MSN602 Group 5 Wiki



= Applying Purnell's Model for Cultural Competence to Birthing Mothers = Providing culturally sensitive care to a patient has a powerful unconscious impact on the provider-patient relationship, creates a mutually respectful environment, and promotes patient-centered care (Purnell, 2015). As providers, we promote culturally competent care when we recognize the importance of culture to patient health (Arelis Moore et al., 2019). One example of a patient population in which culturally competent care is very important is in pregnant women. Many cultures carry specific beliefs and rituals that accompany pregnancy, and may mean the mothers avoid certain foods or activities. It is important for nursing assessment to include questions that screen for these considerations in order to provide culturally competent care (Purnell, 2015).

What is the Purnell Model?
The Purnell Model of Cultural Competence was developed in 1989 by Larry Purnell out of the observed need for a framework for cultural competence education for nursing students. This theory has evolved and is now used to guide education and practice for nurses at many educational levels. This theory has twenty basic assumptions that healthcare providers can use to guide their practice to meet cultural diversity needs. Healthcare providers use effective communication strategies to share information with the multidisciplinary team, recognize the differences that each culture possess, and that each individual has the right to be respected for their uniqueness (Purnell, 2015). To provide adequate culturally competent care, we must appropriately assess and evaluate patient's needs to adapt standard intervention treatment models as needed (Purnell, 2015).

Purnell's Model states that there are many factors that contribute to being culturally competent in caring for others. Many aspects of nursing care describe a nurse providing culturally competent care including avoiding judgment, providing respect, and adapting care to fit the patient (Purnell, 2015). Nurses must always accept the responsibility to learn about cultural characteristics and apply these considerations to their practice. In order to develop cultural competence as a way of practice, nurses must be open to a continual process of learning and adapting (Purnell, 2015).

Purnell's 12 Domains Guide Nursing Assessment and Care
Purnell's Model for Cultural Competence is described using 12 categories: Heritage, Communication, Family Roles and Organization, Workforce Issues, Bio-cultural Ecology, High-Risk Health Behaviors, Nutrition, Pregnancy and Child Bearing Practices, Death Rituals, Spirituality and Healthcare Practices (Purnell, 2015). These domains are used to analyze aspects of culture to assist nurses in a more thorough assessment while building cultural competence (Purnell, 2015). Pregnancy/Childbirth is one of these 12 areas of focus in Purnell's Model because of how important the traditions and considerations are for influencing culturally competent care.

Examples of Cultural Considerations for Pregnant and Birthing Patients
Questions that may arise during assessment of child-bearing aged women often have cultural influences that need to be considered. Questions relating to sexual activity and habits, birth control use, and number of previous pregnancies, abortions, miscarriages, should all be looked at through cultural and religious context (Purnell, 2015). Many religions have beliefs about which type of birth controls are acceptable, therefore information on options should be presented but patient's beliefs and boundaries should be respected and not pushed. Number of current child, or family size and dynamic is also strongly tied to cultural identity, and patients should never feel judgement from a care provider for these decisions.

Pregnant patients may have beliefs about certain foods to eat or avoid because of cultural practices (Purnell, 2015). Pregnant Korean women often avoid spicy food, caffeine and crab, while African American culture may encourage eating non-food items such as clay during pregnancy (Purnell, 2015). Many Asian cultures do not eat cold foods following delivery of the baby, and will only accept cooked foods. A culturally competent provider should throughly assess all aspects of patients beliefs and rituals related to care in order to make the patient feel understood and respected (Purnell, 2015).

Many cultures have specific desires when it comes to who should be present during examinations and delivery in pregnancy and birth. For example, many Filipino patients only want their mother or other female family member present instead of their husbands. Some cultures, such as Central American Natives, wish to give birth in the squatting position instead of in a bed (Purnell, 2015). Aspects of Purnell's Model teach that communication with the patient should be thorough to understand all of the cultural considerations for a specific diagnosis. Self-education should also be ongoing for nurses and care providers to continue to grow in their knowledge of cultural competence (Purnell, 2015).

Post-delivery considerations and traditions are often affected by culture as well. Many patients may chose to include many family members in the time following birth, or chose to have only a spouse present. Russian women often avoid any type of activity following childbirth for fear of complications. Bathing may also be a topic of concern. While Haitian women have traditions around how many baths they take after childbirth given by specific family members, Arab women often avoid bathing post-delivery for fear that air can enter and cause complications (Purnell, 2015). Different cultures may have opposing ideas on the same activities, therefore it is extremely important for care providers to always grow their knowledge base on cultural practices in the patient populations they serve, and follow the knowledge up with thorough assessment questions.

Family Roles and Organization
The area of family dynamic and gender roles within family directly relates to childbirth and must be assessed during pregnancy. According to Purnell's Model, culture plays a role in how family unit's function, who lives in one household, and what are expected gender roles (Purnell, 2015). When assessing a pregnant patient about postpartum care and support, cultural traditions should be considered that shape the lifestyle of each patient. Many religions such as Arab and Indian often have elder generations living in the home with younger generations. Often times these cultures also carry traditions of the women not working outside the home. Conflict can arise for pregnant patient who may be living lifestyles that are alternate to their cultures traditions such as being a divorced mom, working mom or unwed mother (Purnell, 2015). Nurses should use Purnell's Model as a guide of how to assess each patient's cultural roles in their family unit and how they may find support for the postpartum period.

How Cultural Competence Improves Care
The United States is a melting pot of cultural diversity. The blending of different cultures make this country unique with all the changing demographics that although poses contradictory and challenges, remains steadfast in being united. As future nurse practitioners, applying Purnell’s model into practice will not only promote cultural competence and patient satisfaction by understanding their cultural practices, but it will also strengthen the trusting relationship with the client, thus enhancing top quality care. Cultural competence is one of the foundations of nursing (Sharifi, et al., 2019). Evidence-based results show that patients are more involved when their providers understand their unique culture. As much as nurses provide care and treatment plans for the client, societal values must always be a part of that care. By taking the time to learn and understand more about a patient's specific cultural characteristics, nurses have the ability to improve patient satisfaction and patient outcomes (Nair & Adetayo, 2019).

Cultural competence requires providers to be self-aware of their own beliefs and values, open to learning more about the various cultures we encounter, and innovative to incorporate our treatment plan to meet the culturally specific needs of our patients (Arelis Moore et al., 2019).