MEDICAL COLLEGES OF NORTHERN PHILIPPINES

Alimannao Hills, Peñablanca, Cagayan

INSTRUCTIONAL
LEARNING GUIDE

NCM 120
DECENT WORK EMPLOYMENT AND
TRANSCULTURAL NURSING

FIRST SEMESTER F.Y. 2021-2022

Compiled by: PHOT

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LOUISE V. CABLING, RN, MAN
Clinical Instructor
College of Nursing and School of Midwifery
Medical College of Northern Philippines

Reviewed by: PHOTO

WINNIE T. CANCEJO, RRT, MPH

OIC, Vice-President for Academic Affairs
Medical College of Northern Philippines

PREFACE

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 Medical Colleges of Northern Philippines is committed to deliver quality
instruction to its students through various platforms. The Instructional Learning
Guide is one of the initiatives of the institution to address the learning demands of
students in Distance Learning. This guide specifically designed for the subject
Decent Work Employment and Transcultural Nursing which contains learning
materials and assessment tools prepared by the instructor based on a structured
syllabus. The contents have been carefully planned and reviewed to suit the
learning styles of students. It is a collection of discussions from various resources
such as textbooks, journals and online references that are deemed appropriate to
meet the course objectives and Intended learning Outcomes.

How to Use this Learning Guide:

This shall serve as guide of the students in the completion of the course. Lectures,
activities and evaluative assessment are provided in this material.

The learning outcomes are specified in each chapter which shall serve as checklist
of the knowledge and skills acquired by the students upon completion of the lessons
and activities given.

Lecture notes are also provided from the different references used for the subject to
guide the students in understanding the topics supplemented by teacher’s insight
and videos.

Essay questions, case analysis and self-assessment exercises are provided to stir
the critical thinking skills of the students and to evaluate their understanding on the
concepts given. Moreover, the students are required to write a journal at the end of
each term which composed of their learnings, personal reflections and realizations
of the concepts given. All written outputs shall be compiled in their learning
portfolio to be submitted to the subject teacher as part of the requirements of the
course.

Features of the Instructional Learning Guide:

 Learning Outcomes
 Key Terms
 Lectures Notes
 Teachers Insight
 Application
 Self-assessment exercise
 Self-reflection Questions
 Other Activities (to be included in Portfolio Assessments)
 Appendices
 Summary of Additional References

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 TABLE OF CONTENTS

PRELIMINARIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.....

PRELIM
COVERAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I. Decent Work
1. Definition
2. Nature and Conditions of employment
3. Terms of Employment (Labor Code)
a. Wages and benefits
b. Hours of Work
c. Overtime pay
d. Vacation and holidays
e. Sick leave and sick pay
f. Leave of Absence
g. Mandatory Employee Benefits
4. The Magna Carta for Public Health Workers
a. Recruitment and Qualification
b. Performance Evaluation and Merit Promotion
c. Transfer or Geographical Reassignment of Public health Workers
d. Married Public Health Workers
e. Security of Tenure
f. Normal hours of Work
g. Overtime Work
h. Work during rest day
i. Night-Shift Differential
j. Salaries
k. Additional Compensation
MIDTERM COVERAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.....

II. Cultural Foundations

1. Major concepts and definitions
a. Culture
b. Religion
c. Ethnicity
d. Race
e. Socialization
f. Acculturation
g. Assimilation
h. Sensitivity
i. Bias
j. Prejudice
k. Stereotyping

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 2. Cultural Phenomena Affecting Health
2.1 Environmental Control
2.2 Biological Variations
2.3 Social Organization
2.4 Communication
2.5 Space
2.6 Time Orientation
3. Religions
4. Common Ethnic Groups
5. Cultural beliefs and Practices
- Africa
- Asia
- Europe
- North, Central and South America
- Oceania
SEMI-FINAL COVERAGE
.............................................

III. Transcultural Health Domains

1. Health Traditions
2. Healing Traditions
3. Familial Health Traditions
4. Health Care Delivery and Issues

IV. Transcultural Health Care Delivery Perspectives

1. Definition of Transcultural Nursing

2. Major factors influencing Transcultural Nursing
3. Relevance of Transcultural Nursing
4. Evolution of Transcultural Nursing
5. Philosophical, anthropological, cultural, nursing perspectives grounding
Transcultural Nursing
FINAL COVERAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......

6. Theoretical Models of Transcultural Nursing

a. Theory of Culture Care Diversity and Universality(Leininger )
b. Cultural Competency Model (Purnell)
c. Health Traditions Model (R. Specter)
d. Cultural Assessment Model (Campinha Bacote)
e. Cultural Diversity in Health & Illness Model (Rachel Specter)
f. Ethical decision making (Dula Pacquiao)
g. Transcultural nursing model (Davidhizar & Giger)

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PRELIMINARIES - COURSE DETAILS

Subject: NCM 120: Decent Work Employment and Transcultural Nursing

Units: 3 No. of Class Hours: 3/wk Section: __ Year
Level: Four Course: BSNursing
Subject Teacher: __________________ Contact Number:
___________
Schedule/Consultation hours: ________________________

Course Description:

It focuses on the theory and concepts in transcultural nursing and the role of
culture in understanding and caring for diverse clients in health care settings. It
provides an overview of the influence of culture on health care practices and in the
delivery of nursing care for individuals, groups and communities. This course is
designed to assist nursing students in learning about culture, belief systems, values,
and practices that are specific to identified cultures in order to better understand
and provide nursing care that is both culturally competent and culturally sensitive in
nature.

Course Outcomes:

At the end of the course, the students will be able to:

1. Discuss the nature and conditions of employment in the Philippines.

2. Have a broader understanding of the Labor Code and Magna Carta for Public
Health Workers in the Philippines.
3. Apply the theories, concepts and principles of Transcultural Nursing
4. Appreciate the theoretical models of Transcultural Nursing and cultural
values affecting nursing practice.

Methodology of Implementation:

This is a distance learning strategy wherein the students will be provided with a
copy of the Instructional Learning Guide (ILG) or be enrolled in the Learning
Management System (LMS) to acquire the necessary knowledge skills, and attitude
offered by the course. This is in response to the new mode of delivering instruction
without requiring the students to report to school.

The teacher shall conduct an orientation to the students via online platforms or text
message regarding the utilization of this material for them to be guided throughout
the duration of the course.

Topics shall be assigned based on the syllabus of the subject. Specific instructions
on how complete the activities per chapter will be given to the students. Activities

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are given at pre-determined time to be completed by the students. At the
completion of each topic, students are required to take the evaluative examinations
which shall be given by the teacher based on the intended learning outcomes.

During the duration of the course, students can consult their teachers at a specified
time to address their difficulties or challenges they may encounter along the way.

The subjects are structured in sequential order. Course materials and references
shall be provided by the teacher in advance to facilitate teaching and learning
process.

Delivery Mode:
1. Hard copy of the Instructional Learning Guide (Offline)
2. Learning Management System (Online)
3. Audio / video materials
4. Downloaded links

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 PRELIM COVERAGE

Specific Instructions in the completion of each Chapter:

1. Set your learning goals. Read and understand the Intended Learning
Outcomes of each chapter. This shall serve as your checklist of acquired
knowledge and skills after completing the entire chapter, likewise, the basis
of the teacher in the formulation of the summative evaluation given at the
end of each chapter.
2. Lecture notes are provided for you. BE SURE NOT TO SKIP the lecture. Read
and understand before answering the activities. You can take note those
concepts that are not clear to you and refer to your subject teacher during
the specified consultation hours.
3. Read the teacher’s insight and open video links provided to supplement the
lecture notes.
4. As you go on, you will encounter exercises that will test your knowledge and
understanding as well as your critical thinking.
5. Compile your outputs in your Learning Portfolio to be submitted on the date
set by your teacher.
6. Should you have any queries or clarifications with the topics, please contact
your subject teacher during consultation hours (please refer to the
preliminaries of this material).

CHAPTER 1
DECENT WORK EMPLOYMENT
Duration: 9 hours

Intended Learning Outcomes:

At the end of the lesson, students will be able to:

1. Define and give description about decent work.

2. Discuss the four objectives of International Labor Organization.
3. Discuss and cite examples of the different types of employment in the
Philippines.
4. Identify the salient provisions of the Labor Code in the Philippines.
5. Identify the benefits and roles of Public Health Workers in the Philippines.

Let’s Begin!

Decent Work – is employment that respects the fundamental rights of the human
person as well as the rights of workers in terms of conditions of work safety and
remuneration, respect for the physical and mental integrity of the worker in the
exercise of his/her employment.

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According to the International Labor Organization (ILO), decent work involves
opportunities for work that are productive and deliver a fair income, security in the
workplace and social protection for families, better prospects for personal
development and social integration, freedom for people to express their concerns,
organize and participate in the decisions that affect their lives and equality of
opportunity and treatment for all women and men.

Four objectives of ILO’s Decent Work Agenda

1. To create jobs
 The first and foremost objective requires an economy that is capable of
generating investment opportunities, gives impetus to
entrepreneurship, promotes skills development and provides
sustainable livelihoods.
2. To provide guarantee in worker’s rights and rights at work
 This is for the workers to be able to get recognition and respect at
work. It is particularly important that workers who belong to the poor
or disadvantaged category are able to represent, participate and
practice good laws which are in favor of their interests and not against
them.
3. To extend social protection to workers of all categories
 All workers (men and women) are able to enjoy safe working conditions
and are allowed to take rest and get free time by promoting Decent
Work: Concept, Theory and Measurement productivity and inclusion in
the work ethics. Equally important is to take into consideration the
family and social values of the workers and have a mechanism that
provides adequate compensation to a worker whenever there is a loss
or reduction in income and lack to access to adequate health care.
4. To help workers in resolutions of conflict and promotion of social dialogue.
 Social dialogue between workers and employer’s organization helps in
increasing productivity and sense of belonging towards workplace and
may even help in identifying mutual problems beforehand and thus
avoids disputes at work. It further helps in building societies which are
cohesive and intact.
Nature and Conditions of Employment
 Types of Employment in the Philippines
1. Regular or permanent employment
 When an employee performs activities that are usually necessary or
desirable in the usual business or trade of the employer. They enjoy
the benefit of security of tenure provided by the Philippine Constitution
and cannot be terminated for causes other than those provided by law
and only after due process is given to them.

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  Under Article 281 of the Labor Code of the Philippines, the maximum
length of probationary employment shall be 6 months, and is counted
from the date an employee started working.
2. Term or Fixed Employment
 It is when the employee renders service for a definite period of time
and the employment contract must be terminated after such period
expires.
3. Project Employment
 Employee is hired for a specific project or undertaking and the
employment duration is specified by the scope of work and or length of
the project. A project employee may acquire the status of a regular
employee when they are continuously rehired after the completion of
the project or when tasks, they perform are vital, necessary and
indispensable to the usual business or trade of the employer.

4. Seasonal Employment
 When the work to be performed is only for a certain time or season of
the year and the employment is only for that duration. This type is
common to Retail, Food, and Beverage, Hospitality and other related
industries as augmentation to their workforce to cover for the demand
during peak season.
5. Casual employment
 When an employee performs work that is not usually necessary or
primarily related to the employer’s business or trade. The definite
period of employment should be made known to the employee at the
time they started rendering service.

Nature of Employment for Nurses

There are many different fields a nurse can enter. In each, nurses encounter
certain environments, patients and challenges.
1. Hospital
Nurses working in a hospital oversee patient care, administer treatment and
operate medical equipment. Efforts are being made to improve hospital working
environments to better serve patients.
2. Emergency Room
The emergency room environment is fast-paced and highly stressful. ER nurses
frequently encounter patients in critical condition, and they might be expected to
work in ambulances from time to time. Both physical and mental demands on
nurses are higher in the ER than in the general hospital.
3. Surgical
A surgical nurse might be responsible for ensuring that tools are sterilized,
managing the environment of the operating room, assisting surgeons, performing
life-saving actions or managing operating room staff and performing other
administrative functions.
4. Geriatric
A nurse working in a nursing home or geriatric wing of a hospital deals primarily
with the elderly. Responsibilities are likely to include organizing medications,10
managing chronic conditions or assessing a patient’s mental status or cognitive
skills.
5. Private Practice
Labor Code: PD 442 of 1974

 Is there any law prohibiting discrimination or harassment in employment? If

so, what categories are regulated under the law?
 The Labor Code prohibits discrimination against women on account of their
gender, and against children on account of their age.
 The Magna Carta of Women (Republic Act No. 9710, as amended) prohibits
discrimination against women and expressly imposes liability for damages
on the person directly responsible for such discrimination.
 The Anti-Age Discrimination in Employment Act (Republic Act No. 10911)
prohibits discrimination on account of age, and imposes penalties for
violation of the Act.
 The Magna Carta for Persons with Disability (Republic Act No. 7277, as
amended) provides that a qualified employee with disability shall be
subject to the same terms and conditions of employment as a qualified
able-bodied person.
 The Solo Parents’ Welfare Act (Republic Act No. 8972) prohibits an
employer from discriminating against any solo parent employee with
respect to the terms and conditions of employment on account of the
employee being a solo parent.
 The Indigenous Peoples’ Rights Act (Republic Act No. 8371) prohibits
discrimination against Indigenous Cultural Communities or Indigenous
Peoples with respect to recruitment and conditions of employment on
account of their descent.
 The Anti-Sexual Harassment Act (Republic Act No. 7877) prohibits sexual
harassment in the workplace.
 The Mental Health Act (Republic Act No. 11036) requires employers to
develop appropriate policies and programmes on mental health in the
workplace designed to, among others, raise awareness on mental health
issues, correct the stigma and discrimination associated with mental health
conditions, identify and provide support for individuals at risk and facilitate
access of individuals with mental health conditions to treatment and
psychosocial support.
 The Philippine HIV and AIDS Policy Act (Republic Act No. 11166) also 11
prohibits the rejection of job application, termination of employment, or
other discriminatory policies in hiring, provision of employment and other
related benefits, promotion or assignment of an individual solely or partially
Worker representation
Legal basis
 Is there any legislation mandating or allowing the establishment of
employees’ representatives in the workplace?
 The Labor Code provides for and regulates the creation of legitimate labor
organizations, or unions or associations of employees in the private sector
that exist in whole or in part for the purpose of collective bargaining,
mutual aid, interest, cooperation, protection or other lawful purposes. In
particular, unions are organized for collective bargaining as well as other
legitimate purposes, while workers’ associations are organized for mutual
aid and protection or any legitimate purpose other than collective
bargaining.
 The Labor Code also provides that employees may form labor-
management councils to allow employees to participate in policy and
decision-making processes of the establishment where they are employed,
insofar as said processes will directly affect their rights, benefits and
welfare, except those that are covered by collective bargaining
agreements (CBAs) or are traditional areas of bargaining.
Medical examinations
 Are there any restrictions or prohibitions against requiring a medical
examination as a condition of employment?
 the Philippine HIV and AIDS Policy Act prohibits the rejection of a job
application solely or partially on the basis of actual, perceived, or
suspected HIV status. Access to personal data relating to an employee’s
hepatitis B status is bound by the rules of confidentiality and is strictly
limited to medical personnel or if legally required (DOLE Department
Advisory No. 05-10).
 In addition to the foregoing, medical examination results should not be
used to deny employment when the denial of employment would
constitute discrimination under the laws mentioned in question 2. For
example, discrimination under the Magna Carta for Persons with Disability
includes using qualification standards, employment tests or other
selection criteria that screen out or tend to screen out a disabled person
unless such standards, tests or other selection criteria are shown to be
job-related for the position in question and are consistent with business
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necessity.
Drug and alcohol testing
 Are there any restrictions or prohibitions against drug and alcohol testing
of applicants?
  Generally, the law does not require an employment contract to be reduced
into writing, but specific laws may require the same. For example, the
Domestic Workers Act (Republic Act No. 10361) requires an employment
contract to be executed between the domestic worker and the employer in
a language or dialect understood by both the domestic worker and the
employer. The contract must include the duties and responsibilities of the
domestic worker, the period of employment, the agreed compensation and
authorized deductions, among others.
 The Rules and Regulations Implementing the Act Providing for the
Elimination of the Worst Forms of Child Labour (DOLE Department Order
No. 065-04) also provides that, when the employer is in public
entertainment or information, they shall submit to the DOLE regional office
a written employment contract concluded between the employer and the
child’s parents or guardian, and approved by the Department. Under DOLE
Department Order No. 174-17, the employment contracts of employees of
a contractor or subcontractor involved in job contracting are required to
include the following stipulations:
Probationary period
 What is the maximum probationary period permitted by law?
 The Labor Code provides that probationary employment shall not exceed
six months from the date the employee started working unless it is
covered by an apprenticeship agreement stipulating a longer period.
However, the Philippine Supreme Court has held that the probationary
employee may voluntarily agree to an extension if it would afford the
employee another chance to pass the standards for regularisation after
having initially failed the probationary period.

