Pernell s Community Conceptual Model

1. Pernell�s Community Conceptual Model Presented by Faith Vaughn RN, BSN, MSN

2. Overview of The Model THIS MODEL IS 4YRS OLD, AND IS NAMED AFTER THE DESIGNER LARRY PURNELL, A PROFESSOR IN THE DEPT. OF NURSING AT THE UNIVERSITY OF DELAWARE. HE RECEIVED HIS PHD IN ADMINISTRATION, AND HIS AREAS OF INTEREST INCLUDE ADMINISTRATION AND TRANSCULTURAL HEALTH CARE. THE FOUR CONCEPTS INCLUDE: GLOBAL SOCIETY COMMUNITY FAMILY PERSON THE INTERIOR CIRCLES ARE THE 12 CULTURAL DOMAINS AND THEIR CONCEPTS. THESE 12 DOMAINS ARE ESSENTIAL FOR ASSESSING THE ETHNOCULTURAL ATTRIBUTES OF AN INDIVIDUAL, FAMILY, OR COMMUNITY, AND ARE RELATED. EX: COMMUNICATION, FAMILY ROLES AND ORGANIZATIONS, NUTRITION, HIGH-RISK HEALTH BEHAVIORS ETC. THE DARK CIRCLE, REPRESENTS UNKNOWN PHENOMENA ALONG THE BOTTOM OF THE MODEL, AN EROSE SAW SHAPE LINE, REPRESENTS THE CONCEPT OF CULTURAL CONSCIOUSNESS. THIS RELATES PRIMARILY TO THE HEALTH CARE PROVIDER DISCRIMINATION, GENERALIZATIONS, AND STEREO TYPES, CANNOT BE A PART OF THIS VALUE SYSTEMTHIS MODEL IS 4YRS OLD, AND IS NAMED AFTER THE DESIGNER LARRY PURNELL, A PROFESSOR IN THE DEPT. OF NURSING AT THE UNIVERSITY OF DELAWARE. HE RECEIVED HIS PHD IN ADMINISTRATION, AND HIS AREAS OF INTEREST INCLUDE ADMINISTRATION AND TRANSCULTURAL HEALTH CARE. THE FOUR CONCEPTS INCLUDE: GLOBAL SOCIETY COMMUNITY FAMILY PERSON THE INTERIOR CIRCLES ARE THE 12 CULTURAL DOMAINS AND THEIR CONCEPTS. THESE 12 DOMAINS ARE ESSENTIAL FOR ASSESSING THE ETHNOCULTURAL ATTRIBUTES OF AN INDIVIDUAL, FAMILY, OR COMMUNITY, AND ARE RELATED. EX: COMMUNICATION, FAMILY ROLES AND ORGANIZATIONS, NUTRITION, HIGH-RISK HEALTH BEHAVIORS ETC. THE DARK CIRCLE, REPRESENTS UNKNOWN PHENOMENA ALONG THE BOTTOM OF THE MODEL, AN EROSE SAW SHAPE LINE, REPRESENTS THE CONCEPT OF CULTURAL CONSCIOUSNESS. THIS RELATES PRIMARILY TO THE HEALTH CARE PROVIDER DISCRIMINATION, GENERALIZATIONS, AND STEREO TYPES, CANNOT BE A PART OF THIS VALUE SYSTEM

