Cultural Inquiry And Values And Norms In Healthcare Essay

This week, you will prepare for your ethical and cultural inquiry. Consider how culture can impact healthcare decisions and outcomes. Read the following article from the Western Journal of Medicine: Galanti G. A. (2000). An introduction to cultural differences. The Western Journal of Medicine, 172(5), 335–336. doi:10.1136/ewjm.172.5.335 Cultural Inquiry And Values And Norms In Healthcare Essay

Discuss the following:

1. Do you agree with the writer’s premise that treating patients with respect is not enough, and it is necessary to learn about the specific customs of other cultures in order to provide quality health care? Explain your reasoning and provide examples.

2. Do you think there is a danger in stereotyping when discussing cultural norms? Explain and provide examples.

3. Which cultures and customs are you most familiar with?

4. Does culture play a significant role in the healthcare issue that you are researching? Explain.

uing APA reference and citation of the article followed at top, plus other references!! IN EACH QUESTION! Is A MUST!

Culture refers learned patterns of behavior. It can also refer to a range of beliefs and behavior that people or communities pass down to successive generations. Thus, culture encompasses the values, rules, norms, and beliefs institutions share to construct effective and efficient physical worlds. Conversely, competence refers to behaviors reflecting appropriate application of attitude, skills, knowledge, and experience. Healthcare providers ought to be learned, skilled, and experienced to deliver quality and safe care. As a result, they should also learn to attain cultural competence by engaging in assistive, facilitative, and supportive cultural beliefs, responsibilities, norms, and values ensuring patients receive safe and quality care (Lehman, Fenza, & Hollinger-Smith, 2012). Thus, healthcare providers should demonstrate the right skills, attitude, and behavior enabling them to work, associate, and help people from diverse backgrounds. For example, care providers should integrate cultural competence and skills required in the delivery of quality care. For instance, they should have a better understanding of their patients, take into account any cultural differences and preferences, and apply the necessary skills to deliver safe and efficient healthcare services.Cultural Inquiry And Values And Norms In Healthcare Essay

Cultural Competency

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According to Lehman, Fenza and Hollinger-Smith (2012), there are five constructs of cultural competence. The first construct refers to cultural awareness or self-reflections, which enables an individual to identify and understand personal biases. The second construct is known as cultural knowledge. It refers to the process of obtaining information in reference to diverse cultures before an individual can identify the culture they understand and can relate to without conflicts or stereotypes. The third construct refers to cultural skills, which is the process of assessing cultural data of people from different backgrounds. For example, nurses should assess patients’ cultural data to identify measures that they should either embrace or avoid as they help an individual recover and attain quality health.

Cultural encounters refer to personal experiences with people from diverse backgrounds. Thus, healthcare providers should rely on cultural encounters to avoid cultural conflicts as they strive to deliver safe, timely, and quality care to patients from diverse backgrounds. The final construct refers to cultural desire. The process encourages people to attain the will and desire to be culturally competent (Lehman, Fenza, & Hollinger-Smith, 2012). Cultural competence in reference to healthcare, therefore, involves processes providers especially doctors and nurses ought to strive to work within cultural contexts of each patient continuously and consistently.Cultural Inquiry And Values And Norms In Healthcare Essay

The Importance of Culturally Competent Healthcare Providers

The United States government has been seeking to develop a culturally competent community of healthcare providers to reduce health disparities. The expanding and growing elderly population across the United States are identified as people representing a cultural entity with diverse ethnic, religious, socioeconomic, racial values and norms. The government has also noted that the population will increase by 2050 with the largest growth rate being observed among American Indians, African Americans, and Asian Pacific Islanders. The United States Census Bureau conducted a research in 2006 revealing that the nation’s population mainly comprises of people aged above sixty-five years. Thus, the aged are likely to represent at least 39% of the nation’s population by 2050 having grown from 19%. Healthcare settings require sensitivity, competent behaviors, and awareness as concepts of health, ailments, pain, suffering, and delivery of care bear varying meanings to people from diverse backgrounds (Lehman, Fenza, & Hollinger-Smith, 2012). Healthcare providers, therefore, should gain knowledge on cultural customs. Consequently, they can provide better care. Moreover, staffs, residents, and families can help the patients to recover while avoiding cultural misunderstandings.Cultural Inquiry And Values And Norms In Healthcare Essay

Culturally competent healthcare providers can enhance health outcomes and the wellbeing of patients. For example, they can improve and increase healthcare-seeking behaviors by successfully educating patients to embrace appropriate testing and screening. Also, cultural competence can ensure that healthcare providers record fewer diagnostic errors (Lehman, Fenza, & Hollinger-Smith, 2012). For example, the providers can identify measures to implement ensuring patients do not experience drug complications. The providers can also rely on cultural competence to offer patients great and expanded choices seeking to identify and access high quality clinicians. Thus, cultural competency influences healthcare outcomes directly.

