NCS 2202: Culture and Health - Reflection on Patient Care

This essay provides a detailed reflection on the relationship between culture and health, specifically focusing on the case of a 54-year-old Torres Strait Islander patient diagnosed with Type 2 diabetes and showing signs of pre-Alzheimer's dementia. The author, a nurse at Thursday Island Hospital in Australia, utilizes the Purnell Model of Cultural Competence (PMCC) to analyze the cultural factors influencing the patient's health and treatment. The essay discusses the patient's symptoms, the challenges in providing culturally competent care, and the need for practice modifications to create a safe environment. The theoretical frameworks, including WHO's dimensions of health and the concept of indigeneity, are used to support the analysis. Furthermore, the essay emphasizes the importance of cultural knowledge, cultural competence, and cultural encounters in providing effective healthcare, addressing the impact of religious beliefs and social determinants on the patient's well-being, and proposing strategies to reduce disparities and promote health equity.

Running Head: REFLECTION ON RELATION BETWEEN CULTURE AND HEALTH
REFLECTION ON RELATION BETWEEN CULTURE AND HEALTH
Name of the Student
Name of the University
Author Note

Running Head: REFLECTION ON RELATION BETWEEN CULTURE AND HEALTH
On introduction, this essay will discuss the health issue related to a person selected
from the culture group (Torres Strait islander) in Australia. Australian population is divided
in two groups. They are indigenous and non indigenous Australians. Cultural frameworks
will be used later to establish a care strategy. Diabetes type 2 is the disease concerned in this
essay. This diseased condition will be supported by various concepts and theories later in this
essay. The Purnell Model of Cultural Competence (PMCC) theoretical framework will be
used to describe the relationship between health and culture. Torres Straits are indigenous
Australians. The establishment of a safe cultural environment is required to undergo a proper
treatment process. This establishment procedure is also talked about in this paper. Later in
this essay, linkages between the cultural influence and theoretical frameworks, practice
modifications and requirements to achieve a culturally safe environment will also be
discussed.
My client originated from the Torres Strait islander culture group of indigenous
Australians. .Currently, I am practising nursing in Thursday Island Hospital, Australia and
have selected a client for my study. He is fifty-four years old and belongs to Queensland,
Australia. Aboriginal Torres strain constitutes two seventy-four small islands present on the
waterway which separates Australia’s Cape York peninsula from New Guinea. My client
belongs to remote parts of Roma. This place has not got urbanised as major cities of
Australia, located in Queensland. I selected this client because I had previous experiences
with the health issues related to this client. Four weeks earlier, he was admitted to the
hospital. Torres community constitutes the indigenous populations of Australia. They are
mainly lagging than the non-indigenous people because of their living styles and lack of
urbanisation. Christianity is the primary religion of Torres Strain Islanders. Science of
Christianity teaches people to get healed by GOD in case of a diseased condition (Ferngren,
2017). This factor influences the fact of not visiting a hospital after being diseased.

Running Head: REFLECTION ON RELATION BETWEEN CULTURE AND HEALTH
Therefore, the following sections will discuss the health issues associated with my client and
the modifications of practice required to create a culturally safe environment for my client.
Concepts and theories were used to support the diseased condition concluded from
the symptoms. Several symptoms were shown by my client, which helped me to identify the
health issue correctly. The primary sign he was showing was frequent urination. Urination
rate was far more than healthy individuals. The average rate of urination is six to seven times
a day. However, this patient was experiencing frequent urination reported to three litters of
urine excretion per day. Other symptoms included drying of the body increasing thirst, tiring
of body, numbness in hands and feet, vision problems and patches on dark skin. These
physical symptoms first signalled me to reconfirm the disease after he was appointed to me
by the doctor. The disease he was suffering from was Type 2 Diabetes. All the above
symptoms stated earlier are the physical symptoms of diabetes type 2 (Ismail et al., 2017).
According to Schierhout et al., (2016), diabetes type 2 is the most prevalent type of diabetes
prevalent in Torres strait islanders. Type of diabetes was confirmed after his clinical
symptoms were checked after a round of tests. Normal blood sugar levels are around 5.7, and
this patient reported a very high blood sugar level of 6.7. This test result proved a chance of
diabetes type 2, where the mellitus condition occurs. Diabetes mellitus stands for a high
amount of sugar in the blood, along with other diabetic symptoms. In some cases, it can be
seen that secondary diseases start to emerge inside a patients body. These conditions arise
when the human body fails to fight an infection or an illness with their immune system. A
break in the immune system provides the barrier for entry of other diseases. Along with this
issue, he was also experiencing deliriums. At first, this condition was thought to be arising
because of his age. Later it was identified that the patient was also showing symptoms of pre-
Alzheimer's dementia. According to the Australian Bureau of Statistics (Healthdirect.gov.au,
2018), seventy per cent of people living in Australia suffers from mixed conditions of

