Cultural competence in health care | Wikipedia audio article

Cultural competence in health care | Wikipedia audio article


Cultural competence in healthcare refers to
the ability for healthcare professionals to demonstrate cultural competence toward patients
with diverse values, beliefs, and feelings. This process includes consideration of the
individual social, cultural, and feelings needs of patients for effective cross-cultural
communication with their health care providers. The goal of cultural competence in health
care is to reduce health disparities and to provide optimal care to patients regardless
of their race, gender, ethnic background, native languages spoken, and religious or
cultural beliefs. Cultural competency training is important
in health care fields where human interaction is common, including medicine, nursing, allied
health, mental health, social work, pharmacy, oral health, and public health fields. The term cultural competence was first used
by Terry L. Cross and colleagues in 1989, but it was not until almost a decade later
that health care professionals began to be formally educated and trained in cultural
competence. In 2002, cultural competence in health care
emerged as a field and has been increasingly embedded into medical education curriculum
since then. Although cultural competence in healthcare
is a global concept, it is primarily practiced in the United States.==Definitions==
Cultural competence is defined as a set of congruent behaviors, attitudes, and policies
that come together in a system, agency, or among professionals and that enables them
to work effectively in cross-cultural situations. Essential elements that enable organizations
to become culturally competent include valuing diversity, having the capacity for cultural
self-assessment, being conscious of the dynamics inherent when cultures interact, having institutionalized
cultural knowledge, and having developed adaptations to service delivery reflecting an understanding
of cultural diversity. By definition, diversity includes differences
in race, ethnicity, age, gender, size, religion, sexual orientation, and physical and mental
ability. Accordingly, organizations should include
these considerations in all aspects of policy making, administration, practice, and service
delivery.Cultural competence involves more than having sensitivity or awareness of cultures. It necessitates an active process of learning
and developing skills to engage effectively in cross-cultural situations and re-evaluating
these skills over time. Cultural competence is often used interchangeably
with the term cultural competency.==Cultural competence in various settings
=====
Healthcare system===A healthcare system, sometimes referred to
as health system, is the organization of people, institutions, and resources that deliver healthcare
services to meet the health needs of target populations. A culturally competent health system not only
recognizes and accepts the importance of cultural diversity at every level but also assesses
the cross-cultural relations, stays vigilant towards any changes and developments resulting
from cultural diversity, broadens cultural knowledge, and adapts services to meet the
needs that are culturally-unique.As more and more immigrants are coming to America, healthcare
professionals with good cultural competence can use the knowledge and sensitivity that
they obtain in order to provide holistic care for clients from other countries, who speak
foreign languages. The challenges for American healthcare systems
to meet the health needs of the increasing number of diverse patients are becoming very
obvious. The challenges include but are not limited
to the following: Sociocultural barriers
Poor cross-cultural communication Language barriers
Attitudes toward healthcare Beliefs in diagnosis and treatment
Lack of cultural competence in the design of the system===
Leadership and workforce===In response to a rapid growth of minorities
population in the United States, healthcare organizations have responded by providing
new services and undergoing health reforms in terms of diversity in leadership and workforce. Despite improvements and progress seen in
some areas, minorities are still underrepresented within both healthcare leadership and workforce. To improve the weak minorities representation
in leadership and workforce, an organization must acknowledge the importance of cultures,
be sensitive to cultural differences, and establish strategic plans to incorporate cultural
diversity. According to the national survey of the U.S.
