19
The Purnell Model for
Cultural Competence
Chapter 2
LARRY D. PURNELL
This chapter presents the Purnell Model for Cultural
Competence, its organizing framework, and the assump-
tions upon which the model is based. In addition, American
cultural values, practices, and beliefs are presented to assist
non–native American health-care providers to understand
American ways. The American references are meant to
describe, not prescribe or predict, behaviors and practices.
Although the authors recognize that Canada and Mexico are
part of North America, American, as used in this chapter,
refers to the dominant middle-class values of citizens of the
mainland United States. Owing to space limitations, this
chapter deals not with the objective culture—arts, literature,
humanities, and so on—but rather with the subjective cul-
ture. Many Americans are not aware of the subjective culture
because they identify differences as individual personality
traits and disregard political and social origins of culture.
Many view culture as something that belongs only to for-
eigners or disadvantaged groups. However, when Americans
travel abroad, their host country inhabitants many times
stereotypically identify them as Americans because of their
values, beliefs, attitudes, behaviors, speech patterns, and
mannerisms. Some feel that Americans are “fun lovers” and
that, for some Americans, violence is a way of life. However,
“the right to bear arms” is guaranteed by the Constitution.
Most likely, the United States is not any more violent than,
or even as violent as, many other societies, but American
media coverage may be better than other countries, thereby
giving the impression that the United States is more violent
than it actually is. Accordingly, these stereotypes are not
always accurate or desirable.
Western academic and health-care organizations
stress structure, systematization, and formalization when
studying complex phenomena such as culture and eth-
nicity. Given the complexity of individuals, the Purnell
Model for Cultural Competence provides a comprehen-
sive, systematic, and concise framework for learning and
understanding culture. The empirical framework of the
model can assist health-care providers, managers, and
administrators in all health disciplines to provide holis-
tic, culturally competent therapeutic interventions;
health promotion and wellness; illness, disease, and
injury prevention; health maintenance and restoration;
and health teaching across educational and practice
settings.
The purposes of this model are to
1. Provide a framework for all health-care providers
to learn concepts and characteristics of culture.
2. Define circumstances that affect a person’s cul-
tural worldview in the context of historical per-
spectives.
3. Provide a model that links the most central rela-
tionships of culture.
4. Interrelate characteristics of culture to promote
congruence and to facilitate the delivery of con-
sciously sensitive and competent h.
DINA TRISNAWTATI & FITRI DIANA ASTUTI purnel’s cultural competency.pptxFITRIDIANAASTUTI
The Purnell Model for Cultural Competence provides a framework to help healthcare providers deliver culturally sensitive care. The model includes 12 domains that describe cultural considerations, such as overview/heritage, communication, family roles, and health practices. It assumes that understanding a patient's culture is vital for compliance and outcomes. The model also has four levels of cultural competence that providers can develop. Its organizational structure allows practitioners to systematically account for cultural factors.
Comprehensive Cultural Assessment Essay.pdfsdfghj21
The document provides information on conducting a comprehensive cultural assessment using the Giger and Davidhizar Transcultural Assessment Model. The model includes six cultural phenomena for assessment: communication, space, social organization, time, environmental control, and biological variations. Two of these phenomena are reflected on from the perspective of American culture. Additionally, two nursing diagnoses are created for a culturally diverse patient that include rationales and plans for intervention and evaluation.
Read Theory and Practice of Counseling and Psychotherapy, pages.docxdanas19
Read:
Theory and Practice of Counseling and Psychotherapy
, pages 43-45; and
Addressing Diverse Populations in Intensive Outpatient Treatment
I have attached additional reading material, I need this by Thursday,
Serving Special Populations
After completing the reading for this unit, what do you think is the greatest obstacle facing special populations in addiction treatment? What will you do as a counselor to ensure that all of your clients receive the best treatment possible?
Your paper is to be in APA format, 1-2 pages, and include sources. Please see
paper guidelines
for explanation of requirements.
Addressing Diverse Populations in Intensive Outpatient Treatment
1. Introduction
1. Introduction
Culture is important in substance abuse treatment because clients' experiences of culture precede and influence their clinical experience. Treatment setting, coping styles, social supports, stigma attached to substance use disorders, even whether an individual seeks help--all are influenced by a client's culture. Culture needs to be understood as a broad concept that refers to a shared set of beliefs, norms, and values among any group of people, whether based on ethnicity or on a shared affiliation and identity.
Retrieved from,
Substance Abuse: Clinical Issues in Intensive Outpatient Treatment
, Center for Substance Abuse Treatment (2006).
2. What It Means To Be a Culturally Competent Clinician
It is agreed widely in the health care field that an individual's culture is a critical factor to be considered in treatment. The Surgeon General's report, Mental Health: Culture, Race, and Ethnicity, states, "Substantive data from consumer and family self-reports, ethnic match, and ethnic-specific services outcome studies suggest that tailoring services to the specific needs of these [ethnic] groups will improve utilization and outcomes” (U.S. Department of Health and Human Services 2001, p. 36). The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association 1994) calls on clinicians to understand how their relationship with the client is affected by cultural differences and sets up a framework for reviewing the effects of culture on each client.
Because verbal communication and the therapeutic alliance are distinguishing features of treatment for both substance use and mental disorders, the issue of culture is significant for treatment in both fields. The therapeutic alliance should be informed by the clinician's understanding of the client's cultural identity, social supports, self-esteem, and reluctance about treatment resulting from social stigma. A common theme in culturally competent care is that the treatment provider--not the person seeking treatment--is responsible for ensuring that treatment is effective for diverse clients.
Meeting the needs of diverse clients involves two components: (1) understanding how to work with persons from different cultures and (2) understandi.
Trans Cultural Nursing Concepts and Assessment by Azhar.pptxAzhar Munawar
Describe concept of trans-cultural nursing.
Explain key concepts related to trans-cultural nursing.
Identify the components of cultural assessment
Integrate concepts of trans-cultural nursing care throughout the life span.
Identify nursing frameworks and theories applicable to trans-cultural nursing.
Examine culturally related issues across the life span.
Explore the role of family and cultural practices related to the developmental stages.
This document provides an overview of transcultural nursing concepts and cultural competence in healthcare. It defines key terms like culture, ethnicity, religion, and discusses Giger and Purnell's model for assessing cultural variations. The document also summarizes Madeleine Leininger's Culture Care Theory, which focuses on discovering culturally appropriate caring behaviors. It outlines the basic assumptions and key concepts of the theory, including cultural diversity, universality, and the need to interface generic and professional care to provide culturally congruent nursing.
INTRODUCTION TO TRANSCULTURAL NURSING (2).pptxRahilRaj2
This document provides an overview of a lecture on transcultural nursing. It begins by outlining the learning outcomes, which include explaining the need for transcultural nursing, applying Madeleine Leininger's transcultural theory, examining ethical considerations, and discussing cultural competency standards. The document then defines transcultural nursing and expresses the need for it in healthcare. It explains Madeleine Leininger's transcultural nursing theory and the importance of self-awareness for health professionals. Finally, it discusses the individual nurse and health organization's expected cultural competencies.
This document provides information on transcultural nursing concepts and models. It discusses Madeleine Leininger's theory of transcultural nursing, which introduced the concepts of cultural care preservation, accommodation, and repatterning. It also describes Joyce Geiger and Ruth Davidhizer's transcultural assessment model, which identifies six cultural phenomena to assess: communication, space, social organization, time, environmental control, and biological variations. Finally, it examines cultural values and care meanings and actions for several cultures including Anglo-American, Mexican American, Haitian American, African American, and North American Indian cultures.
22CHAPTER 2 Cultural CompetencyAchieving cultural .docxrobert345678
This document discusses cultural competence in healthcare. It makes three main points:
1) Achieving cultural competence requires self-awareness, knowledge of different cultures, and effective communication skills. It involves understanding one's own biases and adapting care to meet patients' unique cultural and personal needs.
2) Culture encompasses many aspects of human behavior and identity, including ideas, beliefs, language, and ways of relating. It is important for healthcare providers to understand culture without making assumptions about patients based on physical characteristics or stereotypes.
3) Providing culturally competent care means recognizing the impact of factors like race, ethnicity, socioeconomic status, and discrimination on health outcomes and accessing care. It requires awareness of one
DINA TRISNAWTATI & FITRI DIANA ASTUTI purnel’s cultural competency.pptxFITRIDIANAASTUTI
The Purnell Model for Cultural Competence provides a framework to help healthcare providers deliver culturally sensitive care. The model includes 12 domains that describe cultural considerations, such as overview/heritage, communication, family roles, and health practices. It assumes that understanding a patient's culture is vital for compliance and outcomes. The model also has four levels of cultural competence that providers can develop. Its organizational structure allows practitioners to systematically account for cultural factors.
Comprehensive Cultural Assessment Essay.pdfsdfghj21
The document provides information on conducting a comprehensive cultural assessment using the Giger and Davidhizar Transcultural Assessment Model. The model includes six cultural phenomena for assessment: communication, space, social organization, time, environmental control, and biological variations. Two of these phenomena are reflected on from the perspective of American culture. Additionally, two nursing diagnoses are created for a culturally diverse patient that include rationales and plans for intervention and evaluation.
Read Theory and Practice of Counseling and Psychotherapy, pages.docxdanas19
Read:
Theory and Practice of Counseling and Psychotherapy
, pages 43-45; and
Addressing Diverse Populations in Intensive Outpatient Treatment
I have attached additional reading material, I need this by Thursday,
Serving Special Populations
After completing the reading for this unit, what do you think is the greatest obstacle facing special populations in addiction treatment? What will you do as a counselor to ensure that all of your clients receive the best treatment possible?
Your paper is to be in APA format, 1-2 pages, and include sources. Please see
paper guidelines
for explanation of requirements.
Addressing Diverse Populations in Intensive Outpatient Treatment
1. Introduction
1. Introduction
Culture is important in substance abuse treatment because clients' experiences of culture precede and influence their clinical experience. Treatment setting, coping styles, social supports, stigma attached to substance use disorders, even whether an individual seeks help--all are influenced by a client's culture. Culture needs to be understood as a broad concept that refers to a shared set of beliefs, norms, and values among any group of people, whether based on ethnicity or on a shared affiliation and identity.
Retrieved from,
Substance Abuse: Clinical Issues in Intensive Outpatient Treatment
, Center for Substance Abuse Treatment (2006).
2. What It Means To Be a Culturally Competent Clinician
It is agreed widely in the health care field that an individual's culture is a critical factor to be considered in treatment. The Surgeon General's report, Mental Health: Culture, Race, and Ethnicity, states, "Substantive data from consumer and family self-reports, ethnic match, and ethnic-specific services outcome studies suggest that tailoring services to the specific needs of these [ethnic] groups will improve utilization and outcomes” (U.S. Department of Health and Human Services 2001, p. 36). The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association 1994) calls on clinicians to understand how their relationship with the client is affected by cultural differences and sets up a framework for reviewing the effects of culture on each client.
Because verbal communication and the therapeutic alliance are distinguishing features of treatment for both substance use and mental disorders, the issue of culture is significant for treatment in both fields. The therapeutic alliance should be informed by the clinician's understanding of the client's cultural identity, social supports, self-esteem, and reluctance about treatment resulting from social stigma. A common theme in culturally competent care is that the treatment provider--not the person seeking treatment--is responsible for ensuring that treatment is effective for diverse clients.
Meeting the needs of diverse clients involves two components: (1) understanding how to work with persons from different cultures and (2) understandi.
Trans Cultural Nursing Concepts and Assessment by Azhar.pptxAzhar Munawar
Describe concept of trans-cultural nursing.
Explain key concepts related to trans-cultural nursing.
Identify the components of cultural assessment
Integrate concepts of trans-cultural nursing care throughout the life span.
Identify nursing frameworks and theories applicable to trans-cultural nursing.
Examine culturally related issues across the life span.
Explore the role of family and cultural practices related to the developmental stages.
This document provides an overview of transcultural nursing concepts and cultural competence in healthcare. It defines key terms like culture, ethnicity, religion, and discusses Giger and Purnell's model for assessing cultural variations. The document also summarizes Madeleine Leininger's Culture Care Theory, which focuses on discovering culturally appropriate caring behaviors. It outlines the basic assumptions and key concepts of the theory, including cultural diversity, universality, and the need to interface generic and professional care to provide culturally congruent nursing.
INTRODUCTION TO TRANSCULTURAL NURSING (2).pptxRahilRaj2
This document provides an overview of a lecture on transcultural nursing. It begins by outlining the learning outcomes, which include explaining the need for transcultural nursing, applying Madeleine Leininger's transcultural theory, examining ethical considerations, and discussing cultural competency standards. The document then defines transcultural nursing and expresses the need for it in healthcare. It explains Madeleine Leininger's transcultural nursing theory and the importance of self-awareness for health professionals. Finally, it discusses the individual nurse and health organization's expected cultural competencies.
