The Challenges of Transcultural Nursing: Purnell Model
At the time of internationalization, the standards of nursing undergo significant changes. Some of the population sub-groups, such as minorities, foreign patients, or other people with different values and beliefs, are often underserved or misunderstood in medical institutions. Therefore, doctors, nurses, and other medical personnel need to adapt to the cultural peculiarities of certain sub-groups. Purnell model is a theory aimed at a comprehensive assessment of a population sub-group and raising medical workers’ awareness about cultural diversity and corresponding medical approaches. This model is actively used in transcultural nursing and other spheres, such as education, and contributes to understanding how cultural differences influence behavior and decision-making.
Chinese Migrant Population: Description and Rationale
The choice of the Chinese sub-group is explained by the presence of Chinese culture in many countries of the world due to the increased immigration rate leading to the demand in transcultural nursing. Besides, Chinese culture is significantly different from European or American, which makes serving such patients in these regions challenging. The highest number of people in the world belong to Chinese culture, and the Chinese population is aging. The major culture-based healthcare problems are connected with insufficient language proficiency and low health literacy among Chinese and unawareness of medical personnel about the peculiarities of Chinese culture. Therefore, it is important to identify the distinctive features of this sub-group to evaluate its possible health-related approaches.
Purnell Model Assessment
Traditions and heritage play an important role in Chinese culture. Due to the high population of China and consequent active immigration, the culture is present in many other countries of the world. Complicated language is considered the main obstacle in communication with such patients. For nurses, it is important to understand that facial expression, body language, and eye contact are highly important for an interpersonal connection. Family is the most important value in Chinese culture. Both mother and father in a family have their own responsibilities. However, it is mostly a masculine culture, which means that a male plays a more significant role in decision-making; older people in the family are also highly respected. As for workforce issues, the most widespread difficulty is the complicated Chinese language and difficulty in acculturation.
China is the most populated country in the world, with the growing tendency of urbanization. As a result, its unfavorable ecological situation leads to a high level of water, soil, and air contamination. Hereditary diseases are frequent among the Chinese and should be taken into account. Another consequence of urbanization is connected with the spread of high-risk behaviors and unhealthy habits among the Chinese, such as smoking, drinking, and substance use. Although a healthy diet is important in Chinese food culture, frequent use of food supplements and high-calorie products may lead to diabetes, obesity, or poisoning. In general, pregnancy problems among the Chinese are connected with unfavorable ecology and individual unhealthy behavior such as alcohol consumption.
Religion and spirituality play an important role in Chinese culture. For example, burial is perceived as the act of bringing peace to the dead, and inhumation is the most widespread death ritual for the Chinese. Chinese people pay a lot of attention to praying and religious practices. According to the traditional views, blood and qi energy flow maintain life in a human body. Traditional Chinese medicine also sees health as a balance between body, mind, and environment of an individual. In Chinese medicine, much attention is given to enhancing the resistance of an organism to diseases. Therefore, group training, outdoor exercise, and other ways of health promotion are rather popular among Chinese, especially elderly people. All healthcare practitioners are very respected in the analyzed culture; inclination towards Western or Chinese medicine is individual.
Local Community Healthcare Issues
Due to the high population and immigration rates, the Chinese sub-group is present on all continents. For example, Tsoh et al. (2016) confirm the growing migrant Chinese population in the U.S. Chinese migrants often have no medical or injury insurance and suffer from deterioration connected with self-treatment. The tense social and economic situation in migrant families can lead to frequent stress and mental diseases, in addition to nutrition deficiency. Moreover, at the local level, a high level of pollution and insufficient regulations over food supplies may result in food poisoning, diabetes, obesity, and related problems. If there are no opportunities for proper physical activity in a community, it may also contribute to the problem of weight gain.
Global Community Healthcare Issues
There are also diseases that are closely connected with the unfavorable environmental situation and the consequent global health deterioration. The developed transportation and industry have a negative impact on the overall health condition of the Chinese. For example, air, soil, and water contamination may lead to defects in newborn children and reproductive diseases in adults. Moreover, air pollution, exhaust fumes, and industrial emission contribute to respiratory diseases, such as asthma. Cancer and cardiovascular issues are also common among Chinese people. Finally, although today a healthy lifestyle is a popular trend among people of all ages, an unhealthy diet and more frequent use of food supplements lead to obesity and diabetes.
Many of the global health issues are connected with the changing lifestyle of Chinese people. According to Li et al. (2016), urbanization is a widespread tendency, and many people move to cities from rural areas. Life in the city, however, requires a lot of energy; therefore, everyday stress and overwork may lead to depression and other psychological issues. Sedentary jobs and lack of proper physical exercise result in obesity. Sexually transmitted diseases and unhealthy behavior, such as tobacco, alcohol, and drug consumption, are also connected with the fast-paced urban life. Hypertension is considered another widespread issue in Chinese culture.
Recommendations
The Purnell model analysis of the Chinese migrant population demonstrated that this sub-group belongs to a culture with a specific attitude to health, medicine, and traditions. First of all, it is necessary to overcome the linguistic barrier with the help of an interpreter or translator, if needed. Then, doctors and nurses need to understand that family involvement is highly important in the whole process of treatment. It is important that decision-making in a Chinese family is often the responsibility of men or older people. Besides, culturally competent medical workers need to be polite and patient with Chinese people to reach mutual understanding and meet patients’ demands.
During treatment, nurses need to evaluate the social and economic environment of patients and possible related conditions. It is important to understand the importance of traditional medical practices for Chinese and the effect they may have on the patients. Nurses need to take into account the psychological condition of migrants and local and global ecological factors influencing patients’ overall well-being. Finally, diet and unhealthy habits of individuals may cause some of the health problems. Provided that all these factors are considered, nurses can comprehensively evaluate the health condition of Chinese migrant patients to define proper medical approaches.
References
Li, X., Song, J., Lin, T., Dixon, J., Zhang, G., & Ye, H. (2016). Urbanization and health in China, thinking at the national, local and individual levels. Environmental Health, 15, 113-123. doi:10.1186/s12940-016-0104-5
Mou, Y. (2017). Predicting the use of traditional Chinese medicine: Health maintenance approach from cultural and spiritual perspectives. Journal of Religion and Health, 56, 971–985. doi:10.1007/s10943-016-0299-3
Purnell, L. (2018). Update: The Purnell theory and model for culturally competent health care. Journal of Transcultural Nursing, 30(2), 1-8. doi:10.1177/1043659618817587
Tiechuan, M. (2016). A study on non-verbal communication in cross-culture. Asian Journal of Humanities and Social Sciences, 4(1), 1-6.
Tsoh, J.Y., Sentell, T., Gildengorin, G., Gem, M.L., Chan, E., Fung, L.-C., Pasick, R.J., Stewart, S., Wong, C., Woo, K., Burke, A., Wang, J., McPhee, S.J., & Nguyen, T.T. (2016). Healthcare communication barriers and self-rated health in older Chinese American immigrants. Journal of Community Health, 41, 741–752. doi:10.1007/s10900-015-0148-4
Xi, J. (2016). Cultural differences and similarities between China and Brazil: A comparative analysis using Hofstede’s cultural dimensions. China and Latin America in Transition, 227–242. doi:10.1057/978-1-137- 54080-5_13