Purnell transcultural health care nov2019-3705.pdf - 2780_FM_i-xx 12:22 PM Page i TRANSCULTURAL HEALTH CARE 2780_FM_i-xx 12:22 PM Page ii Davis\u2019s

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Unformatted text preview: 2780_FM_i-xx 16/07/12 12:22 PM Page i TRANSCULTURAL HEALTH CARE 2780_FM_i-xx 16/07/12 12:22 PM Page ii Davis’s Success Series Q&A Course Review and NCLEX Prep 99Thousands of NCLEX-style questions 99Alternate-item-format questions 99Rationales for correct and incorrect answers 99Test-taking tips Visit Keyword: Success Series to learn more. Davis Mobile APPS Ready. Set. Go Mobile 99iPhone 99iPad 99iPod Touch 99Android Visit Keyword: Davis Mobile to learn more. 2780_FM_i-xx 16/07/12 12:22 PM Page iii 4th Edition TRANSCULTURAL HEALTH CARE A Culturally Competent Approach Larry D. Purnell Phd, RN, FAAN 2780_FM_i-xx 16/07/12 12:22 PM Page iv F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 Copyright © 2013 by F. A. Davis Company Copyright © 2013 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 Publisher, Nursing: Robert G. Martone Director of Content Development: Darlene D. Pedersen Project Editor: Victoria White Electronic Project Manager: Tyler Baber Design and Illustrations Manager: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended 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 warranty, 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 regarding 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. — 4th ed. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8036-3705-4 I. Purnell, Larry D. [DNLM: 1. Cultural Competency—United States. 2. Delivery of Health Care—United States. 3. Cultural Diversity—United States. 4. Ethnic Groups—United States. W 84 AA1] 362.1089—dc23 2012016099 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 $.25 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: 978-0-8036-3705-4/12 0 + $.25. 2780_FM_i-xx 16/07/12 12:22 PM Page v Foreword Knowing is not enough, we must apply. Willing is not enough, we must do. Goethe Goethe’s quote is considered a call to action by organizations as prestigious as the Institute of Medicine, and it remains one of my favorite quotes today. It has such incredible implications for health care, particularly as we struggle with the extended time it takes to translate research into practice. In fact, oftentimes, despite strong evidence, we are slow in enacting the changes we need to improve the health care and nursing we deliver. In some cases we are waiting for the “indisputable” evidence, and in other cases we are simply being resistant to change. But occasionally the need for change is thrust upon us, momentum builds, and the realization emerges that there isn’t a need to prove the obvious before acting but a need to act as the obvious is all around us. This has become the case with cultural competence in health care. My knowing about the importance of cultural competence developed as I grew up in my bilingual, bicultural Puerto Rican family, where perspectives about health and health care were incredibly varied, and at times at odds with Western medicine. My knowing grew, as I trained to be a health-care professional in underserved and diverse settings such as Newark, New Jersey, and New York City, where we saw patients from all cultures, classes, and racial/ethnic backgrounds. What became crystal clear to me was that while we were learning the best medications to treat hypertension or the most advanced algorithms for diagnosing and treating disease, if we couldn’t communicate effectively with our patients or get them to buy into, agree with, and cooperate with what we were trying to accomplish, then all that medical knowledge was worth nothing. Whether a doctor, a nurse, or other health professional, caring for patients required an understanding of the sociocultural factors that might impact their health beliefs and behaviors, ranging from how they presented their symptoms, to how they viewed disease and illness, to what informed their health care, diagnostic, and treatment choices. Cases where we couldn’t bring our knowledge to bear to ease suffering or cure disease because of “cultural differences” with patients were the ones that kept us up at night and were the most frustrating and disappointing of all. Along the way I also learned to appreciate that we all have culture and that the tools and skills I needed to learn to communicate clearly with patients wouldn’t just be helpful in the care of those who were culturally different from me, but to any patient with whom I interacted. For at the end of the day, there were