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Cultural Competence in Nursing: An Interview with a Polish Woman

Madison Krekow
California State University Stanislaus













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Cultural Competence in Nursing: An Interview with a Polish Woman
The world contains many different cultures each unique in its faith, health practices, diet,
and family structure. An individual of a certain heritage will perceive health and health care
very differently from an individual of a different culture. The Purnell Model of Cultural
Competence is a tool that can be used to analyze cultural perception that is useful in healthcare
settings throughout all disciplines. By analyzing a culture using the 12 domains identified in
Purnells model, nurses can identify and develop nursing interventions to improve care in acute
care settings (Purnell, 2005). Following The Purnell Model of Cultural Competence, the author
interviewed Mrs. Cynthia Przybyla, a woman of Polish heritage, in her home on September 15,
2012 in an attempt to unravel the ethno-cultural attributes unique to the Polish culture. The
interviewer then analyzed the cross cultural communication, noting the differences in
communications styles between Polish-American and contemporary American heritage.
Permission to use the interview for scholarly purposes was obtained verbally.
Mrs. Przybyla, who upon starting the interview asked to be called by her first name, is a
first generation immigrant from Poland. Her parents moved to the east coast when she was very
young and then to California as she turned 5 years old. Since then, she has revisited her
homeland and thinks back fondly on the memories she accumulated there (C. Przybyla, personal
communication, September 15, 2012). Poland is an eastern European country that, in the last
century, has had much conflict; all due to a combination of World War II (WWII), the transition
from a communist country to a post-communist society, and the loss of 60,000 miles of territory
post WWII (Szaflarski & Cubbins, 2004). It was during the aftermath of WII and the transition
into a non-communist society that Cynthias parents, along with 20,000 other immigrants chose
to leave their homeland for more opportunities in America (C. Przybyla, personal
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communication, September 15, 2012). Similarly to many other Polish families that came to
America, Cynthias mother stayed at home to raise their four children while her father found a
job working as a laborer on a farm. Later, her father found a higher paying job as a leather
crafter working for Sheldon leathers. Cynthias fathers experience in the job market was a very
common one, Polish immigrants before the 1960s often found work in very labor intensive
environments (From, 1995). When the interviewer asked Cynthia if her parents ever went to
college she stated, My parents believed that hard work was all they needed to succeed in life,
and it worked for them (C. Przybyla, personal communication, September 15, 2012). Cynthia
went to college and then received her masters degree in teaching and feels that education is one
of the most valuable assets a person can have. While older generations of Polish immigrants
may have not valued education, the younger generations of Polish-Americans value education
and culture, and Cynthia is no exception to this rule (From, 1995).
The main language spoken in Poland is Polish, with only minor variations in dialect in
different regions throughout the country. Cynthia likes to remember her grandparents and
parents speaking to her in Polish when she was young. She is quite sad about the fact that she
never became fluent in the language (C. Przybyla, personal communication, September 15,
2012). During the first wave of Polish immigration, that her parents were a part of, there was
much value on assimilation and learning to speak English like an American (From, 1995).
Cynthia has retained a few words, recalling one of her favorite memories she stated, I remember
my grandmother saying she thought Cynthia was an ugly name, so she renamed me Cyntousha
[Sin-toosh-uh]. That has been my nickname ever since (C. Przybyla, personal communication,
September 15, 2012). While Cynthia never became fluent in Polish, she does use common
Polish phrases and Polish names for food in her daily life. The polish way of communication, is
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a very forward style of communication. Cynthia was never reluctant to express her ideas or
values throughout the interview. Upon watching her interaction with her family members, the
interviewer noticed that love is not expressed in a very affectionate way. When asking about
how she expresses love and affection to her family, she replied that in the Polish culture people
are not very physically affectionate with one another and personal space is very important,
except with the case of children. Physical affection is given often and easily to children within
the family. Rather than physical affection towards other adults, Polish affection is displayed in
kind deeds for friends and family (C. Przybyla, personal communication, September 15, 2012).
Eye contact is considered essential to communication in Poland. For example, during a toast at
Cynthias house, if one does not make eye contact with everyone at the table one would be
considered rude. Greetings with friends are expressed by a kiss on each check and a hug, while
greetings with strangers and health care providers are limited to a hand shake (C. Przybyla,
personal communication, September 15, 2012). Time is a very important concept to someone of
Polish heritage. When talking about punctuality, Cynthia seemed immediately disgusted by the
idea of being late. She often scolds her oldest daughter, who is now 30 years old and married,
about her tendency to be late to events.
Traditional Polish families are patriarchal in nature, as was Cynthias family growing up.
