Cultural Competence & Care in Communities

Culturally competent health care within communities aims to eliminate disparities in health status among people from diverse cultural backgrounds. As suggested by Guzy & Petrie (2014, p. 81) cultural competence is by means of acquiring culturally appropriate information and knowledge then applying it within health care delivery. The process of developing cultural competence according to Brown & Edwards (2014, p. 24) requires cultural awareness, knowledge, sills, cultural encounter and desire.

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Community contexts including ethnicity and lifestyle are examples of community settings. By being accepted into the community, nurses can assist in creating better health practices. This is a crucial foundation for a student nurse to have an understanding of and with a career goal of community based nursing, I am especially interested and keen to endeavour to learn more about care in communities.

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Within the community, barriers and enablers encountered include sub-cultures (groups that have values and norms distinct from majority [Miller-Keane (2003)]), homelessness, illicit drug users, conscientious objection to immunisation, chronic health conditions and rural and remote settings.

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A recent article by Gurjeet & Hurriyet (2012) identified barriers affecting cultural competent care for  CALD (Culturally and Linguistically Diverse) communities within Australia. Barriers identified included low health literacy, impaired language skills, lack of interpreters within communities, insufficient confidence in their own abilities/skills, and traveling distances required to access health, especially in rural and remote areas.

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Nurses play a pivotal role in bridging the gap for sub cultural groups within the community. Including people from diverse backgrounds in the decision making process, is an important strategy when delivering cultural health care services (Heidke, 2015). Additionally, nursing practitioners utilise effective tools such as the Gibbs Reflection Tool (Gibbs, 1998) which if used in context within cultural diverse care clients with complex needs, can improve knowledge, skills and ability to meet demands in a culturally diverse health care setting.

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References

Brown, D., & Edwards, H. (2013). Lewis's medical-surgical nursing (3rd ed.). Chatswood, N.S.W.: Elsevier Australia.

Gibbs, G. (1988) Learning by Doing: A guide to teaching and learning methods. Oxford: Oxford Polytechnic Further Education Unit.

Guzys, D., & Petrie, E. (2013). An Introduction to Community and Primary Health Care in Australia. Cambridge: Cambridge University Press.

Miller - K.  (2003). Encyclopedia & Dictionary of Medicine, Nursing, & Allied Health Seventh Edition.  Retrieved January 16 2016 from http://medical-dictionary.thefreedictionary.com/subculture

O'Mara, B., Gill, G., Babacan, H., & Donahoo, D. (2011). Digital technology, diabetes and culturally and linguistically diverse communities: A case study with elderly women from the Vietnamese community. Health Education Journal, 71(4), 491-504. http://dx.doi.org/10.1177/0017896911407054

 

Multiculturalism and Health

Australia is made up of various cultural backgrounds including overseas born people which have migrated to Australia for a better life. It has become a highly diverse society which embraces multiculturalism (Guzys and Petrie, 2014). An accurate understanding of multiculturalism I found was best described by Guszys and Petrie (2014), stating ‘multiculturalism is a philosophy guiding policy and practice in the management of the consequences of cultural diversity, in the interests of the individual and society as a whole.’ Simply put, it is a response to reality of cultural diversity which aims to foster social justice and economic efficiency within Australia.

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Immigrants entering Australia are faced with language barriers and cultural practice challenges that can impact access to health services and participate within community (Heidke, 2015). Australia’s history of immigration has shaped the composition, size, and cultural population. It is one of the most ethnically diverse countries in the world (Julian, 2009). As summarised by Heidke (2015), immigrants may be healthy initially, but can develop chronic conditions over time same as Australian populations.

Image retrieved from migrationblog.border.gov.au

This can be contributed to barriers that exist within the culturally and linguistically diverse populations that migrants are exposed to.  Queensland Government published information pertaining to barriers identified by culturally and linguistically diverse communities, found at http://www.qld.gov.au/web/community-engagement/guides-factsheets/cald-communities/introduction/barriers.html  

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When providing culturally competent care, these barriers and challenges can be detrimental when providing heath care for overseas born people. As I researched further, I found an article by (Griffith, Mellor, Green and Renzaho, 2014) which  suggests culturally competent prevention programmes should consider design and delivery specific to immigrant clientele. This is an example of a health related issues within migrant populations, that I may encounter within a nursing career.

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Additionally, Gill and Babacan (2012) documented how Australian employers value diversity, and recognise the benefit of diversity within the workplace.  In conjunction with effective collaboration with client, family and cultural health workers, this is an example of how to establishing a therapeutic relationship between the patient and I could assist me in meeting their needs (Heidke, 2015).

When responding to changing cultural patterns of health, the Australian Government is committed to deliver services responsive to the diverse community. Issues that immigrants may experience include separation of family, language barriers, employment and housing issues, different cultural practices impacting on ability to participate in society and limited health literacy knowledge. These barriers as described by Heidke (2015) affect access to healthcare, and as I have learnt throughout this course, such barriers will exist and having cultural literacy and competency will aid me in achieving cultural competency and gain greater understanding of multiculturalism in the health care workplace.

