CULTURAL ISSUES
Developing cultural competence in palliative care Paula McGee, Mark RD Johnson
Paula McGee is Professor of Nursing, Birmingham City University; Mark RD Johnson is Professor of Diversity in Health and Social Care, De Montfort University Email: [email protected]
C
ultural competence is an evolving process that depends on self-awareness, knowledge and skills. These points are applicable to the organisation as a whole and to the individuals who work within it. It may also be seen as operating on three levels: w Developing self-awareness w Knowledge w Development and application of skills
© 2014 MA Healthcare Ltd
Developing self-awareness Developing self-awareness is the first step in cultural competence. It requires all those working in palliative care to examine the ways in which their own behaviour, attitudes and beliefs may help or hinder their dealings with patients and their families. From a management perspective, this involves reviewing the organisational culture and reconceptualising its values, beliefs, policies and procedures in terms of commitment to diversity management. Embedding the race-equality strategy into the formal organisational culture is an important step but, if it is to be more than just a paper exercise, managers must also examine ways in which they can bring about change in organisational culture and enable staff to develop their own individual self-awareness. This requires managers to consider the existing organisational style in communicating with staff and users and the subtle ways in which current systems may perpetuate institutional racism. For staff, self-awareness also leads to an appraisal of different styles of communication that may be culturally or linguistically determined (Campinha Bacote, 2003). For example, in Hindi, the most commonly spoken South Asian language, a patient may say ‘mera dil me dard hai’. In strictly literal terms, this means ‘my heart is hurting’ but its more common meaning is simply ‘I am upset’. An understanding of the patient’s usual or preferred communication style, coupled with an awareness of one’s own, is an essential part of establishing effective communication and the basis for therapeutic relationships. Far more difficult, in relation to self-awareness, is the issue of attitudes, beliefs and prejudices. No one is immune to having prejudices, but what matters in this context is an awareness of them and the ways in which they may interfere with the care of patients. Acknowledging one’s prejudices can be a difficult task, both for an organisation and for individuals, but there are good examples in
British Journal of Community Nursing February 2014 Vol 19, No 2
related literature that can act as guides. One example is the work of Sands and Hale (1988) who argue that there is a culture of poverty that includes not only members of black and other minority ethnic groups but also elderly people, alcoholics, substance misusers, the poor and many others who, for one reason or another, have limited means to maintain themselves, cope with people they perceive to be in authority or have little power to exercise their own rights. Such individuals are frequently dehumanised and regarded as inferior by professionals. In this, we can see echoes of the old division between the ‘deserving’ and the ‘undeserving’ poor, originally codified in the English Poor Law of 1601, a concept still evident in the early versions of the welfare state (Callinicos and Jenkins, 1995). It is through this process of dehumanisation that stereotypes, prejudices and racism develop. However, the use of guided personal contact between individual students and those living in the culture of poverty can do much to offset and challenge such negativity (McGee, 1992). The skills of reflection are crucial to the success of such contact and require the ‘investment of time and commitment to establishing meaningful dialogue’ (Kavanagh et al, 1999) to facilitate an attitudinal shift in which both parties move from characterising each other as ‘them’ (the other) towards ‘X, whom we know’ (us). Part of achieving this shift involves a recognition of the ways in which providers of palliative care represent to patients the culture and the power of the health service in which they are employed,
ABSTRACT
Increasing ethnic or cultural diversity in the population served by healthcare services requires improved competence and updated provision. Both individual staff and institutions need to reflect on and prepare to meet new challenges. Three key elements—reflective self-awareness, knowledge of others, and skills in managing difference—must be developed. Recognition of diversity and a database of appropriate information are essential for both workers and management of organisations. Above all, some preparedness for continual change and learning is essential. This article provides some suggestions and examples to assist with this.
KEY WORDS
w End of life w Multicultural w Ethnicity w Equality and diversity w Health-care management
91
CULTURAL ISSUES and the ways in which that power and culture can create and sustain inequalities (Papps and Ramsden, 1996).
individual preferences and differences matter more than generalisations (Kai, 2003).
