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With the formation of a global economy, the number of patients with various health-related characteristics, as well as various cultural beliefs and practices, healthcare expectations and provision have grown in all industrialized nations. As a result, the ability to respond to cultural sensitivity in health care systems is strongly advised. Medical practitioners who embark on the career-long process of gaining cultural competency must acquire and provide culturally relevant services to a varied clientele.
Cultural contacts promote a shared understanding and a productive environment in order to foster effective client connections. Inadequate cultural competency care has a negative influence on the lives of both patients and healthcare personnel. Cultural competence in nursing is increasingly becoming an important aspect in understanding cultural diversity and continuously evolving health care systems. Respecting and recognizing cultural variations and working together with people of different culture are the necessary attributes of achieving a culturally competent organization.
Cultural competence is the delineation to ethical articulation.
Cultural competence is a set of skills, attitudes, policies, and behavior that enable organizations and staff to work effectively in a multi-cultural environment. Cultural competence demonstrates the ability to gain and apply knowledge of people's attitudes and beliefs related to healthcare practices. It postulates a means of communicating with patients to improve the delivery of healthcare services, increase community participation, strengthen programs, and minimize gaps in the provision of healthcare services to diverse groups. Cultural competence also converges on specific issues that affect citizenry along with beliefs related to health and cultural values, the prevalence of diseases, and efficiency of treatment. Cultural competence is a set of conforming attitudes, behaviors and policies that mold a system to work with diverse cultural affiliations efficiently (Jackson, 2007).
Culture refers to the interspersed set of sequence of human behavior which includes the thoughts, actions, communications, customs, beliefs, values, language, and associations of cultural, ethnic, religious, and social assembly. Culture includes a particular set of groups or individual beliefs, norms, values and way of life that can be taught, shared, and conveyed. Culture influences way of thinking, decision making, and behaviors that surround our everyday lives (Wells, 2000).
The way of life of people encompasses more than their respective cultural group or ethnicity. Several determinants such as gender, age, religion, the level of education, geographical location, and occupation should be put into consideration when ascertaining people’s way of life. Competence presupposes having the capacity to work efficiently and within the constraints of cultural beliefs, behaviors, and needs of consumers and the society. Therefore, expertise in nursing can be exemplified as the degree of performance demonstrated in active application of knowledge, attitudes, skills, and judgments (Long, 2012).
The Australian population is made up of diverse cultures within the nation. People who belong to the same ethnic background have a system of shared understanding of their actions, words, values, and beliefs. These characteristics are acquired and become internalized as one grows up. An individual's way of life consists of more than one characteristic. These shared norms, beliefs, and attitudes can be systematically modified with the change in environment or as a result of encountering new challenges. Nursing professionals need to regard this cultural factors to accurately assess and provide convenient care irrespective of one's heritage and cultural alliance (Spector, 2002).
The culture of Aboriginal and Torres Strait Islander is very dynamic and intricate. The culture of the Indigenous people of Australia is described as one of the ancient cultural histories of the world. The capacity of the Aboriginal cultures to adapt and change over time has made their cultural heritage to survive the test of time. The Aborigines and Torres Strait Islander people are inclined to their land, sacred sites, dreaming stories, diversity and adaptation, visual arts and performances which go a long way in explaining the essential part of the Aboriginal life and customs (Duffy, 2001).
Their Cultural heritage can be summed up as accepted ways of living brought about by a selected group of people, which is passed down from one generation to another. The Australian, Indigenous community maintained their cultural tradition alive by instilling knowledge through speaking and teaching languages, protecting cultural materials and arts, as well as the passing of performances and ceremonials of different eras from one generation to another (Long, 2012).
According to Spector (2002), culture and recognition were pivotal to the Aboriginal discernment of good health and ill health, with respect to the emotional, social and general well-being of the whole community as opposed to an individual’s health. The concept of viewing life as a whole can be described in their belief of life after death. The attitudes and recognition of the Aboriginals vary between cultures and communities. The foundation of beliefs and values of the Aboriginals remain consistent because of the different magnitude of dispossession. Medical service providers and researchers must respect and respond to the Aboriginal values and principles. They should recognize and comprehend the immense impact of colonization and its eventuality on the health, identity, and culture of the indigenous people.
According to Duffy (2001), the Aboriginal and Torres Strait Islander people have notably lower life expectancy rate and higher rates of morbidity than non-Aboriginal Australians. The estimated life expectancy of an Aboriginal male is 11.5 years less than that of non-Aboriginal Australian, while that of a female is 9.7 years less than that of non-Aboriginal Australian. Their declining standards of health has been accredited to several factors including poor standards of education, high levels of social and economic welfare, predisposition to genetic diabetes and exposure to communicable diseases. The need for nurses to gain a working knowledge of the historical background of Aboriginal and Torres Strait Islander people will help in understanding how history influences their present day lives.