As a result, healthcare providers should demonstrate that they have a great understanding on how cultural competency impacts accessibility and delivery of quality, safe, timely, and equitable healthcare services. Cultural competency can also assist staff, residents, and patients to recognize common barriers to cultural understanding (Lehman, Fenza, & Hollinger-Smith, 2012). Consequently, they can identify characteristics enhancing healthcare settings while interpreting and responding to diverse and effective measures of delivering quality care. Lastly, cultural competence can demonstrate commitment to appropriate services requiring healthcare staff to apply effective cultural and linguistic skills in leading and mentoring other providers and professionals.Cultural Inquiry And Values And Norms In Healthcare Essay

The National Center for Cultural Competence defines values facilitating delivery of quality healthcare. Thus, NCCC states that healthcare providers including nurses ought to define a set of values and principles demonstrating positive and acceptable attitudes in delivery of safe and quality care. Healthcare providers should also demonstrate that their behaviors, structures, and policies enable them to work effectively across diverse cultures. It also states that healthcare providers ought to have the capacity to value and appreciate diversity. Besides, they should conduct self-assessments and reflections while managing the dynamics of cultural diversity to acquire and institutionalize cultural knowledge (Lehman, Fenza, & Hollinger-Smith, 2012). Consequently, they can embrace diverse cultural contexts among the communities they serve and strive to deliver quality care safely and timely. Lastly, healthcare facilities should formulate policies systematically improving administration practices and service delivery to fulfill needs among the patients, stakeholders, and communities.

In 2010, the State of Queensland published five cross-cultural capabilities clinical staff ought to attain namely, self-reflection, cultural understanding, context, communication, and collaboration. Based on the five capabilities, healthcare providers ought to rely on the following regulations to deliver quality care. Foremost, the providers should consider their individual cultures and understand how they feel when associating with people from diverse cultural backgrounds (QH, 2010). For example, they should gain a better understanding of existing cultural differences by considering social factors affecting patients’ behaviors. Consequently, they can sensitively respond to the patients’ needs while applying varying cultural norms to gain trust, build relationships, communicate effectively, and deliver quality care.Cultural Inquiry And Values And Norms In Healthcare Essay

Cultural self-assessments should also be undertaken to identify personal position on cultural beliefs against that of healthcare system. The self-assessments can assist staffs and patients to recognize power relations produced in the healthcare system. The power differentials on cultural diversity can also be applied to consider interplay of factors such as age, gender, religion, and socioeconomics on how they affect delivery of quality care (QH, 2010). Thus, the self-reflections can ensure healthcare providers are sensitive to cross-cultural values and able to involve cultural and linguistic diversities in delivering quality care.

Personal and organizational biases should also be identified to determine and accommodate staffs and patients diverse needs (QH, 2010). For example, a nurse ought to understand that a patient can fail to identify with his or her own culture. The nurse, however, should appreciate that the patient may have more than one identity. Consequently, he/she can avoid cultural determinism and identify with the patients’ needs. The process, however, requires the nurse understanding different consumer behaviors influenced by cultural norms to deliver culturally appropriate and quality care. Subsequently, providers can avoid making assumptions and judgments about healthcare staff, residents, and patients as they work across disciplines required in delivery of quality care. For example, nurses ought to have the skills to facilitate development of referral pathways. In addition, they should be skilled at establishing collaborative networks to facilitate exchange of information across healthcare disciplinary boundaries. Consequently, patients’ needs can be addressed effectively and efficiently.Cultural Inquiry And Values And Norms In Healthcare Essay

Recommendations

According to Lehman, Fenza, and Hollinger-Smith (2012), cultural awareness decreases ethnocentrism. People aware of diverse cultural values, biases, myths, and stereotypes relate well with their counterparts from different social, cultural, economic, and religious backgrounds. For example, nurses should acknowledge that ageism affects patients and the society. As a result, they should understand the need to have a positive attitude, apply the appropriate behavior, and have the belief that aged patients and their families also desire receiving quality, timely, and safe care. Subsequently, they can learn how to communicate with aged patients without being rude, prejudiced, or discriminative.

