Emerging Standards of Care: Culturally Competent Healthcare - Essay Example

? Emerging Standards of Care: Culturally Competent Healthcare In the vast world of diversity people have differences in so many ways such asculture, beliefs, race, religion, educational attainment, jobs and opinions as well. But despite the differences still people have managed to co habit a community with people of differing beliefs. This is the picture of the modern world and is a challenge to emerge new standards of nursing care to allocate the changes the society made. Today we live in society of multicultural state, where every community is comprised of people with differences such as language. The context of this essay will go around diversity in the viewpoint of health care. Cultural competency is somewhat a part of transcultural nursing that enables nurses to work with people of different cultures. Cultural competency is now widely utilized to bridge the gap of cultural differences among communities such as language differences and other barriers to be able to bring unbiased health care regardless of culture. Key words: culture, cultural competency, multicultural society, barriers Emerging Standards of Care: Culturally Competent Healthcare In a vast multi cultural society people are in, the need for cultural respect and sensitivity is an important aspect to better understand each other and avoid miscommunication. The nurse healthcare system is a definite example of a diverse multi-cultural set up involving vast array of people especially now that the nursing has become a worldwide phenomenon in being globally and culturally competitive in serving clients of different races, ethnicities and cultures. In this aspect the importance of culturally competent nursing care comes into place where the barriers of culture and language is being crossed over to meet the demands of giving the ideal health care to all clients regardless of their cultural differences. Almost everywhere in the world societies are no longer composed of a single culture. In a hospital setting a nurse can attest that not even once in their hospital career that they have not encountered a client of a different culture— how are nurses going to properly assess a Chinese for an example who does not how to speak English at all, or knowing how patriotic Japanese people are that seldom of them knows how to speak other languages so how are nurses going to deal with the language barrier to know what is actually wrong, or how would a nurse care for a Muslim client in a sectarian facility that they would never feel their differences or given otherwise a catholic nurse working in a Muslim land. All these ideas would have gone so difficult for nurses to deal with until the concept of culturally competent care. The make-up of the current world population is changing as a result of immigration patterns and significant increases among racially, ethnically, culturally and linguistically diverse populations. Health care organizations and programs, and state and local governments must implement systemic change in order to meet the health needs of today’s diverse population (National Center for Cultural Competence, 2012). Cultural Competency: What it means Cultural competency has been defined by many health care practitioners all over the world over the years but the context of what it really means lies on the same understanding. One definition defines cultural competence as a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable effective work in cross-cultural situations (Anderson et al., 2003, p. 68). The key to understanding cultural competency lies on the basis of giving people with health service while understanding and respecting a person’s culture and not compromising them along the process. Cultural competence embraces the principles of equal access and non-discriminatory practices in service delivery (NCCC, 2012). Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups (Anderson et al., 2003, p. 68). According to Kersey-Matusiak, a person can gain helpful information by performing a cultural assessment and using a broad definition of culture that reflects the differences in healthcare besides race and ethnicity. These definitions include age, gender, disability, sexual orientation, immigration status, employment status, socioeconomic status, culture, and religion (Kersey-Matusiak, 2012, p. 37). Culture in this sense does not only imply race and ethnicity or culture but it extends vastly to different aspects of cultural differences even between people of the same ethnicity. To have better understanding of this concept is to state an example regarding caring for geriatrics in a community where certain characteristics may be typical but some older adults may demonstrate attributes that differ from the group. Some say that old people have lived their life going through the old ways and defy modernization. For some yes and yet still some enjoys the luxury of using technology such as computers, high technology phones and gadgets despite their age. Thus health care strategy in dealing with the geriatrics people from these two contradicting group would be entirely different from each other. These intra-cultural differences are important to consider; having group knowledge never justifies predicting behaviors of any individual members. As part of a cultural assessment, determine the specific values, beliefs, attitudes, and health needs of each patient. (Kersey-Matusiak, 2012p 37) Competence implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities (Anderson et al., 2003, p. 68). In healthcare, competency deals with how a health care provider such as a nurse performs