This document provides information on transcultural nursing concepts and models. It discusses Madeleine Leininger's theory of transcultural nursing, which introduced the concepts of cultural care preservation, accommodation, and repatterning. It also describes Joyce Geiger and Ruth Davidhizer's transcultural assessment model, which identifies six cultural phenomena to assess: communication, space, social organization, time, environmental control, and biological variations. Finally, it examines cultural values and care meanings and actions for several cultures including Anglo-American, Mexican American, Haitian American, African American, and North American Indian cultures.
22CHAPTER 2 Cultural CompetencyAchieving cultural .docxrobert345678
This document discusses cultural competence in healthcare. It makes three main points:
1) Achieving cultural competence requires self-awareness, knowledge of different cultures, and effective communication skills. It involves understanding one's own biases and adapting care to meet patients' unique cultural and personal needs.
2) Culture encompasses many aspects of human behavior and identity, including ideas, beliefs, language, and ways of relating. It is important for healthcare providers to understand culture without making assumptions about patients based on physical characteristics or stereotypes.
3) Providing culturally competent care means recognizing the impact of factors like race, ethnicity, socioeconomic status, and discrimination on health outcomes and accessing care. It requires awareness of one
Transcultural Nursing is a nursing specialty focused on understanding and providing culturally congruent care to diverse populations. It involves comparing cultures to understand universal similarities as well as culture-specific differences in areas like health beliefs, caring practices, and responses to illness. A key founder, Madeleine Leininger, developed theories recognizing how culture influences health and developed models for providing culturally appropriate care. This includes assessing six cultural dimensions - communication, space, social organization, time, environmental control, and biological variations - that affect healthcare interactions across groups.
Transcultural Nursing is a nursing specialty focused on understanding and providing culturally congruent care to diverse populations. It involves comparing cultures to understand universal similarities as well as culture-specific differences in areas like health beliefs, caring practices, and responses to illness. A key founder, Madeleine Leininger, developed theories recognizing how culture influences health and developed models for providing culturally appropriate care. This includes assessing six cultural dimensions - communication, space, social organization, time, environmental control, and biological variations - that affect healthcare interactions across groups.
This document discusses transcultural nursing concepts and theories. It begins by defining transcultural nursing and describing key concepts related to it such as culture, ethnicity, and cultural identity. It then explains Madeleine Leininger's transcultural nursing theory and care concepts of cultural preservation, accommodation, and re-patterning. The document outlines the nursing process in transcultural care and concludes that nurses must be aware of and sensitive to patients' cultural needs to provide effective care.
Instructions to writer- this is a peer respond- please respond to Gabr.docxhye345678
Instructions to writer: this is a peer respond, please respond to Gabriella and Olga with a minimum of 150 words to each peer and at least 1 academic resource to each peer .
Must meet the following:
I need this in APA Style . Thank you!
This’s Gabriella Discussion Post ↓
The Purnell model for cultural competency is considered a model to improve comprehension on cultural competence for individuals within the healthcare community. The Model’s efficiency has been well-rooted in the globally, informing and bringing awareness, to the client’s culture using assessments, health-care planning, interventions, and evaluations (Purnell, 2013). Members of the healthcare field are acquainted to people from distinct backgrounds, cultures, beliefs, and values daily. The population is growing nationwide and is becoming more assorted. Therefore, nurses and other medical professionals need to become more familiar with cultural diversity or it might have a negative impact on the population. Purnell’s model aims at preventing this from happening by making nurses more culturally knowledgeable and catering to their needs regardless of a patient’s culture and background.
Purnell’s model of cultural competence is an ethnographic model that provides a cultural understanding of people in the process of health protection, development, and coping with diseases (Yalçın Gürsoy, & Tanrıverd, 2020). Purnell’s model is characterized as a model with a focus on four essential concepts which includes person, community, global society, and family. The most outer part of the diagram or model consists of the global society which emphasizes the obligation for healthcare workers to view the world and society as allied and not separate items. The model discusses how globalization and communication skills are effective in the influence of society and the method that individuals depict others based on their cultural background. Nonetheless, the model applies the community as a means of getting healthcare members involved and have the want to explore it as a way of comprehending one’s ethics and viewpoints. The way a certain community is seen, impacts decision making and goals to understand them can provide better care. In communities, family is also very important, as a patient may want a member to be included in any decision-making process. Additionally, professionals within the healthcare community must comprehend that a patient’s cultural tendencies, values and beliefs may revolve around familial connections. Finally, one of the most important concepts of the Purnell model is the person. When a medical professional is providing care to a patient, they must treat them as an individual who has their own morals and values. The four concepts of Purnell’s model, family, person, community, and global society have different ways that an individual interrelates, which may influence the treatment they receive and some of the decisions that are made.
Purnell’s mode.
NRSE 4570 Ohio University Comprehensive Cultural Assessment Essay.pdfbkbk37
This document provides guidance for an Ohio University nursing student's cultural assessment essay assignment. It outlines the key components to address in the paper, including describing a comprehensive cultural assessment, reflecting on two components of one's own American culture, and creating two nursing diagnoses for an imagined patient from a different cultural background. The student is instructed to follow APA formatting and include at least four references, two from course materials and two peer-reviewed sources no older than five years.
Cultural competency cc training moduleMark Massing
Telephone services for those with low health literacy can be improved in 3 key ways: (1) Avoid automated services and menus with many options, (2) Have real people answer calls who can understand questions and provide clear answers, (3) Speak slowly and clearly when providing information over the phone and have the person repeat back what they heard to confirm understanding.
This document discusses Madeleine Leininger's theory of transcultural nursing. It provides definitions of key terms like culture, ethnicity, and acculturation. Leininger established transcultural nursing as a formal area of study in the late 1960s to address the need for culturally competent care. Her theory, depicted in the Sunrise Model, aims to understand healthcare from diverse cultural perspectives to provide caring practices that are culturally congruent.
This document discusses transcultural nursing and the importance of cultural competence in nursing. It defines culture and explains how culture affects health, illness, and the healthcare experience. Transcultural nursing aims to provide culturally sensitive care that respects patients' cultural values and beliefs. Nurses must seek to understand their patients' cultures in order to effectively meet their healthcare needs and provide holistic care. Cultural competence is essential for nurses working in an increasingly diverse world.
This week's lecture discussed comparative health cultures and how cultural models of health, illness, and medicine impact well-being. It covered key concepts like ethnomedicine, the response of human groups to illness, different health care sectors including popular, professional, and folk, and cultural models of illness. The lecture also discussed the culture of public health and how acculturation can impact health. Students were assigned to read Mud Creek Medicine for next week's live discussion on these topics.
This document provides an overview of transcultural nursing and several models of transcultural nursing. It begins with definitions of transcultural nursing and cultural concepts. It then discusses the historical origins and development of transcultural nursing. Several influential models are described, including Leininger's model of culturally congruent care, Giger and Davidhizar's model of six cultural phenomena, and Campinha-Bacote's model of cultural competence with its five constructs. The document serves to introduce some of the key thinkers and frameworks in the field of transcultural nursing.
This document discusses culture and its influence on health beliefs and practices. It defines culture and discusses key related terms like ethnicity, race, religion and spirituality. It also examines the importance of cultural competence and sensitivity in healthcare, including the need for healthcare providers to understand their own cultural backgrounds and avoid biases. The document provides guidance on conducting a cultural assessment of a patient, including building trust, active listening, and considering social and economic contexts. It raises questions about applying these concepts in a case study of a patient.
The demographic profile of the countries suggests that countries are rapidly becoming heterogeneous, multicultural societies. So it is imperative that nurses develop an understanding about culture and its relevance to competent care. Transcultural nursing represents and reflects the need for respect and acknowledgement of the wholeness of all human beings.
It is essential to remember that regardless of race ethnicity or cultural heritage, every human being is culturally unique. Professional nursing care is culturally sensitive, culturally appropriate and culturally competent
Discussion 1 (Lindsay)
Module 1 Discussion
Cultural competence is having the capability to effectively interact with individuals belonging to different cultures. Being culturally competent is essential in the nursing profession. Specifically, because advanced practice nurses (APN) care for many different cultural groups in the community. Cultural competence plays a significant role in eliminating and decreasing health care disparities. Therefore, APNs must have the ability to communicate appropriately with different cultural backgrounds to effectively treat patient’s health concerns in a manner that is acceptable to the patient.
The Purnell model defines culture as behavioral patterns, beliefs, values, lifestyles, and all other factors that influence the human work and thought characteristics of a group of people that guide their worldview and decision making (Purnell, 2005). The Purnell model was a framework designed to use across all disciples and practice settings to assess different cultures. Every healthcare discipline values communication and must know their patients ethnocultural beliefs. Healthcare providers are more effective in caring for patients when they understand ethnocultural diversity. The model is a circle with three rims, the outlying rim represents global society, a second rim representing community, a third rim representing family, and the inner rim representing the person (Purnell, 2005). The interior of the circle is split into 12 parts representing cultural domains and their concepts. The 12 cultural domains construct the framework of the model. The Purnell model was developed for multiple purposes. These include providing a framework to learn concepts and characteristics of culture; define instances that affect an individual’s worldview; provide a tool that links the most significant relationships of culture; interrelate characteristics of culture that promote congruence to deliver sensitive and competent care; provide a structure for analyzing cultural data; and view individuals, families, and communities within their unique ethnocultural environment (Purnell, 2005). Communicating in a culturally sensitive way can minimize prejudices and biases.
Culturally competent communication means communicating with mindfulness and knowledge of health disparities and understanding that sociocultural influences have important effects on beliefs, behaviors, and the skills used to manage these factors appropriately (Taylor & Lurie, 2004). It is also important to recognize and understand different communication needs and styles. For example, identifying patient language preferences, literacy levels, and level of English proficiency. Promoting culturally competent communication in the health care setting reflects high quality care and a holistic approach. Good patient-provider communication is associated with increased adherence to treatment plans, higher patient satisfaction, and improved health outcomes (Taylor & Lurie, 2004). ...
NUR 4551 UP Mitigating Bullying and Lateral Violence Presentation.docxwrite30
This document discusses cultural diversity in healthcare and provides guidelines for incorporating cultural aspects into nursing leadership and management. It describes how to capitalize on a diverse workforce and support cultural differences to improve efficiency. The chapter presents concepts of transculturalism and techniques for managing a culturally diverse workforce. It emphasizes respecting different lifestyles and discusses how diversity affects staff performance.
1. The document discusses the concept of culture and healthcare. It defines culture and explains how cultural norms can impact a person's health beliefs and behaviors.
2. Embracing cultural competence in healthcare can improve quality of care by helping providers understand patient values and beliefs. Awareness of cultural factors is important for developing effective health communication strategies.
3. Analyzing one's own cultural influences is a first step for healthcare providers to improve cultural sensitivity when working with diverse populations.
Rev. Latino-Am. Enfermagem
2010 May-Jun; 18(3):459-66
www.eerp.usp.br/rlae
Corresponding Author:
Flavio Braune Wiik
Universidade Estadual de Londrina. Centro de Letras e Ciências Humanas.
Departamento de Ciências Sociais
Campus Universitário. Caixa-Postal 6001
CEP 86051-990 Londrina, PR, Brasil
E-mail: [email protected]
Anthropology, Health and Illness: an Introduction to the Concept of
Culture Applied to the Health Sciences
Esther Jean Langdon1
Flávio Braune Wiik2
This article presents a reflection as to how notions and behavior related to the processes of
health and illness are an integral part of the culture of the social group in which they occur.
It is argued that medical and health care systems are cultural systems consonant with the
groups and social realities that produce them. Such a comprehension is fundamental for the
health care professional training.
Descriptors: Culture; Anthropology; Health Care; Health Sciences.
1 Anthropologist, Ph.D. in Anthropology, Full Professor, Universidade Federal de Santa Catarina, SC, Brazil.
Email: [email protected]
2 Social Scientist, Ph.D. in Anthropology, Adjunct Professor, Universidade Estadual de Londrina, PR, Brazil.
Email: [email protected]
Original Article
460
www.eerp.usp.br/rlae
Antropologia, saúde e doença: uma introdução ao conceito de cultura
aplicado às ciências da saúde
O objetivo deste artigo foi apresentar uma reflexão de como as noções e comportamentos
ligados aos processos de saúde e de doença integram a cultura de grupos sociais onde
os mesmos ocorrem. Argumenta-se que os sistemas médicos de atenção à saúde,
assim como as respostas dadas às doenças, são sistemas culturais, consonantes com os
grupos e realidades sociais que os produzem. A compreensão dessa relação se mostra
fundamental para a formação do profissional da saúde.
Descritores: Cultura; Antropologia; Atenção à Saúde; Ciências da Saúde.
Antropología, salud y enfermedad: una introducción al concepto de
cultura aplicado a las ciencias de la salud
Este artículo presenta una reflexión acerca de como las nociones y comportamientos
asociados a los procesos de salud y enfermedad están integrados a la cultura de los
grupos sociales en los que estos procesos ocurren. Se argumenta que los sistemas
médicos de atención a la salud, así como las respuestas dadas a la enfermedad son
sistemas culturales que están en consonancia con los grupos y las realidades sociales
que los producen. Comprender esta relación es crucial para la formación de profesionales
en el área de la salud.