Cultural competency encourages healthcare providers to identify help-seeking behavioral patterns. Health education and communication, therefore, relies on cultural competence for staffs and patients to work together in addressing an ailment by applying acceptable attitudes, behaviors, and practices in delivery of care. Thus, healthcare providers should ensure residents and patients understand their views towards medical treatment practices. They should also encourage other providers or professionals and family members to participate in delivery of quality care through collaborative efforts (Lehman, Fenza, & Hollinger-Smith, 2012). For example, nurses should allow family members and patients’ social networks to assist in ensuring an individual attain health. Community-based key informants with knowledge on cultural diversity and competency are also ideal in delivery of quality long-term care. They are often familiar with operating and regulatory environments defining long-term care. Thus, they should be allowed to design and facilitate culturally appropriate programs, practices, and services guarantying that patients will receive quality and safe care effectively and efficiently.Cultural Inquiry And Values And Norms In Healthcare Essay

Cultural competence also ensures healthcare organizations employ bilingual staffs. Staffs using culturally-specific phrases and patterns of expression to gain resident compliance are often aware of cultural variants (Lehman, Fenza, & Hollinger-Smith, 2012). For example, they can express psychological distress without insulting the patient. Thus, cultural competence can ensure healthcare staffs, board members, and volunteers to assess a patient and deliver quality care while applying clear communication skills and appropriate cultural perceptions.Cultural Inquiry And Values And Norms In Healthcare Essay

Healthcare workplaces rely on practices showing compassion. Patients and their families often face difficulties associated with ailments. As a result, cultural competence in the workplace can ensure staffs and patients social and religious beliefs are respected accordingly. Besides, healthcare facilities should attain cultural competency to avoid installing symbols and adornments that can be culturally offensive. Hospitals often admit patients from a cultural background prohibiting them from eating certain meal choices (Lehman, Fenza, & Hollinger-Smith, 2012). Attaining cultural competency, therefore, can ensure such healthcare facilities cater for the patients’ needs appropriately to avoid offending their cultural customs. As a result, healthcare organizations should offer cultural sensitivity training to staffs and residents. The training programs ought to address cultural issues associated with family support. For example, the programs should address issues relating to language and literacy of cultural issues. Consequently, healthcare staffs can understand how to respect patients’ cultural traditions, values, and principles. The training can also encourage healthcare providers to be open-minded and exhibit cultural competence by learning phrases or languages from diverse ethnic communities.Cultural Inquiry And Values And Norms In Healthcare Essay

The most effective resources and people supporting community outreach programs promoting healthcare are often culturally competent. The groups are mainly government, church, and neighborhood-based striving to enhance accessibility and delivery of quality care. They also anticipate partnerships from national and international programs striving to attain a similar goal. In addition, they rely on support from community members to provide relevant healthcare services to the people in need (Lehman, Fenza, & Hollinger-Smith, 2012). As a result, they ought to engage cultural trainers and spiritual leaders with a cultural background of the communities they visit. This demonstrates respect and desire to deliver quality care to people in need without causing culture-based conflicts. For example, a community outreach program should seek information from cultural associations in a particular community to serve diverse ethnic groups with various healthcare needs. Consequently, they can encourage the members of the community to visit healthcare facilities to seek for medical assistance, as they will demonstrate that healthcare providers are friendly and approachable people with skills to deliver safe, timely, and equitable care.Cultural Inquiry And Values And Norms In Healthcare Essay

Principles of cultural competency integrate appropriate linguistic services. They should be applied to improve delivery of safe and quality care provided to the public. Providing healthcare accreditation and related services involves supportive performance (Lehman, Fenza, & Hollinger-Smith, 2012). Healthcare organizations, therefore, should review policies, principles, and practices applied in delivery of care. For example, policies should be reviewed to ensure healthcare services are delivered appropriately culturally and linguistically. Consequently, standards, practices, and principles that are competent can be used to make culturally acceptable healthcare services accessible.

