Contributor: Débora Gutierrez Castanheira Ferreira Aires

We live in times of significant change in Portugal and around the world. We deal or are learning to sell, with the growing and constant movement of people, whether for work reasons, due to conflicts, or simply for tourism. Some people find themselves in precarious situations, very vulnerable and often unprotected. In this new social context, some projects have emerged nationwide to make healthcare accessible. I have been a nurse for 17 years and have always worked in primary healthcare by choice. It’s a field of work that fascinates me, considering the opportunity for nurses to accompany the family throughout their life journey, with the possibility of structuring new family-cantered nursing practices (Figueiredo, 2023).

I have always dealt with migrant and foreign users, but never like today. In 2022, with a very motivated team of doctors, nurses, and technical assistants, I integrated a service for users without a family health team, most of whom are from different nationalities and cultures.

Aware of the insufficient accessibility and lack of quality of care provided to users without a family team in the municipality of Almada, we proposed a project that incorporates the principles of equity in access to healthcare and the provision of qualified healthcare. This working model allows us to guarantee access to essential and urgent healthcare, protecting the most vulnerable population at the most significant health risk. The Via Verde Saúde Almada team currently provides Primary Health Care to around 18,000 users. From refugees, migrants, and tourists to Portuguese users without a doctor for a few years, everyone uses this service. We have users from several countries besides Portugal, such as Brazil, Pakistan, India, Bangladesh, Nepal, Cape Verde, São Tomé and Príncipe, Guinea, Ukraine, China, and several European countries. Thus, this context becomes an opportunity to develop skills and sensitivity to provide “culturally competent healthcare” (Sousa, 2022; Golsäter et al., 2023; De & Richardson, 2022; ).

For Leininger (2001), beneficial care in nursing, culturally based, will contribute to the well-being of the individual and the family. The Transcultural Nursing Theory of Cultural Care, which has been developed over the years after much theoretical and field research with various communities around the world, is an excellent contribution to nurses today if they want to practice advanced and competent nursing suited to the needs and challenges of the current mobility of individuals. Leininger (2001) advocates that “care is the essence of nursing” and that “cultural care is the holistic, broadest way of knowing, explaining, interpreting and predicting the phenomena of cultural care to guide nursing care practices,” with nursing being a “humanistic (…) profession, intending to serve human beings around the world”. It thus becomes the most reliable middle-range theory for providing culturally congruent, competent, and safe care in a growing multicultural world.

While it has been a challenge, it has also been very enriching to accompany families and learn more about their different cultures and customs. However, for some professionals, the differences can generate conflicts, especially when they are only used to a certain way of managing consultations and recommendations, specifically for Portuguese culture. For example, something as simple as introducing food to a baby, traditionally starting with soup in Portugal, is not so simple for someone from an Eastern country and can generate confusion or conflict between the professional and the caregivers (Holmberg et al., 2016). In these situations, I have always tried to get closer to the family’s culture, asking how they usually do it in their country and family. It is something simple and appropriate that we can all do as health professionals, building bridges instead of imposing our culture and customs.

On the other hand, communication with migrant populations often presents itself as the first obstacle. We frequently use English as a basis for communicating, and we have leaflets with substantial information in the most prevalent languages of registered users. Furthermore, we try to view communication not just as a language but as knowledge of the user’s cultural context, understanding and respecting their customs and traditions so that possible communication becomes effective (De & Richardson, 2022).

The multidisciplinary team I am part of is primarily young, knowledgeable about various social realities and easy to communicate or use tools to help communication in other languages. I am open to diversity and know the need to adapt to these users. However, we have to recognize a specific entropy of other elements, with traditional training and still, in a certain way, shaped to Portuguese culture and reality, with great difficulty adapting to different customs and traditions. It has been expected to hear sentences such as “I don’t have to speak other languages to do my job,” “those users don’t know how to feed their children…they don’t make soups in their country”, “these users are very suspicious of vaccines and their origin. I must explain everything…”, among many others. Users who undergo this care without being aware of their needs may experience cultural conflicts, tensions in the therapeutic relationship, and ethical and moral concerns (Leininger, 2001).

In short, I understand that practical sensitivity and effective communication are necessary as bases for adequate care of the multicultural populations we currently deal with. Aren’t they also the same for any other user? The point is to see the whole of the person I have in front of me and respect who they are. Increasingly, as a nurse, in an era where almost everything can be learned on the internet, I feel that more than teaching how to breastfeed or change a diaper or make soup or not, my real challenge is to be a nurse who moves towards the practice of advanced nursing, applying culturally competent nursing care.

References

De, D. Richardson, J. (2022). Using cultural safety to enhance nursing care for children and young people, Nursing chlidren and young people, 34 (6), pp. 36-42

Figueiredo, M. H. (2023). Enfermagem de Saúde Familiar (1.a ed.). Lidel – Edições Técnicas, Lda., pp XIX-XXI

Golsäter,M.; Karlsson Fiallos, M.; Olsson Vestvik, S.; Anefur, H.; Harder, M. (2023). Child health care nurses’ cultural competence in health visits with children with foreign background, Nursing Open, 10 (3), pp 1426-1436

Holmberg Fagerlund, B., Pettersen, K. S., Terragni, L., & Glavin, K. (2016). Counseling Immigrant Parents about Food and Feeding Practices: Public Health Nurses’ Experiences. Public health nursing (Boston, Mass.), 33(4), 343–350. https://doi.org/10.1111/phn.12248

Madeleine M. Leininger. (2001). Culture Care Diversity and Universality: A Theory of Nursing: A Theory of Nursing 1st Edition (1st ed.). Jones & Bartlett Learning.

Sousa JEXF de. Cuidados de Saúde Culturalmente Competentes – Preconceito. In: Cruz DLV, Brancaleone C, Silva MLB da, et al., eds. Problemáticas de Saúde na Sociedade Contemporânea – Diversidade de Perspetivas e Contextos. 1st ed. Editora Omnis Scientia; 2022. doi:10.47094/978-65-5854-626-9/10-20

About Débora Gutierrez Castanheira Ferreira Aires

I am a nurse since 2006, and my experience has been in Primary Health Care, by personal choice. I work and coordinate the nursing team in a Community Health Care Unit, created for people without family health team (doctor and nurse). I love my job in the community.

This post was made in the curricular unit of Nursing Theories of the Master Course in Nursing of the Nursing and Health Faculty of Portuguese Catholic University (Lisbon), with the pedagogical supervision of Professor Zaida Charepe (Ph.D., Associate Professor).