Culturally Competent Care - Essay Example

Culturally Competent Care Culturally Competent Care Introduction Cultural competence in healthcare is termed as the ability to offer care to patients who have varied values, beliefs and behaviors. This practice is inclusive of altering the manner in which health care delivery is provided in order to meet the social, cultural and linguistic needs of the patient. A key constituent to emerging care delivery models, such as patient-centered medical homes and accountable care organizations is seen as the ability to connect and educate patients on their health status. While undertaking this objective presents challenges for all patients, it can even be more tasking due to language barriers, health literacy gap, and cultural variations in communication styles (Health Research & Educational Trust, 2011). It is critical for hospitals and health care systems to comprehend the varied patients and communities they serve as well as the advantages of becoming an ethnically proficient organization. Hospitals and clinicians are required to prepare their nurses and workers o interrelate with patients of diverse background to heighten patient commitment and education and to help in abolishing racial and ethnic inequalities in care. In order to enhance comprehension of diverse cultures, hospitals and care systems should get advice from individuals and groups in the communities where they operate. These populations can aid health care providers to develop educational materials as well as increase patient access to services and enhance health care literacy (Health Research & Educational Trust, 2011). This paper analyzes the cultural competent care framework used by Buffalo Health Care Center a hospital that mostly offers end-of-life care to Chinese-Americans. The paper begins by providing an outline of various Chinese practices regarding health care that nurses and the staff at Buffalo Health Care Center need to know for them to be able to offer better service to the Chinese population. Brief Analysis of the Chinese-Americans Living Near Buffalo Health Care Center Demographics A large number of the Chinese-Americans have their origins in mainland China or Taiwan a nation that is only 75 miles from mainland China. Individuals from these two nations have an identical racial, ethnic, and religious setting. In 2011, the number of Chinese-Americans residing in the U.S. was 4.5. This was an increase of nearly half a million from the 2010 national census. Chinese-Americans form 1.4% of the entire US population and they are currently the biggest Asian ethnic population, consisting of nearly 26% of all Asian Americans. Despite their decreased birthrate, Chinese-American families tend to be big due to the practice of living in extended families (Health Research & Educational Trust, 2011). On average, Buffalo Health Care Center serves 20,000 Chinese-Americans each year. Socio-economics The Chinese-American population is very economically varied. While their mean revenue is greater than the national median income, there are a bigger number of Chinese-Americans living in poverty conditions as compared to the national average. The clarification and explanation of these variations can be best understood from a person’s place of origin. On the mainland China, even the highly educated individuals have minimal exposure to the English language. This means that even the professionals who migrate to the US find it very challenging to fit into the American society and majority of them are unable to hold any meaningful jobs. However, those from Taiwan are better acquainted with the English language and the American culture. This increases their chances of finding better jobs once in the US (Hsiung & Ferrans, 2007). A large section of both mainland and Taiwanese people speak mandarin Chinese, which is the official language in the two nations. There is however another group that speak Cantonese, which is a different kind of Chinese. Although mandarin Chinese and Cantonese are varied, they share the same written language and so it is possible for one to understand the other. Majority of the individuals served at Buffalo Health Care Center only speak Cantonese (Carnes & Fenggang, 2004). Health Care Practices A large number of Chinese use Traditional Chinese Medicine for their ailments. Although this practice is only popular in mainland China, a large number of the early immigrants prefer this type of treatment over the conventional means. Developed over many millenniums, this form of treatment is characterized by a holistic concept of health that stresses on attaining equilibrium and accord on the entire body systems. Qi is a term that the Chinese have always used to denote the life force, and the main aim of traditional Chinese medicine is to restore qi by utilizing different approaches. Some of these popular and widespread approaches are related to herbal medication as well as acupuncture (Wang, 2010). Recent immigrants are most likely to have wide knowledge and are comfortable using traditional Chinese medicine. However, a large section of them are in low earning jobs and are also likely to be without health insurance. Socioeconomics has a very central role in health care applications. Most recent immigrants, who also have wide knowledge about traditional Chinese medicine have a higher likelihood of earning little and therefore not eligible for health insurance. Majority of the recent immigrants who have become US citizens have most likely not heard about Medicare or Medicaid or how to obtain benefits. Traditional Chinese medicines services are usually cheaper for the uninsured as compared to the conventional health care. For this reason, the traditional Chinese medicines are a better option for current immigrants (Wang, 2010). In order for Buffalo Health Care Center to be able to serve the Chinese-American population in a better way, a thorough knowledge of their approach to medicine is critical. In most instances, the Chinese people make use of both the ancient Chinese drugs in combination with the modern medicine. Majority of the Chinese-Americans are comfortable with the concept of using contemporary medical systems. However, there are certain areas of health care provision where only modern science is recommended. A good example of this is identifiable diseases such as cancer and diabetes and emergency services. Majority of Chinese people first try traditional medicines before they can visit a health facility. Since traditional Chinese medicines system emphasizes that each part of the body is interconnected, it should be noted that a large section of Chinese Americans will try to incorporate traditional methods into the care that they are offered and this is