3. Relevance of the Model to  Community/Aggregate Population Care Relevant for all health care providers, and educators, in a diverse environmental contexts. Guide the development of assessment tools, planning strategies, and group interventions Can guide data collection Valuable resource for the study of cultural practices MODEL WILL HEIGHTEN ONE�S AWARENESS OF HIS OR HER OWN EXISTING THOUGHTS, WITHOUT LETTING THESE FACTORS AFFECT THE WAY CARE IS BEING RENDERED. THE PROFESSIONAL NURSE , AND PHYSICIAN WILL BE NONJUDGEMENTAL WHEN APPROACHING A DIVERSE POPULATION. MODEL HAS BEEN USED TO GUIDE DATA COLLECTION FOR MASTER�S AND DOCTORAL STUDENTS, AND COMMUNITY PROJECTS IN THE U.S., BRAZIL AND CENTRAL AMERICA. MODEL WILL HEIGHTEN ONE�S AWARENESS OF HIS OR HER OWN EXISTING THOUGHTS, WITHOUT LETTING THESE FACTORS AFFECT THE WAY CARE IS BEING RENDERED. THE PROFESSIONAL NURSE , AND PHYSICIAN WILL BE NONJUDGEMENTAL WHEN APPROACHING A DIVERSE POPULATION. MODEL HAS BEEN USED TO GUIDE DATA COLLECTION FOR MASTER�S AND DOCTORAL STUDENTS, AND COMMUNITY PROJECTS IN THE U.S., BRAZIL AND CENTRAL AMERICA.

4. Definition of the Concepts Global society: Includes the ability for people to travel around the world and to interact with diverse societies Community: Is a group of people having a common interest or identity and living in a specified locality Family: Is two or more people who are emotionally involved with each other Person: Is a bio-psychosociocultural human being who is constantly adapting

5. Relationship of the Major Concepts Family roles and organization: can affect health care decisions Economic and political conditions: may affect one�s reason for migration Education: is usually interrelated with employment choices Sociopolitical and socioeconomic conditions: influence individual behavioral responses to health and illness AN AWARENESS OF FAMILY DOMINANCE IS IMPORTANT FOR DETERMINING WITH WHOM TO SPEAK AN AWARENESS OF THE GEOGRAPHICAL RESIDENCE OF AN ETHNOCULTURAL GROUP INCREASES OPPORTUNITIES FOR COLLABORATING WITH HEALTH CARE PROVIDERS IN THESE COMMUNITIES. COLLABORATION IS ESSENTIAL FOR HEALTH PROMOTION, HEALTH MAINTENANCE, DISEASE PREVENTION, TREATMENT, AND HEALTH TEACHING THE VALUE PLACED ON FORMAL EDUCATION DIFFERS AMONG CULTURAL AND ETHNIC GROUPS. FOR EXAMPLE, EGYPTIAN AMERICANS PLACE A HIGH VALUE ON EDUCATION, AND THOSE WHO EARN AN ADVANCED DEGREE ARE PLACED IN HIGH ESTEEM OTHERS SUCH AS SOME NEWER MEXICANS, DO NOT STRESS FORMAL EDUCATION BECAUSE IT WAS NOT NEEDED IN THEIR HOME LAND FOR JOBSAN AWARENESS OF FAMILY DOMINANCE IS IMPORTANT FOR DETERMINING WITH WHOM TO SPEAK AN AWARENESS OF THE GEOGRAPHICAL RESIDENCE OF AN ETHNOCULTURAL GROUP INCREASES OPPORTUNITIES FOR COLLABORATING WITH HEALTH CARE PROVIDERS IN THESE COMMUNITIES. COLLABORATION IS ESSENTIAL FOR HEALTH PROMOTION, HEALTH MAINTENANCE, DISEASE PREVENTION, TREATMENT, AND HEALTH TEACHING THE VALUE PLACED ON FORMAL EDUCATION DIFFERS AMONG CULTURAL AND ETHNIC GROUPS. FOR EXAMPLE, EGYPTIAN AMERICANS PLACE A HIGH VALUE ON EDUCATION, AND THOSE WHO EARN AN ADVANCED DEGREE ARE PLACED IN HIGH ESTEEM OTHERS SUCH AS SOME NEWER MEXICANS, DO NOT STRESS FORMAL EDUCATION BECAUSE IT WAS NOT NEEDED IN THEIR HOME LAND FOR JOBS

