Cultural
Competency: The Building Blocks
(2 contact hours)
Instructor: Marlene V. Obermeyer, MA, RN
MEMBER: KANCEP
Culture Advantage is approved as a provider of continuing
nursing education by the Kansas State Board of Nursing. This course is approved for 2 contact hours applicable for relicensure for RNs, LPNs, and LMHTs.
Kansas State Board of Nursing: Provider # LT0243-1250.
This is a free course. Print your certificate of completion upon obtaining a passing score on the exam. This is an introductory course in cultural
competency. It is strongly recommended to start with this course before
proceeding to the culture-specific courses.
Cultural Competency EXAM
Course Evaluation.
________________________________________________________________
Start the course:
Lessons:
I. Cultural Competency: Rationale
for cultural competency
II. Cultural Competency: Terminology
III. The CLAS standards.
IV. History of Cultural Competency in Nursing
V. Developing cultural competence: awareness, knowledge and
skills.
VI. References (available with registration)
Course Objectives:
After completion of the module, the participant will be able to:
1. Define culture, cultural competence, and linguistic competence in
healthcare.
2. Explain at least 4 CLAS standards that affect nursing practice
(Standards 1,2,3,4).
3. Discuss the history of cultural competency in nursing.
4. Describe culturally competent attitudes, knowledge and skills.
I.
Rationale for cultural competency in healthecare.
The United States population is increasingly more diverse racially and
ethnically. In the 1990s, over 26 percent of the US population
constituted of linguistic and cultural minority populations. It is
predicted that by 2010, the minority populations will constitute over
30 percent of the population and by 2050, almost 50 percent of the
total population will be members of ethnic and racial minorities (US
Census 2004).
Research has shown that culture shapes a person's attitudes, beliefs,
and practices toward health and disease; culture influences the
patient-caregiver relationships; and cultural differences contribute to
the health disparities in society.
This course introduces the basic concepts of cultural and linguistic
competency, the guidelines and mandates for cultural competency in
practice, the development of cultural competency in nursing, and basic
concepts of culturally competent attitudes, knowledge and skills.
II.
Terminology
A. Definition
of culture.
In order to understand cultural competency, we must first define what
culture is. Culture has many definitions. One of the definitions is
that culture is the shared beliefs,
values and practices that are learned and transmitted throughout
a society, and influence the way that a group of people live and make
decisions and interact.
Culture has been described as the learned and shared patterns of
information that a group uses to generate meaning among its members.
(Diversity.org 2001)
Health care professionals can be said to have a “culture” in the sense that they have a shared set of beliefs, norms, and values. This is reflected in the
terminology that they use, in emphasis of scientific evidence in their work, and in their mindset, or way of looking at the world. (Surgeon General, 1999)
B. Definition
of cultural competency.
Just as there are different definitions of culture, there are also
different ways of defining cultural competency.
One of the generally accepted descriptions of cultural competency is that it is a developmental process that is
developed over time in order to increase understanding and knowledge of
cultural differences that affect the healthcare experience.
According to some sources, the U.S. healthcare profession has not been
very well-prepared to provide culturally competent care (Surgeon
General Report 2005).
According to Cross (1991), cultural competency is: a set of congruent
behaviors, attitudes and policies that enable a system, agency or
professionals to work effectively in cross-cultural situations.
Cultural situations are encounters with
cultural differences that may or may not include race and ethnicity.
The concept of cultural diversity in healthcare includes not only race,
ethnicity, national origin, age, gender and religion,
but also language, sexual orientation, mental or physical abilities,
social class, educational level, and other
attributes of society that result in different perspectives about
health and disease.
Biology and culture
are equally important in the person’s experience of illness. In
addition, society’s economic and political structures play a critical
part in the risks of diseases and availability and accessibility of
treatments.
Every encounter with a healthcare provider is shaped by the cultural
frameworks of both the client and the medical professional. In today’s
increasingly diverse society, cultural competence becomes a critical
skill in our personal, professional and social environment (Joralemon
1999).
C. Linguistic
competence means communicating effectively.
Linguistic competence is the capacity of an organization and its
personnel to communicate effectively, and convey information in a
manner that is easily understood by diverse audiences .(Source: NCCC
2004).
D.The goal of
cultural competency is to make healthcare more efficient and more
effective.
It is reducing costs of unnecessary tests and procedures, gaining trust
and compliance with treatment in order to promote positive outcomes,
and respecting and acknowledging that beliefs, practices, and genetic
heritage of clients can affect their treatments and outcomes.
It is not learning everything about all the different cultures that you
will encounter; it is developing the skills and resources to deal with
the differences. It is not learning all the different languages that
clients speak, but the knowledge and skills to communicate effectively
with and without interpreters.
E. Some of the
benefits of cultural competence in healthcare (MCC 2005):
Improves
communication with patients
Helps with negotiating differences
Promotes disclosure of patient information
Makes more effective use of time with patients
Promotes patient adherence to treatment
Decreases health worker and patient stress
Builds trust in a relationship
Increases patient and provider satisfaction
Meets increasingly stringent government regulations and
standards
Positively affects clinical outcomes
The Office of Minority Health recently released its findings on the business case for culturally appropriate services. The findings
point out that implementing the CLAS Standards can have benefits in many different areas such as cost reduction, equity, efficiency, quality and reduction of medical errors.
