Instructor and Class,

Addressing the Purnell Model for Cultural Competence and its relevance for advanced practice nurse, it is necessary to note that this theory helps nursing professionals identify twelve cultural domains where they need to practice cultural competence in order to provide high quality patient care.  These domains are as follows: heritage, communication, family roles and organization, workforce issues, bicultural ecology, high-risk behaviors, nutrition, pregnancy and childbearing, death rituals, spirituality, healthcare practices, and healthcare practitioner (Estevan, 2017).  Below, all these twelve domains will be observed in detail.

The domain of heritage refers to concepts related to country of origin, current residence, the effects of the topography of the country of origin and current residence, economics, politics, reasons for emigration, educational status, and occupations (Purnell, 2020).  The domain of communication implicates concepts related to the dominant language and dialects; contextual use of the language; nonverbal communications such as the use of eye contact, facial expressions, touch, body language, spatial distancing practices, and acceptable greetings; and the use of names (Purnell, 2020).  The domain of family roles and organization includes concepts related to the head of the household and gender roles; family roles, priorities, and developmental tasks of children and adolescents; child-rearing practices; and roles of the ages and extended family members; single parenting, sexual orientation, child-less marriages, and divorce (Purnell, 2020).

Further, the domain of workforce issues refers to concepts related to autonomy, acculturation, assimilation, gender roles, ethnic communication styles, individualism, and health care practices from the country of origin (Purnell, 2020).  The domain of bicultural ecology includes variations in ethnic and racial origins such as skin coloration and physical differences in body stature; genetic, heredity, endemic, and topographical diseases; and differences in how the body metabolizes drugs (Purnell, 2020).  The domain of high-risk behaviors includes the use of tobacco, alcohol and recreational drugs; lack of physical activity; nonuse of safety measures; and high-risk sexual practices (Purnell, 2020).

Next, the domain of nutrition includes having adequate food; food choices, rituals, and taboos; and how food and food substances are used during illness and for health promotion and wellness (Purnell, 2020).  The domain of pregnancy and childbearing refers to fertility practices; methods for birth control; views towards pregnancy; and prescriptive, restrictive, and taboo practices related to pregnancy, birthing, and postpartum treatment (Purnell, 2020).  The domain of death rituals includes how the individual and the culture view death, rituals and behaviors to prepare for death, burial practices, and bereavement behaviors (Purnell, 2020).

Finally, spirituality refers to religious practices and individual sources of strength (Purnell, 2020).  Health care practices includes the focus of health care such as acute or preventive; traditional, magicoreligious, and biomedical beliefs; individual responsibility for health; pain tolerance; self-medication practices; and views towards mental illness, and organ donation and transplantation (Purnell, 2020).  Health care practitioner refers to the status, use, and perceptions of traditional, and allopathic biomedical health care providers (Purnell, 2020).

In essence, advanced practice nurses (APNs) are expected to be well-educated and competent in all those twelve domains to be able to act professionally when facing differences and diversity related issues (Purnell, 2019).  Using the Purnell’s model, APNs can become more understanding and adaptive to various circumstances, and better able to apply culturally focused interventions.  The model helps APNs guide their thinking and decision-making process when they plan for holistic patient care (Purnell, 2019).


Estevan, G. (2017). Application of the cultural competence model in the experience of care in nursing professionals Primary Care. Atencion Primaria, 49(9), 549-556. doi: 10.1016/j.aprim.2016.10.013

Purnell, L. (2019). Update: The Purnell theory and model for culturally competent health care. Journal of Transcultural Nursing, 30(2), 98-105. doi: 10.1177/1043659618817587

Purnell, L. D. (2020). The Purnell Model and Theory for Cultural Competence. In Textbook for Transcultural Health Care: A Population Approach (pp. 19-59). Springer, Cham.