Terms of employment (Labor Code: PD 442 of 1974)

1. Working hours (Art. 83)

 Are there any restrictions or limitations on working hours and may an
employee opt out of such restrictions or limitations?
The Labor Code and its implementing rules prescribe eight hours a day, as normal
hours of work, for rank-and-file employees. Work performed beyond the normal
hours entitles the employee to receive overtime pay.
Employees who render services between 10pm and 6am are also entitled to a night
shift differential. Employees are entitled to a rest day of not less than 24
consecutive hours after every six consecutive work days. In emergency cases,
employees may be required to render work on a rest day.

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Special restrictions are imposed on minors who are allowed to work. Minors below
15 years of age may be allowed to work for not more than four hours a day, and not
more than 20 hours a week. They are not allowed to work between 8pm and 6am
the following morning. Minors aged 15 or over but below 18 may work for not more
than eight hours a day, and not more than 40 hours a week. They cannot work
between 10pm and 6am the following morning.
2. Meal Periods (Art 85)

It shall be the duty of every employer to give his employees not less than 60
minutes time-off for their regular meals.

3. Overtime pay
 What categories of workers are entitled to overtime pay and how is it
calculated?
All rank-and-file employees in the private sector, except domestic workers, workers
paid by results and non-agricultural field personnel, are entitled to overtime pay.
Overtime work performed on an ordinary working day entitles employees to an
additional 25 per cent of the hourly rate for that day, which shall increase to 30 per
cent if the work is performed on a holiday, special day or rest day.
 Can employees contractually waive the right to overtime pay?
Generally, overtime pay cannot be waived, and overtime work cannot be offset by
undertime work. However, both the DOLE and the Philippine Supreme Court have
allowed companies to employ a ‘compressed workweek scheme’, where the normal
working week is reduced to less than six days but the total number of work hours
remains at 48 hours per week (or 40 hours per week for firms whose normal
working week is five days). Under a compressed workweek scheme, work beyond
eight hours will not be compensable by the overtime premium provided the total
number of hours worked per day shall not exceed 12 hours (in a 48-hour working
week) or 10 hours (in a 40-hour working week). Employers may implement a
compressed workweek scheme only with the express and voluntary agreement of a
majority of the covered employees and prior notice to the DOLE of the adoption of
the scheme.
4. Vacation and holidays
 Is there any legislation establishing the right to annual vacation and holidays?
Under the Labor Code, rank-and-file employees who have rendered at least 12
months of service, whether continuous or broken, are entitled to a yearly service
incentive leave of at least five days with pay, unless the employee already enjoys
vacation leave with pay of at least five days. The service incentive leave may be
used for vacation or sick leave. Unused service incentive leave is convertible to
cash.
The Administrative Code of 1987 provides for the special and regular holidays in the
Philippines. The president also declares the regular and special holidays through
Presidential Proclamations issued annually. Under the Labor Code, employees who
work during holidays are entitled to additional pay, the amount of which depends on
whether such day is a regular holiday or a special non-working day.

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 5. Sick leave and sick pay
 Is there any legislation establishing the right to sick leave or sick pay?
Philippine law does not require employees to grant sick leave or sick pay. The
minimum required by the law is the service incentive leave, which the employee
may avail of in case of sickness. However, employers are not barred from providing
more favourable benefits such as sick leave on top of those mandated by law.
Under the Labor Code and the Social Security Law (Republic Act No. 11199),
employees are entitled to sickness benefits if they have been confined for more
than three days in a hospital or elsewhere owing to sickness or injury with the
approval of the Social Security System. The Social Security Law likewise grants
benefits in the case of permanent or temporary total disability or permanent partial
disability.
6. Leave of absence
 In what circumstances may an employee take a leave of absence? What is
the maximum duration of such leave and does an employee receive pay
during the leave?
The law does not provide for the circumstances when an employee may take a
leave of absence. The company may, however, introduce reasonable policies to
govern leave of absence. The mandated service incentive leave may also be used
for this purpose.
7. Mandatory employee benefits
 What employee benefits are prescribed by law?
In addition to prescribed hours of work, holiday pay, overtime pay, premium pay,
night shift differential and service incentive leave, employees, when applicable, are
entitled to maternity leave, paternity leave, parental leave for solo parents,
adoption leave, leave for victims of violence against women and their children,
special leave for women who undergo gynaecological surgery, 13th month pay,
retirement pay and benefits, separation pay, benefits under the Employees’
Compensation Program, health insurance benefits, social security benefits and
housing benefits.

I. The Magna Carta of Public Health Workers (Republic Act 7305)

 Approved: March 26, 1992.

 This act aims to promote and improve the social and economic well-being of
the health workers, their living and working conditions and terms of
employment; to develop their skills and capabilities in order that they will be
more responsive and better equipped to deliver health projects and
programs; and to encourage those with proper qualifications and excellent
abilities to join and remain in government service.
 For purposes of this Act, "health workers" shall mean all persons who are
engaged in health and health-related work.
 Recruitment and Qualification: shall be developed and implemented by
the appropriate government agencies concerned in accordance with policies
and standards of the Civil Service Commission: Provided, That in the absence
of appropriate eligibles and it becomes necessary in the public interest to fill

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 a vacancy, a temporary appointment shall be issued to the person who meets
all the requirements for the position to which he/she is being appointed
except the appropriate civil service eligibility: Provided, further, That such
temporary appointment shall not exceed twelve (12) months nor be less than
three (3) months renewal thereafter but that the appointee may be replaced
sooner if (a) qualified civil service eligible becomes available, or (b) the
appointee is found wanting in performance or conduct befitting a government
employee.
 Performance Evaluation and Merit Promotion. - The Secretary of Health,
upon consultation with the proper government agency concerned and the
Management-Health Workers’ Consultative Councils, as established under
Section 33 of this Act, shall prepare a uniform career and personnel
development plan applicable to all public health personnel. Such career and
personnel development plan shall include provisions on merit promotion,
performance evaluation, inservice training grants, job rotation, suggestions
and incentive award system. The performance evaluation plan shall consider
foremost the improvement of individual employee efficiency and
organizational effectiveness: Provided, That each employee shall be informed
regularly by his/her supervisor of his/her performance evaluation. The merit
promotion plan shall be in consonance with the rules of the Civil Service
Commission.
 Transfer or Geographical Reassignment of Public health Workers:
Transfer is a movement from one position to another which is of equivalent
rank, level or salary without break in service; a public health worker shall not
be transferred and or reassigned, except when made in the interest of public
service, in which case, the employee concerned shall be informed of the
reasons therefore in writing. If the public health worker believes that there is
no justification for the transfer and/or reassignment, he/she may appeal
his/her case to the Civil Service Commission, which shall cause his/her
reassignment to be held in abeyance; Provided, That no transfer and/or
reassignment whatsoever shall be made three (3) months before any local or
national elections: Provided, further, That the necessary expenses of the
transfer and/or reassignment of the public health worker and his/her
immediate family shall be paid for the Government.
 Married Public Health Workers. - Whenever possible, the proper
authorities shall take steps to enable married couples, both of whom are
public health workers, to be employed or assigned in the same municipality,
but not in the same office.
 Security of Tenure. - In case of regular employment of public health
workers, their services shall not be terminated except for cause provided by
law and after due process: Provided, That if a public health workers is found
by the Civil Service Commission to be unjustly dismissed from work, he/she
shall be entitled to reinstatement without loss of seniority rights and to
his/her back wages with twelve percent (12%) interest computed from the
time his/her compensation was withheld from his/her up to time of
reinstatement.
 Discrimination Prohibited. - A public worker shall not be discriminated
against with regard to gender, civil status, civil status, creed, religious or
political beliefs and ethnic groupings in the exercise of his/her profession.

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 No Understaffing/Overloading of Health Staff. - There shall be no
understaffing or overloading of public health workers. The ratio of health staff
to patient load shall be such as to reasonably effect a sustained delivery of
quality health care at all times without overworking the public health worker
and over extending his/her duty and service. Health students and apprentices
shall be allowed only for purposes of training and education.
 Administration Charges. - Administrative charges against a public health
worker shall be heard by a committee composed of the provincial health
officer of the province where the public health worker belongs, as
chairperson, a representative of any existing national or provincial public
health workers’ organization or in its absence its local counterfeit and a
supervisor of the district, the last two (2) to be designated by the provincial
health officer mentioned above. The committee shall submit its findings and
recommendations to the Secretary of Health within thirty (30) days from the
termination of the hearings. Where the provincial health officer is an
interested party, all the members of the committee shall be appointed by the
Secretary of Health.
 Safeguards in Disciplinary Procedures - In every disciplinary proceeding,
the public health worker shall have;
(a) the right to be informed, in writing, of the charges;
(b) the right to full access to the evidence in the case;
(c) the right to defend himself/herself and to be defended by a representative of
his/her choice and/or by his/her organization, adequate time being given to
the public health worker for the preparation of his/her defense;
(d) the right to confront witnesses presented against him/her and summon
witnesses in his/her behalf;
(e) the right to appeal to designated authorities;
(f) the right to reimbursement of reasonable expenses incurred in his/her
defense in case of exoneration or dismissal of the charges; and
(g) such other rights as will ensure fairness and impartiality during proceedings.

 Duties and Obligations. - The public health workers shall:

(a) discharge his/her duty humanely wit conscience and dignity;

(a) perform his/her duty with utmost respect for life; and race, gender,
religion, nationality, party policies, social standing or capacity to pay.

 Code of Conduct. - Within six (6) months from the approval of this Act, the
Secretary of Health, upon consultation with other appropriate agencies,
professional and health workers’ organization, shall formulate and prepare a
Code of Conduct for Public Health Workers, which shall be disseminated as
widely as possible.
 Normal Hours of Work. - The normal of wok of any public health worker
shall not exceed eight (8) hours a day or forty (40) hours a week.
Hours worked shall include:
(a) all the time during which a public health worker is required to be on active
duty or to be at a prescribed workplace; and
(b) all the time during which a public health worker is suffered or permitted to
work. Provided, That the time when the public health worker is place on "On
Call" status shall not be considered as hours worked but shall entitled the

17
 public health worker to an "On Call" pay equivalent to fifty percent (50%) of
his/her regular wage. "On Call" status refers to a condition when public health
workers are called upon to respond to urgent or immediate need for
health/medical assistance or relief work during emergencies such that he/she
cannot devote the time for his/her own use.
 Overtime Work. - Where the exigencies of the service so require, any public
health worker may be required to render, service beyond the normal eight (8)
hours a day. In such a case, the workers shall be paid an additional
compensation in accordance with existing laws and prevailing practices.
 Work During Rest Day. Where a public health worker is made to work on
his/her schedule rest day, he/she shall be paid an additional compensation in
accordance with existing laws; and where a public health worker is made to
worm on any special holiday he/she shall be paid an additional compensation
in accordance with existing laws. Where such holiday work falls on the
workers’ scheduled rest day, he/she shall be entitled to an additional
compensation as may be provided by existing laws.
 Night-Shift Differential. - ten percent (10%) of his/her regular wage for
each hour of work performed during the night-shifts customarily adopted by
hospitals; every health worker required to work on the period covered after
his/her regular schedule shall be entitled to his/her regular wage plus the
regular overtime rate and an additional amount of ten percent (10%) of such
overtime rate for each hour of work performed between ten (10) o’clock in
the evening to six (6) o’clock in the morning.
 Salaries. - In the determination of the salary scale of public health workers,
the provisions of Republic Act No. 6758 shall govern, except that the
benchmark for Rural Health Physicians shall be upgraded to Grade 24.
 Deductions Prohibited - No person shall make any deduction
whatsoever from the salaries or public health workers except under
specific provision of law authorizing such deductions
 Additional Compensation. - Notwithstanding Section 12 of Republic Act No.
6758, public workers shall received the following allowances: hazard
allowance, subsistence allowance, longevity pay, laundry allowance and
remote assignment allowance.
 Hazard Allowance. - at least twenty-five percent (25%) of the
monthly basic salary of health workers receiving salary grade 19 and
below, and five percent (5%) for health workers with salary grade 20
and above.
 Subsistence Allowance. - Public health workers who are required to
render service within the premises of hospitals, sanitaria, health
infirmaries, main health centers, rural health units and barangay
health stations, or clinics, and other health-related establishments in
order to make their services available at any and all times, shall be
entitled to full subsistence allowance of three (3) meals which may be
computed in accordance with prevailing circumstances as determined
by the Secretary of Health in consultation with the Management Health
Workers’ Consultative Councils, as established under Section 33 of this
Act: Provided, That representation and travel allowance shall be given
to rural health physicians as enjoyed by municipal agriculturists,
municipal planning and development officers and budget officers.

18
 Longevity Pay. - A monthly longevity pay equivalent to five percent
(5%) of the monthly basic pay shall be paid to a health worker for
every five (5) years of continuous, efficient and meritorious services
rendered as certified by the chief of office concerned commencing with
the service after the approval of this Act.
 Laundry Allowance. - All public health workers who are required to
wear uniforms regularly shall be entitled to laundry allowance
equivalent to one hundred twenty-five pesos (P125.00) per month:
Provided, That this rate shall be reviewed periodically and increased
accordingly by the Secretary of Health in consultation with the
appropriate government agencies concerned taking into account
existing laws and prevailing practices.
 Remote Assignment Allowance. - Doctors, dentists, nurses, and
midwives who accept assignments as such in remote areas or isolated
stations, which for reasons of far distance or hard accessibility such
positions had not been filed for the last two (2) years prior to the
approval of this Act, shall be entitled to an incentive bonus in the form
of remote assignment allowance equivalent to fifty percent (50%) of
their basic pay, and shall be entitled to reimbursement of the cost of
reasonable transportation to and from and during official trips.
 Housing. - All public health workers who are in tour of duty and those
who, because of unavoidable circumstances are forces to stay in the
hospital, sanitaria or health infirmary premises, shall entitles to free
living quarters within the hospital, sanitarium or health infirmary or if
such quarters are not available, shall receive quarters allowance as
may be determined by the Secretary of Health and other appropriate
government agencies concerned: Provided, That this rate shall be
reviewed periodically and increased accordingly by the Secretary of
Health in consultation with the appropriate government agencies
concerned.
 Medical Examination. - Compulsory medical examination shall be
provided free of charge to all public health workers before entering the
service in the Government or its subdivisions and shall be repeated
once a year during the tenure of employment of all public health
workers.
 Compensation of Injuries. - Public health workers shall be protected
against the consequences of employment injuries in accordance with
existing laws. Injuries incurred while doing overtime work shall be
presumed work-connected.
 Leave Benefits for Public Health Workers. - Public health workers
are entitled to such vacation and sick leaves as provided by existing
laws and prevailing practices: Provided, That in addition to the leave
privilege now enjoyed by public health, women health workers are
entitled to such maternity leaves provided by existing laws and
prevailing practices: Provided, further, That upon separation of the
public health workers from services, they shall be entitled to all
accumulated leave credits with pay.
 Highest Basic Salary Upon Retirement - Three (3) prior to the
compulsory retirement, the public health worker shall automatically be
granted one (1) salary range or grade higher than his/her basic salary

19
 and his/her retirement benefits thereafter, computed on the basis of
his/her highest salary: Provided, That he/she has reached the age and
fulfilled service requirements under existing laws.
 Right to Self-Organization. - Public health workers shall have the right to
freely from, join or assist organizations or unions for purposes not contrary to
law in order to defend and protect their mutual interests and to obtain
redness of their grievances through peaceful concerned activities.

 Freedom from Interference or Coercion. - It shall be unlawful for any

person to commit any of the following acts of interference or coercion:

(a) to require as a condition of employment that a public health worker shall not
join a health workers’ organization or union or shall relinquish membership
therein;
(b) to discriminate in regard to hiring or tenure of employment or any item or
condition of employment in order to encourage or discourage membership in
any health workers’ organization or union;
(c) to prevent a health worker from carrying out duties laid upon him/her by
his/her position in the organization or union, or to penalize him/her for the
action undertaken in such capacity;
(d) to harness or interfere with the discharge of the functions of the health
worker when these are calculated to intimidate or to prevent the performance of
his/her duties and responsibilities; and
(e) to otherwise interfere in the establishment, functioning, or administration of
health workers organization or unions through acts designed to place such
organization or union under the control of government authority.

End of Prelim Coverage

Before proceeding to the Midterms Coverage….

 Do not forget to write your reflective journal for this term regarding
your learnings, personal reflections and realizations of the different
concepts given. All written outputs should be compiled in your
learning portfolio to be submitted to the subject teacher as part of
the requirements of the course.

EVALUATION:
1. Individual and group activities.
2. Self-Reflection question at the end of the term.

REQUIREMENTS:
After this module, you are expected to submit the following on the date given by
your instructor:

1. Learning Portfolio composed of:

 A copy of the answer sheet duly accomplished found at the last part of
each term.

