Every day we see people from different background in our hospitals. Various ethnic groups portray different traditions and customs. Culture refers to the behavior, beliefs, and values of a particular group of people that are passed from one generation to the other. You will only understand the culture of a person when you get a chance to interview them. I interviewed Carlos, a Latin American man, in his mid-40s. Carlos has a strong Mexican background, and they came to the United States to look for a new life. They moved to their current location when he was 16 years old, and they brought with them part of the Mexican culture. A person’s significant growth takes place in his childhood and Carlos portrayed that by embracing the culture specific to Mexico. In the United States, Carlos and his family tried to adapt to both the Spanish and English customs. I conducted a detailed cultural interview with Carlos, and he was able to provide specific information regarding his perception of health and illness, current health status and the use of traditional practitioners. Similarly, the paper provides information on cultural assessment using Purnell and Paulanka domain of culture.
Cultural Assessment Using Purnell and Paulanka Domains of Culture
A conceptual framework is helpful to examine and understand any culture. Purnell model for cultural competence is a conceptual framework that encompasses twelve domains of every culture that would be useful to the health care providers (Shen, 2015). Using Purnell and Paulanka domains of culture, the interview questions and responses include the following.
The heritage is a description of place people came from while the residence entails the place people currently live. Precisely, domain includes the origin, current residence, occupation and educational status of an individual. Heritage and residence are essential for health care providers because they provide information on potential illnesses that may be present in a person. What was the reason you migrated from your country of origin to the current residence? The response from Carlos was fascinating. “I came to the United States because of the poor living conditions I endured in Mexico”. There was plenty of disease outbreak, and they wanted to live a healthy lifestyle. Carlos finds the current residence conducive to them because of the availability of medical services.
Communication includes the verbal and nonverbal language, facial expression and the use of touch. Health care providers need to assess the communication of an individual to understand their culture (Hayward, & Charrette, 2012). How well do you speak Spanish? Carlos has a strong Mexican background and speaks fluent Spanish. “Being a Latino is one of the factors that make me a great speaker”. For instance, he provided an articulate response by saying a brief statement in Spanish. His response to the question was that “I grew up in a Spanish-speaking environment and I was quick to learn the language.” One could conclude how good he was at speaking Spanish by the way he responded to questions.
Family Roles and Organization
The domain encompasses the relationship of individuals inside and outside the family. They include the head of the household, roles played by the family, child-bearing practices and developmental responsibilities of children and socials status. What are some of the common roles within your family system? “The husband’s role is to head the family and work during the day. At night, the husband could go out and meet friends. The wife plays the domestic roles that include caring for the family. Children help the family by doing housework, and those who are luck will attend schools.”
The concepts in this domain include how the country of origin practices health care, gender roles, individualism, and assimilation. What are the gender roles in your community? “In a Hispanic speaking community, men have a higher status compared to others.” They make all decisions because they are the leader of the household. Women experience little respect. They work inside the home, and their decisions are considered less valuable.”
Biocultural ecology includes the physical, biologic and physiologic differences that come because of ethnic and racial origin. A physician needs to consider this domain because the ethnic and racial variation of a person alters how the body metabolizes drugs. What health conditions exist in your family? “Obesity is a major medical problem in our family. It is unfortunate that we live a more sedentary lifestyle and use a higher-calorie diet.” According to Juckett (2013), limited medical access exposes the Hispanics to greater risks.
High-risk behaviors are actions or lifestyles that might ruin the health of a person. They include lack of physical activities, avoiding safety measures, the use of alcohol, tobacco, and recreational drugs (Purnell, Xu, Leca, & Hall, 2013). Do you use recreational drugs? Carlos enjoys using reactional drugs because of his background. Mexico is a country that is known for illegal drugs and it being his country of origin; he came with the same behavior to the United States. “I use drugs such as alcohol, crack cocaine, marijuana, and tobacco.”
The concepts in nutrition involve how the culture perceives and use food during illness, availability of food, and rituals and taboos associated with food. Which foods do you eat to maintain good health? Mexican-Americans believe that a person’s good health is because of God’s reward or luck (Juckett, 2013). Similarly, in the Mexican community, a person will maintain good health by taking several course meal. “For breakfast, I will take coffee or fruit and before noon, I will eat bread and fruit juice.” “The most important meal is in the afternoon and includes soup, rice, and meat or chicken. Dinner will be the same as the afternoon meals; however, it will include coffee and milk.”
Pregnancy and Childbearing Practices
The domain entails fertility practices, the culture’s view on pregnancy, taboo practices and birth control methods. According to your culture, what should women do to ensure they deliver a healthy baby and maintain their health? “Mexican-Americans believe that the cause of a person’s health is due to the balance of the hot and cold forces.” Therefore, a person should not combine hot food with another hot food, but should use cold food. “After a woman has endured a hot experience through delivering a baby, she should eat cold food to help restore balance.”
The domain defines how people and their culture view death, the ritual used and the practices involved in preparation for burial. What are the funeral rituals in your culture? “In our culture, the funeral procedure includes a mass conducted by a priest in the church.” The culture accepts females to show open expression of grief. On the other hand, it is against the norm for men to break down into tears. “After a church service, a traditional burial follows whereby friends and relatives accompany the family for the burial process.”
Spirituality includes the strength and behaviors that instill meaning to the life of a person. In addition, it entails the use of prayer and religious beliefs (Shen, 2015). Do you consider your family to be very religious? “We are Roman Catholics because of our Hispanic background.” Carlos continued by saying that “My parents are staunch Christian, and we all go for church services on Sunday.” Spirituality and religion practices influence the lives of many Mexican-American (Hendrickson, 2013). They are primary factors regarding the maintenance of health and longevity in the well-being of a person during chronic illnesses, coping with stress and bereavement.
