Larry Purnell Model for Cultural Competence Explained with 4 Examples

The Larry Purnell Model for Cultural Competence is a model for teaching and learning about intercultural competence, which is a range of cognitive, affective, and behavioral skills that allow for effective and appropriate communication between people of different cultures. For nursing students preparing to enter the field, understanding frameworks like the Purnell model for cultural competence can significantly enhance their ability to deliver patient-centered care. This comprehensive guide explores how the Larry Purnell Model for Cultural Competence can transform your nursing practice and help you address cultural diversity with confidence and sensitivity.

What is the Purnell Model for Cultural Competence?

Developed by Dr. Larry Purnell in the 1990s, the Purnell model offers a structured approach to assessing cultural factors that influence healthcare outcomes. Unlike other cultural competence models in transcultural nursing, the Purnell model provides a holistic framework that examines 12 domains of culture, making it particularly valuable for nursing students and practicing nurses alike.

Overview of the Purnell Model for Cultural Competence

The Purnell Model for Cultural Competence, developed by Dr. Larry Purnell, is a comprehensive, systematic approach to understanding and addressing cultural diversity in healthcare settings. This model is based on the premise that healthcare providers must develop cultural awareness, knowledge, and skills to provide effective care to patients from diverse cultural backgrounds.

Key Components of the Purnell Model

The Purnell Model consists of several key components that form its organizing framework:

1. The Metaparadigm: This includes person, family, community, and global society.
2. The Primary and Secondary Characteristics of Culture: These encompass factors such as nationality, race, gender, age, and educational background.
3. The 12 Domains: These form the core of the model and provide a structured approach to assessing cultural factors.
4. The Unconsciously Incompetent to Consciously Competent Care Continuum: This represents the process of developing cultural competence.

Importance of Cultural Competence in Healthcare

Cultural competence in healthcare is crucial for several reasons:

1. Improved patient outcomes: Culturally competent care leads to better health outcomes by addressing cultural factors that may impact treatment adherence and effectiveness.
2. Enhanced patient satisfaction: Patients who feel their cultural beliefs and practices are respected are more likely to be satisfied with their care.
3. Reduced healthcare disparities: Cultural competence helps bridge gaps in care that may arise due to cultural differences.
4. Increased trust in the healthcare system: When patients feel understood and respected, they are more likely to trust their healthcare providers and the system as a whole.

Cultural Diversity in Nursing Practice

The Purnell Model recognizes that cultural diversity extends beyond race and ethnicity. It encompasses a wide range of factors, including religion, sexual orientation, socioeconomic status, and educational background. By acknowledging this complexity, the model helps nurses develop a more nuanced understanding of their patients’ cultural backgrounds.

12 Domains of the Purnell Model

The 12 domains comprising the organizing framework of the Purnell Model provide a structured approach to assessing and addressing cultural factors in patient care. These domains include:

1. Overview/Heritage
2. Communication
3. Family Roles and Organization
4. Workforce Issues
5. Biocultural Ecology
6. High-Risk Behaviors
7. Nutrition
8. Pregnancy and Childbearing Practices
9. Death Rituals
10. Spirituality
11. Healthcare Practices
12. Healthcare Practitioners

Larry purnell model for cultural competence 12 domains Infographic

Each domain offers a specific lens through which nurses can examine cultural influences on health beliefs and behaviors. For example, when assessing the “Nutrition” domain, a nurse might consider how a patient’s cultural background influences their dietary preferences and restrictions, which could impact their treatment plan or medication regimen.

Impact on Nursing Students and Healthcare Providers

The Purnell Model has a significant impact on nursing education and practice. It provides a framework for nursing students to develop cultural competence throughout their education and career. By integrating the model into nursing curricula, educators can help future healthcare professionals build the skills necessary to provide culturally sensitive care.

For practicing nurses and other healthcare providers, the model offers a tool for continuous improvement in cultural competence. It encourages ongoing self-reflection and learning about diverse cultural practices and beliefs, which can enhance the quality of care provided to patients from various cultural backgrounds.

Why is Cultural Competence Essential for Nurses?