Descriptores: Cultura; Antropología; Atención a la Salud; Ciencias de la Salud.
Introduction
Perhaps it seems out of place to address the theme
of culture in a journal dedicated to the Health Sciences
or to argue that the concept of culture can be useful
for professionals of this area. Everyone has a common
sense idea of what “culture” means. We say that a person
“has culture” when he or sh ...
Transcultural nursing means being sensitive to cultural differences as you focus on individual patients, their needs, and their preferences. Show your patients your respect for their culture by asking them about it, their beliefs, and related health care practices.
This document discusses social and cultural determinants of health and provides examples of how culture impacts health behaviors and healthcare. It defines culture and lists its key elements. It distinguishes between collectivistic and individualistic cultures and how they differ in communication styles and decision making. The document outlines factors healthcare providers should consider regarding patients' views of health, illness, treatment, and interactions with providers to provide culturally competent care.
Madeleine Leininger developed the Culture Care Theory, which emphasizes that nursing care should be provided in a way that respects a patient's cultural values, beliefs, and practices. Her theory was groundbreaking as the first to incorporate culture and consider it essential to quality nursing care. The theory is depicted in her Sunrise Model and has guided 50 years of research on diverse cultural healthcare practices and their influence on health outcomes.
This document provides an overview of medical anthropology and its applications to health care. It discusses how medical anthropology addresses the interfaces between medicine, culture, and health behavior. It describes how cultural systems models examine the influence of culture on health through infrastructure, social structure, and ideological superstructure. These include factors like environment, social relationships, individual behavior, health services, and beliefs. The document emphasizes that understanding a community's cultural values and engaging community members are important for effective health programs and assessing health needs. Medical anthropology aims to incorporate cultural perspectives to improve health care delivery and public health programs.
2. Framework Graphic Candidates will create a graphic that re.docxherminaprocter
2. Framework Graphic
Candidates will create a graphic that reflects an understanding of a conceptual/theoretical framework (preferably related to their dissertation topic). In a graphic, candidates’ creations should clearly represent their vision of the framework and include 1 – 2 paragraphs on how the dependent and independent variables are evidenced.
Dissertation topic that I submitted is in the attachment that has a file name as Survey -27
.
2. Research Article Review – Read one (1) research articles on T.docxherminaprocter
2. Research Article Review
–
Read one (1) research articles on Therapeutic Recreation in Long Term Center or a specific treatment
modality/facilitation technique appropriate for older population in a long term care setting (e.g., assisted living, nursing home, etc.) and write a reaction paper based on guide questions. Must be 3 pages minimum. No plagiarism. Must have knowledge in Therapeutic Recreation Major and modalities.
Attached is an
EXAMPLE
of what I am looking for.
.
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Transcultural Nursing is a nursing specialty focused on understanding and providing culturally congruent care to diverse populations. It involves comparing cultures to understand universal similarities as well as culture-specific differences in areas like health beliefs, caring practices, and responses to illness. A key founder, Madeleine Leininger, developed theories recognizing how culture influences health and developed models for providing culturally appropriate care. This includes assessing six cultural dimensions - communication, space, social organization, time, environmental control, and biological variations - that affect healthcare interactions across groups.
This document discusses transcultural nursing concepts and theories. It begins by defining transcultural nursing and describing key concepts related to it such as culture, ethnicity, and cultural identity. It then explains Madeleine Leininger's transcultural nursing theory and care concepts of cultural preservation, accommodation, and re-patterning. The document outlines the nursing process in transcultural care and concludes that nurses must be aware of and sensitive to patients' cultural needs to provide effective care.
Instructions to writer- this is a peer respond- please respond to Gabr.docxhye345678
Instructions to writer: this is a peer respond, please respond to Gabriella and Olga with a minimum of 150 words to each peer and at least 1 academic resource to each peer .
Must meet the following:
I need this in APA Style . Thank you!
This’s Gabriella Discussion Post ↓
The Purnell model for cultural competency is considered a model to improve comprehension on cultural competence for individuals within the healthcare community. The Model’s efficiency has been well-rooted in the globally, informing and bringing awareness, to the client’s culture using assessments, health-care planning, interventions, and evaluations (Purnell, 2013). Members of the healthcare field are acquainted to people from distinct backgrounds, cultures, beliefs, and values daily. The population is growing nationwide and is becoming more assorted. Therefore, nurses and other medical professionals need to become more familiar with cultural diversity or it might have a negative impact on the population. Purnell’s model aims at preventing this from happening by making nurses more culturally knowledgeable and catering to their needs regardless of a patient’s culture and background.
Purnell’s model of cultural competence is an ethnographic model that provides a cultural understanding of people in the process of health protection, development, and coping with diseases (Yalçın Gürsoy, & Tanrıverd, 2020). Purnell’s model is characterized as a model with a focus on four essential concepts which includes person, community, global society, and family. The most outer part of the diagram or model consists of the global society which emphasizes the obligation for healthcare workers to view the world and society as allied and not separate items. The model discusses how globalization and communication skills are effective in the influence of society and the method that individuals depict others based on their cultural background. Nonetheless, the model applies the community as a means of getting healthcare members involved and have the want to explore it as a way of comprehending one’s ethics and viewpoints. The way a certain community is seen, impacts decision making and goals to understand them can provide better care. In communities, family is also very important, as a patient may want a member to be included in any decision-making process. Additionally, professionals within the healthcare community must comprehend that a patient’s cultural tendencies, values and beliefs may revolve around familial connections. Finally, one of the most important concepts of the Purnell model is the person. When a medical professional is providing care to a patient, they must treat them as an individual who has their own morals and values. The four concepts of Purnell’s model, family, person, community, and global society have different ways that an individual interrelates, which may influence the treatment they receive and some of the decisions that are made.
Purnell’s mode.
NRSE 4570 Ohio University Comprehensive Cultural Assessment Essay.pdfbkbk37
This document provides guidance for an Ohio University nursing student's cultural assessment essay assignment. It outlines the key components to address in the paper, including describing a comprehensive cultural assessment, reflecting on two components of one's own American culture, and creating two nursing diagnoses for an imagined patient from a different cultural background. The student is instructed to follow APA formatting and include at least four references, two from course materials and two peer-reviewed sources no older than five years.
Cultural competency cc training moduleMark Massing
Telephone services for those with low health literacy can be improved in 3 key ways: (1) Avoid automated services and menus with many options, (2) Have real people answer calls who can understand questions and provide clear answers, (3) Speak slowly and clearly when providing information over the phone and have the person repeat back what they heard to confirm understanding.
This document discusses Madeleine Leininger's theory of transcultural nursing. It provides definitions of key terms like culture, ethnicity, and acculturation. Leininger established transcultural nursing as a formal area of study in the late 1960s to address the need for culturally competent care. Her theory, depicted in the Sunrise Model, aims to understand healthcare from diverse cultural perspectives to provide caring practices that are culturally congruent.
This document discusses transcultural nursing and the importance of cultural competence in nursing. It defines culture and explains how culture affects health, illness, and the healthcare experience. Transcultural nursing aims to provide culturally sensitive care that respects patients' cultural values and beliefs. Nurses must seek to understand their patients' cultures in order to effectively meet their healthcare needs and provide holistic care. Cultural competence is essential for nurses working in an increasingly diverse world.
This week's lecture discussed comparative health cultures and how cultural models of health, illness, and medicine impact well-being. It covered key concepts like ethnomedicine, the response of human groups to illness, different health care sectors including popular, professional, and folk, and cultural models of illness. The lecture also discussed the culture of public health and how acculturation can impact health. Students were assigned to read Mud Creek Medicine for next week's live discussion on these topics.
This document provides an overview of transcultural nursing and several models of transcultural nursing. It begins with definitions of transcultural nursing and cultural concepts. It then discusses the historical origins and development of transcultural nursing. Several influential models are described, including Leininger's model of culturally congruent care, Giger and Davidhizar's model of six cultural phenomena, and Campinha-Bacote's model of cultural competence with its five constructs. The document serves to introduce some of the key thinkers and frameworks in the field of transcultural nursing.
This document discusses culture and its influence on health beliefs and practices. It defines culture and discusses key related terms like ethnicity, race, religion and spirituality. It also examines the importance of cultural competence and sensitivity in healthcare, including the need for healthcare providers to understand their own cultural backgrounds and avoid biases. The document provides guidance on conducting a cultural assessment of a patient, including building trust, active listening, and considering social and economic contexts. It raises questions about applying these concepts in a case study of a patient.
The demographic profile of the countries suggests that countries are rapidly becoming heterogeneous, multicultural societies. So it is imperative that nurses develop an understanding about culture and its relevance to competent care. Transcultural nursing represents and reflects the need for respect and acknowledgement of the wholeness of all human beings.
It is essential to remember that regardless of race ethnicity or cultural heritage, every human being is culturally unique. Professional nursing care is culturally sensitive, culturally appropriate and culturally competent
Discussion 1 (Lindsay)
Module 1 Discussion
Cultural competence is having the capability to effectively interact with individuals belonging to different cultures. Being culturally competent is essential in the nursing profession. Specifically, because advanced practice nurses (APN) care for many different cultural groups in the community. Cultural competence plays a significant role in eliminating and decreasing health care disparities. Therefore, APNs must have the ability to communicate appropriately with different cultural backgrounds to effectively treat patient’s health concerns in a manner that is acceptable to the patient.
The Purnell model defines culture as behavioral patterns, beliefs, values, lifestyles, and all other factors that influence the human work and thought characteristics of a group of people that guide their worldview and decision making (Purnell, 2005). The Purnell model was a framework designed to use across all disciples and practice settings to assess different cultures. Every healthcare discipline values communication and must know their patients ethnocultural beliefs. Healthcare providers are more effective in caring for patients when they understand ethnocultural diversity. The model is a circle with three rims, the outlying rim represents global society, a second rim representing community, a third rim representing family, and the inner rim representing the person (Purnell, 2005). The interior of the circle is split into 12 parts representing cultural domains and their concepts. The 12 cultural domains construct the framework of the model. The Purnell model was developed for multiple purposes. These include providing a framework to learn concepts and characteristics of culture; define instances that affect an individual’s worldview; provide a tool that links the most significant relationships of culture; interrelate characteristics of culture that promote congruence to deliver sensitive and competent care; provide a structure for analyzing cultural data; and view individuals, families, and communities within their unique ethnocultural environment (Purnell, 2005). Communicating in a culturally sensitive way can minimize prejudices and biases.
Culturally competent communication means communicating with mindfulness and knowledge of health disparities and understanding that sociocultural influences have important effects on beliefs, behaviors, and the skills used to manage these factors appropriately (Taylor & Lurie, 2004). It is also important to recognize and understand different communication needs and styles. For example, identifying patient language preferences, literacy levels, and level of English proficiency. Promoting culturally competent communication in the health care setting reflects high quality care and a holistic approach. Good patient-provider communication is associated with increased adherence to treatment plans, higher patient satisfaction, and improved health outcomes (Taylor & Lurie, 2004). ...
NUR 4551 UP Mitigating Bullying and Lateral Violence Presentation.docxwrite30
This document discusses cultural diversity in healthcare and provides guidelines for incorporating cultural aspects into nursing leadership and management. It describes how to capitalize on a diverse workforce and support cultural differences to improve efficiency. The chapter presents concepts of transculturalism and techniques for managing a culturally diverse workforce. It emphasizes respecting different lifestyles and discusses how diversity affects staff performance.
1. The document discusses the concept of culture and healthcare. It defines culture and explains how cultural norms can impact a person's health beliefs and behaviors.
2. Embracing cultural competence in healthcare can improve quality of care by helping providers understand patient values and beliefs. Awareness of cultural factors is important for developing effective health communication strategies.
3. Analyzing one's own cultural influences is a first step for healthcare providers to improve cultural sensitivity when working with diverse populations.
Rev. Latino-Am. Enfermagem
2010 May-Jun; 18(3):459-66
www.eerp.usp.br/rlae
Corresponding Author:
Flavio Braune Wiik
Universidade Estadual de Londrina. Centro de Letras e Ciências Humanas.
Departamento de Ciências Sociais
Campus Universitário. Caixa-Postal 6001
CEP 86051-990 Londrina, PR, Brasil
E-mail: [email protected]
Anthropology, Health and Illness: an Introduction to the Concept of
Culture Applied to the Health Sciences
Esther Jean Langdon1
Flávio Braune Wiik2
This article presents a reflection as to how notions and behavior related to the processes of
health and illness are an integral part of the culture of the social group in which they occur.
It is argued that medical and health care systems are cultural systems consonant with the
groups and social realities that produce them. Such a comprehension is fundamental for the
health care professional training.
Descriptors: Culture; Anthropology; Health Care; Health Sciences.
