Culture Class Module 2 Assignment Family Traditions
Culture Class Module 2 Assignment Family Traditions
Familial Health Traditions
Instructions:
- Read and follow the directions on pages 160 and 161.
- Conduct an interview with an older family member.
- Summarize your findings regarding familial and social changes, and your ethnocultural and religiousheritage. (Include one example)
- Your paper should be:
- One (1) page
- Typed according to APA style for margins, formating and spacing standards
- See NUR3045 – Library (located on left-side on menu) for tutorial Using APA Style
- Typed into a Microsoft Word document, save the file, and then upload the file.
- I ATTACHED THE PDF OF THE BOOK SO YOU CAN LOOK AT PAGE 160 AND 161 WHCIH IS PART OF CHAPTER 7
Cultural Foundations
Unit I creates the foundation for this book and enables you to become aware of the importance of developing knowledge in the topics of (1) cultural and linguistic competency; (2) cultural heritage and history—both your own and those of other people; (3) diversity—demographic, immigration, and economic; and (4) the standard concepts of health and illness.
The chapters in Unit I will present an overview of relevant historical and contemporary theoretical content that will help you climb the first three steps to CULTURAL COMPETENCY. You will:
1. Understand the compelling need for the development of cultural and lin- guistic competency.
2. Identify and discuss the factors that contribute to heritage consistency— culture, ethnicity, religion, acculturation, and socialization.
3. Identify and discuss sociocultural events that may influence the life trajec- tory of a given person.
4. Understand diversity in the population of the United States by observing ■ Census 2010 and the demographic changes in the population of the
United States over several decades; ■ immigration patterns and issues; and ■ economic issues relevant to poverty.
5. Understand health and illness and the sociocultural and historical phenom- ena that affect them.
I
2 ■ Unit 1
6. Reexamine and redefine the concepts of health and illness. 7. Understand the multiple relationships between health and illness.
Before you read Unit I, please answer the following questions:
1. Do you speak a language other than English? 2. What is your sociocultural heritage? 3. What major sociocultural events have occurred in your lifetime? 4. What is the demographic profile of the community you grew up in? Has it
changed; if so, how has it changed? 5. How would you acquire economic help if necessary? 6. How do you define health? 7. How do you define illness? 8. What do you do to maintain and protect your health? 9. What do you do when you experience a noticeable change in your health? 10. Do you diagnose your own health problems? If yes, how do you do so? If
no, why not? 11. From whom do you seek health care? 12. What do you do to restore your health? Give examples.
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Chapter 1 Building Cultural and
Linguistic Competence
When there is a very dense cultural barrier, you do the best you can, and if something happens despite that, you have to be satisfied with little success instead of total successes. You have to give up total control. . . .
—Anne Fadiman (2001)
■ Objectives
1. Discuss the underpinnings of the need for cultural and linguistic competence. 2. Describe the National Standards for Culturally and Linguistically Appropri-
ate Services in Health Care. 3. Describe institutional mandates regarding cultural and linguistic
competence. 4. Articulate the attributes of CULTURALCOMPETENCY and CULTURALCARE.
The opening images for this chapter depict the foundations for the building of CULTURALCOMPETENCE. The first image is that of a dandelion that has gone to seed (Figure 1–1). All of the seeds are united, yet each is a discrete entity—they represent the numerous facets necessary for cultural competence. Figure 1–2 is that of a “fake door” in Vejer de la Frontera, Spain. It is a reminder of personal beliefs that shut out all other arguments and ways of understanding people. Figure 1–3 is a translucent door in Avila, Spain, where it is possible to look into a different reality and because it is not locked—one can open it and recognize
Figure 1–1 Figure 1–2 Figure 1–3 Figure 1–4
4 ■ Chapter 1
the view of others. Figure 1–4 represents the steps to cultural competency. A more detailed discussion of each image follows in the forthcoming text.
In May 1988, Anne Fadiman, editor of The American Scholar, met the Lee family of Merced, California. Her subsequent book, The Spirit Catches You and You Fall Down, published in 1997, tells the compelling story of the Lees and their daughter, Lia, and their tragic encounter with the American health care delivery system. This book has now become a classic and is used by many health care educators and providers in situations where there is an effort to demonstrate the need for developing cultural competence.
