MHS502 - 2 CASE

Case Background

External Health Care Provider Factor Models

Early work in cultural competence focused on creating models that explain the universe in which the provider operates and focus on factors that influence a patient’s culture. Leininger (1967), Orque (1983), Giger and Davidhizar (2004), and Purnell (1991) illustrate through their works this approach to cultural competence. The foundation of these models was knowledge of various cultural behaviors.

Internal Provider Factor Models

An important advance in the field of cultural competence research was the development of models which focused on the internal process of the provider. Divergent from the external factor models, these identify domains in which a provider needs to become competent, instead of the environment of the patient. The work of Suh (2004) and Kim-Godwin et al. (2001) are exemplars of research that look specifically at the domains which create cultural competence in an individual. The foundation of these models lies within cultural skill, cultural sensitivity, and cultural knowledge. The general theme of cultural skill is in terms of cultural data assessment, culturally based physical assessments, as well as intercultural communication skills.

Patient-Centered Care

Robinson, Callister, Berry, and Dearing (2008) suggest that the phenomenon of patient-centered care (PCC) is a measure of the quality of health care and that promoting PCC activities will improve adherence and encourage patient responsibility. They present a global perspective of patient-centered care (PCC) that reveals key vantage points of this phenomenon. Their work suggests that the health care field views PCC through various perspectives.

Robinson, Callister, Berry, and Dearing (2008) assert that PCC is a partnership between practitioners, patients, and their families to ensure that decisions respect a patient’s wants, needs, and preferences, that has several perspectives. The economic perspective recognizes patients’ ability to make informed health care choices that balance cost, quality, convenience, and other services characteristics. The clinical perspective is noted to integrate the patient perspective and preferences while involving the patient in decision-making and self-care. The authors note that the patient perspective includes respect, courtesy, competence, efficiency, patient involvement in decisions, time for care, availability/accessibility, information, exploring the patient’s needs, and communication.

Flach et al. (2004) sought to examine the relationship between PCC and the provision of preventive services, and they theorized that PCC is related to prevention care delivery. The work by these authors implies that dimensions within PCC are most closely related to adapting to individuals; improving and supporting patients improves the delivery of care. Unlike the global perspective provided by Robinson and her colleagues, Flach and his colleagues provide an organizational/clinical perspective of PCC used by the Veterans Health Administration, including the following domains: access to care, incorporating patient preferences, patient education, visit coordination, overall coordination of care, courtesy of care, continuity of care, and emotional support.

A major finding by Flach et al. (2004) is that improved communication, specifically continuity of care and emotional support, is associated with improved preventive care delivery. The remaining dimensions of PCC include the following: access to care, incorporating patient preferences, patient education, visit coordination, overall coordination of care, and courtesy of care. These were not found to be associated with the delivery of preventive care. This literature supports the idea that improving communication and emotional support augments provider ability to receive, interpret, and respond to the patient (thus adapting), and has the potential to improve the delivery of care.

The goal of PCC is to develop individualized treatment based on an understanding of the physiological, environmental, and psychosocial contexts within which each person’s illnesses or dysfunctions occur (Robinson et al., 2008; Flach et al., 2004; Galland, 2006). This literature illustrates PCC as the ideal context for the delivery of culturally competent care.

Session Long Project Background

Family Roles and Organization

Sub-constructs of this domain are:

· Head of household

· Gender roles

· Goals & priorities

· Developmental tasks

· Roles of aged

· Extended family

· Social Status

· Alternative lifestyles

As you recall from our first module, surrounding the person is the family with which they identify. Each family, regardless of make up or number of individuals involved, incorporates these concepts.

Families can be headed by a male (patriarchal) or a female (matriarchal). Sometimes, there is complete equality among both roles. Families may have one member responsible for supporting the family financially, or two or more members of the family may be responsible for earning money.

As the “baby boomer” generation continues to age, in many parts of the world it is becoming more and more common to see family members caring for an aged parent. This phenomenon then leads to the question, “What is the role of the aged family member?” All societies have different views of the role and importance of the elderly in their society.

The concept of extended family encompasses those family members that may have more remote relationships (either by blood or geography). Some people include “friends” in their definition of family and/or extended family.

Social status is another important consideration when studying a given culture. What “levels” or strata make up their social architecture? In America, we often hear of the “rich” (or “well-to-do”); the “middle-class”; and the “poor.” The American definitions of class are based on wealth. Other cultures view education as an important determinant of class, or place a high value on a “good” family name. When studying other cultures, it is important to explore how class is determined or decided.

Alternative lifestyle usually refers to the concept of homosexuality. However, this definition has been expanded over the past few years to include transgender individuals. Alternative lifestyles have been well documented in literature as existing in many countries and cultures. Alternative lifestyles may be accepted as normal or rejected as unnatural by members of the dominant culture. Alternative lifestyle can also examine single-parent households, either by design or divorce.

Workforce Issues

Sub-constructs of this domain are:

· Acculturation

· Autonomy

· Language barriers

In every society there are prevalent industries in which people make a living. In some countries, the economy may be based on manufacturing, whereas provision of service may be the primary economy in other countries. Some countries may be highly dependent upon exportation of goods produced, while other countries may generate revenue in other ways. When studying culture, learning about their economy is essential.

Autonomy in the workplace is an interesting concept. Here in America, we value an employer who provides us with sufficient autonomy to be creative in our workplace. In other cultures, the “boss” who is not controlling and providing constant direction may be seen as “wishy-washy” or may be perceived by the workers to be “incompetent.” An understanding of the role of autonomy in the workforce of the culture under consideration can provide you with important information as to what workers expect from their supervisory personnel.

In Module 1, we discussed the role of communication. As people continue to migrate around the globe, the problem of language barriers in the workplace continues to be noted. An understanding of the barriers that exist is the first step in helping companies overcome these challenges in their workplace.

Biocultural Ecology

Sub-constructs of this domain are:

· Biological variations

· Skin color

· Heredity

· Genetics

· Ecology

· Drug Metabolism