The Importance Of Professional Communication Among Asian Americans
Professional communication Cultural Sensitivity Guide
Minority health studies have mainly focused on African American or Hispanic cultures. Asian Americans are a fast growing minority in United States, and they comprise a great percentage of health care workers .The US census bureau (2010) projects that Asian American population will reach 16.5 million by 2015.In education, income, health, occupations, beliefs and values, Asian Americans are very diverse in many ways. There are several health studies done in different minorities, but it is very rarely done among Asian Americans even though it represents a larger number of health care workers. For the purpose of this paper I would like to write about Filipino patients and families and their attitudes towards Advance directives .There are three main reasons, I chose that culture and group. I work with a large group of Filipino nurses and they discuss about taking care of their parents and I was aware of significance of end of life decision making process among them. Second reason …show more content…
being a nurse from India, I was always intrigued how there are many similarities and differences among Asian American cultures .Third reason being not only how end of life care decisions and attitudes are perceived in Filipino culture but there is also a larger percentage of geriatric population now here in United States and it is a growing concern for young adults who take of them. It was also a revelation to learn more about this culture.
According to Denisco and Barker, original health care model that was introduced in United States was intended mainly to serve patients who spoke English, and to those who were able to use that language fluently. But now in health care that is not a typical patient. Human migration, wars, refugees, immigrants and skilled workers came in search of more job opportunities and made health care more diverse and complex. According to Li –Chen Lin (2009), nursing shortages and migration of global population has resulted in recruitment of nurses from foreign countries and major populations of foreign nurses are from Asia. Because of immigration of nurses, their families also came to United States. Larry Purnell’s model of cultural competence domains will help the providers and his 12 domains of culture include “heritage, family roles, and nutrition, death rituals, health care practices, communication, work force issues, high risk behaviors, bio cultural ecology, pregnancy, spirituality, health care practitioners”. Sociocultural differences between patients and providers always affect and can cause inconsistencies in communication and while making clinical decisions. A better understanding and studies of different cultures, back grounds, beliefs and value systems can help and improve communication and will help in making important life decisions.
According to Leininger, cultural competence requires knowledge of transcultural nursing theories and principles. When she introduced the concept in 1950’s, it was not viewed as relevant to nursing practice (Leininger, 1978), because nursing theories were young and in her model she included several components. She always emphasizes diversity is always present, both between and among cultures. Summary of the Article
The article I have chosen focuses on attitudes of critically ill Filipino patients and their families toward advance directives .Advance directives are an important tool while taking take care of critically ill patients as there are treatment choices made daily by health care providers that could augment communication about life supporting devices and also could assist reducing healthcare costs and lawsuits. It is very important for health care professionals to understand how cultures influence their attitudes and health care decisions. Helping patients and families understand their care also helps them to plan for decision for discharge planning.
Filipino Americans in California account for 2.7% of the population. The specific aims of the study were to describe the attitudes and compare the differences in attitude, describe the acculturation and, determine relationship between certain demographics and attitudes toward advance directives and end of life decisions. While reviewing the literature, participants noted Douglas and Brown (2002) reported that patients with more positive attitudes were Caucasian, female elderly and in poor health .No studies focused mainly on attitudes and completion of advance directives among Filipino Americans. Methods used were a descriptive correlational study was done at West Coast medical center in California was done among 22 Filipino American patients and 22 Filipino American families who were in the hospital for cardiac surgery or cardiac intervention treatments. Participants were interviewed with Advance directive Attitude survey and a short acculturation scale for Filipino Americans. Results of the survey: Family members scores were more positive than patients scores on the attitude survey .Family members were more American acculturated than families .Family members were with higher education had more positive attitudes towards advance directives ;overall attitudes were positive ,but completion rate and knowledge of advance directives remained low . Application to practice
In Filipino culture, they believe in bahala na , that means leaving it up to God and illness is perceived as the will of God and this view may prevent them from accepting or complying with advance directives .An estimated 80% Filipinos are Catholics, some belong to interdenominational churches. Tagalog or Pilipino is their main language. Their original health beliefs include rapid alterations from heat to cold leads to illness.
Filipino’s believe in rapid shifts from hot to cold lead to illness. There are several theories of illness, mystical, personality and naturalistic [like thunder and lightning]. Cultural doctors or naturopaths help to protect the body and treat magically with herbal and medicinal treatments. According to McBride, culturally appropriate Geriatric assessment includes greeting and informal conversation.
