University of Delaware
Office of Public Relations
The Messenger
Vol. 5, No. 2/1996
Transcultural nursing

     The world is Larry Purnell's textbook, and he studies how
culture affects the practice of medicine and nursing through
firsthand observation of clinics and hospitals in South America,
Africa, Europe and Asia.
     Purnell, an associate professor of nursing whose fields are
emergency care and administration, has developed expertise in
transcultural nursing. Now, he is involved in helping health-care
professionals understand, appreciate and deal with cultural
differences among patients.
     Purnell, who is a member of the Transcultural Nursing
Society, was invited to present a paper on the topic in Zhuhai,
China, last summer. "It was adventurous visiting China as an
independent tourist," he recalls.
     Even getting a visa was a cliffhanger, he says, as it did
not arrive until two days before his scheduled departure. His
itinerary had to be spelled out in detail in advance: "No hotel,
no visa," he says.
     His first stop was Beijing, where he visited former UD
nursing faculty member Linda Matocha, who is now teaching at
Beijing Medical University, and her husband. "That part was
easy," he says. "I had a driver and interpreter and got around
     During his stay, he gave a lecture on emergency triage to
the faculty of Beijing Medical University and went on clinical
rounds with students, nurses, physicians and faculty, visiting
the intensive care, surgical and medical units.
     Chinese medicine combines Western medicine with such
centuries-old practices as acupuncture, herbal therapy,
acupressure (massage) and moxibustion, where hot metal cups are
applied to the body to draw out excess heat, Purnell says.
     Visiting Xian, site of the famed terra-cotta warriors that
have recently been excavated, and Guangzhou in southern China was
more of a challenge than visiting Beijing, Purnell says.
     "They don't list flights in the airports, so I would read
people's tickets and if they were like mine, I followed them to
the plane. It worked."
     Purnell took buses into the country side, carefully noting
their Chinese number and location so that he could catch the bus
back again. "Legally, as a foreigner, I was supposed to stay in
the city limits," he says, "but I wanted to see the countryside
and how people lived, and buses provided that opportunity."
     In general, Purnell says, he found everyone friendly and
helpful, although the police watched him carefully and
occasionally stopped him.
     His last stop was Zhuhai, where he attended a conference
with an international group of 400 physicians and nurses. Most of
them were Chinese, but others, representing 15 countries from
Europe, Asia and North America, also were present.
     Purnell's current project is a textbook, Transcultural
Health Care: A Culturally Competent Approach, which he is editing
with Betty Paulanka, dean of the College of Nursing. Publication
is scheduled this year.
     The focus of the book is a diagram, "Purnell's Model for
Cultural Competence." The model is a circle, with the outlying
rim "community," the next rim "family" and an inner rim named
     The interior of the circle is cut into 12 pie-shaped wedges
dealing with such issues as nutrition, death, pregnancy, high-
risk behaviors and family organization, which all societies and
humans share.
     For example, in the field of nutrition, it is important for
health-care professionals to understand different ethnic groups,
Purnell says. When a physician prescribes a special diet for
diabetes, the dietitian should develop a diet that adapts to the
client's cultural and religious backgrounds. "People whose
heritage is Jewish, Asian or Hispanic eat quite different foods,
and, if this is not taken into consideration, the patient
frequently will not follow the diet," Purnell says.
     The book has chapters written by representatives from
different cultures that address these common concerns. Purnell is
writing the chapters on Appalachian residents, Mexican Americans
and Italian Americans.
                                             -Sue Swyers Moncure