Diversity in healthcare

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Purnell Model for Cultural Competence

The Purnell model for cultural competence is an organizationframework that is aimed at assisting the healthcare givers to providecare that is culturally sensitive. The model asserts that thecaregiver must provide care that is in line with the culture of thepatient. Additionally, it is clear from the model that the caregivermust be aware of his thoughts and sensations, as well as hisenvironment and should ensure that this does not interfere with hisprocess of providing a culturally sensitive care to his patients(Purnell, 2013). The model is based on various assumptions and theseare as a result of various theories and studies. The model assumesthat the caregiver must have specific and general culturalinformation regarding the patient in order to provide quality andculturally sensitive care. The model continues to assert that thepatients must be given a choice in determining the form of care theyshould receive that is in line with their culture. It is also evidentfrom research that the model assumes that all cultures have somethingin common and they are not different but only have variations.

The other assumption of the mode is that each and every person’sculture should be respected and that a patient’s culture plays asignificant role in the he or she interprets the care he receives.The model calls on nurses to provide culturally sensitive care asthis would ensure that the care provided is of high quality. This isa model that is demonstrated by the use of a circle with variouslayers and an empty space at the center. The four outer rimsrepresent the global society, the community, family and the person(Purnell, 2013). The inner part is divided into the 12 domains andtheir concepts. The empty part at the center of the circle representsthe aspects that are not known about the cultural group. The modelhas cited different primary and secondary characteristics of aculture. The primary characteristics constitute the race,nationality, gender, age and religious beliefs (Flecky &amp Gitlow,2011). On the other hand, the secondary characteristics constitutethe socio-economic status, occupation, political status, educationstatus and sexual orientation, as well as political affiliations.

The model provides a framework that can be used by nurses andhealthcare givers in a diverse society or in a transcultural setting(Purnell, 2013). As it has been stated above, the model calls for therespect of all cultures and for the provision of care that isculturally sensitive. The model also calls for teamwork amongst theemployees in the health sector to ensure that they provide qualitycare regardless of the cultural background of the patient.

12 domains and their concepts

The inner part of the circle constitutes the 12 domains with theirconcepts explained. The domains are as follows:

Overview or the heritage that is said to be associated with aspectssuch as the country of origin, education status, occupation and thereasons for immigration. The second domain is the communication is acritical domain as it relates to aspects of language and dialect, aswell as body language. This domain also constitutes aspects such aseye contact, acceptable greetings and variations in tone and volume(Purnell, 2013). Thirdly there is the family roles and organizationdomain which constitutes elements such as family head, child rearingpractices and the views related to lifestyles such as sexualorientation. The other domain is the workforce issues which mayconstitute elements such as assimilation, ethnic style ofcommunication and form of healthcare in the country of origin(Purnell, 2013).

The other domain in the circle is the bio-cultural ecology whichcomprises of aspects such as difference in skin color and otherdifferences such as hereditary and genetic diseases. High riskbehaviors such as engagement in unprotected sex and the use drugs isother domain the in model. Deficiency of physical activity and theuse alcohol and tobacco also fall under this domain of high riskbehaviors. Another key domain in the model is nutrition. This domainrelates to concepts such as food intake while sick, food rituals andtaboos, as well as food preferences (Purnell, 2013). The other domainis the Pregnancy and child rearing practices which relates toconcepts associated with child bearing process. This domain alsoconstitutes aspects associated with views on birth control methods(Purnell, 2013). The domain of spirituality involves the use ofprayer as a form of strength for the patient. It is essential for thenurse to be aware of this domain since almost every patient will havehis or her own spirituality needs.

The health care practice is the other domain which comprises of theconcept of views on traditional medicine versus the modern forms oftreatment. The responsibility of the individual on his or her owncare also falls under this category (Flecky &amp Gitlow, 2011). Thelast domain that is postulated in the model is the health carepractitioner which is the concept of the views of the care giver aswell as his or her gender.

Application of the model

This model has been used for many years and it has proved to beeffective. This is a model that can be applied in a multi-culturalsociety as it ensures that the caregiver is culturally sensitive(Rose, 2013). The model calls for teamwork in ensuring that thepatients are provided with care that is sensitive to their culturalneeds. Since the model clearly stipulates the 12 domains, it isextremely easy for the caregiver to provide a culturally sensitiveform of care. The caregiver must appreciate and respect the cultureof all the patients and involve the patients in the choices of theform of care they receive (Purnell, 2013). This would ensure that thepatients are responding well to the treatment they are receiving.Caregivers must ensure that they understand the culture of thepatients before embarking on providing care. This would ensure thatthey provide care that sensitive to the cultural needs of thepatients.


Purnell, L. D. (2013).&nbspTranscultural health care: Aculturally competent approach. Philadelphia: F.A. Davis.

Rose, P. R. (2013).&nbspCultural competency for the healthprofessional. Burlington, MA: Jones &amp Bartlett Learning.

Flecky, K., &amp Gitlow, L. (2011).&nbspService-learning inoccupational therapy education: Philosophy andpractice. Sudbury, Mass: Jones and Bartlett Publishers.

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