Transcultural Health Care: A Culturally Competent Approach (Transcultural Healthcare (Purnell)) PDF
Preview Transcultural Health Care: A Culturally Competent Approach (Transcultural Healthcare (Purnell))
© 2008 F A Davis CULTURES COVERED IN THE TEXT People of African American Heritage The Amish People of Appalachian Heritage People of Arab Heritage People of Chinese Heritage People of Guatemalan Heritage People of Egyptian Heritage People of Filipino Heritage People of French Canadian Heritage People of German Heritage People of Haitian Heritage People of Iranian Heritage People of Japanese Heritage People of Jewish Heritage People of Korean Heritage People of Mexican Heritage People of Russian Heritage People of Polish Heritage People of Thai Heritage CULTURES COVERED ON THE DavisPlus WEB SITE (http://davisplus.fadavis.com) People of Baltic Heritage: Estonians, Latvians, and Lithuanians People of Brazilian Heritage People of Greek Heritage People of Cuban Heritage People of Hindu Heritage People of Irish Heritage People of Italian Heritage People of Puerto Rican Heritage Navajo Indians People of Turkish Heritage People of Vietnamese Heritage FABK017-FM[i-xviii].qxd 12/12/2007 10:47am Page i Aptara Inc. © 2008 F A Davis FABK017-FM[i-xviii].qxd 12/12/2007 10:47am Page ii Aptara Inc. © 2008 F A Davis [This page intentionally left blank.] Transcultural Health Care A Culturally Competent Approach Third Edition Betty J. Paulanka, EdD, RN Professor and Dean College of Health Sciences University of Delaware Newark, Delaware Larry D. Purnell, PhD, RN, FAAN Professor College of Health Sciences University of Delaware Newark, Delaware FABK017-FM[i-xviii].qxd 12/12/2007 10:47am Page iii Aptara Inc. © 2008 F A Davis F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2008 by F. A. Davis Company Copyright © 2003, 1998 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Acquisitions Editor: Jonathan D. Joyce Associate Acquisitions Editor: Thomas A. Ciavarella Director of Content Development: Darlene D. Pedersen Art and Design Manager: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recom- mended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no war- ranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regard- ing dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Transcultural health care : a culturally competent approach / [edited by] Larry D. Purnell, Betty J. Paulanka. — 3rd ed. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-0-8036-1865-7 ISBN-10: 0-8036-1865-4 1. Transcultural medical care—United States. 2. Transcultural medical care—Canada. I. Purnell, Larry D. II. Paulanka, Betty J. [DNLM: 1. Delivery of Health Care—North America. 2. Cross-Cultural Comparison—North America. 3. Ethnic Groups—North America. W 84 DA2 T7 2008] RA418.5.T73T73 2008 362.1089--dc22 2007043727 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.10 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 8036-1169-2/04 0 � $.10. FABK017-FM[i-xviii].qxd 12/12/2007 10:47am Page iv Aptara Inc. © 2008 F A Davis v The rise in concern for cultural competence has become one of the most important developments in American health care over the past decade. Medicine and health more generally have moved beyond their traditional equanimous approach of application of scientific rational- ity to clinical problems to one that promotes an easier inte- gration of clinical science with empathy. This development has occurred with a rising tide of the diversity of the popu- lation of the United States. Some of this is driven by actual numbers of immigrants, but other dimensions of this awareness come from the visibility of the “new” ethnics and the waning of the social ideology of the melting pot. Beyond all of this is a younger generation that is much more attuned to diversity as part of their cultural landscape and their comfort with the globalization of perspectives resulting from technological and economic change. From within health care, the advocacy for culturally competent approaches is driven in part by the dawning recognition of the danger to patient safety and overall inadequacy in the quality of outcomes in what we do. The literature around the disparities of outcomes across ethnic, social, and economic groups provides a com- pelling case to ensure that health care is attentive to these differences. But there is also attention to the costs that are driven up by health care that is not culturally competent and discourages compliance. The excess expenditures are associated with poor communication, the failure to use culturally