Cultural Competency

1
Cultural Competency

• Improving Care
• Creating Change

2
Influence of Culture

• Definition first
• Historical Culture is social heritage, or
  tradition that is passed on to future
  generations.
• Behavioral Culture is shared, learned human
  behavior, a way of life.
• Normative Culture is ideals, values, or rules
  for living

3
Influence of Culture

• Functional Culture is the way humans solve
  problems of adapting to the environment or living
  together.
• Mental Culture is a complex of ideas, or
  learned habits.
• Structural Culture consists of patterned and
  interrelated ideas, symbols, or behaviors.
• Symbolic Culture is based on arbitrary assigned
  meanings that are shared by a society

4
Aspects of Culture in Human Behavior

• This is what we see first, that is after we get
  past the dress and food!
• This information is shared among the group. You
  may not always know the whys of your
  observations.
• This behavior has sustained generations!

5
Our cross-cultural experiences

• At first contact
• We may recognize the extreme contrasts
• We may have emotional reactions
• We may be perplexed by some behaviors
• We may make negative attributions
• We may become entrenched in our own values

6
Theoretical Concept for Understanding Culture

• The value of a theory is to explain and predict.
• Theories abound
• Individualism and Collectivism

7
Individualism v. Collectivism

• Autonomy
• Competition
• Independent self
• Ego-focused
• Confrontation OK
• Dependence avoiding
• Success via self
• In/out group fluid

• In group harmony
• Cooperation
• Interdependent self
• Shared emotions (shame)
• Confrontation not OK
• Group achievement
• In/out group boundary strong

8
Culture and Health

• Complex concepts do not have exactly the same
  meaning in all cultures.
• US Good Health may include absence of harmful
  bacteria and/or chemical imbalances.
• China Good Health may involve Yin and Yang
  and health is achieved when harmony present.

9
Culture Specific Concepts

• People learn to express their symptoms of
  distress in ways acceptable to others in their
  culture.

10
Culture General Concepts

• These may include subjective feelings of
  well-being, adequate energy to perform tasks,
  appropriate sexual activity and/or expressions of
  support from others.

11
Developing cultural sensitivity in health care
delivery systems

• Modifying behavior so that recommendations are
  placed into a framework familiar to the patient,
  and have an opportunity to be successful. This is
  demonstrating cultural sensitivity.

12
Achieving Practical Cultural Competency

• Key cultural values that affect care
• Status
• Privacy
• Fatalism
• Emphasis on Individual or Group
• Access to Information

13
Cultural Competency in Organizations

• Cultural destructiveness
• Cultural Incapacity
• Cultural Blindness
• Cultural Pre-competence
• Basic Cultural Competence
• Advanced Cultural Competence

14
Cultural Destructiveness

• Examples within an organized system
• Practice of cultural genocide, sub-humanizing
  patients of color. (Tuskegee Experiment)
• Denying clients access to their natural healers.
• Medical experiments without their knowledge or
  consent

15
Cultural Incapacity

• Not intentionally destructive, but lacks
  capacity to help diverse clients.
• May take a paternal posture toward lesser
  races.
• Disproportionately applies resources.
• Enforces racist policies or maintains
  stereotypes.
• Gives subtle not welcome messages.

16
Cultural Blindness

• While expressing a philosophy of being unbiased,
• believes that color or culture makes no
  difference.
• believes that the helping approaches by dominant
  culture are universally acceptable and
  applicable.
• ignores cultural strengths, encourages
  assimilation.

17
Cultural Pre-Competence

• Realizes weakness in serving diverse population
  and makes attempts at specific improvements.
• Explores ways to reach clients.
• May feel a false sense of accomplishment that
  prevents further movement.
• May engage in tokenism.

18
Basic Cultural Competence

• Has acceptance and respect for differences.
• Engages in continuing self-assessment regarding
  cultural understanding.
• Makes adaptations to service models in order to
  meet client needs.
• Seeks advice and consultation from client
  community.

19
Advanced Cultural Competence

• Holds culture in high esteem
• Adds to the knowledge base by continuing
  research, developing new approaches based on
  culture.
• Hires staff who are specialists in culturally
  competent practice.
• Advocates for systemic cultural competence.

20
Competencies and Resources

• Understanding culture-general ideas
• Understanding culture-specific ideas
• Resources for further growth