1 Anthropologist, Ph.D. in Anthropology, Full Professor, Universidade Federal de Santa Catarina, SC, Brazil.
Email: [email protected]
2 Social Scientist, Ph.D. in Anthropology, Adjunct Professor, Universidade Estadual de Londrina, PR, Brazil.
Email: [email protected]
Original Article
460
www.eerp.usp.br/rlae
Antropologia, saúde e doença: uma introdução ao conceito de cultura
aplicado às ciências da saúde
O objetivo deste artigo foi apresentar uma reflexão de como as noções e comportamentos
ligados aos processos de saúde e de doença integram a cultura de grupos sociais onde
os mesmos ocorrem. Argumenta-se que os sistemas médicos de atenção à saúde,
assim como as respostas dadas às doenças, são sistemas culturais, consonantes com os
grupos e realidades sociais que os produzem. A compreensão dessa relação se mostra
fundamental para a formação do profissional da saúde.
Descritores: Cultura; Antropologia; Atenção à Saúde; Ciências da Saúde.
Antropología, salud y enfermedad: una introducción al concepto de
cultura aplicado a las ciencias de la salud
Este artículo presenta una reflexión acerca de como las nociones y comportamientos
asociados a los procesos de salud y enfermedad están integrados a la cultura de los
grupos sociales en los que estos procesos ocurren. Se argumenta que los sistemas
médicos de atención a la salud, así como las respuestas dadas a la enfermedad son
sistemas culturales que están en consonancia con los grupos y las realidades sociales
que los producen. Comprender esta relación es crucial para la formación de profesionales
en el área de la salud.
Descriptores: Cultura; Antropología; Atención a la Salud; Ciencias de la Salud.
Introduction
Perhaps it seems out of place to address the theme
of culture in a journal dedicated to the Health Sciences
or to argue that the concept of culture can be useful
for professionals of this area. Everyone has a common
sense idea of what “culture” means. We say that a person
“has culture” when he or sh ...
Transcultural nursing means being sensitive to cultural differences as you focus on individual patients, their needs, and their preferences. Show your patients your respect for their culture by asking them about it, their beliefs, and related health care practices.
This document discusses social and cultural determinants of health and provides examples of how culture impacts health behaviors and healthcare. It defines culture and lists its key elements. It distinguishes between collectivistic and individualistic cultures and how they differ in communication styles and decision making. The document outlines factors healthcare providers should consider regarding patients' views of health, illness, treatment, and interactions with providers to provide culturally competent care.
Madeleine Leininger developed the Culture Care Theory, which emphasizes that nursing care should be provided in a way that respects a patient's cultural values, beliefs, and practices. Her theory was groundbreaking as the first to incorporate culture and consider it essential to quality nursing care. The theory is depicted in her Sunrise Model and has guided 50 years of research on diverse cultural healthcare practices and their influence on health outcomes.
This document provides an overview of medical anthropology and its applications to health care. It discusses how medical anthropology addresses the interfaces between medicine, culture, and health behavior. It describes how cultural systems models examine the influence of culture on health through infrastructure, social structure, and ideological superstructure. These include factors like environment, social relationships, individual behavior, health services, and beliefs. The document emphasizes that understanding a community's cultural values and engaging community members are important for effective health programs and assessing health needs. Medical anthropology aims to incorporate cultural perspectives to improve health care delivery and public health programs.
Similar to 19The Purnell Model forCultural CompetenceChapter 2.docx (20)
2. Framework Graphic Candidates will create a graphic that re.docxherminaprocter
2. Framework Graphic
Candidates will create a graphic that reflects an understanding of a conceptual/theoretical framework (preferably related to their dissertation topic). In a graphic, candidates’ creations should clearly represent their vision of the framework and include 1 – 2 paragraphs on how the dependent and independent variables are evidenced.
Dissertation topic that I submitted is in the attachment that has a file name as Survey -27
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2. Research Article Review – Read one (1) research articles on T.docxherminaprocter
2. Research Article Review
–
Read one (1) research articles on Therapeutic Recreation in Long Term Center or a specific treatment
modality/facilitation technique appropriate for older population in a long term care setting (e.g., assisted living, nursing home, etc.) and write a reaction paper based on guide questions. Must be 3 pages minimum. No plagiarism. Must have knowledge in Therapeutic Recreation Major and modalities.
Attached is an
EXAMPLE
of what I am looking for.
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2) In examining Document 4 and Document 6, how did the.docxherminaprocter
2)
In examining
Document 4
and
Document 6
, how did the onset of the Cold War redefine what it meant to be an American? What role do these documents suggest loyal citizens play in waging war against Communism? In examining the political cartoon (
Document 5
), how does the artist critique the “anti-subversive” efforts that took place during the Second Red Scare? In what ways does the McCarthy era continue to influence American society?
3)
The turbulent 1960s saw numerous attempts to identify the root problems within American society and the role of citizens in resolving them. In examining
Document 7
,
Document 8
, and
Document 9
, what common problems are identified within American society? What are some of the differences? What role did each of these documents suggest Americans should play in achieving social justice? Are their arguments persuasive? Why or why not?
4)
The last several decades of the Twentieth Century saw the emergence of new groups of Americans claiming rights as citizens. To what extent does the failure of the Equal Rights Amendment (
Document 10
) to be ratified, but the signing of Title IX (
Document 11
) into law, signal about the changing role and rights of women in modern America? After reading President George H.W. Bush’s remarks (
Document 12
), why do you believe it took so long for the country to acknowledge and protect the rights of the disabled?
5)
How does Maya Angelou’s inauguration poem (
Document 13
) reflect upon the identity of “hyphenated Americans” by the early 1990s? In reading
Document 14
, how does President-Elect Barack Obama define Americanism? Looking back over documents 1-13, did his election, as the first person of color to become President of the United States, resolve the questions and crises surrounding the definition of an American citizen? In a post-9/11 world, has America progressed in its inclusiveness? Why or why not?
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2. Sandra is a parent who believes that play is just entertainment f.docxherminaprocter
2. Sandra is a parent who believes that play is just entertainment for children, whereas Petra is a parent who believes that play is developmentally beneficial for children. Which is likely to be true about Sandra and Petra?
Group of answer choices
A. Sandra’s children are more likely to have richer imaginations than Petra’s children.
B. Sandra is less likely than Petra to encourage pretend play.
C. Petra is more likely than Sandra to encourage associative play.
D. Petra is less likely than Sandra to provide props for her children to play with.
3. Three-year-old Aiko is pretending that her teddy bear is going to the beach and places a paper plate on the teddy bear’s head as a “hat.” Aiko is demonstrating...
Group of answer choices
A. dual representation
B. egocentrism
C. centration
D. animistic thinking
5.
Nikki and Anna are both running for class president. When Anna wins the election, Nikki is jealous and spreads rumors about Anna. Nikki is displaying .. (pick below.......) aggression
A. verbal
B."reactive",
C"physical",
D"proactive"]
6. Kris has a preschool-age daughter named Leila. When Kris gives Leila three cookies and asks her to count them, Leila points to each cookie, one-by-one, and says, “One, two, three.” When Kris asks Leila, “How many cookies do you have?” Leila proudly answers, “Three!” Leila is demonstrating an understanding of...
Group of answer choices
A. Cardinality
B.arithmetic
C. quantity comparisons
D. Ordinality
.
2.2 Discussion What Is LeadershipGetting StartedR.docxherminaprocter
This document provides instructions and background information for an assignment on ethics and values in leadership. It discusses how leaders face ethical dilemmas that require balancing competing priorities and values. Students are asked to read about ethical reasoning and creating an ethical organizational culture from their textbook. They are also instructed to read two articles on virtuous leadership and business. The assignment requires students to describe a personal ethical dilemma, discuss how an ethical culture can influence such dilemmas, and cite the provided sources in a 400-500 word paper.
2. You are a member of the Human Resource Department of a medium-si.docxherminaprocter
2. You are a member of the Human Resource Department of a medium-sized organization that is implementing a new interorganizational system that will impact employees, customers, and suppliers. Your manager has requested that you work with the system development team to create a communications plan for the project. He would like to meet with you in two hours to review your thoughts on the KEY OBJECTIVES OF THE COMMUNICATIONS PLAN. What should those objectives be?
.
2.1. What is Strategic Human Resource Management Differentiate bet.docxherminaprocter
Strategic human resource management involves using HR tools and metrics to align human resource strategies with overall business strategies. Managers can improve employee engagement through job analysis, which collects data on jobs using methods like surveys, interviews, and observations to understand job requirements. Job analysis also identifies the competencies needed for roles, which are written descriptions of knowledge, skills, and abilities required for success.
2,___Use of no less than six slides and no more than seven .docxherminaprocter
2,___Use of no less than six slides and no more than seven:
a. An introductory slide with the title or research question and your name and student number.
b. The remaining 4-5 pieces of information will be responsible for answering the information question:
What was the impact of ________en the history of _________?
c. An APA-style bibliography slide.
3.__one or more than another image in the power point related to the theme. One of these images may be the image of the neighbor being investigated.
4.__Bibliografía (no less than 4 references: Two from the Internet, one from one book and one from an interview- APA style)
7. ___write in your own words. No copy paste.
8. __ (Correct spelling and punctuation and note that the writing is yours and not a copy paste from the Internet or a book). Check the work before delivering it with this same check list.
V. Depth
9.__Desarrollo of the research question. Answer it through the power point presentation.
10. __ Depth in the study. Copy paste is not accepted. Any plagiarism (may be: copy a concept, even a sentence, whose intellectual author is not you, invalidates this research- see the university's politics regarding plagiarism). Each criterion is worth ten points.
¿Cómo impacta la novela a la historia de Puerto Rico?
Yeralis M. Rivera Arguinzoni
B00569846
Dra. Vilma Pizarro
Historia de Puerto rico
Universidad Interamericana Recinto de Barranquitas
Comienzos de la novela en Puerto Rico
La literatura en Puerto Rico comienza a finales del siglo XIX.
Movimiento del romanticismo( Europa: Alemania, Inglaterra y España)
Géneros literarios: Poesía, teatro, ensayo y narrativa( novela, cuentos, leyendas, etc.).
La novela es el último género en llegar a Puerto Rico y a América.
En estas novelas trataban los temas de: el amor a la patria, el destino, la muerte, Dios y el progreso, entre otros.
La primera novela puertorriqueña
Hay dos teorías sobre la primer novela puertorriqueña:
Luz y Sombra(1893) = Escrita por Ana Roque de Duprey, primera novela escrita en Puerto Rico.
“La Peregrinación de Bayoán”(1863) = Escrita por Eugenio María de Hostos, primera novela escrita por un puertorriqueño pero es escrita en España. Esta es la mas aceptada como la primera novela puertorriqueña. Su tema principal era la lucha por la identidad del puertorriqueño. Ideas políticas y sociales de Hostos luego del grito de Lares y el grito de Yara(Cuba), fueron expresadas en esta novela.
Otros escritores importantes de la época
Manuel Zeno Gandía = Considerado como el más grande novelista de Puerto Rico. Sus obras: “La Charca”, “Garduña” y “El Negocio”, conocidas como “Crónicas de un mundo enfermo”, se escriben ya bajo el naturalismo. Presentan a un Puerto Rico enfermo y la situación crítica de un Puerto Rico abandonado por España.
Enrique A. Laguerre = Sus obras más importantes: “La Resaca” y “La llamarada”. Sus obras presentan la pésima situación de vida del campesinado a finales del siglo XIX.
.
2. Multicultural Interview Paper Students may begin this.docxherminaprocter
2.
Multicultural Interview Paper
Students may begin this assignment by selecting an individual from a culture differing from their own. This may be any culture or subgroup covered in the course content, such as adolescents, elderly adults, and persons with disabilities.
Students are not limited to these groups.
Students will create a series of interview questions focused on issues and concerns pertinent to the culture or subgroup
. Interview questions are to be specific and designed to help the student learn more about the culture or subgroup as it relates to Addictions & course studies. Students may use their text book and other course resources as guidelines for developing questions. Students should develop a minimum of eight-10 interview questions.
Students
must
submit interview questions to the course instructor and receive approval of the questions before proceeding with the assignment.
Students will then use these approved questions during the interview with the consenting individual and write a two page summarization of the questions with the answers received by the individual. The paper must be in question/answer format.
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2-4A summary of your findings regarding sexual orientation and.docxherminaprocter
2-4
A summary of your findings regarding sexual orientation and its impact on life-span development, including findings from the resources and from the journal article(s) you selected during your research
An explanation of how you might apply your findings to social work practice
.
2- to 4A description of the services in your local communi.docxherminaprocter
2- to 4
A description of the services in your local community that support individuals in later adulthood
An evaluation of the effectiveness of the services you identified
A description of service gaps you identified
An explanation of how to improve existing services
A description of services that should be added, and why
.
2 or more paragraphAs previously noted, the Brocks have some of.docxherminaprocter
2 or more paragraph
As previously noted, the Brocks have some of their investment portfolio in conservative stocks. These equities have had very slow growth while regularly paying a small dividend.
