Irrespective of its background, every branch of medicine has its footing in culture. The biomedicine of physicians and all healthcare practices including ethno medicine is strongly influenced by culture. In fact, medical structures cannot be freed from aspects of culture such as social systems, politics, philosophy and economics. The effects of culture on health vary with each society and run deep within the medical sector. There are cases where culture has led to vulnerability and exposure to disease through embracing of risk behaviors. In other societies, culture has led to conceptualization and stigmatization of certain health problems. Despite these negativities, culture creates awareness on healthcare requirements and produces health care givers. Culture and cultural practices have powerful emotional and psychodynamic effects in the health and well-being of individuals. As such, it is through culture that economic, political and social impacts of health and medical care are realized (1).
Besides standard medical practices of health care provided by doctors, health experts, physiotherapist and nurses, there are non-standard forms of treatment that are produced by culture. These are used by patients together with standard medical treatments and products. Complementary and Alternative Medicine (CAM) is the collective word for such non-standard health care practices. These may range from acupuncture, chiropractic, traditional and herbal medicines. Although these practices and modes of treatments are commonly sought, research is yet to show their level of safety and effectiveness (2).
Health Care Cultural Competence
There are many health care disparities between the minorities and non-minorities. Whether it is racial or ethnic, many minorities are placed in susceptible situations when seeking medical health care. Regardless of rights to insurance and income use, many people who belong to the minority group continue to receive lower quality health care. One of the main propositions to counter this is the increase of cultural competence. Cultural health care competence refers to a case in which service providers respect and attend to linguistic and cultural needs of their patients. There are calls to educate and train medical and health care service providers on cultural discrepancies. This move is believed to reduce cultural barriers as it humanizes the patient providers to cultural differences thus improving the relationship between health care givers and minorities. The results are more faith and contentment amongst the minorities in the health care service providers and systems (3).
Rationale for Cultural Competence
While the theory of cultural competency may yield many benefits, it has its own shortcomings that create challenges in effective implementation. Cultural competency purports culture to be a scientific skill that can be gained by clinicians and service providers through training and education. This condenses the aspect of culture and fails to recognize the fact that cultural competence is mainly aimed at improving public service delivery.
Cultural competence also fails to take into account the diversity of ethnic and racial backgrounds. The instructions given in cultural competence facilitations assume culture is synonymous regardless of the ethnicity, race, language and nationality. Health care givers are thus at a loss as to how to relate and care for a patient from a particular ethnic or racial background. Cultural competence may thus not help a health service provider realize the different aspects of culture from varied cultural backgrounds (6). Language barrier may also create obstacles and patients may not understand their doctors for this reason.
Patient diversity is at the core of health care provisions. All patients will perceive health and health care services differently. Depending on their ages, gender, language, race, religion, ethnicity, socio-economic abilities and education among other things, every patient will have his or her own perception of quality health care service and service providers. To some extent, patients who are satisfied with interpersonal care are able to adhere to certain Chronic Disease Management Regimens (7). Unlike male patients, the quality of health education and connection of health care contributes largely to female patient satisfaction. Furthermore, female patients are more likely to ask questions and welcome supplementary information. As compared to men, women tend to practice mutual decision making in health care concerns (9).
Language proficiency is an essential aspect of cultural competence because it is the ability to speak and write well in any language. Despite being important in facilitating learning and adaptation of new cultures, proficiency in a language is not a guarantee of cultural competence (8). In some cases, there is need of translation and advocacy for minority patients. Language translators may thus come in handy.
Ethnicity and Race
Although race and ethnicity are used interchangeably to refer to individual distinctiveness defined by culture, they are actually different. Race comprises biological uniqueness of people and people from different races will vary biologically. On the other hand, ethnicity is more related to ancestry with a particular reference made to nationality and origin (8). In the recent times, there are calls to look beyond ethnic and racial conceptions in a bid to focus on the social contractions of socio-political processes. However, it is important to examine how ethnicity and racial aspects are intertwined with other socio-cultural aspects such as gender and social class (5). In Asia, race and ethnicity is regarded with more reservations and sensitivity as compared to other parts of the world. Health care service providers have to exercise more caution and seek permission more often because of many existing boundaries. For instance, certain foods may be prohibited in the dietary practices and some religions may create high levels of submission of women leaving very little room for health issues discussions.
Cultural competence makes health care service providers aware and compassionate to the distinctiveness of aspects of culture such as religion, spirituality, parent-child interaction, values and customs. It is also supposed to make medical practitioners understand and respect personal preferences, wishes, developmental needs and prejudices that a patient may have resulting from their cultural interaction or background. By strengthening health care giver-patient relationship, it is possible to promote cultural competence and health care service providers are able to exploit constructive traits and family strengths in administering treatment. Where cultural competence is practiced, health care givers are in a position to elicit important information from their patients. This can later be used to accurately diagnose health problems and deduce client-centered remedies. Through cultural competencies on the part of health care givers, family views are respected and this expands involvement of client and his options. As a result, there are more positive clinical results and satisfaction of clients. One of the major means of improving cultural competence is by making relevant inquiries in a sensitive manner and seeking the perception of the patient in the problem at hand. This allows you to obtain valuable information on the root cause of the problem as well as the proposed client interventions or preferable treatment. Cultural competence will ultimately acknowledge the differences and similarities of all patients while respecting their culture (9).