Running Head: REFLECTION ON RELATION BETWEEN CULTURE AND HEALTH
diabetes and Alzheimer's disease. Some of the symptoms shown by my client were forgetting
his way back to the room and the names of family members. He was being unconscious of his
activities and experiencing deliriums in the form of unusual dreams. These symptoms made
the doctor perform brain imaging after I reported him about these facts. Memory problems
are mainly associated with Alzheimer’s dementia at this age, as confirmed by a study
(Laukkanen, 2016). My client showed no other symptoms of some other disease. He was
mostly complaining of his urination problems and memory-related issues. These issues were
mainly confirming the fact that he had a combination of diabetes and dementia, diabetes is
the primary disease.
Theoretical frameworks are used here to analyses the cultural factors while
establishing a care plan. The four dimensions of health as described by WHO (World Health
Organisation) are a complete, mental, social and physical being. This factor defines that a
person is stated to be healthy only when he or she is healthy as per the above four criteria. A
nursing care plan was devised, which took care of the cultural influences at a great extent.
Since the impact of culture has a high impact over the patients well being during treatment
tenure in the hospital, this factor has to care. Torres strait islanders are mainly present in
remote areas where the distribution of healthcare resources are not high. As a result, they
depend on Godly power to cure them of the disease. Therefore there is an urgent need to
ensure a proper culturally competent care plan for these people. The Purnell Model of
Cultural Competence (PMCC) is a theoretical framework which shows the relationship
between culture and health (Colleen Marzilli, 2016). The "Purnell Model for Cultural
Competence" was established by Larry D. Purnell and Betty J. Paulanka. This theory was an
border to group and arrange the features that affect the culture of a person. This model
incorporates plans about culture, healthcare and the person in concern. The framework uses
an ethnographic method to encourage cultural awareness and appreciation in relation to

Running Head: REFLECTION ON RELATION BETWEEN CULTURE AND HEALTH
healthcare. This theory is based upon the observations of nurses interacting with patients
from different cultural backgrounds. Culture and value are the two main concepts of this
theory. Culture talks about how an individual behaves with his surroundings, decide on a
social organisation and depending upon several factors. These factors are ethnic, minority and
custom related issues which needs to be taken care of while preparing a care plan for a
patient. I must accept all the religious beliefs to the patient to make him comfortable with my
care plan. This theory is based on the etic viewpoint, where outside observers were used in
deriving a conclusion. Another framework concept deals with quality of relationship with the
patient (Khatri, Gupta & Varma, 2017). This condition will be significantly improved if the
patient is supported by facilities by which he can express his social beliefs. Social
determinants are one of the significant factors inside the cultural frameworks of these people.
This section mainly takes care of the health promotions that can be applied for the patient.
The first criteria under this category are maintaining health equity among patients. This will
ensure that I am treating my client equally as another client, and there should be no biasness
during the treatment. Minority related distinction while taking care of the patients should not
arise. If such conditions appears, patients will suffer from inequality and will hamper the care
plan. Maintaining this framework by not discriminating between patients will ensure a good
impact on the care plan. Patients should never feel socially discriminated while undergoing
the treatment process.
The identified health issue from my side will be Type 2 Diabetes. I have a regular
care plan for my clients. These include, providing the medicines at correct times, providing
assistance to my patients and ensuring the nutritional wellbeing of my client. The above
stated three points always assure the comfortability of a patient. However, my care plan lacks
an emphasis on cultural factors such as respecting every religion and social belief of my
patient. Although the above-stated factor is not of a very great extent in the case of my care

