Globalization and Diversity in Health Care

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Globalization and Cultural Competence in Healthcare

Globalization has encouraged the integration of individuals from various backgrounds in the twenty-first century. Multiculturalism has become more prevalent in this century, and so has the healthcare industry. One needs to be culturally competent in order to work in the health field effectively. The Purnell Model is suggested as an organizing structure in an effort to advance cultural competence among healthcare teams. The model is important for healthcare because it directs cultural competence among multidisciplinary members in all tertiary, secondary, and basic contexts, claim Douglas et al. (2014). As a result, the Purnell Model serves as the foundation for this piece and aids in providing a framework for comprehending the traits of culture and the ways in which various factors affect culture. Purnell Model for Cultural Competence

The Purnell Model for Cultural Competence

The model was initially developed as a structure to help students and staff learn about their cultures and those of their patients. The model is a set of circles and rims that represent different aspects of the society. The outer bordering of the circle symbolizes the global society while the next edge indicates the community. The third denotes family while the individual is represented in the inner rim. Purnell (2016) explains that the interior of the circle has been distributed into twelve wedges that represent cultural concepts. The middle is colored dark to represent an unidentified phenomenon. Also, there is a zigzag line that is placed at the bottom that signifies the nonlinear concepts of cultural awareness (Purnell, 2016).

Understanding Culture in Healthcare

The model has questions that can be utilized to assess culture and could be applied across disciplines and practice settings. Shen (2015) states that it is essential that all healthcare disciplines understand their client's ethnocultural beliefs to promote an efficient communication. Each discipline in the health sector has its own unique set of procedures that they use to know its clients as well as beliefs, attitudes, ideologies, values, norms, roles, and techniques. The knowledge of these factors is relevant within the different disciplines, and morticians, technicians, therapists, nutritionists, nurses, physicians, and other caregivers need to have culturally accurate information. Douglas et al. (2014) add that having an understanding of ethnocultural diversity is important as it improves the effectiveness of all healthcare givers. The twelve cultural domains help understand the organizational framework of the Purnell model.

Purnell's 12 Domains of Culture

Each of the 12 domains of Purnell Model for Cultural Competence provides an organizing framework that is significant in offering a collaboration between culturally diverse groups in the healthcare sector. Purnell (2016) states that the domains are interconnected, and they work together to contribute to the active role of diversity in health care. The first domain is heritage which represents the inhabited zones. According to Shen (2015), this area is essential in the diversity of health care system as the common factors in the country of origin, and current residence determines and impacts an individual's judgment towards other cultures. These factors include reasons for relocation, economics, politics, and value on education. Another domain is communication that involves the concepts that are connected to the dominant dialects and language. This area is concerned with the effectiveness of sharing information between a caregiver and a client using both verbal and nonverbal communication.

Family and Cultural Competence

The next domain is family and its roles. Family holds a part in the diversity of health care as the gender functions, priorities, and tasks assigned to children and adolescents determine how a caregiver will act towards a patient without ignoring the family ideals. The workforce includes issues such as health care practices that are common in the country of origin, assimilation, autonomy, and roles of genders in the workforce. These issues play a crucial role in the development of cultural competence. The next domain is a bio-cultural ecology that involves differences in racial and ethnic origins, hereditary, and how the response of the patient body to medications. As a caregiver, one must be mindful of the medication given to their patient. High-risk behavior is another important domain since people engage in drug abuse, risky sexual activities, and lack of physical activities which determine the type of care that a patient should receive. Nutrition plays a significant role in the diversity of health care as the type, quality, and quantity of food that one takes determines the care needs they have and what foods they use during illness.

Other Domains of the Purnell Model

Practices in pregnancy and childbearing is a domain that determines a person's views of restrictive, prescriptive, and taboo practices related to pregnancy and birthing. The next domain is death rituals which determine how an individual views death and their behaviors and rituals in preparation for burials. Spirituality also plays a key role in diversity in health care as it determines the religious practices and behaviors that one has towards life. To some people, spirituality is a source of strength. The domains also focus directly on health care. Healthcare practices are classified as an area that focuses on biomedical and traditional beliefs. This field shapes an individual's perception and response to pain and sickness. The last domain is comprised of the healthcare practitioners, and it includes the attitudes, usage, and status of both traditional and biomedical caregivers. The gender of the care provider is also focused in this domain, and these concepts determine the attention that a patient receives.

Applying the Purnell Model in Healthcare

One can apply this model to get a better understanding of their cultural practices, values, attitudes, beliefs, and behaviors to become a more culturally competent health care provider. The model can also be applied in different cultural settings to provide more knowledge through information sharing between patients and healthcare providers. A caregiver becomes more competent to handle patients from various cultures.


Douglas, M. K., Rosenkoetter, M., Pacquiao, D. F., Callister, L. C., Hattar-Pollara, M., Lauderdale, J., Milstead, J., ... Purnell, L. (February 18, 2014). Guidelines for Implementing Culturally Competent Nursing Care. Journal of Transcultural Nursing, 25, 2, 109-121.

Purnell, L. (June 29, 2016). The Purnell Model for Cultural Competence. Journal of Transcultural Nursing, 13, 3, 193-196.

Shen, Z. (January 01, 2015). Cultural Competence Models and Cultural Competence Assessment Instruments in Nursing: A Literature Review. Journal of Transcultural Nursing, 26, 3, 308-321.

June 26, 2023
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