The Aboriginal community comprises of 2.5% of the Australian population, 26% of this population live in very remote areas and cannot access mainstream medical services. Misleading presumption and racist stereotyping have to a greater extent led to suboptimal treatment and service provision of the Australian Aborigines. Inadequate information and poor understanding of health due to low literacy levels has led to non-compliance of instructions. There is a significant lack of palliative care services that are culturally appropriate for the Aboriginal Australians. The culture respect framework was developed to influence the systems, practice, and policies for improved outcomes of health care for Aboriginal Australians (Srivastava, 2007).
According to Wells (2001), the Aboriginal people have fought-for and won support from their federal governments in the provision of controlled health services for the Aborigine Community since the early 1970s. Since the establishment of the Aboriginal Medical Services (AMS), which plays a significant role in providing respected and culturally accepted care for the Aboriginal People. Public health services such as the supply of clean water, decent housing, and environmental care are given top priority. The public health system also advocates for active support and assistance in various sectors such as education, economic growth and improved care of the Aborigines.
Historical cultural experiences can affect the current attitudes and cross cultural interactions of indigenous people. The Aborigines had suffered a lot of discrimination and unfair treatment from other cultures. The presentation of health related problems and the overall attendance of people at healthcare facilities was hindered due to discrimination. Proper consideration must be done to eliminate the barriers that inhibit people from accessing main stream health services (Srivastava, 2007).
The concept of Cultural Competence.
The origin of Cultural competence came about from the healthcare industry where it was assumed that fatal consequences would emerge in healthcare where cultural competence was not practiced. Cultural competence was first epitomized as a harmonious set of knowledge, attitudes, and behaviors of individuals that enable them to work effectively in cross-cultural environments. Cultural competence can also be described as the capacity of healthcare professionals to dispense authentic, compelling and respectful service to individuals based on the prior understanding of the differences and similarities between cultural groups. Having these ability enables health care experts to comprehend on the need of knowing the experience and cultural backgrounds of each particular individual. Therefore, patients can be treated in a unique and specialized way to provide a client centered approach to the satisfactory delivery of service (SenGupta, 2004).
According to Long (2012), the emergence of cultural competence for nurses is developing gradually to enable them to provide safe and quality healthcare services to clients in different cultural settings. Cultural competence encompasses five defining attributes which include cultural sensitivity, knowledge, skill, cultural awareness and dynamic cultural process which should be demonstrated by nurses in service delivery.
Cultural awareness refers to the ability of the nurses to be conscious of the different values, norms, beliefs, and ways of life of patients. The cultural similarities and differences which exist among diverse communities should be recognized. The influence of culture on health in the general provision of medical or nursing care should be valued. The assumption, stereotypes, and beliefs of nurses towards other culture perceived to be different should be explored. Nurses therefore, ought to understand the uniqueness of one's beliefs and practices apart from their own set of cultural values and practices (Jackson, 2007).
According to Srivastava (2007), cultural sensitivity refers to the mutual respect, comfort, and appreciation of another person cultural differences. It involves the continued advancement of native cultures, rights, and traditions of the indigenous population. Different people have a distinct way of life because of the inevitability of cultural diversity. This diversity is important to nurses in achieving a common ground for learning and progress. For the provision of satisfactory and genuine service to clients, it is imperative for nurses to respect the other person's cultural differences. Thus, a comfortable and efficient work environment can be established based on both repute and appreciation of one's cultural values and beliefs.
Cultural knowledge refers to the attainment of a sound educational base for healthcare providers, concerning different cultural groups, to better understand their way of life. It involves what to do and what not to do while interacting with clients of different cultures. These activities can be related to the way of communicating, diet, and other attributes. Cultural knowledge can help prevent unintentional cultural offenses and build trust among people. Having sound knowledge helps in avoiding cultural conflicts and providing essential care to individuals. Nurses should familiarize themselves with the concepts, models, and theories about providing quality health care to diverse cultural groups. This awareness helps in establishing nursing options that are appropriate in the identification of health care needs (SenGupta, 2004).
According to Wells (2000), cultural skill implies the ability of healthcare professionals to assess a client's culture. Evaluating a client’s culture is done by collecting relevant background information about a patient's current health problem as well as incorporating this information into careful planning and provision of service in a sensitive cultural manner. Effective communication includes the use of both verbal and nonverbal skills to guarantee the understanding of different aspects of a patient's cultures. The use of interpreters can be essential in eliminating language barriers and fostering mutual understanding. Appropriate and culturally accepted resources should be gathered to plan and execute beneficial and satisfactory services for populations that are culturally diverse.
One of the primary characteristics of cultural competence is a dynamic process. Through the consistent meetings of nurses and patients of different cultures, dynamic process approach focuses on becoming culturally competent as opposed to being culturally competent. Cultural differences of these diverse groups help in the interpretation of sign of illness, expressions of emotions and concerns. Different cultures have predisposed set of beliefs, values, and norms than others. Nurses therefore, ought to be conversant enough to provide sufficient skills and knowledge in the provision of service that is culturally consistent with each particular group (Sargent, 2005).
