The Purnell Model for Cultural Competence

The Purnell Model for Cultural Competence and its Relevance for Advanced Practice Nurse

The Purnell Model for Cultural Competence

A Brief Introduction to the Purnell Model: Definition, Assumptions, and Organizing Framework.

In today’s diverse and interconnected world, healthcare professionals, particularly nurses, play a pivotal role in providing patient-centred care that respects and addresses the unique cultural backgrounds of individuals.

The Purnell Model for Cultural Competence, developed by Larry Purnell, is a comprehensive framework that guides healthcare professionals, including nurses, in delivering culturally sensitive care. With its emphasis on understanding cultural diversity, promoting effective communication, and addressing healthcare disparities, the Purnell Model has become an invaluable tool in the field of nursing. This blog post aims to provide a detailed overview of the Purnell Model, exploring its history, description, and key domains.

The Purnell Model for Cultural Competence emerged as a result of Larry Purnell’s extensive experience in healthcare, research, and teaching. Purnell, a registered nurse and scholar, recognized the need for a systematic approach to cultural competence in nursing practice. In the late 1990s, he introduced the initial version of the model, which has since evolved and gained recognition within the nursing profession.

The Purnell Model for Cultural Competence offers a comprehensive and systematic framework that promotes cultural understanding and sensitivity among healthcare professionals. It consists of twelve interrelated domains, each representing a specific aspect of an individual’s culture. These domains encompass various cultural factors, including communication, family roles and organization, healthcare practices, nutrition, workforce issues, and more.

The Purnell Model is founded on various assumptions. Firstly, it assumes that medical officers require analogous information regarding cultural variations. Secondly, as Doğu, Coşkun, Üzen, and Ulay (2015) reveal, the Model disregards the issue of viewing a particular culture as superior to another. Instead, despite having some fundamental similarities, Purnell’s framework recognizes all cultures as disparate.

Another assumption is that cultures evolve with time. In addition, the Model supposes that culture significantly determines medical practitioners and patients’ understanding of healthcare (Debiasi & Selleck, 2017). It acknowledges people’s privilege of being handled with respect, regardless of their cultural settings. Another hypothesis made is that Purnell’s framework can eliminate any form of favouritism or biases if medical practitioners are culturally competent.

This blog post aims to provide a detailed overview of the Purnell Model, exploring its history, description, and key domains. It focuses on Purnell’s model for cultural competence and the way it is used in nursing and healthcare. It provides the theory’s definition and gives examples. As this study reveals, the Purnell Model for cultural competence provides an organized system for nurses and physicians to effectively deploy when managing patients from diverse settings.

The 12 Domains of the Purnell Model: A Comprehensive Overview of Cultural Influences


The heritage domain focuses on understanding an individual’s cultural background and how it influences their health beliefs and practices. It encompasses factors such as cultural history, values, customs, and traditions that shape an individual’s worldview and impact their approach to healthcare


Effective communication is essential for providing culturally competent care. This domain emphasizes the significance of understanding and adapting communication styles to different cultural contexts. It includes considerations such as language barriers, nonverbal communication, and cultural nuances that influence how messages are conveyed and interpreted.

3.Family Roles & Organisation      

This domain recognizes the influential role of the family in healthcare decision-making and care provision. It explores the structure, dynamics, and hierarchy within families across different cultures. Understanding family roles, responsibilities, and relationships is crucial for engaging families in healthcare decisions and planning appropriate care strategies.

4.Workforce Issues:

Workforce diversity and cultural competence among healthcare professionals are vital aspects of providing equitable care. This domain focuses on promoting cultural diversity within the healthcare workforce and addressing issues related to recruitment, training, and retention of a culturally diverse staff. It recognizes the importance of having healthcare professionals who can relate to and understand the cultural backgrounds of the patients they serve.

  1. Biocultural Ecology:

The biocultural ecology domain emphasizes the interaction between culture, biology, and the environment in shaping health outcomes. It explores how cultural factors, such as dietary practices, physical activity, and environmental influences, impact an individual’s health and well-being. Understanding these interactions helps healthcare professionals develop culturally appropriate interventions and health promotion strategies.

  1. High-Risk Behaviors:

This domain addresses cultural influences on high-risk behaviors such as substance abuse, violence, and risky sexual practices. It highlights the impact of cultural norms, beliefs, and social contexts on engaging in these behaviors. By understanding the cultural factors that contribute to high-risk behaviors, healthcare professionals can develop targeted interventions and prevention strategies.

