Cultural Competence - Assignment Example

Cultural Competence Background: Underpinning Competence The increase in the geographical mobility of people either as a result of globalization or the encouragement for migration has led to unprecedented level of racial and cultural diversity in many societies. In the United States, for example, people from different ethnic backgrounds reached 100 million in the year 2006, constituting at least a third of the US population (Miller & Stoeckel, p. 224). The American Census Bureau projects that by 2050 this figure will increase further and people from different culture and ethnic background will constitute half of the American population. The implication of this development in health practice is immense. Health practitioners must now deal with patients coming from different backgrounds whose culture and ethnicity underpin different views, perspectives, customs and language about health and illness. The thought characteristics of these require an understanding on the part of the practitioners in order for them to be effective. Several authors have pointed out that patients will inevitably have experiences that could be difficult for health care providers to comprehend regarding diseases and health problems, including those that are not common in America (see Ivanov & Blue, 2008, p. 554). Indeed, the perception of health and illness, wrote Miller and Stoeckel, “is enculturated into members of a cultural group” and that other variables unique to their ethnicity such as socioeconomic, educational and religious variables, among others further reinforce the diversity in health beliefs (p. 224). There is also the challenge of making the diverse constituencies of health institutions understand the highly sophisticated American health care system. There so many other factors such as language barriers that further complicate the situation. All these underpin the imperative for cultural competence on the part of health care practitioners. One of the most widely used and, certainly, most comprehensive definitions of cultural competence was written by Cross et al., (1989), who stated that it is “a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system, agency or those professionals to work effectively in cross cultural situations.” This model there depicts health care framework that focuses on an understanding as well as the integration of beliefs, values and behaviors regarding health of a diverse set of constituencies for purposes of health care effectiveness. As this variable is increasingly integrated as a best practice standard in health care practice in the United States, there are mechanisms developed to ensure compliance. A case in point is the standard set by the National Center for Cultural Competence, particularly its cultural competence assessment for health practitioners. The assessment is based on three core principles: 1) cultural competence is a developmental process at both the individual and organizational levels; (2) with appropriate support, individuals can enhance their cultural awareness, knowledge and skills over time; and (3) cultural strengths exist within organizations or networks of professionals but often go unnoticed and untapped (NCCC, 2014). The assessment of cultural competency also underpins its role in addressing several challenges in delivering care to diverse health constituencies. Issues There is another framework that captures cultural competence “the ability to engage in actions or create conditions that maximize the optimal development of the client and client systems” (Carter, p. 8). This is aligned with the Purnell model considered it as a nonlinear and complex process that addressed subjective culture of attitudes, beliefs, valious, behaviors and practices (Lattanzi & Purnell, 2006, p. 26). These explanations of cultural competency indicates that equal treatment of patients may appear to prefer a bias and could discriminate patients from different cultural background. This is because it calls for differential treatment on account of the recognition that people from diverse ethnic and cultural backgrounds have different life experiences. The idea is that people should not be treated equal in care since those from different ethnic groups have different needs and beliefs about health. This is depicted, for instance, in providing mental health care. According to Carter, the goal of cultural competence on the part of practitioners is the achievement of equal access on the part of patients. There is an imperative for different treatment of patients because of their different needs. This now becomes an issue. How do practitioners deal with the disparity of needs? Withholding or prescribing an aspect of care may appear to be prejudiced when done for racial and cultural reasons. But this could be necessary if an effective treatment is to be achieved across a diverse group of patients. There is also the case of confusion. For example, some health care practitioners, may have trouble distinguishing cultural competence from client-centered care and reconciling both models. RNAO (2002) identified the latter an approach where clients are viewed as whole persons, respecting their autonomy, identity, view and participation in the decision-making (p. 12). The problem arises because of the model’s requirement for integrated the clients’ preferences in regard to health, illness and treatment. While client-centered care does not have explicit and direct focus on culture or cultural competence, there is certainly an overlap with respect to how clients are treated. There is a need to clear this issue because the link could be a source of problem. For example, Srivastava pointed out that in client-centered approach, clinically competent health care providers unknowingly provide care that is culturally ineffective and safe (p. 20). Finally, it is useful to note that culture still figures prominently in health disparities in the United States. This is particularly prominent in the number of insured people from different ethnic groups as well as the quality of service provided. This is recognized by the American government and is also reflected in the body of literature on health care access and quality. These are the reason why the issue underpinned several policy measures such as the Healthy People 2010 Initiative. Many statutes were also passed containing cultural competence as an imperative such as the Medicare Improvement Plan for Patients and Providers Act of 2008 and the Children’s Health Insurance Program Reathorization Act of 2009. These factors underscore the importance of cultural competence in achieving effective care. Currently, the National Institute on Minority Health and Health Disparities is at the frontline of the federal government’s objective of eliminating disparities through best practices such as cultural competence in health practitioners. This is a necessary improvement since many aspects of health disparities are caused by ignorance about the health