Cultural Competence - Essay Example

?Running Head: Cultural Competence: A Model Cultural Competence: A Model Based Approach of Submission Cultural Competence: A Model Based Approach Introduction The sphere of social care workers is diversely comprised. The primary focus is on the social workers, anthropologists, physicians, physical therapists, nurses and nutritionists. In an increasingly complex global environment, these professionals and care givers have to work with people from various races, castes, creeds and economic strata. Thus, in discharging the professional duties and accomplishing social tasks, social care workers need to work hard and develop adequate cultural competence. Acceptance among the masses is a precondition to the successful workability of a care giver. Anti-oppressive practice should, therefore, be adopted and proper changes in the service-user communities should be initiated. In the course of cultural competence development, anti-racist practice must focus on the discriminations based on colour and race (Sue, 2006). Improvement in social work development and training can be brought about by the means of thorough comprehension of people’s family arrangements, social norms and values. Social work and support in a culturally sensitive environment has to be based on exploration of the diverse cultural heritages (Laird, 2008). Finally, the research question is in the form of the following statement: Social care workers need to develop knowledge and skills to work effectively with people from similar and diverse backgrounds. Describe one model of cultural competence and discuss the potential benefits and limitations of applying the model. Therefore, this paper will explore a suitable cultural competence model and proceed on related discussions. Purnell’s Model of Cultural Competence Figure – 1 Purnell’s Model of Cultural Competence (Purnell, 2002) The model is a conceptualization based on multiple theories and a research base gained from organizational, administrative, communication, and family development theories as well as anthropology, sociology, psychology, anatomy and physiology, biology, ecology, nutrition, pharmacology, religion, history, economics, political science, and linguistics. A cultural group’s objective cultural attributes, such as art and music, are important and are included as implied assumptions. The primary and secondary characteristics of culture, developed from and expanded upon from Hage’s (1972) variable and non-variable concepts are nationality, race, colour, gender, age, and religious affiliation. Secondary characteristics are educational status, socioeconomic status, occupation, military experience, political beliefs, urban versus rural residence, enclave identity, marital status, parental status, physical characteristics, sexual orientation, gender issues, reason for migration, and immigration status. (Purnell, 2002) At the outermost interface of the model, the global society is placed. Next, there is the interface of community followed by the layer of family. The inner interface represents the person, the metaparadigm concepts. Inside this interface related to the individual, twelve cultural domains have been depicted. The domains are interrelated and they affect each other. The twelve domains are: 1. Overview/ Heritage: Includes concepts related to the current residence and country of origin, reasons for emigration, occupations, educational status, etc. 2. Communication: Includes concepts related to the contextual use of language, dominant language and dialects, paralanguage variations, nonverbal communication, etc. 3. Family roles and organisation: Includes concepts related to social status, lifestyle issues, child rearing, gender roles, family roles, etc. 4. Workforce issues: Includes concepts related to ethnic communication styles, assimilation, acculturation, autonomy, individualism and healthcare practices from the country of origin. 5. Biocultural ecology: Includes variations in ethnic and racial origins, metabolic and immunity behaviour of the body, physical features, etc. 6. High risk behaviours: These include the use of recreational drugs, alcohol, tobacco; risky sexual practices, etc. 7. Nutrition: Includes concepts related to food habits, related rituals and taboos, choice of food during illness, etc. 8. Pregnancy and child rearing practices: Includes views towards pregnancy (and contextual prescriptive, restrictive and taboo practices), postpartum treatment, methods adopted for birth control, etc. 9. Death rituals: Includes the views of the individual and related culture on death, behaviour and rituals in preparation for death, bereavement behaviours, etc. 10. Spirituality: Includes religious practices, beliefs, festivals, rituals and rites, sources of mental strength, etc. 11. Healthcare practice: Includes individual responsibility for health, practices related to self-medications, views related to mental illness, organ donation and transplantation, chronicity, etc. 12. Healthcare practitioner: Includes the views related to traditional, allopathic