Purnell Model of Cultural Competence was established in 1991 as an organizing framework after the author who was teaching undergraduate students realized the need for the students and staff to have a framework of learning about their cultures and the cultures of their patients and families. Comments that were raised by the staff and students made it clear that ethnocentric behavior and lack of cultural awareness, cultural sensitivity, and cultural competence existed.
The Model is designed as a wholistic organizing framework to assess culture that could be used across multidiscipline and practice settings in health care. The model further provides an elaborate structure of culture and its concepts that include cultural competence purpose, underlying assumptions, and the degree to which people adhere to their dominant culture. Purnell Model is documented for developing cultural competence.
Cultural Areas that Affect Nursing Care of a Patient
A vexing question, “How can a nurse deliver culturally competent care where the patient’s health care practices and beliefs are in conflict with nursing practices?” After an interview with a patient, the following areas that affect nursing care were elucidated:
Effective nursing care requires a smooth nurse and patient communication. Pragmatics, dialects, voice and tone variations affect the nursing care. Non-verbal communications, for instance, facial expressions and body language are important issues that underlie the nursing the nurse-patient relationship. In situations where discrepancies exist, there is a communication breakdown resulting to ineffective nursing care.
People’s behavior and practices are largely dependent on culture. For instance, individual beliefs on pregnancy, childbearing, and methods for birth control shape people’s thinking. Besides, views on death, rituals and behaviors exhibited when one is sick are crucial domains in nursing care. Discrepancies in these beliefs between the nursing care provider and patient create a gap that impacts negatively on competent nursing care.
Individual religious practices dictate attitude towards Supreme Being. A patient’s religious position determines his/her attitude towards nursing care. In the situation where there are differences between the religious beliefs and practices between the nursing care provider and patient, a religious conflict exists. This difference creates mistrust between the two parties thus impairing a competent health care atmosphere.
The literacy level of the patient shapes understanding on the relationship between nurse and client. Informed patients cultivate healthy relationships thus promoting nursing care. Similarly, environmental concerns and the socio-economic status of the patient determine the relationship between the patient and the nurse. Healthy relationship promotes nursing care practices.
Healthcare practices involve traditional beliefs, individual responsibility towards healthcare, and personal perspectives on mental sickness that have an influence on healthcare. Similarly, views on health and causes of sickness such as germ theory and curse affect nursing care. In situations where patients view causes of sickness to be traditional as opposed to the nurse’s scientific approach, a discrepancy exists. This gap hinders the nurse from properly executing services thus negatively affecting nursing care.
Changes in Nursing Care Needed to give Culturally Competent Care
The concept involves carrying out an individual analysis and an in-depth study of individual cultural background. It includes recognition of individual biases, assumptions, and prejudices about people coming from other backgrounds. If the nurse is unaware of individual influence cultural values, a risk of engaging in cultural imposition exists that involves imposing individual values, beliefs and behavior patterns on other cultures. For instance, when caring for patients with disabilities, the nurse should analyze individual beliefs and biases towards this culturally diverse group.
Disability rights advocates allege that nurses make erroneous assumptions and fail to comprehend perspectives of physically challenged persons. Many nurses have been alleged of practicing based on illness-based models of disability. They are further accused of being unaware of mind shift towards disability as a challenge existing in the environment rather than in individuals. A healthy interaction with the physically challenged starts with individual recognition of attitudes on disability and further encouraging the nurses to reflect on the question: “Do my actions promote devaluation, stigma, and bias individuals with disabilities?”
In addition, conducting an assessment of client’s physical, psychological, and cultural attributes and using the assessment data for planning and prioritizing of nursing care is another change needed in nursing care to promote culturally competent care.
A healthy therapeutic nurse-client relationship is based on effective communication between the nurse and client. If communication barriers exist, the nurse is responsible for developing a communication plan in the bid to make the client an informed partner in the provision of care. The communication plan can involve both verbal and non-verbal approaches. The nurse can consider working with interpreters. An open and sensitive nurse-client relationship communication promotes trust. Further, an active listening and respect for client’s cultural beliefs and practices are changes needed to give culturally competent care.
Establishing mutual goals
Creativity and commitment that is client-focused is also another change in nursing care needed to give culturally competent care. Negotiating and implementing culturally congruent care and further evaluating health outcomes in order to integrate cultural preferences will be a milestone change needed in nursing care to give culturally competent care.
Cultural Competence Quiz and How My Cultural Competency has Changed
- Awareness: My awareness of cultural prejudice and bias to other cultural groups has been shaped.
- Skill: The crucial skill on performing cultural assessment build on a sensitive approach has been enhanced.
- Knowledge: My knowledge about the patient’s cultural view and the biocultural concept has also been enlightened.
- Encounters: My face-to-face encounter and relations with clients from diverse cultural settings have been shaped.
- Desire: My desire to be culturally competent has been taken to the next level.
Impact of Learning on Nursing Care of Individuals from Diverse Cultures
Cultural competence is a dynamic and life-long learning process. My understanding of the process for analyzing cultural patterns that influence individual and group differences is critical in preventing overgeneralization and stereotyping. Besides, analysis of the perspectives, traditions, values, practices, and family systems of culturally diverse individuals, families, communities, and populations will help me accommodate patients from diverse cultures.
Critical reflexivity is a personal analysis that includes challenging personal beliefs and assumptions to improve professional and personal practice. Critical reflection goes beyond mere awareness by examining and critiquing the assumptions of one’s values and beliefs. It involves an analysis of individual cultural values that have the potential of being in conflict with the values of others, and as such, thus help shape therapeutic relationships for effective nursing care.
Learning about the inclusivity of diverse cultures has shaped my understanding of cultural values and beliefs as well as the culture of others as essential healthy nursing care.