Conclusion

Delivery of quality, safe, timely, and equitable healthcare services involves working with people from diverse cultures. Thus, cultural capability is vital. It should be practiced across diverse social, religious, and economic backgrounds. As a result, healthcare providers should embrace self-awareness to identify their strengths and weaknesses. For example, they should gain insight into diverse cultural backgrounds to understand their ethnic and spiritual heritages. Consequently, they can determine the appropriate attitude as they impacts patients’ health conditions. Also, the providers can avoid making culture-based assumptions about a patient by acknowledging that their personal cultural beliefs, norms, and principles should allow them to make necessary adjustments to deliver quality care. Cultural competency, therefore, encourages healthcare providers to work competently and sensitively with staffs, residents, and patients from diverse backgrounds. They are able to understand their reactions and expectations, judge the extent personal biases can influence relationships with colleagues and patients, and identify appropriate, simple, and competent ways of delivering quality care.Cultural Inquiry And Values And Norms In Healthcare Essay

The increasing diversity of the nation brings opportunities and challenges for health care providers, health care systems, and policy makers to create and deliver culturally competent services. Cultural competence is defined as the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.(1) A culturally competent health care system can help improve health outcomes and quality of care, and can contribute to the elimination of racial and ethnic health disparities. Examples of strategies to move the health care system towards these goals include providing relevant training on cultural competence and cross-cultural issues to health professionals and creating policies that reduce administrative and linguistic barriers to patient care.

Racial and ethnic minorities are disproportionately burdened by chronic illness
Racial and ethnic minorities have higher morbidity and mortality from chronic diseases. The consequences can range from greater financial burden to higher activity limitations.

Among older adults, a higher proportion of African Americans and Latinos, compared to Whites, report that they have at least one of seven chronic conditions — asthma, cancer, heart disease, diabetes, high blood pressure, obesity, or anxiety/ depression.(2) These rank among the most costly medical conditions in America.(3)Cultural Inquiry And Values And Norms In Healthcare Essay

African Americans and American Indians/Alaska Natives are more likely to be limited in an activity (e.g., work, walking, bathing, or dressing) due to chronic conditions.(4)

Older African Americans and Latinos are More Likely to Have Chronic Conditions
The population at risk for chronic conditions will become more diverse
Although chronic illnesses or disabili- ties may occur at any age, the likelihood that a person will experience any activity limitation due to a chronic condition increases with age.(5) In 2000, 35 million people — more than 12 percent of the total population — were 65 years or older.(6) By 2050, it is expected that one in five Americans — 20 percent — will be elderly. The population will also become increasingly diverse (see Figure 2). By 2050, racial and ethnic minorities will comprise 35 percent of the over 65 pop-ulation.(7) As the population at risk of chronic conditions becomes increasingly diverse, more attention to linguistic and cultural barriers to care will be necessary.Cultural Inquiry And Values And Norms In Healthcare Essay

Racial and Ethnic Minorities Will Comprise Almost Half of the Total Population by 2050
Access to health care differs by race and ethnicity
Having a regular doctor or a usual source of care facilitates the process of obtaining health care when it is needed. People who do not have a regular doctor or health care provider are less likely to obtain preventive services, or diagnosis, treatment, and management of chronic conditions. Health insurance coverage is also an important determinant of access to health care. Higher proportions of minorities compared to Whites do not have a usual source of care and do not have health insurance (see Figures 3A and 3B).

Racial and Ethnic Minorities are Less Likely to Have a Regular Doctor and Health Insurance
Language and communication barriers are problematic
Of the more than 37 million adults in the U.S. who speak a language other than English, some 18 million people — 48 percent — report that they speak English less than “very well.”(8) Language and communication barriers can affect the amount and quality of health care received. For example, Spanish-speaking Latinos are less likely than Whites to visit a physician or mental health provider, or receive preventive care, such as a mammography exam or influenza vaccination.(9) Health service use may also be affected by the availability of interpreters. Among non-English speakers who needed an interpreter during a health care visit, less than half — 48 percent — report that they always or usually had one.(10)

Language and communication problems may also lead to patient dissatisfaction, poor comprehension and adherence, and lower quality of care. Spanish-speaking Latinos are less satisfied with the care they receive and more likely to report overall problems with health care than are English speakers.(11) The type of interpretation service provided to patients is an important factor in the level of satisfaction. In a study comparing various methods of interpretation, patients who use professional interpreters are equally as satisfied with the overall health care visit as patients who use bilingual providers. Patients who use family interpreters or non-professional interpreters, such as nurses, clerks, and technicians are less satisfied with their visit.(12)Cultural Inquiry And Values And Norms In Healthcare Essay