Race and ethnicity are individual distinctiveness that is linked with culture but on the other hand, the use of the terms is someway challenging. Race signifies the biological uniqueness of crowd of people with the repercussion that a person from one race is purely different from another. Ethnicity is ancestry of somebody. In any ethnicity issue, reference is made to the national origin (8). Race and ethnicity are generally used in ethnic alternative study. There is call for moving beyond the essential conceptions of race and ethnicity to make sure that the socio-political processes related to social constructions are examined. Nevertheless, there is need to examine the way into which race and ethnicity are articulated with other categories such as the gender, social class, and structure social relationship (5)
Culture is considered as the groundwork of all medicine and the biomedicine of physicians. It is also the foundation of all other ethno medicine and health care practices of culture. Medical structures are thoroughly entwined with the economic, political, philosophical, and social system of culture. Culture affects health in an assortment of ways including creating a risk behavior that can lead to disease exposure. Culture can conceptualize health woes like illness, disease, and sickness and their significance. Health has an effect on the distribution of grounds of disease and health. Nevertheless, culture helps in creating health givers and their organizational reactions to health care requirements. Culture natures the operation of the well-liked folk as well as other subdivisions well thought-out as professional in the health care. As well, cultures produce social, political, and economic impacts on health and health care. In addition, culture can build a psychodynamic and an emotional power on health and well-being. Over the same, culture offers representational and collective mechanism of healing relationships (1).
Complementary and Alternative Medicine (CAM) is an expression for health practices and products considered not part of the standard care. The standard care means what health doctors, associated health experts, and doctors of osteopathy put into practice. Normally doctors of osteopathy are physical therapists and nurses that are registered. Complementary and Alternative Medicine means non-standard treatments that are used by patients alongside the standard treatment. The main examples of Complementary and Alternative Medicine are chiropractic, herbal medicine, and acupuncture. Research has never shown how Complementary and Alternative Medicine treatments are safe and how well they work (2).
. Cultural competence is on the increase as a prospective approach that can improve quality on top of addressing minority health care disparities. It is believed that racial and ethnic minorities have a propensity of receiving a lower quality of health care when compared to non-minorities even when the right to use income and insurance conditions is controlled. Education and training in cultural competence more often than not generates substantial benefits for its possible impact on humanizing the patient provider affiliation when cultural discrepancies exist. Cultural competent health care can be defined as the services reverential of responsiveness to cultural and linguistic needs of patients. Lack of culturally competent care throws in to the inconsistencies in the health care. Patient faith and contentment are an identified patient reported assessment of general practitioner culturally competent communication behaviors (3).
Developed at personal and organizational level, cultural competency is taken as indispensable for effectual public service delivery. In all probability, unrestricted organizations can get better of service delivery by considering the values and the norms of the target population. Moreover, cultural competency provides the flat form for addressing erroneousness in service delivery. The rationale for cultural competence ranges from quality of care to risk management. It also consists of disparity reduction and linguistic competence. Additionally, rationale for cultural competence comprises of fundamental social responsibility. The move towards cultural competence is regarded as tactically and officially driven for the provision of the public services. It is of great significance to note that while language and culture have common characteristics, there exists a distinction connecting the two. As much as language proficiency contributes to cultural competence, language proficiency alone is not equivalent to cultural competence (4).
Cultural competency puts forward that culture can be condensed to scientific skill and for that reason clinicians can be educated to have expertise of it and in so doing, it fails to reconcile with the fact that cultural competence is only taken for effectual public service delivery. Culture is more often than not creating synonymous in the midst of ethnicity, nationality, and language. A series do and do not do in cultural competence do not define how to take care of a patient of a particular ethnic background (6). Cultural competence does not make doctors to realize aspects of different culture of patient. Nevertheless, it may not allow the patient to fully understand the doctor due to language barrier.
Language proficiency can be considered as the capacity to speak as well as write in a specific language. Language proficiency facilitates the learning of new culture but it cannot automatically guarantee cultural competence (8). Professional interpreters are needed to translate language and advocate for patients. Ethnicity and race in Asia is more reserved as much as being more sensitive. Doctors need to be asking for permission because there exist a boundary. The dietary practices forbid eating certain foods. The religion practices makes women to be very submissive to husbands thus there is no discussion of health issues
Cultural competence necessitates compassion to the uniqueness of religious, customs, parent-child interaction, and spiritual needs. It also requires understanding to the exceptionality of wishes, preferences, and developmental needs. Strengthening nurse-client relationship encourages cultural competence, it is through cultural competence that the nurse or doctor can center on family strengths and constructive traits. Cultural competence enables nurse to elicit distinct information that is unique to the client to make accurate diagnosis, develop, and implement client-centered intervention.
Actually, cultural competence increases client and family satisfaction, facilitates positive clinical outcome, and expands client involvement. Cultural competency will become very effective when there is culture sensitivity for asking questions and listening to the patient’s perception of the problem. Furthermore, cultural competency is very significant if can explain the perception of the problem and proposes the treatment. Moreover, it has to discuss and acknowledge the similarities and differences as well as respecting the culture of the patient (9).
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