Cultural Competence For Physical Therapists

individualistic vs. collectivist cultures

Look at charts in notes

CAPTE Perspective?

Normative model - identify, respect and act w/ consideration for patients' differences, values, preferences, and expressed needs in all professional activities

2 definitions of cultural competence?

-"cultural competence is a set of congruent behaviors, attitudes and policies t/ come together in a system, agency or among professionals t/ enables effective work in cross cultural situations." -"cultural competence is the process in which the healthcare professional continually strives to achieve the ability and availability to effectively work within the cultural context of the family, individual, or community"

Learning styles?

-verbal or written -family involvement

Three points about culture?

-a framework t/ guides and bounds life practices -learned not inherited -cultural frameworks evolve

What are folk health beliefs and behaviors? (4)

-causes of disease and disability -selected interventions -pain -role of religion

What are secondary dimensions of diversity? (definition)

-characteristics t/ you can acquire and can modify throughout life. -they define other experiences t/ define who we are and how we see others -encompass more of life's circumstances and experiences as one grows and develops

What is cultural competence? (3)

-cultural differences are accepted and respected -continuous expansion of cultural knowledge and resources and continuous adaptation of services occur -continuous self-assessment about culture and vigilance toward the dynamics of cultural differences exist

What is cultural proficiency? (2)

-cultural differences are highly regarded -need for research on cultural differences and the development of new approaches to enhance culturally competent practices recognized

What is ethnography?

-description of culture -attempt to understand another way of life, from the point of view of the people of that culture

What is expected of us as healthcare providers?(2)

-develop rapport, collect patient data, recognize concerns about function, and develop plan of care --all require cultural competence -need to meet needs of patient w/in context of their family, community, and cultural setting

What must practitioners be aware of that result from cultural differences?

-each party brings a set of experiences and communication style -minimize misperception and misjudgment -more insight - less stereotyping

What are the 10 secondary dimensions of diversity?

-education - if uneducated may take more time to explain info -occupation - maybe hesitant to get back to work if on work comp. -income - affects the resources available -marital status - support at home -religious beliefs -parental status -political beliefs -military experience -urban vs. rural residence -length of time away from country of origin ** The explanations are just examples and don't have to be memorized, but know how each could be related to a patient

What are 8 considerations for managing a diverse population?

-ethnography -degree of acculturation -socioeconomic status -racism -incidence and prevalence of disease and disability -access to health care -communication styles -learning styles -individualistic vs collectivist cultures

Process of cultural competence?(5)

-having cultural awareness -increasing cultural knowledge -developing cultural skills -having a cultural encounter -cultural desire **LOOK AT DIAGRAM

What must be acknowledged by practitioners in reference to the immense influence of culture?

-human nature is to be ethnocentric -patients may be ethnocentric

What is socioeconomic status?

-includes income, level of education, and occupation -arguably most relevant variable affecting a person's worldview and health status -poverty is not randomly distributed, it is strongly related to ethnicity, gender and age

Access of health care?

-lack of knowledge of the system -bureaucracy -ethnic differences

Communication styles?

-limited proficiency in English -use of translators -low context vs high context -->low context = lots of words to explain -->high context = less words relies on common background

What are the 6 primary dimensions of diversity?

-nationality/ethnicity -race -age -gender -mental/physical ability -sexual orientation

Incidence and prevalence of disease and disability?

-not randomly distributed -factors include ethnicity, age, SES, geography -in US, people of color have many more health problems than white population

What is the degree of acculturation? What are 3 of the degrees?

-process by which people from another culture adopt the traits of mainstream culture 1. highly assimilated - largely adopted new culture 2. bicultural - functions comfortably in 2 cultures 3. highly traditional - values and behaviors similar to country of origin --These may affect people's health status, their perspective on health, and their interaction with the health system and clinician

What is cultural incapacity? (2)

-providers and health care systems unable to work effectively w/ patients from other cultures -bias, paternalism, and stereotypes exist

What is cultural pre-competence? (2)

-providers are committed to using appropriate responses to cultural differences -weaknesses are acknowledged and alternatives sought

What is cultural blindness? (4)

-providers assume that they are unbiased -based on incorrect belief that all people are the same -policies and practices do not recognize the need for culturally specific approaches to problem solving -services are ethnocentric encourage assimilation

How must practitioners expand and incorporate their knowledge into everyday practice?

-seek out socio-cultural information t/ will help in knowing what questions to ask and how to ask them and modify interventions based on the persons cultural reality

What are subcultures? (2)

-smaller, distinct units within a larger culture t/ may not hold all the values of the dominant culture -differences in primary/secondary characteristics (socioeconomic status, ethnic, religion) that unify the group and act on each member w/ a conscious awareness of those differences

2 other notes about subcultures...(Didn't know what question to ask for this)

-subcultures may cross primary cultural distinctions when shared experiences and mutual ideologies bond them -may be chosen or may be difficult to be in some subcultures (gangs, homeless, cancer patients/survivors)

What is cultural destructiveness?

-treat in a dehumanizing manner -deny services on purpose

What 4 things must culturally competent practitioners do?

1. acknowledge immense influence of culture 2. assess cross-cultural relations and are vigilant concerning the dynamics t/ result from cultural differences 3. expand their cultural knowledge and incorporate this knowledge into their everyday practice 4. adapt to diversity

What are the six stages of the continuum of cultural competence?

1. cultural destructiveness 2. cultural incapacity 3. cultural blindness 4. cultural pre-competence 5. cultural competence 6. cultural proficiency

What are the 8 components of developing cultural competence?

1. developing awareness of ones existence w/o letting it influence on those from other backgrounds 2. demonstrating knowledge and understanding of patients culture and health needs 3. accepting and respecting cultural differences 4. not assuming that beliefs and values are same as patients 5. resisting judgmental attitudes 6. being open to cultural encounters 7. being comfortable with cultural encounters 8. adapting care to be congruent w/ the patient's culture

3 viewpoints of the Committee on Cultural Competence?

1. promote delivery of culturally competent PT care 2. ensure PT profession reflects demographics of society 3. increase and improve access to PT services to people in underserved communities

Examples of subcultures

African Americans who brace Catholic religion and others embrace Muslim 2nd generation Asian-American woman may hold different views than her 1st generation parents

What is diversity?

Everything t/ makes us different from others, including race, gender, culture, values, physical abilities, life experience, communication styles and characteristics

(Center for Medicare/Medicaid Services) CMS perspective?

Requires organizations to ensure that services are provided in a culturally competent manner to all enrollees, including those w/ limited English proficiency or reading skill and those w/ diverse cultural and ethnic backgrounds (Guide for many other businesses/perspectives)

APTA vision statement?

They will provide culturally sensitive care distinguished by trust, respect, and an appreciation for individual differences.

What effect can racism have?

can and has resulted in disparities in the quality of health care

What are primary dimensions of diversity? (definition)

characteristics t/ are inborn and/or greatly affect how you are socialized. -These dimensions shape your self image, your view of others, and how others perceive you and they are the core of your identity and life experiences -directly observable

How must practitioners adapt to diversity?

develop culturally sensitive examination and treatment techniques (Example: middle eastern women may not want to show skin)

What is culture?

totality of socially transmitted behavioral patterns, arts, beliefs, values, customs, lifeways, and all other products of human work and thought characteristics of a population of people that guide their worldview and decision making (Not going to memorize this)