6. 12 Domains Over view/heritage: concepts related to the country of origin Communication: concepts r/d to the dominant language Family roles and organization: concepts related to head of the household and gender role Workforce issues: r/d to autonomy, gender roles Biocultural ecology: r/d to variations in ethnic and racial origins High risk behaviors: r/d to the use of drugs, alcohol, and tobacco Nutrition: r/d to the meaning of foods, food choices Pregnancy and child bearing practices: methods of birth control Death rituals: r/d to how the individual and the culture view death Spiritual practices, r/d to religious practices, and the use of prayer Health care practice; r/d to focus of health care such as acute or prevention Health care practitioner: r/d to status, use, and perception of medicine

7. Application/Scenario A teenage mother brings her 3 year old son to the clinic, accompanied by her parents. She c/o her son having a bothersome persistent dry cough for the past 3 months. Within the past year, he has been coughing and wheezing every time he gets a cold.  He was diagnosed with mild persistent asthma. The physician ordered Flovent 44mcg 2 puffs BID, (increase to 4 puffs BID in yellow zones X2 weeks), and albuterol 2-4 puffs as needed for asthma symptoms and prior to exercise. Both parents revealed smoking 1-2 packs of cigarettes a day x 2yrs, and has limited knowledge of its link with asthma

8. Purnell�s Model for Cultural Competence Communication Family roles and organization Education High-risk behaviors Health care practices Health care practitioners HIGH-RISK BEHAVIORS - SMOKING HEALTH CARE PRACTICES � NO MEDICAL OR FOLLOW UP CARE / NON CARING ATTITUDE HEALTH PROFESSIONALS � OPEN MIND TO PROVIDE EFFECTIVE TEACHINGHIGH-RISK BEHAVIORS - SMOKING HEALTH CARE PRACTICES � NO MEDICAL OR FOLLOW UP CARE / NON CARING ATTITUDE HEALTH PROFESSIONALS � OPEN MIND TO PROVIDE EFFECTIVE TEACHING

9. Objectives Clinician can utilize communication skills to: Identify family concerns Improve teaching effectiveness Promote patient self-confidence NEED TO KNOW THE DOMINANT LANGUAGE IN THE HOME AND SOME PREFERRED OR COMMON WORDS USED, IN ORDER TO BE EFFECTIVE. USE DIRECT EYE CONTACT TO ENSURE YOUR TRUSTWORTHINESS. THIS TYPE OF APPROACH IS UNIVERSAL.NEED TO KNOW THE DOMINANT LANGUAGE IN THE HOME AND SOME PREFERRED OR COMMON WORDS USED, IN ORDER TO BE EFFECTIVE. USE DIRECT EYE CONTACT TO ENSURE YOUR TRUSTWORTHINESS. THIS TYPE OF APPROACH IS UNIVERSAL.

10. Disparity Considerations Work with each family to develop an action plan that takes into consideration: The families cultural, ethnic, and socioeconomic background The asthma regimen needed The families ability to implement the plan, physically, socially and economically The families high-risk behaviors that may sabotage the plan RELOCATION IS WITH AN ESTABLISHED POPULATION WITH SIMILAR IDEOLOGIES THAT CAN PROVIDE INITIAL SUPPORT, AND ORIENT THEM TO THEIR NEW CULTURE. THEY HAVE NO ASSISTANCE FROM OUTSIDE GROUPS PROVIDE INFORMATION ON THE CLINICS THAT OFFER FREE CARE, AND IS EASY TO ACESS WITHIN THEIR GEOGRAPHICAL LOCATION INTRODUCE THEM TO THE FOOD PROGRAMS, MEALS ON WHEELS. CATHOLIC CHARITIES ETC.RELOCATION IS WITH AN ESTABLISHED POPULATION WITH SIMILAR IDEOLOGIES THAT CAN PROVIDE INITIAL SUPPORT, AND ORIENT THEM TO THEIR NEW CULTURE. THEY HAVE NO ASSISTANCE FROM OUTSIDE GROUPS PROVIDE INFORMATION ON THE CLINICS THAT OFFER FREE CARE, AND IS EASY TO ACESS WITHIN THEIR GEOGRAPHICAL LOCATION INTRODUCE THEM TO THE FOOD PROGRAMS, MEALS ON WHEELS. CATHOLIC CHARITIES ETC.

