Cultural competence has become a buzzword in the global health care when it refers diversity and disparities. Modern health ideology promotes a certain view that providers should understand not only physiological component of the diseases but pay equal attention to patients cultural background. The professional may be extremely knowledgeable about standard practices and laboratory values for pulmonary disease, heart disease, and diabetes but if the treatment plan is not aligned with the patients views regarding recovery, health beliefs, and nutritional customs, the recommendations are not likely to be adhered. Today, many countries are recognizing the following problem by powerfully promoting cultural competence in health care organizations, thereby improving patient care and satisfaction. Diversity also involves having the culturally different personnel that can accurately represent the population it aims to serve. The purpose of this paper is to discuss my own cultures pattern of communication using Purnells Domains of Culture.
Before proceeding to any discussion of cultural peculiarities, it is appropriate to admit that I belong to Puerto Rican heritage. Puerto Ricans are broadly considered to be friendly and hospitable who are always willing to share ideas, emotions, and points of view. In fact, they like to explicit about the problems and feelings as well as demonstrate empathy while having a conversation. People often view themselves as the part of the United States, which is why while having a conversation with Puerto Ricans an interlocutor should not emphasize his/her American origins, as if he/she admitting that they are not. Therefore, it is absolutely inappropriate to inquiry about Puerto Ricans status in the United States, as long as the subject can cause negative emotions. Such private things as marital status and family are also not open for discussion, especially when people have not developed a personal relationship. Furthermore, homosexuality is also regarded as a sensitive and taboo topic for Puerto Ricans. Due to their Roman Catholic heritage, homosexual individuals are rarely tolerated and easily accepted in the society. Even though the young generation is less conservative, the older people continue to actively encourage a macho attitude and masculinity.
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Puerto Ricans consider touching as a means to communicate their feelings and emotions. Shaking Members of the opposite sex, who are friends, may greet each other with cheek kisses. Family members and friends tend to touch each other, such as placing a hand on the back or touching the arm, in order to show that they care and are listening to other peoples concerns and problems. Puerto Ricans consider touch between acquaintances to be totally acceptable. It is worth mentioning that health care providers can demonstrate their empathetic attitude by touching Puerto Rican patients to support them at the moment of crisis.
While close distance between interlocutors are regarded as a sign of rudeness in most cultures, people of Puerto Rican heritage usually like to stand close to each other. The acceptable personal distancing is approximately 1 to 1,5 feet. Less than one feet distance is viewed as a specific physical space which Puerto Ricans do not want to be intruded. Notably, people show high levels of tolerance for close physical distance even with the strangers. This means that they are more likely to touch health care providers during formal or informal conversations. Moving away during a conversation with Puerto Ricans can be perceived as offensive, impolite and disrespectful. Puerto Rican people who were born in the United States commonly show the same level of acceptability to close contact as those born in Puerto Rico.
People tend to avoid direct eye contact during conversations with family, friends as well as strangers. In many situations steady eye contact is considered to be hostile, inappropriate and aggressive. Puerto Rico epitomizes a strong hierarchal culture, which is why subordinates should avoid maintaining intense eye contact with their superiors. Such behavior is usually deemed to be disrespectful, especially when it comes to persons of different age groups. For instance, a son will point his eyes downwards if his mother is talking to him in order to show respect and obedience. Similarly, patients are discouraged from maintaining long strong eye contact with their health care providers, since it may be interpreted as an insult and the lack of respect.
As in most Latin cultures, hand gestures are common in both informal and business settings. The majority of facial expressions and gestures are similar to those used in the United States. When giving a person a relatively small item, it is inappropriate to throw it to him/her. It is acceptable for boys who are friends to push or jab each other. Puerto Ricans wave their fingers to ask a person to come closer to them. While waving fingers and pushing are used in a variety of cultures, little nose crinkle is considered to be a purely Puerto Rican facial expression, which in the United States is often misinterpreted. More specifically, a person uses this gesture as a sign that he/she does not understand something. Puerto Ricans usually wrinkle their noses quickly twice for everyone to notice his/her confusion. In fact, they may continue doing it for a while until they finally get their attention. Americans commonly do not know how to react on Puerto Ricans nose wrinkling, but for those who understand it, the gesture considerably saves time and can be virtually effective.
People tend to stand fairly close to counterparts and can become extremely insulted if a person moves away. Puerto Ricans are widely know for their hospitality and friendliness, which is why a warm handshake is considered as a traditional form of greeting. In some circumstances, a nod of the head may be sufficient to show your friendly attitude and politeness. Male friends often embrace, while females who have close relationship can engage in a brief hug or cheek kiss. In formal environment or during the first meeting it is increasingly important to address Puerto Ricans by a title, Doctor,Señor, Señora, etc. It should be noted that people generally have two surnames, which are acquired from both parents.
Puerto Ricans hold extremely traditional beliefs, and their cultures worldview is past oriented. The most prominent feature of Puerto Rican heritage is their deep attachment to family. Children are raised to respect and cherish their parents, as long as family honor and dignity play the most important role in Puerto Ricans life. The home is perceived to be the center of social life, which is why all holidays, social events, and weddings are celebrated in the home settings. It is not uncommon to find three generations living in one house, and older adults are rarely placed in nursing homes. Even though most people are predominately Catholics, many of them are paying homage to Indian beliefs in nature spirits that are considered to be powerful enough to influence human life and health. Additionally, Puerto Ricans deeply believe in the saints miracles, magical skills and abilities, the evil eye, etc. The later is deemed to be a result of malevolent glare or excessive admiration. In order to protect from the evil eye or disease, parents present their children with bracelets that contains a charm in the form of a fist.
Puerto Rican culture is one of the most influential determining factors in my nursing practices and beliefs. In my country family plays the most significant role in healing, and disease is viewed as a family issue rather than an affair of an individual. Though I do not make a preliminary diagnosis based on the recommendations of relatives, I still engage family members in the process of recovery, since I believe in the effectiveness of holistic approaches in medicine. Many people in Puerto Rico are suspicious of evidence-based and scientifically-approved treatment methods giving a preference to folk medicines. Certainly, I do not heavily rely on unsophisticated health care practices, such as folk medicine and witchcraft, but I attempt to adhere to some of the cultural traditions. While giving a treatment plan I will attempt to combine Western medicines with herbal remedies in order to reduce the possibility of side effects. For example, chamomile and linden tea are some of my preferred herbal remedies to deal with nerve damage and digestive disorders.
All in all, by focusing on national culture in a health care setting providers can foresee and analyze with high level of accuracy how a culturally diverse person will react to his/her treatment plans, as well as assume how a patient will approach them. Therefore, the basic knowledge of Puerto Rican national traits and communication patterns will eliminate unwanted conflicts, provide cultural insights, and enable a provider to successfully interact without insulting and disrespecting them. Taking into account patient health practices and preferences proves to be an effective strategic tool to speed the recovery process. In such a way, a culturally competent provider can turn barriers to adequate health care, such as Puerto Ricans belief in folk medicine, into a tangible advantage, if properly managed.