Cultural competence is an expected component of professional nursing practice. Culturally competent care means conveying acceptance of the patient’s health beliefs during assessment and while sharing information. Demonstrating knowledge and understanding of the client’s culture, health-related needs and culturally specific meanings of health and illness. Culture has a powerful unconscious impact on health professionals. A nurse who understand his/her client’s cultural values, belief, and practice is in a better position to interact with his/her clients and provide culturally acceptable care that improve opportunities for health promotion and wellness.
Vietnamese are a southeast Asian ethnic group with approximately 1.2 million living in the United States and the majority arrived since 1975. Vietnamese in America differs substantially depending on the primary and secondary characteristic of culture. They place a high value on education and accord scholars an honored placed in the society. The teacher is highly respected as a symbol of learning and culture.
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Arabs trace their ancestry and traditions to the nomadic desert tribes of the Arabian Peninsula. They share a common language: Arabic. Most are united by the religion of Islam. Despite these common bonds, great diversity exists among Arabs related to religious preferences and other primary and secondary characteristics of culture. Arabism and Islam are intrinsically interwoven with some elements of Christianity so that Arabs, whether Christian or Muslim, share some basic tradition and beliefs. It is important to know their religion to understand an Arabian client’s cultural frame of reference.
The Vietnamese language is a single distinctive language with northern, central and southern dialects, and it is understood by any individual speaking any of the dialects. It is the only language of the Asian mainland that is regularly writing in the Roman alphabet. If an interpreter is needed during the patient care or assessment and a qualified interpreter is not available. It is best to use an elder female fluent in English when asking about female health related issues instead of a child interpreter. Men are usually comfortable with any gender to interpret for them, while teenagers prefer an unrelated friend.
Arabic is the official language of the Arab world, but it has a variation in dialects, words and meaning in different Arab countries (e.g., Egyptian - Arabic). Yemenis speaks a local version of Arabic which is not widely understood by another Arab world. Arab professionals and business people usually speak English fluently. Although English is a common second language in the Arab world, communication barrier can be a problem in a healthcare setting. It is encouraged to speak clearly and slowly, giving time for a translation. It is best to use a qualified interpreter when necessary and preferably a same sex interpreter. Avoid using a family member if possible, because sometimes family members tend to edit or limit messages to protect the patient in some sensitive discussion.
When performing head to toe assessment on people of Vietnamese be aware that the head is a sacred part of the body that should not be touched. If you must touch the head during assessment, you need to first provide an explanation and ask for permission. During the conversation, looking at another person in the eyes may be deemed disrespectful and they tend to speak with a soft tone, the nature of the language structure makes them to speak fast. For the Arab Speech is loud particularly when is involve a serious discussion, an observer might misunderstand it to be argumentative or aggressive. For a Vietnamese hugging and kissing are not seen outside the privacy of the home, women are not likable to shake hands, men usually shake men hand and wait for the women to extend her hand for a greeting likewise with Arabs. Traditional Vietnamese prefer more distance during personal and social relationships.
Arabs like to be addressed by their titles and their first names. During a conversation with an opposite sex, Arabic people avoid standing close, maintaining steady eye contact and touch. When talking to an Arab sitting or standing properly is critical, to do otherwise shows lack of respect.
Arabs have a strong patrilineal tradition, women are just there to support the men as a subordinate. Interaction with husband and wife is formal in an open place. Older male assumes the role of decision maker, gender plays a big role. Men are the breadwinners, protectors and decision makers for the family while the women assume the responsibility of the children’s care, education and maintenance of their marriage by attending their husband needs. The success or the failure of an Arab children are attributed to the parental influence and upbringing. Arabs believe in physical punishment as a way of discipline a child, explain child abuse law in United State to Arab family as needed. Sexual activities without marriage or pregnancy out of wedlock is a shame to the Arabic family and the parents may disown the child.
Vietnamese are family oriented, men deals with the matters outside the home while the women are responsible for the care of the home. Vietnamese wife is expected to be helpful and respectful to her husband and his parents as well make healthcare decisions for the family. Vietnamese are expected to be devoted to their parent even after their death they are expected to worship their memory. The eldest male child is responsible to enforce the ritual. Vietnamese sees a pregnancy out of wedlock as a shame to the family.