healthcare leaders conducted by the search firm Witt/Kieffer, respondents viewed diverse
leadership as a valuable business builder. They associated it with improved patient satisfaction,
successful decision-making, improved clinical outcomes, and stronger bottom line.To successfully
recruit, mentor, and coach minority leaders in healthcare, it is important to keep these
social science principles and cultural values in mind:
Branding – how health care leaders brand diversity in their organizations? Without inclusion, branding would not be complete
The concepts of self-categorization and “othering” Lack of leadership commitment – diversity
and inclusion should be an imperative of their organization
The compelling national demographics of healthcare leadership and workforce.===Clinical practice===
To provide culturally sensitive patient-centered care, physicians should treat each patient
as an individual, recognizing and respecting his or her beliefs, values and care seeking
behaviors. However, many physicians lack the awareness
of or training in cultural competence. With the constantly changing demographics,
their patients are increasingly getting diverse as well. It is utterly important to educate physicians
to be culturally competent so that they can effectively treat patients of different cultural
and ethnic backgrounds. Implicit bias aimed towards certain races
or ethnicities is frequent in the healthcare field, specifically in the United States,
commonly with Black Americans, Hispanic Americans, and American Indians. Subconscious discrimination occurs regardless
of the advancement of disease prevention in the United States, as shown by the significantly
high mortality rates of the groups mentioned earlier in the paragraph. This discrimination is shaped by attitudes
of healthcare professionals, who often differ in effort and type of treatment based on the
race and physical appearance of a patient. Carrying over to the diagnosis and treatment
of minority patients, the disparities in quality of healthcare increase the likelihood of developing
diseases such as asthma, HIV/AIDs and other life-threatening diseases. For example, a study that focused on the treatment
and diagnosis differences between black women and white women in regards to breast cancer
indicated this discrimination against minorities and its effects. Furthermore, the study indicated that “white
women are more likely to be diagnosed with breast cancer, [and] Black women are more
likely to die from it.”The differences in responses from healthcare professionals to
black patients versus white patients is drastic, indicated by subconscious negative perceptions
of various races. In a study that evaluated physicians’ immediate
assumptions made about different races “two-thirds of the clinicians subconsciously formed a
bias against Blacks (43% moderate to strong) and Latinos (51% moderate to strong)”. Without intentionally concocting stereotypes
about patients, these clinicians are indirectly negatively affecting the patients they mistreat. To remedy this, the study expresses support
for clinicians to form a stronger connection with each patient and to focus on the patient
at hand, rather than considering their race or background. This will help to prevent negative attitudes
and tones when speaking with patients, creating a positive atmosphere that allows for equal
environments and treatments for all patients, regardless of race or physical appearance. In response to the increasingly diverse population,
several states (WA, CA, CT, NJ, NM) have passed legislation requiring or strongly recommending
cultural competency training for physicians. In 2005, New Jersey legislature enacted a
law requiring all physicians to complete at least 6 hours of training in cultural competency
as a condition for renewal of their New Jersey medical license, whether or not they actively
practice in New Jersey. Physicians’ responses to this CME requirement
varied, both positively and negatively. But the overall feedback was positive towards
the outcomes of participation in and satisfaction with the programs.In order to provide culturally
competent care for their diverse patients, physicians should at the first step understand
that patients’ cultures can influence profoundly how they define health and illness, how they
seek health care, and what constitutes appropriate treatment. They should also realize that their clinical
care process could also be influenced by their own personal and professional experiences
as well as biomedical culture. Dr. Like pointed out in one of his articles
that “in transforming systems, transcultural nurses, physicians, and other health care
professionals need to remember that cultural humility and cultural competence must go hand
in hand.”===
Research===Cultural competence in research is the ability
of researchers and research staff to provide high quality research that takes into account
the culture and diversity of a population when developing research ideas, design, and
methodology. Cultural competence can be crucial for ensuring
that the sampling is representative of the population and therefore application to a
diverse number of people. It is important that a study’s subject enrollment
reflect as closely as possible the target population of those affected by the health
problem being studied. In 1994, the National Institutes of Health
established policy (Public Law 103-43) for the inclusion of women, children, and members
of minority groups and their subpopulations in biomedical and behavioral clinical studies. Overcoming challenges to cultural competence
in research also means that institutional review board membership should include representatives
of large communities and cultural groups as representatives.===Medical education===
The critical importance of training medical students to be future culturally competent