Reguired reading: MAKING THE BUSINESS CASE FOR
CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES IN HEALTH CARE:
CASE STUDIES FROM THE FIELD (2007) Pages 5 to 7.
Some of the case studies include examples of:
- Increased market share among limited English proficient patients. Health care organizations implementing CLAS standards have achieved increases in enrollment and patient services among the insured. Cultural competency attracts business.
- Substantial reductions in outsourced language interpretation services and subsequent savings in related costs. Many health care organizations that address the threshold issue of language services have found very efficient ways to make better use of their own bilingual staff or volunteers, thereby reducing substantial costs of outsourcing interpretation services.
- Increased patient and provider satisfaction. A number of health care organizations indicate that projects designed to implement any of the CLAS Standards have improved patient and provider satisfaction with the health care process.
- More efficient use of staff time by reducing communication delays between patients and providers. Simply by addressing language issues, providers, provider office staff and patients enjoy reduced delays and a more efficient health care interaction.
- Cost-savings resulting from shorter hospital stays and more prompt and efficient patient discharges. Efficient and culturally competent solutions to providing discharge instructions and education in a language other than English have resulted in improvements in hospital-wide discharge practices and have yielded significant savings.
III.
The CLAS standards
Required
Reading: Executive Summary.
Pages 27 to 31.
Alternate site: Final Report on
the CLAS standards. PDF file pages 14, 15, 16 and
17. http://www.omhrc.gov/assets/pdf/checked/finalreport.pdf
A. CLAS stands
for Culturally and Linguistically Appropriate Services.
The Standards (link).
The CLAS standards were
developed and issued by the U.S Department of Health and Human
Services’ Office of Minority Health in 2000.
The standards are guidelines
for accreditation and credentialing agencies:
- to assess and compare providers who say
they provide culturally
competent services, and
- to assure quality for diverse
populations.
(Please refer to CLAS link recommended reading pages 7-12).
The 14 standards are
organized by themes:
Standards 1-3: Culturally competent care
Standards 4-7: Linguistic competency
Stamdards 8-14: Organizational supports for cultural competency. (UMCC
2005)
B. Standards 1, 2
and 3 (Culturally Competent Care “Guidelines”): Health
organizations should: (Source: OMH 2005)
Standard 1: ensure that
patients/consumers receive from all staff members effective,
understandable, and respectful care that is provided in a manner
compatible with their cultural health beliefs and practices and
preferred language;
Standard 2:
implement strategies to recruit, retain, and promote at all levels of
the organization diverse staff and leadership that are representative
of the demographic characteristics of the service area;
Standard 3: ensure
that staff at all levels and across all disciplines receive ongoing
education and training in culturally and linguistically appropriate
service delivery
Language access service: Title VI of the Civil Rights Act of 1964
mandates linguistic competency.
Standard 4: describes language
access, stating that the healthcare organization must offer and provide
linguistically appropriate services.
C. Title VI of
the 1964 Civil Rights Act states that services provided with
funding from the federal government must be delivered without regard to
race, color, or national origin.
To comply with Title VI, a program, service or agency must
provide "meaningful access" at no cost to the LEP individual.
Recipients covered by the Guidance include all public and private
entities that receive federal financial assistance.
Examples of such health and social service entities are hospitals,
managed care organizations, state and local welfare agencies,
physicians, and research programs.
They include providers of services funded through Medicaid, Temporary
Assistance for Needy Families (TANF), the State Children's Health
Insurance Program (SCHIP), Head Start, and other programs for families
and youth.
IV. History of
Cultural Competency in nursing.
A. In the
1950s, nurse theorist Madeline
Leininger started to develop the
concepts of cultural competency in nursing, based on cultural care
diversity and universality.
After completing her doctorate degree in anthropology, she established
the field of Transcultural Nursing, which is focused on comparative
cultural caring, health and nursing phenomena and cultures worldwide
(Leininger, 1991).
B. Leininger coined
the term Transcultural. Today it is used interchangeably with
cross-cultural, intercultural and multicultural or ethnic nursing.She
has mentored over 200 transcultural nursing studies and today some of
the nurses she has mentored are making advances in the Transcultural
nursing field (Boyle, Andrews, & Carr, 2002).
The goal of Transcultural nursing is to develop a scientific and
humanistic body of knowledge in order to provide culturally congruent
care. Transcultural nursing blends nursing and similarities and
differences in human care and caring. Transcultural nursing is not
anthropology or medical anthropology.
Although Transcultural nursing studies cultural behavior patterns, the
focus is on the cultural caring phenomena and not with diseases or
specific cultural practices (Leininger, 1991).
C. According to
Leininger (1991), culture consists of the learned, shared and
transmitted values, beliefs, norms and lifeways of a particular
group that guide their thinking, decisions, and actions in patterned
ways.
The nurse and the client engage in decisions to: maintain or preserve,
accommodate or negotiate, or repattern or restructure the client’s
behavior in congruence with his/her values, beliefs and lifeways.