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References

Gill, G. K., & Babacan, H. (2012). Developing a cultural responsiveness framework in healthcare systems: an Australian example. Diversity & Equality In Health & Care, 9(1), 45-55.

Griffith, M., Mellor, D., Green, J., & Renzaho, A. M. (2014). Migration-related influences on obesity among sub- Saharan African migrant adolescents in Melbourne, Australia. Nutrition& Dietetics, 71(4), 252-257.

Guzys, D., & Petrie, E. (2013). An Introduction to Community and Primary Health Care in Australia. Cambridge: Cambridge University Press.

Heike, P. (2015). NURS12002-Inclusive Practice: Study guide. Rockhampton, Qld: CQUniversity Australia

Jordan, J., Buchbinder, R., & Osborne, R. (2010). Conceptualising health literacy from the patient perspective. Patient Education And Counseling, 79(1), 36-42. http://dx.doi.org/10.1016/j.pec.2009.10.001

Cutlural Health Practices and Beliefs

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Cultural Health Practices and Beliefs incorporates the importance of cultural background and how it affects an individuals understanding of health, in relation to culturally sensitive issues relating to faith and ways to address them (Lecture Notes, CQU, 2015). As a student nurse, I believe it imperative that health care practitioners from culturally diverse backgrounds can bring additional skills within the work environment which can facilitate cultural competence (Guzys & Petrie, 2013). Cultural practices and beliefs include faith, dietary considerations, spirituality and preferences in medical procedures with strict guidelines according to cultural and religious beliefs.  

Cultural healing practices are the primary therapeutic interventions which are more commonly known as Complementary and Alternative Medicines (CAM). Sandi Worsley (2015) discussed interventions that are based around four basic concepts. These concepts are best defined by Heidke (2015) are  Holism, Humanism, Balance and Spirituality. Additionally, resourceful information from an online journal article on these concepts can be found at http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume62001/No2May01/AlternativeComplementaryModalities.html

 

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The Code of Ethics by NMBA (2008), Statement 3.3 outlines the diversity of people in the community and nurses recognise and accept cultural diversity (NMBA, 2008). Nursing staff must work within areas of expertise and be aware of professional boundaries and remain non judgmental and respectful of cultural aspects regarding traditional medicines (Worsley, 2015).

In Australia, the practice of traditional indigenous medicine is at risk of being lost (Wood, 2010). Traditional forms of healing and bush medicines were the only source of primary health care, and according to Wood (2010), it is unclear what traditional medical practices remain, and how it sits alongside a biomedical approach to health. Western and traditional therapies date back thousands of years which were verbal and handwritten records (Berman, Kozier & Erb, p. 378, 2012).  

 

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A recent study identified the importance of understanding and acknowledging cultural factors, that are a prerequisite to determining where and how to intervene to improve health (Riggs et al., 2014).

Additionally, further cultural elements that I would be expected to be aware of according to Brown and Edwards (2013), are communication, family and kinship ties, personal space, nutrition and physical contact (touch). It is equally important which model staff will utilise for developing cultural competence. Models include ETHNIC, LEARN, BATHE, and GREET (Guzys & Petrie, P. 85, 2013). Having a sound understanding of these models would support my journey as a student in being culturally appropriate and aware of patients that I may encounter in my career as a registered nurse.

References

Berman, A., Kozier, B., & Erb, G. (2012). Kozier and Erb's fundamentals of nursing (2nd ed., pp. 377-393). Frenchs Forest, N.S.W.: Pearson.

Brown, D., & Edwards, H. (2013). Lewis's medical-surgical nursing (3rd ed.). Chatswood, N.S.W.: Elsevier Australia

Guzys, D., & Petrie, E. (2013). An Introduction to Community and Primary Health Care in Australia. Cambridge: Cambridge University Press.

Heike, P. (2015). Cultural Health Practices and Beliefs. Retrieved from CQUniversity e-courses, NURS12002 Inclusive Practice, http://moodle.cqu.edu.au

Heike, P. (2015). NURS12002-Inclusive Practice: Study guide. Rockhampton, Qld: CQUniversity Australia

Nursing & Midwifery Board of Australia (NMBA). (2008). Code of ethics for nurses in Australia. Retrieved from http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx#codesofethics

Riggs, E., Gibbs, L., Kilpatrick, N., Gussy, M., van Gemert, C., Ali, S., & Waters, E. (2014). Breaking down the barriers: a qualitative study to understand child oral health in refugee and migrant communities in Australia. Ethnicity & Health, 20(3), 241-257. http://dx.doi.org/10.1080/13557858.2014.907391

Wood, C. (2010). A History of Healing Therapies: Western, Eastern, and Alternative Approaches. Choice Reviews Online, 48(02), 219-230. http://dx.doi.org/10.5860/choice.48.02.219

Worsly, S. (2015). Complementary and Alternative Medicine [Blackboard Collaborate Session]. Retrieved from https://moodle.cqu.edu.au/blocks/echo360_echocenter/echocenter_frame.php?id=2455