responsive methods, and ineffective attempts to transfer treatment modalities to make the system cost efficient. Finally, as the health system makes its glacial move to more consumer and individual responsiveness, the system is recognizing that a cultural perspective is essential to provide services that earn high levels of con- sumer satisfaction. Much of the activity aimed at advancing cultural com- petence has been centered on regulations and mandates. However, a generational change that begins with the edu- cation of each new practitioner is needed to bring about a culturally informed and competent professional commu- nity. This edition of Transcultural Health Care provides the critical lessons to introduce students and practitioners to how different cultures construct the social world and the dramatic impact that culture has on how health care, medicine, community, and family interact. These insights into the rich variety of human culture are only small steps toward developing real wisdom regarding culture compe- tence. The first step in such a transformation is awareness of the other. Most young students and many seasoned prac- titioners simply do not have an appreciation of the vari- ety of backgrounds and perspectives that people bring to an encounter with the health-care system. They have the expectation that the patient or consumer will “fit” into their clinic or admission process. Moreover, much of what is done in health care follows a “procedure,” which implies that there are predetermined steps by which any one receiving the care or service must fit. For an increas- ingly large part of the population, nothing could be fur- ther from the truth. The care-seeking behavior, the atti- tude toward authority, the comfort with middle-class America culture that makes up so much of the health-care social world, and the relationship between genders are just a few of the literally hundreds of places at which a disconnect between the individual and the system can occur. When disconnects occur, the efforts by the system to maintain or return health may fail. The second step after awareness is knowledge. What is it that we must know as practitioners in a system of care to reach the other person and overcome the cultural barri- ers? And it is essential that this knowledge pass both ways. What do they need to know about us in order to be an equal part of a team-focused plan to address a prob- lem? Knowledge also speaks to the need for every practi- tioner to be aware of his/her own attitudes, bias, and pre- judices. Everyone has such prejudices; they are not the issue. Awareness of them and the wisdom and insight to adjust care to provide nonjudgmental and supportive interventions is the challenge. A culturally competent practitioner must also have a sense of comfort with the experiential process of engaging others from different cultures. This is perhaps the most difficult of all skills to teach and may only be learned through the practice of engaging others and being able to Preface FABK017-FM[i-xviii].qxd 12/12/2007 10:47am Page v Aptara Inc. © 2008 F A Davis reflect critically on the experience and its impact on the patient as well as on the provider. This process is a famil- iar one, of course, as it is the core of clinical education. But students must come to value the variety of life and learn how to adapt their clinical expertise to different cul- tures and the individual unique development in a multi- cultural context. As we focus on cultural competence, one fear is that we will make the knowledge more transactional than transfor- mational. It needs to be the latter. For the patient or con- sumer, health care presented in a culturally competent way must blend the traditions of the older culture with the promise and resources of modern health care. For the prac- titioner or health-care institution, new patterns of service and organization of care must be transformed using the experience with the new culture. Such a critical perspec- tive of cultural humility is essential for all practitioners in all dimensions of health care and is a vital part of devel- oping into a truly culturally competent provider. This will be greatly assisted as care delivery moves from profession-specific models of care to more interpro- fessional and team-based approaches. This has long been a hope of many involved in efforts to reform health care. If one is truly committed in becoming culturally compe- tent, then one important lesson to learn is how to expand competence and the facility from the culture of nursing to an