​The Purnell Model for Cultural Competence

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Purnell Model for Cultural Competence

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Larry Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Purnell Model: Assumptions ▪ All healthcare professions need much of the same information about cultural diversity and share the metaparadigm concepts of global society, community, family, person, and health. ▪ One culture is not better than another culture; they are just different. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Purnell Model: Assumptions ▪ There are core similarities shared by all cultures. ▪ There are differences within, between, and among cultures. ▪ Cultures change over time, but slowly. ▪ Culture has powerful influences on one’s interpretations and responses to health care. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Purnell Model: Assumptions ▪ If clients are co-participants in care and have a choice in health-related goals, plans, and interventions, health outcomes will be improved. ▪ Variant cultural characteristics determine the degree to which people vary from their dominant culture beliefs, values, and practices. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Purnell Model: Assumptions ▪ Individuals and families belong to several cultural groups, usually known as subcultures. ▪ Each individual has the right to be respected for his or her unique differences and cultural heritage. ▪ Caregivers who can assess, plan, and intervene in a culturally competent manner will improve the care of clients for whom they care. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Purnell Model: Assumptions ▪ Caregivers know themselves better by learning about their own cultures. ▪ Professions, organizations, and associations have their own cultures. ▪ Healthcare teams can benefit from a Model and Organizing Framework that is useable by all healthcare disciplines. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Variant Cultural Characteristics ▪ ▪ ▪ ▪ ▪ ▪ Nationality Race Color Gender Age Religious affiliation Copyright © 2013 F.A. Davis Company ▪ ▪ ▪ ▪ ▪ ▪ Educational status Socioeconomic status Occupation Military experience Political beliefs Urban versus rural residence Transcultural Health Care: A Culturally Competent Approach, 4th Edition Variant Cultural Characteristics ▪ ▪ ▪ ▪ ▪ Marital status Parental status Physical characteristics Sexual orientation Gender issues Copyright © 2013 F.A. Davis Company ▪ Length of time away from the home country ▪ Reason for immigration— sojourner, immigrant, undocumented status Transcultural Health Care: A Culturally Competent Approach, 4th Edition Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Metaparadigm Concept: Global Society ▪ Seeing the world as one large community of multicultural people ▪ Evidence of global society ▪ What happens in other parts of the world affects each community Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck What determines a person’s adherence with his/her dominant culture? a. Metaparadigm concepts b. Variant characteristics c. Global society d. Cultural worldview Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: B Variant cultural characteristics determine the degree to which a person adheres to his/her dominant cultural beliefs and practices. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Metaparadigm concept: Community ▪ A group or class of people having a common interest or identity living in a specified locality but can be an online community as well now ▪ What happens in the community has an effect on the family. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Metaparadigm concept: Family ▪ Two or more people who are emotionally involved with each other ▪ They may, but not necessarily, live in close proximity to each other. ▪ What affects the individual, affects the person. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Metaparadigm concept: Person ▪ A human being, one who is constantly adapting to his or her environment biologically, physically, socially, or psychologically ▪ Person is defined differently in other cultures. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Domain: Overview/Heritage ▪ ▪ ▪ ▪ ▪ ▪ ▪ Origins Residence Topography Economics Politics Education Occupation Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Domain: Communication ▪ ▪ ▪ ▪ ▪ ▪ ▪ Dominant language and dialects Contextual use of the language Paralanguage—volume and tone Temporality—time—and spatial distancing Use of touch Eye contact and facial expressions Greetings and name format Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Domain: Family Organization ▪ ▪ ▪ ▪ ▪ ▪ ▪ Head of household Gender roles Goals and priorities Developmental tasks Roles of the aged and extended family Social status Alternative lifestyles Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Domain: Workforce Issues ▪ Acculturation ▪ Autonomy ▪ Language barriers Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Domain: Biocultural Ecology ▪ ▪ ▪ ▪ ▪ ▪ Biological variations Skin color Heredity Genetics Endemics Drug metabolism Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Domain: High-Risk Behaviors ▪ ▪ ▪ ▪ ▪ ▪ Tobacco Alcohol Recreational drugs Physical activity Safety Sexual behavior Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Domain: Nutrition ▪ ▪ ▪ ▪ ▪ ▪ Meaning of food Common foods Rituals Deficiencies Limitations Health promotion Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Domain: Pregnancy and Childbearing ▪ ▪ ▪ ▪ ▪ ▪ Fertility practices Views toward pregnancy Pregnancy beliefs Birthing practices Postpartum Prescriptive, restrictive, and taboo practices Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Domain: Death and Dying ▪ Death rituals during the dying process ▪ Post mortem practices ▪ Bereavement Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Domain: Spirituality ▪ ▪ ▪ ▪ ▪ Religious practices Use of prayer Meaning of life Individual strength Spirituality and health Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck Contextual aspect of cultural communication includes a. Dominant language b. Dialects c. Explicit versus implicit communication d. Translation versus interpretation Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: C Contextual use of a language is concerned with the number of words used to express a thought. Highcontexted communication uses fewer words to express a thought. Low-contexted communication uses a lot of words to express a thought Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Domain: Health-care Practices ▪ ▪ ▪ ▪ ▪ Focus of health care Traditional practices Magicoreligious beliefs Responsibility for health Self-medication practices Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Domain: Health-care Practices ▪ ▪ ▪ ▪ ▪ ▪ ▪ Responses to pain Sick role Mental health Rehabilitation Chronicity Blood transfusion Transplantation Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Domain: Health-care Practitioners ▪ ▪ ▪ ▪ Perceptions of practitioners Folk practitioners Gender and health care Status of healthcare providers Copyright © 2013 F.A. Davis Company
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