Pam and Josh have received several emails recently with suggestions about various biotechnology, retailing, and environmental companies. The investment advisers believe that these industries would provide an opportunity for strong long-term financial gains.
In recent years, the Brocks have made extensive use of mutual funds in their investment portfolio. However, they are concerned that their selection of the funds may not be coordinated. With over 9,200 different mutual funds available, this financial marketplace is confusing.
The Brocks start the evaluation process by connecting various types of mutual funds to their investments goals. Next, they assess the past performance and management of the funds. Finally, they talk with various financial advisers and other investors to gather additional information.
Life Situation
Pam, 43
Josh, 45
3 Children, ages 16, 14 and 11
Financial Data
Monthly income$4,900 / Living expenses$4,450/ Assets$262,700/ Liabilities$84,600/ Emergency Fund$5,000
Q1. According to Pam, "We both know we should have started our investment program sooner, but we always seemed to have 'emergencies' that took what extra money we had." To what extent should the Brocks invest in stocks as a major portion of their investment portfolio?
.
2-1 IntroductionUber Technologies Inc. (Uber) is a tech startu.docxherminaprocter
2-1 Introduction
Uber Technologies Inc. (Uber) is a tech startup that provides ride-sharing services by
facilitating a connection between independent contractors (drivers) and riders with the use
of an app. Uber has expanded its operations to 425 cities in 72 countries around the world
and is valued at around $70 billion, making it the world’s most valuable startup.
Approximately 30 million users use Uber’s services monthly. Uber has become a key player
in the sharing economy, a new economic model in which independent contractors rent out
their underutilized resources such as vehicles or lodging to other consumers. The sharing
economy is quickly becoming an alternative to owning resources outright. Because its
services cost less than taking a traditional taxi, Uber and similar ride-sharing services have
upended the taxi industry. The company has experienced resounding success and is
looking toward expansion both internationally and within the United States.
However, Uber’s rapid success is creating challenges in the form of legal and regulatory,
social, and technical obstacles. The taxi industry, for instance, is arguing that Uber has an
unfair advantage because it does not face the same licensing requirements as they do.
Others accuse Uber of not vetting their drivers, creating potentially unsafe situations. Some
major cities are banning ride-sharing services like Uber because of these various concerns.
Additionally, Uber has faced various lawsuits, including a lawsuit filed by its independent
contractors. Its presence in the market has influenced lawmakers to draft new regulations to
govern this “app-driven” ride-sharing system. Legislation can often hinder a company’s
expansion opportunities because of the resources it must expend to comply with regulatory
requirements. Uber has been highly praised for giving independent contractors an opportunity to earn money as long as they have a car, while also offering convenient ways for consumers to get around at lower costs. Although its “Surge Pricing” technique has been criticized for charging higher fares during popular times, it is also becoming a model for other companies such as Zappos in how it compensates its call center employees. The biggest issues Uber faces include legal action because drivers are not licensed, rider and driver safety,protection and security of customer and driver information, and a lack of adequate insurance coverage. To be successful, Uber must address these issues in its marketing strategy so it can reduce resistance as it expands into other cities.
2-2 Background
In 2009 Travis Kalanick and Garrett Camp developed a smartphone application to connect
drivers-for-hire with people needing rides to a destination in their city. Earlier in the year the
founders had attended the inaugural address in Washington, D.C. and could not hail a taxi.
They recognized the need for a convenient, low-cost transportation service. This innovative
service was originally founded.
2 postsRe Topic 2 DQ 1Social determinants of health are fac.docxherminaprocter
2 posts
Re: Topic 2 DQ 1
Social determinants of health are factors affecting peoples’ health, functioning and well-being, such as environmental conditions, social, and economic variables. Socioeconomic environmental factors contributing to infectious disease occurrence include crowding, unsanitary, unavailability of uncontaminated foods and water. These conditions provide an environment required for continuous chain of infection; the process required for transmission of disease. There are 6 components in the chain, or a cycle, of infection: organisms, reservoir, portal of exit, transmission, portal of entry, and a suspectable host (Green, 2018). To stop spreading of a communicable disease, the process has to interrupted or the chain of infection has to be broken at any point. Nurses, working in communities can decrease of the infectious diseases spreading. Promoting vaccination to lowering susceptible hosts number; and educating on sign and symptoms for early self-isolation to protect one’s family members from getting sick, breaking the transmission link. Educating on thorough hand hygiene and reducing face touching may protect one from getting sick eliminate portal of entry link. Proper respiratory hygiene, such as using disposable tissues and covering the mouth when sneezing, may stop the transmission on the stage of the pathogen leaving the reservoir via portal of exit (CDC.gov).
Noncommunicable chronic diseases, such as type 2 diabetes, have grown in endemic and epidemic proportions, are developing from a combination of determinants including environmental, physiological, and behavioral factors, additionally to genetic disposition (Green, 2018). Lack of knowledge and motivation, unavailability of healthcare services and financial resources contribute to developing of such diseases.q
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2 peer responses due in 4 hoursMALEETAS POSTWorld War .docxherminaprocter
2 peer responses due in 4 hours
MALEETA'S POST:
World War II film
Saving Private Ryan (1998), directed by one of my favorites,
Steven Spielberg, is what I the topic my topic of week five’s discussion. This film is like no other World War II film that I have seen because of the realistic combat. I found myself getting overwhelmed, covering my eyes, and getting sick to my stomach from time to time through the movie. From the very beginning of the film on Omaha Beach, the D-Day landing scene gave me a glimpse of how the stress of combat experience could have felt.
Movie-watchers do not think about how the color scheme plays a significant part and sets different tones. The muddy browns, dark greens, and greys are the predominant colors throughout the movie. This movie does not have many vibrant, happy colors, and for a good reason. For instance, in
Saving Private Ryan
, the Normandy landing scene opens slowly to a beach. The setting is solemn, and the continuous color scheme of bland greys is an excellent cinematography piece. I felt like it made the red blood colors and the explosion colors stand out even more. Also, almost every shot was dreary and had vintage-like colors that gave the feeling of war and hopelessness. There was a part in this scene when the soldiers were near water that contrasted the typically dreary colors with a calming blue hue. The change of color gave me some hope that it may be safer under the surface, and then those hopes were instantly shattered when shots were fired, and red clouds pierced through the calming blue colors punishing me for even thinking there was any hope approaching the soldiers. This is an excellent mise-en-scene because it represented my change of emotions.
Another color paly example is in the scene where “Duty” is talking and joking as the crew marches toward their mission. Throughout this scene, the conversation is more cheerful, but the lighting and colors of grey and green continue to give a gloomy narrative, so my mood does not change much.
Saving Private Ryan has the same dull, dreary colors and low-key lighting, which looks dark and intensifies the shadows as the other War films in Week Five’s content. The desaturation of color is often used in war films.
Saving Private Ryan’s narrative, editing, camera movement, and color scheme throughout the movie jumped out of the screen and attacked me as a viewer. Every part of its cinematography placed the watcher in the combat experience, and I loved it in a good but bad way.
COLIN'S POST:
The war film I watched for this week was
1917 (2019)
directed by Sam Mendes. This film takes place during World War I and follows two British soldiers throughout most of the movie. This film is unique because it is shot as a "one shot film" where the director uses lighting and different angles with very few cuts to give a continuous feeling throughout the entire film. It gives audiences a more connected feeling as it seems like the scenes never end.
2 Pages for 4 questions below1) Some say that analytics in gener.docxherminaprocter
2 Pages for 4 questions below
1) Some say that analytics in general dehumanize managerial activities, and other say they do not. Discuss arguments for both point of view.
2) What are some of the major privacy concerns in employing intelligent systems on mobile data?
3) Identify some cases of violations of user privacy from current literature and their impact on data science as a profession.
4) Search the internet to find examples of how intelligent systems can facilitate activities such as empowerment, mass customization, and team work.
Reflection paper 3 Pages
What has been significant about this course that will help you perform data science tasks in the future.
Please refer to at least
2 items
in the course content that really stood out to either positive or negative.
.
2 Ethics Session 1.pptxEthics in Engineering Pra.docxherminaprocter
2 Ethics Session 1.pptx
Ethics in Engineering Practice
MET 2711
1
This Photo by Unknown Author is licensed under CC BY-NC-ND
What is Engineering?
Engineers concern themselves with:
“the art of the practical application of scientific and empirical knowledge to the design and production or accomplishment of various sorts of constructive projects, machines and materials of use or value to man.”
“Value is not necessarily measured by an economic yardstick; the ancient pyramids and not a few structures since are of slight economic worth, while their value in terms of faith and beauty has often been considerable.”
2
Socrates on Ethics
Ethics are the norms by which acceptable and unacceptable behavior are measured.
According to Socrates, one develops ethics through maturity, wisdom and love.
Introduced the concept of teaching ethics and acceptable standards of conduct in 400 B.C.
Believed virtue was found primarily in human relationships, love and friendship, not through material gains.
3
https://classroom.synonym.com/what-were-socrates-beliefs-on-ethics-12084753.html
This Photo by Unknown Author is licensed under CC BY-NC-ND
A Brief Look at Engineering Projects Through the Ages
4
Roman Aquaducts
Contributed to the health and welfare of the society
Provided 200 million gallons of clean running water and plumbing to individual structures daily (200 gallons per person)
Supported economic activity
Allowed city of Rome to grow to approximately 1 million people
312 BCE to 500 AD
5
This Photo by Unknown Author is licensed under CC BY-SA
Santa Maria del Fiori (Florence Basilica)
Earliest and largest free-standing dome
Built as Europe recovered from the Black Plague, which killed approximately 1/3 of the population
An example of a project that reflected optimism for the future (faith and beauty)
Design competition in 1423
Brunelleschi proposes unique design, but contract requires him to share project responsibilities with Ghiberti
Brunelleschi had lost prior design competition to Ghiberti
6
This Photo by Unknown Author is licensed under CC BY-NC-ND
https://www.khanacademy.org/humanities/renaissance-reformation/early-renaissance1/sculpture-architecture-florence/v/brunelleschi-dome-of-the-cathedral-of-florence-1420-36
Santa Maria del Fiori (Florence Basilica)
Designs unique dome requiring no scaffolding. Uses brick in herringbone pattern to distribute weight out and down.
Includes a series of horizontal chains to keep structure from expanding outward
When time to install chains, Brunelleschi claims to be ill, so Ghiberti starts chain installation (without full details from Brunelleschi)
Brunelleschi “recovers” and criticizes the work, saying it will all have to be re-done
Setting up his fellow architect to fail (dishonorable conduct)
7
This Photo by Unknown Author is licensed under CC BY-NC-ND
https://www.khanacademy.org/humanities/renaissance-reformation/early-renaissance1/sculpture-ar.
2 1 5L e a r n I n g o b j e c t I v e sC H A P T E R.docxherminaprocter
2 1 5
L e a r n I n g o b j e c t I v e s
C H A P T E R 8
H U M A N R E S O U R C E S
M A N A G E M E N T
They’re not employees, they’re people.
—Peter Drucker
➤ Describe the range of human resource functions in the medical practice.
➤ Appreciate the range of professionals that are found in medical practices.
➤ Articulate the steps in the hiring function.
➤ Understand regulations that are specific to the employment process.
➤ Illustrate the steps in managing change.
➤ Describe why leading change is important to medical practice management.
In t r o d u c t I o n
Healthcare employment constitutes about 9 percent of the American workforce, with about
3 percent being professionals (KFF 2016). Hiring and sustaining a high-caliber staff are
two of the most important functions of managing a physician practice. Without a prop-
erly trained and motivated staff, providing high-quality services to the practice’s patients
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EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 4/7/2020 7:56 PM via SUNY CANTON
AN: 1839064 ; Wagner, Stephen L..; Fundamentals of Medical Practice Management
Account: s8846236.main.eds
F u n d a m e n t a l s o f M e d i c a l P r a c t i c e M a n a g e m e n t2 1 6
is difficult. An old saying in human resources management, “Hire for attitude, and train
for skill,” is particularly applicable today, when in the highly competitive medical practice
environment, patients have increasingly high expectations of their providers. Simply having
technical skills is not adequate to build and maintain a successful practice. Staff must be
able to engage patients in a positive and constructive way to earn their trust and satisfac-
tion. Although data seem to conflict on this point, many researchers believe engaged and
satisfied patients are more likely to comply with the instructions of their providers than are
disengaged, unsatisfied patients, leading to better outcomes (e.g., Kane, Maciejewski, and
Finch 1997). More recently, a study by Fenton, Jerant, and Bertaski (2012) found little
connection between satisfaction and clinical outcome; in fact, the researchers found that
mortality was higher, as were expenditures and utilization, among more satisfied groups.
Other authors have observed this tenuous connection as well (Kennedy, Tevis, and Kent
2014). The controversy has intensified as more physician payment is tied to patient satis-
faction. Some issues that complicate this concept are the lack of common definitions and
measures of satisfaction and the complexity inherent in defining.