When Lia was 3 months old, she was taken to the emergency room of the county hospital with epileptic seizures. The family was unable to communicate in English; the hospital staff did not include competent Hmong interpreters. From the parents’ point of view, Lia was experiencing “the fleeing of her soul from her body and the soul had become lost.” They knew these symptoms to be quag dab peg—“the spirit catches you and you fall down.” The Hmong re- garded this experience with ambivalence, yet they knew that it was serious and potentially dangerous, as it was epilepsy. It was also an illness that evokes a sense of both concern and pride.
The parents and the health care providers both wanted the best for Lia, yet a complex and dense trajectory of misunderstanding and misinterpreting was set in motion. The tragic cultural conflict lasted for several years and caused considerable pain to each party (Fadiman, 2001). This moving incident exem- plifies the extreme events that can occur when two antithetical cultural belief systems collide within the overall environment of the health care delivery sys- tem. Each party comes to a health care event with a set notion of what ought to happen—and, unless each is able to understand the view of the other, complex difficulties can arise.
The catastrophic events of September 11, 2001; the wars in Iraq, Afghanistan, and Libya; the countless natural disasters such as Hurricane Katrina and the earthquakes in Haiti and Japan; and our preoccupation with terrorist threats have pierced the consciousness of all Americans in general and health care providers in particular. Now, more than ever, providers must be- come informed about and sensitive to the culturally diverse subjective meanings of health/HEALTH,1 illness/ILLNESS, caring, and curing/HEALING practices. Cultural diversity and pluralism are a core part of the social and economic en- gines that drive the country, and their impact at this time has significant impli- cations for health care delivery and policymaking throughout the United States (Office of Minority Health, 2001, p. 25).
1This style of combining terms, such as health/HEALTH, will be used throughout the text to con- vey that there is a blending of modern and traditional connotations for the terms. The terms are de- fined within the text and in the glossary. Furthermore, when terms such as CULTURALCOMPETENCY and CULTURALCARE and others are written in all capital letters, it is done so to imply that they are referring to a holistic philosophy, rather than a dualistic philosophy.
Building Cultural and Linguistic Competence ■ 5
In all clinical practice areas—from institutional settings, such as acute and long-term care settings, to community-based settings, such as nurse practitioners’ and doctors’ offices and clinics, schools and universities, pub- lic health, and occupational settings—one observes diversity every day. The undeniable need for culturally and linguistically competent health care services for diverse populations has attracted increased attention from health care pro- viders and those who judge their quality and efficiency for many years. The mainstream health care provider is treating a more diverse patient population as a result of demographic changes and participation in insurance programs, and the interest in designing culturally and linguistically appropriate services that lead to improved health care outcomes, efficiency, and patient satisfaction has increased.
One’s personal cultural background, heritage, and language have a con- siderable impact on both how patients access and respond to health care services and how the providers practice within the system. Cultural and linguistic com- petence suggests an ability of health care providers and health care organiza- tions to understand and respond effectively to the cultural and linguistic needs brought to the health care experience. This is a phenomenon that recognizes the diversity that exists among the patients, physicians, nurses, and caregivers. This phenomenon is not limited to the changes in the patient population in that it also embraces the members of the workforce—including providers from other countries. Many of the people in the workforce are new immigrants and/or are from ethnocultural backgrounds that are different from that of the dominant culture.
In addition, health and illness can be interpreted and explained in terms of personal experience and expectations. We can define our own health or illness and determine what these states mean to us in our daily lives. We learn from our own cultural and ethnic backgrounds how to be healthy, how to recognize illness, and how to be ill. Furthermore, the meanings we attach to the notions of health and illness are related to the basic, culture-bound values by which we define a given experience and perception.
It is now imperative, according to the most recent policies of the Joint Commission of Hospital Accreditation and the Centers for Medicare & Med- icaid Services, that all health care providers be “culturally competent.” In this context, cultural competency implies that within the delivery of care the health care provider understands and attends to the total context of the patient’s situa- tion; it is a complex combination of knowledge, attitudes, and skills, yet
■ How do you really inspire people to hear the content? ■ How do you motivate providers to see the worldview and lived experi-
ence of the patient? ■ How do you assist providers to really bear witness to the living condi-
tions and lifeways of patients? ■ How do you liberate providers from the burdens of prejudice, xenopho-
bia, the “isms”—racism, ethnocentrism—and the “antis” such as anti- Semitism, anti-Catholicism, anti-Islamism, anti-immigrant, and so forth?
6 ■ Chapter 1
■ How do you inspire philosophical changes from dualistic thinking to holistic thinking?
