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Module 4 - Background

INTEGRATION

Case Background

Skill Development

The literature acknowledges that courses developed to increase cultural skills, as well as cultural experiences, do in fact increase overall cultural competence in practitioners. There is evidence that increased experience, including profession, age, visiting other countries, language fluidity, and cultural immersion contribute significantly to developing overall cultural skills.

Through training courses and adoption of cultural competence standards, researchers have realized significant increases in general cultural awareness as it relates to culturally informed diagnosis, culture-based treatment plans, eliciting cultural strengths, materials adapted to culture, and behaviors and attitudes accepting of other cultures.

Organizational Impacts

The organizational setting, which includes the population receiving care, often plays a crucial role in how care is delivered. Both the internal environment (organizational objectives and goals, the nature of the organization’s services, communication processes and networks within the organization) and the external environment (economic, socio-cultural, political and legal, and demographic factors) can influence the provider’s ability to adapt to changes in the cultural attributes of various patient populations.

Cultural Adaptability

Hayes (2012) applies the adaptability hypothesis discussed in Module 3 to the provider to define cultural adaptability as, “the ability to receive, interpret and translate cultural environment cues from patients in to changed behavior.” Specifically:

Receiving - familiarity and awareness of several general cultural associations
Interpreting - being aware, understanding, and identifying cultural influences
Translating - that includes being aware, recognizing, and attempting to improve the utilization of gathered cultural information

Often, cultural competence training acknowledges the need to understand, define, and use cultural competence as a method of improving practitioners’ awareness of culture in clinical work (Giger & Daivdhizar, 2004; Kim-Godwin et al., 2001; Leininger, 1967; Orque, 1983; Purnell, 1991; Suh, 2004). However, there is no explicit recognition of the reciprocal relationship between patients adapting to their environment and providers adapting to their patients and their own environment (Giger & Daivdhizar, 2004; Kim-Godwin et al., 2001; Leininger, 1967; Orque, 1983; Purnell, 1991; Suh, 2004). The cultural adaptability construct may then be used to create actionable steps towards, and account for, the use of culture in treatment interactions.

The cultural adaptability constructs may also be used to provide context to the linear tendency to provide generalizations across cultures and to use ethnicity and culture interchangeably as explanation for cultural similarities or differences. Approaching culture in a linear manner can be counter-productive to the provider-patient interaction because it treats patients who function within even more complex systems with ever-changing cultural associations, as static. Additionally, using ethnic group identification as the primary backdrop for a discussion of cultural competence may lead to stereotyping and therefore hinder the provider-patient interaction. Thus, the cultural adaptability allows health care providers the opportunity to recognize how and where environmental cues can be processed.

Session Long Project Background

HEALTH CARE PRACTICES

Sub-constructs of this domain are:

Focus on health care
Traditional practices
Magicoreligious religious beliefs
Responsibility for health
Transplantation
Rehabilitation/chronicity
Self-medication
Pain/sick role
Mental health
Barriers

The concepts of this domain vary widely among different cultures. In some cultures, magicoreligious beliefs view illness as judgment from the “gods” for evil or wicked ways committed by those afflicted with illness. Illness is viewed by other cultures as being caused by witchcraft or sorcery. Regardless of the individual beliefs, it should be kept in mind that concepts related to health care practices are inextricably related to culture.

When we consider the above, these concepts may seem strange to us. I would like to take this opportunity to remind us of a term introduced in Module 1: “ethnocentricity”. There is a propensity for those of us who live in the “Western” culture to see our model of health care as the only “acceptable” type of health care. However, we must remember that Western Medicine was not always as “scientific” as it is today. In the May 1851 edition of The New Orleans Medical and Surgical Journal, the eminent Dr. Samuel A. Cartwright coined the term “Drapetomania” to describe the disease of the mind that “induces the negro to run away from service.”

By 1870, American Medicine had come to the conclusion that a woman was completely controlled by her ovaries; thus they were thought to be the source of a wide variety of diseases. By 1906, 150,000 women had been relieved of their ovaries for their "cure." Just in case you think these types of conclusions were limited to the 1800’s, in 1966, Robert Wilson, best-selling author of “Feminine Forever,” stated that without estrogen replacement therapy for menopause, “no woman can be sure of escaping the horror of this living decay.” So much for objectivity.

It should also be mentioned that our “high tech” medicine has not done much in the way of improving our infant mortality rates (defined as the number of infants who die before the first year of life). Infant mortality rates are but one measure of a country's health or development. It is interesting to mention that with an average infant death rate of 6.30 deaths per 1,000 live births, the United States does not make it in the “top 40” list for countries with the lowest infant mortality rate. The CIA World Fact book ranks the United States at 42nd in the world for infant mortality (we actually fell one place since last year, meaning we are getting worse; not better). Countries such as Taiwan, Cuba, Portugal, Germany, Norway, Hong Kong, and Singapore are ranked higher than the U.S. Incidentally, Singapore, which ranks number 1 for having the lowest number of deaths, has 2.3 deaths per 1,000 live births. Clearly, our “Western Medicine” has some room for improvement! It should also be noted that it is not uncommon for people in the West to pray to the divine for intervention when someone is sick, even while seeking allopathic, Western medical care.

HEALTH CARE PRACTITIONERS

Sub-constructs of this domain are:

Perceptions of practitioners
Folk practitioners
Gender and health care

Every society has unique beliefs about the origins and appropriate treatment of illness. Within this “health care” infrastructure are individuals educated or trained in the appropriate diagnosis and treatment of these illnesses. In your Session Long Project for this module, you will be exploring the health care practitioners, including their “training,” specific to the group you have selected for study.

Although we may again be tempted to point to the superiority of “Western” medical training, you must keep in mind that physicians have only been “properly” educated for a few short decades. Into the early parts of the 20th century, medical education was completed using an “apprentice” method of learning with minimal curricular consistency. Medical schools were proprietary and many existed only to make money (versus preparing qualified physicians), curriculum was not standardized, and the differences between physicians and “snake oil” salesmen were arbitrary. In the early 1900’s, a man by the name of Abraham Flexner conducted a study and wrote a report (which came to be known as the “Flexner Report”) that outlined the objectionable training received by physicians. Learn more about the Flexner report.

Required Reading

Boelen, C. (2002). A new paradigm for medical schools a century after Flexner’s report [Electronic version]. World Health Organization. Bulletin of the World Health Organization, 80(7), 592-594.

CIA (2006, August 8). Rank Order: Infant mortality rate. Retrieved from
https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

Gueye, V. (2010). Traditional medicine. Los Angeles Sentinel, 76(49), C2.

Purnell, L. (2005). The Purnell model for cultural competence [Electronic version]. Journal of Multicultural Nursing & Health, 11(2), 7-15.

Optional Reading

Cox, C., Cole, E., Reynolds, T., Wandrag, M., et al. (2006, Winter). Implications of cultural diversity in do not attempt resuscitation (DNAR) decision-making [Electronic version]. Journal of Multicultural Nursing and Health, 12(1), 20-28.

Hayes, E. (2012). The impact of organizational culture, climate, and provider characteristics on perceived cultural adaptability of disaster health care providers. TUI University. Dissertations and Theses, 199

Optional Resources

Purdue Online Writing Lab. (2018). General format. Retrieved from https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html

Purdue Online Writing Lab. (2018). In-text citations: The basics. Retrieved from https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/in_text_citations_the_basics.html

Purdue Online Writing Lab. (2018). Reference list: Basic rules. Retrieved from https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/reference_list_basic_rules.html