efficiently and effectively in giving care to clients with a high degree of client satisfaction which means that the nurse has gained professionalism in a globally competitive standard. Cultural competence is a developmental process that evolves over an extended period. Both individuals and organizations are at various levels of awareness, knowledge and skills along the cultural competence continuum (Cross et al., 1989 cited from NCCC, 2012). In addition, cultural competency can be defined as having specific cognitive and affective skills that are essential for building culturally relevant relationships between providers and patients. Having cultural competency is an ongoing, lifetime process that is learned through training and experience. Becoming culturally competent is not an overnight process for it requires continuous self-evaluation, skill development, and knowledge building about culturally diverse groups (Kersey-Matusiak, 2012, p. 35). No nurse or healthcare practitioner is born culturally competent because coming from different cultures, personal cultures and beliefs would not be the same with other people that would come in contradiction that may lead to barrier or misunderstanding. Dealing with these differences and be culturally competent is a learned process. The goal of cultural competency is directed to practice and services design that is achieved by identifying and understanding the needs and help-seeking behaviors of individuals and families. Cultural competency design and implement services that are tailored or matched to the unique needs of individuals, children, families, organizations and the communities served. Also practice is driven in service delivery systems by client preferred choices, not by culturally blind or culturally free interventions (NCCC, 2012). Cultural Competency: The hospital setting Culturally competent care in a hospital setting have a defined set of values and principles and demonstrates behaviors, attitudes, policies and structures that enables the hospital to work effectively among different cultures. A culturally competent health care facility such as a hospital must have the capacity to: value diversity, conduct self-assessment, manage the dynamics of difference, acquire and institutionalize cultural knowledge and adapt to diversity and the cultural contexts of the communities or population the hospital serves (NCCC, 2012). This means that a hospital can ably handle clients of diverse cultures without the tendency of being biased over and across other cultures even their own to be able to give competent world class health service. Cultural competence is an essential ingredient in quality health care for it has the potential to improve health outcomes, increase the efficiency of clinical and support staff, and result in greater client satisfaction with services (Anderson et al., 2003, p. 68). In a hospital setting that caters to individuals of different cultures, satisfaction levels also varies. For example, an Asian immigrant nurse catering health service to an American community would have difficulty giving care if the nurse does not fluently speak English or know anything about the American culture. The language barrier is very important to overcome since communication with the nurse and the patient is very pertinent in discussing what kind of care is intended for the case that will also be intended by the client. Moreover, a culturally competent healthcare setting should include an appropriate mix of the following: a culturally diverse staff that reflects the community served, providers or translators who speak the clients’ language(s), training for providers about the culture and language of the people they serve, signage and instructional literature in the clients’ language(s) and consistent with their cultural norms, and culturally specific healthcare settings (Anderson et al., 2003, p. 68). CLAS promulgation: ensuring the standards The U.S. Department of Health and Human Services Office of Minority Health have promulgated the National Standards for Culturally and Linguistically Appropriate Services in Health Care or what is known as CLAS in order to ensure that cultural competency is met in all areas of healthcare in the United States (2001). These standards are proposed as one means to correct inequities that exist in providing health services making these services more responsive to the any individual’s need. The standards are intended to be inclusive of all cultures and not limited to any particular population group. These standards are especially designed to address the needs of racial, ethnic, and linguistic population groups that experience unequal access to health services and ultimately to contribute to the elimination of cultural health disparities and to improve the health of all Americans (U.S. Department of Health and Human Services Office of Minority Health, 2001). The final 14 standards are organized by themes: Culturally Competent Care (Standards 1-3), Language Access Services (Standards 4-7), and Organizational Supports for Cultural Competence (Standards 8-14). Standards 1-7 address interventions that have the most direct impact on clinical care. Standards 8-14 address organizational structures, policies and processes that support the implementation of the first seven standards (U.S. Department of Health and Human Services Office of Minority Health, 2001). The CLAS standards provide a common understanding and consistent definitions of culturally and linguistically appropriate services in health care. They offer a practical framework for the implementation of services and organizational structures that can help health care