1. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
Chapter 2
Cultural Competency
Copyright © 2015 by Mosby, an imprint of Elsevier Inc.

2. "It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change."--Charles Darwin

3. Cultural Competence
To be culturally aware is to understand those aspects of the human condition that differentiate individuals and groups and that sometimes have an overpowering effect on their health and medical care.
Understanding of a particular culture may be useful in the solution of problems that may at first have seemed intractable. 3

4. A Definition of Culture
Culture in the broadest sense reflects the whole of human behavior, including:
Ideas and attitudes
Ways of relating to each other
Manners of speaking
Material products of physical effort, ingenuity, and imagination 4

5. Culture "Culture” includes: Language Beliefs Morals Education
Sets of dynamically evolving shared traits 5

6. Physical Characteristics
The use of physical characteristics (e.g., gender or skin color) to distinguish a cultural group can be a trap.
There is a sharp difference between distinguishing cultural characteristics and distinguishing physical characteristics. 6

7. Ways to Develop Cultural Competence
Be willing to modify care in keeping with patient’s culture.
Do not expect all members of a culture to behave the same.
Appreciate that cultural values are ingrained and are hard to change.
Recognize that cultural diversity exists.
Demonstrate respect.
Examine own cultural beliefs.
Recognize that cultural definitions of health and illness differ. 7

8. Impact of Culture
Influences on the way patients seek medical care and the way clinicians provide care include:
Age
Gender
Race
Ethnic group
Cultural attitudes
Regional differences
Socioeconomic status 8

9. Impact of Culture (Cont.)
Poverty and inadequate education disproportionately affect various cultural groups.
Ethnic minorities and women
Socioeconomic disparities negatively impact the health and medical care of individuals belonging to these groups. 9

10. A Lexicon of Cultural Understanding
Acculturation
Process of accommodating to another culture
Culture
Integrated system of shared values
Custom
Habitual activity of a group or subgroup
Enculturation
Process of assuming the traits and behaviors of a given culture
Ethnocentrism
Belief in the superiority of one’s own culture with disdain for others 10

11. A Lexicon of Cultural Understanding (Cont.)
Ethnos (ethnic group)
Group of same race or nationality with a common culture and traits
Minority
Group differentiated from the majority population with regard to religion, race, or ethnic origin
Norm
Prescribed standard of allowable behavior within a group
Race
Physical differentiator based on a common heredity
Rite
Prescribed, formal, customary observance 11

12. A Lexicon of Cultural Understanding (Cont.)
Ritual
Stereotypical behavior regulating religious, social, and professional behaviors
Stereotype
Simplified, inflexible conception of the members of a group
Subculture
Subgroup having distinctive traits that differentiate it from the larger culture
Values
Ideals, customs, institutions, and behaviors within a group for which the members have a respectful regard 12

13. Primacy of the Individual in Health Care
Predicting an individual patient's character merely on the basis of common cultural traits is not appropriate.
Cultural attitudes may constrain professional behavior and confuse the context in which the patient is served.
The individual is unique. 13

14. Cultural Assessment Guide: The Many Aspects of Understanding
Health beliefs and practices
Faith-based influences and special rituals
Language and communication
Parenting styles and role of family
Sources of support beyond family
Dietary practices 14

15. Health Beliefs and Practices
Patient view of health and illness
Attitudes about pain, illness, death, handicap
Hygiene practices
Common treatments of illness
Use of prevention measures
Preference of health professionals 15

16. Faith-Based Influences and Special Rituals
Religion to which patient adheres
Special religious practices and beliefs that affect health care when patient is ill or dying 16

17. Language and Communication
Primary language, secondary language
Command of English, literacy
Special signs that demonstrate respect or disrespect
Role of touch in communication 17

18. Dietary Practices Culturally forbidden or required foods
Foods used in rites or ceremonies, fasting
Food beliefs (e.g., foods believed to cause or to cure illness)
Periods of required fasting 18

19. Impact of Culture on Illness
Disease is shaped by illness, and illness is shaped by the totality of the patient’s experience.
Health care providers must consider the substance of illness―the biologic, emotional, and cultural aspects―or else fail to offer complete care. 19

20. Components of a Cultural Response
Make sure you explore and understand the patient’s cultural beliefs and practices.
Avoid making assumptions about cultural beliefs and behaviors without validation from the patient.
Beliefs and behaviors that will have an impact on patient assessment include the following:
Modes of communication
Health beliefs and practices
Nature of relationships within a family
Diet and nutritional practices 20

21. Health Beliefs and Practices
Patients have a view of health and illness, and an approach to cure shaped by a cultural paradigm.
Patients with a “scientific view” are more comfortable with Western medical care.
Patients with a “holistic” or natural approach may be at odds with Western medical care. 21

22. Family Relationships
Family structure and the social organizations to which a patient belongs are among many imprinting and constraining cultural forces in a person’s life.
One type of already known behavior may predict another type of behavior. 22

23. Diet and Nutritional Practices
Beliefs and practices related to food, as well as the social significance of food, play a vital role in everyday life.
Some of these beliefs of cultural and/or faith-based significance may have an impact on your care:
Orthodox Jew
Muslim
Chinese
Herbal, home, and natural therapies 23

24. Summing Up Meet patients on their own terms. Resist stereotyping.
Understand yourself and your attitudes.
Constrain your prejudices and tendencies to be judgmental.
Take these steps to make strides toward cultural competence. 24