Cultural competence “is defined by the National Institutes of Health (2015) as the enabling of health care providers to deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients.” (Potter, 2017, pg. 103). To be considered culturally competent, one must ascertain personal preferences, beliefs, and care requirements, of their patient or patients. Cultural competency is a significant facet of nursing that emphasizes considerations for the provision of care to a vast diversity of patients.
Purnell (2014) stated that:
Health-care providers who understand their own cultures and their patient’s cultural values, beliefs, and practices are in better position to interact with their patients and provide culturally acceptable care that increases opportunities for health promotion and wellness; illness, disease, and injury prevention; and health maintenance and restoration. (pg. 2)
The Mexican culture, is one that has become rampant in the United States.
Mexicans are said to have crossed the border over to the United States, partly due to the loss of a portion of their land to the United States. The other part can be linked to the abject state of their country, which fuels their determination to cross over in search of better opportunities. (Lipson & Dibble, 2005). Hardwick and Guerra (2012) report that one million Mexican indigenes, populate the North Texas area. The Chinese population “has grown more than six-fold since 1980, reaching 2.3 million in 2016, or 5 percent of the approximately 44 million immigrant population overall”. (Zong & Batalova, 2017). Chinese indigenes constitute 0.7% of Houston, The Woodlands, and Sugarland, TX.
(Zong & Batalova, 2017).
The primary languages and dialects of the Mexicans include Chicano Spanish, and Spanish. (Lipson & Dibble, 2005). The primary languages and dialects of the Chinese include “mandarin (pu tong hua), which is spoken by about 70% of the population, but other major, distinct dialects such as Cantonese, Fujianese, Shanghainese, Toishanese, and Hunanese exist”. (Purnell, 2014, pg. 119). When addressing a Mexican, a health care provider should ask how he/she would like to be addressed. (Lipson &Dibble, 2005). In comparison to the Chinese people, they outrightly would like to be addressed by their last names first, followed by their first names. (Purnell, 2014). Eye contact is a nonverbal communication avoided by the Mexican older population, and the Chinese people alike, which could signify a sign of respect, however, the more educated Mexican populace maintain direct eye contact. (Purnell, 2014).
Purnell (2014) suggests that when communicating with a Chinese patient, seating should be arranged in such a way that positive communication is enhanced. Mexicans and Chinese share similar practices in that permission is required, and explanation provided, before executing tasks that require touching or physical contact, such as comprehensive physical examinations. (Purnell, 2014). The Chinese people are noted for hiding their emotions and emotional expressions from strangers however, amongst their kinfolk, there is open display of emotion. (Purnell, 2014). Privacy is a highly momentous notion in the Chinese culture. They are reluctant when it comes to the disclosure of personal information, due to feelings of embarrassment and shame. (Lipson & Dibble, 2005). In contrast, Mexicans willingly share information, especially with close family members, but “Do not spontaneously reveal to healthcare providers their use of home remedies or folk headers/spiritualists”. (Lipson & Dibble, 2005, pg. 333).
A handshake is considered an appropriate gesture in the Mexican culture, whilst Chinese people “do not use many hand gestures”. (Lipson & Dibble, 2005, pg. 100). In both cultures, the use of family members as interpreters, is not considered a professional approach. There may be certain information that the patient would prefer not to be disclosed to family member or members. (Lipson & Dibble, 2005). Both the Mexican and Chinese cultures lack a sense of value for time. They have the tendency to arrive late to appointments, and more inclined to activities of the present, not the future. The need to arrive early to medical appointments, should be emphasized by the healthcare provider. (Purnell, 2014). Consent forms are readily signed in the Chinese culture, after a clear and thorough explanation has been provided to the eldest male in the family. Mexicans, especially illegal immigrants, are highly suspicious and not readily available to sign official or legal documents, because they fear they may be discovered, and hence, deported. (Lipson & Dibble, 2005).
In a Chinese home, a recognized figurehead carries out major decisions and responsibilities for the family. This role is rotated amongst each family member to maintain harmony, as they believe that family is most important than the individual, and the society. (Purnell, 2014). “Maintaining reputation is very important and is accomplished by adhering to the rules of society”. (Purnell, 2014, pg. 122). In Mexican families, “men are expected to provide financial support for the family”. (Purnell, 2014, pg. 310). The decision making is conferred upon the eldest male of the family in a Chinese household. (Lipson & Dibble, 2005). As the breadwinner, males are more respected and valued over the females, who are expected to tend to household matters, such as chores, and raising the children. (Lipson & Dibble, 2005). Among the more westernized Chinese in the United States, the women “usually work and have more-equal relationships with their spouses”. (Lipson & Dibble, 2005, pg. 105). Unlike the Chinese household, the man and the woman can both be responsible for the decision making in the Mexican household, although traditionally, the man is usually accountable. Healthcare providers are encouraged to ask Mexican patients, who makes the decisions for the family. (Purnell, 2014). Like the Chinese household, the man is the head of the household, however, of recent times, women “head households as single parents raising children and holding one or two jobs, attending school, and/or caring for a parent”. (Lipson & Dibble, 2005, pg. 338). In a Chinese household, children are highly valued. They are expected to respect and obey their elders, just as is required in a Mexican household. (Purnell, 2014). Most children and adolescents are mounted the pressure to succeed, and are, therefore, trained to value education over recess. (Purnell, 2014). Independence is encouraged in a Mexican household, whilst education is not adequately enforced, due to the lack of socioeconomic resources. (Lipson & Dibble, 2014).
