The Purnell Model of Cultural Competence

Nursing theories fundamentally provide the background knowledge of healthcare
concepts that define nurse actions and decisions and their reasoning (Smith, 2019). This is
critical because it assists nurse professionals in articulating evidence that validates and
rationalizes the methodologies behind their actions. Dozens of theoretical concepts have been
developed within the last hundreds of years. This discussion will particularly explore the Purnell
Model of Cultural Competence, including its creator, the circumstances that influenced its
development, and the model’s main components. I will also apply the theory to a past scenario,
describe whether it applies to my current workplace, and explain how it can influence
transcultural nursing practice and how transcultural nurses can leverage its components to push
the profession forward.

The Model’s Creator

The Purnell theory was coined by Betty Paulanka and Larry Purnell as a model to arrange
and classify items that can impact an individual’s culture. Purnell currently offers professional
online training in collaboration with the University of Delaware. He has about fourteen textbooks
and at least one hundred book chapters, and referenced journals under his belt. Betty is a former
Dean of Health Sciences at the University of Delaware.
When the Theory was Developed and the Circumstances that Necessitated Its Creation
Purnell and Paulanka proposed the “Purnell Model of Cultural Competence” in 1995
during their stint at the University of Delaware. The framework was primarily intended to help
categorize and classify factors that can influence an individual’s culture. Purnell and Paulanka
were motivated to provide nurses and other healthcare providers a foundation for understanding
factors, features, and concepts related to multiple cultures. The goal was to help nurses deliver

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culturally competent services to patients in clinical settings. Today, the theoretical concept has
been praised for promoting and integrating cultural competency into the nursing care practice.
During the early development stages of the model, Purnell and Paulanka noticed the incoherent
and disjointed nursing services patients were subjected to in multicultural societies like America.
The model was designed to offer a more holistic approach to nursing practice (Purnell & Fenki,
2020).

The Main Components of the Model

` The Purnell theoretical ideology comprises of four metaparadigm concepts and twelve
domains. The metaparadigm concepts (outer circles) include person, global society, family, and
community. The twelve domains, also known as the inner circle, include communication,
heritage/overview, workforce issues, nutrition, family organization and roles, biocultural
ecology, death rituals, high-risk behaviors, spirituality, pregnancy and childbearing, health care
practitioner, and healthcare practices. The four outer circles (metaparadigms) are interlinked
theoretical concepts connected with nursing, especially in delivering services and care. For
instance, ‘global society’ means looking at the world as an interrelated whole. The twelve
domains make up the concepts that nurses or other health providers must consider when
examining patients (Shen, 2014). For example, the ‘biocultural ecology’ construct relates to
diversities and disparities between people and communities based on race, gender, age, sexual
orientation.

Application of the Theory to a Past Scenario

I have interacted with nearly all the twelve domains highlighted in Purnell’s cultural
competence framework in clinical and community settings. For example, I once interacted with
an anemic Jehovah’s Witness patient who refused an urgent blood transfusion because their

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religion forbids followers to receive blood donations. Based on Purnell’s framework, the most
appropriate way of dealing with such “spiritualty-related” cases is to gain considerable
knowledge about the religion’s practices, beliefs, and viewpoints on even issues like treatment,
blood transfusion, and nutrition (Gurung, 2014). After acknowledging and appreciating their
diversity, nurses can then talk these patients into accepting other peoples’ perspectives and
viewpoints or use people who can relate to these patients well to change their position.
Whether The Theory Applies to My Current Work Environment
Admittedly, the theory applies to all my current settings, including school, home, and
workplace. For example, as a medical student, being aware of other people’s diverse cultures,
beliefs, and backgrounds is helping me build strong ties, cooperation, and teamwork with others.
Communication is another vital construct that I think plays a crucial role in every aspect of my
life. In clinical settings, verbal and non-verbal clues helping me to conduct patient diagnoses
correctly. Patients have to explain to me their disease and medication histories, and effective
communication is necessary.

How the Theory Influences Transcultural Nursing Practice
Purnell’s model plays a huge role in assisting nurses, and other providers deliver
culturally competent services, especially in transcultural and multicultural settings. The tool can
help nurses tailor care that explicitly meets patients’ needs, beliefs, perceptions, and expectations
(Shen, 2014). For example, examining the specific nutritional preferences of patients can help
nurses provide bespoke solutions that address the patient’s particular deficits.
How Transcultural Nurses Move Care to the Forefront of Nursing Practice Using the

Components of the Theory

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There are several ways in which transcultural nurses can apply elements of the theory to
improve nursing practice or deliver culturally competent care. For example, they can
communicate directly with immigrant patients and their loved ones. They can also bridge the gap
between health care practice and a specific patient’s religion, family, and culture. According to
RegisteredNursing.org (2021), multicultural nurses can also move the profession forward by
understanding the impact of ethnicity, race, and culture on the emergence of emotional and social
relationships, attitude toward health, and child-rearing practices.

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References

Gurung, R. (2014). Cultural competence: Multicultural approaches to health and wellness in
America. Santa Barbara, California: ABC-CLIO, LLC.
Smith, M. C. (2019). Nursing theories and nursing practice. F.A. Davis.
Purnell, L. D., & Fenki, E. A. (2020). Textbook for transcultural health care: A population
approach: Cultural competence concepts in nursing care. Springer Nature.
RegisteredNurses.org. (2021). Transcultural nurse.
https://www.registerednursing.org/specialty/transcultural-nurse/#transcultural-nurse
Shen, Z. (2014). Cultural competence models and cultural competence Assessment instruments
in nursing: A Literature review. Journal of Transcultural Nursing, 26(3), 308–321.
doi:10.1177/1043659614524790