Culturally Competent Service - Term Paper Example

?Culturally Competent Service Culturally Competent Service Culturally Competent Service Background The population growth of the United States is constantly changing. In 2007, there were almost 38 million immigrants in the United States (Wikipedia, 2011) who contributed to the colorful culture of the country. Many continued to practice their own culture and spoke a language other than English in their own homes. Unfortunately, such socio-cultural diversity to include the limited proficiency in English is a factor causing health care disparities. As a result, most non white population limit themselves from accessing health care even in the midst of a need. Most often, patients hesitate to visit a doctor because of economic reason, fear from intimidation of their held health beliefs, values, and culture, distance from the clinic, and language barrier. This scenario challenges the health care system in particular on the role of nurses and doctors who act as the front liners in the delivery of care. Cultural competence had been introduced within the health care system years ago however its core concept seems to be elusive among the health care workers. Reason might be their inadequacy of exposure to the minority groups who are in most cases cannot avail of decent health care. Cultural competence is defined based on the concept of the health belief model, Purnell, and multicultural models. The health belief model postulates that health behavior depends on the influence of the patient’s perception on the seriousness of their health problems. With this, purnell model proposes that nurses must consider the health and disease perception of the patient to adapt care that is in congruent with their culture. The multicultural understanding model also suggests that nurses must possess a greater understanding, appreciation, and sensitivity of the patient’s values, beliefs and culture because they all play a critical role in the delivery of a culturally competent service. Along this line, defining cultural competence is the ability of the nurse to acquire the right attitude, knowledge, and skills necessary to provide a meaningful and quality health care to diverse population. Presentation of Literature Review Health disparities are observable in almost all illnesses among minorities in the United States surrounding the delivery of healthcare. However, it is most pronounced in chronic diseases like cancer. Cervical and breast cancers are among the diseases afflicting the minority groups in this country. Although these diseases are preventable, incidences of cervical cancer among African American women seems to rock their population with a percentage of 12. 4 per 100,000 which is slightly lower with that of the Hispanic American population (www.cureresearch.com). The reason for this trend points to a disparity in detection of the illness and access to treatment. Although, measures to detect the disease early are available in almost all group of population in the United States, it could hardly be accessed by minority groups who are economically disadvantaged. The failure to seek for Pap test is indicated as the factor for the development of cervical cancer among African American women living in poor areas of the State. It was found out that more than 50% African American women did not have Pap smear for 3 years before they are diagnosed to have cervical cancer. When they are diagnosed, it is already in the advance stage thus having higher mortality rate than white Americans (Hicks et al, 2006). The study of Coker and group (2008) reveals almost similar findings where they also explained in their study that black Americans are diagnosed when their illness is in stage 3 or 4 where treatment could be difficult and at times hopeless. Coker and group further presented that black American women who receive treatment includes cheaper chemotherapy and radiation and is less likely to undergo surgery than their white counterparts. This is despite in situations where surgery is the best option like in the case of localized cancer. Such disparity in treatment indicates again that black women have a lower rate of survival if compared to the Hispanic Americans and the whites. Coker and group identified several contributory factors associated with the higher rate of death. This includes not receiving treatment, no surgery, and advance stage of the disease when diagnosed. They also disclosed that black women with unknown stage are more likely to die. This explains that the stage of cancer is critical for the prognosis of the disease. Giwa and company (2010) in their study indicated that a large number of black women tend to postpone their diagnostic procedure because of medical reasons and fear if they have cancer. This behavior implies that this group has limited knowledge on the role of screening examination in cervical cancer. The extent to which black women has restricted knowledge depends on the availability of information within their community. In most instances, ethnic groups are seldom included in information drive thus there is no improvement on their basic knowledge surrounding cervical cancer. The conclusion of Timber and others (2005) suggest that women and their families should be educated for the potential cure, control of symptoms, and treatment. This is to overcome obstacles in delaying their diagnostic test. Likewise resources for financial support should also be