Low literacy also affects access to health care
The 1992 National Adult Literacy Survey found that 40 to 44 million Americans do not have the necessary literacy skills for daily functioning.(13) The elderly typically have lower levels of literacy, and have had less access to formal education than younger populations.(14) Older patients with chronic diseases may need to make multiple and complex decisions about the management of their conditions. Racial and ethnic minorities are also more likely to have lower levels of literacy, often due to cultural and language barriers and differing educational opportunities.(15) Low literacy may affect patients’ ability to read and understand instructions on prescription or medicine bottles, health educational materials, and insurance forms, for example. Those with low literacy skills use more health services, and the resulting costs are estimated to be $32 to $58 billion — 3 to 6 percent — in additional health care expenditures.(16)Cultural Inquiry And Values And Norms In Healthcare Essay

Lack of cultural competence may lead to patient dissatisfaction
People with chronic conditions require more health services, therefore increasing their interaction with the health care system. If the providers, organizations, and systems are not working together to provide culturally competent care, patients are at higher risk of having negative health consequences, receiving poor quality care, or being dissatisfied with their care. African Americans and other ethnic minorities report less partnership with physicians, less participation in medical decisions, and lower levels of satisfaction with care.(17) The quality of patient-physician interactions is lower among non-White patients, particularly Latinos and Asian Americans. Lower quality patient-physician interactions are associated with lower overall satisfaction with health care.(18)

African Americans, Latinos, and Asian Americans, are more likely than Whites to report that they believe they would have received better care if they had been of a different race or ethnicity (see Figure 4). African Americans are more likely than other minority groups to feel that they were treated disrespectfully during a health care visit (e.g., they were spoken to rudely, talked down to, or ignored). Compared to other minority groups, Asian Americans are least likely to feel that their doctor understood their background and values and are most likely to report that their doctor looked down on them.(19)Cultural Inquiry And Values And Norms In Healthcare Essay

Racial and Ethnic Minorities are Less Satisfied with the Health Care They Receive
WHAT IS CULTURAL COMPETENCE IN HEALTH CARE?
Individual values, beliefs, and behaviors about health and well-being are shaped by various factors such as race, ethnicity, nationality, language, gender, socioeconomic status, physical and mental ability, sexual orientation, and occupation. Cultural competence in health care is broadly defined as the ability of providers and organizations to understand and integrate these factors into the delivery and structure of the health care system. The goal of culturally competent health care services is to provide the highest quality of care to every patient, regardless of race, ethnicity, cultural background, English proficiency or literacy. Some common strategies for improving the patient-provider interaction and institutionalizing changes in the health care system include:(20)

1. Provide interpreter services

2. Recruit and retain minority staff

3. Provide training to increase cultural awareness, knowledge, and skills Cultural Inquiry And Values And Norms In Healthcare Essay

4. Coordinate with traditional healers

5. Use community health workers

6. Incorporate culture-specific attitudes and values into health promotion tools

7. Include family and community members in health care decision making

8. Locate clinics in geographic areas that are easily accessible for certain populations

9. Expand hours of operation

10. Provide linguistic competency that extends beyond the clinical encounter to the appointment desk, advice lines, medical billing, and other written materials

Cultural competence is an ongoing learning process
In order to increase the cultural competence of the health care delivery system, health professionals must be taught how to provide services in a culturally com-petent manner. Although many different types of training courses have been developed across the country, these efforts have not been standardized or incorpo-rated into training for health profession-als in any consistent manner.(21) Training courses vary greatly in content and teaching method, and may range from three-hour seminars to semester-long academic courses. Important to note, however, is that cultural competence is a process rather than an ultimate goal, and is often developed in stages by building upon previous knowledge and experience.Cultural Inquiry And Values And Norms In Healthcare Essay

TRAINING APPROACHES THAT TEACH FACTS ABOUT SPECIFIC GROUPS ARE BEST COMBINED WITH CROSS-CULTURAL SKILL-BASED APPROACHES THAT CAN BE UNIVERSALLY APPLIED

