Cultural competence in healthcare and professional practice

Cultural Competence

The world in general and the United States in specific are becoming increasingly global, with a demographic change that will completely alter the population makeup in within the next half of a century. Already in the U.S. It is possible to see how the number of Latino and Asian residents is steadily growing. Understanding different cultures has always been important for social service workers. Today, with this growing globalization, it is more essential than ever for these professionals to be culturally competent.

According to the National Association of Social Workers and its 10 standards, a culturally competent social worker shall:

Standard 1. Ethics and Values -- function in accordance with the values, ethics, and standards of the profession, recognizing how personal and professional values may conflict with or accommodate the needs of diverse clients.

Standard 2. Self-Awareness -- seek to develop an understanding of their own personal, cultural values and beliefs as one way of appreciating the importance of multicultural identities in the lives of people.

Standard 3. Cross-Cultural Knowledge -- have and continue to develop specialized knowledge and understanding about the history, traditions, values, family systems, and artistic expressions of major client groups that they serve.

Standard 4. Cross-Cultural Skills -- use appropriate methodological approaches, skills, and techniques that reflect the workers' understanding of the role of culture in the helping process.

Standard 5. Service Delivery -- be knowledgeable about and skillful in the use of services available in the community and broader society and be able to make appropriate referrals for their diverse clients.

Standard 6. Empowerment and Advocacy -- be aware of the effect of social policies and programs on diverse client populations, advocating for and with clients whenever appropriate.

Standard 7. Diverse Workforce -- support and advocate for recruitment, admissions and hiring, and retention efforts in social work programs and agencies that ensure diversity within the profession.

Standard 8. Professional Education -- advocate for and participate in educational and training programs that help advance cultural competence within the profession.

Standard 9. Language Diversity -- seek to provide or advocate for the provision of information, referrals, and services in the language appropriate to the client, which may include use of interpreters.

Standard 10. Cross-Cultural Leadership -- be able to communicate information about diverse client groups to other professionals.

In general, cultural competence is the ability to work effectively with other individuals from a wide variety of ethnic, cultural, political, economic, and religious backgrounds. It is being knowledgeable and respectful of the values, beliefs, traditions, and customs of those being served, while recognizing there is often great diversity within the various groups, themselves, such as Native Americans, as between them. It is also being aware of the way one's own culture influences how others are viewed.

Cultural competence is important from both the standpoint of the person being served and those being provided the services. Brislin, et. al explain that this cultural awareness allows human service workers to feel comfortable and effective in their interactions with individuals and families with different cultures from their own. In Likewise, it enables those same people to feel good about their interactions with their human service work and allow the two parties to accomplish their goals.

A culturally competent individual possesses a strong personal identity, has knowledge of the beliefs and values of the culture, displays sensitivity to the affective processes of the culture, communicates clearly in the language of the cultural group, performs socially sanctioned behavior, maintains active social relations within the cultural group, and negotiates the institutional structures of that culture (Lum 6).

Cultural competence is especially important, not only because of the population change, but because of the way people ought to be treated regardless of who they are in order to provide them the help they need. According to Saldana (7), "the cultural appropriateness of mental health services may be the most important factor in the accessibility of services..." By developing culturally sensitive practices, the social workers can help reduce barriers to effective treatment utilization. They can build a rapport, so the client knows who can be of help, as well as develop trust and enhance the individual's investment and continued participation in treatment. They can also determine new ways to better help those in need. New approaches are required in service delivery to address cultural differences among consumers. In addition, as managed care processes extend into the public sector through Medicaid and Medicare, the need to identify a relevant conceptual framework to guide service design and delivery becomes even more essential.

For example, when arriving in the U.S. individuals and families need to adapt to a different culture, or acculturate. This consists of changing one's cultural practices at the same time as learning a new culture and discarding parts of an earlier culture. This process results in changed attitudes, values, and behaviors (Garrison et al.) and may even alter family roles. For example, Latino women may more easily find work than do Latino men, which can reverse traditional dynamics of males as providers. Children often adapt to a new culture more readily and are more capable of acquiring the language, which may result in them helping their parents in "adult" tasks. This results in a stressful shift of power away from men and parents. Culturally competent social workers may need to help empower parents to resume parental roles (Garrison et al.).

In a situation, a family physician cannot understand why his 72-year-old Chinese patient is not complying with his plan of care. The patient has uncontrolled high blood pressure for which the doctor prescribed at the last visit. Now the patient is saying that he has been taking only half of the dose a day. The doctor insists that his patient take the entire amount. The patient nods his head, but does not intend to comply. The problem here is not language, but cultural. Saving face is critical for most Asians. When a physician asks, 'Do you understand?' The reply will likely be 'Yes,' whether or not the patient actually understands." An Asian will not usually say 'No,' because that would imply either that he is too ignorant to understand, or the doctor is not capable of explaining adequately. In this case, it is important to ask open-ended questions like, "What do you need to do next?" If the patient cannot say, he does not understand the instructions (Galanti, 21).

Biases and racism come from having stereotypes about other individuals. It is important to recognize the difference between generalizations and stereotypes. Social scientists will generalize about a culture. That is, they look for broad patterns of similarity among groups. However, when caring for others it is important when to distinguish the difference between stereotypes and generalizations. While these two thought patterns seem to be the same, they are very different. A generalization is a beginning point; which is recognized as a cultural pattern and then looked at to see if the individual fits that pattern. A stereotype, on the other hand, is an end point that can be dangerous. In this form of thinking, individuals develop formulaic and oversimplified conceptions and opinions. It then becomes easy to categorize a person as being a certain way and make no further effort to learn whether the individual in question fits the conception.

A social worker relates a story about a Mexican woman who suddenly developed a critical condition that needed immediate surgery. The nurse, knowing that older Mexican women usually see their husbands as the family decision-makers, explained to the physician she would call the patient's husband. The physician said it was not necessary, since once explaining the situation to the patient, she would no doubt agree to the operation. The nurse called the patient's husband anyway. When the physician talked to the patient, she refused consent and wanted to wait for her husband. Since time was of the essence, the doctor could not wait much longer before surgery. Fortunately, the husband soon arrived and convinced his wife to give consent. Had the nurse not acted upon her generalization of gender role patterns in traditional Mexican households, the patient's outcome might not have been as positive (Galanti, 23).

A stereotype, however, would be a situation where someone would say, "Mexican women often express their pain loudly." If there is a Mexican patient who is complaining loudly about her pain and I the nurse ignores her, thinking, "Don't worry; Mexican women express their pain loudly," then she is guilty of stereotyping. If, on the other hand, she knows in general that female Mexican patients often express themselves this way, she would check with the family to see if this particular woman is vocal when in pain and follow up by checking her complaint (Galanti, 23).

There are stereotypes about all cultures. Blacks being better at sports, Jews being money hungry, Irish being drinkers, etc. There are those about Puerto Ricans, as well -- that they do not want to learn English, all live on welfare, do not want to work, the switchblade-toting teenage gang member, for example. There are also some generalizations that do not include all, but some, Puerto Rican culture: conversations are usually very interactive and full of interruptions. Interruptions mean interest in the subject discussed; silence denotes disinterest rather than paying close attention. If someone is talking to someone else and a third person joins in, the people talking are expected to stop what they are saying and acknowledge the newcomer. Also, it is rude for a man to dance too close to a woman who is not his wife or girlfriend, even if others seem to be doing it. It is considered vulgar and ostentatious to open gifts in public. Gifts are never opened in front of a group of people to avoid people comparing the merits of different gifts.