Cultural competency is having specific cognitive and affective skills that are essential for building culturally relevant relationships between providers and patients. Obtaining cultural competency is an ongoing, lifetime process, not an endpoint. Becoming culturally competent requires continuous self-evaluation, skill development, and knowledge building about culturally diverse groups.
Healthcare disparities are inequalities in healthcare access, quality, and/or outcomes between groups. In the United States, these inequalities may be due to differences in care-seeking behaviors, cultural beliefs, health practices, linguistic barriers, degree of trust in healthcare providers, geographical access to care, insurance status, or ability to pay. Factors influencing these disparities include education, housing, nutrition, biological factors, economics, and sociopolitical power.
Several models of cultural competency exist. In a model called The Process of Cultural Competence in the Delivery of Healthcare Services, by Campinha-Bacote, nurses are directed to ask themselves questions based on the five constructs-awareness, skill, knowledge, encounters, and desire (ASKED)-to determine their own cultural competency. According to this model, nurses need an awareness of their own cultural biases and prejudices, cultural knowledge, and assessment and communication skills. Nurses also need to be motivated to have encounters with culturally diverse groups. In its most recent form, this model suggests that these encounters are the pivotal key constructs in the process of developing cultural competency.
The Giger and Davidhizar Transcultural Assessment Model identifies six cultural phenomena nurses and other healthcare providers assess in their patients: biological variations, environmental control, time, social organization, space, and communication.
Staff should select a model that best fits your specific work setting and patient population.
Discussions about culture in healthcare often focus on race and ethnicity. Taking this approach excludes other factors (biological, psychological, religious, economical, political) that are all aspects of one's cultural experience. When race and ethnicity are overemphasized in conversations about healthcare disparities, the results can be polarizing because nursing remains a White, female-dominated profession. Also, emphasis on racial difference over other equally important differences sets up an "us versus them" dynamic between nurses that may lead to some minority nurses' disengagement from these initiatives. In addition, no one is immune to prejudice. Minorities are just as likely to have room for improvement in cultural competency.
Taking it all in
You can gain helpful information by performing a cultural assessment and using a broad definition of culture that reflects the differences in healthcare besides race and ethnicity. These definitions include age, gender, disability, sexual orientation, immigration status, employment status, socioeconomic status, culture, and religion.
To avoid stereotyping, keep in mind that individuals within a particular group can vary in many respects. For example, among older adults, certain characteristics may be typical but some older adults may demonstrate attributes that differ from the group. Many believe that all older people resist the use of modern technology; however, many people who are elderly enjoy using smartphones, tablets, electronic readers, and other devices. These intracultural differences are important to consider; having group knowledge never justifies predicting behaviors of any individual members. As part of a cultural assessment, determine the specific values, beliefs, attitudes, and health needs of each patient. See Performing a cultural assessment for an example using the Giger and Davidhizar Transcultural Assessment Model.
In the United States, the healthcare system is a cultural entity with its own norms and values. Yet nurses may overlook a facility's institutional culture when they consider the impact culture has on patients' healthcare access and outcomes. Both organizational and hospital unit culture play a role in determining the quality of care a patient receives. When you can determine what interpersonal or institutional barriers exist within a particular institution, clinic, or community setting, you're better able to assist your patients in overcoming them to achieve better healthcare outcomes.
Goals and Considerations of cultural competency
How do you know whether you're providing culturally competent care? Some believe that they've reached the goal of cultural competency as they gain new knowledge or skills, or have encounters with culturally diverse groups. But while providers may meet goals, there is always room for improvement. Helpful questions and considerations when determining cultural competency include:
* What does being culturally competent mean to me and the patients I serve?
* Which cultural competency model and/or assessment tool is most useful to me, given my patient population?
* As I gain cultural knowledge and skills, how can I use that knowledge to improve my patients' healthcare outcomes and assist in reducing healthcare disparities for underserved populations?
* Did the patient demonstrate an understanding of what I was trying to convey or teach?
* What can I do to improve the quality of care I deliver to members of this group?
Kellye Whitney - 2/23/12
reprint from Diversity Executive
Just because you don’t see unconscious bias doesn’t mean it doesn’t exist and that the unseen isn’t having a tangible impact on actual people.
Iowa is dealing with one of the largest class-action lawsuits of its kind against the entire state government’s civil service system. Some 6,000 African-American plaintiffs are saying since 2003 they were systemically passed over for jobs and promotions.
“The plaintiffs … do not say they faced overt racism or discriminatory hiring tests in Iowa, a state that is 91 percent white. Instead, their lawyers argue that managers subconsciously favored whites across state government, leaving blacks at a disadvantage in decisions over who got interviewed, hired and promoted,” an article about the case said.
This is particularly interesting because apparently similar cases against local governments have failed — it’s tough to explicate and prove disparities in mistreatment of this type. But science may be the answer — or at least offer some measure of proof.
The article said that University of Washington psychology professor Anthony Greenwald, an expert on implicit bias who testified on the plaintiffs’ behalf, developed an Implicit Association Test to test racial stereotypes. The resulting research found a preference for whites over blacks in up to 80 percent of test takers among people who did not consider themselves to be racist.
This kind of research makes me want to hop up and down pointing and yelling, ‘See! Told ya.’ This is why I talk the subject of unconscious bias darn near to death. Just because you don’t see it — or don’t want to acknowledge it exists — doesn’t mean it doesn’t exist and that the unseen isn’t having a tangible impact on actual people.
“Attorney Thomas Newkirk said the science and other evidence that shows disadvantaged groups such as blacks face employment discrimination in subtle ways ‘is becoming overwhelming,’” the article said.
Lawyers are asking for lost wages to the tune of $67 million minus what plaintiffs earned in the meantime, and that changes be made in the way state officials train managers, screen candidates and track disparities in hiring. We’ll see how it plays out.
We are interested in what you think? Do you believe Bias can be a subconscious thing? Let us know what you think of this article and the lawsuit that is its subject. Do you agree? Disagree?