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Sample Dissertation Paper on Application of Theory: Purnell Model of Cultural Competence

Nursing theory involves the creative organization of ideas to communicate or represent a phenomenon purposefully and systematically. It is the outcome of systematic inquiry and experience in practice, which enables nursing scholars to develop hands-on knowledge that is valuable and relevant in efforts to improve nursing practice and patient care. In such a context, nursing theory describes a group or series of propositions that is coherent and serves as principles to explain the propositions and their value and significance in nursing practice (Smith, 2019). Such a theory offers a plan for nursing professionals and stakeholders to reflect on and examine the direction of care and management and decision-making in emerging situations. Nursing theory assists in the advancement and improvement of nursing and the formulation of values, beliefs, and goals.

The model of focus in this paper is the Purnell Model of Cultural Competence. This paper assesses the principles and definitions of the model, its qualification as a theoretical framework in nursing, and how it could apply in a nurse practitioner’s role. In the paper’s analysis, the focus shall be on the application of the model in the specialty of a Doctor of Nursing Practice-prepared nurse practitioner. In order to achieve this objective, the paper features a section that reviewing the selected model, a section appraising the model as a nursing theory/framework, a section discussing the model’s application to advanced practice nursing (particularly DNP-prepared nursing practice), and a concluding section featuring a restatement of main points and a self-reflection.

Overview of the Model

The Purnell Model of Cultural Competence (PMCC) is broadly popular and incorporates ideas concerning healthcare, professionals in healthcare, individuals, and cultures into an instrument for evaluation to create and gauge cultural competence in healthcare contexts. This model applies broadly to studies and teachings of competence across cultures in nursing contexts. Cultural competence refers to the capacity to understand, interact with, and communicate effectively with people across cultures, and develop positive attitudes towards differences in culture (Purnell & Fenkl, 2019). The developers of this theory were Larry Purnell and Betty Paulanka in the late 1990s and early 2000s (Whitman, 2006). The two scholars presented it as a framework to arrange and classify different aspects with an impact on an individual’s culture. The model utilizes an ethnographic approach to inspire appreciation and awareness of culture in healthcare contexts, providing a basis for healthcare providers to develop knowledge about features and concepts that relate to diverse cultures. The objective of this focus in the model is to assist individuals in nursing and healthcare to perform or practice culturally competent care (Purnell, 2005; Purnell & Fenkl, 2019). The model considers cultural competence as a continuing process, with individuals advancing from lacking knowledge/awareness about other cultures to developing it.

The Purnell model comprises four circles of different sizes, representing the philosophical concepts and worldviews applicable to nursing (person, global society, community, and family) and an inner circle with 12 parts to illustrate cultural domains, including communications, family roles/organization, nutrition, spirituality, healthcare practices, workforce issues, and death rituals. This arrangement in the model portrays the gradual process of acquiring cultural competence among individuals starting from being unconsciously unskilled (lacking personal knowledge/awareness about other cultures) to awareness of this incompetence, deliberate competence (learning about the cultures of others), and becoming oblivious to cultural competence (instinctive provision of culturally competent care). Some of the purposes of the model are (Purnell, 2005):

§  Providing a framework for learning the characteristics and concepts of culture

§  Defining the circumstances that underlie cultural worldview

§  Interrelating culture's characteristics to stimulate congruence and facilitate the delivery of competent and sensitive healthcare

§  Providing a framework that links the most central relationships of culture

§  Providing a structure to analyze cultural data

§  Enabling the view of individuals, families, and groups within their unique environments from an ethnocultural perspective

PMCC addresses the four aspects of the nursing meta-paradigm. It addresses the person by recognizing personal uniqueness and possession of own sense of the self and personal values, ideas, worldviews, and beliefs. It captures health in terms of the need to fulfill individual needs in a culturally competent manner, and nursing as a practice with a responsibility to fulfill individuals’ needs competently regarding cultural and personal differences. The model addresses the environment in terms of the relevance of cultural characteristics and features in the identity of an individual and the appropriateness and value of delivered care.

Appraisal

The PMCC serves as a theoretical framework relevant to nursing practice because it spells out a scheme to arrange and classify different elements that are relevant in understanding the culture of an individual. It forms a framework that healthcare and nursing practitioners could utilize to develop cultural competence by becoming aware of and appreciating culture and differences in culture among people. PMCC serves as a practical, theoretical scheme for healthcare practitioners to acquire knowledge and skills concerning the concepts and features of diverse cultures, and hence become capable of practicing and offering culturally competent and sensitive nursing and healthcare. The model is practical in nursing practice in terms of assisting professionals in the field to achieve a capacity to deliver culturally competent service to clients.