requirements of specific ethnic groups. Best Practice Based from definitions adopted by the policy networks as well as the body of literature on this subject, several ideal competence characteristics are revealed. There is the thorough understanding of diversity and the need for such awareness in health care practice. Competent health care professionals should be able to recognize differences in beliefs, values and behavior according to cultural and ethnic backgrounds. Specific ideal characteristics include bilingualism or the ability to speak or understand the language of one or more ethnic groups. This is because communication is essential in dealing and treating clients. Articulating health issues and conditions as well as drawing information from patients could become complex processes. The capability to speak and/or understand their language could help a great deal. specific characteristic that is ideal for care practitioners is biculturalism. If they are part of an ethnic group, they will have the perspective and could understand the context that would make treatment and care effective for people from different ethnic backgrounds. These are proven by various studies, which demonstrated the positive link between practitioner’s ethnicity as well as cultural knowledge to positive treatment outcomes (Chow et al., 2003; Gamst et al., 2001). There are two important mechanisms that could ensure that the ideal cultural competence in health care practice is achieved. These are: assessment and training. Assessment As in any other endeavor with a set goals and strategies to achieve them, assessment is critical in achieving cultural competence for health practitioners. Testing and evaluating cross-cultural knowledge and the capability to understand the impact of such knowledge on patient care will reveal gaps, inadequacies and points for improvement. Also, evaluating and reflecting on one’s attitude about people belonging from different ethnicities. The awareness that comes after should be able to help eliminate a boxed mindset and ethnocentrism, particularly the prejudices and stereotypes entailed therein. Currently, there are several cultural competency assessments available. This author, for instance, has used the cultural Competence Health Practitioner Assessment (CCHPA) by the National Center for Cultural Competence (NCCC). This assessment is effective since it helps practitioners and institutions determine the competence of practitioners in six areas: 1) values and belief systems; 2) cultural aspects of epidemiology; 3) clinical decision making; 4) life cycle events; 5) cross-cultural communications; and, 6) empowerment/health management (NCCC). Training Even when a practitioner does not belong to an ethnic group, he will be able to be just as effective through training. It will enable him to obtain cross-cultural knowledge that could help navigate the complexities and challenges in caring for diverse constituencies. There is, however, a critical dimension to this area. If a practitioner trains for cultural competence because it is mandatory or it is necessary to advance one’s career, training will be useless. There is a need for a meaningful training or education strategies that will ensure that the practitioner imbibe values, motivations and commitment necessary to achieve cultural competence. For many health care institutions, this will entail organizational change. Approaches will certainly be needed to change the culture of the organization. By doing so, competency in caring for culturally diverse patient becomes part of the health care practitioners’ values and behavior, leading to a more effective patient care. It is important to note that cultural competence is a process. Here, there is a need to continually learn and work according to the cultural context of the diverse patients. It is multidimensional in the sense that it is not merely about cultural knowledge or awareness. It also involves other constructs such as cultural skills, encounters/experiences and motivation/desire. This is important in the wider improvement of the quality of health care delivery in the United States with its increasingly diverse population. Today, there is already a recognition both on policy and research levels that the level of cultural competence has important bearing on effective provision of health care service. For my personal reflection, I have completed the Cultural Competition Checklist: Personal Reflection by the American Speech-Language-Hearing Association. As I review my answers, I am confident that I recognize all core constructs of cultural competency as a health care practitioner. Most importantly, I would like to point out my deep understanding of different cultures’ norms and how they shape the context of care delivery and behaviors on health and illness. There are few things that I still don’t understand or have to work on. For instance, I feel strongly against being driven by insensitive comments or behaviors. In retrospect, this could indicate intolerance especially when such comments were labeled insensitive based on my own cultural orientation. There is also my current negative recognition with regards to how family members are considered decision makers for services and support. I just realized that in many Asian societies, family is very important so members are not just considered but also valued decision makers. References 1. Miller, M and Stoeckel, P. Client Education: Theory and Practice. Sudbury, MA: Jones & Bartlett Learning, 2010. 2. Ivanov, L and Blue, C. Public Health Nursing: Policy, Politics & Practice. New York: Cengage Learning, 2008. 3. Cross, T, Bazron, B, Dennis, K, Isaacs, M. Towards a culturally competent system of care, Volume 1. Washington DC: Georgetown University Child Development Centre, CASSP Technical Assistance Center, 1989. 4. National Center for Cultural Comptence (NCCC). Cultural Competence Health Practitioner Assesment. NCCC. 2014. Available from: http://nccc.georgetown.edu/features/CCHPA.html. Accessed June 17, 2014. 5. Carter, R. Handbook of Racial-Cultural Psychology and Counseling, Training and Practice. Hoboken, NJ: John Wiley & Sons, 2004. 6. Black Lattanzi JF, Purnell LD. Developing Cultural Competence in Physical Therapy Practice. Philadelphia, PA: FA Davis Co, 2005. 7. Registered Nurses Association Ontario. Nursing best practice guideline: Client-centred care. RNAO. 2002. Available from: http://www.rnao.org/bestpractices/pdf/BPG_cccare.pdf. Accessed June 16, 2014. 8. Srivastava, R. The Healthcare Professionals Guide to Clinical Cultural Competence. Toronto: Elsevier Health Sciences, 2007. 9. Chow, J, Jaffee, K and Snowden, L. Racial/ethnic disparities in the use of mental health services in poverty areas. American Journal of Public Health. 2003; 93(5): 792-798. 10. Gamst, G, Dana, R, DerKarabetian, and Kramer, T. Asian American mental health clients: Effects of ethnic match and age on global assessment and visitation. Journal of Mental Health Counselling. 2001; 23(1): 57-71. Read More