Approaches that focus on increasing knowledge about various groups, typically through a list of common health beliefs, behaviors, and key “dos” and “don’ts,” provide a starting point for health pro-fessionals to learn more about the health practices of a particular group. This approach may lead to stereotyping and may ignore variation within a group, however. For example, the assumption that all Latino patients share similar health beliefs and behaviors ignores im-portant differences between and within groups. Latinos could include first-generation immigrants from Guatemala and sixth-generation Mexican Americans in Texas. Even among Mexican Americans, differences such as generation, level of acculturation, citizenship or refugee status, circumstances of immigration, and the proportion of his or her life spent in the U.S. are important to recognize.Cultural Inquiry And Values And Norms In Healthcare Essay

It is almost impossible to know everything about every culture. Therefore, training approaches that focus only on facts are limited, and are best combined with approaches that provide skills that are more universal. For example, skills such as communication and medical history-taking techniques can be applied to a wide diversity of clientele. Curiosity, empathy, respect, and humility are some basic attitudes that have the potential to help the clinical relationship and to yield useful information about the patient’s individual beliefs and preferences. An approach that focuses on inquiry, reflection, and analysis throughout the care process is most useful for acknowledging that culture is just one of many factors that influence an individual’s health beliefs and practices.(22)

GUIDELINES FROM PROFESSIONAL ORGANIZATIONS HELP PROMOTE CULTURAL COMPETENCE

Many professional organizations representing a variety of health professionals, such as physicians, psychologists, social workers, family medicine doctors, and pediatricians have played an active role in promoting culturally competent practices through policies, research, and training efforts. For example, the American Medical Association provides information and resources on policies, publications, curriculum and training materials, and relevant activities of physician associations, medical specialty groups, and state medical societies.(23)Cultural Inquiry And Values And Norms In Healthcare Essay

Several organizations have instituted cultural competence guidelines for their memberships. For example, based on ten years of work, the Society of Teachers of Family Medicine has developed guidelines for curriculum material to teach cultural sensitivity and competence to family medicine residents and other health professionals. These guidelines focus on enhancing attitudes in the following areas:(24)

Awareness of the influences that sociocultural factors have on patients, clinicians, and the clinical relationship.
Acceptance of the physician’s respon-sibility to understand the cultural aspects of health and illness
Willingness to make clinical settings more accessible to patients
Recognition of personal biases against people of different cultures
Respect and tolerance for cultural differences
Acceptance of the responsibility to combat racism, classism, ageism, sexism, homophobia, and other kinds of biases and discrimination that occur in health care settings.Cultural Inquiry And Values And Norms In Healthcare Essay
ACCREDITATION STANDARDS THAT ADDRESS CULTURAL COMPETENCE IN MEDICAL SCHOOLS HAVE THE POTENTIAL TO REACH MANY FUTURE PHYSICIANS

Accreditation standards are important tools that can have widespread effects on the cultural competence of medical students, health care professionals, and health care organizations. For example, the Liaison Committee on Medical Edu-cation (LCME) — the nationally recognized accreditation body for medical schools in the U.S. and Canada — recently mandated higher standards for curriculum material on cultural competence than were previously in place. As a result, medical schools must now provide students with the skills to understand how people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments. Students must also be able to recognize and appropriately address racial and gender biases in themselves, in others, and in the delivery of health care.(25)

Commitment to cultural competence is growing among health care providers and systems
Health systems are beginning to adopt comprehensive strategies to respond to the needs of racial and ethnic minorities for numerous reasons. First, there are increasingly more state and federal guidelines that encourage or mandate greater responsiveness of health systems to the growing population diversity. Second, these strategies may be seen as essential to meeting the federal government’s Healthy People 2010 goal of eliminating racial and ethnic health disparities. Third, many health systems are finding that developing and implementing cultural competence strategies are a good business practice to increase the interest and participation of both providers and patients in their health plans among racial and ethnic minority populations.

