The Importance Of Cultural Competence In Health Care

Abstract

In the past five to ten years, American medical system has not only become technologically advanced but multiculturally diverse. That is why being culturally competent is very important in the healthcare field. One reason cultural competency is important is that it allows healthcare professionals to better provide patient centered care to those whose beliefs and values are different than their own. Another reason is that it gives them an opportunity to gain knowledge and new perspective of the patient’s culture. In my essay, I will go into depth of two cultures: Chinese and Arabian. I will compare the cultures and analyze how will the nurse provide care to these patients. My goal for this essay is to not only gain knowledge about these cultures but to understand the role of the nurse when assigned a patient of a diverse ethnic background. Although working with different ethnic background groups can be challenging, it can provide an interesting dimension in one’s work that can lead to patient satisfactory.

Cultural Competence

As mentioned before achieving cultural competence is very essential in today’s healthcare field, especially in nursing. Before becoming competent in taking care of people with different culture a nurse should first understand their own beliefs, values, and biases before taking care multicultural patients. By self-reflection, it allows the nurse to understand themselves and become sensitive in face of other beliefs, values, and biases. The goal is to be more empathetic and embrace different cultures, so quality healthcare is being done (Galanti, 2008). During this essay, I will examine two cultures: Chinese and Arabian.

Communication

In Chinese culture, the primary language and dialect are Cantonese and Mandarin (Lipson & Dibble, 2005). When expressing emotion with close friends and family, they provide a lot of facial and body expressions. However, when in contact with a healthcare provider he or she are very private and -conservative with disclosing information. In their culture, asking questions to authority figures is considered disrespectful. Chinese people avoid making eye contact as a sign of respect; they prefer four to five feet of personal space (Lipson & Dibble, 2005). It is uncommon for them to touch others unless it is among close family and friends.

In Arabian culture, the primary language is Arabic (Lipson & Dibble, 2005). When expressing emotion with close family and friends they are more vocal and use a lot of non-verbal gestures. When interacting with a healthcare provider, he or she value modesty and privacy. In this culture, he or she prefer to speak with same gender clinician. For example, a male patient may prefer a male nurse or doctor. Unlike the Chinese culture, sustained eye contact is considered a sign of trust (Lipson & Dibble, 2005). With personal space, Arabian families expects very little of it. However, someone who is of same gender, the closeness can between 10-12 inches. Touching is more appropriate when it is of the same gender as well.

To take care of both cultures successfully, I should make sure to build a level of trust. For my Chinese patient, I will make sure that I avoid eye contact to establish respect. For my Arabian patient, I need to be mindful that if they are male, they may refuse my care because I am a woman. If there is not a male nurse who I can switch with, I will inform the patient and ask permission in providing care to him.

Family Roles and Organization

In Chinese culture, family is placed above any individual values or beliefs. It is not uncommon to see two or three generations living in the same household (Lipson & Dibble, 2005). Also, extended families are very common. In fact, the wife is expected to become part of the husband’s family. The head of the household is usually the woman. The eldest male is usually the decision-maker (Lipson & Dibble, 2005). When it comes to gender roles, males are highly more respected than their female counterparts and expected to make more money than them. The elders of the family are honored and respected. In extended families, they are usually the caretakers of their grandchildren. Adult children are obligated to take care of their parents unless they are working. As it comes to lifestyle choices, Chinese people are very modest and unwilling to discuss anything sexually, therefore they do not discuss birth control. They do not frown upon women having abortion because pregnancy out of wedlock is considered a dishonor to the family (Lipson & Dibble, 2005). Chinese families do not acknowledge gay or lesbian sexual orientation or relationships (Lipson & Dibble, 2005).

As for Arabian families, they are family oriented. They embraced extended families such as uncles, nieces, nephews, and grandparents in their household (Lipson & Dibble, 2005). The women are the head of the household. The eldest male makes the decisions; however, the parents and siblings are still involved. Elders in Arabian families are expected to be respected. The sons of these families are responsible of taking care of their parents. Elderly women, especially those with children gain more power in the family as they grow older (Lipson & Dibble, 2005). Children of the elderly parents are always expected to be at the bedside to support them. As far as lifestyle choices, Arabs accepts birth control only for married couples after their first or second child is born. Birth control pills or diaphragms are method of choice. Sexual transmitted infections are feared upon. Due to the rise of religious influence, abortion is the least practiced option. For women, sex before marriage is forbidden. Although men are discouraged to have sex before marriage, it is tolerated more than women (Lipson & Dibble, 2005). As far as sexual orientation, homosexuality is strictly forbidden and never acknowledged.