It can be argued that the development of CULTURALCOMPETENCY does not occur in a short encounter with programs on cultural diversity but that it takes time to develop the skills, knowledge, and attitudes to safely and sat- isfactorily become “CULTURALLYCOMPETENT” and to deliver CULTURALCARE. Indeed, the reality of becoming “CULTURALLYCOMPETENT” is a complex process—it is time consuming, difficult, frustrating, and extremely interesting. It is a philosophical change wherein the CULTURALLYCOMPETENT person is able to hear, understand, and respect the nonverbal and/or non-articulated needs and perspectives of a given patient.
CULTURALCOMPETENCY embraces the premise that all things are con- nected. Look again at the dandelion that has gone to seed. Each seed is a dis- crete entity, yet each is linked to the other (Figure 1–1). Each facet discussed in this text—heritage, culture, ethnicity, religion, socialization, and identity— is connected to diversity, demographic change, population, immigration, and poverty. These facets are connected to health/HEALTH, illness/ILLNESS, curing/HEALING, and beliefs and practices, modern and traditional. All of these facets are connected to the health care delivery system—the culture, costs, and politics of health care, the internal and external political issues, public health is- sues, and housing and other infrastructure issues. In order to fully understand a person’s health/HEALTH beliefs and practices, each of these topics must be in the background of a provider’s mind.
I have had the opportunity to live and teach in Spain and to explore many areas, including Cadiz and the surrounding small villages. There was a fake door within the walls of a small village, Vejer de la Frontera (Figure 1–2), that appeared to be bolted shut. The door was placed there during the early 14th century to fool the Barbary pirates. The people were able to vanquish them while they tried to pry the door open. It reminded me of the attempt to keep other ideas and people away and not open up to new and different ideas. Another door (Figure 1–3), found in Avila, Spain, was made of translu- cent glass. Here, the person has a choice—peer through the door and view the garden behind it or open it and actually go into the garden for a finite walk. This reminded me of people who are able to understand the needs of others and return to their own life and heritage when work is completed. This polarity represents the challenges of “CULTURALCOMPETENCY.”
The way to CULTURALCOMPETENCY is complex, but I have learned over the years that there are five steps (Figure 1–4) to climb to begin to achieve this goal:
1. Personal heritage—Who are you? What is your heritage? What are your health/HEALTH beliefs?
2. Heritage of others—demographics—Who is the other? Family? Community?
3. Health and HEALTH beliefs and practices—competing philosophies 4. Health care culture and system—all the issues and problems
Building Cultural and Linguistic Competence ■ 7
5. Traditional HEALTH care systems—the way HEALTH was for most and the way HEALTH still is for many
Once you have reached the sixth step, CULTURALCOMPETENCY, you are ready to open the door to CULTURALCARE.
Each step represents a discrete unit of study, each building upon the one below it. The steps have been constructed with “bricks,” and they represent the fundamental terms, or language, of the content. Table 1–1 lists many examples
Table 1–1 Bricks: Selected CULTURALCARE Terms
Access Acupuncture Ageism Alien Allopathic philosophy Amulet Apparel Assimilation Bankes Borders Calendar Care Census Citizen CLAS Community Costs Cultural conflict CULTURALCARE CULTURALCOMPETENCY Culturally appropriate Culturally competent Culturally sensitive Culture Curandera/o Customs Cycle of poverty Demographic disparity Demographic parity Demography Diagnosis Diversity Documentation Education Empacho Envidia Ethics Ethnicity Ethnicity Ethnocentrism Evil eye Family Financing Food Garments Gender specific care Green Card Gris-gris Habits Halal HEALING Health HEALTH Health care system Health disparities HEALTH Traditions Healthy People 2020 Herbalist Heritage Heritage consistency Heritage inconsistency
Heterosexism Hex Homeland security
Homeopathic philosophy
Homophobia Iatrogenic Illness
ILLNESS Immigration Kosher Language Law Legal Permanent
Resident (LPR) Life trajectory Limpia
Linguistic competence Literacy Mal ojo Manpower Meridians Migrant labor Milagros Modern Modesty Morbidity Mortality Naturalization Office of Minority Health
Orisha Osteopathy Partera
Pasmo Politics Poverty Poverty guidelines Powwow Procedures Promesa Quag dab peg Racism Reflexology Refugee Religion Remedies Sacred objects Sacred places Sacred practices Sacred spaces Sacred times Santera/o Senoria Sexism Silence Silence Singer Socialization Spell Spirits Spiritual Spirituality Title VI Traditional Undocumented person Visitors Voodoo Vulnerability Welfare Worldview Xenophobia Yin &Yang Yoruba
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of the bricks and the terms are used in the following chapters as appropriate and most are defined in the Key Terms list in Appendix A. These selected terms and many more are the evolving language or jargon of CULTURALCARE.
