cultural domainsthe theorist also identified 12 domains H e a l t h M e d i c a l

cultural domainsthe theorist also identified 12 domains H e a l t h M e d i c a l

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Cuellar, Jacqueline Tatiana

Purnell’s Cultural Competence

Cultural competence refers to how individuals, aware of their lack of knowledge on a different culture, begin learning, and become proficient. In multi-cultural communities, health professionals should provide culturally competent care to meet their healthcare, emotional and psychological needs. When a health professional understands a patient’s culture, they become empowered to develop and offer care solutions that conform to the patient’s beliefs, thereby increasing compliance and improving outcomes.


Purnell’s model comprises two distinct sections: an inner circle highlighting 12 cultural domains and four outer circles representing nursing metaparadigms (Purnell, 2014).


The outermost circle depicts the global community, the next represents the local community, the third highlights the family, and the final circle represents the person. The global society comprises communities from different cultures. Factors such as globalization and technological advancement influence cultural interaction and integration (Purnell, 2014). During caregiving, health professionals should consider a person’s place in the global society to understand their world view.

The consideration of a person’s cultural community is essential to caregiving because it empowers the nurse to provide culturally competent care. For example, some patients from the Hispanic community prefer communicating in Spanish than English. If a nurse understands this, they can arrange for an interpreter’s presence during the consultation.

During interactions with patients, nurses can gather information about the friends and family members involved in the patient’s care and collaborate with them in yielding the desired outcomes (Purnell, 2014). Finally, health professionals should consider the patient’s unique sense of self, beliefs, preferences, and values aside from the community and family influence.

Cultural Domains

The theorist also identified 12 domains that were essential to developing cultural competence. Per Purnell, a health professional’s understanding of their origin facilitates knowledge of the self and the patient. During communication, the nurse should understand non-verbal cues such as posture, sound, body language, and gestures (Purnell, & Fenkl, 2019). Notably, understanding the patient’s place and role in the family enhances the nurse’s knowledge of the convalescent’s support system and the primary decision-makers. Health professionals should also consider workplace challenges such as language barriers and their impact on patient experience.

Other factors that the health professional should consider include biocultural ecology, nutrition, and high-risk behavior. By studying the differences between cultures, the professional will understand social practices (Purnell, 2014). High-risk behaviors such as alcohol consumption and promiscuity may differ between cultures. This information could guide history taking and the choice of screening tools. Similarly, an understanding of a community’s nutritional practices shows the development of a holistic treatment plan.

Similarly, every community practices different traditions concerning death, child-bearing, and spirituality. It is necessary to consider ways to incorporate these into the diagnosis and treatment processes to enhance the patient experience, build trust, and promote loyalty. Finally, the knowledge of a person’s or community’s beliefs regarding healthcare practices and practitioners will help the professional tailor the experience to meet the patient’s needs.

Relevance to Advanced Practice Nursing

Advance practice nurses serve as educators in the organizational setting. Therefore, advance practice nurses (APN) who know Purnell’s cultural competence model can use it to educate other nurses on the topic. Resultantly, these professionals can apply this knowledge to the practice setting to provide culturally competent care.


Purnell, L. (2014). Transcultural health care: A culturally competent approach. (4th ed.). Philadelphia: F.A. Davis Co. ISBN: 9780803637054

Purnell, L. D., & Fenkl, E. A. (2019). The purnell model for cultural competence. In Handbook for Culturally Competent Care (pp. 7-18). Springer, Cham.

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