organizations and providers be responsive to the cultural and linguistic issues presented by diverse populations (U.S. Department of Health and Human Services Office of Minority Health, 2001). The CLAS standards is not generally utilized in all health care set up even years after it was promulgated maybe due to little aberrations with its implementation that is why all of the standards are not met even until today. First, even after the recommendation of standards in culturally competent healthcare there has not been a tool to measure what is culturally competent or how it is best measured. By this alone one facility can actually say that they are culturally competent on the basis of sensitivity to the needs of the minorities but not with proper basis. Alongside with this is the lack of standard cultural competency training programs that is duly funded by the government or so funded by the institution aiming for culturally competent status. One angle that can be attributed this is that it would incur additional cost for the hospital. This lack of training contributes to lack of diverse staff which is essential to meet with the needs of a growing multi cultural society. Although with the immigration of nurses from different parts of the world to parts of America have contributed to increasing bicultural and bilingual staff that could answer to the needs of hospitals culture and language barrier. Lack of research to evidently prove relationship between culturally competent health services and health status is another factor that hinders the commitment of standards. Researches would provide more evidence that could help health organizations and facilities believe and eventually adhere in CLAS thus including it in their policy and standards of practice. Moreover information dissemination is not well established with regards to the need of CLAS even among nurses statewide. In an article written by Susan Wessling that appeared online in Minority Nurse Website, Josepha Campinha-Bacote, RN and president and founder of Transcultural C.A.R.E. Associates in Cincinnati, said that in her 1,000 lectures to health care organizations since 1991, wherein sixty percent of those are to nursing groups, Ninety-eight percent of the time, no one has heard about CLAS. The sad part according to Bacote is that it was almost two years later and nurses still do not know about CLAS (Wessling, 2002). Despite health care providers and facilities ignorance of the CLAS proposal there are some organizations that have adopted the principle. The Annie E. Casey Foundation for example is one of the foundations that believe in the values of ensuring racial and ethnic equity by promoting understanding, and sharing data around issues of disparity that continue to result in opportunity and achievement gaps in low-income communities of color and ethnic diversity (The Annie E. Casey Foundation, 2012). According to the foundation, the over-representation of people of color and ethnic minorities among disadvantaged children and families is largely an outgrowth of historical and current patterns of discrimination, segregation, and racism. These patterns have fostered disparities in income, wealth, housing, education, and health. These disparities have made it more difficult for people of color to gain a foothold in mainstream society (The Annie E. Casey Foundation, 2012). On the other hand, language access services that is comprised of CLAS standard 1-4 is a thing that is far from total realization. Provision of language assistance services is still not implemented in all hospitals one could be due to the added cost it will bear. Since these standards are directed to giving care to clients the increasing number of differences in health outcomes per culture is evidence enough that CLAS standards still are not fully met. One example is the findings brought out in the sixth annual America’s Children: Key National Indicators of Well-Being report, published in July 2002 that says that in the year 2000, 86% of Caucasian children in the U.S. were reported to have very good health, compared to only 75% of Hispanic children and 74% of African-American children. In addition, about 70% of youngsters from families living below the poverty line were reported as being very healthy, while the figure for children in higher-income families was 85% (“Minority Children’s Health Gets Poor Report Card”, 2002). These differences shows that minorities still suffer more with regards to health outcome proving that cultural competency is still at the verge of fulfilling its purpose. Nursing care will greatly be affected when these CLAS standards will not be met since the world is already a growing multicultural place, healthcare clients come in variants. When these standards are all met, clients coming from different cultures will be satisfied with the kind of service culturally competent healthcare facilities are giving. Increasing number of satisfied clients would also mean increasing good health outcome since despite culture difference they were able to get the desired health service they actually needed. This would increase minority patients’ compliance to treatment since culturally competent health facility makes sure clients understand the plan of treatment in the way they should understand it even if it mean speaking the clients native language if situation asks for it. Thus with all these favorable results of cultural competency favorable health outcomes in minorities will also increase such as remarkable decrease in number of mortality and morbidity in ethnic groups compared to the totality of the whole population. On the contrary, when these standards are not met