Professional Help

Patricia Milena Lessa Camacho

University of Saint Augustine

HSC 6 031 IDS – Cultural Competence

Dr. Erica Kiernan

June, 2015

Introduction

The diversity of cultural difference in the United States is one the main reasons I believe being cultural educated is extremely important for health care providers. This country is an accumulation of cultural backgrounds which can often set the stage for feelings of confusion, anger, mistrust, and a host of other emotions when dissimilar cultures disagree. Cultural competence knowledge can help decrease these barriers and provide a platform for health care professionals to follow in the mission to understand a patient's culture and background. When a health care professional takes the time to learn about a given culture prior to providing care, it implies she/he respects the patient's right to their, customs, beliefs and culture. It does not necessarily mean that the patients choices is the best for themselves but it does show that she/he is willing to be open minded and deferential. It is the responsibility of the health care providers to take the time to educate themselves on the various cultures they may be exposed to in their work (Kaiser Family Foundation, 2003). It is also, a right of every patient.

In my understanding, being cultural competent in health care practice does not only entails to accept and respect differences, but acknowledge that every culture also have similarities. In reality, we all share many common traces and being able to understand differences and similarities is what makes a good health care professional competent. My understanding also, believes that being cultural competent can’t never be achieved by taking an online course or attend seminars. Cultural competence is an complex understanding of racial, ethnicity, age , sexual orientation , choices, backgrounds , education and other traces that shape every individual in a unique form. To me, being cultural competent is not only a skill but a life long journey that every professional should study throughout his/her career .

The ultimate goal of becoming cultural competent in Physical Therapy Practice is being able to meet the patient half way. I believe that good outcomes in rehabilitation requires way more than knowledge of protocols and treatments. In syntheses, we are dealing with complex unique individuals that are shaped in different forms and cultures. If we can’t understand patient choices, preferences and ideas, we will never be able to gain their trust, and therefore most treatments will set to fail. Many of us heard patients agreeing with everything we would say during a consultation, but doing something completely different when they get home or get back to their work routines. Why is so difficult sometimes to increase compliance among certain patients and what can we do to address the issue in a more effective way is what I think is progressing to being more cultural competent in Physical Therapy practice.

The goal set by APTA vision and mission regarding cultural competence also reflects many of my vision about the subject. Consumer centricity allow us to engage every possible effort to gain respect and understanding from patients while working with their difference in cultural choices and background.

Accordingly with the national standards for culturally and linguistically appropriate services in health and health care (CLAS) there are several principles that should help health care providers improve their cultural understanding among other population, including minorities. One of the principal standard, suggest that providers should be capable to offer effective, equitable, understandable and respectful quality care and services that are directed to diverse cultural health beliefs and practices, spoken languages, health literacy and any other communication needs. Several other standards include language assistance, partnership with communities to improve relationship between patients and providers and others related with accountability ( OMH, 2015)

Concerns among racial and ethnic groups

As the recommended textbook point it out, the United States is a country with a vast diversity of racial and ethnic group. Accordingly with (AUTHOR A) race refers to group of people who have difference and similarities in biological traits and ethnicity refers to cultural practices, perspectives and distinctions that separate one group of people from another. In this scenario, a multicultural diversity is not something isolate, moreover in certain states, but a concern that should be addressed in the beginning of every health care training. There are so many differences, especially in ethnicity, that separate patients compliance among different groups, that physical therapist need to be cultural sensitive and cultural competent to accommodate the diversity of patients. Let’s discuss a little bit about the largest groups and their particularities.

American Indians and Alaskan Native population

The American Indian and Alaska Native population refer themselves as “American Indian or Alaska Native” or includes entries such as Navajo, Blackfeet, Inupiat, Yup’ik, or Central American Indian groups or South American Indian groups.

Today, American Indians and Alaskan Natives encounter several health related problems. Specially for American Indians, the diagnose and treatment of diseases under their culture is very different of what we considered usual in the big cities and Western medicine(Kaiser Family Foundation, 2013). AI are often in state of poverty, and with the poor living, the lifespan decreases: malnutrion, tuberculosis and high maternal and infant death rates are today one of the many challenges health care professionals face while trying to help this population.

Therefore, health care professionals often face problems with this population as the culture and beliefs are very different that we consider "normal". (KFF, 2013).Pregnant woman frequent smoke during pregnancy, they frequent start pre-natal after the first trimester, they have high records of pos-partum depression and recurrence of mortality rates are higher than in the white population. Religious beliefs are important components of the American Indian and Alaska Native population includes people who consider themselves as “American Indian or Alaska Native” or reported entries such as Navajo, Blackfeet, Inupiat, Yup’ik, or Central American Indian groups or South American Indian groups.

