Cultural Competence: An Overview _____________________________________________________________
VETERANS The effects of military service and deployment to military com- bat on the individual and the family system are wide-reaching. According to the U.S. Department of Defense, there were 3.4 million current military personnel in 2023 and 15.8 million veterans in 2023 [106; 107]. The Army has the largest number of active-duty members, followed by the Navy, Air Force, and Marine Corps [106]. Military service presents its own set of risk and protective factors for a variety of mental health issues, including post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression and suicide, substance abuse, and interpersonal violence. In particular, transitioning from combat back to home life can be particularly trying for veterans and their families. As the number of military conflicts and deployments has increased since 2001, the need to identify and provide bet- ter treatment for veterans and their families has become a greater priority. The first step in providing optimal care is the identification of veterans and veteran families during initial assessments, with an acknowledgement that veterans may be any sex/gender and are present in all adult age groups. Unfortunately, veterans and military families often do not voluntarily report their military service in healthcare appoint- ments. In 2015, the American Medical Association updated its recommendations for social history taking to include military history and veteran status [108]. In addition, the American Academy of Nursing has designed the Have You Ever Served? Initiative to encourage health and mental health professionals to ask their patients about military service and related areas of concern [109]. This program provides pocket cards, posters, and resource links for professionals working with veterans and their families. Recommended questions for intake include [109]: • Have you or has someone close to you ever served in the military? • When did you serve? • Which branch? • What did you do while you were in the military? • Were you assigned to a hostile or combative area? • Did you experience enemy fire, see combat, or witness casualties? • Were you wounded, injured, or hospitalized? • Did you participate in any experimental projects or tests? • Were you exposed to noise, chemicals, gases, demolition of munitions, pesticides, or other hazardous substances?
PROMOTING CULTURALLY SENSITIVE COMMUNICATION Communication, the process of sending a message from one party to another, consists of both verbal and nonverbal com- ponents. Verbal and nonverbal communications are embedded within the culture of the parties disseminating the information and within the culture of the parties receiving the informa- tion. Communication is complex and multilayered because it involves unstated, implicit rules about a variety of factors, including physical distance between parties, tone of voice, acceptable topics of discussion, physical contact, and amount of eye contact [84]. Each of these variables is influenced by the perception of the level of formality/informality of the situation. Frequently, misunderstandings occur because the decoding and interpretation of these nonverbal cues are not accurate. The verbal component of communication is just as compli- cated. Certainly, similarity in language shared by both parties enhances communication, but assuming that both parties in a conversation speak the same language, how the information is interpreted is still influenced by a host of factors. Linguists have posited that approximately 14,000 different meanings and interpretations can be extracted from the 500 most common English words [85]. Consequently, practitioners must be aware of the different communication styles held by diverse ethnic minority patients, as the clinical communication process is the primary vehicle by which problems and solutions are identified and conveyed [86]. Styles of communication can be classified from high- to low- context [87]. High-context cultures are those cultures that disseminate information relying on shared experience, implicit messages, nonverbal cues, and the relationship between the two parties [85; 88]. Members of these cultural groups tend to listen with their eyes and focus on how something was said or conveyed [84; 87]. On the other hand, low-context cultures rely on verbal communication or what is explicitly stated in the conversation [85]. Consequently, low-context communica- tors listen with their ears and focus on what is being said [84; 87; 88]. Western culture, including the United States, can be classified as a low-context culture. On the other hand, groups from collectivistic cultures, such as Asian/Pacific Islander, Hispanic, AI/AN, and Black and African American, are from high-context cultures [87]. Communicators from high-context cultures generally display the following characteristics [84; 85; 88]: • Use of indirect modes of communication • Use of vague descriptions • Less talk and less eye contact • Interpersonal sensitivity • Use of feelings to facilitate behavior
37
EliteLearning.com/Counselor
Powered by FlippingBook