Benefits of Culturally Competent Care

Culturally competent care offers numerous benefits for both patients and healthcare providers:

1. Improved communication: Understanding cultural nuances in communication can help prevent misunderstandings and ensure that patients fully comprehend their care plans.
2. Increased patient engagement: When patients feel their cultural beliefs are respected, they are more likely to actively participate in their care.
3. Enhanced trust: Cultural competence fosters trust between patients and healthcare providers, leading to more open and honest interactions.
4. Better health outcomes: By addressing cultural factors that may impact health behaviors, culturally competent care can lead to improved health outcomes.

Challenges in Achieving Culturally Sensitive Healthcare

Despite its importance, achieving cultural competence in healthcare faces several challenges:

1. Lack of awareness: Some healthcare providers may not fully recognize the impact of cultural factors on health and healthcare delivery.
2. Limited resources: Healthcare organizations may lack the resources needed to provide comprehensive cultural competence training.
3. Unconscious bias: Healthcare providers may have unconscious biases that affect their interactions with patients from different cultural backgrounds.
4. Rapidly changing demographics: As patient populations become increasingly diverse, healthcare providers must continually update their cultural knowledge and skills.

Training and Education for Culturally Competent Nurses

To address these challenges and develop cultural competence, nursing education and ongoing professional development should focus on:

1. Cultural awareness: Helping nurses recognize their own cultural biases and assumptions.
2. Cultural knowledge: Providing information about various cultural practices, beliefs, and health behaviors.
3. Cultural skills: Teaching practical skills for cross-cultural communication and assessment.
4. Cultural encounters: Offering opportunities for nurses to interact with individuals from diverse cultural backgrounds.

What are the Applications of the Purnell Model in Nursing Care?

Using the Purnell Model in Patient Assessment

The Purnell Model can be applied as a cultural assessment tool in nursing practice. By systematically addressing each of the 12 domains, nurses can gather comprehensive cultural information about their patients. This assessment helps identify potential cultural barriers to care and informs the development of culturally appropriate interventions.

For example, when assessing a patient using the “Spirituality” domain, a nurse might inquire about religious practices that could impact treatment schedules or dietary restrictions. This information can then be used to tailor the care plan to accommodate the patient’s spiritual needs.

Interventions Based on Cultural Needs

Once cultural factors have been assessed, nurses can develop interventions that are culturally sensitive and appropriate. These interventions might include:

1. Adapting communication styles to match cultural preferences
2. Incorporating traditional healing practices into the care plan when appropriate
3. Accommodating dietary restrictions or preferences
4. Respecting cultural beliefs about modesty or gender roles in care delivery

By basing interventions on cultural needs, nurses can improve patient compliance and satisfaction with care.

Evaluating Health Outcomes through Cultural Competence

The Purnell Model also provides a framework for evaluating the effectiveness of culturally competent care. By considering cultural factors in outcome measures, healthcare providers can assess whether their interventions are truly meeting the needs of diverse patient populations. This evaluation process can lead to continuous improvement in the delivery of culturally competent care.

How Does the Purnell Model Compare to Other Cultural Competence Models?