Knowledge
Development and application of skills
92
The development and application of skills, underpinned by knowledge and self-awareness, is the third element of cultural competence (Campinha-Bacote, 2003). From a management perspective, these skills are concerned with tackling institutional racism and ensuring that the criteria for organisational procedures and decisions are clear and equitably applied within the context of a diverse workforce and patient population (Cornelius, 2002). For staff, the development and application of skills is focused on the adaptation of practice in ways that take account of cultural and religious values. For example, some patients may wish to avoid medication derived from animals because of cultural, religious or secular beliefs. There is little research on this subject, but one small study of Muslim patients found that more than half would stop taking prescribed medication if they thought it was of porcine (pig) origin and thus, in their view, haram, or forbidden (Bashir et al, 2001). Therefore, exploring patients’ beliefs in accordance with the ‘patient choice’ agenda (Department of Health, 2003) is important as a basis for achieving concordance.
Organisational approaches It is clearly not enough to examine only the attitudes, knowledge and behaviour of individuals. Managers need to examine the degree to which their services have the commitment, structures and information available to support change. Increasingly, in order to generate the Race Equality Action Plans required under the Race Relations Amendment Act (2001), organisations are turning to the use of toolkits and checklists to examine their whole practice (Chirico et al, 2000). Key questions that they need to ask include reviewing the language and ‘feel’ of the organisation, the data on potential and actual users (monitoring), the mission and management agenda (ensuring that these are designed to be inclusive), staffing, and the overall processes at work, to ensure that these are not unintentionally discriminatory simply because nobody has thought about the degree to which they may be culturally sensitive (or insensitive). In short, managers and board members need to ask themselves and their organisations seven key questions (Box 1). The first key question is to examine whether a needs assessment and profile of the potential users has been undertaken. This should include information from the census and surveys about the ethnic and cultural make-up of the catchment area. Following on from this is a need to determine who actually uses the services and how they come to know about or get referred to them. Ethnic monitoring is now well established as a technique, but often the data are collected and never analysed or used. This wastes resources and causes frustration (Johnson, 2001). A clear understanding of responsibilities and the importance of having, and implementing, policies and protocols
British Journal of Community Nursing February 2014 Vol 19, No 2
© 2014 MA Healthcare Ltd
Knowledge is the second element in developing cultural competence (Campinha-Bacote, 2003). In itself, knowledge will not facilitate culturally competent palliative care provision, but it is needed to inform both managers and practitioners about appropriate codes of behaviour. From a management perspective, developing an appropriate knowledge base begins with the application of ethnic monitoring that is geared towards identifying the diverse elements in the population to be served. In palliative care, data should include information about such factors as the culture, ethnicity, religion and preferred language of those who use current services and epidemiological data about the types of problems for which they require care (Johnson, 2001). Such a database should also include information about black and minority ethnic groups in the locality whose members do not appear to use palliative care services, as a prelude to establishing why this may be so. Absence of data broken down by ethnic groups is itself a barrier to improving access to palliative care, but absence of evidence of use should not be confused with absence of need. Reducing inequalities is dependent on information that allows measurement of the severity of health problems, the need for and appropriateness of treatments, and the outcomes obtained. This has been made more difficult by a dearth of good-quality ethnic data in relation to many issues, including the incidence of cancer in older members of black and other minority ethnic groups (Johnson et al, 2001; Aspinall and Jacobson, 2004). For staff, developing knowledge should, initially at least, focus on the particular black and minority ethnic groups represented in the locality in relation to their ideas about the body, health, illness, treatment and care. Beliefs about these factors are culturally determined. For example, the causes of illness and disease are frequently conceptualised in terms of relationships, either between the individual and other people, or between that person and God. Thus, practitioners need to understand a patient’s frame of reference in answering questions such as ‘Why me?’ (Helman, 2000). Similarly, ideas about the body may differ. For example, some South Asian people have no concept of the circulation of the blood (personal communication with Gatrad, 2005) and, therefore, no words to describe it. In such circumstances, explaining conditions such as diabetes or peripheral vascular disease, as shown in an Australian study (Trudgen, 2000), presents health professionals with a number of challenges. Notions of the ways in which illness should be treated, the type of treatment and the way in which the professionals should behave are all part of the knowledge base of the culturally competent practitioner. However, practitioners— be they doctors, nurses or allied health professionals—must also acknowledge that this knowledge base can only ever be partial. It is through encounters with patients that knowledge will be extended, provided that the practitioner keeps an open mind and recognises that
CULTURAL ISSUES is essential. It is best if a ‘lead’ on matters such as equality and sensitivity is shown and owned by managers rather than left to somebody (else). Designated responsibilities need to be embedded in structures and job roles, so that if a member of staff or the director leaves, the impetus for change and monitoring is not lost. User engagement is a fundamental element of health and social care (and business) planning and management. It is important to ensure this includes minority communities even if they are not seen to be using the service at present. This may be made easier by seeking collaborative working arrangements and partnerships with communitybased organisations such as religious and social groups. In the process, people in the organisation, and the agency itself, may come to appreciate the value and interest of diverse cultures. Last but not least is the need to recruit, respect and support staff from minority backgrounds, which increases the pool of people available to work in the organisation and brings in new and useful skills. BJCN
Afterword
© 2014 MA Healthcare Ltd
The authors are pleased to have this opportunity to represent an extract from the chapter ‘Developing culturally competent services in palliative care: management perspectives’, which appears in Gatrad et al (2007). The population of the UK is now far more diverse than in 2007 and there is a growing recognition that cultural competence can no longer focus solely on black and minority ethnic groups. The Equality Act 2010 reflects the new understanding that ethnicity and culture cannot be separated from other, equally important characteristics such as age, disability, sexual orientation, religion, gender, race, pregnancy, gender reassignment and marriage/civil partnership. Individuals may, at any point in their lives, find that they possess some or all of these characteristics. Cultural beliefs, values and practices may impact on each one in multiple ways. For example, the culture of an individual of same-sex orientation has to be considered alongside age, ethnicity, marriage/civil partnership status and whether s/he has children. In this context an individual belongs to multiple cultures rather than a single one. While cultural competence is still based on self-awareness, knowledge and skills, the nature of these three factors requires a much deeper understanding of, and sensitivity towards, the reality of complex lives. In particular, nurses need organisations that enable them to develop broad and appropriate repertoires for practice, the confidence to apply these and managers who will support them. A version of this article was previously published in the British Journal of Community Nursing volume 18, no. 6 (June). Some factual and typographical errors were introduced during the editing process. This article is now re-presented with the errors corrected and an afterword added which notes the reinforced relevance of the article to palliative care in the present day. Palliative Care for South Asians: Muslims, Hindus and Sikhs (2007), edited by Rashid Gatrad, Erica Brown and Aziz Sheikh.