2 Requirements Elicitation A Survey of Techniques, Ap.docxherminaprocter
2 Requirements Elicitation: A Survey of Techniques,
Approaches, and Tools
Didar Zowghi and Chad Coulin
Abstract: Requirements elicitation is the process of seeking, uncovering, acquir-
ing, and elaborating requirements for computer based systems. It is generally un-
derstood that requirements are elicited rather than just captured or collected. This
implies there are discovery, emergence, and development elements to the elicita-
tion process. Requirements elicitation is a complex process involving many ac-
tivities with a variety of available techniques, approaches, and tools for perform-
ing them. The relative strengths and weaknesses of these determine when each is
appropriate depending on the context and situation. The objectives of this chapter
are to present a comprehensive survey of important aspects of the techniques, ap-
proaches, and tools for requirements elicitation, and examine the current issues,
trends, and challenges faced by researchers and practitioners in this field.
Keywords: requirements, elicitation, techniques, approaches, tools, issues, chal-
lenges, trends, survey.
2.1 Introduction
The importance of requirements engineering (RE) within software systems deve l-
opment has long been established and recognized by researchers and practitioners
alike (Chapter 1). The elicitation of requirements represents an early but continu-
ous and critical stage in the development of software systems. The requirements
for a software system may be spread across many sources. These include the prob-
lem owners, the stakeholders, documentation, and other existing systems. Because
of the communication rich nature of requirements elicitation activities, many of
the effective techniques do not originate from the traditional areas of software en-
gineering or computer science research. Techniques for requirements elicitation
are derived mostly from the social sciences, organizational theory, group dynam-
ics, knowledge engineering, and very often from practical experience.
The process of requirements elicitation is generally accepted as one of the criti-
cal activities in the RE process. Getting the right requirements is considered as a
vital but difficult part of software development projects [36]. A recent field study
of fifteen RE teams carried out by Hofmann and Lehner [31] identified key RE
practices that should lead to project success. Effective elicitation of requirements
was arguably among the most important of the resulting recommended good RE
practices.
Requirements elicitation itself is a very complex process involving many activi-
ties, with multiple techniques available to perform these activities. The multi-
disciplinary nature of requirements elicitation only adds to this complexity. Elici-
tation is subject to a large degree of error, influenced by key factors ingrained in
communication problems. Despite the importance of requirements elicitation
within software development, insufficient.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Find out more about ISO training and certification services
Training: ISO/IEC 27001 Information Security Management System - EN | PECB
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General Data Protection Regulation (GDPR) - Training Courses - EN | PECB
Webinars: https://pecb.com/webinars
Article: https://pecb.com/article
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Slideshare: http://www.slideshare.net/PECBCERTIFICATION
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
Reimagining Your Library Space: How to Increase the Vibes in Your Library No ...Diana Rendina
Librarians are leading the way in creating future-ready citizens – now we need to update our spaces to match. In this session, attendees will get inspiration for transforming their library spaces. You’ll learn how to survey students and patrons, create a focus group, and use design thinking to brainstorm ideas for your space. We’ll discuss budget friendly ways to change your space as well as how to find funding. No matter where you’re at, you’ll find ideas for reimagining your space in this session.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
19The Purnell Model forCultural CompetenceChapter 2.docx
1. 19
The Purnell Model for
Cultural Competence
Chapter 2
LARRY D. PURNELL
This chapter presents the Purnell Model for Cultural
Competence, its organizing framework, and the assump-
tions upon which the model is based. In addition, American
cultural values, practices, and beliefs are presented to assist
non–native American health-care providers to understand
American ways. The American references are meant to
describe, not prescribe or predict, behaviors and practices.
Although the authors recognize that Canada and Mexico are
part of North America, American, as used in this chapter,
refers to the dominant middle-class values of citizens of the
mainland United States. Owing to space limitations, this
chapter deals not with the objective culture—arts, literature,
humanities, and so on—but rather with the subjective cul-
ture. Many Americans are not aware of the subjective culture
because they identify differences as individual personality
traits and disregard political and social origins of culture.
Many view culture as something that belongs only to for-
eigners or disadvantaged groups. However, when Americans
travel abroad, their host country inhabitants many times
stereotypically identify them as Americans because of their
values, beliefs, attitudes, behaviors, speech patterns, and
mannerisms. Some feel that Americans are “fun lovers” and
that, for some Americans, violence is a way of life. However,
2. “the right to bear arms” is guaranteed by the Constitution.
Most likely, the United States is not any more violent than,
or even as violent as, many other societies, but American
media coverage may be better than other countries, thereby
giving the impression that the United States is more violent
than it actually is. Accordingly, these stereotypes are not
always accurate or desirable.
Western academic and health-care organizations
stress structure, systematization, and formalization when
studying complex phenomena such as culture and eth-
nicity. Given the complexity of individuals, the Purnell
Model for Cultural Competence provides a comprehen-
sive, systematic, and concise framework for learning and
understanding culture. The empirical framework of the
model can assist health-care providers, managers, and
administrators in all health disciplines to provide holis-
tic, culturally competent therapeutic interventions;
health promotion and wellness; illness, disease, and
injury prevention; health maintenance and restoration;
and health teaching across educational and practice
settings.
The purposes of this model are to
1. Provide a framework for all health-care providers
to learn concepts and characteristics of culture.
2. Define circumstances that affect a person’s cul-
tural worldview in the context of historical per-
spectives.
3. Provide a model that links the most central rela-
tionships of culture.
4. 5. Differences exist within, between, and among
cultures.
6. Cultures change slowly over time.
7. The primary and secondary characteristics of
culture (see Chapter 1) determine the degree to
which one varies from the dominant culture.
8. If clients are coparticipants in their care and
have a choice in health-related goals, plans,
and interventions, their compliance and health
outcomes will be improved.
9. Culture has a powerful influence on one’s inter-
pretation of and responses to health care.
10. Individuals and families belong to several sub-
cultures.
11. Each individual has the right to be respected for
his or her uniqueness and cultural heritage.
12. Caregivers need both culture-general and
culture-specific information in order to provide
culturally sensitive and culturally competent
care.
13. Caregivers who can assess, plan, intervene, and
evaluate in a culturally competent manner will
improve the care of clients for whom they care.
14. Learning culture is an ongoing process that
develops in a variety of ways, but primarily
through cultural encounters (Campinha-
Bacote, 2006).
5. 15. Prejudices and biases can be minimized with
cultural understanding.
16. To be effective, health care must reflect the
unique understanding of the values, beliefs,
attitudes, lifeways, and worldview of diverse
populations and individual acculturation
patterns.
17. Differences in race and culture often require
adaptations to standard interventions.
18. Cultural awareness improves the caregiver’s
self-awareness.
19. Professions, organizations, and associations
have their own culture, which can be analyzed
using a grand theory of culture.
20. Every client encounter is a cultural encounter.
Overview of the Theory, the Model,
and Organizing Framework
The Purnell model has been classified as holographic and
complexity theory because it includes a model and orga-
nizing framework that can be used by all health-care
providers in various disciplines and settings. The model is
a circle, with an outlying rim representing global society,
a second rim representing community, a third rim repre-
senting family, and an inner rim representing the person
(Fig. 2–1). The interior of the circle is divided into 12 pie-
shaped wedges depicting cultural domains and their con-
cepts. The dark center of the circle represents unknown
phenomena. Along the bottom of the model, a jagged
line represents the nonlinear concept of cultural con-
6. sciousness. The 12 cultural domains (constructs) provide
the organizing framework of the model. A box following
the discussion of each domain provides statements that
can be adapted as a guide for assessing patients and
clients in various settings. Accordingly, health-care
providers can use these same questions to better under-
stand their own cultural beliefs, attitudes, values, prac-
tices, and behaviors.
MACRO ASPECTS OF THE MODEL
The macro aspects of this interactional model include the
metaparadigm concepts of a global society, community,
family, person, and conscious competence. The theory
and model are conceptualized from biology, anthropol-
ogy, sociology, economics, geography, history, ecology,
physiology, psychology, political science, pharmacology,
and nutrition as well as theories from communication,
family development, and social support. The model can
be used in clinical practice, education, research, and the
administration and management of health-care services
or to analyze organizational culture.
Phenomena related to a global society include world
communication and politics; conflicts and warfare; nat-
ural disasters and famines; international exchanges in
education, business, commerce, and information tech-
nology; advances in health science; space exploration;
and the expanded opportunities for people to travel
around the world and interact with diverse societies.
Global events that are widely disseminated by television,
radio, satellite transmission, newsprint, and information
technology affect all societies, either directly or indirectly.
Such events create chaos while consciously and uncon-
sciously forcing people to alter their lifeways and
worldviews.
13. Fam
ily roles and
organization
Head of household
Gender roles
Goals & priorities
Developmental tasks
Roles of aged
Extended family
Social status
Alternative
lifestyles
Death rituals
Death rituals
Bereavement
W
orkforce issues
A
cculturation
25. 22 • CHAPTER 2
personal health status or the health status of the nation or
community. Health can also be subjective or objective in
nature.
How do you define your community in terms of
objective and subjective cultural characteristics?
How has your community changed over the last 5
to 10 years? The last 15 years? The last 20 years? If
you have changed communities, think of the com-
munity in which you were raised.
Whom do you consider family? How have they
influenced your culture and worldview? Who else
has helped instill your cultural values?
A family is two or more people who are emotionally
connected. They may, but do not necessarily, live in close
proximity to each other. Family may include physically
and emotionally close and distant consanguineous rela-
tives as well as physically and emotionally connected and
distant non–blood-related significant others. Family
structure and roles change according to age, generation,
marital status, relocation or immigration, and socioeco-
nomic status, requiring each person to rethink individual
beliefs and lifeways.
A person is a biopsychosociocultural being who is
constantly adapting to her or his community. Human
beings adapt biologically and physiologically with the
aging process; psychologically in the context of social
relationships, stress, and relaxation; socially as they
interact with the changing community; and ethnocultur-
ally within the broader global society. In Western cul-
tures, a person is a separate physical and unique psycho-
26. logical being and a singular member of society. The self is
separate from others. However, in Asian and some other
cultures, the individual is defined in relation to the fam-
ily or other group rather than a basic unit of nature.
In what ways have you adapted (1) biologically
and physiologically to the aging process, (2) psy-
chologically in the context of social relationships,
(3) socially in your community, and (4) ethnocul-
turally within the broader society?
Health, as used in this book, is a state of wellness as
defined by the individual within his or her ethnocultural
group. Health generally includes physical, mental, and
spiritual states because group members interact with the
family, community, and global society. The concept of
health, which permeates all metaparadigm concepts of
culture, is defined globally, nationally, regionally, locally,
and individually. Thus, people can speak about their
How do you define health? Is health the absence
of illness, disease, injury, and/or disability? How
does your profession define health? How does
your nation or community define health? How do
these definitions compare with your original
ethnic background?
MICRO ASPECTS OF THE MODEL
On a micro level, the model’s organizing framework com-
prises 12 domains and their concepts, which are common
to all cultures. These 12 domains are interconnected and
have implications for health. The utility of this organiz-
ing framework comes from its concise structure, which
can be used in any setting and applied to a broad range of
empirical experiences and can foster inductive and
27. deductive reasoning in the assessment of cultural
domains. Once cultural data are analyzed, the practi-
tioner can fully adopt, modify, or reject health-care inter-
ventions and treatment regimens in a manner that
respects the client’s cultural differences. Such adaptations
improve the quality of the client’s health-care experiences
and personal existence.
The Twelve Domains of Culture
The 12 domains essential for assessing the ethnocultural
attributes of an individual, family, or group are
1. Overview, inhabited localities, and topography.
2. Communication.
3. Family roles and organization.
4. Workforce issues.
5. Biocultural ecology.
6. High-risk behaviors.
7. Nutrition.
8. Pregnancy and childbearing practices.
9. Death rituals.
10. Spirituality.
11. Health-care practices.
12. Health-care practitioners.
OVERVIEW, INHABITED LOCALITIES,
AND TOPOGRAPHY
This domain, overview, inhabited localities, and topography,
includes concepts related to the country of origin, the
current residence, the effects of the topography of the
country of origin and current residence on health, eco-
nomics, politics, reasons for migration, educational sta-
tus, and occupations. These concepts are interrelated. For
example, economic and political conditions may affect
one’s reason for migration, and educational attainment is
29. with the descriptions to some degree and on some level.
Moreover, we believe the descriptions about the domi-
nant American culture are true for white middle-class
European Americans (and many other groups as well)
who hold the majority of prestigious positions in the
United States. The degree to which people conform to
this dominant culture depends on the primary and sec-
ondary characteristics of culture discussed in Chapter 1 as
well as individual personality differences. We recognize
that some Americans do not think there is an American
culture and resent any attempt at generalizations. Many
foreigners believe that all Americans are rich, everyone
lives in fancy apartments or houses, crime is everywhere,
everyone drives an expensive gasoline-inefficient car, and
there is little or no poverty. For the most part, these mis-
conceptions come from the media and Americans who
travel overseas.