biomedical and magicoreligious healthcare practices. Gender of the care giver is also given importance. (Purnell, 2002) The centre of the model is empty which represents the unknown aspects of the cultural group. Along the bottom of the model is an erose (saw-toothed) line that represents the concept of cultural consciousness. The model is based on a broad perspective and it does not particular ethnic, cultural or national values and beliefs. (Purnell, 2002) This model in orchestration with transcultural healthcare professionals can be used to access, utilise and develop culturally specific information about their clients. The assessment guide helps to analyse cultural practices, values and beliefs of various indigenous, aboriginal or ethnic minority or immigrant groups (Purnell and Paulanka, 1998). In the process of delivering healthcare services in synchronisation with cultural competence and socio-scientific modelling in the field is both critical and welcome. (Campinha-Bacote, 1999). Further, Purnell’s Model of Cultural Competence fits into the context of practice and service design too which comprises the following assumptions: Practice & Service Design Cultural competence is achieved by identifying and understanding the needs and help-seeking behaviors of individuals and families. Culturally competent organizations design and implement services that are tailored or matched to the unique needs of individuals, children, families, organizations and communities served. Practice is driven in service delivery systems by client preferred choices, not by culturally blind or culturally free interventions. Culturally competent organizations have a service delivery model that recognizes mental health as an integral and inseparable aspect of primary health care. (National Center for Cultural Competence, n.d.) Benefits of Applying the Model Applying Purnell’s Model of Cultural Competence, problems arising from the transcultural differences in the practice settings can be solved. Thus, it can also serve as a “complexity and holographic theory” (Purnell, 2002). Theory construction in applied sociology has not been an easy task. Any theory in this context needs to be practically viable and dynamic enough to serve the purposes of the rapidly changing world. Transcultural social work remains a problematic area in this regard (Hage, 1972). Purnell’s model, in this context, has been already applied and adopted in a number of social care giving settings and organisations. It has provided enough room for socio-psychological assimilation and the process of harmonising the different isolated and largely unrelated social groups and the potential risk groups which have been really benefited (Purnell, 2002). The ongoing framework and model can thus potentially serve as a productive resource to study and organise the cultural practices and the lifestyles of the clients through both short term and long term applications. Applying the model, the healthcare perspectives and practices among the various social groups (based on ethnicity, religion, nationality, economy, etc.) can be explored and synchronised with the modern practices suggested by the model discussed and this is certainly beneficial. The model can be winningly applied in the cases of people from both similar and diverse backgrounds, since there is no racial, economic and other sorts of specifications in the model. The model provides a crucial framework for inter-cultural manipulation. It considers even the critical and controversial issues like politics and religion. For example, when the client is from South Asia, religion is crucial. In the case he or she is from China, political considerations have to be kept in mind. The model also helps to understand family issues, workplace issues, food habits and nutrition, biocultural ecology and heritage of the target groups and the transcultural clients. Systematic categorisation of human behaviour in the context of social care giving and anti-oppressive practice is another potential benefit of applying the model. In the context of UK, the model can help us to understand and serve the refugees, asylum seekers and economic migrants mainly from China, the Caribbean, Bangladesh, Pakistan and India (Liard, 2008). Limitations of Applying the Model Cross, T., Bazron, B., Dennis, K., and Isaacs, M. (1989)  list five essential elements that contribute to an institution’s or agency’s ability to become more culturally competent. These include:  1. valuing diversity;  2. having the capacity for cultural self-assessment;  3. being conscious of the dynamics inherent when cultures interact;  4. having institutionalized cultural knowledge; and  5. having developed adaptations of service delivery reflecting an understanding of cultural diversity. (Culturediversity.org, 2008) These five elements should be manifested at every level of an organization, including policy making, administration, and practice. Further, these elements should be reflected in the attitudes, structures, policies, and services of the organization. Developing