physicians has been recognized by accrediting bodies such as the Accreditation Council on
Graduate Medical Education (ACGME) and the Liaison Committee on Medical Education (LCME)
and other medical organizations such as American Medical Association (AMA) and the Institute
of Medicine (IOM). Culture is definitely beyond ethnicity and
race. Healthcare professionals need to learn about
the tolerance of other’s beliefs. Professional care is about meeting patients’
needs even if they do not align with the caretaker’s personal beliefs. Discovering one’s own beliefs and their origin
(from upbringing or modeling of parents, for example) helps understand what is believed
and moderates actions at times when others are cared for with different beliefs. As a result, it is essential for healthcare
professionals to practice cultural competence and recognize the differences as well as cultural
sensitivities to provide holistic care for the patients. According to the LCME standard for cultural
competence, “the faculty and students must demonstrate an understanding of the manner
in which people of diverse culture and belief systems perceive health and illness and respond
to various symptoms, diseases, and treatments.” In response to the mandates, medical schools
in the U.S. have incorporated teaching cultural competency in their curricula. A search on cultural competency in the curriculum
of a medical school revealed that it was covered in 33 events in 13 courses in spring 2014. A similar search was performed on health disparities
yielding 16 events in 10 courses covering the topic. The cultural competence curriculum is intended
to improve the interaction between patients and physicians and to assure that students
will possess the knowledge, skills, and attitudes that enable them to provide high quality and
culturally competent care to patients and their families as well as the general medical
community.A “visual intervention” was completed to educate healthcare professionals on the
dangers of subconscious discrimination toward minority groups in order to lessen the common
discrimination certain races or ethnicities face in a healthcare setting. This study allowed for physicians to focus
more on the problems of their patients, and truly listening to their issues. By creating a supportive space that fosters
a strong channel of communication, the study targeted the lack of connection between healthcare
professionals and patients due to either language barriers or the patient’s mistrust in the
professional.===Patient education===
Patient-Physician communication involves two sides. While physicians and other healthcare providers
are being encouraged or required to be culturally competent in delivery of quality healthcare,
it would be reasonable to encourage patients as well to be culturally sensitive and be
aware that not all health care providers are equally competent in cultures. When it comes to illness, cultural beliefs
and values affect greatly a patient’s behavior in seeking healthcare. They should try their best to communicate
their concerns relating to their beliefs, values and other cultural factors that might
affect care and treatment to their physicians and other healthcare providers. If effective communication is unlikely achieved,
then they should be provided with language assistance and interpretation services. Recognizing that patients receive the best
care when they work in partnership with doctors, the General Medical Council issued guidance
for patients “What to expect from your doctor: a guide for patients” in April 2013.==Challenges to cultural competence=====
Language barriers===Linguistic competence involves communicating
effectively with diverse populations, including individuals with limited English proficiency
(LEP), low literacy skills or are not literate, disabilities, and individuals with any degree
of hearing loss. According to the U.S. Census in 2011, 25.3
million people are considered limited English proficient, accounting for 9% of the U.S.
population. Hospitals frequently admit LEP patients for
treatment. With cultural and linguistic barriers, it
is not surprising that it is hard to achieve effective communication between the health
care providers and the LEP patients. In order to improve communication and mutual
understanding, health care systems have used the professionally trained interpreters to
help health care providers to communicate with patients whose English proficiency is
limited. Studies have shown that trained professional
interpreters or bilingual health care professionals have a positive effect on LEP patients’ satisfaction,
their quality of care, and outcomes.The National Culturally and Linguistically Appropriate
Services (CLAS) Standards in Health and Health Care developed by the Office of Minority Health
(OMH) are intended to advance health equity, improve quality and help eliminate health
care disparities. The three themes of the fifteen CLAS standards
areGovernance, Leadership, and workforce; Communication and Language Assistance; and
Engagement, Continuous Improvement, and Accountability. The standards clearly emphasized that the
top levels of an organizational leadership hold the responsibility for CLAS implementation,
and that language assistance should be provided when needed, and quality improvement, community
engagement, and evaluation are importance. that is a very good resource for healthcare
systems and organizations to follow to become culturally and linguistically competent in
the delivery of health care.===Cultural barriers=====
See also==Community-based participatory research
Culturally relevant teaching Global health
Health status of Asian Americans Health system
Intercultural competence Medical ethics
Purnell Model for Cultural Competence

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