Heritage and Residence
The United States comprises 3.5 million square miles and
a population of nearly 300 million people, making it the
world’s third most populous country (CIA Factbook,
2006). The United States is mostly temperate but tropical
in Hawaii and Florida, arctic in Alaska, semiarid in the
great plains west of the Mississippi River, and arid in the
Great Basin of the southwest. Low winter temperatures in
the northwest are ameliorated in January and February by
warm Chinook winds from the eastern slopes of the
Rocky Mounatins. There is a vast central plain; moun-
tains in the west; hills and low mountains in the east;
rugged mountains and broad river valleys in Alaska; and
rugged, volcanic topography in Hawaii.
When Europeans began settling the United States in
the 16th century, approximately 2 million American
30. Indians, who mostly lived in geographically isolated
tribes, populated the land. The first permanent European
settlement in the United States was St. Augustine, Florida,
which was settled by the Spanish in 1565. The first
English settlement was Jamestown, Virginia, in 1607. By
1610, the nonnative population in the United States was
only 350 people. By 1700, the population increased to
250,900; by 1800, to 5.3 million; and by 1900, to 75.9
million (Time Almanac, 2001). From 1607 until 1890,
most immigrants to the United States came from Europe
and essentially shared a common European culture. The
plantation economy of the South paid for the forced relo-
cation of natives from (primarily Western) Africa begin-
ning in 1619 and ending with the American Civil War
(1861–1865). This group did not share the common cul-
ture, and their acculturation was strongly influenced by
their status as slaves.
In the 1830s, a war with Mexico resulted in the annex-
ation of greater Texas. From 1860 until 1865, the North
and South fought over the issue of slavery, which resulted
not only in the elimination of slavery but also in the
industrialization of the North and the establishment of
the United States as a major military power. The Spanish-
American War (1898) resulted in the United States becom-
ing a colonial power, with the annexation of Spain’s last
colony in the Western Hemisphere, Cuba, and also its
colony in the Philippines. World War I (1914–1918) estab-
lished the United States as one of the world’s superpow-
ers, and World War II (1939–1945) significantly extended
U.S. military power. In the postwar period, the ideological
differences between the United States and the USSR
resulted in the Cold War, which lasted until 1989. Today,
U.S. military, cultural, and economic power affect almost
every other country on the planet.
31. The American colonies broke with the parent country,
Britain, on July 4, 1776, and were recognized as the new
nation of The United States of America with the original
13 colonies following the Treaty of Paris in 1783. During
the 19th and 20th centuries, 37 new states were added to
the original 13 as the nation expanded across the North
American continent and acquired a number of overseas
possessions.
The Constitution of the Untied States was ratified in
1789 and included seven articles, which laid the founda-
tion for an independent nation. The Bill of Rights, the
first 10 amendments to the Constitution, guarantees free-
dom of religion, speech, and the press; the right to peti-
tion, bear arms; and the right to a speedy trial. Only 17
additional amendments have been made to the
Constitution. The 13th Amendment in 1865 prohibited
slavery; the 14th Amendment in 1868 defined citizenship
and privileges of citizens; the 15th Amendment in 1870
gave suffrage rights regardless of race or color; and the
19th Amendment in 1920 gave women the right to vote.
The United States is the world’s oldest constitutional
democracy with three branches of government: (1) the
executive branch, which includes the Office of the
President and the administrative departments; (2) the leg-
islative branch, Congress, which includes both the Senate
and the House of Representatives; and (3) the judicial
branch, which includes the Supreme Court and the lesser
federal courts. The Supreme Court has nine members
appointed by the President and approved by Congress.
The Justices serve a life term if they so choose. The
THE PURNELL MODEL FOR CULTURAL COMPETENCE •
23
33. from Laos, 3482 from Ukraine, 2959 from Cuba, and 1787
from Iran. As of June 2005, 32,229 refugees had been
admitted (CIA Factbook, 2006).
The United States has the largest and most technologi-
cally powerful economy in the world, with a per capita
gross domestic product (GDP) of $42,000. In this market-
oriented economy, private individuals and business firms
make most of the decisions, and the federal and state gov-
ernments buy needed goods and services predominantly
in the private marketplace. U.S. business firms enjoy
greater flexibility than their counterparts in Western
Europe and Japan in decisions to expand capital plant, to
lay off surplus workers, and to develop new products. At
the same time, they face higher barriers to enter their
rivals’ home markets than foreign firms face entering U.S.
markets. U.S. firms are at or near the forefront in techno-
logical advances, especially in computers and in medical,
aerospace, and military equipment; their advantage has
narrowed since the end of World War II.
The on-rush of technology largely explains the gradual
development of a “two-tier labor market,” in which those
at the bottom lack the education and the professional/
technical skills of those at the top and, more and more,
fail to get comparable pay raises, health insurance cover-
age, and other benefits. Since 1975, practically all the
gains in household income have gone to the top 20 per-
cent of households.
The response to the terrorist attacks of September 11,
2001, showed the remarkable resilience of the economy.
The war in March–April 2003 between a U.S.-led coalition
and Iraq, and the subsequent occupation of Iraq, required
major shifts in national resources to the military. The rise
in GDP in 2004 and 2005 was supported by substantial
34. gains in labor productivity. Hurricane Katrina caused
extensive damage in the Gulf Coast region in August 2005
but had a small impact on overall GDP growth for the
year. Soaring oil prices in 2005 and 2006 threatened infla-
tion and unemployment, yet the economy continued to
grow through mid 2006. Imported oil accounts for about
two-thirds of U.S. consumption. Long-term problems
include inadequate investment in economic infrastruc-
ture, rapidly rising medical and pension costs of an aging
population, sizable trade and budget deficits, and stagna-
tion of family income in the lower economic groups (CIA
Factbook, 2006).
People have been attracted to immigrate to the United
States because of its vast resources and economic and per-
sonal freedoms, particularly the dogma that “all men are
created equal.” Immigrants and their descendants
achieved enormous material success, which further
encouraged immigration.
Reasons for Migration and Associated
Economic Factors
The United States has a very large middle-class popula-
tion and a small, but growing, wealthy population.
Approximately 12.7 percent of the population lives in
poverty, with higher rates among children (17.8 percent),
older persons (20.5 percent), blacks (24.7 percent), and
nonwhite Hispanics (21.9 percent) (U.S. Bureau of the
Census: Poverty Rates, 2006c). The social, economic, reli-
gious, and political forces of the country of origin play an
important role in the development of the ideologies and
the worldview of individuals, families, and groups and are
often a major motivating force for emigration.
35. The earlier settlers in the United States came for better
economic opportunities, because of religious and political
oppression and environmental disasters such as earth-
quakes and hurricanes in their home countries, and by
forced relocation such as slaves and indentured servants.
Others have immigrated for educational opportunities
and personal ideologies or a combination of factors. Most
people immigrate in the hope of a better life; however,
the individual or group personally defines this ideology.
A common practice for many immigrants is to relocate
to an area that has an established population with similar
ideologies that can provide initial support, serve as cul-
tural brokers, and orient them to their new culture and
health-care system. For example, most people of Cuban
heritage live in New York and Florida; French Canadians
are concentrated in the Northeast; and the Amish are
concentrated in Pennsylvania, Indiana, and Ohio. When
immigrants settle and work exclusively in predominantly
ethnic communities, primary social support is enhanced,
but acculturation and assimilation into the wider society
may be hindered. Groups without ethnic enclaves in the
United States to assist them with acculturation may need
extra help in adjusting to their new homeland’s language,
access to health-care services, living accommodations,
and employment opportunities. People who move volun-
tarily are likely to experience less difficulty with accultur-
ation than people who are forced to emigrate. Some indi-
viduals immigrate with the intention of remaining in this
country only a short time, making money, and returning
home, whereas others immigrate with the intention of
relocating permanently.
24 • CHAPTER 2
FABK017-C02[19-55].qxd 12/12/2007 10:35am Page 24
39. Associate Acquisitions Editor: Thomas A. Ciavarella
Director of Content Development: Darlene D. Pedersen
Art and Design Manager: Carolyn O’Brien
As new scientific information becomes available through basic
and clinical research, recom-
mended treatments and drug therapies undergo changes. The
author(s) and publisher have
done everything possible to make this book accurate, up to date,
and in accord with accepted
standards at the time of publication. The author(s), editors, and
publisher are not responsible
for errors or omissions or for consequences from application of
the book, and make no war-
ranty, expressed or implied, in regard to the contents of the
book. Any practice described in this
book should be applied by the reader in accordance with
professional standards of care used in
regard to the unique circumstances that may apply in each
situation. The reader is advised
always to check product information (package inserts) for
changes and new information regard-
ing dose and contraindications before administering any drug.
Caution is especially urged when
using new or infrequently ordered drugs.
Library of Congress Cataloging-in-Publication Data
Transcultural health care : a culturally competent approach /
[edited by] Larry D. Purnell,
Betty J. Paulanka. — 3rd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-8036-1865-7
ISBN-10: 0-8036-1865-4
41. The rise in concern for cultural competence has become
one of the most important developments in American
health care over the past decade. Medicine and health
more generally have moved beyond their traditional
equanimous approach of application of scientific rational-
ity to clinical problems to one that promotes an easier inte-
gration of clinical science with empathy. This development
has occurred with a rising tide of the diversity of the popu-
lation of the United States. Some of this is driven by actual
numbers of immigrants, but other dimensions of this
awareness come from the visibility of the “new” ethnics
and the waning of the social ideology of the melting pot.
Beyond all of this is a younger generation that is much
more attuned to diversity as part of their cultural landscape
and their comfort with the globalization of perspectives
resulting from technological and economic change.
From within health care, the advocacy for culturally
competent approaches is driven in part by the dawning
recognition of the danger to patient safety and overall
inadequacy in the quality of outcomes in what we do.
The literature around the disparities of outcomes across
ethnic, social, and economic groups provides a com-
pelling case to ensure that health care is attentive to these
differences. But there is also attention to the costs that are
driven up by health care that is not culturally competent
and discourages compliance. The excess expenditures are
associated with poor communication, the failure to use
culturally responsive methods, and ineffective attempts
to transfer treatment modalities to make the system cost
efficient. Finally, as the health system makes its glacial
move to more consumer and individual responsiveness,
the system is recognizing that a cultural perspective is
essential to provide services that earn high levels of con-
sumer satisfaction.
42. Much of the activity aimed at advancing cultural com-
petence has been centered on regulations and mandates.
However, a generational change that begins with the edu-
cation of each new practitioner is needed to bring about a
culturally informed and competent professional commu-
nity.
This edition of Transcultural Health Care provides the
critical lessons to introduce students and practitioners to
how different cultures construct the social world and the
dramatic impact that culture has on how health care,
medicine, community, and family interact. These insights
into the rich variety of human culture are only small steps
toward developing real wisdom regarding culture compe-
tence.
The first step in such a transformation is awareness of
the other. Most young students and many seasoned prac-
titioners simply do not have an appreciation of the vari-
ety of backgrounds and perspectives that people bring to
an encounter with the health-care system. They have the
expectation that the patient or consumer will “fit” into
their clinic or admission process. Moreover, much of what
is done in health care follows a “procedure,” which
implies that there are predetermined steps by which any
one receiving the care or service must fit. For an increas-
ingly large part of the population, nothing could be fur-
ther from the truth. The care-seeking behavior, the atti-
tude toward authority, the comfort with middle-class
America culture that makes up so much of the health-care
social world, and the relationship between genders are
just a few of the literally hundreds of places at which a
disconnect between the individual and the system can
occur. When disconnects occur, the efforts by the system
44. cultural context.
As we focus on cultural competence, one fear is that we
will make the knowledge more transactional than transfor-
mational. It needs to be the latter. For the patient or con-
sumer, health care presented in a culturally competent
way must blend the traditions of the older culture with the
promise and resources of modern health care. For the prac-
titioner or health-care institution, new patterns of service
and organization of care must be transformed using the
experience with the new culture. Such a critical perspec-
tive of cultural humility is essential for all practitioners in
all dimensions of health care and is a vital part of devel-
oping into a truly culturally competent provider.
This will be greatly assisted as care delivery moves
from profession-specific models of care to more interpro-
fessional and team-based approaches. This has long been
a hope of many involved in efforts to reform health care.
If one is truly committed in becoming culturally compe-
tent, then one important lesson to learn is how to
expand competence and the facility from the culture of
nursing to an interdisciplinary culture that includes
pharmacy, medicine, and the allied health professions.
This seems obvious, but without these skills of closer
adaptation and accommodation among all health profes-
sions, how can you imagine practitioners adapting to
cultures that are more alien than those we encounter on
a routine basis?
Synthesizing cultural adaptations within the health pro-
fessional perspectives and offering adapted care to patients
may not be sufficient to guarantee individual cultural com-
petence. Practitioners who achieve such skill will need to
change their orientation from one that is focused on the
profession and its clinical world to one that is patient-centric.
