Book schools nurses in cultural differences

Larry D. Purnell, professor of nursing, and Betty J. Paulanka, dean of the College of Health and Nursing Sciences

9:13 a.m., Dec. 23, 2004--Guide to Culturally Competent Health Care, the new cross-cultural nursing handbook written by Betty J. Paulanka, dean of the College of Health and Nursing Sciences, and Larry D. Purnell, professor of nursing, has sold more than 10,000 copies in less than four months.

Buyers’ interest probably was piqued by the pedigree of the handbook’s award-winning companion textbook. Transcultural Health Care: A Culturally Competent Approach, also authored by Paulanka and Purnell, landed on the prestigious Brandon Hill list of most recommended nursing books and was translated into Spanish, French, Flemish and Korean. In the United States, 54 percent of undergraduate baccalaureate nursing programs and 62 percent of graduate nursing programs use it.

The new handbook, right-sized for nurses to keep in a large pocket, is a quick guide to how 27 individual cultures approach health issues. It explains each culture’s take on family roles, nutrition, death rituals, pregnancy, workforce issues, high-risk health behaviors and health-care practices and practitioners.

The handbook is based on the Purnell Model for Cultural Competence, a template for assessing how a patient’s culture may affect beliefs relating to health and wellness.

It provides specific instructions on how to get patients to tell nurses what’s wrong.

Purnell said cultural differences were only given lip service in nurses’ training until recently. “People said, ‘Take into account your patients’ culture,’ but nobody knew what that meant,” he said.

Paulanka explained that doctors often blithely prescribed diabetic diets for foreign-born listing foods only Americans would eat: “If they’re trying to prescribe American food to traditional Chinese or Vietnamese patients, they’re not going to follow the diet because those are not the foods they eat.’’

Even something as simple as how to address a patient can cause friction. “Americans call everybody by their first names,’’ Purnell said. “In some cultures, that’s just really, really rude behavior.’’

The new handbook is a quick-reference guide to the customs and communication problems with patients from 27 cultures commonly found in North American hospitals.

Paulanka said the book is meant only as a guideline because people from all cultures become acculturated in the United States at different rates, and families keep customs in different ways and to different degrees.

She said the book is a guide for the nurse, who is encouraged to ask the patient specific questions and watch for verbal and nonverbal cues in assessing health and pain.

Purnell said nurses should be trained to assess patients’ faces for cues to their pain and their attitudes toward suggestions because, in some cultures, patients will not tell doctors or nurses anything they think might disappoint the health professional. “Many Asian patients don’t like to answer, ‘No,’ so they answer, ‘Yes,’ to everything. And, in some cultures, people are taught to respect doctors, nurses and and people in authority, so they won’t complain to them, even if they’re in pain.’’

Paulanka said foreign-born patients would turn around and leave emergency rooms rather than submit to practices that offend their culture--such as a male physician giving a total physical exam to a female patient.

From the Amish to Arabs, the handbook lays out cultural health attitudes and practices that should be understood by health professionals.

In Russia, for example, a primary treatment for respiratory illness is cupping--a small glass cup filled with alcohol-saturated cotton is lighted and then turned upside down on the patient’s back, sucking skin into the cup and producing small bruises. American health professionals unfamiliar with cupping have reported innocent parents as potential child-abusers.

The guide provides specific instructions for approaching patients and family members, as well as interventional strategies for problem situations.

Betty Paulanka was appointed dean in 1997. Her focuses include distance education, memory impairment, Alzheimer’s disease, learning technology, computer assisted learning and nursing intervention.

Larry Purnell, who heads the Master’s Program in Nursing and Health Service Administration, teaches transcultural health care across several departments.

Article by Kathy Canavan
Photo by Kathy Atkinson

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