inclusive of hospice. Majority of the individuals might craft their own therapy such as the alteration of diet or seeking help from practitioners who might not be licensed medics. Some of the patients might not be willing to admit their use of traditional Chinese medicine out of fear that the American clinicians will disapprove (Wang, et al., 2004). The Authority of Doctors One thing that the staff at Buffalo Health Care Center needs to know is that in the Chinese culture, doctors are seen as highly trustworthy people and in most cases their opinion is accorded high importance. Doctors are seen as highly intelligent, honorable, ethical and holding special knowledge. Elderly people might find it easy to trust the opinion of doctors over that of their children. For this reason, identifying a health care proxy could be seen as meaningless to the aged population in China. An agreement among relatives is treasured and the outlook of the doctor can affect and guide end-of-life deliberations, while the thoughts of a proxy may be perceived as a hindrance to the decision making process (Crawley, & Kagawa, 2007). Apart from this, Confucian philosophy calls for the respect of elders and as such most children feel that they are responsible over the health of their aged parents. Due to the insistence on emotional harmony, most Chinese individuals do not encourage the discussion of death matters since they believe that it interferes with the inner harmony. In addition to this, the Chinese culture insists on the role of destiny in fatalism. This means that majority of the life events are considered by the Chinese to be beyond control. While individuals may have the feeling that they need to direct their destiny, the ultimate result, such as acquiring a serious disease or undergoing a loss is often seen as a pre-determined event (Crawley, & Kagawa, 2007). Standards of Cultural Competence Assessing the Community Demographics In order to be able to offer services to the community, Buffalo Health Care Center has undertaken an extensive study on the community demographics. The whole idea of this process was to ensure that they understood the diversity of the entire community. In obtaining the data, the hospital sought to establish whether there were more people with Taiwanese or mainland China roots. The data was also helpful in determining the dialects that the people within this community spoke. In essence, the information proved useful as a way of determining if the immigrants recently entered the country as refugees or if they were born in the United States. Lastly, the demographic data analyzed the average age, level of education and the earning power of the Chinese-American group (Salimbene, 2005). Carrying out this exercise was helpful for the hospital since it was used in formulating the right the right approach to convince the target group to join the program. Understanding the background of the target group is critical since it helps in establishing a suitable strategy to reach the Chinese population. The Taiwanese who are the majority in this population are conversant with the English language as well as the American way of life and as such convincing them to join the program was not hard. This was also important since it helped in designing a program that the individuals within this group could afford. The Chinese of Taiwanese origin have an higher economic power and the hospital was able to avoid setting the cost too low like it would be the case when dealing with mainland Chinese majority of who have a low income due to their inability to transition into the American culture (Wilson-Stronks & Mutha, 2010). Community Liaison One critical aspect of conducting a successful culturally competent care is having a community liaison. This individual is meant to act as a link between the health care facility and the target population. Buffalo Health Care Center has fulfilled this requirement as it has set a bilingual, bicultural person who is well connected to the local Chinese-American population. In choosing this individual, the healthcare facility considered the necessary skills that are required to attain its objectives. The health care center also considered the credibility that the chosen individual would bring to the hospital. On top of having the traditional qualifications, the chosen individual is capable of working with a wide range of individuals. Before his being hired, his credibility and access to the Chinese-Americans was first assessed. The individual who was finally chosen for this task had strong ties with both Christians and Buddhists thus making him ideal for the task (Salimbene, 2005). Given the amount of trust that the Chinese people accord to doctors, the selection of a community liaison who is a qualified doctor and who has wide knowledge on Chinese culture has helped the health facility to attain the trust of the community. Today, people come to Buffalo because they have a strong trust that their wishes will be respected and out of belief that the staff has their interests at heart. Although the Chinese do not like discussing about death, they believe that being prepared for it is ideal and hence the high number of Chinese –Americans who have signed for the program (Salimbene, 2005). Community Engagements For any health care facility to be able to offer culturally competent care, it is critical to seek the opinion of the target community before setting up any initiatives. Before setting up the facility, a team of surveyors was sent out to interview the Chinese-American population who were living in the area to seek their opinion about the program. The survey also targeted Chinese-American families that had received hospice to determine their opinion and experiences with hospice. This survey was also meant to find out what this population would have wanted to be changed about hospice. This survey determined that the origin of the Chinese-Americans was critical in determining their reception to discussing end-of life issues (Bowman & Singer, 2001). Being engaged with the community is critical since it helps the health care facility or any other body to set up the right strategies. In addition to this, the obtained data is used during the process of staff training. In the event that community engagement is not pursued, a health care facility finds it setting up strategies that end up being rejected by the target population. In addition to this, lack of community engagement makes it hard for the health care providers to organize staff training since training is in most cases based on what the target population has voiced out. In addition to this, conducting such a survey helps is setting up priorities that the community members have set out. In short, community