Most of marriages in Arabs are annul on grounds of consanguinity which prone Arabs for genetic disorders, such as the Mediterranean fever. It is characterized by a recurrent fever, peritonitis or pleurisies. Tuberculosis, malaria trachoma and typhoid fever are common with new Arabic immigrants. Most Arabs have dark or olive colored skin, blonde or auburn hair, blue eyes and fair in complexion. During a skin assessment for jaundice, cyanosis and pallor on dark skinned Arab, assess the oral mucosa and conjunctiva. Arab men and woman usually wear gown and robe to cover their body, most of the young women will not do pelvic exams because of the concern for the potential loss of virginity. Some Arabs will take a shower every day while some will not, Some Arabs women may refuse to get a shower postnatally or during menstruation, they think they are harmful during that period. Some Arabs are reluctant to use foreign bathrooms, they need orientation and encouragement. Arabs prefer to use water for peri care after use of bathroom because they believe that the toilet paper is not enough. They may use a urinal or a commode if provided with a privacy. They expect the family and the hospital personnel to provide a total care for them when they are sick.
Leprosy and lactase deficiency are the genetic diseases found in Vietnamese people, betel- nut pigmentation may be found in some adults due to chewing of chau, mainly on the older women, they use it due to its narcotic effect on gums. Vietnamese skin color is pale ivory to dark brown. Some of Vietnamese new born will have Mongolian spots on their lower back. Skin care and hygiene are very important, especially peri care. Vietnamese like to have a shower every day and most will prefer to use a bathroom for urination and defecation than using a bed pan. Vietnamese family will want to assist in providing self-care to their family even in the hospital. Some Vietnamese wear Western attire, but a typical Vietnamese woman wear clothing that will only expose her head, hands and feet.
Arabs prefer to eat food with their right hand, eating is important for recovery when they are sick especially a hot soup, they may avoid mixing milk and fish, sweet and sour in meals as it is unhealthy when they are ill. Some Arabs observe Ramadan, Muslims fast, which they will not eat and drink from sunset to sunrise. Vegetables simmered with tomato sauces, chicken, lamb, beef or fish and rice are their common food. Arab prefer to make their food from scratch, and they prefer to kill the animal they need for meat like goat or chicken them self especially the Muslims Arabs.
Vietnamese prefer to use chopsticks for meals, white or polished rice provide 80% of their daily calories, they serve rice with a salty, marinated fish sauce. Their diet may be deficient in iron, calcium and excessively high sodium. They prefer hot foods and beverages when they are sick and avoid cold juice and drink. They prefer to cook their food from scratch.
Vietnamese people accept death as normal part of life. Most Vietnamese prefer to die at home than in the hospital. Many will not want artificial prolong life but their relative do have a problem to consent to terminate an active intervention. Having a family conference and providing information help them in making decision. When a Vietnamese die the family gather around the body of a deceased relative and express great emotion. Traditional mourning practices include wearing of a white cloth for 14 days. Cremation is accepted.
Arabs accept death as God’s will. Muslims will turn the bed to face the holy city of Mecca and after the death the deceased is washed three times by a Muslim of the same sex. The body is wrapped in a white material and buried as soon as possible in a grave. Cremation is not practiced.
Majority of Arabs are Muslims, they believe in combining spiritual medicine, daily prayer and conventional medical treatments.
Most Vietnamese are Buddhists, Confucianists and Taoists. Few are Catholics. They have an altar in their home and practice the daily prayer and believe in spiritual healing.
Vietnamese believe that harmony and balance with the two basic opposing forces cold or hot. An excess of either may leads to sickness or discomfort. For example, diarrhea and some fever diseases are due to an excess of cold, while skin problems like pimples are cause by hot. Most Vietnamese will try home remedies before seeking professional assistance when they are sick. Vietnamese accept blood transfusion and averse to organ donation.
Arabs believe that good health is the ability to fulfill one’s roles. Sicknesses are attributed to an inadequate diet, shift of hot and cold, emotional and spiritual stress. They may be reluctant to seek for medical care. Arabs may accept a blood transfusion but will not agree with organ donation. Arabic people may not accept exercise to keep healthy.
The implications for providing culturally competent care for Vietnamese and Arab clients are creating an avenue for them to accept care that improve the opportunities for health promotion and wellness.
References
- Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2003). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497553/
- Giddens, J. F. (2017). Concepts for nursing practice. St. Louis (Missouri): Elsevier.
- Lipson, J. G., & Dibble, S. L. (2008). Culture & clinical care. San Francisco, CA: UCSF Nursing Press.
- Purnell. (2009). Guide to Culturally Competent health Care. F A Davis.
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