Chapter 4

Learning objectives-

At the end of this chapter, students should be able to:

•   Explain differing perspectives on the use of health-related technology by cultural groups.

•   Discuss the relevance of recruiting diverse healthcare professionals.

•   Identify cultural views regarding modern medical approaches.

•   Describe the cultural competence continuum.

•   Express the key elements of the Purnell model, the LEARN model, and the assumption exercise and their relevance to cultural competency and health professionals.

Different Perspective

“An analysis of ethnicity and social class membership reveals that members of the lower socioeconomic and ethnic minority groups are much more likely than upper-class majority groups to have a parochial form of social organization, and to adhere to a popular or nonscientific health orientation.”

(Suchman, 1964)

CULTURAL VIEWS REGARDING MODERN MEDICAL PRACTICES

· Cultural practices may impact the seeking of health care and health behaviors.

· Such cultural practices require an interdisciplinary approach.

· See example of Haitian women in Little Haiti in Miami and cervical cancer (pg. 44 in e-book)

· This above scenario, paints the picture of why knowledge about culture is important.

· How can we as health professionals collect this type of information in a non-judgmental way?

· RECRUITING DIVERSE HEALTHCARE PROFESSIONALS

· Greater work-force diversity improved public health.

· Diverse work force may help patients to feel comfortable.

· There must be particular efforts to attract employees from diverse racial and cultural backgrounds.

· Training in cultural competence is important for employees

· It is inappropriate to assume because the individuals are of diverse backgrounds they are culturally competent.

· Aspects of Diversity

· Race

· Gender

· Age

· physical appearance

· Nationality

· Cultural heritage

· Life experience

· Aspects of Diversity 2

· Economic status

· Religion

· Language

· Marital status

· Educational level

· Sexual orientation

· Although cultural competency cannot be achieved without diversity, diversity alone is insufficient.

CULTURAL COMPETENCE CONTINUUM

6 components/levels

· Cultural Destructiveness

· Cultural Incapacity

· Cultural Blindness

· Cultural Precompetence

· Cultural Competence

· Cultural Proficiency

CULTURAL COMPETENCE FRAMEWORK

5 constructs

· cultural awareness

· cultural knowledge

· cultural skill

· cultural encounters

· cultural desires

PARAMETERS THAT DIFFERENTIATE CULTURES

1. the view of time and space

2. physical space between people

3. the roles of men and women

PURNELL MODEL FOR CULTURAL COMPETENCE

· a schematic combined with an organizing framework that is applicable to all healthcare disciplines and has been translated into French, Spanish, Flemish, and Korean (Purnell, 2002)

The 19 assumptions within the context of the model focus on:

· Information

· key factors that all healthcare professions share

· cultural differences and similarities

· changes in culture over time

· variations from the dominant culture

· clients and coparticipants in their care

· the influence of culture on interpretation of care

· cultural groups of individuals and families

· cultural respect

· importance of cultural information for caregivers to ensure the provision of culturally competent care

· importance of culturally competent skill sets

· how culture is learned

· minimization of cultural biases and the need for health care to reflect understanding of values, beliefs, attitudes, life ways, and views of cultures and acculturation patterns

· differences in race and culture need adaptation to standard interventions

LEARN MODEL

The LEARN model is an educational framework that enables healthcare providers to improve communication, increase their awareness of cultural issues relevant to the care of their patients, and gain better acceptance by patients of treatment plans.

L Listen with sympathy and understanding to the patient’s perception of the problem

E Explain your perceptions of the problem

A Acknowledge and discuss the differences and similarities

R Recommend treatment

N Negotiate agreement