Social greetings like, how you are, communicates respect, with permission; providers can address elderly patients who are older as grandma or grandpa. There are communication issues both verbal and nonverbal when dealing with Filipino culture, that is always identical with other Asian cultures .Many Filipino elders could be insulted if they are asked about need for an interpreter, because they are proud of their proficiency to read and write and communicate in English as they had studied in English classes when they were young .It is always better to ask for permission for interpreters. Direct questions such as “Do you understand?” “Do you follow me” are considered impolite. Another method that would benefit would be to ask patient to repeat instructions or verbal teach back to make sure they have understood the
teaching.
Non-verbal communication methods should be also taken in consideration while talking to Filipino Americans. Eye contact, speed of conversation physical distance, touch, gestures and time are some of them .Most of this information was obtained by talking to my fellow Filipino coworkers.
Eye contact –Prolonged eye contact can be considered impolite and even intimidating. Staring is considered rude .Prolonged eye contact by a young female clinician and an older male Filipino male is considered flirtation. Speed of conversation is important, allow for brief periods of silence in the encounter to process information. Physical distance-always give yourself a personal space of one to two feet distance .Touch-Young female providers should be careful to touch older Filipino male patients. Elderly Filipino women may spontaneously touch a hand or arm to show appreciation. Gestures- To call someone, the palm faces downward and the fingers are moved in a rubbing motion .Moving your index finger alone back and forth is considered rude. Nodding head has many meanings range from yes, no, I hear you and agreeing with another person. Time –Time orientation may differ, may be tardy in social settings.
End of life preferences-Elders and family may avoid talking about advance directives or dying as they believe talking about it may bring the event sooner in their lives. In those matters it is always best to approach with caution and brought gradually with trusted physician or clergy or to bring up with a health care professional health care worker in their family. Discussion of adverse outcomes may provoke anxiety.
According to Melen McBride, many elders, in Filipino culture, particularly, that from big families, always seeks advice from a reliable adult family member who has knowledge in health care, as their “surrogate decision maker” and would expect the clinician to keep this individual informed of issues related to their health. Such preference may not be expressed or openly discussed by the elders or other family members. For Filipino culture, while considering end of life decisions, a health care provider need to be treated with respect, they do not want to argue or have disagreement with them. While talking to Filipino nurses, they also have a difficult time talking about advance directives to their family members, while encouraging open communication. Health care providers need to reassure elderly gentlemen that asking questions or opinions would not offend them.
According to Denisco and Barker, understanding the elements of culture, while caring for a patient is a demonstration of cultural competence .Understanding culture helps in collaborating care to patient and family. Conclusion
Nurses should comprehend client needs through effective listening, attentive body language, and eye contact. Other non-verbal communications includes time, space, silence, distance and other unique cultural patterns and expressions. Learning about traditions, cultures and beliefs and attitudes to end of life care issues of other cultures helps in improving the care of patient and gain respect of patients and that makes patients feel they have been taken care with respect. According to Denisco and Barker, “the nursing assessment, care plan, problem list, diagnosis, progress note or discharge plan” can be effectively done when cultural influences are addressed. As I read articles about Filipino culture and their attitudes to end of life care issues, I was able to understand them more and their hesitation towards completing advance directives, how it is a sensitive subject to them and how families with higher education had a positive attitude toward them.
References
1. Anderson, J. (1983). Health and illness in Pilipino immigrants. In In Cross-cultural medicine [special issue].Western Journal of Medicine139 (6) (pp. 811-819)
2. Denisco, S. M., & Barker, A. M. (2013). chapter22, chapter 24,. In A. Harvey (Ed.), Advanced practice nursing: Evolving roles for the transformation of the profession (2nd ed., pp.482-516). Burlington, MA: Jones &Bartlett Learning.
