The dawn of the 21st century signaled the complexity and diversity of cultures, including in the area of health care.
Nursing, as a medical profession, holds a vital part in satisfying the patient’s need of getting well. It is the nurse that occasionally visits and attends to the patients more than the attending physician could do.
But then, nursing is not a simple profession as many would think so. Nursing, as a profession, entails many challenges for the attainment of its noble goals.
The Purnell Model
The Purnell Model of Cultural Competence is a framework designed to help medical professionals to adapt with the multiculturalism in the technical field (Wiki, 2007).
The Purnell Model of Cultural Competence is in circular shape with the outer ring which represents the global society. Meanwhile, the second ring represents the “community” which refers to a certain group of people with individuals with a common interest and identity situated o thriving in a particular place (Wiki, 2007).
The third ring represents the family which we know defined as two or more persons who are involved with each other emotionally—who are bound by marriage or any legal means. The fourth ring, meanwhile, represents the “person.” (“Cultural Competency and Haitian Immigrants”, 2007)
The Purnell Model suggests the following major points:
Every culture may find one major similarity.
One culture is not actually comparable to another given their respective features and characteristics.
Cultures around the world change as permitted and caused by time.
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There can never be differences between, within, and among cultural orientation because they are not comparable.
Culture plays a very vital part on one’s responses towards health care.
Health could and should also manifest or show the beliefs, values, attitudes and the worldview of the diverse populations.
Through cultural encounters, another culture develops and learns.
Cultural understanding is the best way to avoid prejudices and biases among the different cultures of the world.
A caregiver’s self awareness could be improved and widen by cultural awareness.
An individual deserves to be respected for his or her cultural characteristics.
Individuals and families may also belong to their respective different cultural group; to several cultural groups.
People who are into care giving must have both culture-specific and culture-general for them to be able to provide a kind of care that is competent and culturally sensitive.
All health care practitioners should be oriented with the pertinent information on cultural diversity.
Also included in the Purnell Model of Cultural Competence are twelve wedges with their respective components:(“Cultural Competency and Haitian Immigrants”, 2007)
· Heritage- under this are the concepts of politics, education status, occupations, residency, effects of topography on health, among others;
· Communication-under this are the concepts of dialects, dominant language, certain cultural communication patterns, and non-verbal cues;
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· Family Roles and Organization-under this are the concepts of family goals and priorities, acceptance of alternative lifestyles like single parenting, childless marriages, divorce, among others;
· Workforce issues-under this are the concepts of assimilation, gender roles, and autonomy.
· Biocultural ecology-under this are the concepts of skin color, and diseases.
· High-risk behavior-under this are the concepts of drug use, nicotine use, degree of sedentary lifestyle, among others.
· Nutrition-under this are the concepts of food availability, meaning of food to culture, among others.
· Pregnancy and childbearing practices—under this are the concepts of labor, delivery practices, and fertility practices.
· Death rituals-under this are the concepts of mercy killing, burial customs, among others
· Spirituality-under this are the concepts of worship and other religious means.
· Health care practices-this include sick role, barriers to care health, and some other traditional practices.
Filipinos: An overview
Filipinos refers to those people who live or natives in the Philippines, a country in the Southeast part of Asia. According to historical accounts, the word “Filipino” was actually intended to refer to Spaniards who were born in the Philippines. During the nineteenth century, the word has been referred to the inhabitants of the country.(“Filipino Society and Culture”, 2007)
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The cultural orientation of the Filipinos is basically connected with the cultures of other groups such as the Mexicans and the Spanish, also from the Indian and Chinese cultures.
Philippines is overwhelmed by Christians with Catholic as the main religion I the country. Over 83 percent of the 80 million of its population are Roman Catholics. This is the result of the Spanish colonization.
The diversity of culture in the Philippines alone starts with the dialects that spoken from the more than 7000 islands of the country. There are roughly 170 dialects spoken in the country.