Feature	Purnell Model	Leininger’s Sunrise Model	Campinha-Bacote’s Process	Giger & Davidhizar’s Transcultural Model
Developer	Larry Purnell	Madeleine Leininger	Josepha Campinha-Bacote	Joyce Newman Giger & Ruth Elaine Davidhizar
Year Developed	1995	1950s	1991	1988
Core Structure	12 domains within a circle surrounded by global society, community, family, and person	Sunrise imagery with cultural care worldview at top, gradually moving to nursing care decisions and actions	Five intersecting constructs (awareness, knowledge, skill, encounters, desire)	Six cultural phenomena assessed through nursing process
Organizing Framework	• Overview/Heritage• Communication• Family Roles and Organization • Workforce Issues • Biocultural Ecology<br>• High-Risk Behaviors<br>• Nutrition<br>• Pregnancy and Childbearing Practices<br>• Death Rituals<br>• Spirituality<br>• Healthcare Practices<br>• Healthcare Practitioners	• Technological factors<br>• Religious & philosophical factors<br>• Kinship & social factors<br>• Cultural values & lifeways<br>• Political & legal factors<br>• Economic factors<br>• Educational factors	• Cultural awareness<br>• Cultural knowledge<br>• Cultural skill<br>• Cultural encounters<br>• Cultural desire	• Communication<br>• Space<br>• Social organization<br>• Time<br>• Environmental control<br>• Biological variations
Primary Focus	Comprehensive assessment across multiple settings and disciplines	Theory of transcultural nursing and culturally congruent care	Process-oriented approach to developing cultural competence	Assessment of cultural variables through nursing process
Scope of Application	All healthcare disciplines and settings	Primarily nursing	Healthcare providers with direct patient contact	Primarily nursing
Theoretical Approach	Practical and clinically oriented	Highly theoretical with anthropological basis	Process-focused and developmental	Assessment-focused clinical tool
View of Culture	Complex, multifaceted phenomenon with primary and secondary characteristics	Universal and diverse care patterns influenced by social structure	Process requiring awareness, knowledge, skill, encounters and desire	Variables that differ among cultural groups
Development Process	Linear continuum from unconsciously incompetent to unconsciously competent	Integration of cultural care into nursing decisions and actions	Continuous process with five interdependent constructs	Application of nursing process to six cultural phenomena
Educational Use	Structured framework for assessing diverse cultural factors	Teaching transcultural nursing concepts	Teaching the process of becoming culturally competent	Teaching cultural assessment in clinical practice
Research Applications	Identifying variations in health practices and beliefs	Ethnonursing research method	Measuring cultural competence development	Identifying cultural variables in health and illness
Key Strength	Comprehensive and systematic approach with practical applications	Strong theoretical foundation for nursing practice	Focus on ongoing process and motivation (desire)	Straightforward assessment framework
Key Limitation	May be overwhelming with 12 domains to assess	Complex theoretical framework that can be difficult to apply	Focuses more on provider development than patient assessment	May oversimplify complex cultural phenomena
Distinguishing Feature	Organizes assessment into 12 concrete domains with developmental continuum	Emphasizes discovering culturally congruent care practices	Includes “desire” as motivational component	Focuses on six specific cultural phenomena

Key Differences Between Models

Purnell vs. Leininger

• Structure: Purnell uses 12 domains vs. Leininger’s 7 cultural and social dimensions
• Focus: Purnell emphasizes practical application while Leininger is more theoretical
• Scope: Purnell designed for all healthcare disciplines while Leininger focuses on nursing specifically
• Approach: Purnell uses a developmental continuum while Leininger emphasizes decisions and actions

Purnell vs. Campinha-Bacote

• Framework: Purnell organizes by domains while Campinha-Bacote focuses on process components
• Emphasis: Purnell emphasizes comprehensive assessment while Campinha-Bacote emphasizes provider development
• Structure: Purnell has a linear developmental continuum while Campinha-Bacote has interdependent constructs
• Unique element: Campinha-Bacote includes “cultural desire” as a motivational component

Purnell vs. Giger & Davidhizar

• Complexity: Purnell has 12 domains vs. 6 cultural phenomena in Giger & Davidhizar
• Application: Purnell is broader in scope while Giger & Davidhizar is more focused on assessment
• Integration: Purnell integrates multiple levels (person to global society) while Giger & Davidhizar focuses on individual assessment
• Approach: Purnell has developmental continuum while Giger & Davidhizar applies nursing process

Integration in Nursing Education

Many nursing education programs integrate multiple cultural competence models to provide comprehensive understanding:

1. Theoretical Foundation: Often begins with Leininger’s theoretical perspectives
2. Process Understanding: Incorporates Campinha-Bacote’s process of developing competence
3. Assessment Framework: Uses Purnell or Giger & Davidhizar for structured assessment
4. Practical Application: Combines elements from multiple models based on clinical context

This integrated approach helps nursing students develop a nuanced understanding of cultural competence that can be applied across diverse healthcare settings.

What Role Do Healthcare Providers Play in Cultural Competence?

