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Define culturally competent care appropriate for your own workplace, based on your perusal of the assigned readings
Cultural competence care is defined as the ability of a health care provider to deliver care services using a framework that is congruent with the patient’s cultural health beliefs (Marx & Miceli, 2008). In a clinical setting cultural competence care can be achieved by the provider’s ability to create an environment where the patient will be comfortable in sharing important information about cultural health beliefs. Marx & Miceli (2008) say that “in the long run, the health care provider will be able to present appropriate care planning and interventions, improving adherence to treatment and health outcomes” (p. 127). Culturally competent care services have been singled out as one of the major strategies to eliminate health care disparities (NCCC, 2010). Marx & Miceli (2008) noted that culturally competent care is a promising solution, whose origin is reflected in various nursing position statements and recommendations by the AACN.
Over the time, there has been an increasing recognition of the prevalence of racial and ethnic disparities in health care delivery and outcomes in the United States (AHRQ, 2011). Also, AHRQ (2011) report indicated that “culturally competent care targets culturally and linguistically diverse groups of limited English proficiency typically experience less adequate access to care, lower quality of care and poorer health status and outcomes”. Culturally competent care addresses the racial and ethnic minorities tend to receive a lower quality of health care than non-minorities. AHRQ (2011) report noted that such situations happen even when such patient’s insurance status and income, are controlled. There is a need for key stakeholders, researchers, health care payers and administrators to understand the reasons for these disparities and at the same time design methods to reduce or eliminate them (NCCC, 2010). This means that there is a need for improved cultural and linguistic competence in the provision of health care services. AHRQ (2011) report noted that “it is not easy to alleviate health care disparities without first improving the cultural and linguistic competence of the health care services provided”.
Collins et al. (2002) noted that a good proportion of minorities feel they would receive better care, if they were of a different race or ethnicity. AHRQ (2011) report outlined that “the pursuit of culturally competent care is an ongoing process that begins with an awareness of the increasing diversity among Americans”. There is a need for plans that will meet financial and quality goals will recognize that members have different customer-service and health-care needs based on their cultural backgrounds. AHRQ (2011) report also says that “for Asian Americans and African Americans, the health care system presents formidable barriers to both accessing and receiving care”. This implies that critical plans are needed to develop and continuously improve services and processes of culturally competent care (AHRQ, 2011). The creation of effective, culturally competent care systems requires extensive collaboration of all the key players (AHRQ, 2011).
Identify the populations served and any issues of population vulnerability
According to Marx & Miceli (2008), vulnerable populations served by culturally competent care include ethnic populations and economically disadvantaged populations who suffer in an environment where economic forces alone dominate health care delivery. Such populations lack health care insurance for any reason or lack of interpreters for limited English proficiency patients. Collins et al. (2002) in their research came up with research findings of the populations’ vulnerabilities in culturally competent care. In their research they noted that 15% of African Americans, 13% of Hispanics and 11% of Asian Americans said there had been a time when they felt they would have received better care, if they had been of a different race or ethnicity (Collins et al., 2002).
Collins et al. (2002) in their study indicated that populations served by culturally competent care were 16% of African Americans and 18% Hispanics who felt they had been treated with disrespect during a health care visit. At the same time, Asian Americans were least likely to feel that their doctor understood their background and values and were most likely to report that their doctor looked down on them (Collins et al., 2002). Vulnerable populations in competent care were identified on the basis of access to language interpreters. Collins et al. (2002) also say that among non-English speakers there is a need in an interpreter during a health care visit, less than one-half 48% said they always had one.
In addition, vulnerable populations in culturally competent care were African Americans, Hispanics, and Asian Americans who used alternative therapies are likely to tell their doctors about that use than white patients. Collins et al. (2002) researched that 70% of white respondents said they told their doctor about their use of alternatives therapies, compared with 55% of African Americans, 50% of Hispanics, and 63% of Asian Americans who did not inform. Lum (2010) indicated that African Americans and other ethnic minorities report less partnership with physicians, less participation in medical decisions, and lower levels of satisfaction with care. Lum (2010) also noted that “the quality of patient physician interaction is lower among non-white patients, particularly Latinos and Asian Americans” (p. 24). African Americans is a vulnerable population in culturally competent care because they are more likely to feel they were treated disrespectfully during a health care visit (Lum, 2010).