the reciprocal outcome will be the result. For example due to language barrier more clients will often come back to hospital due to recurrent sickness due to communication failure in discharge plan or mistrust will be more likely since the understanding level between the client and the health team is not at its full capacity due to language barrier. This will likewise lead to decreasing health outcomes since lots of minority people would rather not seek consult and poor health outcome will develop. For example in the United States, culturally and linguistically diverse groups and individuals of limited English proficiency typically experience less adequate access to care, lower quality of care, and poorer health status and outcomes. These cultural differences can affect the delivery of health care to all individuals in the community. At present, the Institute of Medicine's recent report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, states that racial and ethnic minorities tend to receive a lower quality of health care than non-minorities, even when access-related factors, such as patient's insurance status and income, are controlled (Agency for Healthcare Research and Quality, 2003). Population: diversities versus disparities For decades, the prevalence of racial and ethnic disparities in health care delivery and outcomes in the world has been increasingly recognized (Agency for Healthcare Research and Quality, 2003). Healthcare disparities are inequalities in healthcare access, quality, and/or outcomes between groups. These inequalities may be due to differences in care-seeking behaviors, cultural beliefs, health practices, linguistic barriers, and degree of trust in healthcare providers, geographical access to care, insurance status, or ability to pay. Factors influencing these disparities include education, housing, nutrition, biological factors, economics, and sociopolitical power (Kersey-Matusiak, 2012, p. 36). To avoid disparity, stereotyping should be avoided, which can distract from the most important aspects of care—developing a rapport and getting to know and understand the patients you serve. Although cultural competency models are important, they can’t substitute for good interpersonal and patient-centered communication that lets you establish a trusting relationship with your patients (Kersey-Matusiak, 2012p 37). Language is another stakeholder in the success of cultural competency since the society is made up of many cultures and many people of different national origin speaks different languages. Language is what people used to communicate and interact with each other, it is important in conveying messages that people wants other people to know or hear in that sense. Communication is a very important aspect of providing healthcare because healthcare providers base the plan of care according to patients needs usually taken from the patient’s data acquired through communication. Good patient-healthcare provider communication is associated with better patient satisfaction, better adherence to treatment recommendations, and improved health outcomes (Taylor & Lurie, 2004, sp.1). Culturally competent communication refers to communicating with awareness and knowledge of healthcare disparities and understanding that socio-cultural factors have important effects on health beliefs and behaviors, as well as having the skills to manage these factors appropriately (Taylor & Lurie, 2004, sp.1). Culturally competent communication matters because patients brought to a healthcare facility encounter cultural backgrounds, beliefs, practices, and languages that require culturally competent communication to maximize the quality of care they receive. For instance, patients and providers may have different understandings of the relationships among illnesses, symptoms, etiology, expectations about appropriate treatment, and what is expected of them in the process (Taylor & Lurie, 2004, sp.2). Differences in language will put up a barrier between the nurses and patient regarding care, both may take each other differently due to misinterpretation of language. To help bridge the barrier with language differences, Taylor & Lurie have cited steps in improving culturally competent communication somewhat base on the CLAS standards that includes: making cultural competency a core institutional value, undergoing training and evaluation on cultural competency, collecting data on patients’ race and ethnicity so quality of care for patients from different racial or ethnic groups can be assessed, collecting data on patients’ primary language, ensuring the provision of professional translation services, contracting with institutions and providers located in racial and ethnic minority communities and helping patients locate providers who speak their language and increasing staff diversity (Taylor & Lurie, 2004, sp.3). Competency Goal: Meeting the demands The need for cultural competence is of numerous rationales and is very important. One, it is intended to respond to current and projected demographic changes such as in the United States. The American population is multicultural society as a result of changing immigration patterns that contributes to increasing diversity in race, ethnicity, culture and language thus the state must implement systemic changes to address the health needs of this diverse population (NCCC, 2012). Second, is to eliminate long- standing disparities in the health status of people of diverse racial, ethnic and cultural backgrounds. The prevalence of disparities in the incidence of illness and death among minor cultural groups compared with the whole population is higher. In the US, the