Asian Population

Approximately 12 million of people constitute the Asian population in the United States. New Asian immigrants are different from general population in the social and health-related issues. They reside in communities, main stream to small, isolated spaces, and consist of several subgroups, such as Asian Indians, Cambodians, Chinese, Filipinos, Hmong, Japanese, Koreans, Laotians, Thais, and Vietnamese. Among this group, the Chinese and Filipinos are the two largest subgroups.( Asian Health Services, 2014)

The most common problem encounter by Asian population regarding health care issues is related with poor crowded working and living conditions. Diseases like cancer, diabetes and heart conditions are more frequent among Asian population. But the concern is the higher rates of mental health issues that are frequent hidden by embarrassment and cultural shame. (APA, 2006)

Health care professionals should be aware that most Asian families patterns are characterized by filial piety, male authority, and respect for elders and that this pattern often determines decision-making practices relating to health care for recent immigrants. Moreover, family support it is most important values in Asian American population groups. Health care professional must know how traumatic separation from family members can be to a culture that core values are essentially the family.

While dealing with this so unique population, health care professionals should be aware of small details that would enhance the quality of care they must offer to Asian patients: younger people, regardless of their rank, greet elders first and address them in a formal manner. Since physicians/ clinicians hold a very high position in society, the patient may show esteem by looking away when talking to avoid meeting the physician's eye. A further sign is sitting with the legs crossed, or leaning on a table or desk, or directing at anything with the foot when speaking are considered signs of disrespect to the person whom one is addressing. ( Nayar & Tse, 2006) Most Asians consider their head the sacred and very important part of the body and Physical Therapist should never touch it without permission. Inadvertently touching could imply that the clinician is interfering in the soul of the patient ( even more in child).

African Americans

Black or African American is a title state to the population having background and origins in any of the black race groups of Africa. Discrepancy in behavioral health care for racial and ethnic minority populations are well documented . There are several seminal reports, studies and papers that concentrate finding on the scientific, clinical, and policy issues surrounding these discrepancies.(Spector,2009)

Culture, race and ethnicity , along with cultural background of disparities, in addition of living in poverty, has the most measurable outcomes on the rates of mental illness accordingly with the National African American Mental Health and Substance Abuse Summit. Since a lot of African American doesn’t have access to health care for many different reasons, represent a large portion of poverty, low income families , and tendency to wait until the symptoms are very severe, and self treat illness, the outcome couldn't be more catastrophic: African Americans surpass white Americans in several diseases including , heart conditions, malignant neoplasm , cerebrovascular diseases and diabetes mellitus as being responsible for the most health care visits. ( Spector,2009) Sadly yet reality, data show that African American populations are over represented in our nation’s most vulnerable populations, such as the poor, the uninsured, the homeless, and the incarcerated, yet have little to poor access to meaningful mental health services. In order to attend and exceed in quality while treating this population, health care professionals should be aware of particularities between African Americans. For instance, Haitian background makes, completely difference, in cultural aspect as having Jamaican or African roots. However intentional mistreatment seems to be a common factor suffering from most African American in health care centers, hospitals and community centers. (CDC, 2014).

Frequently, the provider have some underlying difficulty in relating to the patients real needs. Providers tend to fear whatever they do not have familiarity and experience about it.(APA, 2012). Communication in an efficient way is not only legally important necessary, but to avoid misdiagnosis and mistreatment . In many different countries, including the U.S, black patients , especially undocumented, are the primary source of "experimental'' or material for student practices and medical research.

Hispanic and Latin Population

Hispanics experience a number of diseases that causes this population to constantly seek  health care help. In 2004, the leading causes of death among Hispanics was : diseases of the heart, malignant neoplasm and unintentional injuries.  For the purpose of this assignment, I would like to discuss  HIV, as nowadays,  remains a leading cause of death among Hispanic population. Accordingly with Kaiser Family Foundation , the rate of HIV among this population is four times higher than within the white population.

            To my concern, this topic is extremely sensitive as the Hispanic group is the largest growing ethnic group inside the U.S. In addition, a number of challenges add to the widespread cases in Latino communities, including poverty, injection drug use, stigma and discrimination, limited access to health care, and language or cultural barriers in health care settings. This subject needs to be addressed urgently  as the health care expenditure to treat those population , especially in terminal ill, will also grow exponentially.

Diversity in patient population and necessity of better systems.

It is no secret that with diversity of ethnic groups, the necessity of better system increase accordingly. From, Jewish, Middle Eastern Cultures, African Americans, Hispanic, Asian, Veteran and Military Culture all Health care beliefs are linked intimately with our culture, demonstrating that being cultural competent in health care should not be an option, rather a required skill.