British Journal of Community Nursing February 2014 Vol 19, No 2
Box 1. Key questions for developing culturally competent managers in palliative care w Who are we here to serve? w Who are our users? w Who does what? w How are users involved? w How do we work with others? w Do we respect and celebrate diversity? w Do we respect and value our staff? Book priced at £19.99, published by Quay Books. Order it at www.quaybooks.co.uk. Aspinall PJ, Jacobson B (2004) Ethnic Disparities in Health and Health Care: A Focused Review of the Evidence and selected Examples of Good Practice. http:// tinyurl.com/qd3pwls (accessed 2 January 2014) Bashir A, Asif F, Lacey F, Langley C, Marriorr J, Wilson K (2001) Concordance in Muslim patients in primary care. Int J Pharm Practice 9(Suppl): R78 Callinicos A, Jenkins G (1995) Community without care. Socialist Review 186. http://tinyurl.com/pmq3csw (accessed 2 January 2014) Campinha-Bacote J (2003) The Process of Cultural Competence in the Delivery of Healthcare Services: a Culturally Competent Model of Care, 4th edn. Transcultural C.A.R.E. Associates Chirico S, Johnson M, Pawar A, Scott M (2000) The Toolbox: Culturally Competent Organisations, Services and Care Pathways. http://tinyurl.com/oc4lgfo (accessed 2 January 2014) Cornelius N (ed) (2002) Building Workplace Equality: Ethics, Diversity and Inclusion. Thompson, London Department of Health (2003) Building on the Best: Choice, Responsiveness and Equity. http://tinyurl.com/nv2evkr (accessed 2 January 2014) Gatrad R, Brown E, Sheikh A (2007) Palliative Care for South Asians: Muslims, Hindus and Sikhs. Quay Books, London Helman C (2000) Culture, Health and Illness, 4th edn. Heinemann Butterworth, Oxford Johnson MRD (2001) Ethnic monitoring and nursing. In: Culley L, Dyson S (eds), Ethnicity and Nursing Practice. Palgrave, Basingstoke Johnson MRD, Bains J, Chauhan J, Saleem B, Tomlins R (2001) Improving palliative care for minority ethnic communities in Birmingham: a report for Birmingham Specialist Community Health NHS Trust and Macmillan Cancer Relief. April. Kai J (2003) Ethnicity, Health and Primary Care. Oxford University Press, Oxford Kavanagh K, Absalom K, Beil W Jr, Schliessmann L (1999) Connecting and becoming culturally competent: a Lakota example 1999. J Adv Nurse Sci 21(3):13 McGee P (1992) Teaching Transcultural Care. Chapman and Hall, London Papps E, Ramsden I (1996) Cultural safety in nursing: the New Zealand experience. Int J Qual Health Care 8(5): 491–7 Sands R, Hale S (1988) Enhancing cultural sensitivity in clinical practice. J Natl Black Nurses Assoc 2(1): 54–63 Trudgen R (2000) Why Warriors Lie Down and Die: Towards an Understanding of Why the People of Arnhem Face the Greatest Crisis in Health and Education since European Contact. Aboriginal Resource and Development Services Inc, Darwin, Australia
KEY POINTS
w The core elements of cultural competence are developing self awareness, knowledge and the development and application of skills— recognise your own culture and the expectations this creates w The elements of cultural competence can be applied at organisational level as well as in direct patient care, so organisations should monitor and compare their users with their catchments w Managers are responsible for creating organisational cultures which enable and encourage culturally competent practice which embodies continuous learning and development to respond to change
93
Developing cultural competence in palliative care Paula McGee, Mark RD Johnson
Paula McGee is Professor of Nursing, Birmingham City University; Mark RD Johnson is Professor of Diversity in Health and Social Care, De Montfort University Email: [email protected]
C
ultural competence is an evolving process that depends on self-awareness, knowledge and skills. These points are applicable to the organisation as a whole and to the individuals who work within it. It may also be seen as operating on three levels: w Developing self-awareness w Knowledge w Development and application of skills
© 2014 MA Healthcare Ltd
Developing self-awareness Developing self-awareness is the first step in cultural competence. It requires all those working in palliative care to examine the ways in which their own behaviour, attitudes and beliefs may help or hinder their dealings with patients and their families. From a management perspective, this involves reviewing the organisational culture and reconceptualising its values, beliefs, policies and procedures in terms of commitment to diversity management. Embedding the race-equality strategy into the formal organisational culture is an important step but, if it is to be more than just a paper exercise, managers must also examine ways in which they can bring about change in organisational culture and enable staff to develop their own individual self-awareness. This requires managers to consider the existing organisational style in communicating with