Awareness Online Continuing Education Course (Est. 1 to 1.25 Contact
March 22, 2006.
By the end of this module, the participant will be able
1. Define cultural competence.
2. Discuss the stages of cultural competence.
3. Differentiate between cultural competence, cultural awareness and
4. Define stereotype, prejudice, ethnic identity and worldview.
3. Explore several tools for cultural self-assessment.
4. Assess and evaluate own level of personal competence.
This is the third module
on the Cultural Competency Series.
This course builds on the concepts from Cultural Competency I and
Cultural Competency II. It is recommended that the participant
review the concepts introduced in those courses.
Competency I course is available here.
|"How does a
nurse achieve the requisite knowledge, skills and respect for
differences that lead to cultural competence?
The first step is awareness and an honest exploration of one's own
cultural values, beliefs and prejudices against other cultures.
Humility and self-understanding come first before the study of
another culture. (Leonard 2001) (1)
Central to the concept of cultural competency is
that it is a developmental process
that evolves over an extended period. In order to respect and
differences, a person needs to know and accept himself or herself as a
Self-assessment is not only for individuals, but
it also expected of organizations in
which individuals belong.
Conducting cultural self-assessments by
individuals and organizations is one of the key elements in achieving
cultural competence (1,2,3,4,5).
Both organizations and individuals are at various levels of
awareness, knowledge and skill acquisition along the cultural
as self-assessment is an ongoing process, not a one-time occurrence
In this section, we will review some basic
concepts of cultural competency,
and introduce definitions of terminology commonly used in the
discussion of cultural competence.
II. First is a review of the
definition of culture.
According to Leininger, the founder of
culture consists of the learned, shared and transmitted values,
beliefs, norms and lifeways of a particular group that guide their
decisions, and actions in patterned ways (2).
Elements of cultural
competent system would:
- value diversity
- have the capacity for
- be conscious of the
dynamics inherent when cultures interact;
institutionalized cultural knowledge; and
- have developed
adaptations to diversity." (Terry Cross et.al. 1989)(2)
“Practice must be based
on accurate perceptions of behavior,
policies must be
impartial, and attitudes must be unbiased.” (Terry Cross et al. 1989.)
III. Cultural competence
competence: "The complex integration of attitudes,
knowledge, and skills to facilitate communication and
appropriate interactions between persons of
diverse cultures." (American Academy of Nursing, 1993)
is the ability to work effectively in a multicultural setting.
Campinha-Bacote defines cultural competence as "the process in which
the healthcare professional continually strives to achieve the ability
and availability to effectively work within the cultural context of a
client" (family, individual or community) (3).
competence: “Care that takes into account issues related
to diversity, marginalization, and vulnerability due to
culture, race, gender, and sexual orientation. This
care is guided by nursing theories, models, and/or
research”. (National Academy of Nursing expert panel, 1990)
|“Cultural awareness is developing an awareness of one's own
culture, existence, sensations, thoughts, and environment without
letting them have an undue influence on those from other
is defined as the process of conducting a self-examination of one’s own
biases towards other cultures and the in-depth exploration of one’s
cultural and professional background." (Campinha-Bacote 2002).
Sensitivity: Knowing that cultural differences as well as
similarities exist, without assigning values, i.e., better or worse,
right or wrong, to those cultural differences (National Maternal and
Child Health Center on Cultural Competency, 1997).
IV. Background terminology for cultural
Bias: An inclination of temperament or
outlook; especially a personal and sometimes
unreasoned judgment (6).
Stereotypes: Overall impressions based on
the assumption that all
members of a group possess similar attributes(7).
Stereotypes are the cognitive precursors of prejudice and
Prejudice: A negative feeling toward a
group based on a faulty generalization (9).
Racial identity: Generally refers to
physical characteristics of individuals to
include skin color, facial features, hair, etc; used to define race
(eg, White, African American, Native American, Asian) (10).
Ethnic identity: refers to how individuals
self-identify based not only on
physical characteristics, but on religious background, nationality, and
cultural experience (10).
Cultural identity is a broader term: people
from multiple ethnic
backgrounds may identify as belonging to the same culture.
Cultural identity: Any combination of shared
and psychological factors that influence the perspectives of different
cultural groups (7, 10).
One example would be people from Mexico,
may identify with the Latin American culture at the same time
with different ethnic cultures.
Leininger refers to the different subcultures within the healthcare
the patient's culture, the care-giver's culture, and the healthcare
organization are all part
of the larger healthcare system "culture".
Caregivers may have their own ethnic identity, yet
self-identify as part of a professional culture,
within a specific department's subculture. For example, an operating
may have his/her own ethnic identity and still hold a professional
identity as an OR nurse,
with a culture that is distinct from a medical-surgical nursing culture.
Values: Ideas held by human individuals or
groups about what is desirable, proper, good or bad.
Differing values represent key aspects of
variations in human culture.
What individuals value is strongly influenced by the specific culture
they happen to live. (8)
Worldview: A framework through which an
individual interprets the world and interacts in it.
A collection of beliefs about life and the universe held by an
individual or a group (11)
Almost everything that we experience is shaped by
the perceptions provided by our
view of the world. Culture filters what we see and what we
perceive. Culture determines the generally accepted definitions of
social reality (11)
For example, the predominant Technological
Worldview of most Western countries, that technology would be able to
solve most human disease and illnesses, might be in
contrast to a holistic worldview of other cultures.
V. Cultural competence: a
According to the
Campinha-Bacote model, cultural competency is
not an end-result to be achieved, but a continuous process of life-long
learning and desire, to achieve the ability to
work effectively within the cultural context of the client.
The Papadopoulos, Tilki and Taylor Model for
Developing Cultural Competence
describes a four-stage model that starts with cultural awareness, to
of cultural knowledge, to the development of cultural sensitivity and
cultural competence (4).
Developing cultural awareness requires
and self-acceptance of one's own cultural identity. It requires "a
life-long commitment to self-evaluation and self-critique...(3)".
Self-awareness must not only be intellectual, it must be emotional
or heart-felt to be effective (11). It requires recognition of one's
prejudices, and recognizing the limits of one's competence (12).
Source: Papadopoulos, Tilki and Taylor Model ( www.mdx.ac.uk/www/rctsh/modelc.htm).
“Cultural identity development is a major
toward the self, others of the same group,
dominant group”. (4)
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