Responsibilities of Nurses in Culturally Competent Care

Nurses play a crucial role in delivering culturally competent care. Their responsibilities include:

1. Conducting cultural assessments
2. Developing and implementing culturally appropriate care plans
3. Advocating for patients’ cultural needs within the healthcare system
4. Continuously improving their own cultural competence through education and reflection

Collaboration with Diverse Cultural Groups

To enhance cultural competence, healthcare providers should actively collaborate with diverse cultural groups in their communities. This collaboration can involve:

1. Partnering with community organizations to understand local cultural needs
2. Involving cultural leaders in healthcare planning and decision-making
3. Seeking feedback from patients and families about their cultural experiences in healthcare settings

Workforce Issues Related to Cultural Competence

Achieving cultural competence also involves addressing workforce issues, such as:

1. Recruiting and retaining a diverse healthcare workforce
2. Providing ongoing cultural competence training for all staff members
3. Creating a workplace culture that values and promotes cultural diversity
4. Developing policies and procedures that support culturally competent care

Related Article:The Purnell Model for Cultural Competence

Larry Purnell Model for Cultural Competence Example

Cultural sensitivity of health care is a concept that emphasizes health practitioners’ and hospitals’ ability to effectively respond to various attitudes, beliefs, and feelings of individuals from common and distinctive races, religions, and cultural heritage (Sekerci & Bicer, 2019). Culturally sensitive care aims to create a caring environment that accommodates every patient’s needs and expectations. It includes maintaining equitability and efficiency and improving the quality of care against detrimental factors like social constructs, norms, and cultural prejudices. Generally, Sekerci and Bicer (2019) observe that cultural sensitivity applies to various aspects of health care to ensure efficiency and equitability. Health care providers who understand and embrace cultural sensitivity facilitate the development of personalized relationships between their patients and themselves by being compassionate and dignified in providing health care. Moreover, cultural sensitivity is ideal for promoting and ensuring the effectiveness of health promotion interventions (Purnell & Fenkl, 2019). It makes it easy for health providers to understand patients, build trust, and reduce cultural complexities across hospitals.

Purnell Model and Transactional Healthcare

Larry Purnell developed the Purnell model framework by incorporating observations made by undergraduate students during their interaction with patients from diverse backgrounds. Marilyn (2016) observes that Purnell bases the model’s concepts on meta-paradigm like micro and macro characteristics and assumptions, such as all cultures are equally important and share fundamental similarities. Health providers require the same cultural understanding to ensure cultural sensitivity. Moreover, Purnell and Fenkl (2019) illustrate that it incorporates ideas from fields like ecology, economics, and anthropology to conceptualize the significance of communication, family, and social support. Consequently, the model’s organizational framework is circular in structure, with the outer rim indicating the global society, followed by the worldwide community on the second rim, the family on their rim, and the inner rim representing a person (Purnell & Fenkl, 2019). The inner rim consists of 12 structures describing cultural domains and their aspects. It evaluates culture by dividing it into primary and secondary features, whereby the primary components consist of races, country of origin, and religion. On the other hand, the secondary features include gender, residence, and immigration status.

Notably, the model is essential to transcultural health care since it provides the basis through which health care providers can understand the significance of culture in care provision (Marilyn, 2016). Such knowledge determines the type of care provided due to the differences in health care provision attributed mainly to factors like individual’s attitudes, beliefs, and feelings.

Purnell’s 12 Domains of Healthcare

There are 12 domains in the Purnell model (Purnell & Fenkl, 2019). First, the communication domain incorporates verbal aspects like language and non-verbal aspects like eye contact. It makes it easy to accommodate the needs and feelings of patients speaking different languages. Second, family roles and organization entail household factors like social status and facilitate diversity by determining how families interact when caring for their sick in hospitals. Third, workforce issues include factors like language barriers that promote diversity. Health care providers familiar with the model can effectively understand patient needs by incorporating many elements like non-verbal cues to identify patient’s needs. Fourth, Purnell and Fenkl (2019) observe that biocultural ecology consists of differences in racial and ethnic origins like heredity and enables health care providers to understand and appreciate the biological variation of a patient. Fifth, high-risk behaviors comprise the consumption of harmful substances like tobacco and facilitate diversity by enabling nurses to understand its degree of use and fluctuation across different cultures. Sixth, Nutrition consists of factors like food choices and promotes nurses’ understanding of the food intake levels and value of food types across different cultures.