The model is particularly valuable for the specialty area of DNP practice in nursing in terms of helping the practitioners to understand differences in culture and train nursing staff effectively to deliver culturally competent care. It is possible through the application of an ethnographic approach to understand and appreciate the culture and encourage cultural awareness. DNP-prepared nurses serve as educators, leaders, guides, and policy-makers in nursing environments (Nichols, O’Connor, & Dun, 2014). In these roles, PMCC could serve as a suitable and practical instrument to teach and influence cultural competence in work among nursing staff. It enables these practitioners to assist nursing staff in attaining a capacity to perform and adhere to culturally competent care.

Application in Advanced Care Practice

PMCC can serve as a theoretical framework to inform and guide nursing practice in advanced care practice in terms of the leadership, policy-making, researching, and guidance roles of DNP-prepared nurses. It can enable these practitioners to teach, train, and study intercultural competence based on an approach of systems theory. It offers these practitioners a practical and elaborate way to create/promote and evaluate cultural competence. In the educator roles of these practitioners, PMCC can apply to teach nursing staff cultural competence progressively to inspire a change from complete lack of personal awareness about other cultures to the capacity to provide culturally sensitive care instinctively. This would occur through consideration of the four meta-paradigms in nursing and 12 domains of culture, including nutrition, family roles/organization, topography and localities, workforce issues, spirituality, bio-cultural ecology, high-risk behaviors, death rituals, and healthcare practices.

A specific example of a population with which the PMCC may be useful is frontline nursing staff in a healthcare organization. Sammer and James (2011) note that these professionals have direct and constant contact with patients from diverse cultural backgrounds, implying the need for their cultural competence to know how to communicate and interact with these patients effectively and address their health needs competently and satisfactorily. In this context, PMCC would apply to inspire a capacity to deliver culturally sensitive care instinctively. This would be possible through training to enable a view of individuals, groups, and families within their unique ethnocultural environment and inspire learning of the characteristics and concepts of culture. The application of the model would involve promoting a shift in levels of awareness of culture from a total lack of personal knowledge/awareness about other cultures to awareness of this incompetence, efforts to learn about the cultures of others, and eventually an instinctive capacity to provide culturally competent care.

Conclusion

The PMCC is a valuable theoretical framework in teaching intercultural competence among healthcare and nursing practitioners. It spells out a scheme to arrange and classify different elements that are relevant in understanding the culture of an individual, such that nursing practitioners could utilize it to develop cultural competence by becoming aware and appreciating culture and differences in culture among people. In the role of a DNP-prepared nurse, this model could be valuable as an instrument to teach and influence cultural competence. It could apply to promote a gradual shift in levels of awareness of culture from a total lack of personal knowledge/awareness about other cultures to awareness of this incompetence, an active effort to learn about the cultures of others, and eventually an instinctive capacity to provide culturally competent care.

From a personal perspective, this model offers a practical way of understanding culture and cultural differences at the community and individual levels. The incorporation of 12 domains of culture in the model makes it highly effective and exhaustive in promoting the understanding of culture and cultural differences in nursing. The model’s basis on an understanding of culture as a continuous process is appropriate because it incorporates the aspects of learning and personal development in cultural competence.

References

Nichols, C., O’Connor, N., & Dun, D. (2014). Exploring early and future use of DNP-prepared nurses within healthcare organizations. The Journal of Nursing Administration 44(2): 74-78.

Purnell, L. (2005). The Purnell Model for Cultural Competence. The Journal of Multicultural Nursing and Health 11(2): 7-15.

Purnell, L., & Fenkl, E. (2019). Handbook for culturally competent care. New York, US: Springer.

Sammer, C., & James, B. (2011). Patient safety culture: The nursing unit leader’s role. The Online Journal of Issues in Nursing 16(3).

Smith, M. (2019). Nursing theories and nursing practice. Philadelphia, PA: FA Davis

Whitman, M. (2006). An examination of cultural and linguistic competence in healthcare. Auburn University dissertation. Retrieved from: https://etd.auburn.edu/bitstream/handle/10415/541/WHITMAN_MARILYN_10.pdf;sequence=

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