_____________________________________________________________ Cultural Competence: An Overview
Culturally sensitive assessment involves a dynamic framework whereby the practitioner engages in a continual process of questioning. Practitioners should work to recognize that there are a host of factors that contribute to patients’ multiple identi- ties (e.g., race, gender, socioeconomic status, religion) [127]. WELCOMING AND SAFE ENVIRONMENT Improving access to care can be facilitated, in part, by provid- ing a welcoming environment. The basis of establishing a safe and welcoming environment for all patients is security, which begins with inclusive practice and good clinician-patient rap- port. Shared respect is critical to a patient’s feeling of psycho- logical well-being. Security can also be fostered by a positive and safe physical setting. For patients who are acutely ill, both the illness experience and treatment process can produce trauma. This is particularly true if involuntary detainment or hospitalization is necessary, but exposure to other individu- als’ narratives of experienced trauma or observing atypical behaviors from individuals presenting as violent, disorganized, or harmful to themselves can also be traumatic. As such, care environments should be controlled in a way to minimize traumatic stress responses. Providers should keep this in mind when structuring the environment (e.g., lighting, arrangement of space), creating processes (e.g., layout of appointments or care systems, forms), and providing staff guidance (e.g., non- verbal communication, intonation, communication patterns). During each encounter, the patient’s perception of safety is impacted by caretakers and ancillary staff. Experts recommend the adoption and posting of a nondis- crimination policy that signals to both healthcare providers and patients that all persons will be treated with dignity and respect [128]. Also, checklists and records should include options for the patient defining their race/ethnicity, preferred language, gender expression, and pronouns; this can help to better cap- ture information about patients and be a sign of acceptance to that person. If appropriate, providers should admit their lack of experience with patient subgroups and seek guidance from patients regarding their expectations of the visit. Front office staff should avoid discriminatory language and behaviors. For example, staff should avoid using gender-based pronouns, both on the phone and in person. Instead of asking, “How may I help you, sir?” the staff person could simply ask, “How may I help you?” Offices that utilize electronic health records should have a system to track and record the gender, name, and pronoun of all patients. This can be accomplished by standardizing the notes field to document a preferred name and pronoun for all patients [129]. Some persons who identify as non-binary (i.e., neither or both genders) may prefer that plural pronouns (e.g., they) be used.
Questions should be framed in ways that do not make assump- tions about a patient’s culture, gender identity, sexual orienta- tion, or behavior. Language should be inclusive, allowing the patient to decide when and what to disclose. Assurance of confidentiality should be stressed to the patient to allow for a more open discussion, and confidentiality should be ensured if a patient is being referred to a different healthcare provider. Asking open-ended questions can be helpful during a history and physical. The FACT acronym may be helpful for healthcare providers. Providers should: • F ocus on those health issues for which the individual seeks care • A void intrusive behavior • C onsider people as individuals • T reat individuals according to their gender Training office staff to increase their knowledge and sensitivity toward persons will also help facilitate a positive experience for patients. CONCLUSION Culture serves as a lens through which patients and practitio- ners filter their experiences and perceptions. Patients will bring their unique life stories and concerns to the practitioner, and their cultural values and belief systems will inevitably shape how the problem is defined and their beliefs about what is effec- tive in solving the problem. However, the cultural backgrounds and values of patients are not necessarily scripts that define behavior, and when practitioners view culture as a strength and not a pathology, practitioners will be able to more effectively join with patients to mobilize change.
WORKS CITED https://uqr.to/CulturalCompOverview
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