Seventh, pregnancy and childbearing practices comprise perceptions about pregnancy and facilitate understanding of the beliefs and practices about pregnancy that must be respected when caring for pregnant patients. Eighth, death rituals comprise perceptions about death and enable health care providers to understand an individual’s customs and traditions about death, including burial ceremonies that must be performed across different cultures (Purnell & Fenkl, 2019). Ninth, spirituality comprises religious practices and facilitates nurses’ assessment of patients from different cultures, such as their prayer habits which hospitals should honor by giving those patients time to pray. Tenth, health care practices comprise patients’ responses to pain or surgery procedures and facilitate diversity by enabling nurses to comprehend the patient’s culture and condition before channeling treatment. Eleventh, health care practitioner’s factors comprise views about traditional and western medical care, which must be considered during healthcare provision since the practitioners have different cultural perspectives. Lastly, heritage comprises an individual’s origins and education which are significant during a patient’s assessment, like determining the need to introduce translators due to language barriers between the patient and provider.

Application of the Purnell Model in Different Cultures

The model increases nurses’ awareness of patients’ cultures and cultural environments, which is vital in identifying suitable delivery models for patients from different cultural backgrounds (Purnell & Fenkl, 2019). Additionally, health providers can apply the model to explain circumstances affecting patients’ perspectives. This involves personalizing health care interventions based on patients’ needs, such as family or cultural orientations. Moreover, the model links central domains within a culture (Brottman et al., 2020). This facilitates the interrelation of various cultural features in promoting congruency and facilitating the delivery of conscious and competent health care.

Also, it enables nurses to overcome language barriers by utilizing verbal and non-verbal cues. Improved communication increases patients’ willingness to share their problems or concerns about the type of care provided, enabling the providers to make necessary adjustments. Lastly, Brottman et al. (2020) explain that it improves health care providers’ competencies by increasing collaboration during care provision, such as medical practices requiring informed consent like heart surgery. In such as case, the providers will incorporate aspects of the model, such as health care practitioner’s aspects and heritage, to appropriately channel the type of care provided, including blending new care practices with cultural traditions to aid maintenance of the patient’s health.

References

Brottman, M. R., Char, D. M., Hattori, R. A., Heeb, R., & Taff, S. D. (2020). Toward cultural competency in health care: a scoping review of the diversity and inclusion education literature. Academic Medicine, 95(5), 803-813. https://doi.org/10.1097/ACM.0000000000002995

Marilyn, A. R. (2016). Transcultural caring dynamics in nursing and health care (2nd ed.). Philadelphia, PA: F.A. Davis Company. ISBN-13: 9780803677548

Purnell, L. D., & Fenkl, E. A. (2019). Handbook for culturally competent care. Springer International Publishing. https://link.springer.com/book/10.1007/978-3-030-21946-8?noAccess=true

Sekerci, Y. G., & Bicer, E. K. (2019). Cultural Sensitivity in Immigrant Patients’ Healthcare: How is it Perceived by Interning Medical and Nursing Students? International Journal of Caring Sciences, 12(1). https://www.internationaljournalofcaringsciences.org/docs/6_gumus_12_1.pdf

How to Apply the Purnell Model in Clinical Practice

Understanding the theory behind the Purnell model is important, but knowing how to apply the model in real-world settings is what truly matters. Here’s a step-by-step approach:

Step 1: Self-Assessment

Before you can effectively address cultural diversity in your patients, you must examine your own cultural beliefs and biases. The Purnell model emphasizes that cultural competence begins with self-awareness.

A social worker might use an ecomap to understand their own cultural positioning, and similarly, a nursing student can use the Purnell model to reflect on personal cultural influences. This self-assessment helps identify areas where you might unintentionally impose your values on patients.

Step 2: Patient Assessment

When working with a patient, systematically explore the 12 domains of the Purnell model. Remember that not all domains will be equally relevant for every patient—it’s helpful to prioritize based on the clinical situation.

Some questions you might ask include:

• “Can you tell me about traditional health practices in your culture?”
• “How does your family typically make healthcare decisions?”
• “Are there any religious or spiritual practices that might affect your care?”

Like genograms provide insight into family structure, the Purnell model offers a framework to understand the cultural factors shaping your patient’s health beliefs.

Step 3: Intervention Development

Based on your assessment, develop interventions that respect and incorporate the patient’s cultural beliefs and practices. This might involve:

• Modifying communication strategies
• Including family members in care planning
• Incorporating traditional healing practices when safe and appropriate
• Adjusting nutritional recommendations to align with cultural preferences

A therapist might use various tools to address internal dynamics; similarly, nurses can use the Purnell model to develop culturally appropriate interventions.

