Cultural Competence: An Overview _____________________________________________________________
Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice. Disclosure Statement It is the policy of TRC Healthcare/NetCE not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activ- ity to learners. HOW TO RECEIVE CREDIT • Read the entire course online or in print. • Complete a mandatory test (a passing score of 80 percent is required). Test questions link content to learning objectives as a method to enhance individualized learning and material retention. Provide required personal information and payment information. • Complete the mandatory Course Evaluation. INTRODUCTION Culturally competent care has been defined as “care that takes into account issues related to diversity, marginalization, and vulnerability due to culture, race, gender, and sexual orientation” [1]. A culturally competent person is someone who is aware of how being different from the norm can be marginalizing and how this marginalization may affect seeking or receiving health care [1]. To be effective cross-culturally with any diverse group, healthcare professionals must have aware- ness, sensitivity, and knowledge about the culture involved, enhanced by the use of cross-cultural communication skills [2]. Healthcare professionals are accustomed to working to pro- mote the healthy physical and psychosocial development and well-being of individuals within the context of the greater community. For years, these same professionals have been identifying at-risk populations and developing programs or making referrals to resources to promote the health and safety of at-risk groups. But, because of general assumptions, persistent stereotypes, and implicit and explicit biases, culture- related healthcare disparities persist [2]. In the increasingly diverse landscape of the United States, assessing and addressing culture-related barriers to care are a necessary part of health care. This includes seeking to improve one’s cultural compe- tence and identifying blind spots and biases.
DEFINITIONS
CULTURAL COMPETENCE In healthcare, cultural competence is broadly defined as prac- titioners’ knowledge of and ability to apply cultural informa- tion and appreciation of a different group’s cultural and belief systems to their work [4]. It is a dynamic process, meaning that there is no endpoint to the journey to becoming cultur- ally aware, sensitive, and competent. Some have argued that cultural curiosity is a vital aspect of this approach. CULTURAL HUMILITY Cultural humility refers to an attitude of humbleness, acknowl- edging one’s limitations in the cultural knowledge of groups. Practitioners who apply cultural humility readily concede that they are not experts in others’ cultures and that there are aspects of culture and social experiences that they do not know. From this perspective, patients are considered teachers of the cultural norms, beliefs, and value systems of their group, while practitioners are the learners [5]. Cultural humility is a lifelong process involving reflexivity, self-evaluation, and self-critique [6]. DISCRIMINATION Discrimination has traditionally been viewed as the outcome of prejudice [7]. It encompasses overt or hidden actions, behav- iors, or practices of members in a dominant group against members of a subordinate group [8]. Discrimination has also been further categorized as lifetime, which consists of major discreet discriminatory events, or everyday, which is subtle, continual, and part of day-to-day life and can have a cumulate effect on individuals [9]. DIVERSITY Diversity “encompasses differences in and among societal groups based on race, ethnicity, gender, age, physical/mental abilities, religion, sexual orientation, and other distinguishing characteristics” [10]. Diversity is often incorrectly conceptu- alized into singular dimensions as opposed to multiple and intersecting diversity factors [11]. INTERSECTIONALITY Intersectionality is a term to describe the multiple facets of identity, including race, gender, sexual orientation, religion, sex, and age. These facets are not mutually exclusive, and the meanings that are ascribed to these identities are inter-related and interact to create a whole [12]. This term also encompasses the ways that different types and systems of oppression intersect and affect individuals.
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