Comment on standards of cultural competence that appear to be met and any that are not met
Scholars note that ethnocentric approaches to healthcare practice can be ineffective in meeting health care needs of diverse cultural groups of patients and clients (Dreeben, 2006). Dreeben mentioned that ineffective ethnocentric approaches gave rise to the fourteen national standards for culturally appropriate services in health care (2006). The importance of cultural competence care standards is to tackle the inequities which exist in the provision of health care and to make services more responsive to individual needs (Rose, 2011). This in turn plays a key role to those who seek care in the United States through the elimination of racial and ethnic health disparities (Rose, 2011). One of the standard that has been met is that health care organizations have ensured that the patients receive from all staff members’ an effective understandable, and respectful care which is provided in a manner compatible with their cultural beliefs and practices and preferred languages (Rose, 2011). The second standard being met according to Rose (2011) is that health care organizations have implemented strategies to recruit, retain, and promote at all levels of the organization a diverse staff and leadership that are representative of the demographic characteristics of the service area.
The third standard which has not been met is that health care organizations have not provided an ongoing education and training in culturally and linguistically appropriate service delivery to all staff members (Rose, 2011). Also Rose (2011) indicated that “health care organizations have not managed to provide language assistance services, including bilingual staff and interpreter services at no cost to each patient limited to English proficiency at all points of contact, in a timely manner during all hours of operation” (p. 105). The second standard that has not been met is that health care organizations have not made easily understood patient related materials and post signage in languages of the commonly encountered groups and or groups represented in the service area (Rose, 2011).
Moreover, Rose (2011) noted that “another standard that has been met is that health care organizations have ensured that data on the individual patient’s race, ethnicity, and spoken and written language are collected in health records, integrated into the organizations management information system and periodically updated” (p. 105). Health care organizations have maintained a current demographic, cultural and epidemiologic profile for the community as well as a needs assessment to accurately plan for and implement health care services which are in line to the cultural characteristics of the service area (Rose, 2011). Rose (2011) argues that “health care organizations have not ensured that conflict and grievance resolution process are culturally sensitive and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by patients” (p. 106).
Identify how delivery of nursing care could be affected where standards are being met and where they are not being met
In the last three decades, special attention has been given to the notion of culture-based care. Bomar (2004) says that were standards are being met, the challenges of the future of nursing care mandate a renewed interest in and commitment to using both knowledge and practice skills in providing for the many cultures in and among diverse racial and ethnic groups whose members seek health care assistance and service in the United States. Bomar further says that nurses working within trans-cultural settings need an understanding of various anthropological concepts (2004). Where standards are being met, nursing care should reflect a trans-cultural approach to health care, in which the nurse attempts to recognize and transcend barriers and obstacles established by cultural uniqueness (Bomar, 2004).
Elliott, Aitken & Chaboyer (2007) noted that where standards are being met from a trans-cultural nursing perspective, culturally competent nursing care requires the nurse to incorporate cultural knowledge, the nurse’s own cultural perspective and the patient’s cultural perspective into intervention plans were the standards are being met. Where standards are being met nursing care are advised to critically examine theories and models to guide their practice and ensure they deliver care that is both appropriate and effective for the people they work with (Elliott, Aitken & Chaboyer, 2007). Also where culturally competence care standards are being met, nursing care is practiced in a sound manner rather than individual nurses behaving correctly. Elliott, Aitken & Chaboyer (2007) argued that “in culturally competent care, nursing care is about the nurses’ knowledge about their own cultural beliefs and practices and the impact they may have on others” (p. 45). Also the actions of the nurse are to improve the patient’s health experience, and the integration of culture in clinical practice (Elliott, Aitken & Chaboyer, 2007).
Comment on solutions that could be implemented where standards are not being met
The key solution that could be implemented where standards are not being met is to identify the needs of the patient population being served and assess how well these needs could be met through the current system. Rose (2011) indicated that another solution is “to bring people across the health care organization together to explore cultural and language issues by sharing experiences, evaluating current practices, discussing barriers and determining gaps” (p. 116). Another solution that could be implemented where the culturally competent care standards are not being met is to make assessment, monitoring and evaluation of cultural and language needs and services a continuous process (Rose, 2011).
Carter (2009) noted that the staff should come up with attitudes that enable the development of culturally competent care. Enabling attitudes are those that facilitate learning about other cultures and developing an appreciation for differences in culture. Carter (2009) says that this can be achieved by wanting the best outcomes possible for an individual or a population group. Also a focus on outcomes enables one to actively explore cultural differences that might interfere with obtaining a good outcome and to identify those cultural differences that may improve this type of care (Carter, 2009).
In their studies, Ruiz & Primm (2009) recommended that “where culturally competent care was not being met, the organization should partner with multi-cultural communities in the planning, development, and implementation of cultural health system” (p. 28). Health care organizations should also recruit and retain a culturally diverse workforce at all levels of the organization that reflects the cultural diversity of the setting (Ruiz & Primm, 2009). It is also important to integrate cultural competence and diversity into health care staff training, development and educational activities where culturally competent care standards are not being met.