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Models of Transcultural Care - Cultural Competence

Purnell’s Model of Transcultural Health Care

(Purnell & Paulanka, 1998)

In the literature, the model is generally referred to as Purnell’s model. However, Purnell and Paulanka (1998) are the editors of the textbook in which the model has been described and its applications illustrated through the contributions of other authors. Hence, this resource refers to Purnell’s model when addressing issues directly related to the model, and Purnell and Paulanka (1998) when referring to the book as a source.

Purnell and Paulanka (1998) conceptualise the development of cultural competence along an upward curve of learning and practice. An increasing level of achievement of competence characterises the model that views the practitioner moving through the following 4 levels:

These are described in great detail and take into consideration the experiences and knowledge of the practitioner. Purnell and Paulanka (1998) also suggest that it may be possible to devise criteria to measure these levels of competence.

The model
The concepts that make up Purnell’s model of cultural competence are not unlike those found in Leininger's, and Giger and Davidhizar’s models. However, Purnell’s model extends some of the categories under which the concepts are organised.

Purnell’s model of cultural competence consists of 2 sets of factors that are described as the macro aspects and micro aspects. In the diagrammatic representation of the model, Purnell and Paulanka use concentric circles to locate the macroaspects and microaspects. The macroaspects form the wider outer circles and the microaspects the inner circle, all constituting segments of the whole.

From the outermost circle moving inwards to the centre, the concentric circles are made up of the ‘global society’, the community, the family and the person. Purnell and Paulanka (1998, p.8-9) suggest that the model is informed by a range of fields of inquiry that include ‘biology, anthropology, sociology, economics, geography, history, ecology, physiology, psychology, political science, pharmacology, and nutrition as well as communication, family development, and social support’. They go on to say that ‘the model can be used in clinical practice, education, research, and the administration and management of health-care service’.

Global society is described with reference to the wider world, politics, communication systems, commerce and economies, technologies and events, and the impact of these in shaping the individual’s or persons’ worldviews.

The community is described in terms of a group of people living in the same locality and sharing interests and a common identity.

The family is described as two or more people, emotionally involved, living together or not, but close. Family structure and roles vary. The person is conceptualised as ‘a biopsychosociocultural human being who is constantly adapting' (Purnell & Paulanka, 1998, p. 9). Health is viewed as permeating aspects of culture, and defined at different levels, global, national, regional, local and individual. Health is also defined, and takes on board the ethnocultural perspective of the people, and relates to the physical, mental, spiritual states in the context of the people and their interactions with the family, community and the wider world.

The microaspects are represented by segments that make up the 12 domains:

These domains are interrelated and provide for a comprehensive view of the individual. They include concepts that are common to the other models. The descriptive details this model reflects, are to a large extent those that have been described earlier in Giger and Davidhizar’s model.

However, the domains of Purnell’s model allow for a more focused analysis. Purnell and Paulanka (1998) provide guidelines to facilitate the further exploration of issues under each of these domains.

Applications
Used with a framework for nursing assessment, intervention and evaluation, the model can provide useful insight into the aspects of the person’s cultural needs in relation to each domain. It can also provide explanatory models for health and illness across cultures.

Critical overview
There may be overlap as a result of common elements being present in any two or more of the domains, as well as in the domains and the macroaspects.

The model tries to be all inclusive. The risk is that it may not be appropriate to practitioners unless the breadth and depth of their knowledge and skills is matched with the requirements of health care users.

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