staff and users and the subtle ways in which current systems may perpetuate institutional racism. For staff, self-awareness also leads to an appraisal of different styles of communication that may be culturally or linguistically determined (Campinha Bacote, 2003). For example, in Hindi, the most commonly spoken South Asian language, a patient may say ‘mera dil me dard hai’. In strictly literal terms, this means ‘my heart is hurting’ but its more common meaning is simply ‘I am upset’. An understanding of the patient’s usual or preferred communication style, coupled with an awareness of one’s own, is an essential part of establishing effective communication and the basis for therapeutic relationships. Far more difficult, in relation to self-awareness, is the issue of attitudes, beliefs and prejudices. No one is immune to having prejudices, but what matters in this context is an awareness of them and the ways in which they may interfere with the care of patients. Acknowledging one’s prejudices can be a difficult task, both for an organisation and for individuals, but there are good examples in
British Journal of Community Nursing February 2014 Vol 19, No 2
related literature that can act as guides. One example is the work of Sands and Hale (1988) who argue that there is a culture of poverty that includes not only members of black and other minority ethnic groups but also elderly people, alcoholics, substance misusers, the poor and many others who, for one reason or another, have limited means to maintain themselves, cope with people they perceive to be in authority or have little power to exercise their own rights. Such individuals are frequently dehumanised and regarded as inferior by professionals. In this, we can see echoes of the old division between the ‘deserving’ and the ‘undeserving’ poor, originally codified in the English Poor Law of 1601, a concept still evident in the early versions of the welfare state (Callinicos and Jenkins, 1995). It is through this process of dehumanisation that stereotypes, prejudices and racism develop. However, the use of guided personal contact between individual students and those living in the culture of poverty can do much to offset and challenge such negativity (McGee, 1992). The skills of reflection are crucial to the success of such contact and require the ‘investment of time and commitment to establishing meaningful dialogue’ (Kavanagh et al, 1999) to facilitate an attitudinal shift in which both parties move from characterising each other as ‘them’ (the other) towards ‘X, whom we know’ (us). Part of achieving this shift involves a recognition of the ways in which providers of palliative care represent to patients the culture and the power of the health service in which they are employed,
ABSTRACT
Increasing ethnic or cultural diversity in the population served by healthcare services requires improved competence and updated provision. Both individual staff and institutions need to reflect on and prepare to meet new challenges. Three key elements—reflective self-awareness, knowledge of others, and skills in managing difference—must be developed. Recognition of diversity and a database of appropriate information are essential for both workers and management of organisations. Above all, some preparedness for continual change and learning is essential. This article provides some suggestions and examples to assist with this.
KEY WORDS
w End of life w Multicultural w Ethnicity w Equality and diversity w Health-care management
91
CULTURAL ISSUES and the ways in which that power and culture can create and sustain inequalities (Papps and Ramsden, 1996).
individual preferences and differences matter more than generalisations (Kai, 2003).
Knowledge
Development and application of skills
92
The development and application of skills, underpinned by knowledge and self-awareness, is the third element of cultural competence (Campinha-Bacote, 2003). From a management perspective, these skills are concerned with tackling institutional racism and ensuring that the criteria for organisational procedures and decisions are clear and equitably applied within the context of a diverse workforce and patient population (Cornelius, 2002). For staff, the development and application of skills is focused on the adaptation of practice in ways that take account of cultural and religious values. For example, some patients may wish to avoid medication derived from animals because of cultural, religious or secular beliefs. There is little research on this subject, but one small study of Muslim patients found that more than half would stop taking prescribed medication if they thought it was of porcine (pig) origin and thus, in their view, haram, or forbidden (Bashir et al, 2001). Therefore, exploring patients’ beliefs in accordance with the ‘patient choice’ agenda (Department of Health, 2003) is important as a basis for achieving concordance.