always three cultures in the room—my culture; the patient’s culture; and the cultures of medicine, nursing, and other health professions—making every encounter cross-cultural in one way or another. Despite these almost daily epiphanies during my training, there were few resources available that might provide me with guidance on how to become an effective communicator and caregiver in this new world I was entering. Fortunately, this has changed. New models have been developed, leaders have emerged, and health-care professionals no longer need to go blindly into cross-cultural encounters without guidance, as there are real and practical approaches that facilitate improved understanding, communication, and care. Knowing is not enough, we must apply. Transcultural Health Care: A Culturally Competent Approach builds on a framework for cultural competence—which is essential in the care of the individual—by bringing together health-care providers of various backgrounds and disciplines to share their knowledge, expertise, and experiences in the field with particulars about different populations. This information is presented to provide details about the social and cultural fabric of different cultural groups, with the important caveat that it is not to be used to stereotype patients within these groups, as each patient is an individual and diversity can be as extensive within groups as it is among groups. It is from this principle—that learning background information about cultural groups can help health-care providers both develop a “radar” for potential pitfalls when caring for them and serve as a springboard for inquiry with the individual patient—that Transcultural Health Care emerges. Why is this book, and this edition, so timely? In the past, arguments about the importance of cultural competence were based primarily on making the case that our nation was becoming increasingly diverse and that as health-care professionals we need to be prepared to care for patients of different sociocultural backgrounds. This is an important argument, no v 2780_FM_i-xx 16/07/12 12:22 PM Page vi vi Foreword doubt. Shortly thereafter, research began to emerge demonstrating that being inattentive to cultural issues in the clinical setting leads to lower quality of care for specific populations, such as racial and ethnic minorities—a term that became known as disparities in health care. Yet what has evolved more recently is a burgeoning literature documenting the impact of cultural factors on health-care quality, cost, and safety. New research demonstrates that when we are not skilled or prepared to care for patients from diverse backgrounds, they may, when compared to their Caucasian counterparts, suffer more medical errors with greater clinical consequences; have longer hospital stays for the same common clinical conditions; and may have more unnecessary tests ordered—all due to language or cultural barriers between health-care providers and patients. With health-care reform and payment reform on the horizon, we literally can no longer afford to be ill prepared to meet the needs of an increasingly diverse nation. As we look toward the future, we see signs of a breakthrough occurring. More and more is being written about the topic of cultural competence. Students who years ago had to be convinced of the importance of this issue are now arriving more sensitized about cultural competence than ever before and are demanding to build their skills in the field. More research is being conducted on cultural competence and its impact on quality, safety, and cost. Additional areas are being cross-linked to cultural competence, such as patient-centeredness and health literacy. New quality measures and accreditation standards are being developed, and in some states cultural competence training has become a condition of health professional licensure. There is little doubt that the field of cultural competence is moving from the margin to the mainstream and from a luxury to a necessity. As individual providers, we must all do our part to ensure that we are delivering high-quality care to any patient we see, regardless of her or his race, ethnicity, culture, socioeconomic class, or language proficiency. Transcultural Health Care: A Culturally Competent Approach helps us build the radar to identify and understand key cross-cultural issues among diverse populations and, when applied with the tools and skills that are essential for exploring the sociocultural perspectives of the individual patient, positions us for success. Now it is time for us to learn the lessons and