20
  Your reflective journal in using the module.
2. Term examinations.

REFERENCES:

1. Berman, A., (2021). Kozier and Erb’s, Fundamentals of Nursing Concepts,

Process and Practice volume 1 + volume 2.
2. Cooper, K. & Gosnell, K. (2019). Adult health nursing (8th edition). USA:
Lippincott Williams and Wilkins.
3. Hinkle, J. & Cheever, K. (2022). Brunner and Suddarth’s textbook of medical
– surgical nursing volume 1 & 2 (14th edition). USA: Wolters Kluwer Health
4. Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2019). Wong's nursing care
of infants and children. St. Louis, MO: Elsevier.
5. Silbert-Flagg, J., & Pillitteri, A. (2023). Maternal & child health nursing : care
of the childbearing & childrearing family. Wolters Kluwer.

MIDTERM COVERAGE

Specific Instructions in the completion of each Chapter:

1. Set your learning goals. Read and understand the Intended Learning
Outcomes of each chapter. This shall serve as your checklist of acquired
knowledge and skills after completing the entire chapter, likewise, the basis
of the teacher in the formulation of the summative evaluation given at the
end of each chapter.
2. Lecture notes are provided for you. BE SURE NOT TO SKIP the lecture. Read
and understand before answering the activities. You can take note those
concepts that are not clear to you and refer to your subject teacher during
the specified consultation hours.
3. Read the teacher’s insight and open video links provided to supplement the
lecture notes.
4. As you go on, you will encounter exercises that will test your knowledge and
understanding as well as your critical thinking.
5. Compile your outputs in your Learning Portfolio to be submitted on the date
set by your teacher.
6. Should you have any queries or clarifications with the topics, please contact
your subject teacher during consultation hours (please refer to the
preliminaries of this material).

CHAPTER II
Cultural Foundations

21
Duration: 9 hours

Intended Learning Outcomes:

At the end of the lesson, students will be able to:

1. Define Culture
2. Explain the characteristics of culture.
3. Identify the important terminologies pertaining to culture.
4. Discuss the cultural phenomena affecting health.
5. Identify the different religions in the world.
6. Identify the cultural beliefs and practices of the different continents (Asia,
Europe, America, Australia, Africa)

Let’s Begin!

Major concepts and definitions

What is Culture?

Culture is one of the most important and basic concepts of sociology. In sociology,
culture has a specific meaning. The anthropologists believe that the behavior, which
is meant, is called culture. In other words the behavior which is transmitted to us by
someone is called culture. The way of living, eating, wearing, singing, dancing and
talking is all parts of a culture.

In common, parlance, the word culture, is understood to mean beautiful, refined or

interesting. In sociology, we use the word culture to denote acquired behavior,
which are shared by and transmitted among the members of the society. In other
words, culture is a system of learned behavior shared by and transmitted among
the members of a group.

Definitions of Culture:

Culture has been defined in various ways by sociologists and anthropologists.

Following are the important definitions of culture.

E.B. Tylor defines "Culture is that complex whole which includes knowledge, belief,
art, morals, Jaw, customs and any other capabilities and habits acquired by man as
a member of society".

Edward Sapir says, "Culture is any socially inherited element of the life of man,
material and spiritual".

Malionwski defines "Culture the handwork of man and conventional understanding

manifest in art and artifact which persisting through which he achieves his ends".

Redfield remarks that "Culture is an organized body of conventional understanding

manifest in art and artifact which persisting through, characterizes a human group".

22
Mac Iver is of the view that "Culture is the expression of our nature in our modes of
living, and our thinking, intercourses in our literature, in religion, in recreation and
enjoyment.

According to E.S. Bogardus "Culture is all the ways of doing and thinking of a
group".

Characteristics of Culture

For a clear understanding of the concept of culture, it is necessary for us to know its
main characteristics. Culture has several characteristics. Following are the main
characteristics of culture.

1. Culture is learnt

Culture is not inherited biologically, but learnt socially by man. It is not

an inborn tendency. There is no culture instinct as such culture is often called
learned ways of behavior. Unlearned behavior such as closing the eyes while
sleeping, the eye blinking reflex and so on are purely physiological and
culture sharing hands or saying ‘namaskar’ or thanks and shaving and
dressing on the other hand are culture. Similarly wearing clothes, combing
the hair, wearing ornaments, cooking the food, drinking from a glass, eating
from a plate or leaf, reading a newspaper, driving a car, enacting a role in
drama, singing, worship etc. are always of behavior learnt by man culturally.

2. Cultural is Social

Culture does not exist in isolation neither it is an individual

phenomenon. It is a product of society. It originates and develops through
social interaction. It is shared by the members of society. No man can acquire
culture without association with other human beings. Man becomes man only
among men. It is the culture, which helps man to develop human qualities in
a human environment. Deprivation is nothing but deprivation of human
qualities.

3. Culture is shared

Culture in the sociological sense, is something shared. It is not

something that an individual alone can possess. For example customs,
tradition, beliefs, ideas, values, morals, etc. are shared by people of a group
or society. The invention of Arya Bhatta or Albert Einstein, Charaka or Charles
Darwin, the literary, works of Kalidas or Keats, Dandi or Dante, the
philosophical works of Cunfucius or Lao Tse, Shankaracharya or Swami
Vivekananda, the artistic work of Kavi Verma or Raphael etc. are all shared
by a large number of people. Culture is something adopted, used, believed
practiced or possessed by more than one person. It depends upon group life
for its existence. (Robert Brerstedt)

4. Culture is Transmissive

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 Culture is capable of being transmitted from one generation to the
next. Parents pass on culture traits to their children and them in turn to their
children arid so on. Culture is transmitted not trough genes but by means of
language. Language is the main vehicle of culture. Language in its different
forms like reading, writing and speaking makes it possible for the present
generation to understand the achievements of earlier generations. But
language itself is a part of culture. Once language is acquired it unfolds to the
individual in wide field. Transmission of culture may take place by intution as
well as by interaction,

5. Culture is Continuous and Cumulative

Culture exists, as a continuous process. In its historical growth, it tends

to become cumulative. Culture is growing completely which includes in itself,
the achievements of the past and present and makes provision for the future
achievements of mankind. Culture may thus be conceived of as a kind of
stream flowing down through the centuries from one generation to another.
Hence, some sociologists like Lition called culture the social heritage of man.
As Robert Brerstedt writes culture or the money of human race. It becomes
difficult for us to imagine what society would be like without this
accumulation of culture what lives would be without it.

6. Culture is Consistent and Interconnected

Culture, in its development has revealed tendency to be consistent. At

the same time, different parts of culture are interconnected. For example, the
value system of a society, a society is closely connected with, its other
aspects such as morality, religion, customs, traditions, beliefs and so on.

7. Culture is Dynamic and Adaptive

Though culture is relatively stable, it is not altogether static. It is

subject to slow but constant change. Change and growth are latent in culture.
We find amazing growth in the present Indian culture when we compare it
with the culture of the Vedic time. Hence, culture is dynamic.

Culture is responsive to the changing conditions of the physical world.

It is adaptive. It also intervenes in the natural environment and helps man in
his process of adjustment. Just as our house
shelters us from the storm, so also does our culture help us from natural
dangers and assist us to survive. Few of us indeed could survive without
culture.

8. Culture is Gratifying

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 Culture provides proper opportunities, and prescribes means for the
satisfaction of our needs and desires. These needs may be biological or social in
nature. Our need for food, shelter and clothing and our desire for status, name,
fame and money etc are all, for example, fulfilled according to the cultural ways.
Culture determines and guides the varied activities of man. In fact culture is
defined as the process through which human beings satisfy their wants.

9. Culture varies from Society to Society

Every society has a culture of its own. It differs from society to society.
Culture of every society in unique to itself. Cultures are not uniform. Cultural
elements such as customs, traditions, morals, ideals, values, ideologies, beliefs
in practices, philosophies institutions, etc. are not uniform everywhere. Ways of
eating, speaking, greeting, dressing, entertaining, living etc. of different sects
differ significantly. Culture varies from time to time also. No culture ever
remains constant or changeless.

10.Culture is Super Organic and Ideational

Culture is sometimes called the super organic. By super organic

Herbert Spencer meant that culture is neither organic nor inorganic in nature
but above these two. The term implies the social meaning of physical
objectives and physiological acts. The social meaning may be independent of
physiological and physical properties and characteristics. For example, the
social meaning of a national flag is not just a piece of colored cloth. The flag
represents a nation. Similarly, priests and prisoners, professors and
profanation, players, engineers and doctors, farmers and soldiers and others
are not just biological beings. They are viewed in their society differently.
Their social status and role can be understood only through culture.

Other terminologies:

1. Cultural Identify - The sense of being part of an ethnic group or culture

2. Culture-universals - Commonalities of values, norms of behavior, and life
patterns that are similar among different cultures.
3. Culture-specifies - Values, beliefs, and patterns of behavior that tend to be
unique to a designate culture.
4. Material culture - refers to objects (dress, art, religious arti1acts)
5. Non-material culture - refers to beliefs customs, languages, social
institutions.
6. Subculture - Composed of people who have a distinct identity but are
related to a larger cultural group
7. Bicultural - A person who crosses two cultures, lifestyles, and sets of values.
8. Diversity - refers to the fact or state of being different. Diversity can occur
between cultures and within a cultural group.
9. Religion – the belief in a divine or superhuman power to be obeyed and
worshipped as the creator and ruler of the earth.
10.Ethnic – social group within a cultural and social system that claims or is
accorded special status on the basis of complex, often variable traits
including religious, linguistic, ancestral, or physical characteristics.

25
11.Ethnicity – the condition of belonging to a particular ethnic group
12.Race – Classification of people based on physical or biological characteristics.
13.Socialization – the process of being raised within a culture and acquiring the
characteristics of that group. Education (Elementary school, high school,
college or a given health care provider program) is a form of socialization.
14.Acculturation – the process of learning the beliefs and behaviors of a
dominant culture and assuming some of the characteristics.
 While becoming a competent participant in the dominant culture, a
member of the non-dominant culture is always identified as a member
of the original culture.
 The process of acculturation is involuntary in nature, and the member
of the minority group is forced to learn the new culture to survive.
Individuals experienced second-cuture acquisition when they must live
within or between cultures.
 Acculturation also refers to cultural or behavioral assimilation and may
be defined as the changes of one’s cultural patterns to those of the
host society. In the US, people assume that usual course of
acculturation takes three generations; hence the adult grandchild of an
immigrant is considered fully americanized.
15. Cultural shock - the state of being disoriented or unable to respond
to a different cultural environment because of its sudden strangeness,
unfamiliarity, and incompatibility to the stranger's perceptions and
expectations at is differentiated from others by symbolic markers (cultures,
biolo gy, territory, religion).
16.Assimilation – the process by which an individual develops a new cultural
identity.
 Assimilation means becoming in all ways like the members of the
dominant culture. The process of assimilation encompasses various
aspects, such as cultural or behavioral, marital, identification, and
civic. The underlying assumption is that the person from a given
cultural group loses this cultural identity to acquire the new one. In
fact, this is not always possible, and the process may cause stress and
anxiety
 Four forms of assimilation:
a. Cultural – ability to speak excellent American English
b. Marital – occurs when members of one group intermarry with members
of another group.
c. Primary structural – the relationships between people are warm,
personal interactions between group members in the home, the
church, and social groups.
d. Secondary structural – there is nondiscriminatory sharing, often of a
cold impersonal nature, between different groups in settings such as
schools and workplaces.
 The concepts of socialization, assimilation, and acculturation are complex and
sensitive. The dominant society expects that all group of immigrants are in
the process of acculturation and assimilation and that the worldview that we
share as health care practitioners is commonly shared by our patients.
Because we live in pluralistic society, however, many variations of health
beliefs and practices exist.

26
 17.Sensitivity – the ability to recognize and appreciate the personal
characteristics of others.
18.Bias – a preference that inhibits impartial judgment of others.
19.Prejudice – a strong feeling or belief about a person or subject that is formed
without reviewing facts or information.
20.Stereotyping – process of assuming that everyone in a particular group is
the same.

Cultural Phenomena Affecting Health

1. Environmental Control
 The ability of members of a particular cultural group to plan activities that
control nature or direct environmental factors. Included in this concept are
the complex systems of traditional health and illness beliefs, the practice of
folk medicine, and the use of traditional healers. This particular cultural
phenomenon plays an extremely important role in the way patients respond
to health-related experiences, including the ways in which they define health
and illness and seek and use health care resources and social supports.
2. Biological Variations
 The several ways in which people from one cultural group differ biologically
from members of other cultural groups constitute their biological variations.
Examples:
a. Body build and structure, including specific bone and structural
differences between groups, such as smaller stature of Asians.
b. Skin color, including variations in tone, texture, healing abilities, and
hair follicles.
c. Enzymatic and genetic variations, including differences in response to
drug and dietary therapies.
d. Susceptibility to disease, which can manifest itself as a higher
morbidity rate of certain diseases with certain groups.
e. Nutritional variations – “hot and cold” preferences among Hispanic
Americans. The yin and yang preferences found among Asian
Americans, and the rules of the Kosher diet found among Jewish and
Islamic Americans. A relatively common nutritional disorder, lactose
intolerance, is found among Mexican, African, Asian, and Eastern
European Jewish Americans.

3. Social Organization
 The social environment in which people grow up and live plays an essential
role in their cultural development and identification.

27
  Children learn their cultural responses to life events from the family and its
ethnoreligious group.
 This socialization process is an inherent part of heritage
 It refers to the family unit (nuclear, extended, single parent), and the social
group organization (religious or ethnic) with which patients and families may
identify.
 Countless social barriers, such as unemployment, underemployment,
homelessness, lack of health insurance, and poverty, can also prevent people
from entering the health care system.
4. Communication
 Communication differences present themselves in many ways, including
language differences, verbal and non-verbal behaviors, and silence.
 Language differences are possibly the most important obstacle to providing
multicultural health care because they affect all stages of the patient-
caregiver relationship.
 Clear and effective communication is important when dealing with any
patient, especially if language differences create a cultural barrier. When
deprived of the most common medium of interaction with patients- the
spoken word - health care providers often become frustrated and ineffective.
Accurate diagnosis and treatment is impossible if the health care professional
cannot understand the patient. When the provider is not understood, he or
she often avoids verbal communication, which is all to often the painful
isolation of patients who do not speak the dominant language and who are in
an unfamiliar environment. Consequently, patients experience cultural shock
and may react by withdrawing, becoming hostile, or being uncooperative.
5. Space
 Refers to people’s behaviors and attitudes toward the space around
themselves.
 Territoriality is the term for the behavior and attitude people exhibit about an
area they have claimed and defend or react emotionally when others
encroach on it. Both personal space and territoriality are influenced by
culture, and thus different ethnocultural groups have varying norms related
to the use of space
 Space and related behaviors have different meanings in the following zones:
a. Intimate zones – extends up to 1.5 feet. Because this distance allows
adults to have the most bodily contact for perception of breath and
odor, incursion into this zone is acceptable only in private places.
Visual distortions also occur at this distance.
b. Personal distance – extends from 1.5 to 4 feet. This is an extension of
the self that is likely having a “bubble” of space surrounding the body.
At this distance, the voice may be moderate, body odor may not be
apparent, and visual distortion may have disappeared.

28
 c. Social distance – extends from 4 feet to 12 feet. This is reserved for
impersonal business transactions. Perceptual information is much less
detailed.
d. Public distance – extends 12 feet or more. Individuals interact only
impersonally. Communicator’s voices must be projected and subtle
facial expressions may be lost.
It must be noted that these generalizations about the use of personal space
are based on the behaviors of European North Americans. Use of personal
space varies among individuals and ethnic groups. The extreme modesty
practiced by members of some cultural groups may prevent members from
seeking preventive health care.