culturally competent programs is an ongoing process, There seems to be no one recipe for cultural competency. It's an ongoing evaluation, as we continually adapt and re-evaluate the way things are done. For nurses, cultural diversity tests our ability to truly care for patients, to demonstrate that we are not only clinically proficient but also culturally competent, that we care. (Culturediversity.org, 2008) The above discussion clearly demonstrates that a layered approach and categorical analysis may not be sufficient for the purposes of the social care giver in a highly complex environment. Purnell’s model suggests the practitioner to value diversity, but for a real time environment a step-wise technique is rather unavailable. Cultural self assessment should be a two-way mechanism, but again there is no clear roadmap in this context. Cultural knowledge being institutionalised, the scope of the domains suggested in Purnell’s model needs to be broader. Alos, until the practitioner is able to obtain a thorough understanding of the cultural diversity among his or her clients, Purnell’s model cannot find much application beyond its theoretical format. Further, Campinha-Bacote (2002) has raised certain important questions in the context of cultural competence. The questions to facilitate proper inter-cultural interaction should be based on the following: 1. Cultural awareness 2. Cultural skills 3. Cultural knowledge 4. Cultural encounter 5. Cultural desire In this way, the social work student can know what is respectful behaviour, how to manage cultural clashes, how to save the minority communities from oppressive practices, etc. (Campinha-Bacote, 2002). Purnell’s model, however, does not provide a technical approach for precise and productive question answer sessions. Conclusion Cultural competence is becoming an increasingly important, thought provoking and complicated issue in the light of the fact that migration is becoming prevalent all over the world. Socio-scientific modelling is supposed to be productive and practical in relation to cultural competence. Development of cultural competence programs thus becomes a dynamic process. In this paper, Purnell’s Model of Cultural Competence has been adopted as a viable option. It is expected that with lapse of time, applicability of this model will become clearer, appreciable and time tested. Proper working and execution of transcultural programs are essential for the social care workers so that they can develop necessary knowledge and skills. Propensity to monolithic understanding of culture, difficulty to differentiate between anti-oppressive and oppressive practices, failure to understand Anglo-centric parameters in social work practice and theory, difficulty in imbibing culturally suitable practices and provisions and avoidance of engaging in political discussions on integration are the primary problems faced by the social care workers, particularly those who are at the beginning of their career. Contextually, Liard (2008) has stressed the importance of the policy and practice guidance frameworks like National Service Framework for Mental Health, National Strategy for Carers, Care Management and Assessment: Practitioners’ Guide, National Service Framework for Older People, National Service Framework for Children, Young People and Maternity Services, etc. The guidance principles may appear to be delimiting for a while, but when broader aspects are considered, these guidance resources can be directly applied or suitably modified. Thus, it can be expected that a combined effect of the contemporary frameworks and Purnell’s model together with continued research will finally give satisfactory results. Reference List Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care, Journal of Transcultural Nursing Care, 13 (3), pp. 181-184 Campinha-Bacote, J. (1999). The Process of Cultural Competence in the Delivery of Healthcare Services: A Culturally Competent Model of Care. (3rd ed.). Cincinnati: Transcultural CARE Associates Cross T, Bazron B, Dennis K and Isaacs N. (1989). Toward a Culturally Competent System of Care, Volume 1. Washington DC: Georgetown University Culturediversity.org. (2008). Cultural Competency. Available: http://www.culturediversity.org/cultcomp.htm. Last accessed 29 March 2011 Hage, J. (1972). Techniques and Problems of Theory Construction in Sociology. New York: John Wiley Liard, S. (2008). Anti-Oppressive Social Work: A Guide for Developing Cultural Competence. London: Sage Publications National Center for Cultural Competence (n.d.) Conceptual Frameworks/Models, Guiding Values and Principle :: National Center for Cultural Competence. Available: http://nccc.georgetown.edu/foundations/frameworks.html. Last accessed 28 March 2011 Purnell, L. (2002). The Purnell Model of Cultural Competence, Journal of Transcultural Nursing, 13 (3), pp. 193-196 Purnell, L and Paulanka, B. (1998). Transcultural Healthcare: A Culturally Competent Approach. Philadelphia: FA Davis Sue, DW. (2006). Multicultural Social Work Practice. Hobokon: John Wiley and Sons Read More