In all, with these two cultures, as a nurse, I should expect family to be at the bedside supporting and being apart of the patient’s care. I would make sure that I respect both cultures family dynamics and discuss updates about the patient to the patient’s point of contact. Also, I will have family involved in assisting the patient with activities of daily living.

Biophysical Aspects

Health conditions that are common to people of the Chinese heritage include Lactose Intolerance, Hepatitis B, Tuberculosis, and Diabetes (Purnell, 2014). For activities of daily living, Chinese people express an extreme sense of modesty, especially women. They value good hygiene, however, patients may not want to wash their hair while they are sick. Privacy is very important while toileting. They may prefer a toilet than a bedpan or urinal. While hospitalized, some may wear articles such as jade or rope to ensure good health and good luck (Purnell, 2014). Most Chinese people prefer to handle their handle their own daily self care, but some older men expect family or staff to care for them. One high risk behavior that Chinese people are associated with is smoking. It occurs in many men and teenagers.

Health conditions that are common in the Arabian culture include malaria, sickle cell disease, epilepsy, and phenylketonuria (Purnell, 2014). For activities of daily living, great modesty is expected of both men and women. For skin care, it varies by country of origin, however, some women may wish to wear makeup in the hospital. Arabs prefer to wash their hair weekly while hospitalized because they are afraid of catching a cold. When toileting, patients of Arabian heritage may prefer to wash after having a bowel movement or urination instead of using toilet paper (Purnell, 2014). Depending on the country of origin, many women may consider their head scarves. Some patients may want a Koran or bible next to the bed or under the pillow (Purnell, 2014). For self-care, they believe in complete rest during illness so their energy can be reserved and restored.

As the nurse, because both cultures are very modest, I will make sure that I maintained their privacy. When toileting, if the patient is unable to ambulate to use the bathroom, I will close the curtains as he or she is toileting. In addition to maintaining their privacy, I would allow the family to take part of their care. For people of Chinese heritage who has a history of smoking, for secondary prevention, I will conduct screening for smoking related health conditions. For people of Arabian heritage that insist on resting all the time, I, the nurse, would clearly explain to the patient the rationale and importance for self-care such as exercise in their road to recovery.

Nutrition

In Chinese culture, food is served to guests at any time of the day or night. These meals are served in a specific order with a focus on a balanced heathy body. Common foods include beans, peanuts, rice, noodles, shrimp, and chicken. They also eat Tofu, which provides a rich source of protein (Lipson & Dibble, 2005). Fruits and vegetables are peeled and eaten raw (Lipson & Dibble, 2005). Vegetables are stirred fried lightly with oil, spice, and salt. Drinks with dinner include tea, soda, juice, and beer. When using chopsticks, they should never be stuck in the food upright because it is considered bad luck (Lipson & Dibble, 2005).

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On the other hand, in Arabian culture, their cooking includes many spices and herbs such as cinnamon, cloves, ginger, and bay leaves (Lipson & Dibble, 2005). Favorite fruits and vegetables include bananas, mangos, spinach, tomatoes, and melon (Lipson & Dibble, 2005). Bread is served with every meal because it is viewed as a gift from God (Lipson & Dibble, 2005). Lamb and chicken are the most popular meats. Skewer cooking and slow simmering are typical modes of preparation. Due to their religious practices, they are forbidden to eat pork and pork products. Food is eaten with the right hand because it is regarded as clean (Purnell, 2014). Eating and drinking at the same time is considered unhealthy (Purnell, 2014). During Ramadan, the Muslim month of fasting, abstinence from eating and drinking during the daylight hours is enforced (Lipson & Dibble, 2005).

To achieve optimal health for my patient, I would provide and inform my Chinese patient about diets that are high in fats and salt. I will also be mindful that with Chinese culture, they consider yin and yang to prevent imbalances and indigestion. It is important for their physical and emotional harmony. As for my Arabian patients, I would, if necessary, feed them with the right hand regardless of dominant hand. I will serve their beverages after their meal has been eaten. Although individuals that are sick during Ramadan are not required to fast, some will still practice of respect of their culture. If a patient decides to do so, I would have to adjust their mealtimes and medications after the sunset.

Death Rituals

Death is considered a natural part of life to the Chinese culture. Death and bereavement traditions are centered around ancestor worship, which is a form of paying respect (Lipson & Dibble, 2005). The dead are honored by placing food, money, or articles around the coffin. The purchase of life insurance may be avoided because they fear that invites death. Organ donations are not common in this culture because they believe that the body should be kept intact (Lipson & Dibble, 2005). If the body is not intact, the spirit may not have a place to go.