identified. Not only in women is screening and treatment disparity apparent among blacks but also in men. The study of Leone and company (2011) found out that normal weight Africans has the lowest rate of screening compared to any other groups. A small number of African American men submit themselves for screening diagnosis. This is most especially among the medium weight African male population. The above review of literature indicates that disparity in health care delivery is conspicuous. This is reflected in researches involving ethnic groups such as African American women, Hispanic American, and Asian American groups. Such is most evident in the differences in the incidences of cervical and breast cancer cases, the differences in morbidity and mortality rates where African American group have higher rates of illnesses and death in all subgroups, and the differences in care given to black American women. Black women have lesser chance to be referred for evaluation or to be worked out particularly those with high grade abnormality. The persistence in the differences in accessing for screening examination is obvious. Although, numbers of incidences were reduced as a result of the implementation of certain measures among the white population, it remains to be high among the ethnic groups. Differences in the prevalence and incidences of these diseases among the American population are influenced with screening and follow-up rates, treatment, behavioral risk factors, and biological variations (Levi, et al. 2008). Such differences indicate that health care providers are not culturally aware, culturally knowledgeable, and culturally skilled to deliver culturally competent healthcare service. According to the model of Leininger, cultural and social structures may impact health disparities. Patients who belong to low socioeconomic level are often times the most vulnerable to be discriminated. One reason for this disparity points to the role of health insurance on health care services. Ethnic groups living in far flung areas in most cases are not offered health insurance or have a hard time to reimburse their medical coverage thus at often times they are denied treatment because physicians have little incentives from them. In times they are treated, they receive low quality health care. This is most apparent in the case of African American population in the States of Texas where there is a large proportion of African American women with a poverty rate higher than 10%. The impact of socioeconomic status on healthcare disparity is not confined in cervical cancer cases alone but it also cascades to other cancer cases such as the breast cancer which is also prevalent among the African American women. African Americans are found to have higher incidences of breast cancer compared to any other group and with a higher mortality rate. The socioeconomic status is pointed as a factor in this disparity (Tian, et al. 2010). In most cases, it cannot be denied that ethnic communities have lesser doctors to attend to them, fewer clinics, and hospitals reducing their access to health care services. Furthermore, patients who are poor do not give screening tests a priority not until they reach the advance stage where they can only seek medical attention. Blanchard and company (2004) indicated similar reason for disparity in the access of screening examination of breast cancer. Factors include economic reason, language factor, insurance issues, and racial and ethnic group barriers. It was also noted that a small percentage of patients go back for screening which was available for the next 10 years showing an inadequacy of culturally competent skill of the health care providers in following up clients of ethnic groups. Leininger model assumes that such low percentage of adherence to screening should have been prevented if health care providers are culturally competent across ethnic groups. Kinship in Leininger’s model is another dimension influencing health disparity. African women with social networks whether it is within the extended family, friends or neighbors are found to have gone through screening examination. The role of family is very important because they may encourage sick member for initial visit to physicians and in following subsequent schedules as well as gaining acceptance for recommended treatments. They act to regulate positive behavior towards screening (Hou, 2006). Patients who have limited knowledge of the disease, screening tests and treatments are mostly those who did not finished high school. The support of their husband and other family members are deemed crucial in their decision making. In addition, members who could speak English language well may serve as interpreters during encounters with the health care providers which in most cases solve the problem of communication barrier. Leininger also established technical aspects like transportation to influence prevalence of cervical cancer among ethnic groups. Normally, people who live in far flung areas have limited public and private transportations for them to access healthcare facilities for their health problems including screening tests. Added to this is the inadequacy of “good” amenities believed to contribute to healthy lifestyles. The absence of sidewalks, decent playground, and health facilities make them lazy to practice healthy lifestyle. Jogging, healthy walking, eating healthy foods, and health screenings is far from their daily routine. For the most