interdisciplinary culture that includes pharmacy, medicine, and the allied health professions. This seems obvious, but without these skills of closer adaptation and accommodation among all health profes- sions, how can you imagine practitioners adapting to cultures that are more alien than those we encounter on a routine basis? Synthesizing cultural adaptations within the health pro- fessional perspectives and offering adapted care to patients may not be sufficient to guarantee individual cultural com- petence. Practitioners who achieve such skill will need to change their orientation from one that is focused on the profession and its clinical world to one that is patient-centric. This is easy to affirm but very difficult to deliver because of the power and cultural hegemony of the clinical world. This cultural blindness serves neither the patient nor the practi- tioner. It is also a source of much of the dysfunction of the current system of care, both in terms of costs and quality. The final stage in cultural competency is the ability to balance self-awareness with other-awareness. Such a balance is the hallmark of an outstanding clinician and is also the basis of all true cultural competence. This value allows for a response ability that transcends the simple knowledge of all practitioners knowing every detail about particular cul- tures and allows a different relationship to emerge between the provider of service and the recipient. In this way, the work toward developing the skills of a culturally compe- tent practitioner assists in the broader goal of becoming an outstanding clinician in any setting. This edition of Transcultural Health Care provides an outstanding guide to the journey of becoming just such a practitioner. EDWARD O’NEIL, MPA, PHD, FAAN Professor Departments of Family and Community Medicine, Preventive and Restorative Dental Sciences and Social and Behavioral Sciences, and Director of the Center for the Health Professions University of California, San Francisco San Francisco, California vi • PREFACE FABK017-FM[i-xviii].qxd 12/12/2007 10:47am Page vi Aptara Inc. © 2008 F A Davis The editors would like to thank all those who helped in the preparation of the third edition of this book. We espe- cially thank acquisitions editor, Jonathan D. Joyce, and associate acquisitions editor, Thomas A. Ciavarella, at F. A. Davis for their support and enthusiasm for the project; and Julie Catagnus, developmental editor, for her atten- tion to detail, timeliness, and patience during the editing process. We thank the copyeditors at F. A. Davis for their assistance in bringing the book to completion. Most importantly, we want to thank the many multicultural populations and health professionals who are the impe- tus for this book. Finally, we thank our families, friends, and colleagues for their patience and support during the preparation of the book. Acknowledgments vii FABK017-FM[i-xviii].qxd 12/12/2007 10:47am Page vii Aptara Inc. © 2008 F A Davis FABK017-FM[i-xviii].qxd 12/12/2007 10:47am Page viii Aptara Inc. © 2008 F A Davis [This page intentionally left blank.] Diane Alain, Med, RN Teacher La Cité Collégiale University of Ottawa Ottawa, Ontario, Canada Josepha Campinha-Bacote, PhD, MAR, APRN, BC, CNS, CTN, FAAN Clinical Assistant Professor Case Western Reserve University Cleveland, Ohio President, Transcultural C.A.R.E. Associates Cincinnati, Ohio Marga Simon Coler, EdD, APRN-C, FAAN Professor Emeritus University of Connecticut Storrs, Connecticut Adjunct Professor University of Massachusetts Amherst, Massachusetts Collaborating Professor Federal University of Paraíba Paraíba, Brazil Jessie M. Colin, PhD, RN Professor Barry University School of Nursing Miami Shores, Florida Ginette Coutu-Wakulczyk, RN, MSc, PhD Associate Professor School of Nursing Faculty of Health Sciences University of Ottawa Ottawa, Ontario, Canada Tina A. Ellis, RN, MSN, CTN Nursing Instructor Florida Gulf Coast University Fort Myers, Florida Rauda Gelazis, RN, PhD, CS, CTN Associate Professor Ursuline College Pepper Pike, Ohio Divina Grossman, PhD, RN, FAAN Dean College of Nursing and Health Sciences Florida International University Miami, Florida Homeyra Hafizi, RN, MS, LHRM Occupational Health Dynamac Corporation Kennedy Space Center, Florida Sandra M. Hillman, PhD, MS, BSN Professor Nelson Mandela Metropolitan University Port Elizabeth, South Africa David Hodgins, MSN, RN, CEN Indian Health Service Shiprock, New Mexico Olivia Hodgins, RN, PhD, MSA, BSN Map Instructor and Nurse Executive Indian Health Service San Fidel, New