Some of the traits of the Filipinos evident in their culture are: their belief of utang na loob (debt of gratiude), pakikisama (harmony), close family ties, among others.(“Filipino Society and Culture”, 2007)
Utang na loob or debt of gratitude is the Filipinos’ appreciation of the things that a person has done him or her especially during time of hard ships. This debt of gratitude is usually exchanged also by another good deed of the person who is “indebted.”(“Filipino Society and Culture”, 2007)
Pakikisama, meanwhile, is the Filipinos “vow” to get along with people to attain a stable relationship or friendship.(“Filipino Society and Culture”, 2007)
And lastly, the close family ties. Filipinos are known to be much attached to their family. In the Philippines, even if a child reached the legal age (eighteen years old), she is still under his or her parents. Parents and their children do not live separately until the children would get married. In some cases, even if already married, children continue to live with their parents in the same house.
The unique culture of the Filipino people needs a special understanding among nurses or any other medical professional.
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It is important that a nurse what is the cultural orientation of his or her clients to come up with effective means or treatments that would not violate the cultural orientation of the people or the patient.
The above mentioned traits of the Filipinos may bear in the understanding of the culture of the Philippines. The nurse, tasked to give care and assist the doctor is bringing out the best in the health of the patient would find it helpful if they would try to understand and contextualize their means in treating the patient.
In the Filipino culture, for example, due to the close family ties find the affection of their co-family members helpful in coping up wit their sickness.
Also the attending nurse should also be sensitive enough in attending to the needs of the patients without violating or offending the culture of the patient. Be it emotional, physical, or spiritual aspect of the culture of the patient.
“Cultural Differences” and dealing with it
Culture is commonly defined as the over all characteristics of a society which encompasses the society’s total behavioral patterns, customs, expression of arts and thought characteristics of a population.
The patterns involving culture may be implicit or explicit or may vary or change according to circumstances that may arise within the society. Part and parcel of culture, are its influences on the other aspects that are present in the society.
With culture, we could also relate illness and health. Just think of the varying “medicinal practices” that we have around the world.
Consider this scenario: a nurse visited a toddler in is home who has severe physical and other developmental retardations. She says to the kid’s parents that she would like to
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suggest that the child should have some sort of physiotherapy and occupational therapy for the child to cope with his disabilities and difficulties and also for him to learn the importance
of independence despite this illness. Then, the parents immediately refused immediately
stating that they are the child’s parent who has the responsibility of taking care of their child—most especially that their child is disabled. The nurse felt upset because she thinks that the parents are too irrational that they do not consider the improvement of state of their child.
The anecdote above simply shows how cultural differences could affect the health services of the caregivers or any other medical practitioners.
The nurse did not understand first that people differ in culture and values. In the case of the above story, the family is obviously very close and puts forth the importance of taking care of each other—especially the parents to their child.
In the case of the Filipinos, they value close family ties. This means that the family members are close with each other. Their culture shows that a family member who is evidently in dire need of caring should be given the attention and affection needed by the person who is ill. Though in the context of Filipino families, parents always want the best for their children and sometimes ended up on a “spoon feeding” techniques. In essence, this technique embraces the idea of too much dependence of children to their parents.
One of the most important aspects of providing culturally-sensitive care is reflection. A care giver or any other medical professional intended to be involved in personal health care, most especially, should consider some time to reflect that their would be dealing with.
Reflection, basically, helps nurses to identify some values and biases that they would be dealing with as they go on in their profession. The nursing profession entails a lot of
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cultural awareness since you would be dealing with practically different bunches of people.
But then, cultural biases are not actually easy to identify. Occasionally, what we know is what we think right. Too, often, we base our cultural prejudice on the things that we readily see, without having a deep understanding and awareness on the cultural characteristics that we have to deal with.
The nursing profession itself has also its own culture. Empathy, caring, and promoting health also involve certain values under culture.
The cultural awareness needed by nurses in their profession could be coped by having dome time to reflect on the culture that they would be dealing with. Nurses should put in their minds that their profession entails a broad understanding of the culture of their present and future clients to ensure sensitivity.
Another aspect is acquiring cultural knowledge. It is, of course, understandable that nurses would not have an in-depth understanding of their clients’ culture. But then, it is possible that nurses have a broader understanding of their clients’ culture by acquiring the needed cultural knowledge.
Talking in the context of health in the acquisition of cultural knowledge, an individual’s culture may affect beliefs and values in the following areas:
· Opinions or perceptions towards illness, death, and illness;
· Suffering’s role and meaning;
· Perception about nurses, doctors, other healers and even the hospitals;
· Limitations or boundaries concerning age, gender, privacy and relationships;
· Value and the efficacy of the different types of therapies.