skills so gracefully shared with us in this book to make a difference in patients’ lives. Willing is not enough, we must do. Joseph R. Betancourt, MD, MPH Director, The Disparities Solutions Center and Director of Multicultural Education, Massachusetts General Hospital Associate Professor of Medicine, Harvard Medical School Cofounder, Manhattan Cross-Cultural Group 2780_FM_i-xx 16/07/12 12:22 PM Page vii Preface The Purnell Model for Cultural Competence and its accompanying organizing framework continue to be used in education, clinical practice, administration, and research. The Model and selected chapters have been translated into Arabic, Flemish, French, Korean, Portuguese, Spanish, Turkish, and Korean, attesting to its value on a worldwide basis. In addition, many health-care organizations have adapted the organizing framework as a cultural assessment tool, and numerous students in the United States and overseas have used the Model to guide research for theses and dissertations. The Model is increasingly being used as a guide to help ensure organizational cultural competence. This fourth edition of Transcultural Health Care: A Culturally Competent Approach has been revised based upon responses from students, faculty, and practicing health-care professionals such as nurses, physicians, emergency medical technicians, nutritionists, and people in noetic sciences. In addition, this edition is divided into two units. Unit 1, Foundations for Cultural Competence: Individual and Organizational, has the following features: • An expanded chapter on the overview of transcultural diversity and health care • A separate chapter on the Purnell Model for Cultural Competence, with specific questions in the organizing framework instead of objectives • A separate chapter on individual competence and evidence-based practice • A separate chapter on organizational cultural competence • A separate chapter on global health Unit 2 is entitled Aggregate Data for CulturalSpecific Groups. As in previous editions, we have made a concerted effort to use nonstereotypical language when describing cultural attributes of specific cultures, recognizing that there are exceptions to every description provided and that the differences within a cultural group are determined by variant cultural characteristics. One important change on the Model is that the primary and secondary characteristics of culture are now called “variant cultural characteristics” at the suggestion of gay, lesbian, and transgendered communities. The first time a cultural term is used in a chapter, it is in boldface type and is defined in the glossary. Because faculty and clinical practitioners have found the Appendix—Cultural, Ethnic, and Racial Diseases and Illnesses—valuable, it remains in the book. Abstracts are included in the main textbook for each culturally specific full chapter located on Davis Plus. Space and cost concerns limit the number of chapters that are included in the book; therefore, additional cultural groups are on Davis Plus. Also on Davis Plus are student resources such as review questions, Web sites of interest, case studies, and reflective exercises. Additional faculty resources on Davis Plus include PowerPoint slides with clicker check questions for each chapter and a question bank. Specific criteria were used for identifying the groups represented in the book and those included in electronic format. Groups included in the book were selected based on any of the following six criteria: • The group has a large population in North America, such as people of Appalachian, Mexican, German, and African American heritage. • The group is relatively new in its migration status, such as people of Haitian, Somali, and Arab heritage. • The group is widely dispersed throughout North America, such as people of Iranian, Korean, Hindu, and Filipino heritage. • The group is of particular interest to readers, such as people from Amish heritage. • The group is of particular interest to students and staff from other countries, such as European Americans. A particular strength of each chapter is that it has been written by individuals who are intimately familiar with the specific culture. Again, we have strived to portray each culture comprehensively, positively, and without stereotyping. We hope you enjoy the book. Larry D. Purnell vii 2780_FM_i-xx 16/07/12 12:22 PM Page viii 2780_FM_i-xx 16/07/12 12:22 PM Page ix Contributors Richard Adair, MD Adjunct Professor of Medicine University of Minnesota Minneapolis, Minnesota Karen Aroian, PhD, RN, FAAN Director of Research and Chatlos Endowed