The Need For Cultural Awareness, Respect And Competency

THE NEED FOR CULTURAL AWARENESS, RESPECT AND COMPETENCY

What is culture? It is difficult to define culture. A characteristic usually included in definitions of culture is that it is "shared by people." Culture is also said to distinguish insiders from outsiders, those who are members of one cultural group from those who are not. This idea of culture leads to the following useful suppositions:

1. Culture is learned. It is transmitted from one generation to another through observation and discourse. Thus, culture is shared with those from whom it is learned and with those to whom it is taught. Older adults have had a great deal of time to learn cultural values and beliefs from those groups with which they have had contact.

2. Culture is localized. Culture is created through specific interactions with specific individuals. Each person draws meaningful elements from these interactions and shares them with some but not all individuals within society.

3. Culture is patterned. Patterns emerge from the repetition of specific samples of behaviour and talk. Repeated patterns establish the normal and customary expectations that structure social interactions. Habit and ritual may be central to their lives.

4. Culture is evaluative. Values are a central component of culture and are reflected in individual behaviours. Values reflect shared beliefs that facilitate the social interaction without which society would not be possible. However, individuals continuously evaluate societal values in terms of personal relevance. The value systems of elders reflect the interactions they have had over a lifetime.

5. Culture has continuity, with change. In general, cultural identity is stable, but one's cultural knowledge changes over the life course as one encounters new objects, situations, and ideas in the personal environment. These experiences shape a unique person. Across society, many individuals may experience the forces for change almost simultaneously and respond in similar, though not identical, ways.

Why should the Western health care system adapt to the needs of other cultural groups? Why don't they learn to speak English?... Some people would say, yes they should adapt to our culture and learn our language. However, that is not the most compassionate or practical response. Unless cultural differences are taken into account we cannot provide optimal health care for all patients. Misunderstandings can often lead to misdiagnoses. A healthcare provider who lacks knowledge about cultural, psycho sociological, and language differences evident in diverse multicultural populations is likely to make inaccurate assessments.

Cultures develop norms, values, and behaviours that are suited to that environment. Over time, they take on the strength of tradition. Whether patients should speak English and adapt to our ways and customs is irrelevant. The fact is that they do not and may not. The options then are to provide inferior care or to make accommodations so as to provide optimal care. In a multicultural society such as ours, healthcare providers are likely to encounter patients from diverse settings. We need to develop a cultural insight and a deeper appreciation and respect for the rights of culturally diverse individuals. When cultural beliefs and practices are not appropriately identified, the significance of behaviour may confuse the healthcare provider and result in the delivery of inappropriate care. The goal of the health care system is to provide optimal care for all patients. We must keep in mind that culture and ethnicity are strong determinants in an individual's interpretation or perception of health and illness. Religion, ethnicity, and culture interweave into the fabric of each response of a particular individual to treatment and healing.

What is cultural competence? To be culturally competent the healthcare provider needs to understand his/her own worldviews and those of the patient, while avoiding stereotyping and misapplication of scientific knowledge. Cultural competence is obtaining cultural information and then applying that knowledge. This cultural awareness allows you to see the entire picture and improves the quality of care and health outcomes. Adapting to different cultural beliefs and practices requires flexibility and a respect for others view points. Cultural competence means to really listen to the patient, to find out and learn about the patient's beliefs of health and illness. To provide culturally appropriate care we need to know and to understand culturally influenced health behaviours. Since the perception of illness and disease and their causes varies by culture, these individual preferences affect our approaches to health care. Culture also influences how people seek health care and how they behave toward healthcare providers. How we care for patients and how patients respond to this care is greatly influenced by culture. Health care providers must possess the ability and knowledge to communicate and to understand health behaviours influenced by culture. Having this ability and knowledge can eliminate barriers to the delivery of healthcare. As healthcare providers, we need to learn to ask questions sensitively and to show respect for different cultural beliefs. Most important, we must listen to our patients carefully. The main source of problems in caring for patients from diverse cultural backgrounds is the lack of understanding and tolerance.

Providers of healthcare and patients often begin their relationship separated by a huge cultural gap. As providers of health care we are socialized into the culture of our profession. This professional socialization teaches us a set of beliefs, practices, habits, likes, dislikes, norms and rituals, factors that comprise a given culture. We speak a different language (medical terminology) and our understanding and beliefs regarding health and illness differ greatly from the population at large. Patients and staff also differ in social class.

Western medicine by its nature treats patients as medical objects, a biomechanical entity. Patients are detached from their own lives and life stories and physically taken from their home settings into the unfamiliar setting of a hospital, to be treated by different specialists. But patients often resist this treatment in a number of ways and the resulting conflicts express themselves as "ethical problems." Given the cultural and economic gaps between health care providers and patients, it is not surprising we often make moral judgments on the behaviour of patients.