DNP Peers’ Posts Needing Responses

Instructions: Choose 2 of the following areas to discuss:

1. Do you think you are a role model for nursing practice in your healthcare setting? If so, what qualities enable you role-model effectively? If not, what qualities would enhance your ability to role-model?

2. What social determinants of health affect health inequities globally? 

3. How has nursing historically analyzed data?  What has been the major focus? 

4. Discuss the Purnell Model for Cultural Competence.

5. One role of the DNP graduate is to evaluate care delivery models.  Identify and briefly discuss a theory/model that may used by the DNP graduate to evaluate care delivery models

2. Social Determinants of Health That Affect Health Inequities Globally

One of the most marked characteristics of the global social structure is the existence of substantial inequalities in wealth and income, which also find expression in differences in health between countries and between social groups within countries (Borde and Hernandez, 2019).   The causes of health inequalities include social inequalities and social determinants of health.  According to Office of Disease Prevention and Health Promotion (ODPHP, n.d.) social determinants of health (SDOH)  is defined as the conditions in the places where people live, learn, work, and play that can affect health outcomes;  SDOH have a major impact on people’s health, well-being, and quality of life. Examples of SDOH include safe housing, transportation, neighborhoods, racism, discrimination, violence, education, job opportunities, income, access to nutritious foods and physical activity opportunities, polluted air and water, language and literacy skills (ODPHP, n.d.).  In low and middle-income nations, health inequities are typically at their worst.   Inequities in employment conditions, social protection, housing and access to health care serve as the ‘causes of the causes’ of poor health, and are themselves driven by inequities in power, money and resources (Townsend et al, 2020).  People of lower socioeconomic have a higher risk of developing cardiovascular disease, diabetes, and some types of cancer as a result of dietary patterns and lack of access to dietary dense foods and drinks. Distance to grocery stores and lack of transportation are barriers that can hamper access to healthy food options.

Race and ethnicity are another major socioeconomic predictor of health (Brown, et al., 2018). The conceptualization of racism as historically rooted in systems, structures, andinstitutions of US society have important implications for addressing social determinants of health (Blankenship et al., 2023).  It is more common for people of color to face health inequalities than it is for white people. Blacks and Latinos in the US, for instance, are disproportionately affected by the prevalence and mortality rates of certain chronic illnesses including hypertension and diabetes. Globally, this patterning is also evident in infant mortality rates varying between 2 per 1000 live births in Iceland and over 120 per 1000 live births in Mozambique (Borde and Hernandez, 2019).  Black women are more than 4 times more likely to die from pregnancy-related complications, and almost 2 times more likely to die in the hospital than White women due to lower quality healthcare (Greenberg et al., 2022). The pregnancy-related mortality ratio for Black women aged 40 years or older in one cohort approached 150 maternal deaths per 100,000 live births vs 40 per 100,000 live births among White women in the same age group (Greenberg et al, 2022). 

Globally, developing and low-income countries due to lack of wealth and power, experience poverty, inequitable access to health care, lack of education, stigma and racism on a larger scale, leading to health inequalities

4. The Purnell Model for Cultural Competence

The Purnell Model for Cultural Competence is a framework designed to help healthcare providers understand and respond to the cultural and ethnic differences of their patients (Purnell, 2019). Developed by Dr. Larry Purnell in 1991, this model is based on the idea that cultural competence is a lifelong process of developing an awareness and understanding of one's own cultural values and biases, as well as those of others.

The Purnell Model consists of 12 domains, each of which represents a different aspect of cultural competence:

1. Cultural awareness: Recognizing one's own cultural values and biases and their impact on the care of patients from diverse backgrounds.

2. Cultural knowledge: Acquiring information about different cultures, their beliefs, practices, and values.

3. Cultural skill: Developing the ability to communicate effectively with patients from different cultures, and to respond to their cultural needs.

4. Cultural encounters: Understanding the importance of cultural humility and recognizing the power dynamics that exist in cross-cultural encounters.

5. Cultural desire: Demonstrating a genuine interest in learning about and serving patients from diverse cultural backgrounds.

6. Cultural awareness of the health care system: Understanding how the healthcare system and policies may impact access and quality of care for patients from different cultural backgrounds (Zarzycka, et al., 2020).

7. Cultural competence in assessment: Using culturally appropriate methods to assess patients' physical, mental, and social health needs.

8. Cultural competence in diagnosis: Considering the cultural context of patients' symptoms and experiences when making a diagnosis.

9. Cultural competence in treatment: Developing culturally sensitive and appropriate treatment plans for patients from diverse cultural backgrounds.

10. Cultural competence in care coordination: Working with interdisciplinary teams to ensure that patients receive culturally competent care.

11. Cultural competence in health promotion and disease prevention: Developing culturally appropriate health promotion and disease prevention strategies.

12. Cultural competence in research: Ensuring that research is culturally sensitive and appropriate, and that the results are relevant to diverse populations.

The Purnell Model provides a comprehensive framework for cultural competence in healthcare and can serve as a useful tool for healthcare providers as they work to deliver culturally sensitive and effective care to patients from diverse backgrounds. By incorporating the principles of the Purnell Model into their practice, healthcare providers can help to address health inequities and improve health outcomes for all patients.



Blankenship, K. M., Rosenberg, A., Schlesinger, P., Groves, A. K., & Keene, D. E. (2023).  Structural Racism, the Social Determination of Health, and

       Health Inequities: The Intersecting Impacts of Housing and Mass Incarceration.  American Journal of Public Health113, S58–S64.

