The Purnell Model for Cultural Competence

The Purnell Model for Cultural Competence




The Purnell Model for Cultural Competence

Cultural competence has become an essential component within the health care settings due to multiculturalism and diversity in health care. Providing holistic and more individualized health care services based on patients cultural values and beliefs has become the cornerstone of health care practice. Several models have been developed to guide nurses and other health care professionals to deliver cultural congruent care (Shen, 2014). This essay will discuss Purnell model of cultural competence and its relevance within the health settings. The essay describes the 12 domains of Purnell model and assesses how each domain plays an active role when applied by nurses serving patients from different ethnic backgrounds.

The Theory and Organizational Framework of the Purnell Model

Larry Purnell developed a model of cultural competence while teaching undergraduate students concerning cultural differences. The model includes circles with 12 constructs that influence culture. The inner rim of the circle represents the person, followed by the circle representing the family then the community. The outer rim represents the global society. Purnell model of cultural competence is based on several theories and research related to family development, communication, organizational theories, and other disciplines like religion nutrition and ecology (Betancourt et al., 2014).

According to Betancourt et al., (2014), developing cultural competence requires health care practitioners to achieve competency through four main processes. Nurses need to initially develop unconscious incompetence before gaining conscious competence to reach unconscious competence. The core concepts of culture include religious affiliation, gender, age, race, nationality, and color. Secondary characteristics include political beliefs, parental and marital status and physical characteristics among others (Betancourt et al., 2014),

The inside circles of the model comprise of 12 pieces shaped blocks that represent cultural domains and their constructs with each one being interrelated. The center of the model is empty meaning that there are unknown facets of cultural groups. Purnell model acknowledges the fact that several cultures do not have manageable expressions for the meta-paradigm concepts. Healthcare providers are compelled to adapt the meta-paradigm concept that matches individual cultural needs (Arasaratnam, 2012).

The 12 Domains of Purnell’s Model and How Each Domain Plays an Active Role in the Diversity of Health Care

The twelve concepts of Purnell’s model include;

1. Heritage; – this includes patients origin, residence, economic status, levels of education, political and occupation.

2. Communication: communication involves analyzing features like dilates, dominant language, names, facial expressions, touch, volume, tone, body language, eye contact and spatial distancing practices (Arasaratnam, 2012).

3. The role of family and organization: this involves analyzing patient’s lifestyle, social status, child rearing practice, gender roles, head of household, patient’s priorities in life, the role of the aged within the family and developmental tasks.

4. Workforce issues; these features include understanding patients acculturation, assimilation autonomy, and any language barrier (Arasaratnam, 2012).

5. Bicultural ecology; includes features like biological variation, hereditary factors, economic, genetic status, skin color

6. High-risk behaviors; understanding patients risk factors related to tobacco and alcohol use, use of recreation drugs, patients general safety, his levels of engagement in physical activities.

7. Nutrition: Understanding patients dietary preferences, like common food intake, deficiencies, health promotion activities and patient limitations regarding diet.

8. Pregnancy and childbearing practices: these include an understanding feature like fertility practices, beliefs related to pregnancy, birthing, any postpartum issues, and patients view towards pregnancy (Arasaratnam, 2012).

9. Death ritual: understanding patient view towards death and how they handle bereavement.

10. spirituality; these include assessing patient religious practice, view of life, inspiration and strength use of prayer and his general understand about spiritual healing.

11. Healthcare practice; these includes patients’ traditional practices, his traditional beliefs, issues of self-medication, transplantation, patients mental health, rehabilitation, his responsibility for health and barriers to health.

12. Health care practitioner; understanding patient’s perception towards practitioners, gender, and his view regarding gender and health care (Arasaratnam, 2012).

Application of the Model When Working With Different Cultures

Purnell model is relevant for nurses and other health care providers during planning, assessing and when developing appropriate interventions to improve patients, family and the community health. The 12 domains are helpful for nurses because they contribute to cultural competence behavior. According to Purnell, nurses should develop awareness of their sensation thoughts and environment without necessarily letting these factors influence service provision (Shen, 2014).

According to Shen, (2014), self-awareness is important towards offering culturally competent care. The model encourages nurses to be aware of their individual values and beliefs and also nursing values. Nurse are required to engage in introspection and reflection frequently to understand their attitude regarding patients from different ethnic background and how to acknowledge how their personal beliefs can act as barriers to providing quality care, especially when offering services to a diverse population (Shen, 2014).

Having knowledge is important in gaining cultural competence, nurses need to learn about different cultures and understand patient’s worldview. Understanding patient worldview will enable nurses to analyze patient behavior and certain beliefs that might directly impact on care (Shen, 2014).

Communication is vital when working with diverse cultures; the nurse can enhance cross-cultural communication by adopting important elements like active listening and analyzing paying patient’s non-verbal cues to understand how patient perceive their situation and health the treatment (Shen, 2014).


Nurses play unique roles in health care; nurses are responsible for taking care of patients with different cultural beliefs and values. The main cultural competence developed by Purnell when adopted by nurses can improve quality care. Nurses need to engage in ongoing learning, advocating and understanding core components of cultural competency.


Arasaratnam, L. A. (2012). Intercultural spaces and communication within: An explication. Australian Journal of Communication, 39(3), 135.

Betancourt, J. R., Corbett, J., & Bondaryk, M. R. (2014). Addressing disparities and achievingequity: cultural competence, ethics, and health-care transformation. CHEST Journal, 145(1), 143-148.

Shen, Z. (2014). Cultural Competence Models and Cultural Competence Assessment Instrumentsin Nursing A Literature Review. Journal of Transcultural Nursing, 9(2014)1043659614524790. Doi: 10.1177/1043659614524790