1. Purnell’s Model for Cultural Competence
Circular Model including the following macroaspects:
Global, Community, Family, Person and Conscious Competence

2. 12 Inner aspects of the model:
Overview, topography
Communication
Family Organization
Workforce Issues
Biocultural Ecology
High-risk health behaviors
Nutrition
Pregnancy
Death Rituals
Spirituality
Health-care practices
Health-care practitioners

3. Overview, Topography, Inhabited Localities
General overview
Heritage and Residence
Migration reasons, Economic factors
Educational Status, Occupations
(Refer to Table 2-1, p. 20)
Important to know the location of the person’s country of origin. This helps with history, information about political climate, economics, .....
1. Heritage and Residence=What country did they immigrate from? Do they now reside in an area with others from their culture? (see pp )
2. Reasons for migration and assoc. economic factors-Why did they come to the U. S.? What brought the Irish here? {Potatoe famine}
What brought the Jews here? {Political and religious persecution}
What about the Cubans? {personal ideologies/oppression}
3. What value do they place on formal education? What is the primary learning styles? (theory or application)
Occupations- Did they bring a skill/trade with them? Is there skill something that you need to be aware of for health screening issues? (ie-worked in mining in Poland or Ireland and need assessed for respiratory disease)

4. Communication Dominant Language and Dialects
Cultural Communication patterns
Temporal Relationships
Format for Names
(Refer to Table 2-2, p. 24)
Important to be aware of verbal and nonverbal communication characteristics of that culture.
1. Dominant language/dialects- be aware of various dialects within a culture. If you have limited knowledge of a language, seek out a skill interpreter if possible. One wrong verb tense can cause numerous problems.
==> list of 15 items when speaking to persons who do not speak English
(pp )
Be careful to watch your voice tone, volume, quickness in speech.....
2. Cultural Comm. Patterns- Is this a culture who is not very open to sharing their thoughts and feelings? Use of Touch, Personal Space, Eye Contact, Facial Expressions, Greeting someone, and Waving to them.
3. Temporal Relationships-Past, Present, or Future Oriented
Future-oriented group- saves $ to buy prescription meds later.
Present-oriented-buys a nonessential item because it’s available and defers buying their prescription meds.
Punctuality==>
4. Format for names-Many cultures have their own unique format.

5. Family Roles and Organization
Gender Roles, Head of Household
Prescriptive, Restrictive, and Taboo Behaviors
Family Roles, Priorities
Alternative Lifestyles
(Refer to Table 2-3, p. 27)
1. Gender roles/head of household- who is the perceived head of the household? How do gender roles differ between men and women in that culture?
2. Prescriptive beliefs=things children should do for family harmony
Restrictive beliefs=things children should not do
Taboo beliefs=things that are likely to cause a neg. outcome
3. Family goals/priorities- How important are children in this culture? What about the elderly of this culture? Parental roles?
4. Alternative lifestyles=Who lives in the household? Are parents divorced, never married? What about homosexual relationships?

6. Workforce Issues Culture in the workplace Autonomy Issues
(see Table 2-4, p. 29)
Workforce issues are affected by various aspects such as:
Education level
Gender issues
Language barriers
Degree of assimilation
1. Issues related to professional autonomy, religious issues,…
Polish nurses and Pakistani nurses may have a difficult time with the idea of autonomy in U.S. nurses experience.
Possibly Asian nurses may not be as assertive with American doctors as their American counterparts.
Some difficulties arise when several nurses from the same country speak in their native language while at work. American nurses may take offense however, it is important to realize that this might be the best way for them to express their feelings and ideas among one another.

7. Biocultural Ecology Skin color, biologic variations
Diseases/health conditions
Drug metabolism variations
(see Table 2-5, p. 30)
Biological
1. What are the expected skin tones and physical variations for this cultural group?
2. How will the health care provider adequately assess someone with a different skin tone than themselves?
3. Is the HC provider knowledgeable to biological variations within this cultural group?
Diseases
4. What specific risk factors are present based on the person’s country of origin?
5. Any endemic diseases or increased risk for certain diseases or conditions?
Drug metabolism
6. Variations in drug metabolism?

