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Cultural Competency for the Health Professional, 1st Edition
Authors: by Patti R. Rose (Author)
Cultural Competency for the Health Professional reviews the importance of the implementation of cultural competency by allied health professionals, and the process of assessment, training and evaluation. This comprehensive text includes a clear and concise overview of the necessary tools to apply cultural competency processes as well as systematic and disciplined approaches to the process of achieving it. Attention is also given to some of the reservations that may exist in various health professions with interests in moving in the direction of cultural competency such as associated costs, limited time, and beyond. Cultural Competency for the Health Professional provides health professions students with key cultural competency information and practical insight into how to apply this knowledge in their day-to-day work environments as they deal with patients on a clinical basis. Interview With Dr. Shalala Chapter 10 includes an interview with Dr. Shalala conducted by the author of this text. Dr. Donna Shalala is currently the President of the University of Miami, in Florida. She has been in this position since 2001. Prior to her current role, she was appointed by President Clinton to serve as U.S. Secretary of Health and Human Services (HHS) and held this position for 8 years which amounted to the longest serving HHS Secretary in U.S. history to date. She was responsible for a budget of almost $600 billion, overseeing a number of programs such as Social Security, Medicare, Medicaid, Child Care and Head Start, Welfare, the Public Health Service, the National Institute of Health (NIH), The Center for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) (Shalala,2011). FEATURES Overview of the demographic changes in the United States Accreditation requirements (programmatic, specialized and institutional) Cultural nuances of specific groups Comprehensive view of the Culturally and Linguistically Appropriate Services (CLAS) standards with an emphasis on the clinical aspect of various allied health professions Attitudinal survey with established reliability and validity INSTRUCTOR RESOURCES • PowerPoint Slides • Over 150 Test Questions • Case Studies STUDENT RESOURCES Companion Site including: o Additional Case Studies o Crossword Puzzles o Interactive Glossary o Flashcards o Matching Exercises o Web Links o Acronyms Glossary o Acronyms Flashcards
The 2010 Census data has emerged, and it is clear the United States is more diverse than ever before. Consequently, the term “minority,” which is used to describe various racial groups and the Hispanic ethnic group, in terms of their previous national percentages relative to the mainstream population, is becoming obsolete. The current replacement term for minority is “emerging majority.” This new information is relevant to health professionals and will help them serve these emerging majority groups in a more culturally competent manner. According to Kosoko-Lasaki, Cook, and O’Brien (2009, p. xiii), “Cultural competency has been addressed by legislative, accreditation and regulatory mandates since 1946 (Hill-Burton) Act (p. xiii).” To some this is a known fact, but I often encounter individuals who disagree with the necessity for cultural competency. For example, I recently gave a presentation for approximately 300 health professionals at a university. The lecture was entitled “Cultural Competency in the Clinical Setting.” The main points in my lecture, also covered in this text, were to explain the difference between cultural competency and diversity, provide insight into nuances of various cultural groups, and review the cultural competence continuum.
After the lecture I was met with a long line of students, eager to ask questions and speak with me one-on-one. One student approached me and indicated he had a great deal of concern about the focus of my talk; he stressed that it promoted “tribalism.” He believed all people immigrating to the United States or from a minority group living in the United States should assimilate to the mainstream culture. He also believed that there should not be accommodations made to meet “their” needs but they should conform to “our” way of life. Interestingly, I was not surprised by his comments. There are always individuals in attendance who have strongly held beliefs in this regard. From a linguistic competency perspective, some of these same individuals believe that in order to be treated by health professionals,
patients must speak English. This view does not take into consideration the need to value and appreciate the diversity of all people, and the importance of health professionals to continually learn about other cultures to ensure the provision of optimal health services.
According to Snipp (2010), “The process of identifying some people as ‘like us’ and others as ‘not like us’ is one that predates written history and quite possibly was present in the earliest forms of human societies” (p. 106). Snipp (2010) further states “counting people by race is a tradition deeply embedded within the governing framework of the United States” (p. 111). Understanding that there are culturally diverse groups in the United States who may or may not want to assimilate into mainstream culture but nevertheless need health care providers who value and appreciate their diversity, would seem to be an area of agreement in the healthcare field, but is not necessarily the case. Sometimes the lack of cultural understanding leads to areas of concern, including malpractice suits and other forms of disagreement,
which are discussed thoroughly in this text.
The health professions are very diverse, with more than 200 recognized professional fields comprising a substantial portion of the US healthcare workforce (all fields except for physicians and nurses are considered within the term “health professionals” in this text). Because of the enormity of this field, the services are far reaching, resulting in various encounters with culturally diverse individuals. Furthermore, as demographics continue to change rapidly in the United States, occupations in the health professions continue to grow. To meet the needs of health care in the United States, based on the new healthcare reform bill signed into law in 2010, there will inevitably be a need to increase the number of those individuals who can help foster the system through the offering of their expertise. These individuals
include but are not limited to physician assistants, medical assistants, physical and occupational therapists, laboratory technicians, radiology technologists, dental hygienists, dieticians, surgical assistants, phlebotomists, audiologists/speech-language pathologists and respiratory therapists. Given that all these health professionals are formally educated, clinically trained and credentialed within the context of the certification process, and registered and/or licensed, it is clear that cultural competency should be included in the process. This inclusion in their education will only enhance the health professional’s ability to interact with culturally diverse patients and hopefully provide more positive outcomes. The following is according to Koenig (2008, p. 161):
The United States’ persistent health disparities are widely recognized. In 2003 the Institute of Medicine (IOM 2003) published a major report examining the state of minority health in the United States. The report documented differences in rates of common diseases like cancer or heart disease, as well as significant variations in mortality rates and overall life expectancy. Black-white differences are especially troubling; U.S. whites consistently outlive blacks. And these differences persist even among those with equal access to health insurance, such as those older than 65 who are covered by Medicare. The experts convened by the IOM cited a large body of empirical research that underscores the existence of this and other health disparities among U.S. groups.
An important aspect of this book is the discussion of health disparities and its relevance to health professions.
Another aspect is to provide insight into how cultural competency, as a skill set acquired by health professionals, will help to alleviate these serious issues health disparities cause. Clearly, a number of contributing factors are relevant to health disparities, also pointed out by Koenig (2008, p. 161) in her indication that “… lack of health services, and unequal treatment when care is sought, account for a significant portion of racial and ethnic health disparities….” This text offers a detailed perspective on how cultural competency plays a crucial role in finding a resolution.