Cultural Competence

Cultural Competence

Cultural competence is defined as “a dynamic, fluid, continuous process whereby an individual, system or health care agency find meaningful and useful care delivery strategies based on knowledge of the cultural heritage, beliefs, attitudes, and behavior of those to whom they render care” (Giger & Davidhizar, 2002, p.186).

To assist healthcare providers in achieving competency in providing culturally appropriate care, the APN must take the responsibility to acquire the necessary skills.

The five constructs of cultural competence form the foundation of the practice model discussed in “Process of Cultural Competence in the Delivery of Healthcare Services” (Campinha-Bacote, 2002).

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Self-examination of one’s own prejudices and biases toward other cultures. An in-depth exploration of one’s own cultural/ethnic background.

Cultural Awareness

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The very essence of what health and disease denotes can vary from culture to culture. Therefore, there is a wide spectrum of what are considered appropriate interventions, which may not be compatible with Western medicine. Based on the cultures’ perceptions of disease causation, symptomatology, and pathology, appropriate interventions may diverge from Western medicine’s approach (Gesler & Kearns, 2002). The textbook provides many examples of the beliefs of direct cultures and the influence they play in healthcare. There are some long-standing health disparities in minorities. Minority health is often viewed as a variant form of Anglo-Protestant culture, with the scientific foundation and the principles of cause and effect as the basis of our healthcare.

Madeline Leninger’s groundbreaking transcultural nursing theory (1978) addresses several areas that encompass culture, including values, beliefs, customs, and traditions. These are held by a specific group of individuals and are passed down from generation to generation through language. Leninger (2002) describes cultural competence as the ability of the practitioner to bridge cultural gaps in caring and to work with cultural difference, enabling the family and patient to receive meaningful and supportive care. She also describes culturally congruent care as care that is centered on a person’s values and meaning as opposed to care that has been predetermined by other criteria.

Paisley defines ethnicity as “the aggregate of cultural practices, social influences, religious pursuits, and racial characteristics shaping the distinctive identity of community” (Paisley et al., 2002, p. 138). This differs from race. Race is defined as a biological designation whereby group members share features (e.g., skin color, bone structure, genetic traits such as blood groupings) (Purnell & Paulanka, 2005, p. 452). Nationality usually refers to the country of birth, or the ancestors’ country of birth.

Cultural competence in nursing consists of four principles.

  • Care is designed for the specific client.
  • Care is based on the uniqueness of the person’s culture and includes cultural norms and values.
  • Care includes self-employment strategies to facilitate client decision making to improve health behaviors.
  • Care is provided with sensitivity and is based on the cultural uniqueness of clients.

Cultural nursing assessment is a systematic identification and documentation of the cultural care beliefs, meaning, values, symbols, and practices of individuals or groups using a holistic perspective.

The APN may also use the Kleinman Explanatory Model of Illness (1978). Below are the questions that can be utilized.

  • What do you call your problem?
  • What do you think caused your problem?
  • Why do you think it started when it did?
  • What does your sickness do to you?
  • What do you fear most about your sickness?
  • What are the chief problems your sickness has caused you?
  • What kind of treatment do you think you should receive?
  • What is the most important result you hope to receive from the treatment?

According to Giger and Davidhizer (2000), although cultures differ, they all have the same basic organizing factors that must be assessed in order to provide care for culturally diverse patients. These factors include

  • communication (verbal and nonverbal);
  • personal space;
  • social organization;
  • time perception;
  • environmental control; and
  • biological variations.

Several models have emerged to assist healthcare providers to meet the challenge of providing culturally relevant care. Campinha-Bacote (2002) views cultural competence as an ongoing learning process as the providers continuously strive to achieve the best outcomes for patients, families, and populations.

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Cultural Competence

Cultural Competence

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