Health Care Practices
The domain describes concepts that relate to traditional practices, barriers to health care, type of treatment accepted by the culture and issues such as organ donations and rehabilitations. Are you against organ donation or transplantation? Christianity and particularly the Catholics advocates organ donation. “Being in a member of the Catholic Church allows me to donate or transplant my organs.” “Conversely, my suffering from obesity would limit my chances to donate organs.” The knowledge on patient’s health care practices assists the physicians to assess the patient and provide an appropriate education (Purnell, Xu, Leca, & Hall, 2013).
Health Care Practitioners
The domain explains concepts that include the status of the practitioner in the culture, the role of gender and the type of practitioners used in the culture (Hayward, & Charrette, 2012). Do you value the services provided by healthcare providers such nurses, physicians, and traditional practitioners? “All the healthcare providers do outstanding jobs to ensure patients get the right treatment. For the case of serious illnesses, the Mexican-Americans seek the services of qualified doctors. However, in situations of minor illnesses, they value folk medicine.”
Discussion on the Client’s View towards Health and Illness
Cultures in our societies have a system of health beliefs that explains the causes of illness, their treatment and the practitioners to involve in the process. The existence of patient education and the influence of culture determine how the individual receives information from the health care providers and their willingness to use (Tuck, Moon & Allocca, 2010). Industrialized societies perceive diseases to have occurred due to natural scientific phenomena while some societies consider it believes that they experience illness because of the supernatural phenomena. My client is a Hispanic with a Mexican origin, and they share a strong heritage that encompasses the family and religion. On important issues that entail health and illness, the community consults older family members and relatives. They consider illness as a divine punishment from God because of the sinful behaviors of the people.
According to the client, in situations of a health issue, the patient would prefer to consult a traditional practitioner. Moreover, Mexican-Americans have a strong belief that the balance between the forces of hot and cold represents health. Therefore, in circumstances when we have an imbalance of the forces, an illness would occur. On the same note, they would consider to treat a hot illness with a cold substance (Juckett, 2013). Conversely, in the case of cold illness, they will treat it with a hot substance. Lastly, the client had special medical concerns on the significant obstacles they face to obtain health care services. Most medical facilities lack trained interpreters and therefore, it is hard for them to communicate with nurses and other physicians. Similarly, their inabilities to afford health insurance give them the option to use self-treatments.
Client’s Current Health Status
The health status encompasses the effect of disease on the patient function according to the patient report. Patients focus on the complete range of their health status whereas the nurses focus on the diagnosis of the illness and the assessment of symptoms (Shen, 2015). Therefore, physicians use standardized surveys to measure the health status of the patients and use the information to make decisions regarding the outcome. The client is suffering from obesity due to taking high-calorie diet and living a sedentary lifestyle. From the customer information, genetic factors and high carbohydrates intake play critical roles in their health conditions. The rate of obesity is high among Hispanics compared to the non-Hispanics.
Client’s Use of Traditional Therapies or Practitioners
In situations of minor illnesses, the client uses the services of traditional practitioners as an alternative to scientific medical practices. The most common type of Mexican-American folk medicine that the client uses is curanderismo (Hendrickson, 2013). The curanderas are the traditional healers, and the client would consult them because he believes that the practitioners have a gift from God to heal sick people. In circumstances when the client suffers from a natural illness, he will consult the curanderas (Hendrickson, 2013). The consultation of the traditional healer would occur either before or concurrent with seeking the service of a professional medical care. During the treatment, the traditional healers will use herbs, oil, religious symbols and manipulate spiritual forces to help in healing the patient.
The interview was captivating, and I learned a lot from Interviewing Carlos. The cultural differences that exist in the society are astounding. My findings from this interview include the following. Despite the differences in culture, communities share same goals. They all believe in the existence of God and the power of healing come from Him. The health care providers consider the importance of honoring family values and roles. Interview findings show that males are the dominant group in the Mexican-American Community. Since we share same goals, cultural competence would allow the inclusion of men in decisions that concern the family health. The American heritage has influenced my client’s culture. They have affected the way they grieve, use of traditional practitioners and communication. He wishes that the American Communities could change and follow the Mexican lifestyle. I will consider this as a positive idea since it would help to solve some of the differences that exist in our communities.
Hendrickson, B. (2013). New Contexts for Curanderismo: Recasting Mexican American Folk Healing within American Metaphysical Religion. Journal of the American Academy of Religion, 81(3), 620-643.
Hayward, L. M., & Charrette, A. L. (2012). Integrating cultural competence and core values: an international service-learning model. Journal of Physical Therapy Education, 26(1), 78-89.
Juckett, G. (2013). Caring for Latino patients. American family physician, 87(1), 48-54
Purnell, T. S., Xu, P., Leca, N., & Hall, Y. N. (2013). Racial Differences in Determinants of Live Donor Kidney Transplantation in the United States. American Journal of Transplantation, 13(6), 1557-1565.
Shen, Z. (2015). Cultural competence models and cultural competence assessment instruments in nursing: a literature review. Journal of Transcultural Nursing: Official Journal of the Transcultural Nursing Society / Transcultural Nursing Society, 26(3), 308-21.
Tuck, I., Moon, M., & Allocca, P. (2010). An Integrative Approach to Cultural Competence Education for Advanced Practice Nurses. Journal of Transcultural Nursing, 21(4), 402-409.
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