Her father was head of household and the person who provided all of the income. Her mother
took care of the children, the house, and provided meals for her family. In her own family,
Cynthia and her husband share responsibilities. Before retirement, they both had successful
careers and spent the same amount of time away from the house. Cynthia explained that rules
for her children as they grew up were very traditionally Polish rules. Obedience was valued
when her children were very young, and punishment involved labor rather than physical
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consequences. Cynthia recalled once when her son shot another child with a paintball gun, she
made him carry 100 football sized rocks up a hill to the house for a garden wall she was building.
She stated, It taught him a lesson, and I got my garden wall finished. Lets just say he never
shot that paintball gun again (C. Przybyla, personal communication, September 15, 2012).
When the interviewer asked Cynthia if she considered extended family an important part of the
family system, she explained that when they were alive, extended family like her aunts and
uncles were very important and involved in raising children. Things have changed since then,
her brothers and sisters are not very involved in each others lives, so her family consists of
herself and her husband and their two children, one of which was recently married. Cynthias
family is considered alternative to her other Polish relatives. After she married her husband Rob,
Cynthia recalled her Auntie Rose, saying, Every time I saw my Auntie Rose she would ask me
why dont you find a nice polish boy to marry?. I dont think she understood that there was no
Polish community center where I was living in Berkley (C. Przybyla, personal communication,
September 15, 2012). But regardless of the confusion her family felt when Cynthia married her
husband; they still supported them and accepted him into the family.
In terms of the elderly, the Polish community considers aging in neutral terms,
understanding that it is a normal part of life. As her parents and Auntie Rose aged, Cynthia
played a role in taking care of all of them. According to Berdes & Zych (1996), the
multigenerational family still structures the roles, expectations, and dependency relationships of
elderly people in Poland. In fact, the responsibility of children to their parents in formalized in
polish law. Unlike in American culture, Polish people place a high value in the knowledge and
experience that the elderly people in their family have gained throughout life.
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In the Polish culture, hard work has always been a very valued trait. Since immigration
into this country, they have been very successful in the work place and often rise to management
levels relatively quickly. The strong Polish work ethic exhibited as volunteering for overtime,
being punctual, and rarely taking sick days is valued by employers (From, 1995). Cynthia
explained that the work ethic she gained from her parents tends to keep her very focused at work.
She tends not to gossip in the workplace like many of her other colleagues. At first, she felt odd
and out of place refusing to participate in the gossiping, but now feels confident in the fact that
she didnt. By not gossiping at work, I feel that I made the most genuine friends; that is advice
I would give any young person starting their first job (C. Przybyla, personal communication,
September 15, 2012). Cynthia, due to her good work ethic and her professionalism, had a very
successful career and retired a highly respected employee at the school she taught for.
Polish people are generally a short people; no one in Cynthias family is taller than five
feet six inches. Also, Polish men tend not to be very hairy at all. None of her brothers are able
to grow a beard, and her son, who is only half polish, can only grow chin hair. They are a
relatively fair race with mostly blonde hair and blue eyes, but Cynthia seems to think that being
Polish allows her to get a great tan in the summer time (C. Przybyla, personal communication,
September 15, 2012). Light skin leaves polish people more susceptible to skin cancer, and there
is also a higher incidence of cardiovascular disease associated with being polish (Szaflarski &
Cubbins, 2004). After asking Cynthia about any health problems she felt were predominantly
Polish, she stated, just about everyone in my family smoked and had high blood pressure (C.
Przybyla, personal communication, September 15, 2012).
After stating that most people smoked cigarettes, the interviewer asked about any other
high-risk health behaviors she felt were due to ethnicity. Cynthia went on to explain that in
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Polish culture, drinking is very important in social settings. Every night Cynthia and her husband
have a glass or two of brandy together and share how their days went. Cynthia explained that
she used to watch her parents do that nightly so as she became an adult, she felt that it was just a
part of being an adult (C. Przybyla, personal communication, September 15, 2012). In regards to
seeking health care, Polish people are reluctant to go to the doctor but are very active in living
health life styles. Cynthia recalls having sprained her ankle once and refusing to have it treated
professionally. This is in stark contrast to her daily trips to the gym and yearly bike trips around
Europe. Last year, she and her husband both participated in a triathlon and won in their age
groups, Cynthia was very proud of this achievement. Every year she and her family participate
in the local Turkey Trot, a 5 mile run, on the morning of Thanksgiving. When Cynthia was asked
about the use of safety measures, she explained that she always wears a helmet on bike rides, and
always wears her seatbelt in the car. She also added that whenever she leaves a public restroom,
she uses the paper towel to open the door (C. Przybyla, personal communication, September 15,
2012).
To the Polish, food holds a festive and hospitable meaning. It provides a time to be
social with family and friends (C. Przybyla, personal communication, September 15, 2012). In
terms of nutrition, traditional polish food is high in protein and high in carbohydrates. The most
common, food in a Polish meal consists of potatoes, cabbage, sausage, and bread (Sokolowski &
Jasinski, 1948). Common practices for food preparation include blanching and baking.