45. This is easy to affirm but very difficult to deliver because of
the power and cultural hegemony of the clinical world. This
cultural blindness serves neither the patient nor the practi-
tioner. It is also a source of much of the dysfunction of the
current system of care, both in terms of costs and quality.
The final stage in cultural competency is the ability to
balance self-awareness with other-awareness. Such a balance
is the hallmark of an outstanding clinician and is also the
basis of all true cultural competence. This value allows for
a response ability that transcends the simple knowledge of
all practitioners knowing every detail about particular cul-
tures and allows a different relationship to emerge between
the provider of service and the recipient. In this way, the
work toward developing the skills of a culturally compe-
tent practitioner assists in the broader goal of becoming
an outstanding clinician in any setting. This edition of
Transcultural Health Care provides an outstanding guide to
the journey of becoming just such a practitioner.
EDWARD O’NEIL, MPA, PHD, FAAN
Professor
Departments of Family and Community Medicine,
Preventive and Restorative Dental Sciences and
Social and Behavioral Sciences, and
Director of the Center for the Health Professions
University of California, San Francisco
San Francisco, California
vi • PREFACE
FABK017-FM[i-xviii].qxd 12/12/2007 10:47am Page vi
Aptara Inc.
47. [This page intentionally left blank.]
Diane Alain, Med, RN
Teacher
La Cité Collégiale
University of Ottawa
Ottawa, Ontario, Canada
Josepha Campinha-Bacote, PhD, MAR, APRN, BC,
CNS, CTN, FAAN
Clinical Assistant Professor
Case Western Reserve University
Cleveland, Ohio
President, Transcultural C.A.R.E. Associates
Cincinnati, Ohio
Marga Simon Coler, EdD, APRN-C, FAAN
Professor Emeritus
University of Connecticut
Storrs, Connecticut
Adjunct Professor
University of Massachusetts
Amherst, Massachusetts
Collaborating Professor
Federal University of Paraíba
Paraíba, Brazil
Jessie M. Colin, PhD, RN
Professor
Barry University School of Nursing
Miami Shores, Florida
48. Ginette Coutu-Wakulczyk, RN, MSc, PhD
Associate Professor
School of Nursing
Faculty of Health Sciences
University of Ottawa
Ottawa, Ontario, Canada
Tina A. Ellis, RN, MSN, CTN
Nursing Instructor
Florida Gulf Coast University
Fort Myers, Florida
Rauda Gelazis, RN, PhD, CS, CTN
Associate Professor
Ursuline College
Pepper Pike, Ohio
Divina Grossman, PhD, RN, FAAN
Dean
College of Nursing and Health Sciences
Florida International University
Miami, Florida
Homeyra Hafizi, RN, MS, LHRM
Occupational Health
Dynamac Corporation
Kennedy Space Center, Florida
Sandra M. Hillman, PhD, MS, BSN
Professor
Nelson Mandela Metropolitan University
Port Elizabeth, South Africa
David Hodgins, MSN, RN, CEN
Indian Health Service
Shiprock, New Mexico
50. Deputy Director
Wayne County Health and Human Services
Detroit, Michigan
Professor
Oakland University
Rochester, Michigan
Juliene G. Lipson, RN, PhD, FAAN
Professor Emerita
University of California, San Francisco School of
Nursing
Mill Valley, California
Afaf Ibrahim Meleis, PhD, DrPS(hon), FAAN
Margaret Bond Simon Dean of Nursing
Professor of Nursing and Sociology
University of Pennsylvania School of Nursing
Philadelphia, Pennsylvania
Mahmoud Hanafi Meleis, PhD, PE
Retired Nuclear Engineer
Philadelphia, Pennsylvania
Denise Moreau, PhD, MSc, RN
Assistant Professor and Lecturer
University of Ottawa
Ottawa, Ontario, Canada
Dula F. Pacquiao, EdD, RN, CTN
Associate Professor and Director
Bergen Center for Multicultural Education,
Research and Practice
School of Nursing
University of Medicine and Dentistry of New Jersey
51. Newark, New Jersey
Irena Papadopoulos, PhD, MA, RN, RM, DipNEd,
NDN Cert
Professor of Transcultural Health and Nursing
Middlesex University, United Kingdom
Highgate Hill, London
Ghislaine Paperwalla, BSN, RN
Research Nurse in Immunology
Veterans Administration Medical Center
Miami, Florida
Henry M. Plawecki, RN, PhD
Professor of Nursing
Purdue University Calumet School of Nursing
Hammond, Indiana
Judith A. Plawecki, RN, PhD
Professor
University of South Florida
Tampa, Florida
Lawrence H. Plawecki, RN, JD, LLM
Health Law Consultant
Plawecki Consultants, LLC
Highland, Indiana
Martin H. Plawecki, PhD, MD
Faculty
Indiana University School of Medicine
Indianapolis, Indiana
Jeffrey Ross, BFA, MA, MAT
Graphic Designer and Language Arts Teacher
52. Archbishop Hoban High School
Akron, Ohio
Ratchneewan Ross, PhD, MSc, RN, Certificate in
Midwifery
Assistant Professor
College of Nursing
Kent State University
Kent, Ohio
Maryam Sayyedi, PhD
Adjunct Professor
Department of Counseling
California State University, Fullerton
Fullerton, California
Janice Selekman, DNSc, RN
Professor
University of Delaware
Newark, Delaware
Linda S. Smith, MS, DSN, RN, CLNC
Associate Professor and Director
Idaho State University
Pocatello, Idaho
Jessica A. Steckler, MS, RNBC
National Program Manager
Employee Education System, VHA
Erie, Pennsylvania
Gulbu Tortumluoglu, PhD
Assistant Professor
Nursing Department Chief
Yuksekokulu, Canakkale, Turkey
54. Anna Frances Z. Wenger, PhD, RN, CTN, FAAN
Professor and Director of Nursing Emerita
Goshen College
Goshen, Indiana
Senior Scholar
Interfaith Health Program
School of Public Health
Emory University
Program Consultant
Ethiopia Public Health Training Initiative
The Carter Center
Atlanta, Georgia
Marion R. Wenger, PhD
Retired Professor of Foreign Languages and Linguistics
Emory University
Atlanta, Georgia
Sarah A. Wilson, PhD, RN
Associate Professor
Director, Institute for End of Life Care Education
Marquette University College of Nursing
Milwaukee, Wisconsin
Cecilia A. Zamarripa, RN, CWON
56. Introduction
...............................................................................................
......... xvii
Chapter 1 Transcultural Diversity and Health Care
........................................ 1
LARRY D. PURNELL
Chapter 2 The Purnell Model for Cultural Competence
.............................. 19
LARRY D. PURNELL
Chapter 3 People of African American Heritage
............................................ 56
JOSEPHA CAMPINHA-BACOTE
Chapter 4 The Amish
........................................................................................ 75
ANNA FRANCES Z. WENGER and MARION R. WENGER
Chapter 5 People of Appalachian Heritage
.................................................... 95
KATHLEEN W. HUTTLINGER and LARRY D. PURNELL
57. Chapter 6 People of Arab Heritage
................................................................ 113
ANAHID DERVARTANIAN KULWICKI
Chapter 7 People of Chinese Heritage
.......................................................... 129
YAN WANG and LARRY D. PURNELL
Chapter 8 People of Guatemalan Heritage
.................................................... 145
TINA A. ELLIS and LARRY D. PURNELL
Chapter 9 People of Egyptian
Heritage.......................................................... 157
AFAF IBRAHIM MELEIS and MAHMOUD HANAFI MELEIS
Chapter 10 People of Filipino Heritage
.......................................................... 175
DULA F. PACQUIAO
Chapter 11 People of French Canadian
Heritage............................................ 196
GINETTE COUTU-WAKULCZYK, DENISE MOREAU, and
DIANE ALAIN
59. Chapter 15 People of Japanese Heritage
.......................................................... 260
SUSAN TURALE and MISAE ITO
Chapter 16 People of Jewish Heritage
............................................................ 278
LARRY D. PURNELL and JANICE SELEKMAN
Chapter 17 People of Korean Heritage
............................................................ 293
EUN-OK IM
Chapter 18 People of Mexican Heritage
.......................................................... 309
RICK ZOUCHA and CECILIA A. ZAMARRIPA
Chapter 19 People of Russian Heritage
............................................................ 325
LINDA S. SMITH
Chapter 20 People of Polish Heritage
.............................................................. 337
HENRY M. PLAWECKI, LAWRENCE H. PLAWECKI,
JUDITH A. PLAWECKI, and MARTIN H. PLAWECKI
60. Chapter 21 People of Thai Heritage
................................................................ 355
RATCHNEEWAN ROSS and JEFFREY ROSS
Appendix Cultural, Ethnic, and Racial Diseases and
Illnesses.................... 373
Abstracts People of Baltic Heritage: Estonians, Latvians,
and Lithuanians
............................................................................ 381
RAUDA GELAZIS
People of Brazilian
Heritage.......................................................... 383
MARGA SIMON COLER
People of Greek Ancestry
..............................................................385
IRENA PAPADOPOULOS and LARRY D. PURNELL
People of Cuban
Heritage.............................................................. 387
DIVINA GROSSMAN and LARRY D. PURNELL
People of Hindu Heritage
61. .............................................................. 389
LARRY D. PURNELL
People of Irish Heritage
................................................................ 391
SARAH A. WILSON
People of Italian
Heritage.............................................................. 393
SANDRA M. HILLMAN
People of Puerto Rican Heritage
.................................................. 395
LARRY D. PURNELL
Navajo Indians
................................................................................397
OLIVIA HODGINS and DAVID HODGINS
People of Turkish Heritage
............................................................399
GULBU TORTUMLUOGLU
People of Vietnamese Heritage
.................................................... 401
63. People of Greek Heritage
IRENA PAPADOPOULOS and LARRY D. PURNELL
People of Cuban Heritage
DIVINA GROSSMAN and LARRY D. PURNELL
People of Hindu Heritage
LARRY D. PURNELL
People of Irish Heritage
SARAH A. WILSON
People of Italian Heritage
SANDRA M. HILLMAN
People of Puerto Rican Heritage
LARRY D. PURNELL
Navajo Indians
OLIVIA HODGINS and DAVID HODGINS
People of Turkish Heritage
GULBU TORTUMLUOGLU
People of Vietnamese Heritage
65. education, clinical practice, administration, and research,
giving credence to its usefulness for healthcare providers.
They have been translated into Spanish, French, Flemish,
Portuguese, Turkish, and Korean. Healthcare organiza-
tions have adapted the organizing framework as a cultural
assessment tool and numerous students have used the
Model to guide research for theses and dissertations in the
United States and overseas. The Model’s usefulness has
been established in the global arena, recognizing and
including the client’s culture in assessment, healthcare
planning, interventions, and evaluation. The Model is
now being used more with organizational cultural com-
petence as well.
The third edition of Transcultural Health Care: A
Culturally Competent Approach has been revised based
upon response from students and practicing healthcare
professionals such as nurses, physicians, physical thera-
pists, emergency medical technicians, and nutritionists to
name a few as well as educators from associate degree,
baccalaureate, masters, and doctoral programs in nursing.
We appreciate their review and suggestions.
Chapter 1 has three important changes: (a) a more
extensive section on health disparities, (b) a more exten-
66. sive section on organizational cultural competence, and
(c) a section on evidence-based practice as it relates to cul-
ture care. We have made a concerted effort to use non-
stereotypical language when describing cultural attributes
of specific cultures, recognizing that there are exceptions
to every description provided and that the differences
within a cultural group may be greater than the diversity
between and among different cultural groups. We have
also tried to include both the sociological and anthropo-
logical perspectives of culture.
Chapter 2 expands the description of the Purnell Model
for Cultural Competence to include application of the
domains and concepts of culture to the dominant
American Culture in a cross-cultural fashion. Chapters 1
and 2 have critical thinking questions dispersed throughout
each chapter. The glossary remains as it did in the second
edition because users have noted its importance. Cultural
specific chapters have changes based on users’ suggestions.
Instead of one large case study at the end of each chapter,
shorter vignettes covering several domains with study
questions are dispersed throughout each chapter.
Given the world diversity and the diversity within cul-
67. tural groups, it is impossible to cover each group more
extensively. Space and cost concerns limit the number of
chapters that are included in the book; therefore, additional
cultural groups, PowerPoint slides, test banks, useful web
sites, and additional case studies are include on DavisPlus.
Specific criteria were used for identifying the groups
represented in the book and those included in electronic
format. Groups included in the book were selected based
on any of the six criteria that follow.
• The group has a large population in North
America, such as people of Appalachian, Mexican,
German, and African American heritage.
• The group is relatively new in its migration status,
such as people of Haitian, Cuban, and Arab her-
itage.
• The group is widely dispersed throughout North
America, such as people of Iranian, Korean, and
Filipino heritage.
• The group has little written about it in the health-
care literature, such as people of Guatemalan,