Core Concepts in Cultural Competence

Core Concepts in Cultural Competence Key Concepts (printable) |Cultural Competence | | | | |Definition: |Cultural Competence is a set of values, behaviors, attitudes and practices within a system, organization, program or among | | |individuals that enables them to work effectively across cultures.Cultural competence refers to the ability to honor and respect | | |the beliefs, language, interpersonal styles and behaviors or children and families receiving medical care, as well as those of the | | |staff who are providing such care. Cultural competence is a dynamic, ongoing developmental process that requires a long term | | |commitment and is achieved over time. | | | |Examples: |Examine Cultural Competence in the following examples: | | |Example 1: Maria Hernandez arrives late for her appointment, and explains that she spent a few hours with her elderly aunt on the | | |way to her appointment.The nurse, Ella, greets Maria warmly and comments on Maria’s devotion to her family. Ella understands that | | |in the Hispanic community, caring for family often comes before an individual need such as an appointment. | | |Example 2: When Gina, the social worker, enters an examining room she is already alert to the fact that the family she is meeting | | |may have views about healthcare that are different than her own.She inquires about the family’s beliefs, drawing on her knowledge | | |of the culture, but primarily interested in what the family tells her about their unique views. | | |Example 3: Fred, the pharmacist, becomes frustrated with an Asian family who has been using herbal remedies. With great authority, | | |he tells them that they are â€Å"doing the wrong thing. † Fred is not behaving in a culturally competent manner. | | | |Application: |When meeting a patient or family for the first time, be aware that their beliefs and practices may differ from your own. Try to | | |learn as much as you can about the family's life and how they view t he world. | | | | | | |Culture | | | | |Definition: |Culture is defined as the sum of one's beliefs, rituals, customs and practices that guide thinking, decisions and actions in a | | |patterned way.They are learned throughout a lifetime and passed on through generations. | | | | |Examples: |Examine Culture in the following examples: | | |Example 1: Among some cultures in India, the occasion on which a child first eats solid foods is celebrated with great ceremony. | |Example 2: â€Å"Family† is defined differently in different cultures: in some cultures, â€Å"family† means primarily parents and children. | | |In other cultures, â€Å"family includes a large number of relatives, loosely related. | | |Example 3: Disabilities are viewed differently in different cultures. In some cultures, people with disabilities are hidden, in | | |others they are believed to be endowed with special gifts.In some cultures, people with disabilities are encouraged to become | | |indepen dent and live independently; in others, it is the family’s wish and responsibility to care for the disabled person. | | | | |Application: |Because of differences between cultures, patients’ behaviors and beliefs may be different from one’s own. | | | | | | |Explanatory Model | | | | |Definition: |The Explanatory Model is the belief system that people from a given culture have about what has caused their illness and what the | | |illness does to them.Patients’ beliefs about what will help cure them depend on their explanatory model. | | | | |Examples: |Examine the Explanatory Model in the following examples: | | |Example 1: A Romani patient may believe that bad luck, bad behavior or contamination has caused his illness. | | |Example 2: An Hispanic mother may believe that her child has Mal d’ojo, or has been cursed with the â€Å"evil eye. | | |Example 3: An Asian patient may believe she is having a difficult birth because of an imbalance between ho t and cold in her body. As| | |pregnancy is a â€Å"cold† condition she may request a drink of hot water, for balance. | | | | |Application: |In order to learn about your patients’ explanatory model, you may want to ask something like: â€Å"I know different people have very | | |different ways of understanding illness†¦Please help me understand how you see things. † | | | | | | | |Health Beliefs | | | | |Definition: |Patients’ beliefs about their health. Health eliefs include cultural beliefs about what causes illness, what will help illness and | | |who is best prepared to help the illness. The â€Å"Health Belief Model† as defined by Becker, postulates that patients weigh more | | |general beliefs such as whether or not they really believe they are ill and whether they believe the treatment offered by the | | |physician will offer relief, against potential disadvantages of the treatment. | | | |Examples: |Examine Health Beliefs in the follo wing examples: | | |Example 1: A mother’s health belief may involve the idea that a particular amulet will protect her daughter. | | |Example 2: Some Native American tribes health beliefs include the idea that taking a photograph of a person will rob the person of | | |his or her soul. | |Example 3: A mother may believe that her daughter doesn’t have asthma, but just coughs occasionally and that the inhaled steroids | | |are dangerous for her daughter. She may therefore decide that the potential risks of the medication outweigh the benefits. | | | | |Application: |A patient whose health belief is that his illness is a punishment for past sins may not believe that biomedical care will help him. | |He may believe that he will only get better when he atones for his sins. | | | | | | | |Social Factors | | | | |Definition: |Social Factors refer to environmental factors which affect how the family functions.These include (but are not limited to) | | |financial factors (such as socioeconomic status or type of – or lack of – insurance), logistical factors (such as transportation or | | |juggling many demands), housing, childcare and accessible health care. Social factors sometimes also include family relationships or| | |family dynamics which affect a child or family member. This often, in turn, influences emotional factors. | | | |Examples: |Some examples of Social Factors are: | | |Example 1: Some families do not buy medications that they need because they do not have insurance or cannot afford the co-pay. | | |Example 2: A child may come to clinic dirty, not because the mother doesn't care about cleanliness but because the water has been | | |off and the landlord refuses to return her phone calls. | |Example 3: A child's divorced parents may be angry at each other, causing tension in the family and interfering with the consistency| | |of his care as he moves between their homes. | | | | |Application: |It is always important to learn as m uch as you can about the social factors that affect a family. This will help you understand the | | |choices they make and the constraints they are under. | | | | | | |Acculturation | | | | |Definition: |The adoption of the behavior patterns of the dominant culture; the process of assimilating new ideas into an existing cognitive | | |structure. Acculturation is the process of acquiring a second culture.Assimilation is the process of replacing one's first culture | | |with a second culture. | | | | |Examples: |Some examples of Acculturation are: | | |Example 1: A first generation Italian who lives in an Italian enclave in he United States may continue to speak just Italian and to| | |follow the norms and mores of his Italian origins. This person will not have become highly acculturated to American culture. | | |Example 2: The granddaughter of a Chinese immigrant has gone to American schools and will now attend an American college. She spends| | |time primarily with her American frie nds, dresses as they do and shares their values and interests.She has become highly | | |acculturated into American culture. | | | | |Application: |The degree to which a patient holds the health beliefs of his country-of-origin will depend in part on how acculturated he has | | |become to American culture. |