6. Time Orientation
 The viewing of time in the present, past, or future varies among cultural
groups.
 Most cultures include all three-time orientations, but one orientation is more
likely to dominate.
 Certain cultures in the United States and Canada tend to be future-oriented.
People who are future-oriented are concerned with long range goals and with
health care measures in the present to prevent occurrence of illness in the
future. They prefer to plan by making schedules, setting appointments, and
organizing activities. Others are oriented more to the present than the future
and may be late for appointments because they are less concerned about
planning to be on time.
 The European-American focus on time tends to be directed to the future,
emphasizing time and schedules. European Americans often plan for next
week, their vacation, or retirement. Other cultures may have a different
concept of time. Example, the Navajo Indians are present and past oriented,
and do not have a word for “late”. A Navajo mother may view her child’s
development differently from European Americans, and might not measure
her child’s milestones, such as toileting and walking by the same targeted
schedule as other cultures. African Americans are often generalized as
present oriented as well, with a focus on current health status, rather than
the anticipation of what may happen in the future. Socio economic status
may also influence time orientation. The middle class is generally future
oriented however, lower socioeconomic classes are generally present
oriented because of the focus on daily survival, which may not allow for the
luxury of being able to plan for the future.
 The culture of nursing and health care values punctuality and is future
oriented. Appointments are scheduled

Selected Examples of Etiquette as Related to Selected Cultural Phenomena

TIME Visiting Inform person when you are coming
Being on Avoid surprises
time Explain your expectations about time
Taboo times Ask people from other regions and cultures

29
 what they expect.
Be familiar with the times and meanings of
person’s ethnic and religious holidays.
SPACE Body Know cultural and/or religious customs
language regarding contact such as eye and touch from
and many perspectives
distances
COMMUNICATIO Greetings Know the proper forms of address for people
N from a given culture and the ways by which
people welcome one another. Know when touch,
such as embrace or handshake, is expected and
when physical contact is prohibited.
Gestures Gestures do not have universal meaning; what
is acceptable to one cultural group is taboo with
another.
Smiling Smiles may be indicative of friendliness to
some, taboo to others.
Eye contact Avoiding eye contact may be a sign of respect
SOCIAL Holidays Know what dates are important and why.
INVESTIGATION Whether or not to give gifts, what to wear to
special events, what the customs and beliefs
are.
Special Know how the event is celebrated, meaning of
events colors, used for gifts, expected rituals at home
or religious services.
Births
Weddings
Funerals
BIOLOGICAL Food Know what can be eaten for certain events,
VARIATIONS customs what foods may be eaten together, what and
how utensils are used.
ENVIRONMENTA Health Know what the general health traditions are for
L CONTROL practices a given person and question observations for
and validity with the health care providers and
remedies system.

Religion – organized system of beliefs, by followers, ceremonies, practices and

worship that are

Asian Religions:

1. Christianity – Philippines
2. Islam – Middle East Asia
3. Hinduism – India
4. Buddhism – throughout Asia
5. Judaism - Israel
6. Taoism - China
7. Shamanism – Thailand
8. Shinto – Japan

30
What Religions Have in Common

Deity or
Sacred
Religion Supreme Golden Rule Pilgrimage
Writings
Being

Baha'i (5-7 Monotheisti Writings of Blessed is he Holy places in

million) c God the Báb who Iraq and Iran
and preferreth
Bahá'u'lláh his brother
before
himself.

Buddhism No Tripitaka Hurt not Bodh Gaya in

(520 million) supreme and The others in India
being, the Sutras ways that
path of the you yourself
Buddha, would find
Siddhartha hurtful.
Gautama is
followed to
reach
nirvana

Christianity God The Bible Do unto The Holy Land

(2,420 other as you
million) would have
them do unto
you

Confucism (6 No Four Books What you do Mount Tai, a holy

million) supreme not wish for mountain in
being but yourself, do China
Confucius is not do to
honored. others.

Hinduism Shiva The Vedas Treat others Sacred sites in

(1,150 as you treat India
million) yourself

31
 Deity or
Sacred
Religion Supreme Golden Rule Pilgrimage
Writings
Being

Islam (1,800 Allah The Quran That which Mecca

million) you want for
yourself,
seek for
mankind

Jainism (4 Arihant and The Treat all Shatrunjaya in

million) Siddha Agamas creatures the Gujarat
way you
want to be
treated.

Judaism (17 Monotheisti Tanach or Love your Jerusalem

million) c God the Jewish neighbor as
Bible yourself:

Shinto (100 Kami The Kojiki The heart of Three Grand

million) and the the person Shrines in Japan
Nihon-gi before you is
a mirror. See
there your
own form.

Sikhism (30 Waheguru Guru Treat others Amritsar and

million) Granth like precious Harmandir
Sahib jewels and Saheb (the
do do hurt Golden Temple)
them.

Taoism No God like The Tao Te Regard your Sacred

(Daoism) - other Ching and neighbor's mountains in
(12-173 religions Lao-tzu gain and China
million) losses as
your own.

Zoroastrianis Ahura and Gathas and Do not do The Iranshah

m (124-190 Mazda Yasna unto others Atash Behram
thousand) whatever is
injurious to
yourself.

Other Belief Systems

32
Atheist – a person who does not believe in any deity
Agnostic – an individual who believes that the existence of God cannot be proved
or disproved.

Cultural beliefs and Practices

 Asian Health Care Beliefs

1. Yin and Yang
2. Respect for Physician
3. Limited concept of mental illness
4. Traditional self-care, self-medication, self-dosing
5. Fearful of blood work, excessive testing, surgery
6. Self-restraint – may refuse pain medication out of courtesy
7. Do not touch the head – private and personal
8. Modesty
9. Eye contact
10.Fasting (Ramadan)
11.Visiting hours – large group of family members
12.Birthing beliefs

 Asian Health Care Practices

1. Coining (Caogio)
2. Cupping (Giac)
3. Steaming (Xong)
4. Acupuncture
5. Patent medicines

What is the role of the nurse?

1. Provide care that is congruent with cultural values, beliefs, and practices.
2. Perform transcultural assessments
3. Develop culturally competent interventions
4. In-service staff on cultural competency

Culturally Sensitive Interventions:

1. Arrange Nursing Care so that it does not interrupt prayer session.
2. Try to schedule medication administration so it does not interfere with
fasting.
3. Try to accommodate dietary needs specific to culture
4. Learn about alternative/complimentary medications

 The practice of nursing today demands that the nurse identify and meet the
cultural needs of diverse groups, understand the social and cultural reality of
the client, family, and community, develop expertise to implement culturally
acceptable strategies to provide nursing care, and identify and use resources
acceptable to the client (Boyle, 1987).

Activity:

The class will be divided into groups and each will be given an assigned topic to 33
discuss the cultural beliefs and practices.
ACTIVITY:
 Transcultural Dialogic Engagement (50 points)
Guidelines: The purpose of this activity is to explore and know caring persons from
a transcultural lens.
Process:
1. Select a person/s (he/she/they could be any person/s not known to you) and
arrange a time for a dialogic encounter convenient to you and the client.

Criteria in selecting the client

 He/She/they belongs to a specific group or tribe in his/her /their place
 Must be able to answer specific questions indicated in the guidelines
 Can be a Filipino or anyone belonging to another nationality who have been
residents of the place in the past 2-3 years

Transcultural Dialogic Engagement

2. Record a 4-page paper that will be developed from the dialogic encounter
utilizing the following organization and headings:
1. Caring for self
2. Cultural traditions and practices
3. Cultural Care
Ask at appropriate moments in your dialogue:
2.1 How do you care for yourself day to day?
2.2 What traditional health care practices do you observe as you care for
yourself and your family?
2.3 How do you promote/maintain the cultural care needs of your
self/family/community?
3. Reflections on the engagement
Carefully reflect on the encounter.
How do you feel about this person’s caring for self and family as expressed in
the dialogue?
What new meanings emerged?
4. Circles of meaning
How do these new meanings relate to the knowledge gained from the
course? What is the meaning of this experience to your understanding of
transcultural nursing ?
Evaluation
Substantive dialogue recorded/documented (20 pts.)
Insightful reflections on self and others (20 pts)
Integration of readings in uncovering meaning and patterns of knowing (10
pts)
Reflective Journal ( 30 pts)
References ( 10 pts)
Use of APA format 6th edition (10 Pts.)

34
 End of Midterm Coverage

Before proceeding to the Semi-finals Coverage….

 Do not forget to write your reflective journal for this term regarding
your learnings, personal reflections and realizations of the different
concepts given. All written outputs should be compiled in your
learning portfolio to be submitted to the subject teacher as part of
the requirements of the course.

EVALUATION:
3. Individual and group activities.
4. Self-Reflection question at the end of the term.

REQUIREMENTS:
After this module, you are expected to submit the following on the date given by
your instructor:

3. Learning Portfolio composed of:

 A copy of the answer sheet duly accomplished found at the last part of
each term.
 Your reflective journal in using the module.
4. Term examinations.

REFERENCES:

6. Berman, A., (2021). Kozier and Erb’s, Fundamentals of Nursing Concepts,

Process and Practice volume 1 + volume 2.
7. Cooper, K. & Gosnell, K. (2019). Adult health nursing (8th edition). USA:
Lippincott Williams and Wilkins.
8. Hinkle, J. & Cheever, K. (2022). Brunner and Suddarth’s textbook of medical
– surgical nursing volume 1 & 2 (14th edition). USA: Wolters Kluwer Health
9. Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2019). Wong's nursing care
of infants and children. St. Louis, MO: Elsevier.
10. Silbert-Flagg, J., & Pillitteri, A. (2023). Maternal & child health nursing : care
of the childbearing & childrearing family. Wolters Kluwer.

35
 SEMI-FINAL COVERAGE

Specific Instructions in the completion of each Chapter:

1. Set your learning goals. Read and understand the Intended Learning
Outcomes of each chapter. This shall serve as your checklist of acquired
knowledge and skills after completing the entire chapter, likewise, the basis
of the teacher in the formulation of the summative evaluation given at the
end of each chapter.
2. Lecture notes are provided for you. BE SURE NOT TO SKIP the lecture. Read
and understand before answering the activities. You can take note those
concepts that are not clear to you and refer to your subject teacher during
the specified consultation hours.
3. Read the teacher’s insight and open video links provided to supplement the
lecture notes.
4. As you go on, you will encounter exercises that will test your knowledge and
understanding as well as your critical thinking.
5. Compile your outputs in your Learning Portfolio to be submitted on the date
set by your teacher.
6. Should you have any queries or clarifications with the topics, please contact
your subject teacher during consultation hours (please refer to the
preliminaries of this material).

CHAPTER III
Transcultural Health Domains

Duration: 9 hours

Intended Learning Outcomes:

At the end of the lesson, students are able to:
1. Explain the health tradition model.
2. Identify the different traditional health maintenance.
3. Discuss the Transcultural health care delivery perspectives.

1. Health Traditions
Health Traditions Model
 Uses the concept of holistic health and explores what people do from a
traditional perspective to maintain health, protect health or prevent illness,
and restore health, in this traditional context, has nine interrelated facets,
represented by:
1. Traditional methods of maintaining health – physical, mental, and spiritual

36
 2. Traditional methods of protecting health - physical, mental, and spiritual
3. Traditional methods of restoring health - physical, mental, and spiritual
 Traditional methods of health maintenance, protection, and restoration
require the knowledge and understanding of health-related resources from
within a given person’s ethnoreligious cultural heritage. These methods may
be used instead of or along with modern methods of health care. They are
not alternative methods of health care because they are methods that are an
integral part of a person’s given ethnocultural religious heritage.
Traditional health Maintenance
 The traditional ways of maintaining health are the active, everyday ways
people go about living and attempting to stay well, that is, ordinary
functioning within society.
1. Clothing
- boots when it snows and sweaters when it is cold, long sleeves in the sun,
and scarves to protect from drafts and dust.
- Many traditional ethnic groups or religions may also prescribe special
clothing or head coverings.
2. Food
- The food that is eaten and the methods for preparing it contribute to
people’s health.
- traditional diets are followed, and food taboos and restrictions obeyed.
3. Mental health – maintained by concentrating and using the mind – reading,
crafts, games, books, music, hobbies.
4. Spiritual health – maintained in the home with family closeness – prayer
and celebrations
Traditional Etiology
 The protection of health rests in the ability to understand the cause of a
given illness or set of symptoms.
 Some of the traditional health and illness beliefs regarding the causation of
illness differ from the modern model of etiology.
 Illness is most often attributed to the “evil eye”. The evil eye is primarily a
belief that someone can project harm by gazing or staring at another’s
property or person. This belief is probably the oldest and most widespread of
all superstitions, and it is found to exist in many parts of the world, such as
southern Europe, the Middle East, and North Africa.
 The common beliefs in the evil eye assert that:
1. The power emanates from the eye (or mouth) and strikes the victim.
2. The injury, be it illness or other misfortune, is sudden.
3. The person who casts the evil eye may not be aware of having this power.
4. The afflicted person may or may not know the source of the evil eye.
5. The injury caused by the evil eye may be prevented or cured with rituals
or symbols.
6. This belief helps to explain sickness and misfortune
 The nature of the evil eye is defined differently by different populations

37
 How it is cast:
- Philippines – the evil is cast through the eye or mouth;
- Mediterranean – the avenging power of God;
- Italy – a malevolent force like a plague and is warded off by wearing
amulets.
Who can cast it:
- Mexico – strangers
- Iran – kinfolk
- Greece – witches

Degree of power:
- Mediterranean – devil
- Near East – Deity
 Germans – evil eye is known as aberglobin or aberglaubisch and causes
preventable problems, such as evil, harm, and illness. Among the Polish, the
evil eye is known as szatan, literally, “Satan”.
 Some “evil spirits” are equated with the devil and can be warded off by
praying to a patron saint or guardian angel.
 Szatan is also averted by prayer and repentance and the wearing of medals
and scapulars.
 Illness can also be attributed to people who have the ability to make others
ill, e.g. witches, practitioners of voodoo.
Health Protection
Traditional practices used in the protection of HEALTH include:
1. The Use of protective objects – worn, carried, or hung in the home.
Objects that protect health:
 Amulets – objects such as charms, worn on a string or chain around the
neck, wrist, or waist to protect the wearer from the evil eye or the evil
spirits that could be transmitted from one person to another, or could
have supernatural origins.
 Examples:

mano milagroso – worn by many people in Mexican origin for luck and prevention
of evil

38
 a mano negro is placed on babies wrist or chain or
pinned to the diaper or shirt an is worn throughout
the early years of life

 Amulets may also be written documents on parchment scrolls, and these are
hung in the home to protect the family from the “evil eye”, famine, storms,
diseases and countless other dangers

 Bangles are worn by people originating from the west Indies. The silver
bracelets are open to “let out evil” yet closed to prevent evil from entering
the body. They are worn from infancy, and as the person grows they are
replaced with larger bracelets. The bracelets tend to tarnish and leave a
black ring on the skin when a person is becoming ill. When this occurs, the
person knows it is important to rest, to improve the diet, and to take other
needed precautions. Many people believe they are extremely vulnerable to
evil, even to death, when the bracelet are removed. Some people wear
numerous bangles.

39
 In addition to amulets, there are talismans. Talisman is believed to possess
extraordinary powers and may be worn on a rope around the waist or carried
in a pocket or purse.
 A talisman is any object ascribed with religious or magical powers intended
to protect, heal, or harm individuals for whom they are made. Talismans are
often portable objects carried on someone in a variety of ways, but can also
be installed permanently in architecture.

Talisman - an object, typically an inscribed ring or stone, that is thought to have

magic powers and to bring good luck.

Written talisman of Korean

2. The use of substances – ingested in certain ways and amounts or

eliminated, and substances worn or hung in the home.
Substances that protect health:
 People from any ethnic backgrounds eat raw garlic or onions in an effort to
prevent illness. Garlic or onions may be worn on the body or maybe hung in
the Italian, Greek or Native American home
 Chahayotel, a seed may be tied around the waist by a Mexican person to
prevent arthritic pain.
 Ginseng root, the most famous of Chinese medicines. It has universal
medicinal applications and is used preventively to “build the blood,”

40
 especially after childbirth. Tradition states that the more the root looks a
man, the more effective it is. Ginseng is also native to the United States and
is used in this country as a restorative tonic.

Ginseng Root
Chachayotel seed

 Diet regimens also are used to protect health. It is believed that the body is
kept in balance or harmony by the type of food that one eats.
- Traditionalists have strong beliefs about diet and foods and their
relationship to the protection of health.
- Kosher diet – a practice among Jewish people which mandates the
elimination of pig products and shellfish. Only fish with scales and fins are
allowed, and only certain cuts of meat from animals with a cleft hoof and
that chew the cud can be consumed (e.g. cattle and sheep).
- Muslims – avoidance of pig products; the meats are “Halal.”
- Jews – believed that milk and meat must never be mixed and eaten at the
same meal.
- Traditional Chinese homes – a balance must be maintained between foods
that are yin or yang. These are eaten in specified proportions.
- Hispanic homes – foods must be balanced as to “hot” and “cold”. These
foods too, must be eaten in the proper amounts, at certain times, and in
certain combinations.

3. The practices of religion such as the burning of candles, the rituals of

redemption, and prayer.
Spiritual practices that protect health:
 Religion strongly affects the way people choose to protect health, and it plays
a strong role in the rituals associated with health protection.
 Religion dictates social, moral, and dietary practices that are designed to
keep a person in balance.
 Many people believed that illness and evil are prevented by strict adherence
to religious codes, morals, and religious practices. They view illness as a
punishment for breaking a religious code
 Example of protective religious figure is the Virgin of Guadalupe, the patron
saint of Mexico, who is pictured on medals that people wear or in pictures

41
 hung in the home. She is believed to protect the person and home from evil
and harm, and she serves as a figure of hope.