Theoretical and philosophical application
Florence Nightingale’s, who was working as a nurse with the Australians aboriginal people during the Crimean war, was the first transcultural nurse in history. However, the concept of instituting transcultural nursing and cultural competence was first introduced by Madeleine Leininger with her culture care and culture care diversity theory in the early 1950s. Leininger’s culture care theory guides health professionals to conduct cultural assessment and develop plans that are culturally sensitive and within the individual’s cultural background. Culture care theory focused on understanding both the difference and similarities of diverse groups. This theory allows the medical practitioner to assess and use resources available to provide the most effective and culturally respected care to specific individuals or community (SenGupta, 2004).
According to Spector (2002), nurses are required to use practices and theories that are transcultural based on providing efficient care to individuals of diverse affiliations. The underlying purpose of the Leininger’s theory is to understand and explain different cultures based on factors which influence health, sickness, and death of individuals. The primary goal and purpose of this method relate to using research to provide culturally competent and desirable care for people of diverse cultures. This approach has been well established and is known for its holistic and broad approach which focuses on providing meaningful care to cultural specific groups.
Developing cultural competence should be an ongoing process aimed at providing healthcare according to a client's cultural framework. Cultural competence process involves developing cultural knowledge, skills, and awareness to treat all patient's uniquely. Nurses in practice can learn from these diverse and unique cultural setups and become culturally proficient in service delivery and minimize barriers to health care. The desire for appropriate cultural competence care provision is not new in Australia. Efforts by the Australian federal government through policy documents and initiatives has led to improved sectors of the economy, education, and healthcare (Long, 2012).
According to Sargent (2005), cultural competence model has five essential principles which include valuing diversity, conducting cultural self-assessment, systematize cultural knowledge, discerning the dynamics of difference, and adapting to diversity. Valuing diversity means appreciating and respecting the cultural differences within cultures. Every organization has its own set of cultures. Some actions may be misread by people of different culture. To avoid such miscommunications, an organization can conduct a cultural self-assessment (Sargent, 2005).
Knowledge concerning culture should be institutionalized into every aspect of a health facility. Nurses should not only be trained but must be in a position to utilize the gained knowledge effectively in the provision of medical care. The practices and policies set should be able to address the differences and similarities in diverse cultural populations and enhance the positive images of all cultures. Attitudes, beliefs, behaviors, values, structures, and policies should be integrated in such a way that it becomes attuned to cultural diversity. When these principles are incorporated in the system, culturally competent health care providers can effectively meet the needs of indigenous groups (Jackson, 2007).
Positive communication reinforces the quality of care, level of satisfaction and adherence of the prescribed medicine. Through continuous cultural interactions, nurses can gain a lot of additional knowledge about the diverse cultures and become culturally competent in the delivery of healthcare services. Disparities in the health care system will improve significantly among specific cultural groups with the aid of cultural competence. Active communication and feedback will be enhanced between the care giver and the client. Nurses become more culturally aware and proficient in the discharge of their duties. Medical personnel gain respect and trust as they can understand and address the specific individual needs of clients. Cultural interactions facilitate a common understanding, and productive environment to build relationships and successful engagements with the clients (Long, 2012).
According to Duffy (2001), having a culturally competent working team for healthcare providing organizations minimizes the cost of care and improves the overall service. Providing culturally competent care decreases claims due to malpractice which is very crucial for any healthcare organization. Therefore, in developing cultural competence promulgation of new knowledge in a medical institution increases delivery of service, quality of medical care, and the reputation of healthcare professionals and organizations. Health care professionals need to equip themselves with broad range of knowledge, practices, attitudes, and skills which can guide their relationships with co-workers and patients and improve their cultural competence.
Cultural competence is a set of skills, attitudes, policies, and behavior that enable organizations and staff to work effectively in multi-cultural environments. It demonstrates the ability to apply knowledge learned concerning people’s attitudes and beliefs concerning healthcare. Health care providers need to equip themselves with a wide range of knowledge and skills to guide them in providing safe and culturally accepted health care. The culture care theory was developed to guide nurses in the provision of approved quality care to specific individual groups that match their needs. The concept of cultural competency focuses on the primary attributes such as knowledge, skills, awareness, and sensitivity that should be demonstrated by nursing professionals in their delivery of their practice.
Duffy, M. E. (2001). A critique of cultural education in nursing. Journal of Advanced Nursing, 36(4), 487-495.
Long, T. B. (2012). Overview of teaching strategies for cultural competence in nursing students. Journal of cultural diversity, 19(3), 102.
Sargent, S. E., Sedlak, C. A., & Martsolf, D. S. (2005). Cultural competence among nursing students and faculty. Nurse education today, 25(3), 214-221.
SenGupta, S., Hopson, R., & Thompson‐Robinson, M. (2004). Cultural competence in evaluation: An overview. New Directions for Evaluation, 2004(102), 5-19.
Spector, R. E. (2002). Cultural diversity in health and illness. Journal of Transcultural Nursing, 13(3), 197-199.
Srivastava, R. (Ed.). (2007). The healthcare professional's guide to clinical cultural competence. Elsevier Health Sciences.
Wells, M. I. (2000). Beyond cultural competence: A model for individual and institutional cultural development. Journal of community health nursing, 17(4), 189-199.
Jackson, A. K. (2007). Cultural competence in health visiting practice: a baseline survey. Community Practitioner, 80(2), 17.
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