Traditional foods such as cabbage and pierogi are prepared and stuffed, then boiled. Specific
foods are often associated with holidays, for instance pierogi are always made for thanksgiving,
and on Easter Cynthia always makes mushroom soup with a boiled egg and toast (C. Przybyla,
personal communication, September 15, 2012). While the food they eat does not negatively
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affect their health, there are often not enough fruits and vegetables consumed on a daily basis
(From, 1995). In times of illness, Cynthias mother would make traditional polish health
remedies such as honey and lemon tea, chicken soup, and dried prunes to promote wellness (C.
Przybyla, personal communication, September 15, 2012).
Growing up, Cynthias family consisted of five children and birth control was not
utilized. Family planning was her parents method of birth control because of their highly
catholic background. Cynthia used the birth control pill as her means of family planning (C.
Przybyla, personal communication, September 15, 2012). Pregnancy in the Polish culture is
considered a very positive experience and women are encouraged to overeat in hopes of having a
large baby. During labor, it is taboo for the woman to show weakness or admit to pain. When
talking about the delivery of her own children, she stated, When I had my children it was like
zip, zap and then youre done. No big deal (C. Przybyla, personal communication, September
15, 2012). Cynthia had no epidural during labor, was in labor for only a few hours before
delivering, and thinks that cesarean sections are extremely taboo. She also thinks that waiting for
the right time to have children is unnecessary. Cynthia stated, If you are waiting for the right
time to have children, you will never have any (C. Przybyla, personal communication,
September 15, 2012). She and her daughter frequently talk about this, and Cynthia is very
anxious to have grandchildren.
In terms of death and spirituality, Cynthia is very different from Polish tradition. While
she says she has a sense of spirituality and life after death, her feelings of religion are not always
positive. She has not regularly attended church since she moved out of her parents house for
college. Culturally, Polish see death as either moving into heaven or hell. Mourning occurs for
no specific amount of time, but is not done loudly. People may mourn together in the presence
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of food and most Polish have either a Catholic or Jewish funeral. These funerals consist of a
wake where family members may speak to the community, food is often provided, and then a
burial is overseen by a religious leader. Cremation is an optional practice but it is not taboo.
When Cynthias parents died, they were both given a traditional Catholic funeral but neither
were cremated (C. Przybyla, personal communication, September 15, 2012). The dominant
religions in the Polish culture are Judaism and Catholicism. The use of prayer in both of these
religions is an essential part of repenting sins and reaching heaven in the afterlife after ones
body has died (From, 1995). After asking Cynthia what gives meaning and strength in life, she
stated that her family and friends, rather than any religion give her life meaning and give her
strength in times of hardship. She expressed that she feels religion is often corrupt, and too
easily creates extreme beliefs that discriminate against vulnerable populations (C. Przybyla,
personal communication, September 15, 2012). Cynthia has a less is more approach to health
care and believes strongly in prevention rather than treatment. Rather than her religion
influencing her healthcare, she treats her body as a metaphorical temple and does everything in
her power to keep it from becoming unhealthy. Cynthias belief that healthcare should be
perceived separately from religious views are how most modern and educated Poles feel today
(From, 1995).
The predominant Polish view on health care is that one should be dependent on
themselves and that pain should be handled internally without help from others. Cynthias
experience with birth is proof of this. Her belief that birth hurts less than a broken toe, truly
demonstrates the Polish attitude that one should handle pain and sickness with a stoic and
independent attitude. This may contribute greatly to the healthy life style that modern Poles
practice. In Poland and America, Polish people have been found to hike and bike more
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frequently than those of other ethnicities (Szaflarski & Cubbins, 2004). In view of acute care
settings Cynthia simply stated, I would want to get out of there. While admitting she has never
truly been sick, she feels that being hospitalized despite the reason does not provide a cure, but
rather implied that one was not accountable for their health and wellbeing (C. Przybyla, personal
communication, September 15, 2012).
In traditional Polish culture, doctors provide primary care unless in the case of childbirth,
where a midwife may be used. In the care of over-the -counter medications Cynthia believes that
there is a time in a place that they will be used, and will utilize them in the case of headache or
muscle ache after the gym. In terms of self-reporting the severity of disease, Cynthia tends to
underreport. She explained that she underreports pain and illness because she wants to be in
charge of her own wellness and rehabilitation during illness. When asking Cynthia about
accepting blood transfusions and organ donations she did not have a problem with the idea.
Doctors and mid-wives are occupations that are very highly admired and accepted in polish
culture, Cynthia at one point in her life wanted to become one. While these professions are
highly admired for what they do, there is always that autonomous attitude of the Polish people
about being independent and responsible for their own care. There exist no unique or traditional
healers within the Polish culture; they were phased out as Europe developed modern medicine
that dominates developed countries today (C. Przybyla, personal communication, September 15,
2012).
