Clinical guidelines in nursing were developed to guide our practice and optimize patient care (Dains et al., 2019). Those guidelines are inclusive of the need to be culturally competent (CDC, 2020). Cultural competence is the ability of a professional to work effectively across various cultural situations using “a set of common set of values, attitudes and policies within a system or agency” (CDC, 2020). When working with Filipino patients such as Mono Nu, cultural competence with a high level of cultural skill, is essential (Ball et al., 2019). The RESPECT model is often used by providers to maintain cultural competence (Ball et al., 2019). The Institute of Medicine report shows that there is inconsistency in care received by minorities compared to other populations. Specifically, cultural competence is defined using the descriptions from the Culturally and Linguistically Appropriate Services (CLAS) standards and the definition from Cross (Young & Guo, 2016).

Explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with Mono Nu.

          Individuals such as Mono Nu being from the Philippines has a culture that is made up of traditional Filipino, Spanish Catholic as well as Chinese, Indonesian and Malay traditions (Lopez & Tram, 2023). The Philippines is considered a third world country where the residents are said to have a socioeconomically poorer background, but are family oriented and appreciate art, fashion, music, and food. Filipinos speak Tagalog but have multiple dialects (Lopez & Tram, 2023) and (Bhimla et al., 2017). These authors continued that they are one of the most diverse immigrant populations in the United States. They tend to be bicultural since they have integrated their native culture, traditions, and beliefs with American culture. The acculturation levels of Filipino immigrants however differ based on where they settle in the United States.  When it comes to healthcare seeking behavior in Filipinos, studies show that many visit a provider (Bhimla et al., 2023). Despite this being a general synopsis of Filipinos, nursing professionals must remember to treat everyone as being unique and not assume that all Filipinos have the same practices (Lopez & Tram, 2023) and (Ball et al., 2019). “Multiple studies have shown that healthcare providers activate these implicit stereotypes, or unconscious biases, when communicating with and providing care to minority patients” (Ball et al. 2019). Filipinos are an ethnic minority that need to be asked about “stressors, support networks, sense of life control and literacy” (Ball et al. 2019). Cultural humility is key when assessing patients (Ball et al. 2019).

Explain the issues that you would need to be sensitive to when interacting with the patient, and why.

          Based on Ball et al. 2019 cultural competence guidelines I would conduct my assessment in a manner that it patient centered, be aware of my own biases and appreciate diversity. When it comes to providing care to Mono Nu I would establish if he wished to speak in English, Tagalog or a specific Filipino dialect. In interviewing him I would be sensitive to his culture and religious practices and ask about current practices. I would get an understanding of how his culture and religious practices affect his diet and medication compliance.  I would avoid technical language, frequent interruptions, and jargon.  I would respect his beliefs and the meaning of illness as indicated by Ball et al. 2019).I would relate to him in simple uncomplicated terms that he can understand and not be judgmental. I would establish his health insurance status and ability to pay for care. As an immigrant, Mono Nu may be from a poorer socioeconomic society and his ability to pay could affect his treatment/medication compliance (Ball et al., 2019). He will also be educated on the fact that different individuals respond differently to the various mediations and will be taught that it is not a case where the medications are not working (Ball et al., 2019). I would identify if there were other cultural practices that involve the consumption of any type of drugs or alcohol that would impair the effectiveness of the prescribed medications. I would ask about other medications that he is taking if any.

          Diet education would be a priority, knowing his foods and eating habits and make him aware that soy products can interfere with the appropriate therapeutic actions of blood thinners (McCance & Huether, 2019) and (Takahashi et al., 2019). Bhimla et al. 2017 discovered in their research that Filipino participants believed that high blood pressure was attributed to Filipino diet and genetics but did not think they needed medications to control it. Mono Nu’s consumption of fish and tofu is high in protein content, but soy products are high in vitamin K which counteracts the effects of blood thinners (anti-coagulants) (McCance & Huether, 2019). Such a diet has been known to exist for centuries within Asian populations and though studies have mentioned cardiovascular benefits it has not been shown as per studies that it prevents clotting. As seen in the study as per Bhimla et al. 2017 high blood pressure was more prevalent in Filipino females than males.  Being that Mono Nu is in his 40s and male, he may not anticipate having risks for cardiac issues. Additionally, it must be established if he is engaged in employment or exercise activities that influence the metabolism of the medications. A two-week period may not be enough to fully grasp how his lifestyle factors influence the body’s utilization of the medication. Bhimla et al. 2017 has also indicated their study of Filipino- Americans in Philadelphia, that high blood pressure and high cholesterol was noted as top health condition. Asian culture is different in beliefs and lifestyle. Moreover, even within the same cultural group, responses to and acceptance of health care can vary depending on generation and environment (Ball et al., 2019). Chinese for instance view hot and cold as yin and yang, not referring to temperature but negative and positive. In health it may be seen as illness and health (Ball et al. 2019).

Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

• What has led to you taking these medications? Establishes a health history.
• Please tell me about your background and do they affect how you take your medications? (Builds the health history).
• Do you experience any side effects from the medications?
• Do cardiac issues run in your family? (Builds the health history).
• What is your complete diet and exercise activities like?
• Do you know what foods to avoid while taking these medications? (Helps to set the tone for teaching).

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Bhimla, A., Yap, L., Lee, M., Seals, B., Aczon, H., & Ma, G. (2017). Addressing the Health Needs of High-Risk Filipino Americans in the Greater Philadelphia Region. Journal of Community Health, 42(2), 269–277. https://doi.org/10.1007/s10900-016-0252-0Links to an external site.

Centers for Disease Control and Prevention. (2020, October 21). Cultural competence in health and human servicesLinks to an external site.. Retrieved from https://npin.cdc.gov/pages/cultural-competence

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Lopez, J. M., & Tram, J. M. (2023). Falling behind and forgotten: The impact of acculturation and spirituality on the mental health help-seeking behavior of Filipinos in the USA. Asian American Journal of Psychology, 14(2), 218–230. https://doi.org/10.1037/aap0000293

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Takahashi, Y., Konishi, T., & Yamaki, K. (2019). Tofu and fish oil independently modulate serum lipid profiles in rats: Analyses of 10 class lipoprotein profiles and the global hepatic transcriptome. PloS One, 14(1), e0210950. https://doi.org/10.1371/journal.pone.0210950

Young, S., & Guo, K. L. (2016). Cultural diversity trainingLinks to an external site.. The Health Care Manager, 35(2), 94–102. https://doi.org/10.1097/hcm.0000000000000100