Professor University of Florida College of Nursing Orlando, Florida Linda Ciofu Baumann, PhD, RN, FAAN University of Wisconsin-Madison Madison, Wisconsin Joseph R. Betancourt, MD, MPH Director of Disparities Solutions Center Massachusetts General Hospital Boston, Massachusetts Josepha Campinha-Bacote, PhD, MAR, PMHCNS-BC, CTN-A, FAAN Transcultural Healthcare Consultant Transcultural C.A.R.E. Associates Blue Ash, Ohio Marga Simon Coler, EdD, Dr. Causa Honoris, FAAN, APRN-BC Professor Emeritus University of Connecticut South Hadley, Massachusetts Jessie M. Colin, PhD, RN, FAAN Professor and Director of Nursing PhD, Nursing Administration and Nursing Education Programs Barry University Miami Shores, Florida Tina A. Ellis, RN, MSN, CTN Nursing Instructor Florida Gulf Coast University Fort Myers, Florida Myriam Gauthier, MSN Graduate Student in Nursing Faculté des sciences infirmières, Université Laval Pavillon Ferdinand-Vandry, Québec Homeyra Hafizi, MSN, RN, COHN/S, LHRM Coordinator, Employee Health and Workers’ Compensation Wuesthoff Health System/HMA Rockledge, Florida Laurie B. Hartjes, PhD, RN, PNP-BC Educational Design Consultant Lodestone Safety International Beverly, Massachusetts Keiko Hattori, RN, PhD Assistant Professor Kawasaki University of Medical Welfare Kurashiki, Okayama, Japan Sandra M. Hillman, PhD, MS, BS, RN Associate Professor College of Mount Saint Vincent Bronx, New York 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 Huttlinger, PhD, RN Associate Director for Graduate Programs New Mexico State University Las Cruces, New Mexico Eun-Ok Im, PhD, MPH, RN, CNS, FAAN Professor and Marjorie O. Rendell Endowed Professor University of Pennsylvania Philadelphia, Pennsylvania Misae Ito, RN, MW, MSN, PhD Professor Kawasaki University of Medical Welfare Kurashiki, Okayama, Japan Rauda Gelazis, RN, PhD Retired, Associate Professor Ursuline College Pepper Pike, Ohio ix 2780_FM_i-xx 16/07/12 12:22 PM Page x x Contributors Jayalakshmi Jambunathan, PhD, MSN, BSN, MA BSc Professor, CON UW Oshkosh Director, Research and Evaluation and Assistant Dean UW Oshkosh Oshkosh, Wisconsin Galina Khatutsky, MS Research Analyst RTI International Waltham, Massachusetts Sema Kuguoglu, PhD, BSN, RN Professor Emeritus, University of Mamara Funded Professor, University of Gazikent Istanbul and Gaziantep, Turkey Anahid Kulwicki, PhD, RN, FAAN Professor and Associate Dean for Research Director of the PhD in Nursing Program Florida International University Miami, Florida Ginette Lazure, PhD Professeure titulaire Université Laval Pavillon Ferdinand-Vandry Médecine, Québec Stephen R. Marrone, EdD, RN-BC, CTN-A Deputy Nursing Director State University of New York SUNY Downstate Medical Center Brooklyn, New York Susan Mattson, RNC-OB, CTN-OB, PhD, FAAN Professor Emerita Arizona State University College of Nursing and Health Innovation Scottsdale, Arizona Afaf Ibrahim Meleis, PhD, DrPS (hon), FAAN Margaret Bond Simon Dean of Nursing University of Pennsylvania School of Nursing Philadelphia, Pennsylvania Mahmoud Hanafi Meleis, PhD, PE Retired Nuclear Engineer Philadelphia, Pennsylvania Cora Munoz, PhD, RN Professor Emerita/Adjunct Professor Capital University Columbus, Ohio Irena Papadopoulos, PhD, MA (Ed), BA, RN, RM, NDN, FHEA Professor Middlesex University Highgate Hill, London, UK Ghislaine Paperwalla, BSN, RN Research Nurse in Immunology Veterans Administration Medical Center Miami, Florida Jeffrey R. Ross, MAT, MA, BFA ESL Teacher and Tutor Springfield School System and the University of Akron Akron, Ohio Ratchneewan Ross, PhD, MSc (Public Health), RN Associate Professor and Director of International Activities Kent State University Kent, Ohio Susan W. Salmond, EdD, RN, CNE, CTN Dean and Professor University of Medicine and Dentistry of New Jersey Newark, New Jersey Stephanie Myers Schim, PhD, RN, PHCNS-BC Associate Professor Wayne State University College of Nursing Detroit, Michigan Janice Selekman, DNSc, RN Professor Nursing University of Delaware Newark, DE Jessica A. Steckler, MS, RN-BC CEO The Firm of Jessica A. Steckler Erie, Pennsylvania Marshelle Thobaben, RN, PHN, MS, FNP, PMHNP Department Chair, Professor Humboldt State University Arcata, California Hsiu-Min Tsai, RN, PhD Dean of Academic Affairs and Associate Professor Chang Gung University of Science and Technology Tao-Yuan, Taiwan 2780_FM_i-xx 16/07/12 12:22 PM Page xi Contributors Anna Frances Z. Wenger, PhD, RN, FAAN Professor and Director Emeritus of Nursing Goshen College Goshen, Indiana Marion R. Wenger, PhD Professor of Lin...
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