  1. Nutrition:

The nutrition domain focuses on cultural influences on dietary practices and beliefs. It examines the cultural significance of food, traditional dietary patterns, food preferences, restrictions, and rituals. Understanding these cultural factors helps healthcare professionals provide culturally sensitive nutritional guidance and support.

  1. Pregnancy and Childbearing Practices:

Culture plays a significant role in pregnancy, childbirth, and child-rearing practices. This domain explores cultural beliefs, rituals, and healthcare-seeking behaviors related to pregnancy and childbirth. It addresses factors such as prenatal care, birthing practices, postpartum care, and cultural customs surrounding newborn care. Understanding and respecting cultural practices in this domain enables healthcare professionals to provide culturally competent care throughout the perinatal period.

  1. Death Rituals:

Death rituals and mourning practices vary across cultures. This domain examines cultural beliefs, practices, and rituals surrounding death, dying, and bereavement. It acknowledges the importance of respecting and supporting cultural expressions of grief and providing culturally sensitive end-of-life care.

  1. Spirituality:

Spirituality is a core aspect of many individuals’ cultural identities and can significantly influence their health and healing processes. This domain explores the cultural dimensions of spirituality, including religious beliefs, practices, rituals, and the integration of spirituality into healthcare..


  1. Healthcare Practices:

The healthcare practices domain focuses on the cultural beliefs, practices, and preferences related to healthcare-seeking behaviors and the perception of illness and healing. It recognizes that different cultures may have unique approaches to healthcare, including traditional healing methods, folk remedies, and cultural interpretations of illness.

  1. Medical Practitioners

Medical practitioners, including physicians, nurses, and other healthcare professionals, play a crucial role in providing medical care and promoting health and well-being. They are trained and licensed professionals who diagnose and treat medical conditions, offer preventive care, and provide guidance and support to patients.

The Purnell Model’s key strength lies in its holistic and comprehensive approach to cultural competence. By considering each of the twelve domains, healthcare professionals, particularly nurses, can gain a nuanced understanding of patients’ cultural backgrounds and tailor care accordingly. This model moves beyond stereotypes and generalizations, recognizing that cultural diversity is multifaceted and dynamic. The Purnell Model has been used by nurses, physicians, and physical and occupational therapists in practice, education, administration, and research in Australia, Belgium, Canada, Central America, Great Britain, Korea, South America, and Sweden. The model has also been translated into Flemish, French, Korean, and Spanish. Although the model is only 4 years old, it shows promise for becoming a major contribution to transcultural nursing and health care.

Primary and Secondary Characteristics of Culture

Culture is a complex and multifaceted concept that encompasses a wide range of primary and secondary characteristics. The Purnell Model for Cultural Competence includes primary and secondary characteristics of culture that determine variations in values, beliefs, and practices of an individual’s cultural heritage. The primary characteristics of culture include:

  • Communication: This includes verbal and nonverbal communication, language, and dialects.
  • Space: This refers to the physical space between individuals and how it is used.
  • Time: This includes the perception of time and how it is used in different cultures.
  • Social organization: This includes family structure, gender roles, and social hierarchies.
  • Environmental control: This refers to the degree to which individuals believe they can control their environment.
  • Biological variations: This includes physical characteristics such as skin color, body type, and hair texture.

The secondary characteristics of culture include:

  • Values: This includes beliefs about what is right and wrong, good and bad, and important and unimportant.
  • Beliefs: This includes religious, spiritual, and philosophical beliefs.
  • Practices: This includes customs, traditions, and rituals.
  • Customs: This includes behaviors that are considered normal or expected in a particular culture.
  • Traditions: This includes practices that have been passed down from generation to generation.
  • Rituals: This includes symbolic actions that have a specific meaning in a particular culture.

The Purnell Model’s primary and secondary characteristics of culture are relevant for advanced practice nurses because they provide a framework for understanding patients’ cultural backgrounds and promoting cultural competence in healthcare settings. By understanding patients’ cultural attributes, advanced practice nurses can provide care that is respectful of their beliefs and values, communicate effectively with patients from different cultures, and reduce health disparities.

