theoretical models for cultural competence - week 4 Flashcards
Framework for teaching cultural skills to medical students and residents
Pneumonic device made to assist students with communication techniques L: listen E: explain A: acknowledge R: recommend N: negotiate
LEARN model
with sympathy and understanding to the patient’s perceptions of the problem
what do you feel might be causing the problem? How do you feel the illness is affecting you? What do you feel might be of benefit?
Listen
your perceptions of the problem
Diagnosis is often an educated guess at first. Here is some preliminary explanation.
-formulate your diagnosis
explain
discuss the differences and similarities
Find areas of agreement between explanatory models. Bridge gaps between different belief systems.
-where you and your patient are different
acknowledge
treatment
Involve patient in the planning of treatment to incorporate culturally relevant approaches. Check for patient understanding and acceptance of recommendations.
recommend
agreement
recovery is more likely when the therapeutic process fits within the cultural framework of the patient’s perception of healing and health.
-make a deal
negotiate
Originally an organizing framework that
developed into a model
Based on multiple theories
Holographic theory
Practitioners need both general and specific
cultural knowledge
The Purnell Model
12 cultural domains
- Overview/Heritage
- Communication
- Family views/organization
- workforce issues
- bicultural ecology
- high risk behaviors
- nutrition
- pregnancy and childbearing
- death rituals
- spirituality
- health care practices
- health practitioner
Purnell model
Concepts related to country of origin, current residence, the effects of the topography of the country of origin and current residence, economics, politics, reasons for emigration, educational status, and occupations
- overview and heritage of Purnell model
Concepts related to the dominant language and dialects; contextual use of the language; paralanguage variations such as voice volume, tone, and intonations; and the willingness to share thoughts and feelings. Nonverbal communications such as the use of eye contact, facial expressions, touch, body language, spatial distancing practices, and acceptable greetings; temporality in terms of past, present, or future worldview orientation; clock versus social time; and the use of names are important concepts.
- communication of Purnell model
Concepts related to the head of the household and gender roles; family roles, priorities, and developmental tasks of children and adolescents; child-rearing practices; and roles of the ages and extended family members. Social status and views toward alternative lifestyles such as single parenting, sexual orientation, child-less marriages, and divorce are also included in the domain.
- family roles and organization of Purnell model
Concepts related to autonomy, acculturation, assimilation, gender roles, ethnic communication styles, individualism, and health care practices from the country of origin
- workforce issues of Purnell model
Includes variations in ethnic and racial origins such as skin coloration and physical differences in body stature; genetic, heredity, endemic, and topographical diseases; and differences in how the body metabolizes drugs.
knowledge you need to know
- bicultural ecology of Purnell model
Includes the use of tobacco, alcohol and recreational drugs; lack of physical activity; nonuse of safety measures such as seatbelts and helmets; and high-risk sexual practices.
pregnancy or teenage pregnancy
- high risk behaviors of Purnell model
Includes having adequate food; the meaning of food; food choices, rituals, and taboos; and how food and food substances are used during illness and for health promotion and wellness.
- nutrition of Purnell model
Includes fertility practices; methods for birth control; views towards pregnancy; and prescriptive, restrictive, and taboo practices related to pregnancy, birthing, and postpartum treatment.
- pregnancy and childbearing of Purnell model
Includes how the individual and the culture view death, rituals and behaviors to prepare for death, and burial practices. Bereavement behaviors are also included in this domain.
- death rituals of Purnell model
Includes religious practices and the use of prayer, behaviors that give meaning to life, and individual sources of strength
- spirituality of Purnell model
Includes the focus of health care such as acute or preventive; traditional, magicoreligious, and biomedical beliefs; individual responsibility for health; self-medication practices; and views towards mental illness, chronicity, and organ donation and transplantation. Barriers to health care and one’s response to pain and the sick role are included in this domain.
- health care practices of Purnell model
Concepts include the status, use, and perceptions of traditional, magicoreligious, and allopathic biomedical health care providers. In addition, the gender of the health care provider may have significance.
- health care practitioner of Purnell model
4 types of cultural consciousness
- Unconsciously incompetent
- Consciously incompetent
- Consciously competent
- Unconsciously competent
Not being aware that one is lacking knowledge about another culture
you don’t know you are doing a bad job
unconsciously incompetent
Being aware that one is lacking knowledge about another culture
you know you are doing a bad job
consciously incompetent
Learning about the client’s culture, verifying generalizations about the client’s culture, and providing culturally specific interventions
im doing a great job, I know what I need to do and I have steps to get there
consciously competent
Automatically providing culturally congruent care to clients of diverse cultures
I don’t even realize that I have done the right thing
-Highest level
unconsciously competent
4 types of cultural consciousness are affected by…
age, generation, nationality, race, color, gender, religion, educational status, socioeconomic status, occupation, military status, political beliefs, urban versus rural residence, enclave identity, marital status, parental status, physical characteristics, sexual orientation, gender issues, and reason for migration (sojourner, immigrant, undocumented status)
Cultural groups deserve to experience their care based on an approach which their culture is respected
outcome is for patients to participate in their care
Healthcare practitioners and organizations should be co-participants
Use for assessing, planning, implementing, and evaluating interventions
Purnell model summary