Borde, E., & Hernández, M. (2019). Revisiting the social determinants of health agenda from the global South.  Global Public Health14(6/7),

        847–862. https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.1080/17441692.2018.1551913

Brown, C. E., Engelberg, R. A., Sharma, R., Downey, L., Fausto, J. A., Sibley, J., Lober, W., Khandelwal, N., Loggers, E. T., & Curtis, J. R. (2018).

        Race/Ethnicity, Socioeconomic Status, and Healthcare Intensity at the End of Life.  Journal of palliative medicine21(9), 1308–1316.

Greenberg, M. B., Gandhi, M., Davidson, C., & Carter, E. B. (2022). Society for Maternal-Fetal Medicine Consult Series #62: Best practices in

        equitable care delivery–Addressing systemic racism and other social determinants of health as causes of obstetrical disparities.  American

          Journal of Obstetrics and Gynecology227(2), B44–B59.

Office of Disease Prevention and Health Promotion. (n.d.). Social Determinants of Health.  Healthy People 2030. U.S. Department of Health and

         Human Services. 

Purnell L. (2019). Update: The Purnell Theory and Model for Culturally Competent Health Care.  Journal of transcultural nursing : official journal of

          the Transcultural Nursing Society30(2), 98–105. 

Townsend, B., Friel, S., Baker, P., Baum, F., & Strazdins, L. (2020). How can multiple frames enable action on social determinants? Lessons from

         Australia’s paid parental leave.  Health Promotion International35(5), 973–983. 


Zarzycka, D., Chrzan-Rodak, A., Bąk, J., Niedorys-Karczmarczyk, B., & Ślusarska, B. (2020). Nurse Cultural Competence-cultural adaptation and

        validation of the Polish version of the Nurse Cultural Competence Scale and preliminary research results.  PloS one15(10), e0240884.

Professor Melissa Cheeks

Thanks for kicking off this week's discussion, Remi.

Excellent discussion on the global health impact of the SDOH. The racial disparity R/T pre-term birth, infant mortality, and pregnancy related complications/mortality is significant. Despite improvement efforts, it is still a problem that is ripe for innovation for DNP-prepared leaders to address. Are you familiar with the work being done by Cradle Cincinnati ( )? If not, and this is an area of interest for you, I recommend taking a look at how they are addressing the issue to close the disparity gap. 

QUESTION: I am curious if you have utilized the Purnell Model in practice? If yes, what's your experience been before and after?

Dr. Cheeks

Islam, M. M. (2019). Social determinants of health and related inequalities: Confusion and implications.  Frontiers in Public Health7. https://doi.org/10.3389/fpubh.2019.00011

Jack, K., Hamshire, C., & Chambers, A. (2017). The influence of role models in undergraduate nurse education.  Journal of Clinical Nursing26(23-24), 4707–4715. https://doi.org/10.1111/jocn.13822


What social determinants of health affect health inequities globally?

Social determinants of health are defined as the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life (Osmick & Wilson, 2020). The long-term repercussions of social determinants of health (SDOH) have been well understood to front-line healthcare workers for decades. The narrative is evident with working in a clinic or making house calls to patients. Unemployment or underemployment, unsafe neighborhoods, failing schools, broken staircases, leaky roofs, peeling paint, empty refrigerators, mildew and pests, and unfilled prescriptions are all problems. The American Dream hangs precariously in the balance as prescription bottles, unhealthy living conditions, and wealth inequality increasingly disadvantage minorities. There is no denying that disadvantage, prejudice, and poverty lead to poor health, and that no amount of better and more advanced medical treatment, procedures, or medications will be able to reverse this trend globally (Osmick & Wilson, 2020).

These dynamics are impacted by how money, power, and resources are allocated at the international, national, and local levels, which are in turn molded by political decisions, as well as relating socioeconomic factors to disparities in health opportunities. In the United States and globally, several individual organizations, multisector initiatives, and collaborations are paving the way both nationally and internationally. However, this task is too large, crucial, and significant to be left in the hands of a select group of valiant fighters. Instead, it calls for all of us in all spheres of society to be prepared to face and alter implicit and explicit biases that support the status quo and to work tirelessly today to produce results that may not be seen for decades or generations, knowing that this effort will lead to a more equitable and healthy society (Osmick & Wilson, 2020).

How has nursing historically analyzed data?  What has been the major focus? 

Standard query language (SQL) has been the fundamental method in data preparation and analysis. Without proper preparation of data, the analysis can be misleading and erroneous. Details are very important. How each variable in the analysis is defined affects how predictive it will be. Major focus has been healthcare analytics. This has the potential to reduce treatment costs, forecasts outbreaks of epidemics, avoid preventable diseases, and improve the quality of life. Healthcare professionals are skillful in gathering enormous volumes of data and look for the best approaches to use these numbers. Data analytics has helped the healthcare setting by providing personalized medicine and prescriptive analytics, medical risks interference and predictive analytics, computerized external and internal reporting of patient data, homogeneous medical terms and patient registries, and fragmented point solutions (Tanwar et al., 2020).


Osmick, M. J., & Wilson, M. (2020). Social Determinants of health—relevant history, a call to action, an organization’s transformational story, and what can employers do?  American Journal of Health Promotion34(2),                    219–224. 

Tanwar, P., Jain, V., Liu, C.-M., & Goyal, V. (2020).  Big Data Analytics and Intelligence: A Perspective for Health Care. Emerald Publishing Limited.