LARRY PURNELL'S MODEL FOR CULTURAL COMPETENCE It is true that sociologists and anthropologists have many definitions of culture. Purnell defines it as totality of behaviors, arts, custom, ways of life, beliefs, and values that are transmitted from one society to another. He looks at it as the product of human work that is believed to guide the way people view the world and how they make decisions. These patterns may be explicit or implicit but are learned and transmitted from family and could be shared by members of a particular culture. It could include emergent phenomena, which changes in response to the global phenomena. People learn about their culture in the family, community, school and social organizations such as the church (Purnell, 2003, p. 3).

Chose a Cultural Group That Is Different from Yours

In this case we choose Hispanic/Latino population. These are the people of Latin America, or Iberian ancestry who are fluent in Spanish (Nevaer, 2016).

List of Purnell Model's 12 Domains of Cultural Assessment and Their Characteristics

Purnell Model for cultural competence comprises of the following 12 cultural domains:

The outer Rim which represents the global society

The second Rim that represents the community

The third Rim, which represents the family

The Inner Rim, which represents the person

The interior represents the 12 domains

The center is empty and represents whatever that we do not know about the culture

The saw-toothed line represents the concept of cultural consciousness.

Figure 1- Purnell model for cultural competence

12 Cultural Domains

The domains are interdependent and affect one another.

Overview

The fastest and largest growing minority population in the U.S. is the Hispanic or Latino. The U.S. census defines a Latino or Hispanic as a person of the Spanish culture, with an origin in South and Central America, Puerto Rica, Mexico and Cuba, regardless of their race.

In the recent years, the term Latino has been commonly used to refer to people whose primary ethnic heritage originates from Latin America. The terms Latino and Hispanic are used interchangeably even by the U.S. Census Bureau, but Hispanic is often used in the government, statistical and research records. Latino has also become common and is used elsewhere.

Communication

The most shared characteristic among the many Latino/Hispanic groups is the retention and usage of the Spanish Language. On the other hand, factors such as geographical area, residence, economic background, education level, cohort effects, and nativity history, greatly influence proficiency in English language. Individuals with limited proficiency in English have encountered barriers when it comes to accessing social and medical services.

The use of Spanish by the Latino/Hispanic elders serve as a sense of identity and is also used to determine the quality of life one leads. In the U.S. census, the term linguistically isolated is used to refer to people who live in households where there is no person who is aged 14 and above who can speak English fluently. The U.S. census puts this figure to about 2/5 elderly Hispanic Latino who only speak Spanish and so they are linguistically isolated (Talamantes, Lindeman, & Mouton, 2010)

The Roles and the Organization of the Family

Mexican/Latino/Hispanic culture is considered important when it comes to family. Latino mothers play an important role in determining whether medical care is needed by the family members even though the families may make a decision to send any of the family members to a medical facility. The oldest male in any family is considered a decision maker; it may not necessarily be the father but could be the grandfather, depending on how the family lives. However, very important decisions may involve the entire family. The father or the oldest male in the family is the family spokesperson because it is believed that the older adult makes decisions that are good for everyone, especially if they are living with their children or grandchildren (Talamantes, Lindeman, & Mouton, 2010). The Hispanic children are likely to get married at a younger age compared to their non-Hispanic white women.

WorkForce Issues

U.S Census reveals that more than half of the U.S. Latino residents who are aged 5 and above speak English fluently; however, there are significant numbers of Latino adults who cannot speak English or cannot speak it very well. The immigration status may play a role since Hispanics who live in the U.S. may be taken advantage of if they cannot avail the correct paperwork. It is also estimated that 30.7% of the Hispanics lack health insurance.

Bicultural Ecology

Terms such as Cuban, Rican, Puerto, Spanish, Mexican, Latino, and Hispanic...