3. Douglas, M. K., Pierce, J. U., Rosenkotter, M., Callister, L. C., & Lauderdale, J. (2009). Standards of Practice for culturally competent Nursing care: A request for comments Journal of Transcultural nursing, July 2009(3), 257-269. http://dx.doi.org/101177/1043659609334678 4. McAdam, J. L., Stotts, N., Padilla, G., & Puntillo, K. (2005, January). Attitudes of critically ill Filipino patients and their families toward advance directives. American journal of critical care, 14(1), 17-25. Retrieved from ajcc.aacnjournals.org. 5. McBride, M. (2000). Health and health care of Filipino American elders. Retrieved from http://web.stanford.edu/group/ethnoger/ebooks/filipino.html 6. Lin, L. C. (2009). A synthesis of the literature on Asian nurses work experience in the United States. Research and Theory for Nursing practice, an international journal, 23(3), 230. http://dx.doi.org/10.1891/1541-6577.23.3.230
Minority health studies have mainly focused on African American or Hispanic cultures. Asian Americans are a fast growing minority in United States, and they comprise a great percentage of health care workers .The US census bureau (2010) projects that Asian American population will reach 16.5 million by 2015.In education, income, health, occupations, beliefs and values, Asian Americans are very diverse in many ways. There are several health studies done in different minorities, but it is very rarely done among Asian Americans even though it represents a larger number of health care workers. For the purpose of this paper I would like to write about Filipino patients and families and their attitudes towards Advance directives .There are three main reasons, I chose that culture and group. I work with a large group of Filipino nurses and they discuss about taking care of their parents and I was aware of significance of end of life decision making process among them. Second reason …show more content…
being a nurse from India, I was always intrigued how there are many similarities and differences among Asian American cultures .Third reason being not only how end of life care decisions and attitudes are perceived in Filipino culture but there is also a larger percentage of geriatric population now here in United States and it is a growing concern for young adults who take of them. It was also a revelation to learn more about this culture.
According to Denisco and Barker, original health care model that was introduced in United States was intended mainly to serve patients who spoke English, and to those who were able to use that language fluently. But now in health care that is not a typical patient. Human migration, wars, refugees, immigrants and skilled workers came in search of more job opportunities and made health care more diverse and complex. According to Li –Chen Lin (2009), nursing shortages and migration of global population has resulted in recruitment of nurses from foreign countries and major populations of foreign nurses are from Asia. Because of immigration of nurses, their families also came to United States. Larry Purnell’s model of cultural competence domains will help the providers and his 12 domains of culture include “heritage, family roles, and nutrition, death rituals, health care practices, communication, work force issues, high risk behaviors, bio cultural ecology, pregnancy, spirituality, health care practitioners”. Sociocultural differences between patients and providers always affect and can cause inconsistencies in communication and while making clinical decisions. A better understanding and studies of different cultures, back grounds, beliefs and value systems can help and improve communication and will help in making important life decisions.
According to Leininger, cultural competence requires knowledge of transcultural nursing theories and principles. When she introduced the concept in 1950’s, it was not viewed as relevant to nursing practice (Leininger, 1978), because nursing theories were young and in her model she included several components. She always emphasizes diversity is always present, both between and among cultures. Summary of the Article
The article I have chosen focuses on attitudes of critically ill Filipino patients and their families toward advance directives .Advance directives are an important tool while taking take care of critically ill patients as there are treatment choices made daily by health care providers that could augment communication about life supporting devices and also could assist reducing healthcare costs and lawsuits. It is very important for health care professionals to understand how cultures influence their attitudes and health care decisions. Helping patients and families understand their care also helps them to plan for decision for discharge planning.
Filipino Americans in California account for 2.7% of the population. The specific aims of the study were to describe the attitudes and compare the differences in attitude, describe the acculturation and, determine relationship between certain demographics and attitudes toward advance directives and end of life decisions. While reviewing the literature, participants noted Douglas and Brown (2002) reported that patients with more positive attitudes were Caucasian, female elderly and in poor health .No studies focused mainly on attitudes and completion of advance directives among Filipino Americans. Methods used were a descriptive correlational study was done at West Coast medical center in California was done among 22 Filipino American patients and 22 Filipino American families who were in the hospital for cardiac surgery or cardiac intervention treatments. Participants were interviewed with Advance directive Attitude survey and a short acculturation scale for Filipino Americans. Results of the survey: Family members scores were more positive than patients scores on the attitude survey .Family members were more American acculturated than families .Family members were with higher education had more positive attitudes towards advance directives ;overall attitudes were positive ,but completion rate and knowledge of advance directives remained low . Application to practice
In Filipino culture, they believe in bahala na , that means leaving it up to God and illness is perceived as the will of God and this view may prevent them from accepting or complying with advance directives .An estimated 80% Filipinos are Catholics, some belong to interdenominational churches. Tagalog or Pilipino is their main language. Their original health beliefs include rapid alterations from heat to cold leads to illness.
Filipino’s believe in rapid shifts from hot to cold lead to illness. There are several theories of illness, mystical, personality and naturalistic [like thunder and lightning]. Cultural doctors or naturopaths help to protect the body and treat magically with herbal and medicinal treatments. According to McBride, culturally appropriate Geriatric assessment includes greeting and informal conversation.