incidence of mortality and morbidity is high with African Americans, Latino/Hispanic Americans, Native Americans, Asian Americans, Alaskan Natives and Pacific Islanders as compared with the US population as a whole. This could be due to the large difference in health services minorities received due to cultural barriers in seeking health services (NCCC, 2012). To improve the quality of services and health outcomes is another need for cultural competence. Despite similarities, fundamental differences among people arise from nationality, ethnicity and culture, as well as from family background and individual experience. These differences affect the health beliefs and behaviors of both patients and providers have of each other (NCCC, 2012). In delivering high-quality primary health care that is accessible, effective and cost efficient, health care practitioners must have deeper understanding of the socio-cultural background of patients, their families and the environments clients live. In doing so, the degree of care that will be given to clients will be met according to their personal and cultural needs. In the same context the clients are like given a personalized care suited for their satisfaction. Thus culturally competent primary health services results to favorable outcomes such as high client satisfaction (NCCC, 2012). And since client satisfaction is the basis for good service the continuous evaluation of service will yield into improving service performance with the end goal of having satisfied clients and a healthy community. In addition, another need for cultural competence is for the health care system to meet legislative, regulatory and accreditation mandates. Cultural competence is important in giving utmost care to clients regardless of their culture without culture barriers. In practicing cultural competence there is an assurance that the civil rights of every individual is executed that is to provide every person with no exclusion of race, color or origin in giving health care (NCCC, 2012). The public is assured that health facilities abide by the rules of the state in providing culturally competent care. Moreover, government agencies increasingly rely on private accreditation entities to set standards and monitor compliance with these standards. Both the Joint Commission on the Accreditation of Healthcare Organizations, which accredits hospitals and other health care institutions, and the National Committee for Quality Assurance, which accredits managed care organizations and behavioral health managed care organizations, support standards that require cultural and linguistic competence in health care that ensure effective delivery of care in a multicultural society such as the United States. Therefore it can be stated that cultural competence increases a healthcare facility’s competitiveness over none culturally competent facilities (NCCC, 2012). Another need for cultural competency is to decrease the likelihood of liability and malpractice in the provision of health services. The ability to communicate well with patients is proven to be an effective way of avoiding the likelihood of malpractice claims. In a 1994 study published in the journal of the American Medical Association, it is indicated that the patients of physicians who are frequently sued had the most complaints about communication while physicians who had never been sued were likely to be described as concerned, accessible and willing to communicate (NCCC, 2012).. Same instances can be attributed to nurses, for the likelihood of providing care to patients will rely on the patients consent and understanding of the treatment. When giving medication to clients it is important to let them know of the medication and why it is given so that the nurse’s competency is built with the client and their level of trust increases. When health professionals treat patients with respect, listen to them, give them information and keep communication lines open, therapeutic relationships are enhanced and medical personnel reduce their risk of being sued for malpractice (NCCC, 2012). Evidence shows that having cultural competency skills promotes better nurse-patient communication. New cultural partnerships that emerge between patients and nurses enhance patients’ and caregivers’ understanding of the patients’ disease process and treatment needs. When nurses collaborate with patients about the kind of care they desire, patients are more likely to adhere to treatment protocols (Kersey-Matusiak, 2012, p. 38). Although cultural competency is a popular approach in providing unbiased care to a multicultural society and has been proven to effectively and efficiently service with equity, still the increasing number of migrants and immigrants in all parts of the world still paves way for cultural differences that makes cultural competency a challenge. Although the government and other concerned organizations and agencies have stated policies on providing culturally competent service the need for reviewing the effectiveness of enforcing it and reinforcing it on a regular basis needs to be done since diversities all over the world continues to expand and evolve. For disparities in health care is never totally eradicated some minorities, such as the Latino youth of Minnesota, face limited access to educational opportunities, institutionalized discrimination, crowded housing, substandard living conditions, all of which may adversely affect their health (Svetaz, 2008). This disparity can tell by the statistics of the cultural competency level of health care providers in that community. A certain community should take into itself the act of enforcing cultural