8. High-risk behaviors High-risk behaviors Health care practices
(see Table 2-6, p. 31)
What high risk behaviors are common to this cultural/religious group?
High-risk
(alcohol, tobacco use, recreational drugs)
Health care Practices
1. How do they typically seek health care?
2. Level of Physical activity?
3. Use of safety measures (lack of seat belt use, motorcycle helmets)

9. Nutrition Meaning of food Common foods/food rituals
Dietary practices related to health promotion
Nutritional deficiencies/food limitations
(see Table 2-7, p. 33)
Meaning of food:
What meaning does food have in that group? (is it used to promote healing, show closeness, kinship, or simply used to relieve hunger--thus survival)
Common foods:
Identify foods, major ingredients
Food rituals--afternoon tea, morning coffee breaks
Diet and Health promotion
What is used to treat illness or promote health?
Nutr. Deficiencies
Food intolerances/ nutritional deficiencies
Native food limitations which cause difficulties

10. Pregnancy/Childbearing
Fertility practices/views of pregnancy
Prescriptive, restrictive and taboo practices during pregnancy
(see Table 2-8, p. 35)
Lots of fertility practices exist in various cultures.
In North America, we use birth control pills, foams, Norplant, IUDs,….
Prescriptive beliefs- Polish-Americans--> expected to eat well, rest, and seek preventative care.
Restrictive--Navajo--> must not purchase clothes for infant before birth
Taboo- in some African-American communities-cannot reach overhead during pregnancy or cord may be around baby’s neck at birth.

11. Death Rituals Death rituals/expectations Responses to death and grief
(see Table 2-9, p. 37)
Death Rituals and Expectations
1. Identify culturally specific death rituals and expectations
2. Explain the purpose of death rituals and mourning practices.
3. What are specific burial practices, such as cremation?
Responses to Death and Grief
4. Identify cultural expectations of responses to death and grief.
5. Explore the meaning of death, dying, and the afterlife.

12. Spirituality Dominant religion/use of prayer
Meaning of life/individual sources of strength
Spiritual beliefs and health care practices
(see Table 2-10, p. 38)
Religious Practices and Use of Prayer
1. Identify the influence of the dominant religion of this group on health-care practices.
2. Explore the use of prayer, meditation, and other activities or symbols that help individuals reach fulfillment.
Meaning of Life and Individual Sources of Strength
3. Explore what gives meaning to life for individuals.
4. Identify the individual’s sources of strength.
Spiritual Beliefs and Health-care Practices
5. Explore the relationship between spiritual beliefs and health practices.
(free choice, purpose of life, self-esteem)

13. Health-care practices
Health seeking behaviors/beliefs
Responsibility for health care
Folk practices
Barriers to health care
Cultural responses to health/illness
Blood transfusion/organ donation beliefs
(see Table 2-11, p. 42)
A. 1 Identify predominant beliefs that influence health-care practices.
2. Describe the influences of health promotion and prevention practices
B. 3. Describe the focus of acute-care practice (curative or fatalistic).
4. Explore who assumes responsibility for health care in this culture.
5. Describe the role of health insurance in this culture.
6. Explore behaviors associated with the use of over-the-counter medications.
C. 7 Explore combinations of magicoreligious beliefs, folklore, and traditional beliefs that influence health-care behaviors.
D. 8.Identify barriers to health care such as language, economics, and geography for this group.
E. 9. Explore cultural beliefs and responses to pain that influence interventions. Does pain have a special meaning?
10. Describe beliefs and views about mental illness in this culture.
11. Differentiate between the perceptions on mentally and physically handicapped in this culture.
12. Describe cultureal beliefs and practices related to chronicity and rehabilitation.
13. Identify cultural perceptions of the sick role in this group
F. 14. Describe the acceptance of blood transfusions, organ donation and organ transplantation among this group.

14. Health-care Providers
Traditional versus Biomedical care
Status of health-care providers
(see Box 2-12, p. 44)
A. 1. Explore the roles of traditional, folklore, and magicoreligious practitioners and their influence on health practitioners.
2. Describe the acceptance of healthcare practitioners in providing care to each gender. Does the age of the practitioner make a difference?
B. 3. Explore perceptions of healthcare practitioners with this group.
4. Identify the status of health=care providers in this society.
5. Describe how different health-care practitioners view each other.

15. That’s it!!