Running Head: REFLECTION ON RELATION BETWEEN CULTURE AND HEALTH
plans, however, it still plays a significant role in my care plans. Diabetes treatment includes
the use of insulin injections. This factor may sound an easy process, but cultural factors like
religious beliefs, ethnic factors, values and safety play a significant role in administering
insulin to a patient. The above-stated statement may sound absurd; however, it is well
supported by an article (Khatri, Gupta & Varma, 2017). According to the concept of
indigeneity, the definition of indigenous states that people who live in native and other local
areas (Kowal, 2016). Therefore they do not get enough privileges from birth due to lack of
urbanisation. According to my client, he was admitted to another hospital which was in his
locality. He stated that healthcare practices were mainly dependant on cultural beliefs. The
processes weren’t enough scientific but linked mostly to God. As a result, since my client
belongs from a place where the social and cultural behaviour is different from conventional
scientific thinking, a modification in my care plan is required. This modification will help my
client to feel comfortable in terms of cultural background. One change will be to remove the
disbeliefs in insulin injection procedure during the treatment process. Frantz Fanon provided
a conceptual technique for promoting culture as the means of social safety in case of patients.
He stated that power imbalance linkage and inequitable relationships in case of social
determinants are the main aims of cultural safety. He said that nurses should understand the
linkages between colonisation and the statuses of health to change their attitudes towards the
patients (Molloy, & Grootjans, 2014). Therefore, my healthcare plan will act in such a way,
so that it fully supports the hegemonic practices and healthcare systems to support both
Torres strait islanders and Aboriginals. Hegemonic practices mean the domination of a
diversified cultural society by a higher class which manipulates the culture of the community
(Milner, 2018). Another modification can be to implement cultural competency in the care
plan (). This procedure will ensure the removal of disparities between rural and urban people
undergoing treatment. I can improve my care plan by following closing the gap strategy to

Running Head: REFLECTION ON RELATION BETWEEN CULTURE AND HEALTH
reduce the discriminations between the people of Torres straits and urban ones (Power et al.,
2018).
There are some requirements to be achieved during the creation of a culturally safe
environment for the patient and nurse. A few factors were already discussed in the previous
paragraphs. However, the primary four requirements will be discussed here. First comes the
cultural knowledge. Cultural knowledge stands for the understanding of cultural practices of
my client (Sargeant, Smith & Springer 2016). I have to know every type of cultural practices
performed in Torres Straits in order to understand my client's beliefs. This factor will ensure
a good relationship between the patient and the nurse and will allow the patient to undertake
the treatment process will full comfort. Cultural competence comes second during the
treatment process (Kelly et al., 2016). Cultural skills and desires mainly fall in this category.
Cultural desires mainly emphasise on motivation for learning about the cultural beliefs of the
patient. Cultural encounters are one of the main cultural competence factors. This process
will encourage nurses to engage themselves in cross-cultural interactions. I can learn more
about different types of cultural elements from people of different cultural backgrounds.
Access and alternative sources are the last two requirements to be achieved to ensure a
culturally competent care plan for patients (Savolainen, 2016). Indirect alternative processes
can be to undertake and attend several public healthcare programs. These programs provide
education about the cultural beliefs of indigenous Australians. Leading a group of NGO can
also be used as an alternative technique to interact with different types of people. Interacting
with different people will provide an excellent engaging impact on me and increase the
knowledge about diversities in communities. Therefore, these are the identifiable
requirements which can be implemented to ensure a good nursing plan in terms of cultural
aspect.