competency for the sake of all the people within their community just by taking into account all the good effects of cultural competency with pure social responsibility. Cultural competency: how competent are we? As the frontlines of healthcare, nurses in all areas and levels of nursing plays an important role in contributing to high satisfactory level care to clients that improves health care services over the years. Likewise nurses play an important role in performing cultural assessments and delivering culturally and linguistically appropriate care assuring that every individual regardless of differences is provided equally in terms of health and health services. Nurse educators have an obligation to prepare new nurses in developing culturally competent skills that address the healthcare disparities that exist (Kersey-Matusiak, 2012 38). Information dissemination and CLAS propagation is an important role of nurses to finally emerge in a culturally competent health care environment. Since the world is a vast multi cultured place cultural competency is essential in dealing with other people not just in the field of health but in all community aspects as well. By being culturally competent one can fully deal with another regardless of the culture difference. The world is becoming more culturally diverse every day. And the need to cater to the vast culture of the world is a need since the global society has opened paths for cultures to cross and interact. Nurses need to have the skills and competence to care for clients of a multicultural society. Although there will always be barriers that will separate people of different backgrounds, still as versatile men can be there are ways to overcome and bridge over those barriers. Cultural competency starts with evaluating one’s own personal beliefs, educating themselves and others on cultural assessment and by developing and collaborating with health care team members of strategic plan of cultural competency. Simply by opening one and being aware of one’s own culture a nurse will be able to provide culturally competent care to clients of different cultural and ethnic background no matter how evolving it is (Mcbride, 2008). Lacking cultural competence is a huge problem in the health care industry. Cultural competence educates a nurse on how to professionally deal with and communicate with people of different backgrounds. Cultural competence is like putting oneself on the client’s shoe and viewing the world the way the client views it and looking in a similar context on how they view life, illness, medicine, gender and health care. Without this knowledge it is virtually impossible to provide culturally diverse people with adequate care (Mcbride, 2008). That is why it is highly suggested to include cultural competency in the academe so that students upon entering the work force arena will have the adequate knowledge and competency to provide service in a multicultural world. One can never deny the differences one posse over the other but that does not mean one is of less value. In our modern world people have learned to bridge the gap between differences. Man went an extra mile to understand social differences after so many social reforms. Respect is the key to honor each other’s differences; people are raised differently and therefore have grown up to have different opinion. Let each other enjoy the freedom of expressing one’s uniqueness in belief and culture as long as it will not violently go over another’s belief people will be survive each other’s differences. References Agency for Healthcare Research and Quality (2003) Planning Culturally and Linguistically Appropriate Services Guide for Managed Care Plans. Retrieved from http://www.ahrq.gov/populations/planclas.htm Anderson L., Scrimshaw S., Fullilove M., Fielding J. & Normand J. (2003) Culturally competent healthcare systems: A systematic review. American Journal of Preventive Medicine, 24 (3), pp. 68-79 McBride J. (2008). The Cultural Diversity of Patients and the Importance of Providing Culturally Competent Care. Retrieved from http://nurs211w08researchfinal.blogspot.com/2008/03/cultural-diversity-of-patients-and.html Kersey-Matusiak G. (2012) Culturally competent care: Are we there yet? Nursing Management, 43. 4, pp. 34–39. “Minority Children’s Health Gets Poor Report Card” (2002) Minority Nurse. Retrieved from http://www.minoritynurse.com/vital-sign/minority-children%E2%80%99s-health-gets-poor-report-card National Center for Cultural Competence (2012) Foundations for Cultural & Linguistic Competence. Georgetown University Center for Child and Human Development. Retrieved from http://www11.georgetown.edu/research/gucchd/nccc/foundations/need.html Svetaz V. (2008) A collaborative, multidisciplinary, bicultural/bilingual healthy youth development program in a primary health care setting. Quality Health Care for Culturally Diverse Populations. Retrieved from http://dx.confex.com/dx/8/webprogram/Paper2083.html Taylor S. & Lurie N. (2004) The Role of Culturally Competent Communication in Reducing Ethnic and racial Healthcare Disparities. American Journal of Managed Care, (10), sp.1-4. The Annie E. Casey Foundation (2012). Ensuring Racial & Ethnic Equity. Retrieved from http://www.aecf.org/OurApproach/EnsuringRacialAndEthnicEquity.aspx U.S. Department of Health & Human Services, Office of Minority Health (2001) National Standards for Culturally and Linguistically Appropriate Services in Health Care. Retrieved from http://minorityhealth.hhs.gov/assets/pdf/checked/executive.pdf Wessling S. (2002) CLAS Action. Minority Nurse. Retrieved from http://www.minoritynurse.com/cultural-competency/clas-action Read More