Mexico Kathleen W. Huttlinger, PhD, RN Associate Director for Research and Interim Director of Graduate Programs School of Nursing New Mexico State University Las Cruces, New Mexico Eun-Ok Im, PhD, MPH, FAAN Professor The University of Texas at Austin Austin, Texas ix Contributors FABK017-FM[i-xviii].qxd 12/12/2007 10:47am Page ix Aptara Inc. © 2008 F A Davis Misae Ito, MSN, RN, NMW Associate Professor, Fundamental Nursing Department of Nursing, Faculty of Health Sciences Yamaguchi University School of Medicine Yamaguchi-Ken, Japan Anahid Dervartanian Kulwicki, RN, DNS, FAAN Deputy Director Wayne County Health and Human Services Detroit, Michigan Professor Oakland University Rochester, Michigan Juliene G. Lipson, RN, PhD, FAAN Professor Emerita University of California, San Francisco School of Nursing Mill Valley, California Afaf Ibrahim Meleis, PhD, DrPS(hon), FAAN Margaret Bond Simon Dean of Nursing Professor of Nursing and Sociology University of Pennsylvania School of Nursing Philadelphia, Pennsylvania Mahmoud Hanafi Meleis, PhD, PE Retired Nuclear Engineer Philadelphia, Pennsylvania Denise Moreau, PhD, MSc, RN Assistant Professor and Lecturer University of Ottawa Ottawa, Ontario, Canada Dula F. Pacquiao, EdD, RN, CTN Associate Professor and Director Bergen Center for Multicultural Education, Research and Practice School of Nursing University of Medicine and Dentistry of New Jersey Newark, New Jersey Irena Papadopoulos, PhD, MA, RN, RM, DipNEd, NDN Cert Professor of Transcultural Health and Nursing Middlesex University, United Kingdom Highgate Hill, London Ghislaine Paperwalla, BSN, RN Research Nurse in Immunology Veterans Administration Medical Center Miami, Florida Henry M. Plawecki, RN, PhD Professor of Nursing Purdue University Calumet School of Nursing Hammond, Indiana Judith A. Plawecki, RN, PhD Professor University of South Florida Tampa, Florida Lawrence H. Plawecki, RN, JD, LLM Health Law Consultant Plawecki Consultants, LLC Highland, Indiana Martin H. Plawecki, PhD, MD Faculty Indiana University School of Medicine Indianapolis, Indiana Jeffrey Ross, BFA, MA, MAT Graphic Designer and Language Arts Teacher Archbishop Hoban High School Akron, Ohio Ratchneewan Ross, PhD, MSc, RN, Certificate in Midwifery Assistant Professor College of Nursing Kent State University Kent, Ohio Maryam Sayyedi, PhD Adjunct Professor Department of Counseling California State University, Fullerton Fullerton, California Janice Selekman, DNSc, RN Professor University of Delaware Newark, Delaware Linda S. Smith, MS, DSN, RN, CLNC Associate Professor and Director Idaho State University Pocatello, Idaho Jessica A. Steckler, MS, RNBC National Program Manager Employee Education System, VHA Erie, Pennsylvania Gulbu Tortumluoglu, PhD Assistant Professor Nursing Department Chief Yuksekokulu, Canakkale, Turkey Susan Turale, DEd, MNStud, BN, DApSci(AdvPsychNurs), RN, RPN, FRCNA, FANZCMHN Professor of International Nursing Department of Nursing, Faculty of Health Sciences Yamaguchi University School of Medicine Yamaguchi-Ken, Japan Yan Wang, MSN, RN-BC Nursing Informatics System Specialist III Duke University Health System Duke Health Technology Solutions Durham, North Carolina x • CONTRIBUTORS FABK017-FM[i-xviii].qxd 12/12/2007 10:47am Page x Aptara Inc. © 2008 F A Davis Anna Frances Z. Wenger, PhD, RN, CTN, FAAN Professor and Director of Nursing Emerita Goshen College Goshen, Indiana Senior Scholar Interfaith Health Program School of Public Health Emory University Program Consultant Ethiopia Public Health Training Initiative The Carter Center Atlanta, Georgia Marion R. Wenger, PhD Retired Professor of Foreign Languages and Linguistics Emory University Atlanta, Georgia Sarah A. Wilson, PhD, RN Associate Professor Director, Institute for End of Life Care Education Marquette University College of Nursing Milwaukee, Wisconsin Cecilia A. Zamarripa, RN, CWON Wound, Ostomy, and Continence Nurse University of Pittsburgh Medical Center Pittsburgh, Pennsylvania Rick Zoucha, APRN, BC, DNSc, CTN Associate Professor Duquesne University School of Nursing Pittsburgh, Pennsylvania CONTRIBUTORS • xi FABK017-FM[i-xviii].qxd 12/12/2007 10:47am Page xi Aptara Inc. © 2008 F A Davis FABK017-FM[i-xviii].qxd 12/12/2007 10:47am Page xii Aptara Inc. © 2008 F A Davis [This page intentionally left blank.] Introduction ........................................................................................................ xvii Chapter 1 Transcultural Diversity and Health Care ........................................ 