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 easily." 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 "person." 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