Social greetings like, how you are, communicates respect, with permission; providers can address elderly patients who are older as grandma or grandpa. There are communication issues both verbal and nonverbal when dealing with Filipino culture, that is always identical with other Asian cultures .Many Filipino elders could be insulted if they are asked about need for an interpreter, because they are proud of their proficiency to read and write and communicate in English as they had studied in English classes when they were young .It is always better to ask for permission for interpreters. Direct questions such as “Do you understand?” “Do you follow me” are considered impolite. Another method that would benefit would be to ask patient to repeat instructions or verbal teach back to make sure they have understood the
teaching.
Non-verbal communication methods should be also taken in consideration while talking to Filipino Americans. Eye contact, speed of conversation physical distance, touch, gestures and time are some of them .Most of this information was obtained by talking to my fellow Filipino coworkers.
Eye contact –Prolonged eye contact can be considered impolite and even intimidating. Staring is considered rude .Prolonged eye contact by a young female clinician and an older male Filipino male is considered flirtation. Speed of conversation is important, allow for brief periods of silence in the encounter to process information. Physical distance-always give yourself a personal space of one to two feet distance .Touch-Young female providers should be careful to touch older Filipino male patients. Elderly Filipino women may spontaneously touch a hand or arm to show appreciation. Gestures- To call someone, the palm faces downward and the fingers are moved in a rubbing motion .Moving your index finger alone back and forth is considered rude. Nodding head has many meanings range from yes, no, I hear you and agreeing with another person. Time –Time orientation may differ, may be tardy in social settings.
End of life preferences-Elders and family may avoid talking about advance directives or dying as they believe talking about it may bring the event sooner in their lives. In those matters it is always best to approach with caution and brought gradually with trusted physician or clergy or to bring up with a health care professional health care worker in their family. Discussion of adverse outcomes may provoke anxiety.
According to Melen McBride, many elders, in Filipino culture, particularly, that from big families, always seeks advice from a reliable adult family member who has knowledge in health care, as their “surrogate decision maker” and would expect the clinician to keep this individual informed of issues related to their health. Such preference may not be expressed or openly discussed by the elders or other family members. For Filipino culture, while considering end of life decisions, a health care provider need to be treated with respect, they do not want to argue or have disagreement with them. While talking to Filipino nurses, they also have a difficult time talking about advance directives to their family members, while encouraging open communication. Health care providers need to reassure elderly gentlemen that asking questions or opinions would not offend them.
According to Denisco and Barker, understanding the elements of culture, while caring for a patient is a demonstration of cultural competence .Understanding culture helps in collaborating care to patient and family. Conclusion
Nurses should comprehend client needs through effective listening, attentive body language, and eye contact. Other non-verbal communications includes time, space, silence, distance and other unique cultural patterns and expressions. Learning about traditions, cultures and beliefs and attitudes to end of life care issues of other cultures helps in improving the care of patient and gain respect of patients and that makes patients feel they have been taken care with respect. According to Denisco and Barker, “the nursing assessment, care plan, problem list, diagnosis, progress note or discharge plan” can be effectively done when cultural influences are addressed. As I read articles about Filipino culture and their attitudes to end of life care issues, I was able to understand them more and their hesitation towards completing advance directives, how it is a sensitive subject to them and how families with higher education had a positive attitude toward them.
References
1. Anderson, J. (1983). Health and illness in Pilipino immigrants. In In Cross-cultural medicine [special issue].Western Journal of Medicine139 (6) (pp. 811-819)
2. Denisco, S. M., & Barker, A. M. (2013). chapter22, chapter 24,. In A. Harvey (Ed.), Advanced practice nursing: Evolving roles for the transformation of the profession (2nd ed., pp.482-516). Burlington, MA: Jones &Bartlett Learning.
3. Douglas, M. K., Pierce, J. U., Rosenkotter, M., Callister, L. C., & Lauderdale, J. (2009). Standards of Practice for culturally competent Nursing care: A request for comments Journal of Transcultural nursing, July 2009(3), 257-269. http://dx.doi.org/101177/1043659609334678 4. McAdam, J. L., Stotts, N., Padilla, G., & Puntillo, K. (2005, January). Attitudes of critically ill Filipino patients and their families toward advance directives. American journal of critical care, 14(1), 17-25. Retrieved from ajcc.aacnjournals.org. 5. McBride, M. (2000). Health and health care of Filipino American elders. Retrieved from http://web.stanford.edu/group/ethnoger/ebooks/filipino.html 6. Lin, L. C. (2009). A synthesis of the literature on Asian nurses work experience in the United States. Research and Theory for Nursing practice, an international journal, 23(3), 230. http://dx.doi.org/10.1891/1541-6577.23.3.230