Cultural Competency in Health Care Services

Cultural competency has been often defined as a manner of continuous self assessment regarding one’s outlook towards society, people and traditions. In this essay, we shall look at the manner in which health service attendants (nurses) are culturally competent in handling situations that do not normally occur. Situations may vary from ethnicity to language barriers. We shall also cover some major challenges these nurses’ face and elements to tackle them. When covering the role of family, we not only look into the dynamic influences by the members of one or more families but also the effects of aspects like property, tradition, culture, etc.

Besides these, mention must be made about trust as being the centrifugal force that binds human relationships and thereby creating motivation that is not only displayed in family members but also in relation to employees, customers, communities and others. Cultural competency can be defined as “a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enable them to work effectively in cross-cultural situations.

It is the acceptance and respect for difference, a continuous self-assessment regarding culture, an attention to the dynamics of difference, the ongoing development of cultural knowledge, and the resources and flexibility within service models to meet the needs of minority populations” (Cross et al. , 1989). However, the concept of competency does not relate to the numbers of representation, either in clients or in service providers nor does it refer to the establishment or maintenance of diversity per se.

It refers more explicitly to formal and informal helping networks, rituals, dialects, folkways, traditions, customs, and so forth. Therefore, in these areas, knowledge of client’s needs is to be given proper services based on knowledge about various cultures and development of specific skills and attitudes*. Another practical view of defining cultural competence is obtaining cultural information and then applying that knowledge. This particular awareness depicts a clear picture and improves the quality of care and health outcomes.

It therefore includes certain criteria of managing different qualities such as, adapting to different cultural beliefs and practices, flexibility and a respect for others view points. One must really listen to the patient, to find out and learn about the patient’s beliefs of health and illness. In order to provide culturally appropriate care we therefore need to know and to understand culturally influenced health behaviors. To be culturally competent the nurse needs to learn how to merge cultural understanding with nursing care.

Cross, T. , Bazron, B. , Dennis, K. , and Isaacs, M. (1989) list five essential elements to tackle this issue. They are: 1. value diversity; 2. have the capacity for cultural self-assessment; 3. be conscious of the dynamics inherent when cultures interact; 4. have institutionalized cultural knowledge; and 5. develop adaptations of service delivery reflecting an understanding of cultural diversity. These should be manifested at every level of an organization, including policy making, administration, and practice.

Further, these elements should be reflected in the attitudes, structures, policies, and services of the organization. Meyer CR. (1996) describes four major challenges for cultural competency in healthcare. • Straightforward challenge: recognizing clinical differences among people belonging to different ethnic groups. • Communication challenge: concerned with need for interpreters to nuances of words in various languages. • Ethics: respect belief systems of others and the effects of those beliefs on well-being. • Trust.

On that note, one of the main sources of problems in caring for patients from diverse cultural backgrounds is lack of understanding and tolerance. In order to reduce barriers to effective treatment utilization, cultural competency is very important. Apart from cultural appropriateness of mental health services one must not forget to mention about rapport building, new approaches that are needed in service delivery to address cultural differences among consumers and the need to identify a relevant conceptual framework to guide service design and delivery, cultural competency steps in to fulfill these tasks.

These services therefore place a great deal of responsibility upon the mental health professional. Therefore, one must acquire a set of generally expected levels of knowledge, skills and attributes in providing culturally competent mental health services. In most countries, health care is managed and administered by health organizations that have the responsibility to meet, within a limited funding envelope, the health needs of a pre-defined population. This worldwide occurrence has been brought into focus by various health care reforms and other system-level developments.

In fundamental nature, as there are more claims on resources than there are resources available, some form of priority setting must occur**. Therefore resources are scarce, regardless of how many resources are available in total, to make choices about what to fund and what not to fund. To counter this issue there are two key economic principles that underlie health care priority setting. First is that of opportunity cost. It is the understanding in investing resources. One of the keys in setting priorities is to measure or weigh out the costs and benefits of doing one thing in comparison with another.