11. Communication Tips for Explaining Asthma Make it simple and use pictures of airways Use the �fist� example, asking parent/patient to do it with you. Convey the dynamic of open/shut airways A PICTURE IS WORTH A THOUSAND WORDS. THAT IS TRUE WITH MOST CULTURES. THIS WILL BOOST THEIR ATTENTION, AND HELP THEM TO CONNECT AND UNDERSTAND THE SERIOUSNESS OF THE PROBLEM.A PICTURE IS WORTH A THOUSAND WORDS. THAT IS TRUE WITH MOST CULTURES. THIS WILL BOOST THEIR ATTENTION, AND HELP THEM TO CONNECT AND UNDERSTAND THE SERIOUSNESS OF THE PROBLEM.

12. Interventions Provide written instructions in client�s preferred language Implement some of their cultural practices into the plan of care Provide explanations for all Rx and OTC products at family in teaching. Emphasize not to share child�s treatment with others Educational level appropriate to client/family. Emphasize to call 911, if there�s no improvement in wheezing or breathing Explain the problems associated with smoking and second hand smoking. Explain role modeling, and the benefits of not smoking Seek help from primary MD, regarding FDA approved prescriptions. Contact local smoke cessation programs. Baptist Health (202-7069), or Dept. of Health (825-5055) THE WHOLE FAMILY IS INVOLVED IN THE TEACHING PROCESS. FIND OUT THE DOMINANT LANGUAGE AND PROVIDE LITERATURE TEACH ABOUT THE SIDE-EFFECTS AND COMPLICATIONS IN SIMPLE TERMS LET THEM KNOW THAT DEATH WILL OCCUR IF THE MEDICAL REGIMEN IS NOT FOLLOWED. FIND OUT THEIR LEVEL OF EDUCATION, TO TALK IN TERMS THEY CAN UNDERSTAND LET THEM KNOW THE CHILDREN VIEW THEM AS ROLE MODELS, AND OVER 50% STATED THEY DEVELOPED THE HABIT FROM THEIR PARENTS. THE WHOLE FAMILY IS INVOLVED IN THE TEACHING PROCESS. FIND OUT THE DOMINANT LANGUAGE AND PROVIDE LITERATURE TEACH ABOUT THE SIDE-EFFECTS AND COMPLICATIONS IN SIMPLE TERMS LET THEM KNOW THAT DEATH WILL OCCUR IF THE MEDICAL REGIMEN IS NOT FOLLOWED. FIND OUT THEIR LEVEL OF EDUCATION, TO TALK IN TERMS THEY CAN UNDERSTAND LET THEM KNOW THE CHILDREN VIEW THEM AS ROLE MODELS, AND OVER 50% STATED THEY DEVELOPED THE HABIT FROM THEIR PARENTS.

13. Teachable Moments Office visits Checking in Rooming Phone calls Grocery Store Health fairs Mentoring

14. Parents can ask� Does my child need a "quick-relief inhaler" more than TWO TIMES A WEEK? Does my child wake up at night with asthma more than TWO TIMES A MONTH? Do we refill the "quick-relief inhaler" more than TWO TIMES A YEAR? Do I smoke EARLY IN THE MORNING or EVENING? If yes, the asthma OR SMOKING may not be control

15. References Association for the Advancement of Health Education, Cultural Awareness and sensitivity: Guidelines for Health Educators. Campinha-Bacote, J. (1999). The process of cultural competence in the delivery of health care services: A culturally competent Model of care (3rd ed.). Cincinnati, OH: Transcultural C.A.R.E. Associates. Diversity in the workplace (1996).Washington DC: Veterans Health Association Management Support Office. Purnell, L., & Paulanka, B. (1998). Transcultural health care: A culturally competent approach. Philadelphia: F. A. Davis.