The railings represent “responsibility and resiliency”—for it is the respon- sibility of health care providers to be CULTURALLYCOMPETENT and, if this is not met, the consequences will be dire. The resiliency of providers and patients will be further compromised and we will all become more vulnerable. Contrary to popular belief and practice, CULTURALCOMPETENCY is not a “condition” that is rapidly achieved. Rather, it is an ongoing process of growth and the develop- ment of knowledge that takes a considerable amount of time to ingest, digest, assimilate, circulate, and master. It is, for many, a philosophical change in that they develop the skills to understand where a person from a different cultural background than theirs is coming from.
This discussion now presents an overview of the significant content re- lated to the ongoing development of the concepts of cultural and linguistic competency as they are described by several different organizations. Presently, there has been a proliferation of resources related to this content and a discus- sion of selected items is included here. Box 1–2, at the conclusion of the chap- ter, lists numerous resources.
■ National Standards for Culturally and Linguistically Appropriate Services in Health Care
In 1997, the Office of Minority Health undertook the development of national standards to provide a much needed alternative to the patchwork that has been undertaken in the field of cultural diversity. It developed the National Stan- dards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care. These 14 standards (Box 1–1) must be met by most health care-related agencies. The standards are based on an analytical review of key laws, regula- tions, contracts, and standards currently in use by federal and state agencies and other national organizations. Published in 2001, the standards were developed with input from a national advisory committee of policymakers, health care pro- viders, and researchers. The CLAS standards are primarily directed at health care organizations. The principles and activities of culturally and linguistically appropriate services must be integrated throughout an organization and imple- mented in partnership with the communities being served. Enhanced standards are currently being developed but are not yet available. The new standards, National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care: A Blueprint for Advancing and Sustaining CLAS Pol- icy and Practice will be available at https://www.thinkculturalhealth.hhs.gov/.
Accreditation and credentialing agencies can assess and compare provid- ers who say they provide culturally competent services and assure quality care for diverse populations. This includes the Joint Commission on Accreditation of Healthcare Organizations (JCAHO); the National Committee on Quality
Building Cultural and Linguistic Competence ■ 9
Box 1–1
Office of Minority Health’s Recommended* National Standards for
Culturally and Linguistically Appropriate Services in Health Care
The Fundamentals of Culturally Competent Care 1. Health care organizations should ensure that patients/consumers receive
from all staff members effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language.
2. Health care organizations should implement strategies to recruit, retain, and promote at all levels of the organization a diverse staff and leadership that are representative of the demographic characteristics of the service area.
3. Health care organizations should ensure that staff at all levels and across all disciplines receive ongoing education and training in culturally and linguisti- cally appropriate service delivery.
Speaking of Culturally Competent Care 4. Health care organizations must offer and provide language assistance
services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.
5. Health care organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services.
6. Health care organizations must assure the competence of language assistance provided to limited English-proficient patients/consumers by interpreters and bilingual staff. Family and friends should not be used to pro- vide interpretation services (except on request by the patient/consumer).
7. Health care organizations must make available easily understood patient- related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area.
8. Health care organizations should develop, implement, and promote a writ- ten strategic plan that outlines clear goals, policies, operational plans, and management accountability/oversight mechanisms to provide culturally and linguistically appropriate services.
Structuring Culturally Competent Care 9. Health care organizations should conduct initial and ongoing organizational
self-assessments of CLAS-related activities and are encouraged to integrate cultural and linguistic competence–related measures into their internal au- dits, performance improvement programs, patient satisfaction assessments, and outcomes-based evaluations.
(continued)
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Assurance; professional organizations, such as the American Medical Associa- tion and the American Nurses Association; the Transcultural Nursing Society; and quality review organizations, such as peer review organizations.
In order to ensure both equal access to quality health care by diverse populations and a secure work environment, all health care providers must “promote and support the attitudes, behaviors, knowledge, and skills necessary for staff to work respectfully and effectively with patients and each other in a culturally diverse work environment” (Office of Minority Health, 2001, p. 7). This is the first and fundamental standard of the 14 standards that have been recommended as national standards for CLAS in health care.