Second is that of the margin. It is about shifting or changing the resource mix. The concept of the margin is crucial to the development of an economic approach to priority. The social dimension of performance is exacerbated when an organization is embedded in family culture. Therefore, culture as a framework sustains relationships that delve with high quality relationships at work and family. However, studies on culture are relatively limited due to dealings in cultural complexity.

It is taken for granted that performance and effectiveness are ongoing processes of social construction, representation and judgment produced, reproduced and legitimated by people or groups in terms of organizational activities, products and outcomes (Morin, Savoie ; Beaudin, 1994). Let us first understand the family and organizational culture. Family organization is a large perspective in which the management and organizational dynamic are influenced by the members of one or many families in different ways.

These include aspects of property, management, tradition, culture, and symbolism. In family organizations, family becomes the explicative, powerful and organizing principle of organizational life. Family culture is developed within family organizations and hence provides a gamut of meanings, shared ideas and emotional experiences that frame social processes, understandings, management practices and conditions at work. But family is not a static concept; it is continually being shaped and modified, aligned by family and non family members alike (Fletcher, 1997).

Therefore, family becomes the vehicle for exploring the interactivity of its members by consanguity and by consideration. The organization constitutes environments where social, cultural and emotional aspects of organizing appear in an exacerbated manner (Davel ; Colbari, 2003). Shifting the discussion to family culture and performance, according to Aronoff and Ward (1995: 127), within family organization one is more likely to find an understanding of human relationships and motivation displayed not just in relation to family members, but to employees, customers, communities, and others.

Family culture encrusted in family organizations may offer a sense of transcendent meaning to their participants – whether or not they are in the family – because family organizations embody the legacies of their owners, and because they maintain values related to both profitability and other goals, including the sense of meaning that can transcend not only the space between individuals, but also the time that separate generations (Aronoff ; Ward, 1995). Thereby, family organizations are embedded in a cultural context marked by an intensive human dimension: ‘people matter’ (Colli, 2003).

It is a key integration mechanism in family organization (Mccollom, 1988) that concentrates in coordination, trust and loyalty in social performances. Delving further, certain dynamics may inspire us to think of trust as a social performance component. Trust in family organizations is a vector of performance (Allouche and Amann, 1998) for at least three reasons: implicit rules outweigh explicit ones; organizational members have more capability to deduct the rules of organizational functioning from weak and subtle signs; family members learning is tacitly and easily transferred to organizational members.

In fact, the source of ‘absolute trust’ is the family unit which is seen to function jointly for the common good (Ram ; Holliday, 1993). Culture, performance and family organizations may be thought of as interrelated universes where culture plays an important role in the construction and maintenance of high-quality relationships in organizations. To develop effective case management strategies and case plans, knowledge of family’s cultural value system related to supervision of children, discipline, as well as their different children based on age, gender or birth order are necessary requirements.

The standards we use to assess ourselves and others, our beliefs about what is worthwhile and desirable or important for well being are largely influenced by culture. To become culturally responsive, self assessment is an important feature. An essential tool in building personal and professional interactions beyond racial assessments to cultural relevancy is cultural responsiveness. It is also of being aware of, and capable of functioning in, the context of cultural difference.

Therefore its approaches help in aiding family functioning that may be caused due to poverty, the environment, and/or culture from those due to unhealthy family conditions or behaviors. Cultural information can provide a background upon which family functioning can be comprehensively assessed. References: Cross, Terry, et. al, (1989) Towards a Culturally Competent System of Care, With the Assistance of the Portland Research and Training Center for Improved Services to Severely Emotionally Handicapped Children and Their Families, Washington, D. C.

Aronoff, C. E. , ; Ward, J. L. (1995). Family-owned businesses: A thing of the past or a model for the future? Family Business Review, 8(2), 121-130. Cross, T. , Bazron, B. , Dennis, K. , and Isaacs, M. Toward a Culturally Competent System of Care, Volume 1. Washington, D. C. : Georgetown University. (1989. ) Footnotes: * Farrar S, Ryan M, Ross D, Ludbrook A: Using discrete choice modeling in priority setting: an application to clinical service developments. ** Davel, Chasserio, ; Tremblay, 2003; Davel ; Colbari, 2003; Davel ; Robichaud, 2002.