How Nurses Can Use the Purnell Model to Develop Cultural Competence Skills that Enable them to Provide Quality Care to Diverse Patient Populations

Nurses can use the Purnell Model for Cultural Competence to develop cultural competence skills that enable them to provide quality care to diverse patient populations in the following ways:

  • Understanding the primary and secondary characteristics of culture: Nurses can use the model to understand the primary and secondary characteristics of culture that determine variations in values, beliefs, and practices of an individual’s cultural heritage. This understanding can help nurses provide care that is respectful of patients’ beliefs and values.
  • Assessing patients’ cultural backgrounds: Nurses can use the model to assess patients’ cultural backgrounds by using the 12 domains of the model as a guide. This assessment can help nurses identify patients’ cultural attributes and provide care that is tailored to their needs.
  • Communicating effectively with patients from different cultures: Nurses can use the model to develop communication skills that enable them to communicate effectively with patients from different cultures. This includes understanding patients’ language, dialects, and nonverbal communication.
  • Providing culturally competent care: Nurses can use the model to provide culturally competent care by incorporating patients’ cultural beliefs and practices into their care plans. This includes respecting patients’ preferences for food, clothing, and other cultural practices.
  • Reducing health disparities: Nurses can use the model to reduce health disparities by providing care that is respectful of patients’ cultural beliefs and practices. This can help improve patient outcomes and reduce healthcare costs

Why Cultural Competence is Important for Healthcare Providers and How it Can Help Reduce Health Disparities

Cultural competence, particularly in healthcare, entails the ability of professionals in this sector to exhibit the awareness of clients’ multicultural diversity and ethnic variations following their different beliefs, feelings, and principles. As such, healthcare providers emphasize the need for considering the individual patient’s cultural and social needs when administering various medical services to them. Cultural competency in healthcare seeks to moderate health discrepancies.

Cultural competence is important for healthcare providers because it helps them provide quality care to patients from diverse backgrounds. Here are some reasons why cultural competence is important in healthcare:

  1. Reducing health disparities: Cultural competence can help reduce health disparities by providing care that is respectful of patients’ cultural beliefs and practices. This can help improve patient outcomes and reduce healthcare costs.
  2. Improving patient satisfaction: Cultural competence can improve patient satisfaction by providing care that is tailored to their needs and preferences. This can help build trust between patients and healthcare providers.
  3. Enhancing communication: Cultural competence can enhance communication between patients and healthcare providers by understanding patients’ language, dialects, and nonverbal communication. This can help ensure that patients understand their diagnosis, treatment options, and medication instructions.
  4. Increasing access to care: Cultural competence can increase access to care by providing care that is respectful of patients’ cultural beliefs and practices. This can help reduce barriers to care, such as language barriers or lack of trust in the healthcare system.
  5. Promoting health equity: Cultural competence can promote health equity by providing care that is respectful of patients’ cultural beliefs and practices. This can help ensure that all patients receive the same quality of care, regardless of their cultural background or economic status.

Cultural competence is important for healthcare providers because it helps them provide quality care to patients from diverse backgrounds. By reducing health disparities, improving patient satisfaction, enhancing communication, increasing access to care, and promoting health equity, cultural competence can help improve patient outcomes and reduce healthcare costs.



In conclusion, exploring the Purnell Model for Cultural Competence and its various domains has provided valuable insights into the significance of cultural diversity in healthcare, particularly for advanced practice nurses. By understanding the primary and secondary characteristics of culture within this framework, nurses can enhance their cultural competence, strengthen patient-provider relationships, and deliver patient-centred care.

The primary characteristics of culture, such as race, ethnicity, and religious affiliation, help nurses appreciate the uniqueness of individuals and communities they serve. The secondary characteristics, including language, healthcare practices, and communication styles, allow nurses to adapt their care approaches and effectively address the cultural needs and preferences of patients.

By integrating the principles of the Purnell Model into their practice, nurses can develop cultural awareness, assess cultural influences, adapt care approaches, improve communication, and address healthcare disparities. These actions contribute to better patient outcomes, increased patient satisfaction, and a more inclusive healthcare environment.

I hope this blog has provided you with a deeper understanding of the Purnell Model and its relevance to advanced practice nursing. By embracing cultural competence and applying this knowledge in your practice, you are taking a crucial step towards providing high-quality and culturally sensitive care to your patients.

Remember, cultural competence is a continuous journey, and ongoing self-reflection and learning are essential. By staying open-minded, seeking cultural knowledge, and engaging in meaningful cross-cultural interactions, you can further enhance your ability to provide patient-centred care to individuals from diverse backgrounds.

Thank you for taking the time to read this blog. I hope it has been helpful in expanding your knowledge and understanding of cultural competence in healthcare. May your continued dedication to cultural competence lead to positive impacts on the lives of your patients and the advancement of healthcare as a whole.

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