The U.S. Census has changed the terms from the Hispanic/Non-Hispanic white to include options that add another culture to it so that the people can identify with being African-American & Hispanic or Spanish & Latino. The top ten causes of death in the Hispanics/Latinos by 2009 include: heart disease, cancer, diabetes, stroke, unintentional injuries, cirrhosis, chronic liver diseases, pneumonia, nephritis, homicide and chronic lower respiratory diseases.
There are plenty of terms that refer to other cultures but related to this culture. They include Cuban, Rican, Puerto, Spanish and Cuban. The U.S. Census has changed the term that is used to refer to this category to Non- Hispanic white.

High Risk Behaviors

Obesity is prevalent in males who are 20 years or younger. The prevalence was highest in Mexican-Americans; by 2004- 2007, the rate of preventable hospitalization was found to be higher among the Hispanics who were considered non- Hispanic whites. There are many reasons that were believed to be causing this. They include distrust or fear of the health care system. The burden of HIV diagnoses continues to be experienced in the Hispanics who are more likely to be harassed and incarcerated by the law enforcement compared to their white counterparts. Smoking is thought to be the main cause of the over 87% of the lung cancer death in the U.S. Lung cancer is thought to be the leading cause of death among the Hispanics.

Nutrition

The diet for any Latino/Hispanic include: vegetables, whole grain corns, fruits, rice, spices, herbs, and beans. The traditional food should be high in fresh meats such as beef, pork, turkey; vegetables like tomatoes, cactus, greens, squash, cilantro and chili peppers. Fruits include: papaya, mangoes, guava, coconut, bananas and avocados. Beans, spices, corn and rice consists of cinnamon, garlic, cumin, vanilla, mace and cocoa (Colby).

Child Bearing and Pregnancy

Pregnancy is believed to be a natural condition and does not need any medical attention. The pregnant Hispanic / Latino women have lower folic acid levels and are not required to consume any food that contains folic acid.

Death Rituals

Most Latinos are Christians and believe in after life where one is punished or rewarded for leading an evil or a good life respectively. The importance attached to death is symbolized in the Mexican-American Celebrations of El Dia de Los Muertos (the Day of the Dead). The day is also referred to as All Saints Day and feature masks, dolls, figures of skulls and skeleton. The funeral rituals vary just like other religious ceremonies but they all include gathering of fictive and real kin (Vigil, 1996).

Spirituality

Just as it is in other cultures, spirituality varies depending on demographics but many patients seek healing from curanderos or any other folk healers. Most people believe that God is active in the day-to-day life. The Latinos pray every day and have religious objects and crucifix in their homes. Most of them attend religious services at least once per month. Latinos also believe that miracles are still being performed in the modern world just as it was in the ancient times. They also believe that religious believers are rewarded with wealth and good health.

Health Care Practices

Most of the Hispanic-Americans consider illness as the imbalance of the soul and the body. The imbalance is believed to be between the external sources and the internal one (e.g., natural vs. supernatural, cold and hot).

Depression is not considered as an illness. If it is present in the male who is also the head of the household, it is considered as a weakness, which embarrasses the family. This is why males often delay medical care until when the condition worsens. Other reasons for delaying the attention are many and range from language barriers and poverty to absence of an insurance cover (Peterson-Iyer, 2008).

Health Care Practitioners

Latinos feel that they are less listened to and understood by doctors compared to African- Americans and Americans. They also don't understand their doctors and often leave the doctor's office without asking a question. They are likely to feel that they have been treated unfairly by the medical system hence develop distrust in the biomedical system. Risks Common to a Cultural Group and How the Assessment Data Can Be Used to Formulate Culturally Prevention Strategy

Hypertension

This is a chronic arterial blood pressure believed to be a major risk factor for stroke and heart disease. Its prevalence in Hispanics is the same as it is in the non- Hispanic Whites even though it may be lower. According to studies, the rate of hypertension was at some point lower in the Hispanics than the non- Hispanic whites, but currently, the rates are similar (Escarce, Morales, & Rumbaut, 2006).Assessment…