engagement acts as a road map for the health care provider (American Hospital Association and Institute for Diversity in Health Management, 2012). On the aspect of engaging the community, it is also important to do a study to build strong bridges with the target community and augment the outreach potential. This calls for the undertaking of homework to establish who is influential in the community and then meet with these individuals to explain what the outreach is trying to undertake. In this case, the most influential individuals within the Chinese-American descent mainly include the clergy, interpreters, and also the social service providers. It is also important to approach the political representatives since they usually possess a convincing power over the population (American Hospital Association and Institute for Diversity in Health Management, 2012). Education Principles for Cultural Competence Becoming an ethnically proficient organization calls for a thorough comprehension of the values that typify cultural competence. To begin with, the staff needs to comprehend the factors that are pushing the health care provider to become culturally proficient. The staff also needs to comprehend and realize the cultural and clinical dynamics in dealings with patients. Attaining cultural competence incorporates developing and attaining the necessary skills that are necessary to identify and assist patients from varied cultures. Once they get the right skills and mindset, the staff can easily point out the services that are needed by a patient and this increases positive health outcomes (Community Tool Box, 2013). For Buffalo Health Care Center, the first thing that was sought was to identify whether the staff was comfortable in addressing the end-of-life concerns that might come up in the course of service that are of particular concern to the Chinese-Americans. The other thing that the management sought was to create a sense of certainty that the members of the staff would serve the target community with respect and cultural sensitivity. This also involved setting up effective systems that would address the emerging communication barriers as well as systems that would make it possible to deal with the issue of patient autonomy. Using Culturally Appropriate Language In the event that an organization is working with a largely immigrant society, it is important to set focus on employing culturally correct language both in the written communication and within the healthcare setting. There is always need to not only translate documents but also to trans-create them. What this entails is that such literature or documents should be written in a language that is easy to understand and in a manner that is appropriate for the target community and not just direct translation. In the process of offering required health care, it is always essential to avail the most competent and well-versed translators to support in the provision of the health services. Interpreters are critical in facilitating the provision of quality health care to Chinese-Americans since the best interpreters understand not only the necessary cultural consideration but the language skills as well (Community Tool Box, 2013). In this aspect, Buffalo Health Care Center uses family members as interpreters, which is not ideal. Studies in this area have shown that untrained health care interpreters such as family members might be unable to communicate the right information between the patient and the health care providers. This is why it is critical to have well trained medical trainers among the staff members as either volunteers or ones that have been hired on a contract basis, and as noted earlier, it is critical to understand the existing diversity in Chinese dialects. A large section of individuals from mainland China use Mandarin Chinese while those from Taiwan use Cantonese. While these two languages use the same written language, there are some critical variations between the written languages in mainland China and Taiwan that should not be ignored (Community Tool Box, 2013). Building Trust One of the most important things that an organization such as Buffalo Health Care Center need to do in its initial stages of interacting with the cultural community is to create trust. Just like any other venture, acquiring the trust of the community requires time, and developing this trust should be the major objective in the pursuit for new partnerships and building relationships. In the current society that is goal-oriented, it is very easy to place much emphasis on goals and forget the more important issue of developing relationships. What any organization should know is that meaningful relationships are the ideal path to long-term success (Cook, 2010). In order for Buffalo Health Care Center to build a successful partnership and execute its outreach activities with the Chinese-American society, it is important for them to create an environment of trust. As noted earlier, the Chinese put a lot of trust on medical practitioners and might value their opinions more than they value the opinion of their own children. Conclusion and Recommendations Hospitals and care systems are called to prepare their clinicians and workers to relate with patients of varied backgrounds to enhance patient involvement and education to abolish racial and ethnic disparities in care. Cultural competence is necessary to offer care to the Chinese-Americans identified in this study. This is because they have diverse values, beliefs, as well as behaviors. Buffalo Health Care Center, as part of its mission, is keen on lowering variations in care and has been employing various techniques in its efforts to train staff to become culturally competent. While the hospital has tried hard to understand the cultural competence as well as the diverse community that it serves, there is still more that it needs to do for its mission to be fully realized, and especially in the area of employing interpreters. In the past, Buffalo Health Care Center has been relying on family members to offer interpretation services. The problem with this approach is that such individuals might not offer the right interpretation between the patient and the clinician thus making it hard for the right intervention to be administered. This calls for the need to look for an individual with medical background either as a volunteer or to be hired on contract basis. References American Hospital Association and Institute for Diversity in Health Management. (2012, June). Diversity and Disparities: A Benchmark Study of U.S. Hospitals. Chicago: IL. Bowman, K., & Singer, P. (2001). Chinese Seniors’ Perspectives on End of Life Decisions. 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