10. Health care organizations should ensure that data on the individual patient’s/ consumer’s race, ethnicity, and spoken and written language are collected in health records, integrated into the organization’s management information systems, and periodically updated.
11. Health care organizations should maintain a current demographic, cultural, and epidemiological profile of the community as well as a needs assessment to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area.
12. Health care organizations should develop participatory, collaborative part- nerships with communities and utilize a variety of formal and informal mechanisms to facilitate community and patient/consumer involvement in designing and implementing CLAS-related activities.
13. Health care organizations should ensure that conflict and grievance resolu- tion processes are culturally and linguistically sensitive and capable of iden- tifying, preventing, and resolving cross-cultural conflicts or complaints by patients/consumers.
14. Health care organizations are encouraged to regularly make available to the public information about their progress and successful innovations in implementing the CLAS standards and to provide public notice in their communities about the availability of this information.
*CLAS standards are non-regulatory and therefore do not have the force and effect of law. The standards are not mandatory but they greatly assist health care providers and organiza- tions in responding effectively to their patients’ cultural and linguistic needs. Compliance with Title VI of the Civil Rights Act of 1964 is mandatory and requires health care providers and or- ganizations that receive federal financial assistance to take reasonable steps to ensure Limited English Proficiency (LEP) persons have meaningful access to services.
CLAS standards use the term patients/consumers to refer to “individuals, including accompa- nying family members, guardians, or companions, seeking physical or mental health care ser- vices, or other health-related services” (p. 5 of the comprehensive final report; see http:// minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15).
Source: National Standards for Culturally and Linguistically Appropriate Services in Health Care. Final Report. Washington, DC, March 2001. http://minorityhealth.hhs.gov/templates/ browse.aspx?lvl=2&lvlID=15, accessed April 6, 2011.
Box 1–1 Continued
Building Cultural and Linguistic Competence ■ 11
■ Cultural Competence Cultural competence implies that professional health care must be developed to be culturally sensitive, culturally appropriate, and culturally competent. Cultur- ally competent care is critical to meet the complex culture-bound health care needs of a given person, family, and community. It is the provision of health care across cultural boundaries and takes into account the context in which the pa- tient lives, as well as the situations in which the patient’s health problems arise.
■ Culturally competent—within the delivered care, the provider under- stands and attends to the total context of the patient’s situation and this is a complex combination of knowledge, attitudes, and skills.
■ Culturally appropriate—the provider applies the underlying back- ground knowledge that must be possessed to provide a patient with the best possible health/HEALTH care.
■ Culturally sensitive—the provider possesses some basic knowledge of and constructive attitudes toward the health/HEALTH traditions ob- served among the diverse cultural groups found in the setting in which he or she is practicing.
■ Linguistic Competence Title VI of the Civil Rights Act of 1964 states, “No person in the United States shall, on ground of race, color, or national origin, be excluded from participa- tion in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance” (Dirksen Congressio- nal Center, 2011).
To avoid discrimination based on national origin, Title VI and its imple- menting regulations require recipients of federal financial assistance to take rea- sonable steps to provide meaningful access to Limited English Proficiency (LEP) persons. Therefore, under the provisions of Title VI of the Civil Rights Act of 1964, when people with LEP seek health care in health care settings such as hospitals, nursing homes, clinics, day care centers, and mental health centers, services cannot be denied to them. It is said that “language barriers have a del- eterious effect on health care and patients are less likely to have a usual source of health care, and have an increased risk if non-adherence to medication regi- mens” (Flores, 2006, p. 230).
The United States is home to millions of people from many national ori- gins. Currently, because there are growing concerns about racial, ethnic, and lan- guage disparities in health and health care and the need for health care systems to accommodate increasingly diverse patient populations, language access ser- vices (LAS) have become more and more a matter of national importance. This need has become increasingly pertinent given the continued growth in language diversity within the United States. English is the predominant language of the United States and according to the 2010 American Community Survey estimates it is spoken at home by 79.4% of its residents over 5 years of age (U.S. Census Bureau, 2012a). In the total of over 13 million Spanish-speaking households,
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there are 3.2 million households where no one over 14 speaks English only or speaks English “very well.” There are over 5.2 million Indo-European and over 3.7 million Asian and Pacific Island households where no one over 14 speaks English only or speaks English “very well.” (U.S. Census Bureau, 2012b). The most common, non-English languages spoken by people over 5 at home are Spanish, Chinese, French, German, and Tagalog. Vietnamese, Italian, Korean, and Russian and Polish are next among the top 10 languages (U.S. Census Bureau, 2012c).