Our Lady of Guadalupe (Spanish: Nuestra

Señora de Guadalupe), also known as the Virgin
of Guadalupe (Spanish: Virgen de Guadalupe), is
a Catholic title of Mary, mother of Jesus associated
with a series of five Marian apparitions in
December 1531, and a venerated image on a
cloak enshrined within the Basilica of Our Lady of
Guadalupe in Mexico City. The basilica is the most-
visited Catholic shrine in the world, and the world's
third most-visited sacred site.

 Religion can, therefore , help to provide the believer with an ability to

understand and interpret the events of the environment and life.
Health Restoration
 Health restoration in the physical sense can be accomplished by the use of
countless traditional remedies such as herbal teas, liniments, special foods
and food combinations, massage, and other activities.
 The restoration of health in the mental domain may be accomplished by the
use of various techniques such as exorcism, calling on traditional healers,
using teas or massage, and seeking family and community support.
 The restoration of health in the spiritual sense, can be accomplished by
healing rituals; religious healing rituals; or the use of symbols and prayer,
meditation, special prayers, and exorcism.
Folk Medicine
1. Natural Folk Medicine
 Represents one of humans’ earliest uses of the natural environment
and utilizes, herbs, plants, minerals, and animal substances to prevent
and treat illnesses.
 Natural folk medicine has been and still is widely practiced throughout
the world. In general, this form of prevention and treatment is found in
old-fashioned remedies and household medicines. These remedies
have been passed down for generations, and many are in common use
today.

42
  Much folk medicine is herbal in nature, and the customs and rituals
related to the use of this herbs vary among ethnic groups. Commonly,
across cultures, these herbs are found in nature and are used by
humans as a source of therapy, although how these medicines are
gathered and specific modes of use may vary from group to group and
place to place.
 In general, folk medical traditions prescribed then time of year in which
the herb was to be picked; how it was to be dried; how it was to be
prepared; the method, amount, and frequency of taking, and so forth.

2. Magicoreligious Folk Medicine

 Represents the use of charms, holy words, and holy actions to prevent
and cure illnesses.
 The magicoreligious form of folk medicine has existed for as long as
humans have sought to maintain, protect, and or restore their health.
It has now, in this modern age of science and technology, come to be
labeled by some as “superstition,” old-fashioned nonsense,” or
foolishness,’ yet, for believers it may go so far on the continuum as to
take the form of religious practices related to health maintenance,
protection, restoration, and healing.

2. Healing Traditions
Healing
 The professional history of nursing was born with Florence Nightingale’s
knowledge (1860) that “nature heals.”
 Blattner (1981) has written a text designed to help nurses assist patients
to upgrade their lives in a holistic sense and to heal the person – body,
mind, and spirit.
 Krieger (1979), in The Therapeutic Touch, has developed a method for
teaching nurses how to use their hands to heal.
 From the fields of anthropology and sociology come texts that describe
rituals, customs, beliefs, and practices that surround healing
 Buxton (1973) describes traditional beliefs and indigenous healing rituals
in Mandari and relates the source of these rituals with how man views
himself in relation to God and earth. In this culture, the healer experiences
a religious calling to become a healer. Healing is linked to beliefs in evil
and the removal of evil from the sick person.
Ancient forms of healing
 Illness was considered to be crises and the people of ancient times
developed elaborate system of healing.
 The cause of an illness, once again, was attributed to the forces of evil,
which originated, either within or outside the body. Early forms of healing
dealt with the removal of evil. Once a method treatment was found

43
 effective, it was passed down through the generations in slightly altered
forms.
 If the house of sickness-causing was within the body, treatment involved
drawing the evil out of the body. This may have been accomplished
through the use of purgatives that caused either vomiting or diarrhea, or
by blood-letting: “bleeding” the patient or “sucking-out” blood.
 Leeching was another method used to remove corrupt humors from the
body.
 If the source of the evil was outside the body, there were a number of
ways to deal with it. One source of “external” evil was witchcraft. In a
community, there were often many people (or a single person) who were
“different” from the other people. Quite often, when an explainable or
untreatable illness occurred, it was these people (or person) who were
seen as the causative agents. In such a belief system. Successful
treatment depended on the identification and punishment of the person
believed responsible for the disease. By removing or punishing the guilty
person from the community, the disease would be cured.
 In some communities, the healers themselves were seen as witches and
the possessors of evil skills.
 Various rituals were involved in the treatment of ill people. Often, the sick
people was isolated from the rest of the family and community. Sacrifices
and dances often were performed in an effort to cure the ills.
 Another cause of illness was believed to be the envy of people within the
community. The best method, consequently, of preventing such an illness
was to avoid provoking the envy of one’s friends and neighbors.

3. Familial Health Traditions

Activity 1:

Ask yourself the following questions regarding your health/ health beliefs and
practices:

1. What remedies and/or methods do you use to maintain, protect, and restore
your health/health?
2. Do you know the health/health and illness beliefs and practices that were or
are part of your heritage?
3. Were you ever thought to be mortally ill/ill?
4. What did your mother or grandmother do to take care of you?
5. Did she consult someone in your own ethnic/religious community to find out
what was wrong?

44
This procedure is useful for making you aware of the overall history and
health/health belief and practice-related folklore and ethnocultural knowledge of
your family. Because the ethnocultural history of each family is unique, you may
want to discover more than health/health beliefs and practices with this interview.
Ask questions about your family surname, traditional first names, family stories, the
history of family “characters” or notorious family members, how historical events
affected your family in past generations, and so forth.

Activity 2:
.
Conduct an interview to your grandmothers, great-aunts, and mother

1. What is your family’s ethnic background? Place of origin? Religion?

2. What did they do to maintain health? What did their mothers do?
3. What did they do to protect health? What did their mothers do?
4. What home remedies did they use to restore health? What did their mothers
use?
5. What are their traditional beliefs regarding pregnancy and childbirth?
6. What are their traditional beliefs regarding dying and death?

Two reasons for exploring your familial heritage:

1. It draws your attention to your ethnocultural and religious heritage and
health-related belief system. Many of your daily habits relate to early
socialization practices that are passed on by parents or additional significant
others. Many behaviors are both subconscious and habitual, and much of
what you believe and practice is passed on this manner.
2. To sensitize you to the role your ethnocultural and religious heritage has
played. You must reanalyze the concepts of health/illness and, once again,
view your own definitions from another perspective.

Family Health Histories Obtained from Students of Various Ethnic

Backgrounds and Religions

Ethnicity/ Health Health Health Restoration

religion Maintenance Protection

Austrian (US), Eat wholesome Camphor around Sore throat: go to the

Jewish foods, homegrown the neck (in the village store; find a
fruits and winter) in a small salted herring, wrap it

45
 vegetables, bake cloth bag to in a towel, put it
own bread prevent measles around the neck, and
and scarlet fever let it stay there
overnight; gargle with
salt water
Boils: fry chopped
onions, make a
compress and apply to
the infections

Black and Native Eat balanced meals Keep everything Bloody nose: place
American, three times a day, clean and sterile; keys on a chain
Baptist dress right for the stay away from around the neck to
weather people who are stop.
sick; Regular
Sore throat: Suck
check-ups;
yolks out of eggshell;
blackstrap
honey and lemon;
molasses
baking soda, salt,
warm water; onions
around the neck; salt
water to gargle.

Black African Keep the area Eat hot food such Eat hot and sour
(Ethiopia), clean; pray every as pepper; fresh foods, such as lemons,
Orthodox morning when garlic, lemon fresh garlic, hot
Christian getting up from bed mustard, red pepper;
make a kind of
medicine from leaves
and roots of plants
mixed together.
Colds: hot boiled milk
with honey.
Evil eye: they put
some kind of plant
root on fire and make
the man who has the
evil eye smile and the
man talks about his
illness

Canadian, Cleanliness Sleep Kidney problems:

Catholic Herbal teas
Food: people should Lots of good food
eat well (fat people Colds: hot lemons
Elixirs containing
used to be
herbs and brewed, Infected wounds: raw
considered healthy

46
 Prayer: health was given as a vitamin onions placed on
always mentioned tonic wounds
in prayer
Wear camphor Cough: shot of
around the neck to whiskey
ward off any evil
Sinuses: Camphor
spirit; Use Father
placed in a pouch and
John’s medicine
pinned to the shirt
November to May
Fever: Lots of blankets
and heat make you
sweat out a fever
Headache: Lie down
and rest in complete
darkness
Aches and pains: Hot
Epsom salt baths
Eye infections:
Potatoes are rubbed
on them or a gold
wedding ring is placed
on them and the sign
of the cross is made
three times.

Eastern Europe Go to doctor when Observe Colds: Fluids, aspirin.

(US); Jewish sick precautions, such Rest
as dressing
Health care for Stomach upset: eat
warmly, not going
others, not self light and bland foods
out with wet hair;
Reluctantly sought getting enough Muscle aches:
medical help rest, staying in bed massage with alcohol
if not feeling well
Health for self not a (mother) Sore throat: gargle
priority with salt water; tea
Not much to with lemon and honey
Physician twice a prevent illness-
year very ill today with Insomnia: glass of
chronic diseases wine; chicken soup
Doctor only when
used by mother and
pregnant Vitamins and water grandmother
pills

English, Baptist Eat well; daily Earache: honey and

walks, read, keep tea, warm cold-liver in
warm ear; stay in bed

47
 Cold: heat glass and
put on back

English, Catholic Lots of exercise, Maintain a good Cuts: wet tobacco

proper sleep; lots of diet; fresh
Colds: chicken soup;
walking; no drinking vegetables;
herb tea made from
or smoking; vitamins; little
roots; alcohol
hardwork; bedroom meat; lots of fish;
concoctions; vicks and
window open at no fried foods; lots
hot towels on chest;
night; take baths; of sleep; strict
lots of fluids, rest;
good housekeeping; enforcement of
vicks, sulfur and
never wear dirty lifestyle; keep
molasses
clothing; immediate kitchen at 900F in
clean-up after winter and house Sore throat: four
meals; wash pan will be warm onions and sugar
before meals; rest steeped to heal and
soothe the throat
Rashes: burned linen
and cornstarch

French (France), Proper food; rest; Every spring give Colds: rubs chest with
Catholic proper clothing; sulfur and vicks; honey
cold liver oil daily molasses for 3
days as a laxative
to get rid of worms

French Canadian, Wear rubbers in the Sulfur and Colds: brandy with
Catholic rain and dress molasses in spring warm milk; honey and
warmly; take part in to clear the system lemon juice; hot
sports; active body; poultice on the chest;
Cold liver oil in
lots of sleep tea; whiskey and
orange juice
lemon
No “junk foods”;
Back pain: mustard
play outside; daily
packs and
use of Geritol;
camphor on Rashes: Oatmeal
clothes; balanced baths
meals
Sore Throat: wrap raw
potatoes in sack and
tie around neck; soap
and water enemas
Warts: rub potato on
wart, run outside and
throw it over left
shoulder

48
Iran (US), Islam Cleanliness; diet Dress properly for Sore throat: gargle
the season and with vinegar and
weather; keep feet water
from getting wet in
Cough: honey and
the rain
lemon
Inoculations
Indigestion: baking
soda and water
Sore muscles: alcohol
and water
Rashes: apply
cornstarch

Italian (US), Hearty and varied Garlic cloves Chicken soup for
Catholic nutritional intake; strung on a piece everything from colds
lots of fruits, pasta, of string around to having a baby
wine (even for the neck of infants
Boils: cooked oatmeal
children), cheese, and children to
wrapped in a cloth
homegrown prevent colds and
(streaming hot)
vegetables, and “evil” stares from
applied to drain pus
salads; exercise in other people which
form of physical they believed could Headache: fill a soup
labor; molasses on caused headaches bowl with cold water
a piece of bread, or and a pain or and put some olive oil
oil and sugar on stiffness in the in a large spoon; hold
bread; hard bread back or neck (a the spoon over the
(good for the teeth) piece of red ribbon bowl in front of the
or cloth on an person with the
Pregnancy: 2 weeks
infant served the headache; while doing
early: girl
same purpose) this, recite words in
2 weeks late: boy Italian and place index
Keep warm in cold
finger in the oil in the
Heartburn: baby weather; Keep feet
spoon: drop three
with lots of hair warm; eat
drops of oil in the
properly; never
Eat fruit at end of water; the severity of
wash hair or bathe
meal cleans teeth; headache can be
during period;
early to bed and determined (large =
never wash hair
early to rise more severe); after
before going
this is done three
outdoors or at
times, the headache is
night; stay out of
gone.
drafts;
Upset stomach: herb
To prevent “evil” in
tea
the newborn, a
scissor was kept Sprains: beat egg

49
 open under the whites, apply to part,
mattress of the wrap part
crib wrapped
Fever: cover with
around the baby
blankets to sweat it
from the waist to
out
the feet
Colic: warm oil on
If infants got their
stomach
nights and days
mixed up, they Acne: apply baby’s
were tied upside urine
down and turned
all the way around Toothache: whiskey
applied topically

Examples of selected Familial Ethnocultural and Religious Beliefs and

Practices Related to birth and death

Nation of Origin Birth beliefs Death beliefs

and Religion

Cape Verde - Baptism Death is a part of life

Christian

England - Baptism Person goes to heaven

Christian
Natural event Body dying
Funeral and prayer
Everlasting life with Christ

Germany - Do not take baby out God’s will

Lutheran until it is baptized
Body dies when we die – souls go to
Mother does not go to heaven and enjoy everlasting life
the baptism
Celebrate person’s life and the
Birth is sacred promise of eternal life

Greece - Orthodox After 40 days mother The good go to the paradise; the
and newborn go to bad go to the hell
church – baby is
After death light a candle that burns
blessed and prayers
all night
are said to keep away
the evil spirits Visit grave daily
Baptized at 2 gifts Hold a special service on the 40th
given to the baby to day
protect it from the evil
Bones are unburied after 3 years

50
 eye – charms of white and are put into a holy box and are
and blue beads are placed in the church or are reburied
worn on the wrist in the family grave
If the baby cries In mourning women wear black for
excessively, exorcism the rest of their lives and men grow
may be performed facial hair
Wrap the baby in Some older people believe in ghosts
blankets and pin to
sheets to relax

Ireland-Catholic Baby shower before Wake – “a party with one less

birth but never set-up person”
the crib until after birth
Final separation of the soul from the
Men not present at body – soul lives on and is
birth transported to God
Tell of pregnancy at 3 Dying: pray the Rosary aloud as it is
months a stepping stone to the Virgin Mary
asking her to watch over this person
and guide them to everlasting
peace.
Blessing with oils and receive the
Eucharistic for the last time
Dying person wears a Rosary
around their neck to keep evil
spirits away and God closer
After death, the body is washed and
prepared for the wake at home by a
neighbor and then the wake and
mass
Mourning: Keening – a ritual of
professional criers coming to the
home and crying for hours over the
death of a family member
Gathering family and friends
Spirit goes to heaven or hell

Italy - Cathoic Life begins at Closed casket

conception
cremation

Japan-Shinto Umbilical cord saved – Cremation

a lasting bond between

51
 mother and child
100-day old child taken
to the Shrine

Lithuania - Baptism Pray for the dead

Catholic
Visit graves

Portugal Throw a party for the Celebrate a painless death – means

birth of a boy (relates the person has been good and is
to the time when males now with Jesus
were needed to work
A party comforts the loved ones
on the farms)
If one dies in a painful way there is
Women during
no celebration
pregnancy get less
pretty with a girl Widow must forever wear black –
because the baby is this serves as a warning to other
taking her mother’s men that she has suffered a loss
looks and is not attractive to prevent
shame from being brought to her

Sicily - Catholic Gift from God The day you were born, it was
known the day you were to die
Baptism
Women mourn for years, wearing
only black and seldom going
outside
Close all shades and never go out
during daylight.

CHAPTER IV
Transcultural Health Care Delivery Perspectives

What is Transcultural?
 extending through all human cultures; "a transcultural ideal of freedom
embracing all the peoples of the world" ...(free dictionary)

52
What is Transcultural Health Care?
 Provision of individualized and holistic health care to clients across cultures.
 Health Care professionals recognize and appreciate cultural differences in
health care values, beliefs & customs.
 The need for transcultural nursing will continue to be an important aspect in
healthcare

What is Transcultural Nursing?