Running Head: REFLECTION ON RELATION BETWEEN CULTURE AND HEALTH
On a concluding note, it can be stated that a culturally significant care plan can
provide comfort to my clients. Although cultural aspects are divided into many categories,
they can make a better nursing plan if implemented correctly. Starting from the knowledge
and ending at alternative sources makes the cultural aspect a very diverse factor for people.
Categories may make the process slow; however a good future can be hoped of provided
every nursing plan becomes culturally significant.

Running Head: REFLECTION ON RELATION BETWEEN CULTURE AND HEALTH
References:
Ferngren, G. B. (Ed.). (2017). Science and religion: a historical introduction. JHU Press.
Healthdirect.gov.au. (2018). Dementia statistics. Retrieved 20 September 2019, from
https://www.healthdirect.gov.au/dementia-statistics
Ismail, K., Moulton, C. D., Winkley, K., Pickup, J. C., Thomas, S. M., Sherwood, R. A., ... &
Amiel, S. A. (2017). The association of depressive symptoms and diabetes distress
with glycaemic control and diabetes complications over 2 years in newly diagnosed
type 2 diabetes: a prospective cohort study. Diabetologia, 60(10), 2092-2102.
Kelly, J., Wilden, C., Chamney, M., Martin, G., Herman, K., & Russell, C. (2016). Improving
cultural and clinical competency and safety of renal nurse education. Renal Society of
Australasia Journal, 12(3), 106.
Khatri, N., Gupta, V., & Varma, A. (2017). The relationship between HR capabilities and
quality of patient care: the mediating role of proactive work behaviors. Human
resource management, 56(4), 673-691.Taylor, S., Thompson, F., & McDermott, R.
(2016). Barriers to insulin treatment among Australian Torres Strait Islanders with
poorly controlled diabetes. Australian Journal of Rural Health, 24(6), 363-370.
Kowal, E. (2016). Descent, classification and indigeneity in Australia. In Mixed race
identities in Australia, New Zealand and the pacific islands (pp. 31-47). Routledge.
Laukkanen, T., Kunutsor, S., Kauhanen, J., & Laukkanen, J. A. (2016). Sauna bathing is
inversely associated with dementia and Alzheimer's disease in middle-aged Finnish
men. Age and Ageing, 46(2), 245-249.
Marzilli, C., 2016. A Review of Cultural Competence in Healthcare. Researchers World,
7(4), p.45.

Running Head: REFLECTION ON RELATION BETWEEN CULTURE AND HEALTH
Milner, A. (2018). Cultural studies and cultural hegemony: comparing Britain and Australia.
In Again, Dangerous Visions: Essays in Cultural Materialism (pp. 298-318). BRILL.
Molloy, L., & Grootjans, J. (2014). The ideas of frantz fanon and culturally safe practices for
aboriginal and torres strait islander people in Australia. Issues in mental health
nursing, 35(3), 207-211.
Power, T., Virdun, C., Gorman, E., Doab, A., Smith, R., Phillips, A., & Gray, J. (2018).
Ensuring Indigenous cultural respect in Australian undergraduate nursing students.
Higher Education Research & Development, 37(4), 837-851.
Sargeant, S., Smith, J. D., & Springer, S. (2016). Enhancing cultural awareness education for
undergraduate medical students: Initial findings from a unique cultural immersion
activity. Australasian Medical Journal (Online), 9(7), 224.
Savolainen, R. (2016). Approaches to socio-cultural barriers to information seeking. Library
& Information Science Research, 38(1), 52-59.
Savolainen, R. (2016). Approaches to socio-cultural barriers to information seeking. Library
& Information Science Research, 38(1), 52-59.
Schierhout, G., Matthews, V., Connors, C., Thompson, S., Kwedza, R., Kennedy, C., &
Bailie, R. (2016). Improvement in delivery of type 2 diabetes services differs by mode
of care: a retrospective longitudinal analysis in the Aboriginal and Torres Strait
Islander Primary Health Care setting. BMC health services research, 16(1), 560.