Step 4: Evaluation and Adjustment

Cultural competence is an ongoing process. Regularly evaluate the effectiveness of your interventions and be willing to adjust your approach. The Purnell model emphasizes that developing cultural competence is a journey, not a destination.

The Purnell Model’s Domains Applications: Case Studies

To illustrate how the Purnell model can be applied, let’s consider some examples:

Mrs. Patel’s Nutritional Challenge

Aanya, a second-year nursing student, was assigned to care for Mrs. Patel, a 67-year-old woman recovering from gallbladder surgery. Despite being three days post-op, Mrs. Patel had barely touched her meals, causing her primary nurse to worry about delayed healing.

During morning care, Aanya noticed Mrs. Patel pushing food around her plate rather than eating. Instead of immediately documenting “poor appetite” or requesting a nutrition consult, Aanya remembered the nutrition domain of the Purnell model.

“Mrs. Patel, I’ve noticed you haven’t been eating much. Is there something about the food that doesn’t appeal to you?” she asked gently.

After some hesitation, Mrs. Patel explained that as a devout Hindu, she was vegetarian and couldn’t eat the meat-based protein options provided. Additionally, certain spices integral to her daily diet were missing, making the hospital food taste bland and unappetizing.

Aanya took action. She consulted with the dietary department, arranged for vegetarian meals with appropriate spices, and even spoke with Mrs. Patel’s daughter about bringing some homemade dal and roti that complied with post-surgical dietary restrictions.

Within two days, Mrs. Patel’s intake improved dramatically. By applying the nutrition domain of the Purnell model, Aanya addressed not just the physical need for calories but respected the deep cultural and spiritual significance food held for her patient.

The Rodriguez Family and End-of-Life Care

Miguel Rodriguez, 78, was admitted to the ICU with end-stage heart failure. His prognosis was poor, and the medical team recommended transitioning to comfort care. But when nurse Jamal tried to discuss end-of-life decisions with the family, he encountered unexpected resistance.

Drawing on the death rituals and family roles domains of the Purnell model, Jamal took a step back to understand the family dynamics at play. He learned that in the Rodriguez family’s Mexican Catholic tradition, discussing death was considered disrespectful and potentially harmful to the patient’s spirit. Additionally, major healthcare decisions weren’t made individually but required family consensus, with particular deference to the eldest son.

Rather than pushing the hospital’s standard approach to end-of-life discussions, Jamal adapted his strategy. He arranged for a family meeting that included extended family members, provided a private space where they could discuss among themselves, and brought in a Spanish-speaking chaplain familiar with Catholic traditions.

Jamal also recognized that the family’s desire to have someone at the bedside constantly wasn’t “excessive family presence” but an expression of cultural values around not leaving a loved one alone during illness. He arranged for flexible visitation hours and a larger room that could accommodate family members.

By applying multiple domains of the Purnell model, Jamal helped facilitate a culturally appropriate transition to comfort care that honored both the patient’s medical needs and the family’s cultural practices around death and dying.

Sarah’s Pregnancy Journey

Midwifery student Taylor was assigned to work with Sarah, a 22-year-old Indigenous woman expecting her first child. During prenatal visits, Taylor noticed Sarah seemed reluctant to commit to the standard hospital birth plan and hesitated when discussing pain management options.

Remembering the pregnancy and childbearing practices domain of the Purnell model, Taylor created space for Sarah to share her cultural perspectives on childbirth.

“I’m curious about how women in your family or community traditionally experience pregnancy and birth,” Taylor offered. “Would you be comfortable sharing any practices that are important to you?”

Sarah explained that in her tribal tradition, birth was a sacred ceremony led by women, typically occurring at home with specific rituals to welcome the baby to the community. She feared these important cultural elements would be lost in a hospital setting but was equally concerned about safety.