 Is a comparative study of cultures to understand similarities (culture
universal) and difference (culture specific) across human groups (Leininger,
1991)
 a humanistic and scientific area of nursing study and practice that focuses on
how patterns of behavior in health, illness, and caring are influenced by the
values and beliefs of specific cultural groups ( medical dictionary 2015)
The goal of Transcultural Nursing
 to provide culture specific and universal nursing care practices for the health
& well-being of people or to help them face unfavorable human conditions,
illness, or death in culturally meaningful ways.
The focus of Transcultural Nursing
 The focus of transcultural nursing is the differences between cultural groups
that require care providers to identify culture specific health and illness
practices and caring behaviors as well as to identify behaviors that transcend
cultural groups and appear to be universal human care practices.
The scope of Transcultural Nursing
 The scope of transcultural nursing is the delivery of personalized care in
health promotion and maintenance, as well as illness situations.
The importance of Transcultural Nursing

Major factors influencing Transcultural Nursing

 Trends of globalization, migration, transculturalism, transcultural nursing,
culturally congruent care are new concepts that nurses must learn to make
transcultural health care more beneficial and meaningful.
 Increasing number of immigrants and refugees from diverse culture.
 Advancing technology and worldwide use of cybernetics and new modes of e-
communications, health technologies.
 Increased use of alternative/complementary modalities or generic health care
practices
 Increased in ethical and moral cultural health care concerns ( e.g.cultures of
life & death)
 The rise in womens’ and mens’ human rights

53
Leininger (1995) cites eight factors that influence her to establish
transcultural nursing.
1. There was a marked increase in people within and between countries
worldwide. Transcultural nursing is needed because of the growing diversity
that characterizes our national and global populations.
2. There has been a rise in multicultural identities, with people expecting their
cultural beliefs, values, and lifeways to be understood and respected by
nurses and other healthcare providers.
3. The increased use of healthcare technology sometimes conflicts with cultural
values of clients, such as Amish prohibitions against using certain apnea
monitors, IV pumps, and other such health care technologic devices in the
home.
4. Worldwide, there are cultural conflicts, clashes, and violence that have an
impact health care as more cultures interact with one another.
5. There was an increase in the number of people traveling and working in
many different parts of the world.
6. There was an increase in legal suits resulting from cultural conflict,
negligence, ignorance, and imposition of health care practices.
7. There has been a rise in feminism and gender issues, with new demands on
health care systems to meet the needs of women and children.
8. There has been an increase demand for community and culturally based
health care services in diverse environmental contexts (Andrews, Margaret M
and Joyceen S Boyle).

Relevance of Transcultural Nursing

 TCN is imperative in nursing education for nurses to provide safe and
meaningful care to people of diverse culture.
 provides nurses a new way to learn about and provide culturally congruent
and meaningful care to people.
 nurses must learn about and respect different cultures and care needs.
 TCN nurses thinking and actions need to be based about specific cultures
including values, beliefs, caring patterns.

Historical Development of Transcultural Nursing

Dr. Madeleine M. Leininger was the founder and leader of this new, specific
cognitive specialty in nursing. The first professional nurse with graduate preparation
to complete a doctorate in anthropology, Leininger took the “culture” construct
from anthropology and “care” from nursing and reformulated these two dominant
constructs into “culture care”. Her pioneering work began with her theory of
“cultural care diversity and universality,” refined by 1975 with the conceptual
“sunrise model.” She divides the evolution of transcultural nursing into three eras:
1. Establishment of the field (1955–1975)
2. Program and research expansion (1975–1983)
3. Establishment of transcultural nursing worldwide (1983 to the present)
At the start in the mid-1950s, no cultural knowledgebase existed to guide
nursing decisions and actions to understand cultural behaviors as a way of

54
providing therapeutic care. Leininger wrote the first books in this field and coined
the terms, “transcultural nursing” and “culturally congruent care”. Leininger
developed and taught the first university course in transcultural nursing in 1966 at
the University of Colorado. Programs and tracks in transcultural nursing for masters
and doctoral preparation were launched shortly after, in the early 1970s. In
recognition of her leadership, Leininger was honored as a Living Legend of the
American Academy of Nursing in 1998.
Today, transcultural nursing theory continues to expand and refine itself.
Recent educational and theoretical approaches in the field include the transcultural
assessment model, the model of heritage consistency, the model for cultural
competence, the health care services model, and advocacy for the application of
transcultural nursing in clinical and community contexts as well as a transcultural
nursing assessment guide (Murphy).

End of Semi-finals Coverage

Before proceeding to the Finals Coverage….

 Do not forget to write your reflective journal for this term regarding
your learnings, personal reflections and realizations of the different
concepts given. All written outputs should be compiled in your
learning portfolio to be submitted to the subject teacher as part of
the requirements of the course.

EVALUATION:
5. Individual and group activities.
6. Self-Reflection question at the end of the term.

REQUIREMENTS:
After this module, you are expected to submit the following on the date given by
your instructor:

5. Learning Portfolio composed of:

 A copy of the answer sheet duly accomplished found at the last part of
each term.
 Your reflective journal in using the module.
6. Term examinations.

REFERENCES:

11.Berman, A., (2021). Kozier and Erb’s, Fundamentals of Nursing Concepts,

Process and Practice volume 1 + volume 2.
12.Cooper, K. & Gosnell, K. (2019). Adult health nursing (8th edition). USA:
Lippincott Williams and Wilkins.
13.Hinkle, J. & Cheever, K. (2022). Brunner and Suddarth’s textbook of medical
– surgical nursing volume 1 & 2 (14th edition). USA: Wolters Kluwer Health
14.Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2019). Wong's nursing care
of infants and children. St. Louis, MO: Elsevier.

55
 15. Silbert-Flagg, J., & Pillitteri, A. (2023). Maternal & child health nursing : care
of the childbearing & childrearing family. Wolters Kluwer.

FINAL COVERAGE

Specific Instructions in the completion of each Chapter:

1. Set your learning goals. Read and understand the Intended Learning
Outcomes of each chapter. This shall serve as your checklist of acquired

56
 knowledge and skills after completing the entire chapter, likewise, the basis
of the teacher in the formulation of the summative evaluation given at the
end of each chapter.
2. Lecture notes are provided for you. BE SURE NOT TO SKIP the lecture. Read
and understand before answering the activities. You can take note those
concepts that are not clear to you and refer to your subject teacher during
the specified consultation hours.
3. Read the teacher’s insight and open video links provided to supplement the
lecture notes.
4. As you go on, you will encounter exercises that will test your knowledge and
understanding as well as your critical thinking.
5. Compile your outputs in your Learning Portfolio to be submitted on the date
set by your teacher.
6. Should you have any queries or clarifications with the topics, please contact
your subject teacher during consultation hours (please refer to the
preliminaries of this material).

Continuation of CHAPTER IV

Theoretical Models of Transcultural Nursing

I. Theory of Culture Care Diversity and Universality (Leininger )

Madeleine Leininger
 Madeleine Leininger was born in Sutton, Nebraska
 In 1948, she received her diploma in Nursing from St. Anthony’s School of
Nursing in Denver, Colorado.
 In 1950, she earned a B.S. from St. Scholastica (Benedictine College) in
Atchison, Kansas, and in 1954 earned an M.S. in Psychiatric and Mental
Health Nursing from the Catholic University of America in Washington, D.C.
 In 1965, she was awarded a Ph.D. in Cultural And Social Anthropology from
the University of Washington, Seattle (Tomey and Alligood,2001).

Transcultural Nursing
 Defined as a substantive area of study and practice focused on
comparative cultural care (caring) values, beliefs, and practices of
individuals or groups of similar or different cultures with the goal of
providing culture-specific and universal nursing care practices in
promoting health or well‐being or to help people to face unfavorable
human conditions, illness, or death in culturally meaningful ways.

 Leininger’s theory is to provide care measures that are in harmony with an

individual or group’s cultural beliefs, practices, and values. In the 1960’s, she
coined the term CULTURALLY CONGRUENT CARE, which is the primary
goal of TRANSCULTURAL NURSIN PRACTICE

 Leininger developed new terms for the basic tenets of her theory:
 CARE is to assist others with real or anticipated needs in an effort to
improve a human condition of concern or to face death.

57
 CARING is an action or activity directed towards providing care.
 CULTURE refers to learned, shared, and transmitted values, beliefs,
norms, and lifeways of a specific individual or group that guide their
thinking, decisions, actions, and patterned ways of living.
 CULTURAL CARE refers to multiple aspects of culture that influence and
enable a person or group to improve their human condition or to deal with
illness or death.
 CULTURAL CARE DIVERSITY refers to the differences in meanings,
values, or acceptable modes of care within or between different groups of
people.
 CULTURAL CARE UNIVERSALITY refers to common care or similar
meanings that are evident among many cultures.
 NURSING is a learned profession with a disciplined focused on care
phenomena.
 WORLDVIEW refers to the way people tend to look at the world or
universe in creating a personal view of what life is about.
 HEALTH refers to a state of well‐being that is culturally defined and
valued by a designated culture.
 CULTURAL AND SOCIAL STRUCTURE DIMENSIONS include factors
related to religion, social structure, political/legal concerns, economics,
educational patterns, the use of technologies, cultural values, and
ethnohistory that influence cultural responses of human beings within a
cultural context.
 Cultural care preservation or maintenance refers to nursing care
activities that help people of particular cultures to retain and use core
cultural care values related to healthcare concerns or conditions.
 Cultural care accommodation or negotiation refers to creative
nursing actions that help people of a particular culture adapt to or
negotiate with others in the healthcare community in an effort to attain
the shared goal of an optimal outcome for client(s) of a designated
culture.
 CULTURAL CARE REPATTERNING OR RESTRUCTURING refers to
therapeutic actions taken by culturally competent nurse(s) or family.
These actions enable or assist a client to modify personal health behaviors
towards beneficial outcomes while respecting the client’s cultural values.

58
 Leininger’s theory is depicted as the sunrise enabler to discover culture care,
symbolic of the hope to generate new knowledge for nursing.
 The model shows factors such as (1) technological, (2) religious and
philosophical, (3) kinship and social, (4) cultural values and lifeways, (5)
political and legal, (6) economic, and (7) educational, forming sunrays that
influence individuals, families, and groups in health and illness.
 As the model indicates, it is applicable in assessing and caring for individuals,
families, groups, communities, and institutions in various health systems. The
CCDU theory has undergone refining for 6 decades and is used in nursing as
well as in other health-related disciplines.
 Leininger emphasizes that the nurse need not only be a mediator or broker
but has to be “very knowledgeable about the client’s culture and diverse
factors influencing . . . needs and lifeways”.
 Shown in constantly interacting circles, nursing care bridges generic or folk
systems and professional systems—two major constructs of the CCDU.
 According to Leininger, the culture care theory’s focus is culture and care
“because they were missing . . . and long neglected” in theory development
during the 1980s and 1990s.
 Leininger (2002a, 2002b) places great emphasis on the role of appropriate
culturological assessment when working with individuals, families, groups,
and institutions to provide culturally congruent care.

59
  Acknowledging the time constraints in the acute settings, Leininger (2002)
suggested a short culturological assessment in five phases: recording of
observations using all five senses; paying close attention and listening,
including for generic folk practices; identifi cation of patterns and narratives;
synthesis of themes and patterns; and development of a culturally congruent
care plan jointly with the client.
 The CCDU theory has three action modes for providing culturally congruent,
holistic nursing care in health and well-being or when dealing with illness or
dying namely preservation and/or maintenance, accommodation and/or
negotiation, and repatterning and/or restructuring

Cultural and Social Structure Dimensions

 Include factors related to religion, social structure, political/legal
concerns, economics, educational patterns, the use of technologies,
cultural values, and ethnohistory that influence cultural responses of
human beings within a cultural context.

Cultural care preservation or maintenance

 refers to nursing care activities that help people of particular cultures
to retain and use core cultural care values related to healthcare
concerns or conditions.

Cultural care accommodation or negotiation

 refers to creative nursing actions that help people of a particular
culture adapt to or negotiate with others in the healthcare community
in an effort to attain the shared goal of an optimal health outcome for
client(s) of a designated culture.

Cultural Care Re-Patterning or Re-Structuring

 Refers to therapeutic actions taken by culturally competent nurse(s)
or family. These actions enable or assist a client to modify personal
health behaviors towards beneficial outcomes while respecting the
client’s cultural values.

Leininger’s Assumptions derived from her theory:

 Care is the essence and central focus of nursing.
 Caring is essential for health and well--‐being, healing, growth, survival, and
also for facing illness or death.
 Culture care is a broad holistic perspective to guide nursing care practices.
 Nursing’s central purpose is to serve human beings in health, illness, and if
dying.
 There can be no curing without the giving and receiving of care. There can be
no curing without the giving and receiving of care.
 Culture care concepts have both different and similar aspects among all
cultures of the world.
 Every human culture has folk remedies, professional knowledge, and
professional care practices that vary. The nurse must identify and address
these factors consciously with each client in order to provide holistic and
culturally congruent care.

60
  Cultural care values, beliefs, and practices are influenced by worldview and
language, as well as religious, spiritual, social, political, educational,
economic, technological, ethnohistorical, and environmental factors.
 Beneficial, healthy, satisfying culturally based nursing care enhances the
well--‐being of clients.
 Culturally beneficial nursing care can only occur when cultural care values,
expressions, or patterns are known and used appropriately and knowingly by
the nurse providing care.
 Clients who experience nursing care that fails to be reasonably congruent
with the client’s cultural beliefs and values will show signs of stress, cultural
conflict, noncompliance, and ethical moral concerns.

A Culturally Competent Nurse:

Consciously addresses the fact that culture affects nurse–client exchanges:
 With compassion and clarity, asks each client what their cultural practices
and preferences are.
 Incorporates the client’s personal, social, environmental, and cultural
needs/beliefs into the plan of care wherever possible.
 Respects and appreciates cultural diversity, and strives to increase
knowledge and sensitivity associated with this essential nursing concern.

In summary:
 Culturally competent nursing care can only occur when client beliefs and
values are thoughtfully and skillfully incorporated into nursing care plans.
 Caring is the core of nursing.
 Culturally competent nursing guides the nurse to provide optimal holistic,
culturally based care.

II. Cultural Care Assessment for Congruent Competency practices (Purnell)

A. Who is the proponent?

Larry Purnell is an Emeritus Professor from the University of Delaware. His
model, the Purnell Model for Cultural Competence has been translated into
Arabic, Czech, Flemish, Korean, French, German, Japanese, Persian,
Portuguese, Spanish, and Turkish. His textbook, “Transcultural Health Care: A
Culturally Competent Approach” won the Brandon Hill and American Journal
of Nursing Book Awards. He has over 100 refereed journal publications, 100
book chapters, and 14 textbooks, including updated editions. He has made
presentations throughout the United States as well as in Australia, Colombia,
Costa Rica, England, Italy, Korea, Panama, Russia, Scotland, Spain, and
Turkey. He is the US Representative to the European Union’s Commission on
Intercultural Communication resulting from the Salamanca, Sorbonne,
Bologna, and WHO Declarations. He is a Fellow in the American Academy of
Nursing, a Transcultural Nursing Scholar, Luther Christman Fellow, and is on
the Rosa Parks Wall of Fame for Teaching Tolerance.

61
 A. What is the Model?

The Purnell Model of Cultural Competence is proposed as an organizing framework

to guide cultural competence among multidisciplinary members of the healthcare
team in a variety of primary, secondary, and tertiary settings. The Purnell Model for
Cultural Competence started as an organizing framework in 1991 when the author
was teaching undergraduate students and discovered the need for both students
and staff to have a framework for learning about their cultures and the cultures of
their patients and families. Comments from staff and students made it dear that
ethnocentric behavior and lack of cultural awareness, cultural sensitivity, and
cultural competence existed. The Purnell Model was designed as a wholistic
organizing framework with specific questions and a format for assessing culture that
could be used across disciplines and practice settings. Multidisciplinary healthcare
professionals can use the Purnell Model as a guide for assessing, planning,
implementing, and evaluating interventions.

The Model is a circle, with an outlying rim representing global society, a second rim
representing community, a third rim representing family, and an inner rim
representing the person. The interior of the circle is divided into 12 pie-shaped
wedges depicting cultural domains and their concepts. The dark center of the circle
represents unknown phenomena. Along the bottom of the model is a jagged line
representing the nonlinear concept of cultural consciousness. The 12 cultural
domains (constructs) provide the organizing framework of the model. The value and
utility of the Purnell Model has been documented in developing cultural competence
across disciplines and in stimulating further inquiry and knowledge quest.

Healthcare providers can use this same process to understand their own cultural
beliefs, attitudes, values, practices, and behaviors.

Purnell Model for Cultural Competence by Larry Purnell

62
The Purnell Model for Cultural Competence comprises of 12 culture domains. In the
figure below:
 the Outer Rim represents global society;
 the Second Rim represents community;
 the Third Rim represents family;
 the Inner Rim represents person;
 the Interior depicts 12 domains;
 the Center is empty, representing what we do not yet know about culture;
and
 the Saw-Toothed Line represents concepts of cultural consciousness.

