properly is a great help. The cultural practices of a certain country or of a person can be a big help to professionals, because by knowing it, even if you will not ask more detail sometimes the records answers our questions.

27. References for this presentation were mostly internet base.