For Arabs, it is considered God’s will. Muslim death rituals include turning the patient’s bed to face the holy city of Mecca and reading from the Koran (Lipson & Dibble, 2005). After death, the deceased is washed three times a day and wrapped in white cloth (Lipson & Dibble, 2005). Prayers for the deceased are recited either at home, a mosque, or at the cemetery. Weeping is allowed but beating the cheeks or tearing garments are prohibited (Lipson & Dibble, 2005). Organ donations are not allowed because they want to bury the body so they can meet the Creator with integrity (Lipson & Dibble, 2005).

Death can be very devastating to family especially when they are unexpected. For both cultures, I will respect the families for privacy by closing the doors and blinds on the windows. Also, if the hospital floor has an available, I would invite the family in that room so they can pray and mourn in peace.

Spirituality

The main formal religions in China are Buddhism, Catholicism, Protestantism, Taoism, and Islam. Prayer is considered a source of comfort (Lipson & Dibble, 2005). The individual may use meditation, exercise, massage, and prayer. Some may use herbalists or acupunctures before seeking help (Lipson & Dibble, 2005). Drugs, herbs, food, good air, and artistic expression may also be used. The family are usually a source of strength (Lipson & Dibble, 2005).

Most Arabs how up unless are Muslim; Islam is the official religion (Lipson & Dibble, 2005). Islam believe in God (Allah) and His messenger Prophet Mohammed, fast during the month of Ramadan, give back to the poor, make pilgrimages to Mecca, and pray five times a day in silence. Muslims do not expect a Muslim religious leader to someone has died (Lipson & Dibble, 2005).

As a nurse, spirituality for both cultures should always be respected. When assisting families with this aspect, I should consult with a chaplain to help me accommodate to their needs such as finding a bible or Koran. In addition, privacy should be appreciated, especially in times of prayer.

Health Care Practice

According to the Chinese culture, good health is a balance of body and its environment. When there was a physical and mental illness, the Chinese believed their overall harmony has been interrupted (Lipson & Dibble, 2005). For example, some fear to have their blood drawn because they believe it will give the body less energy (Lipson & Dibble, 2005). Before finding a primary care provider, they will first adjust their diet. However, for complex disease processes such as cancer, the Chinese will seek out biomedical physicians (Lipson & Dibble, 2005). Traditional practitioners of Chinese medicine prescribe herbs and acupuncture based on diagnosis an imbalance of yin and yang. They are accepting of immunizations but do not consent to diagnostic tests because they are invasive. They do not complain of pain because they do not want to bother the nurse or doctor (Lipson & Dibble, 2005). To relieve the pain, they will utilize with acupressure or acupuncture. If having dyspnea, they usually treat it with hot soup and broth (Lipson & Dibble, 2005).

On the other hand, their concept of health is a gift of God to eat well, be socially involved, be in a good mood, be strong, and not in pain (Lipson & Dibble, 2005). To improve their health, Arabians avoid hot/cold and dry/moist shifts, avoiding wind and drafts, staying warm, being well fed and resting well (Lipson & Dibble, 2005). They will accept diagnostic testing if they trust the provider and his or her expertise. When it comes to pain, they are very expressive, especially with family. Some manage it with by self-medication or reading with the Koran or bible. Arabian control their dyspnea, nausea, and vomiting by medication. They tend to take it because they trusted the prescribing doctor (Lipson & Dibble, 2005).

Although the nurse respects the wishes of patients when refusing care due to cultural differences, it is important to educate them on health care practices and promotion. The reason it is important to teach is because the patient may not fully understand what procedure is being done. That is why having an available licensed interpreter is valuable because he or she can explain the care the healthcare team is trying to give them in their native language.

Conclusion

Overall, cultural competence demonstrates a knowledge and understanding of the patient’s culture, accepting and respecting cultural differences and adapting care like the patient’s culture (Giddens, 2017). The nurse’s role in regards of this is that he or she must show a culture desire, a sense of awareness, respect, and empathy. Once the nurse accepts and values the patient’s culture, the outcome can be great quality care, positive patient satisfactory, and newfound trust towards that caregiver (Giddens, 2017). However, if the nurse does not respect that patient’s culture, it can cause the patient to not trust them, patient dissatisfaction, and lack of therapeutic communication.

References

1. Galanti, G.-A. (2008). Caring for Patients from Different Cultures. Philadelphia: University of Pennsylvania Press.
2. Giddens, J. F. (2017). Concepts for Nursing Practice. St. Louis: Elsevier.
3. Lipson, J. G., & Dibble, S. L. (2005). Culture and Clinical Care. San Franscisco: UCSF Nursing Press.
4. Purnell, L. D. (2014). Guide to Culturally Comptent Health Care. Philadelphia: FA Davis Company.