In addition to increasing the cultural competence of health care providers, organizational accommodations and policies that reduce administrative and linguistic barriers to health care are also important. Policies that strive to achieve cultural competence throughout the organization must address issues on all levels, from the organization’s top management to clinicians to office staff to billing and administrative staff. Organizational policies that address language and literacy barriers have been among the most successful efforts.Cultural Inquiry And Values And Norms In Healthcare Essay

BILINGUAL AND BICULTURAL SERVICES ARE EFFECTIVE

Traditionally, community health centers that serve the Asian American or Latino communities have the most fully developed linguistic capabilities. For example, Asian Counseling and Referral Services (ACRS) in Seattle is a community-based mental health organization that effectively addresses language needs. They try to provide bilingual and bicultural clinicians that match the client’s background. When this is not possible, ACRS provides trained staff to act as co-providers with a licensed mental health professional. These trained individuals act not only as interpreters, but also help provide a cultural context for the client’s beliefs and practices. Stemming from 30 years of experience in this arena, ACRS has developed a training curriculum, “Building Bridges: Mental Health Interpreter Training for Interpreters of Southeast Asian Languages.” This curriculum will be used as a model for a national mental health interpreter training project to address the needs of limited-English speaking people. This national project includes training for interpreters, trainers, and health providers, as well as a mental health interpreter certification process.(26)Cultural Inquiry And Values And Norms In Healthcare Essay

Within the Latino community, the use of promotoras, also known as peer edu-cators, is becoming increasingly popular. Promotoras are generally ordinary people from hard-to-reach populations who act as bridges between their community and the complicated world of health care. They learn about health care principles from doctors or non-profit groups, and share their knowledge with their com-munities. The peer education model is not only cost-effective, but also has been shown to be more effective in terms of reaching populations who find the information more credible coming from someone with a familiar background.(27)

ASSESSING LITERACY LEVELS CAN BREAK DOWN BARRIERS

Methods employed to assess literacy levels include the use of screening instruments that test for certain skills related to functional literacy or less formal tools that allow health care professionals to determine a person’s comfort level with various modes of communication. For example, at the To Help Everyone (T.H.E.) Clinic in Los Angeles, nurses and health care professionals speak individually with patients when they arrive at the health clinic to determine whether the patient prefers to learn by using written materials, pictures, verbal counseling, or some other technique. This method of assessment allows the patient to identify their own learning style preference without having to take a literacy test; it also reduces feelings of fear or humiliation that may occur when singled out.(28)Cultural Inquiry And Values And Norms In Healthcare Essay

FEDERAL STANDARDS AND GUIDELINES FOR PROVIDING CULTURALLY AND LINGUISTICALLY APPROPRIATE CARE
1. The Department of Health and Human Services has provided important guidance on how to ensure culturally and linguistically appropriate health care services. The Office for Civil Rights published “Title VI Prohibition Against National Origin Discrimination as it Affects Persons with Limited English Proficiency.” Very few states have developed standards for linguistic access. States that have developed such standards have focused on managed care organizations, contracting agreements with providers, and specific health and mental health services in defined settings.(29)Cultural Inquiry And Values And Norms In Healthcare Essay

2. In August 2000, the Health Care Financing Administration (now Centers for Medicare and Medicaid Services) issued guidance to all state Medicaid directors regarding interpreter and translation services, emphasizing that federal matching funds are available for states to provide oral interpretation and written translation services for Medicaid beneficiaries.(30)

3. In December 2000, the Office of Minority Health of the Department of Health and Human Services issued 14 national standards on culturally and linguistically appropriate services (CLAS) in health care. These standards are intended to correct current inequities in the health services system and to make these services more responsive to the individual needs of all patients. They are designed to be inclusive of all cultures, with a particular focus on the needs of racial, ethnic, and linguistic population groups that experience unequal access to the health care system. The CLAS standards provide consistent definitions of culturally and linguistically appropriate services in health care and offer a framework for the organization and implementation of services. CLAS standards can be found at http://www.omhrc.gov/CLAS/Cultural Inquiry And Values And Norms In Healthcare Essay

4. In 2002, two guides were developed to assist managed care plans with cultural and linguisti-cally appropriate services: “Providing Oral Linguistic Services: A Guide for Managed Care Plans” and “Planning Culturally and Linguistically Appropriate Services: A Guide for Managed Care Plans.” Both guides can be found at www.cms.gov/healthplans/quality/project03.asp

Conclusion
Cultural competence is not an isolated aspect of medical care, but an important component of overall excellence in health care delivery. Issues of health care quality and satisfaction are of particular concern for people with chronic conditions who frequently come into contact with the health care system. Efforts to improve cultural competence among health care professionals and organizations would contribute to improving the quality of health care for all consumers. Cultural Inquiry And Values And Norms In Healthcare Essay