People who are limited in their ability to speak, read, write, and under- stand the English language experience countless language barriers that can result in limiting their access to critical public health, hospital, and other medical and social services to which they are legally entitled. Many health and social service programs provide information about their services in English only. When LEP persons seek health care at hospitals or medical clinics, they are frequently faced with receptionists, nurses, and doctors who speak English only. The language barrier faced by LEP persons in need of medical care and/or social services se- verely limits the ability to gain access to these services and to participate in these programs. In addition, the language barrier often results in the denial of medi- cal care or social services, delays in the receipt of such care and services, or the provision of care and services based on inaccurate or incomplete information. Services denied, delayed, or provided under such circumstances could have seri- ous consequences for an LEP patient as well as for a provider of medical care. Some states, for example California, Massachusetts, and New York, recognize the seriousness of the problem and require providers to offer language assis- tance to patients in health care settings. Language access services are especially relevant to racial and ethnic disparities in health care. A report by the Institute of Medicine (IOM) on racial and ethnic disparities in health care documented through substantial research that minorities, as compared to their White Ameri- can counterparts, receive lower quality of care across a wide range of medical conditions, resulting in poorer health outcomes and lower health statuses. The research conducted by the IOM showed that language barriers can cause poor, abbreviated, or erroneous communication and poor decision making on the part of both providers and patients (Smedley, B. D., A. Y. Stith, and A. R. Nelson, 2004, p. 3). Each patient must be carefully assessed to determine his or her language needs, and information must be delivered in a manner that is under- standable by the patient. When a patient does not understand English, compe- tent interpreters or language resources must be available.
■ Institutional Mandates Since 2003, the Joint Commission has been actively pursuing a course that en- sures that cultural and linguistic competency standards become a part of their accreditation requirements. Since this time, they have published several docu- ments relevant to this topic and in 2010 they published a monograph, Advanc- ing Effective Communication, Cultural Competence, and Patient and Family
Building Cultural and Linguistic Competence ■ 13
Centered Care: A Roadmap for Hospitals. The monograph provides checklists to improve effective communication during the admission, assessment, treatment, end-of-life, and discharge and transfer stages of a given patient’s hospitalization trajectory. They strongly state that:
Every patient that enters the hospital has a unique set of needs—clinical symptoms that require medical attention and issues specific to the individ- ual that can affect his or her care. (The Joint Commission, 2010, p. 1)
They implicitly recognize that when a given person moves through the hospital- ization continuum, he or she not only requires medical and nursing intervention, but they also require care that addresses the spectrum of each person’s demo- graphic and personal characteristics. The Joint Commission has made many ef- forts to understand personal needs and then provide guidance to organizations to address those needs. They initially focused on studying language, culture, and health literacy needs and presently (as of 2011), they are focusing on effective communication, cultural competence, and patient- and family-centered care.
The Joint Commission defines cultural competency as:
the ability of health care providers and health care organizations to under- stand and respond effectively to the cultural and language needs brought by the patient to the health care encounter. (2010, p. 91)
They further recognize that:
cultural competence requires organizations and their personnel to: (1) value diversity; (2) assess themselves; (3) manage the dynamics of difference; (4) acquire and institutionalize cultural knowledge; and (5) adapt to diver- sity and the cultural contexts of individuals and communities served. (The Joint Commission, 2010, p. 91)
These principles apply to each segment of the institutional experience from admission to discharge or end of life, and for each facet there are specific actions that must be undertaken. These actions include informing patients of their rights, assessing communication needs, and involving the patient and family in care plans. Each segment is accompanied by a checklist for activities; for example, there is a checklist to Improve Effective Communication, Cultural Competence, and Patient- and Family-Centered Care during admission (The Joint Commis- sion, p. 9).
■ CULTURALCARE The term CULTURALCARE expresses all that is inherent in the development of health care delivery to meet the mandates of the CLAS standards and other cul- tural competency mandates. CULTURALCARE is holistic care. There are countless conflicts in the health care delivery arenas that are predicated on cultural misun- derstandings. Although many of these misunderstandings are related to universal situations—such as verbal and nonverbal language misunderstandings, the con- ventions of courtesy, the sequencing of interactions, the phasing of interactions,