part, ethnic group relies on their cultural beliefs when they are sick. They treat illness in accordance to their cultural rituals and practices. Others adhere to their religious beliefs that God has an intention for them to be sick and that only prayer can bring them back to their normal state of health. With such disparities, ethnic groups have to be empowered for them to modify their behavior towards health screenings and treatments. This could be done through educational approach. Education Plan Objectives At the end of the lecture presentation, the African American women should be encouraged to seek for screening test, adhere to medical interventions needed, seek information regarding cervical cancer, and be knowledgeable of the available screening procedures, and encouraged to advocate the same to other women. Methodology My method of instruction would be through lecture and pamphlet since my audiences are adults. Lecture could be presented with audio visual aides to get their attention. This would be with the use of computer aided discussions hand in hand with pamphlet containing the lecture and other pertinent information. The use of pamphlet is to enhance the lecture for them to read it handy at home and to share for those who were not able to join the lecture. It could be an independent assignment. Most importantly the pamphlet should contain information regarding the types of available screening tests within their area such as mammogram, magnetic resonance imaging (MRI), thermography, and other screening tests, and where to avail them. The discussion would include presentation of information that African American women have the highest morbidity and mortality rates when it comes to cervical cancer for them to be aware and help to identify reasons for such. The importance of screening tests in detection of the onset and the prevention of its progression has to be explained too because it has a strong association with the illness (Cook, et al. 2010). Defining certain concepts is also helpful. Prevention through early detection and intervention should be emphasized for them to understand the importance of screening examinations. Other activities would be a short open forum. This will give the participants the chance to clarify vague information presented during the lecture through question and answer method. It is also to clarify their concept of cancer and medical interventions. Informal feedbacks are also given at this point to serve as an improvement for the next lecture sessions. The sharing of experiences of survivors could also be highlighted to modify behavior in seeking medical interventions despite the presence of other barriers. Finally, it could also be a way to evaluate if the lecture was understood by majority. Venue With the strong presence of the church in areas with low socio economic status, it would be the best place to conduct my educational training. This is because there would be more women in attendance of any age and the possibility to include their husband. Besides, participants are already conditioned after the mass for the lecture. In addition, words could get easily around that may encourage more participants. The presence of amenities like chairs and blackboard makes the church a good choice too. Evaluation To evaluate if the strategy I introduced is effective, I would do survey after the lecture to check if their level of knowledge has improved. Questions should include the types of screening test and treatments, where to avail, and if level of knowledge about cervical cancer has changed. This could be followed up with checking with statistics in clinics and hospitals if the number of women who submitted themselves for appointment on screening and treatment has increased. This may explain if there are changes in their behavior. Another survey may follow to identify which factor had the greatest influence on their behavior. Sources Cited Blanchard, K., et al. (2004). Mammogram screening: patterns of use and estimated impact on breast cancer carcinoma survival. Cancer. (3):495-507. Coker, A. et al. ( 2008). Ethnic disparities in cervical cancer survival among Texas women. Journal of women’s health. (10). 1577-1583. Cook, N., et al. (2010). Role of patient race/ethnicity, insurance and age on Pap smear compliance across ten community health centers in Florida. Pubmed. 20(4):321-6. Giwa, A. (2010). Diagnostic and therapeutic delays among multiethnic sample of breast and cervical cancer survivors. Cancer . (13):3195-204. Hicks, ML. et al. (2006). Disparities in cervical cancer screening, treatment and outcome. PDF. 3-63–S3-66. Retrieved from http://www.ishib.org/journal/16-2s3/ethn-16-2s3-63.pdf on July 31, 2011 Hou, SI. ( 2006). Perceived spousal support and beliefs toward cervical smear screening among Chinese women. Californian Journal of Health Promotion. ( 4) 57-164 Leone, LA. et al. ( 2011). Cancer screening patterns by weight group and gender for African American church members. Journal of community health. Levi, D., et al. ( 2008). Disparity in cervical cancer in diverse population. Gynecologic oncology S22–S30 Tian, N., et al. ( 2010). Identification of racial disparities in breast cancer mortalitiy: Does scale matter? International journal of health geographics. Retrieved from http://www.ij-healthgeographics.com/content/9/1/35 on July 31, 2011. Timber, E., et al. ( 2005). Untreated cervical cancer in the United States. Gyneclogic oncology. (96).271-277 Read More