If a Polish patient, like Cynthia, was in an acute care setting, interventions would need to
be implemented in order to provide her with culturally competent care. According to Leiningers
Sunrise Model, there are three modalities to provide culturally appropriate care (Leininger &
McFarland, 2002). The first mode of care is to provide care while preserving culture. This
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allows a patient to attain what they need, only after a nurses recognition of that need. For
example, if during a hospital stay, Cynthia wanted pierogis and kielbasa to make her feel more
comfortable we should allow her to have that as long as it is not contraindicated by her disease
process. If food from home is contraindicated, then compromise is necessary, and caregivers can
implement an intervention using the second mode. The second mode of cultural care is
accommodation and/or negotiation, which includes negotiating with patients to satisfy patient
needs while providing the best outcome (Leininger & McFarland, 2002). If a patient wants food
from home but they are on a cardiac diet with limited salt, before the caregiver agrees with food
from home, they must negotiate the type of food the patient may have. Kielbasa in this case
might not be acceptable because it is high in sodium so the nurse may recommend a substitution.
A culturally competed nurse could recommend a lower sodium option like gobki [guh-lump-
kee], which is a leaf of cabbage stuffed with ground beef and then steamed (Sokolowski &
Jasinski, 1948). The third mode of cultural care is repatterning and restructuring. In this mode,
when compromise is not always an option, we may have to provide patients with alternatives but
find ways that will least likely disrupt their culture. For example, a patient like Cynthia will
refuse to admit they have pain due the stoic nature of their culture and the idea that pain is
unacceptable. As health care professionals, it is widely known that pain will delay healing and
inhibits movements that facilitate rehabilitation after illness. To encourage the treatment of pain
we must include an intervention in patient care that establishes the patients tolerance for pain, a
desire level of pain, and address any fears they have about pain medication such as addiction and
nausea.
The interview that occurred between Cynthia and the interviewer was an interesting cross
cultural communication experience. The first apparent difference was that the interviewee had a
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very direct manner of speaking. Answers were very direct and to the point, and she did not any
express any information that was not directly asked. The only change in communication that
was made to create a more effective interview experience is the interviewer had to leave out all
personal opinions during the interview. If a personal opinion was introduced to Mrs. Przybyla
she immediately became reluctant to answering questions and instead would ask the interviewer
questions about why that she felt that way. Becoming proficient and interviews is an art, and a
very difficult one at that.
The lesson that can be learned from this interview is the idea that a healthcare provider
cannot assume the needs and preferences of a patient based solely on their appearance. While a
person of Polish heritage may look like someone of traditionally American heritage, they may be
completely different. By recognizing and becoming informed about different cultures we can
address needs and implement appropriate interventions with cultural foods and special attention
to pain management. While it is true that American culture is a direct descendent of European
culture, much of these cultures are lost due to assimilation. A person who still retains the culture
of their country of origin will require culturally sensitive healthcare to perceive that healthcare as
effective and excellent.
The polish culture is one that has had many hardships throughout the last 100 years. The
people that consider themselves of this heritage have developed a sense of resiliency, stoicism,
and pride in their heritage. Culturally competent care must be provided to these individuals, and
of individuals of all the cultures that healthcare workers encounter in their profession.
Interventions need to be developed not just on a cultural basis, but for each individual in an
attempt to not stereotype individuals from a culture as all the same. An interview with Mrs.
Przybyla, a first generation American of polish descent, is proof of this. She varies from her
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traditional culture in many ways but retains the essence of it. Each healthcare professional
should be encouraged to pursue transcultural competence because with it, the acute care setting
could be a much more supportive, and pleasant experience for both professionals and patients.















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References
Berdes, C., & Zych. A. A. (1996). The quality of life of polish immigrant and polish American
ethnic elderly. Polish American Studies, 53(1), 17-62.
From, M. A. (1995). Polish-americans. Retrieved from http://www.stjoenj.net/polish.html
Leininger M & McFarland M (2002) Transcultural Nursing Concepts, Research and
Practice.Mc Graw-Hill, New York
Purnell, L. (2005). The purnell model for cultural competence. The Journal of Multicultural
Nursing & Health, 11(2), 7-15.
Sokolowski, M., & Jasinski, I. (Ed). (1948). Treasured polish recipes for americans.
Minneapolis, Minnesota: Polanie Club
Szaflarski, M., & Cubbins, L. A. (2004). Self-reported health in poland and the united states: a
comparative analysis of demographic, family and socioeconomic influences. health: An
Interdisciplinary Journal for the Social Study of Health Illness and Medicine, 8(1), 5-31.
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