Concepts of Cultural Consciousness

Variant cultural characteristics: age, generation, nationality, race, color,
gender, religion, educational status, socioeconomic status, occupation, military
status, political beliefs, urban versus rural residence, enclave identity, marital
status, parental status, physical characteristics, sexual orientation, gender issues,
and reason for migration (sojourner, immigrant, undocumented status)

Unconsciously incompetent - Not being aware that one is lacking knowledge

about another culture
Consciously incompetent - Being aware that one is lacking knowledge about
another culture
Consciously competent - Learning about the client’s culture, verifying
generalizations about the client’s culture, and providing culturally specific
interventions

Unconsciously competent - Automatically providing culturally congruent care to

clients of diverse cultures
12 Cultural Domains
It is not intended for domains to stand alone, rather, they affect one another.
1. Overview/heritage
Concepts related to country of origin, current residence, and the effects of the
topography of the country of origin and current residence, economics, politics,
reasons for emigration, educational status, and occupations.
2. Communication
Concepts related to the dominant language and dialects; contextual use of the
language; paralanguage variations such as voice volume, tone, and intonations; and
the willingness to share thoughts and feelings. Nonverbal communications such as
the use of eye contact, facial expressions, touch, body language, spatial distancing
practices, and acceptable greetings; temporality in terms of past, present, or future
worldview orientation; clock versus social time; and the use of names are important
concepts.
3. Family roles and organization

63
 Concepts related to the head of the household and gender roles; family roles,
priorities, and developmental tasks of children and adolescents; child-rearing
practices; and roles of the ages and extended family members. Social status and
views toward alternative lifestyles such as single parenting, sexual orientation,
child-less marriages, and divorce are also included in the domain.
4. Workforce issues
Concepts related to autonomy, acculturation, assimilation, gender roles, ethnic
communication styles, individualism, and health care practices from the country of
origin.
5. Bicultural ecology
Includes variations in ethnic and racial origins such as skin coloration and
physical differences in body stature; genetic, heredity, endemic, and topographical
diseases; and differences in how the body metabolizes drugs.
6. High-risk behaviors
Includes the use of tobacco, alcohol and recreational drugs; lack of physical
activity; nonuse of safety measures such as seatbelts and helmets; and high-risk
sexual practices.
7. Nutrition
Includes having adequate food; the meaning of food; food choices, rituals, and
taboos; and how food and food substances are used during illness and for health
promotion and wellness.
8. Pregnancy and childbearing
Includes fertility practices; methods for birth control; views towards pregnancy;
and prescriptive, restrictive, and taboo practices related to pregnancy, birthing, and
postpartum treatment.
9. Death rituals
Includes how the individual and the culture view death, rituals and behaviors to
prepare for death, and burial practices. Bereavement behaviors are also included in
this domain.
10. Spirituality
Includes religious practices and the use of prayer, behaviors that give meaning
to life, and individual sources of strength.
11. Health care practices
Includes the focus of health care such as acute or preventive; traditional,
magico-religious, and biomedical beliefs; individual responsibility for health; self-
medication practices; and views towards mental illness, chronicity, and organ
donation and transplantation. Barriers to health care and one’s response to pain
and the sick role are included in this domain.
12. Health care practitioner
Concepts include the status, use, and perceptions of traditional, magico-
religious, and allopathic biomedical health care providers. In addition, the gender of
the health care provider may have significance. The major focus: is to identify
culture care beliefs, values, patterns, expressions, and meanings related to the
clients’ needs for obtaining or maintaining health or to face acute or chronic illness,
disabilities, or death.
In cultural care assessment the nurse goes beyond assessment of physical,
psycho. , social, and mental aspects to include or tap the holistic or totality living
and functioning dimensions. Nurses are taught in Trans- cultural nursing to use
liberal arts and other broad areas of knowledge to get a realistic and accurate
picture of people and their health needs or concerns

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Assumptions of Purnell’s Model for Cultural Competency:

 All healthcare professions need similar information about cultural diversity.

 All healthcare professions share the metaparadigm concepts of global
society, family, person, and health.
 One culture is not better than another culture; they are just different.
 Cultures change slowly over time.
 The primary and secondary characteristics of culture determine the degree to
which one varies from the dominant culture.
 If clients are co-participants in their care and have a choice in health-related
goals, plans, and interventions, their compliance and health outcomes will be
improved.
 Culture has a powerful influence on one's interpretation of and responses to
health care.
 Individuals and families belong to several cultural groups.
 Everyone has the right to be respected for his or her uniqueness and cultural
heritage.
 Caregivers need both cultural-general and cultural-specific information to
provide culturally sensitive and culturally competent care.
 Caregivers who can assess, plan, intervene, and evaluate in a culturally
competent manner will improve the care of clients for whom they care.
 Learning culture is an ongoing process that develops in a variety of ways, but
primarily through cultural encounters (Campinha-Bacote, 2004).
 Prejudices and biases can be minimized with cultural understanding.
 To be effective, health care must reflect the unique understanding of the
values, beliefs, attitudes, lifeways, and worldview of diverse populations and
individual acculturation patterns.
 Differences in race and culture often require adaptations to standard
interventions.
 Cultural awareness improves the caregiver's self-awareness.
 When individuals of dissimilar cultural orientations meet in a work or
therapeutic environment, the likelihood for developing a mutually satisfying
relationship is improved if both parties in the relationship attempt to learn
about each other's culture.
 Culture is not border bound; people bring their culture with then when they
migrate.
 Professions, organizations, and associations have their own culture, which
can be analyzed using a grand theory of culture.

The critical points of the model:

65
Individual values, beliefs, and behaviors about health and well-being are shaped by
various factors such as race, ethnicity, nationality, language, gender, socioeconomic
status, physical and mental ability, sexual orientation, and occupation. Cultural
competence in health care is broadly defined as the ability of providers and
organizations to understand and integrate these factors into the delivery and
structure of the health care system. The goal of culturally competent health care
services is to provide the highest quality of care to every patient, regardless of race,
ethnicity, cultural background, English proficiency or literacy.

Cultural competence comprises four components: (a) Awareness of one's own

cultural worldview, (b) Attitude towards cultural differences, (c) Knowledge of
different cultural practices and worldviews, and (d) cross-cultural skills. Cultural
competence is not an isolated aspect of medical care, but an important component
of overall excellence in health care delivery. Issues of health care quality and
satisfaction are of particular concern for people with chronic conditions who
frequently come into contact with the health care system. Efforts to improve
cultural competence among health care professionals and organizations would
contribute to improving the quality of health care for all consumers. The Purnell
Model of Cultural Competence is proposed as an organizing framework to guide
cultural competence among multidisciplinary members of the healthcare team in a
variety of primary, secondary, and tertiary setting. Multidisciplinary healthcare
professionals can use the Purnell Model as a guide for assessing, planning,
implementing, and evaluating interventions. Through a systematic appraisal for
each client and individualizing care, improved opportunities for health promotion,
illness and disease prevention, and health restoration occurs. Cultural general
knowledge and skills ensures that providers have a process for becoming culturally
competent. The purposes of the Purnell Model are: to provide a framework for all
healthcare providers to learn concepts and characteristics of culture; provide a
model that links the most central relationships of culture; and interrelate
characteristics of culture to promote congruence and to facilitate the delivery of
consciously sensitive and competent health care.

Purposes of a culture care assessment:

1. To discover the clients culture care and health patterns and meanings in relation
to the clients worldview, life ways, cultural values, beliefs, practices, context, and
social structure factors.
2. To obtain holistic culture care information as a sound basis for nursing care
decisions and actions.
3. To discover specific culture care patterns… that can be used to make differential
nursing decisions that fit the client’s values and life ways and to discover what
professional knowledge can be helpful to the client.
4. To identify potential areas of cultural conflicts, clashes, and neglected areas
resulting from emic and etic value differences between clients and professional
health personnel

66
5. To identify general and specific dominant themes and patterns that need to be
known in context for culturally congruent care practices.
6. To identify comparative cultural care information among clients of different or
similar cultures, which can be shared and used in clinical, teaching, and research
practices.
7. To identify both similarities and differences among clients in providing quality
care.
8. To use theoretical ideas and research approaches to interpret and explain
practices for congruent care and new areas of Trans- cultural nursing knowledge for
discipline users.

The sunrise model serves as a guide to cultural assessment. The major

areas for assessment are the following:
1. Cultural values, beliefs, and practices.
2. Religious, philosophical, and spiritual beliefs.
3. Economic factors.
4. Educational factors.
5. Technological views.
6. Kinship and social ties.
7. Political and legal factors.

Principles for culturological assessment

1. To show a genuine and sincere interest in the client as one listens to and learns
to and learns from the client.
2. To give attention to gender or class differences, communication modes (with
special language terms), and interpersonal space.
3. The nurse need to remain fully aware of one’s own cultural biases and prejudices.
If not aware about she will fall in a (cultural blindness)
4. To remain an active listener to fit client expectations and create a climate that is
trusting so that the client feels it is safe and beneficial to share ones beliefs and
life ways.

Transcultural communication modes

The nurse should understand the many verbal and nonverbal modes of many
diverse cultures. This is an imperative today in this multicultural world. Nurses
should speak at least two languages today. Body language expressions are forms of
communication and are culturally patterned. Kinesics is the term that refers to body
movements’ communication modes, which include posture, facial expressions
(smile or anger), gestures, eye contact, and other body features.

Proxemics: it refers to the use and perception of interpersonal or personal space in

socio cultural interactions. Finally, within the many areas of Tran cultural
communication, a few pointers need to be given about the use of interpreters to get
accurate assessments. The interpreter should know the clients cultural language
and knows the culture. ("Cultural Care Assessment for Congruent Competency
Practices")

Leininger’s short culturological assessment guide:

67
Phase 1: Record observation of what you see, hear or experience with clients
(includes dress and appearance, body condition features, language, mannerisms
and general behavior, attitudes, and cultural features).
Phase 2: Listen to learn from the client about cultural values, beliefs, and daily
(nightly) practices related to care and health in the clients environmental context.
Give attention to generic (home or folk) practices and professional nursing
practices.
Phase 3: identify and document recurrent client patterns and narratives (stories)
with client meanings of what has been seen, heard or experienced.
Phase 4: Synthesize themes and patterns of care derived from the information
obtained in phase 1, 2, 3.
Phase 5: Develop a culturally-based client-nurse care plan as co-participants for
decisions and actions for culturally congruent care.

Caring rituals important to assess:

In doing culture care assessments there are special areas bearing on caring
patterns and healing that provide valuable information.
1. Eating rituals
2. Daily and nightly ritual care activities
3. Sleep and rest ritual patterns
4. Life cycle rituals are especially crucial because they demonstrate patterns of
caring for health, as well as illnesses and generic folk life ways
5. Nurse and hospital rituals

Standards for culturally competent and congruent care

1. Consumers of diverse cultures have a right to have Tran cultural care standards
used to protect and respect their generic (folk) values, beliefs, and practices and to
have health personnel incorporate.
2. Nurses assessing and providing care to diverse culture or subcultures have a
moral obligation to be prepared in Transcultural nursing to provide knowledgeable,
sensitive, and research-based care to the culturally different.
3. Cultural assessment and practices need to demonstrate the use of Tran cultural
nursing concepts, principles, theories, and research findings and competencies to
ensure safe, congruent, and competent practices.
4. Nurses as caregivers have an ethical, morale, professional obligation and
responsibility to study, understand, and use relevant research-based Transcultural
care for safe, beneficial, and satisfying client or family outcomes.
5. Providing culturally competent and congruent care should reflect the caregiver’s
ability to assess and use culture-specific data without biases, prejudices,
discrimination, or related negative outcome
6. Nurses caring for clients of diverse cultures should seek to provide holistic care
that is comprehensive and takes into account the clients worldview and includes
ethno history, religion (or spiritual), morale/ ethical values, specific cultural care
beliefs and values, kinship ties.
7. Nurses demonstrating cultural competence and congruent care maintain an
open, learning, flexible attitude and desire to expand their knowledge of diverse
cultures and caring life ways.
8. Nurses with Transcultural competencies show evidence of being able to use local,
regional, and national resources for beneficial care outcomes.

68
9. Nurses with Transcultural competencies demonstrate leadership skills to work
with other nurses and interdisciplinary colleagues who need help to provide
culturally safe and congruent client practices, thus preventing cultural imposition,
cultural pain offenses, cultural conflicts, and many other negative and destructive
outcomes.
10. Nurses with Transcultural competencies are active to defend, uphold, and
improve care to clients of diverse cultures and to share their research findings and
competency experiences in public and professional arenas ("Cultural Care
Assessment For Congruent Competency Practices").

III. Health Traditions Model by RACHEL E. SPECTOR, PhD, RN, CTN, FAAN
(Associate Professor, Boston College School of Nursing

Health Traditions Model started with this research question…

“What do people really do to maintain, protect, and restore their physical,

mental and spiritual health?

Health Traditions Model

 Was formally created in 1994

 Uses the concept of holistic health
 HEALTH as a complex, interrelated phenomena— the balance of all facets of
the person—the body, mind, and spirit.
 The balance of a person, both within one’s being –- physical, mental, and
spiritual –- and in the outside world – natural, familial, and communal, and
metaphysical.
 ILLNESS (imbalance)
 HEALING (restoration of person’s balance..)
 explores what people do from a traditional perspective to maintain HEALTH,
protect HEALTH or prevent illness, and/or restore HEALTH
 A method for describing traditional culturally based HEALTH beliefs and
practices used to:
 Maintain through daily HEALTH practices such as diet, activities, and
clothing
 Protect through special HEALTH practices, such as food taboos, seasonal
activities, and protective items worn, carried, or hung in the home or
workplace and/or
 Restore through special HEALTH practices such as diet changes, rest,
special clothing or objects, prayer or meditation

The Health Traditions Model

Physical Mental Spiritual

Maintain Dietary Senses Rituals

HEALTH
Protect HEALTH Amulets Traditions Talisman

69
 Restore HEALTH Herbals Massage Prayer and
meditation

 The model has six discrete categories of ways to examine HEALTH in

the dimensions mentioned above. It examines the three parts of HEALTH
physical, mental, and spiritual and the ways HEALTH may be maintained,
protected, and restored.

HEALTH Traditions from a personal perspective

Health Physical Mental Spiritual

Maintain Proper clothing, proper Social and family Religious

diet, exercise and rest support systems practices, prayer
hobbies and/or meditation
Protect special diets and food Avoid certain people Religious customs
taboos, symbolic who can cause illness Supertitions
clothing Family and amulets and
community activities talisman
Restore Homeopathic remedies Relaxation, exorcism Religious rituals,
Liniments Curanderos and changing names,
Herbal teas traditional healers exorcism
Special foods
Massage
Acupuncture
moxibustion

 HEALTH Traditions from a personal perspective, provides examples of what can

be expected in each of the categories. For example, are certain types of clothing
necessary? Are certain foods encourages or prohibited? What amulets may the
person use?

HEALTH Traditions from a community perspective

Health Physical Mental Spiritual

Maintai Availability of proper Availability of Availability and

n shelter, clothing, and traditional sources of promulgation of
food entertainment, ritual and religious
Safe air, water, soil concentration, and worship meditation
“rules” of the culture

Protect Provision of the Provision of the The teaching of

knowledge of knowledge of what religious customs,
necessary special people and situations superstitions,
foods and food to avoid, family wearing
combinations, the activities amulets and other
wearing of symbolic symbolic objects to

70
 clothing, and prevent the “evil
avoidance of excessive eye” or how to
heat or cold defray other sources
of harm
Restore Resources provide Traditional healers with The availability of
homeopathic remedies the knowledge to use healers who use
Liniments such modalities as magical and
Herbal teas relaxation, exorcism supernatural ways to
Special foods Story-telling, and/or restore health:
Massage nerve teas including religious
Acupuncture rituals, special
moxibustion prayers, meditation,
traditional healings,
and or exorcism

 HEALTH Traditions from a community perspective, provides examples of what

can be expected in each of the categories. For example, where are certain types
of clothing obtained? Where are certain foods available and what foods are
prohibited? What amulets may the person use? Where are they obtained?

Process
The process component of the course focused on several steps:
1. The first step explores personal heritage—Who are you? What is your heritage?
What are your health/HEALTH beliefs?
There are 4 questions that can be asked in doing a “Heritage Assessment” to help
determine the degree to which a person identifies with a traditional heritage:
1. Do you mostly participate in social activities with members of your
family?
2. Do you mostly have friends from a similar heritage (cultural background)
as you?
3. Do you mostly eat the foods of your family’s traditional heritage?
4. Do you mostly participate in the religious and ethnic traditions of your
family?
If the 3 or 4 of these questions are answered “yes,” the person most likely identifies
with his or her traditional family and heritage. The chances of this person following
traditional HEALTH beliefs and practices are high.

2. Heritage of others—demographics— Who is the other person? Family?

Community? The same four questions as above may be asked with similar
expectations.

3. Health/HEALTH beliefs and practices—What are the HEALTH beliefs and

practices that this person/family/community is bringing to the health care
setting? Are there competing philosophies? For example, if the given person
practices the principles of HEALTH care from their tradition the practices may
be incompatible with modern technological medical care. When this is the
situation, there may be countless issues of non-adherence to modern
medicine and ethical conflicts.