1 LARRY D. PURNELL Chapter 2 The Purnell Model for Cultural Competence .............................. 19 LARRY D. PURNELL Chapter 3 People of African American Heritage ............................................ 56 JOSEPHA CAMPINHA-BACOTE Chapter 4 The Amish ........................................................................................ 75 ANNA FRANCES Z. WENGER and MARION R. WENGER Chapter 5 People of Appalachian Heritage .................................................... 95 KATHLEEN W. HUTTLINGER and LARRY D. PURNELL Chapter 6 People of Arab Heritage ................................................................ 113 ANAHID DERVARTANIAN KULWICKI Chapter 7 People of Chinese Heritage .......................................................... 129 YAN WANG and LARRY D. PURNELL Chapter 8 People of Guatemalan Heritage.................................................... 145 TINA A. ELLIS and LARRY D. PURNELL Chapter 9 People of Egyptian Heritage.......................................................... 157 AFAF IBRAHIM MELEIS and MAHMOUD HANAFI MELEIS Chapter 10 People of Filipino Heritage .......................................................... 175 DULA F. PACQUIAO Chapter 11 People of French Canadian Heritage............................................ 196 GINETTE COUTU-WAKULCZYK, DENISE MOREAU, and DIANE ALAIN Chapter 12 People of German Heritage .......................................................... 213 JESSICA A. STECKLER Chapter 13 People of Haitian Heritage ............................................................ 231 JESSIE M. COLIN and GHISLAINE PAPERWALLA Chapter 14 People of Iranian Heritage ............................................................ 248 HOMEYRA HAFIZI, MARYAM SAYYEDI, and JULIENE G. LIPSON Contents xiii FABK017-FM[i-xviii].qxd 12/12/2007 10:47am Page xiii Aptara Inc. © 2008 F A Davis Chapter 15 People of Japanese Heritage .......................................................... 260 SUSAN TURALE and MISAE ITO Chapter 16 People of Jewish Heritage ............................................................ 278 LARRY D. PURNELL and JANICE SELEKMAN Chapter 17 People of Korean Heritage ............................................................ 293 EUN-OK IM Chapter 18 People of Mexican Heritage .......................................................... 309 RICK ZOUCHA and CECILIA A. ZAMARRIPA Chapter 19 People of Russian Heritage............................................................ 325 LINDA S. SMITH Chapter 20 People of Polish Heritage .............................................................. 337 HENRY M. PLAWECKI, LAWRENCE H. PLAWECKI, JUDITH A. PLAWECKI, and MARTIN H. PLAWECKI Chapter 21 People of Thai Heritage ................................................................ 355 RATCHNEEWAN ROSS and JEFFREY ROSS Appendix Cultural, Ethnic, and Racial Diseases and Illnesses.................... 373 Abstracts People of Baltic Heritage: Estonians, Latvians, and Lithuanians ............................................................................ 381 RAUDA GELAZIS People of Brazilian Heritage.......................................................... 383 MARGA SIMON COLER People of Greek Ancestry ..............................................................385 IRENA PAPADOPOULOS and LARRY D. PURNELL People of Cuban Heritage.............................................................. 387 DIVINA GROSSMAN and LARRY D. PURNELL People of Hindu Heritage.............................................................. 389 LARRY D. PURNELL People of Irish Heritage ................................................................ 391 SARAH A. WILSON People of Italian Heritage.............................................................. 393 SANDRA M. HILLMAN People of Puerto Rican Heritage .................................................. 395 LARRY D. PURNELL Navajo Indians ................................................................................397 OLIVIA HODGINS and DAVID HODGINS People of Turkish Heritage ............................................................399 GULBU TORTUMLUOGLU People of Vietnamese Heritage .................................................... 401 LARRY D. PURNELL Glossary................................................................................................................ 403 Index .................................................................................................................... 411 xiv • CONTENTS FABK017-FM[i-xviii].qxd 12/12/2007 10:47am Page xiv Aptara Inc. © 2008 F A Davis
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