Transcultural nursing theory recognizes that clients and caregivers are
cultural beings and bring their own beliefs, values and lifeways to the
cultural encounter, within the context of the healthcare setting.
D. The
interrelationship of the three cultures, the nurse, the patient, and
the setting, is complex and requires cultural sensitivity,
research-based knowledge of cultural differences, and
interpersonal skills in order to prevent inappropriate and unethical
cultural imposition.
E. Personal
experience as an ethnic minority does not confer expertise in
practicing Transcultural nursing if not accompanied with a background
in theory and research-based cultural knowledge.
V. Developing
cultural competence: awareness, knowledge and skills.
Culturally competent attitudes, knowledge and skills are the affective,
cognitive, and behavioral domains that influence the nurse’s caregiving
practices. The Campinha-Bacote Model views cultural competence
as a journey, with the following dimensions (ASKED):
1. A is for
AWARENESS: Awareness of the impact of cultural differences on
patient’s health and illness necessitates self-assessment and
self-knowledge one’s own values, beliefs and practices. Caregivers
need to examine their biases and preconceptions and how they
potentially impact the care and treatment of clients.
Promoting mutual respect, awareness of the varying degrees of
acculturation, a client-centered perspective, acceptance that
beliefs may influence a patient’s response to health, illness, disease
and death. (From the Seven Domains of Cultural Competence.)
2. S is for SKILLS:
Culturally competent skills include the ability to conduct cultural
assessment of individual clients, groups, families, communities and
institutions as well as culturally-based physical assessment.
The nurse needs to be knowledgeable in biological variations (Mongolian
spot in infants), genetic traits and disorders, such as Tay Sachs
disease and Sickle Cell Anemia, risk factors for particular diseases
and injuries (for example occupational hazards), health conditions, and
variations in drug metabolism among different ethnic and cultural
groups.
Culturally competent behaviors and skills include development of new
behavior patterns based on cultural knowledge. For example, it includes
the ability to send and receive verbal and nonverbal messages
accurately and appropriately. It also requires adaptation of the
environment, processes service delivery to meet the needs of diverse
clients (for example, keeping longer office hours to accommodate
working women).
Providing alternatives to written communication; accomodating the
physical environment to the client's needs; culturally appropriate
materials, resources, and interior design; literacy sensitive
magazines, brochures, audio and visual materials.
(From the Seven Domains), )
3. K is for
KNOWLEDGE: The professional needs to base his/her practice on
theory and research-based knowledge of cultural differences in beliefs,
traditions and other cultural dimensions such as communication
patterns, space and time variations.
The professional healthcare provider needs to possess specific
knowledge about the particular group with which he or she is working,
their history and experiences (for example, political refugee or
high-tech immigrant worker), lifestyle and values, (for example, New
Age belief in alternative healthcare practices or expectations of
high-tech care), and how these factors potentially impact the
healthcare experience.
Population-based clinical practice; culturally skilled clinicians avoid
misapplication of scientific knowledge; avoiding stereotyping while
appreciating the importance of culture; knowing one's own worldviews;
learning about the changes in demographics; understanding
sociopolitical infuences; practicing intervention skills and strategies.
(From the Seven Domains)
4. E is for
ENCOUNTERS: The process where the healthcare professional
engages in face-to-face encounters with diverse clients in order to
gain first-hand knowledge and experience, and to modify preconceptions
about cultural groups. Learning about cultural differences is not a
substitute for personal knowledge from experience.
Continuous, active involvement of community leaders and members;
written policies and procedures and mission statements reflect
engagement in the community; multicultural and multilingual staff
reflecting the community.
(From the Seven Domains)
5. D is for DESIRE:
According to Campinha-Bacote, "Cultural desire is the motivation of the
healthcare professional to “want to” engage in the process of becoming
culturally aware, culturally knowledgeable, culturally skillful and
seeking cultural encounters; not the “have to.” "
The professional engages in life-learning not only for professional,
but also for continued personal development.
Conclusion:
Developing cultural competence requires the integration of
cultural awareness, knowledge and skills in the practice of
professional nursing. Culturally competent care requires the ability
and the capacity to provide respectful and effective patient care.
Congratulations! You
are now ready for the exam! After you pass the exam, please complete the Course Evaluation. We cannot verify course completion without a completed evaluation.
Print your test results as certificate of completion. Exam may be repeated until you obtain a passing score of at least 70%.
Cultural Competency EXAM
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Faculty
and other accreditation:
Culture Advantage is
approved as a provider of continuing nursing education by the Kansas State Board of Nursing. This course is
approved for 2 contact hours applicable for relicensure for RNs,
LPNs, and LMHTs.
Kansas State Board of Nursing: Provider # LT0243-1250.
FAQs.
Course requirements:
- Complete the lessons
and the required readings. You should spend approximately the same number of minutes as the contact hours provided for the course.
- Provide a valid name, state of licensure and license number.
- Pass the exam. The required passing grade is 70% on the exam. Exams may be repeated
twice. (Password: xresultx)
- Complete the course evaluation.
- Print, sign and date your certificate.
- Completion of the course indicates agreement to the course
requirements.
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