71
 4. Modern Health Care - culture and system—What is the situation within the
dominant culture’s health care system? What are the prevailing issues and
problems in the nurses’ practice settings?
5. Traditional HEALTH Care culture and systems—the way HEALTH care was
for most and the way HEALTH care still is for many. What are the HEALTH
beliefs and practices that are found in the intangible cultural heritage of a
given person/family/community?
6. Ongoing process for developing CULTURALCOMPETENCY, and you are
ready to open the door to CULTURALCARE. CULTURALCARE is holistic care.
The need to provide CULTURALCARE is essential, and nurses must be able to
assess and interpret a patient’s HEALTH beliefs and practices, cultural and
linguistic needs. CULTURALCARE alters the perspective of health care
delivery as it enables nurses to understand, from a cultural perspective, the
manifestations of the patient’s cultural heritage and life trajectory. The nurse
must serve as a bridge in the health care setting between the given
institution, the patient, and the people who are from different cultural
backgrounds. In addition to seeking answers for the above questions an
“urban hike” was held in Alicante to observe selected community resources
The students visited sites, including Santa Faz, a sacred shrine where people
go seeking HEALING, the central market, and an herbal store to observe
various community resources available to meet the parameters of the
HEALTH Traditions Model.

Health Traditions Assessment Model

Maintain Health
Physical Are there special clothes one must wear; foods one must
eat, not eat, or combinations to avoid; exercises one must
do?
Mental Are there special sources of entertainment; games or other
ways of concentrating; traditional rules of behavior?
Spiritual Are there special religious customs; prayers; meditations?
Protecting Health and Preventing Illness

Physical Are there special foods that must be eaten after certain life
events such as childbirth; dietary taboos that must be
adhered to; symbolic clothes that must be worn?
Mental Are there special people that must be avoided; rituals for
self-protection, familial roles?
Spiritual Are there special religious customs; superstitions; amulets;
oils or waters?
Restoring Health
Physical Are there special folk remedies; liniments; procedures such
as cupping, acupuncture, and maxibustion?
Mental Are there special healers such as curanderos available,
rituals, folk medicines?
Spiritual Are there special rituals and prayers; meditations; healers?

72
Assessment Guide for personal methods to maintain, protect, and restore
health

Health Physical Mental Spiritual

Maintai Are there special clothes What do you do for Do you practice
n you must wear at certain activities such as your religion and
times of the day, week, reading, sports, attend church or
year? games? other communal
Are there special foods Do you have activities?
you must eat at certain hobbies? Do you
times ? Do you visit family pray/meditate?
Do you have any dietary often? Do you observe
restrictions? Do you visit friends religious customs?
Are there any foods that often? Do you belong to
you cannot eat? fraternal
organizations?
Protect Are there foods that you Are there people or Do you observe
cannot eat together? situations that you religious customs?
Are there special foods have been taught to Do you wear any
that you must eat? avoid? amulets or hang
Are there types of Do you take them in your
clothing that you are not extraordinary house?
allowed to wear? precautions under Do you have any
certain practices such as
circumstances? always opening
Do you take time for the window when
yourself? you sleep?
Do you have any
practices to
protect yourself
from “harm”?
Restore What kinds of medicines Do you know of any Do you know any
do you take before you specific practices healers?
see a doctor or nurse? your mother or Do you know of
Are there special foods grandmother may any religious
that you must eat? use to relax? rituals that help to
Are there herbs that you Do you know how big restore health?
take? problems can be Do you meditate?
Are there special cared for in your Do you ever go to
treatments that you use? community? a healing service?
Do you drink special Do you know
teas to help you about exorcism?
unwind or relax?

IV. Cultural CARE Assessment (Capinha Bacote)

73
“Cultural competence is a process of becoming culturally competent, not being
culturally competent.” - Dr. Campinha-Bacote

“The Process of Cultural Competence in the Delivery of Healthcare Services,” is a

culturally conscious model of healthcare delivery that defines cultural competence
as “the process in which the healthcare professional continually strives to achieve
the ability and availability to effectively work within the cultural context of a client”
(family, individual or community). It is a process of becoming culturally competent,
not being culturally competent. This model of cultural competence views cultural
awareness, cultural knowledge, cultural skill, cultural encounters and cultural desire
as the five constructs of cultural competence. Cultural encounter is the pivotal
construct of cultural competence that provides the energy source and foundation
for one’s journey towards cultural competence. (Bacote, Dr. Capinha)
1. Clinical – We provide direct and indirect consultation regarding clients with
health care and mental health issues related to their cultural and/or ethnic
background.
2. Administrative – We provide agencies with consultation, training and
presentations regarding such administrative issues as organizational cultural
competence, recruitment and retention of minorities, and cultural diversity in
the workforce.
3. Research – We provide consultation on research grants, demonstration
projects, and proposals in the areas of cultural competency and the delivery
of culturally responsive healthcare services and cultural competence in the
health professions.
4. Educational – We conduct workshops, seminars and presentations on
various topics of cultural competence in health care and mental health, as
well as provide in-service education to clinicians and other healthcare
providers on cultural competence. (Bacote, Dr. Capinha)

V. Cultural Diversity in Health & Illness Model (Rachel Specter)

Activity:
1. Form 5 groups.
2. Each group will choose one TCN model for presentation.
3. Guide questions for presentations:
a. What is the model?
b. Who is the proponent? (Give a short biography of the author)
c. What are its assumptions and explain briefly each.
d. What are the critical points of the model? Discuss its usability
in any health care setting.

VI. Ethical decision making (Dula Pacquiao)

A. What is the model?

74
Ethical decision-making models provide a suggested mechanism for critical thinking
and planning for the resolution of ethical dilemmas. An ethical decision-making
model is a tool that can be used by health care providers to help develop the ability
to think through an ethical dilemma and arrive at an ethical decision.

Nurses encounter ethical dilemmas constantly in our fast-paced healthcare field.

Ethical principles are thus one of the most important aspects of clinical practice.
Ethical principles are a set of standards that help nurses make informed decisions
when evaluating the consequences of their actions.

What are these principles?

Nurses are first and foremost expected to respect all patients equally without
discrimination. They must also give patients autonomy, meaning patients must be
allowed to make their own decisions about treatment even if it isn't in their best
interest. And another essential principle of nursing practice is nonmaleficence,
which reminds us to cause no intentional harm to patients. This includes things like
identifying both benefits and risks of medical treatment options.

Each of these main principles of respect, autonomy, and nonmaleficence should be

carefully evaluated when ethical conflicts arise to ensure that decisions do not
jeopardize any of these principles.

B. Who is the proponent? (Give short biography of the author)

- Dula F. Pacquiao is the proponent of Cultural Competence in Ethical Decision

Making. On 1992, she graduated Doctor of Education (EdD) major in Anthropology
of Education at Rutgers University, New Brunswick, NJ and she had her Master of
Arts, Curriculum and Institution in Nursing on 1997 at Teachers College, Columbia
University, NY. On 1968 she graduated Bachelor of Science in Nursing at University
of the Philippines and she is the class valedictorian.

- On 1998-1999, she became the director of Transcultural Nursing Institute and

Graduate program in Nursing at Kean University and on 1992-1998, she became the
Assistant professor at Kean University.

- On 1993- 1998, Ms. Dula became the Board Member and Chair of Education
Committee, NJ. On 1994-1996, she became the Secretary of Transcultural Nursing
Society and became the Chair, Nursing Practice ana Education Committee, National
Council of State Boards of Nursing, at Chicago. On 1995-1996, she became the
President of Transcultural Nursing Society and became a member of NJ
commissioner of health, nursing advisory committee and presented certified in
Transcultural Nursing. On 1998, she presents Associate editor, Journal of
Transcultural Nursing and on 1999-2002, Ms. Dula became the Vice President of
Transcultural Nursing Society.

C. What are its assumptions and explain briefly each.

1. First it must be understood that "Access to cultural competence care is basic
human rights"

75
-culturally Competent Care is defined as care that respects the diversity of patient
populations and cultural factors that may affect health and healthcare, such as
language, style, communication, beliefs, attitudes, and behaviors.

2. The second assumption made for the model is that in order to provide ethical
care, it must be culturally congruent and competent.
-it must be culturally congruent and competent meaning involves applying
knowledge of how culture influences one's health beliefs, health practices, and
communication patterns at each stage of the nursing process.

3. The third modular assumption is that the "culture of health care organizations
and professions reflect the dominant societal culture".
-a dominant culture is one that has established its own norms, values, and
preferences as the standard for an entire group of people. Preferences and norms
are imposed regardless of whether they contradict what is usual for other members
of the group.

4. The fourth assumption is that ethical decision must be made with "awareness of
personal, professional and organizational cultural values and biases as well as
understanding their influence on interactions with others" to be truly competent.
-the ability to recognize the different beliefs, values, and customs that someone has
based on that person's origins, and it allows a person to build more successful
personal and professional relationships in a diverse environment.

5. The fifth assumption states that cultural competence needs to take place on all
levels: practitioner, organizational, societal or community.
- Cultural competence in the workplace to help managers and employee’s better
communication and coordinate with co-workers and clients. This can increase
engagement and productivity.

6. The sixth assumption made is that "culturally competent ethical decisions use the
-modes of cultural preservation, accommodation, and repatterning separately or
simultaneously"
-Cultural preservation refers to nursing care activities that help people of particular
cultures to retain and use core cultural care values related to healthcare concerns
or conditions.
-Culture care repatterning includes those assistive, supporting, facilitative, or
enabling professional actions and decisions that help clients reorder, change, or
greatly modify their lifeways for new, different, and beneficial health care pattern
while respecting the clients' cultural values.

7. Lastly, " application of cultural action modes requires understanding of the

values, beliefs, and lifeways of clients, families, and communities"

-There are certain values considered most important in providing nursing care,
these include patient well-being and patient choice. You are accountable to listen
to, understand, and respect patients' values, opinions, needs, and ethno-cultural
beliefs.

76
D. What are the critical points of ethical discission making?

There are three important factors that can influence ethical decision making, which
are individual, organizational, and opportunity factors. All three of these factors can
weigh heavily on a person during the decision-making process, especially in the
work place. Many people look to friends or associates for guidance when making
questionable decisions. Sometimes a person may make a decision based on the
opportunity they are put into. Some people make decisions based on their own
moral beliefs and the way they were raised. No matter how a person comes to make
a decision, there are usually three factors that influence a person’s ethical decision-
making process.

End of Finals Coverage

 Do not forget to write your reflective journal for this term regarding
your learnings, personal reflections and realizations of the different
concepts given. All written outputs should be compiled in your
learning portfolio to be submitted to the subject teacher as part of
the requirements of the course.

EVALUATION:
1. Individual and group activities.
2. Self-Reflection question at the end of the term.

REQUIREMENTS:
After this module, you are expected to submit the following on the date given by
your instructor:

1. Learning Portfolio composed of:

 A copy of the answer sheet duly accomplished found at the last part of
each term.
 Your reflective journal in using the module.
2. Term examinations.

REFERENCES:

1. Berman, A., (2021). Kozier and Erb’s, Fundamentals of Nursing Concepts,

Process and Practice volume 1 + volume 2.
2. Cooper, K. & Gosnell, K. (2019). Adult health nursing (8th edition). USA:
Lippincott Williams and Wilkins.
3. Hinkle, J. & Cheever, K. (2022). Brunner and Suddarth’s textbook of medical
– surgical nursing volume 1 & 2 (14th edition). USA: Wolters Kluwer Health
4. Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2019). Wong's nursing care
of infants and children. St. Louis, MO: Elsevier.
5. Silbert-Flagg, J., & Pillitteri, A. (2023). Maternal & child health nursing : care
of the childbearing & childrearing family. Wolters Kluwer.

77
Other References:

1. Bacote, Dr. Capinha (2017). "The Process Of Cultural Competence In The

Delivery Of Healthcare Services". Transcultural C.A.R.E Associates. Retrieved
from: http://transculturalcare.net/the-process-of-cultural-competence-in-the-
delivery-of-healthcare-services/.

2. "Cultural Care Assessment For Congruent Competency Practices".

Google.Com.Ph, 2017, https://www.google.com.ph/url?
sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKE
wi89WN_bTRAhUFoJQKHVkpBXEQFggzMAE&url=http%3A%2F
%2Ffaculty.ksu.edu.sa%2F73861%2FNUR471%2FCultural%2520care
%2520assessment%2520for%2520congruent%2520competency
%2520practice.doc&usg=AFQjCNEjy3dkeAS3nP9W5bRa_pWOmEdJGw&sig2=
CSn1s4kwgjosIJtjw_lj4Q

3. Murphy, Sharon. "Mapping The Literature Of Transcultural Nursing". Pubmed

Central (PMC), 2017,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1463039/.
4.
5. Pacquiao, Dula (2017). "Ethics And Cultural Diversity- A Framework For
Decision Making". Retrieved from:
https://practicalbioethics.org/files/members/documents/Pacquiao_17_3_4.pdf.

6. Spector, Rachel (2017). “Cultural Diversity in Health and Illness".

Journals.Sagepub.Com,
http://journals.sagepub.com/doi/pdf/10.1177/10459602013003007.

7. "The Giger and Davidhizar (2017). Transcultural Assessment Model - Jun 29,
2016".
Journals.Sagepub.Com,http://journals.sagepub.com/doi/abs/10.1177/1045960
2013003004.

78
 APPENDICES

RUBRIC FOR GROUP PRESENTATION

Poor (2 Fair (3 Good (4 Very Good (5

Points) Points) Points) Points)

Organizatio Audience Audience Student Student presents

n cannot has difficulty presents information in
understand following information logical, interesting
presentatio presentation in logical sequence which
n because because sequence audience can
there is no student which follow.
sequence jumps audience
of around. can follow.
information
.

Subject Student Student is Student is Student

Knowledge does not uncomfortab at ease with demonstrates
have grasp le with expected knowledge by
of information answers to answering
information and is able all questions with
; student to answer questions, explanation.
cannot only but fails to
answer rudimentary elaborate
questions questions.
about
subject.

Elocution Student Student's Student's Student uses a

mumbles, voice is low. voice is clear voice and
incorrectly Student clear. correct, precise
pronounce incorrectly Student pronunciation of
s terms, pronounces pronounces terms so that all
and speaks terms. most words audience members
too quietly Audience correctly. can hear
for members Most presentation;excell
students in have audience ent rate of speed

79
 the back of difficulty members for delivery
class to hearing can hear
hear; presentation presentatio
speaks too ; speed n; good rate
fast or delivery is a of speed for
leaves long bit fast in delivery
pauses. spots and
slow in
others

Audio Student Student use Student's Student's A/V

/visual uses No audiovisual A/V relate explain and
audio/visua aids to read to text and reinforce topic and
l aids out the presentatio presentation.
material n.

Creativity Shows creative

No Lacks some
creativity/ creativity creativity
right out
from book

80
 RUBRICS FOR SHORT ANSWER ESSAY

5 4 3 2 1 0

Excellent Very Good Fair Poor Non-

Good Compliant

Correctnes Correct Answer Answer Answer Answer (No answer

s of answer is provided is provided provided given is Provided)
Answer given correct but is similar is not incorrect,
(right incomplete concept clear and has no
terminolog with the relation to
y or correct the topic or
concept) answer. question
being
asked.

Concise Explanatio Explanatio Explanati Explanatio Explanation No answer

explanatio n is n is correct on is n is is incorrect. Provided
n supported but is not correct missing
with supported but the
appropriat with supportin significant
e appropriat g informatio
concepts. e concept. concepts n.
is not
applicable
.

Sentence Answer is Answer is Answer Answer is Sentences No answer

compositio presented presented does not too long are Provided
n briefly briefly but follow the and lacks incomprehe
with with format significant nsible.
correct grammatic provided. informatio
grammar al errors. n.
and
punctuatio
ns.

Total: 15 Points

81
 RUBRICS FOR STUDENT’S PORTFOLIO

Good Fair Poor

10 POINTS 7 POINTS 4 POINTS

COMPONENTS
All components Some of the Many of the
are included preliminary components
Includes cover page and clearly components are needed are
(Vision, Mission) marked missing. missing.
Level Outcomes
ORGANIZATION
Organization Organization Organization
follows all the slightly follows does not follow
It follows the instructions for the instructions the instructions
instructions for the the portfolio. for the portfolio. given for the
portfolio portfolio.

NEATNESS and Presentation Presentation has Presentation

CREATIVITY demonstrate the sligth doesn't shows
neatness and demonstration of neatness nor
creativity in all neatness and creativity.
areas and pages creativity to
of the portfolio some extent

COMPLETENESS OF Contents are Some of the Most of the

CONTENTS completely filed contents are contents are
and submitted missing and missing and/ or
disarranged. disarranged

82
ROMPTNESS
Student Student portfolio Student
Working Days
portfolio is submitted one portfoilio
submitted on day after the submitted two
time given deadline. days, a week, or
more after the
given deadline.

83