Implementing a better system can vary from groups to groups. For instance among the American Native and Alaskans population, a better system of inserting universities and health care centers to join forces between students and community to enhance cultural care among AN/AI, could be an option. The reality of treating this population , for some students, are very remote. They have never been in contact with this community, they don't understand their particularities and they rarely have interest in doing health care traveling, for instance. If Universities could implement core rotations to expose students to this so in need population, a greater amount of future providers could experience work and learn more about American Indian and Alaskan native population.

In Asian population for instance, we should inforce regulations to serve states with higher number of Asians and definitely act with the population demands. Using cultural strategies to understand family role versus individual role; respectfulness of authority, shame, health beliefs and fatalism; taboo subjects (homosexuals for instance);avoiding direct expression of feelings; and traditional healing might help providers become more natural and cultural efficient. Hospitals and big community health centers should implement traditional and cultural week training, specially for new employees , or even as part of the hiring week process.

In African American population , a better system should stimulate , nurses of color that face a particular challenge , since diabetes is a big problem in so many of their own communities. The idea is to increase cultural knowledge with this population, as many of those nurses have confidence and advantage in identifying and help patients in risk more efficiently, educating and demonstrating that early prevention , screening and disease management are the most efficient way for patients looking to keep a healthy and long life. Increase number of African Americans providers is a must in this situation.

In Hispanic population, better system should also estimulate health care professionals speak a second language. The educational level base is a very inexpensive solution that might produce faster results while dealing with Hispanic population. For instance as in most countries in Europe, the majority of health care professional does speak at least one extra idiom. Students are required to be proficient at a second language while in grad school as part of core curriculum. This help most of them improve their cultural care skills from early educational background.

Culturally competent care: access, disparities ad quality

Accordingly with the national standards for culturally and linguistically appropriate services in health and health care (CLAS) there are several principles that should help health care providers improve their cultural understanding with other populations , including minorities. One of the principal standard suggest that providers should be able to offer effective, equitable, understandable and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and other communication needs. Several other standards include language assistance, partnership with communities to improve relationship between patients and providers and others related with accountability ( OMH, 2015)

As language barriers seems to be a constant problem while discussing cultural care, I would suggest be implementing a second language core course on health care graduation curriculum. For instance in the city of Miami, over 80% of patients in the major hospitals are Hispanic speaking and not even half of the providers speak a second language. The state boards and local authorities should implement a system requiring providers to able to address the patients needs, and therefore, speak their language.

Minorities and woman often receive lower quality health care then white males counterparts. African-American and Hispanic-American/Latino men are less likely than white men to see a doctor, minority men are less likely to get timely preventive care, such as flu shots and colonoscopies, African-American men are 30 percent more likely to die from heart disease compared to non-Hispanic white men; American Indians and Alaska Natives have especially high rates of depression, suicide, and substance abuse and others as Asians and Pacific Islanders make up 4.5 percent of the U.S. population but have more than half of the chronic cases of hepatitis B. Statistics among minorities doesn't only affect the population involved: the whole country suffers with the consequences. Health care price adjustment, increase in number of social security claims, which affects every single taxpayer in the country. The most effective way to approach health care in minorities, besides education, is to improve the numbers of health care providers with minority background. Becoming a cultural diverse professional includes immerge in patients life style and cultural background.

References

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American Psychology Association (February 2006) Asian American Mental Health Retrieved from: http://www.apa.org/monitor/feb06/health.asp accessed June 30 , 2015

APTA's Guide to Physical Therapist Practice, 2nd Edition (Guide2): Interactive Guide

to Physical Therapist Practice by American Physical Therapy Association.2003.

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Center for Disease and Prevention Control (2014) Asian American Populations. Retrieved from: http://www.cdc.gov/minorityhealth/populations/REMP/asian.html. Accessed June 27,28 2015

Diana Burgess, PhD, Michelle van Ryn, PhD, MPH, John Dovidio, PhD,4 and Somnath Saha, MD, (2007) Reducing Racial Bias Among Health Care Providers: Lessons from Social- Cognitive Psychology. Retrievfrom: http ://www.ncbi.nlm.nih. gov/pmc/ articles/ PMC2219858/ accessed June 29, 2015

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Health Care. Retrieved from: http://www.azdhs.gov/bhs/pdf /culturalComp/ccih.pdf.

Accessed June 26, 2015

Kaiser Family Foundation (2013). Health Coverage and Care for American Indians and Alaska

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working with Asian Service Users. Retrieved from: http://www.psychosocial.com

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