3. GLOBAL SOCIETY

4. COMMUNITY

5. FAMILY

6. PERSON

7. 12 Inner aspects of the model:
 Overview/Heritage
 Communication
 Family Organization
 Workforce Issues
 Biocultural Ecology
 High-risk health behaviors
Nutrition
Pregnancy
Death Rituals
Spirituality
Health-care practices
Health-care practitioners

8. OVERVIEW/HERITAGE
Country of Origin
 Current Residence
 The effects of the Topography
of country of origin and current
residence on health
 Economics
 Politics
Reasons for Migration
 Education Status
Occupations

9. Dominant Language
Dialects
Contextual use
Volume/Tone
Spatial Distancing
Eye Contact
Facial Expressions
Greetings
Temporality
Time
Name
Touch

10. FAMILY ROLES and ORGANIZATIONS
 The head of the household
 Gender roles
 Family goals and priorities
 Developmental tasks of children and
adolescents
 Roles of ages
 Roles of extended family members
 Individual and social status in the
community
Acceptance of alternative lifestyle

11. WORKFORCE ISSUES
 Autonomy
Acculturation
Assimilation
Gender roles
Ethnic communication style
Individualism
Health care practices from the country of origin

12. BIOCULTURAL ECOLOGY
 Skin color
 Body type
 Disease that are genetic,
heredity, topographic, or endemic
 How the culture metabolizes drugs

13. HIGH-RISK BEHAVIOR
Drug use
Alcohol use
Nicotine use
Dangerous behaviors
Use of safety equipment's
Degree of sedentary lifestyle
Consumption of unhealthy food

14. NUTRITION
Availability of food
Rituals and taboos associated with food
The meaning of food to the culture
How food is used in sickness and in health

15. PREGNANCY and
CHILDBEARING PRACTICES
Fertility practices
Labor and delivery practices
Practices that are considered taboo, prescriptive or
restrictive during pregnancy
Labor and postpartum

16. DEATH RITUALS
How death is viewed
Preparation for death
Burial practices
Bereavement practices

17. SPIRITUALITY
Practices that gives strength and meaning of life
Religious practices
How prayer is used

18. HEALTH CARE PRACTICES
 Does the culture seek preventative or acute
treatment?
 Magicoreligious and healthcare beliefs
 Traditional practices
 Individual responsibility for health
 Self medicating practices
 Views towards issues such as:
• Organ donations
• Mental illness
• Rehabilitation
 How pain is expressed
 The sick role
 Barriers to health care

19. HEALTH CARE PRACTITIONERS
 Type of practitioners the culture uses
Traditional or Folk
Biomedical
 Does gender of the practitioner comes in to play

20. CONCEPTS OF CULTURAL
CONSCIOUSNESS
 Unconsciously incompetent
 Consciously incompetent
 Unconsciously competent
 Consciously competent

21. • All healthcare disciplines require the same information
regarding cultural diversity.
• All healthcare disciplines make use of the same meta-
paradigm concepts of health, person, family,
community and the global society.
• There is no culture that is better than the other; instead,
they are merely different.
• There are core similarities across all cultures.
• There are differences within, between and among
cultures.
• Cultures are subject to change gradually in a society
that is stable;
• The following are the major assumptions
of the Purnell’s model for cultural
competence:

22. • The level to which a culture differs from the dominant
culture is determined by the secondary and primary
characteristics of culture.
• If patients are co-participants in health care and are given
the choice in selecting health-related interventions, plans
and goals, then, there will be an improvement in health
outcomes.
• Culture exerts a significant impact on a person’s
interpretation of healthcare and how he/she responds to
care.
• Families and individuals fit in numerous cultural groups.
• Each person deserves to be respected for his/her cultural
heritage and uniqueness.
• Caregivers require both specific and general cultural
information in order to offer care that is both culturally
competent and sensitive.

23. • Assessments, plans and interventions that are culturally
competent tend to improve patients’ care.
• Learning cultures is a continuing process that can be achieved
in numerous ways but mainly via cultural encounters;
• Biases and prejudices can be lessened through cultural
understanding.
• Effectiveness of care can be improved through reflecting on
distinctive understanding of the life ways, beliefs, and values
of individual acculturation patterns and diverse populations.
• Cultural and racial differences need the adaptations of the
standard interventions.
• Cultural awareness tends to improve the self-awareness of the
caregiver.
• Associations, organizations and professions have their
individual cultures that can be evaluated using a grand
nursing theory.

24. In this regard, a health care provider who is
culturally competent tends to be aware of
his/her thoughts, existence, environment and
sensations and does not let these factors
influence the patient receiving care. Cultural
competence entails adapting care in a way that
it is consistent with the patients, culture.

25. The purnell’s model for cultural competence originated out of
education and practice
 The 12 domains comprising the organizing framework are
briefly described along with the primary and secondary
characteristic of culture, which determines variations in values,
belief and practices of an individual’s cultural heritage. All
healthcare providers in any practice setting can use the model,
which make it especially desirable in today’s team-oriented
healthcare environment.
 The model has been used by nurses, physician and occupational
therapist in practice, education, administration and research in
Australia, Belgium, Canada, Central America, Great Britain,
Spanish. Although the model is 4 years old, it shows promise
for becoming a major contribution to transcultural nursing and
healthcare.

26. When I am making my report on this model, I can say that it
really fit me even if I am in the school setting.
> As a School Nurse I deal with 1300 students , who came from
different tribe. When there are accidents that happen. I always
observe the student and as to what tribe does he/she belong,
because my next step depends as to what tribe they belong. In the
province where I work you must be aware of the cultural practices
of each club. When a student is wounded and blood is seen,
Anticipate that sometimes conflict can arise. I also talk to them
using the dialect that they are using because sometimes they are
not comfortable talking to their teachers even me as their school
nurse. Some students who enter the clinic and seek for help, when
I asked them if they informed their parents just take their silence
and sometimes make an alibi. Some of the students especially
those who came from the barrio doesn’t go at the hospital for
check-up because they lack the money needed.

27. Sometimes I always hear from them that they go to a “quack
Doctor” and have a hilot. The province have a lot of cultural
practices that can hardly remove, everything was still strong, as a
nurse its really hard to enter into situation when conflict has
already arises. Sometimes accidents are normal because high
school students especially grade 7 are playful. Sometimes they are
not aware that they are already hurting each other. Some parents are
not open-minded.
 In my area, this theory help me to be more sensitive, especially
in the future. I can understand my patients easily and
communicate even in a simple gestures. Not every patients
express their emotions or talk to us abruptly, some of them just
shut their mouth and look at us. This model alone when used
properly is a great help. The cultural practices of a certain
country or of a person can be a big help to professionals,
because by knowing it, even if you will not ask more detail
sometimes the records answers our questions.

28. References for this
presentation were
mostly internet base.