The extended family is an important faction in a Chinese household, which consists of grandparents, uncles, and aunts, that help to take care of the children of the household. In some instances, the children are sent to live with their aunts and/or uncles, to attain better education. (Purnell, 2014). Adult children in a Chinese household, are expected to care for their elders, especially when they can no longer do so themselves. (Purnell, 204). In Mexican households, “families may feel obligated to care for an elder parent or relative, but this obligation does not preclude placement in a long-term-care facility”. (Lipson & Dibble, 2005, pg. 339). In the Chinese culture, teenage pregnancies and divorce proceedings, are highly frowned upon. (Purnell, 2014). In the Mexican culture, “children born out of wedlock are loved regardless of parents’ marital status”. (Purnell, 2014, pg. 311). Social status in a Mexican home, is attained through the acquisition of a high level of education, bearing a highly recognized title, and having a respectable family. (Purnell, 2014).
Majority of the Mexican populace can be identified by their dark hair, dark eyes, some blonde hair and blue eyes, whilst some others are diversified. (Purnell, 2014). Some Chinese people have pink, dark, or yellow undertones in their skin, with the presence of Mongolian spots in their lower back and buttocks. (Purnell, 2014). Cardiovascular diseases, hypertension, and diabetes mellitus are some of the popular diseases affecting the Mexican community, caused by environmental, genetic, and lifestyle factors. (Purnell, 2014). In the Chinese community, health conditions such as thalassemia, glucose-6-phosphate dehydrogenase deficiency, amongst others, are prevalent, and are caused by genetic, lifestyle, and environmental factors. (Purnell, 2014). Modesty is immensely esteemed in the Mexican and Chinese cultures, hence, most Mexicans are reluctant about “exposing their bodies to someone of opposite gender”. (Lipson & Dibble, 2005, pg. 333).
Constant baths and showers are taken, and hair is washed in the process. Cleanliness is greatly encouraged. Regular manicures and pedicures are optional, but diabetics require strict education on the care of their foot. (Lipson & Dibble, 2005). Chinese patients practice good hygiene, but may choose not to wash their hair while in the hospital. There is also no special care required for their nails. (Lipson & Dibble, 2005). Mexicans and Chinese people are private when it comes to matters regarding how they use the restroom. (Lipson & Dibble, 2005). Mexicans usually have amulets such as crucifixes, while Chinese patients usually wear certain articles for good luck. (Lipson & Dibble, 2005). Healthcare providers should handle these respectfully, and should give these to the family member, if removal is required. (Lipson & Dibble, 2005). When in the hospital, Mexicans expect that assistance with self-care will be provided, as opposed to Chinese patients, who would personally, rather handle their self-care. In the Mexican and Chinese cultures, smoking is a shared behavior, while alcohol consumption is common in the Mexican culture. (Purnell, 2014). Seatbelts appear foreign to Mexican immigrants, due to lack of constant use in their motherland. (Purnell, 2014).
In Chinese culture, food is vital for the maintenance of the body’s “cold” (yin) and “hot” (yang), and follows the traditional breakfast, lunch, and dinner arrangement. (McKinney, 2018). Mexicans believe in the balancing of the consumption of “hot” foods such as chocolate, with “cold” foods such as fish. (Lipson & Dibble, 2005). Large meals are consumed at lunch, and smaller meals are consumed for dinner, in the Mexican household. (Lipson & Dibble, 2005). Rice, beans, and tortillas, are common Mexican staples, while rice and noodles are frequently consumed by Chinese indigenes. (Lipson & Dibble, 2005). The “rice is usually steamed but can be fried with eggs, vegetables, and meats as well”. (Purnell, 2014, pg. 126).
Some Mexicans add flavor to their food through the use of coconut oil and animal fat, which increased caloric intake. (Purnell, 2014). Sweetened drinks and flour tortillas, should be discouraged, to reduce caloric intake, while natural juices, corn tortillas, and vegetables should be encouraged to improve calcium levels in the body. (Purnell, 2014). The Chinese community encourage the consumption of a well balanced diet to prevent nutritional imbalances and promote physical, and emotion well-being. (Purnell, 2014). When ill, Chinese patients prefer to drink hot tea, consume yin foods and avoid yang foods if illness is caused by yang excesses, and vice versa. (Lipson & Dibble, 2005). Mexicans use herbal teas when ill, and steer clear of foods that cause discomfort, such as dairy foods. (Lipson & Dibble, 2005).
The use of condoms, uterine devices, and abortion, go against the Mexican beliefs, because they are considered immoral. (Purnell, 2014). Abortion is practiced commonly amongst the Chinese community, due to a “one couple”, “one child” law. (Purnell, 2014). Sterilization and the rhythm method may be acceptable methods of birth control in the Mexican community. (Purnell, 2014). Pregnancy, in the Mexican community, is viewed as a normal phenomenon that women go through. It is also held in high regard in the Chinese community. (Purnell, 2014). Meat is highly consumed by pregnant women, shellfish is avoided to prevent allergies, and anything associated with cold environments are avoided during postpartum period, as it is considered a taboo to be in contact with anything cold, in the Chinese community. (Purnell, 2014). In the Mexican community, it is believed that birth defects are caused by pregnant women walking in the moonlight, and during the postpartum period, women are highly discouraged from washing their hair or taking baths for the next six weeks. (Purnell, 2014).
In the Chinese and Mexican communities, death is considered a natural phase of life, and after which, the afterlife follows. (Lipson & Dibble, 2005).
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