Taylor didn’t dismiss Sarah’s cultural practices as superstitions or impractical traditions. Instead, she worked with Sarah to create a birth plan that incorporated cultural elements while maintaining medical safety. This included:

• Arranging for female providers when possible
• Creating space for a tribal elder to perform a blessing ceremony in the hospital room
• Preserving the placenta for a traditional burial ceremony
• Using a birthing position from her cultural tradition rather than the standard lithotomy position
• Incorporating traditional songs and prayers during labor

When Sarah delivered a healthy baby girl three months later, the birth honored both her cultural traditions and modern medical safety practices. Taylor’s application of the Purnell model created a birth experience that respected Sarah’s cultural identity while providing excellent clinical care.

Mr. Chen and Pain Management

Fifth-year nursing student Devon was completing a clinical rotation on a surgical floor when he was assigned to Mr. Chen, a 56-year-old Chinese man recovering from spinal surgery. The night nurse reported that Mr. Chen rarely requested pain medication despite wincing when moving, leading to concerns about inadequate pain control affecting his recovery.

Rather than immediately encouraging Mr. Chen to “speak up” about his pain, Devon applied the healthcare practices domain of the Purnell model. Through thoughtful conversation, Devon learned that in Mr. Chen’s cultural background, stoicism during physical suffering was highly valued. Additionally, Mr. Chen harbored concerns about becoming addicted to pain medications and believed that pain was necessary for proper healing.

Devon adjusted his approach. He explained how controlled pain actually promotes faster healing by allowing deeper breathing and earlier mobility. Rather than waiting for Mr. Chen to request pain medication, Devon implemented scheduled dosing and framed it as “medicine to help with healing” rather than simply “pain relief.”

Devon also incorporated aspects of traditional Chinese medicine that Mr. Chen valued, working with the healthcare team to allow acupressure from Mr. Chen’s wife and adjusting the room’s feng shui as much as hospital constraints permitted.

By the third day, Mr. Chen was participating more actively in physical therapy, sleeping better, and healing more quickly—all because Devon used the Purnell model to understand and address cultural influences on pain perception and management.

Integrating the Purnell Model with Other Nursing Frameworks

The Purnell model doesn’t exist in isolation—it can be integrated with other nursing theories and frameworks. For example:

• Nursing Process: The Purnell model can enhance each step of the nursing process, from assessment to evaluation
• Patient-Centered Care: Cultural competence supports the broader goal of patient-centered care
• Evidence-Based Practice: Cultural considerations should inform the application of evidence-based interventions

Like how a counselor might combine different therapeutic approaches, nurses can integrate the Purnell model with other frameworks to provide comprehensive care.

FAQs on Larry Purnell Model for Cultural Competence

How does the Purnell model differ from other cultural competence frameworks?

The Purnell model stands out with its comprehensive 12-domain structure that systematically addresses all aspects of cultural influence on healthcare. Unlike models that focus primarily on communication or beliefs, Purnell’s framework examines everything from biocultural ecology to workforce issues, providing nurses with a complete roadmap for cultural assessment.

Can the Purnell model be used for cultures not specifically mentioned in Purnell’s original research?

Absolutely! While Purnell initially developed the model studying specific cultural groups, the 12 domains are universally applicable across all cultures and ethnic backgrounds. The framework’s strength lies in its flexibility as a structured approach to cultural assessment rather than a collection of culture-specific information.

Can the Purnell model help address healthcare disparities in underserved communities?

The Purnell model is an excellent tool for addressing healthcare disparities as it helps nurses identify cultural barriers that may prevent patients from accessing or adhering to care. By systematically exploring domains like healthcare practices and communication, nurses can develop interventions that bridge cultural gaps contributing to disparities in health outcomes.

What is the Purnell Model for Cultural Competence in nursing?

The Purnell Model is a comprehensive framework that helps nurses understand and address cultural factors in patient care. It consists of 12 domains that cover various aspects of culture and provides a systematic approach to developing cultural competence.

Which four components are included in the culturally competent model of care?

The four main components of a culturally competent model of care are:

1. Cultural awareness
2. Cultural knowledge
3. Cultural skill
4. Cultural encounters

What are the 4 steps of the cultural competency model?

 The four steps of the cultural competency model are:

1. Cultural awareness
2. Cultural knowledge
3. Cultural sensitivity
4. Cultural competence

What are the six stages of cultural competence nursing?

The six stages of cultural competence in nursing are:

1. Cultural destructiveness
2. Cultural incapacity
3. Cultural blindness
4. Cultural pre-competence
5. Cultural competence
6. Cultural proficiency