· Communication gestures like direct eye contact and avoidance of direct eye contact;
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· decision pertaining to the consent of treatment;
· family and social relationships (e.g. roles of the family members in the care giving process)
A smooth communication flow between a nurse and his or her client is definitely a must for an effective therapeutic session. Whenever a communication barrier is evident, the nurse should be willing to identify and wrestle those by coming up with a communication plan. And those communication barriers do not only include verbal communication but non-verbal communication, or gestures, as well.
In the case of the Filipinos, most of the people are fluent only in English and Filipino. If the client only speaks Filipino, and the nurse only speaks English, then there the communication comes in.
In cases like this, interpreters may have their role to transcend the communication barrier but seems to be impractical. The interpreter may come from the family members of the client, a professional interpreter, or just someone who could speak and understand both of the languages.
A common disadvantage of “using” or seeking the help of interpreters is that the chosen interpreter may not be well-versed with medical terms and concepts. The integrity of the information to be relayed would be gravely affected if this kind of problem arises.
There are also instances that nurses or other health professional do not actually see the need for an interpreter in a client-to-nurse conversation. Below are some guidelines on how an interpreter could effectively work amidst the nurse-to-client conversations:
Above all, the nurse must seek the consent of the client if they could “employ” an interpreter for them to transcend the verbal communication barrier;
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Before depending on the interpreter, the nurse must first consider the “accuracy” of the interpreters’ translation of words like age, social status, and most especially differences in dialect.
The nurse must give emphasis to the interpreter the importance of repetition in translating words without omitting any word or implying judgments.
The nurse should not talk directly to the interpreter but instead to the client. This would allow non-verbal communication gestures facilitate the communication process.
The nurse must also avoid too much jargon that the interpreter could not understand.
Information should be given to the interpreter bit by bit so that the interpreter would not miss or summarize the words that the nurse would say.
Some nurses do not actually consider the need for an interpreter in conversations with clients who have a different language. Some of them just resort to observing non-verbal cues from their clients and give their clients as well non-verbal cues to facilitate the communication process.
Non-verbal communication clues would include facial expression, tone of voice and even body posture that tell something. All of these gestures may signal the reaction or assessment of the client toward the performance of the nurse.
However, given that the meanings of these non-verbal communication clues vary from one culture to another, the nurse must also exert an effort to research or at least ask people on what do certain gestures mean.
For example, in the Philippines, a nod means approval or contentment of the nurse’s service and performance while some other countries, a nod means discontent or dismay.
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The communication barriers mentioned above are just some the probable problems that a nurse may encounter if he or she will be taking care of a client coming from a different cultural group.
Some medical practitioners are too reluctant to admit that communication, indeed, is a very crucial part of the therapeutic process. It seems that the communication differences are just a minor part of the therapeutic process.
But then, the therapeutic process itself is a communication process thus, an effective communication is required.
Culture Care Preservation
Culture Care preservation would mean the efforts of the nurse to interrogate with his or her client culturally. This usually involves the nurse’s efforts to understand the preferences of the client in terms of emotional, physical, and spiritual health. (Andrews, 1995)
In the case of the Filipinos, for example, most of the clients prefer utmost protection not just from the nurse but also from the family members.
The nurse should be sensitive enough to the consideration that, in a family of Filipinos, affection of their co-family members sometimes helps for the patient to recover faster.
In the field of medical health, being sensitive to the culture of the patients helps in order for the therapeutic process to be effective.
The Purnell Model of Cultural Competence is a perfect guide that nurses and other medical professionals should follow.
Andrews, M., & Boyle, J. (1995). Transcultiral concepts in nursing care (2nd ed.). Philadelphia: Lippencott.
Cultural Competency and Haitian Immigrants. (2007). Retrieved April 16, 2007, from http://www.salisbury.edu/nursing/haitiancultcomp/purnellsmodel.htm
Filipino Society and Culture. (2007). Retrieved April 16, 2007, from http://www.livinginthephilippines.com/philculture/filipino_society_culture.html
Wiki, F. (2007). Cultural Considerations and Their Impact on Individuals and Communities. Retrieved April 16, 2007, from http://www.fluwikie.com/pmwiki.php?n=Main.CulturalConsiderationsAndTheirImpactOnIndividualsAndCommunities