Organisational approaches It is clearly not enough to examine only the attitudes, knowledge and behaviour of individuals. Managers need to examine the degree to which their services have the commitment, structures and information available to support change. Increasingly, in order to generate the Race Equality Action Plans required under the Race Relations Amendment Act (2001), organisations are turning to the use of toolkits and checklists to examine their whole practice (Chirico et al, 2000). Key questions that they need to ask include reviewing the language and ‘feel’ of the organisation, the data on potential and actual users (monitoring), the mission and management agenda (ensuring that these are designed to be inclusive), staffing, and the overall processes at work, to ensure that these are not unintentionally discriminatory simply because nobody has thought about the degree to which they may be culturally sensitive (or insensitive). In short, managers and board members need to ask themselves and their organisations seven key questions (Box 1). The first key question is to examine whether a needs assessment and profile of the potential users has been undertaken. This should include information from the census and surveys about the ethnic and cultural make-up of the catchment area. Following on from this is a need to determine who actually uses the services and how they come to know about or get referred to them. Ethnic monitoring is now well established as a technique, but often the data are collected and never analysed or used. This wastes resources and causes frustration (Johnson, 2001). A clear understanding of responsibilities and the importance of having, and implementing, policies and protocols
British Journal of Community Nursing February 2014 Vol 19, No 2
© 2014 MA Healthcare Ltd
Knowledge is the second element in developing cultural competence (Campinha-Bacote, 2003). In itself, knowledge will not facilitate culturally competent palliative care provision, but it is needed to inform both managers and practitioners about appropriate codes of behaviour. From a management perspective, developing an appropriate knowledge base begins with the application of ethnic monitoring that is geared towards identifying the diverse elements in the population to be served. In palliative care, data should include information about such factors as the culture, ethnicity, religion and preferred language of those who use current services and epidemiological data about the types of problems for which they require care (Johnson, 2001). Such a database should also include information about black and minority ethnic groups in the locality whose members do not appear to use palliative care services, as a prelude to establishing why this may be so. Absence of data broken down by ethnic groups is itself a barrier to improving access to palliative care, but absence of evidence of use should not be confused with absence of need. Reducing inequalities is dependent on information that allows measurement of the severity of health problems, the need for and appropriateness of treatments, and the outcomes obtained. This has been made more difficult by a dearth of good-quality ethnic data in relation to many issues, including the incidence of cancer in older members of black and other minority ethnic groups (Johnson et al, 2001; Aspinall and Jacobson, 2004). For staff, developing knowledge should, initially at least, focus on the particular black and minority ethnic groups represented in the locality in relation to their ideas about the body, health, illness, treatment and care. Beliefs about these factors are culturally determined. For example, the causes of illness and disease are frequently conceptualised in terms of relationships, either between the individual and other people, or between that person and God. Thus, practitioners need to understand a patient’s frame of reference in answering questions such as ‘Why me?’ (Helman, 2000). Similarly, ideas about the body may differ. For example, some South Asian people have no concept of the circulation of the blood (personal communication with Gatrad, 2005) and, therefore, no words to describe it. In such circumstances, explaining conditions such as diabetes or peripheral vascular disease, as shown in an Australian study (Trudgen, 2000), presents health professionals with a number of challenges. Notions of the ways in which illness should be treated, the type of treatment and the way in which the professionals should behave are all part of the knowledge base of the culturally competent practitioner. However, practitioners— be they doctors, nurses or allied health professionals—must also acknowledge that this knowledge base can only ever be partial. It is through encounters with patients that knowledge will be extended, provided that the practitioner keeps an open mind and recognises that
CULTURAL ISSUES is essential. It is best if a ‘lead’ on matters such as equality and sensitivity is shown and owned by managers rather than left to somebody (else). Designated responsibilities need to be embedded in structures and job roles, so that if a member of staff or the director leaves, the impetus for change and monitoring is not lost. User engagement is a fundamental element of health and social care (and business) planning and management. It is important to ensure this includes minority communities even if they are not seen to be using the service at present. This may be made easier by seeking collaborative working arrangements and partnerships with communitybased organisations such as religious and social groups. In the process, people in the organisation, and the agency itself, may come to appreciate the value and interest of diverse cultures. Last but not least is the need to recruit, respect and support staff from minority backgrounds, which increases the pool of people available to work in the organisation and brings in new and useful skills. BJCN
Afterword
© 2014 MA Healthcare Ltd
The authors are pleased to have this opportunity to represent an extract from the chapter ‘Developing culturally competent services in palliative care: management perspectives’, which appears in Gatrad et al (2007). The population of the UK is now far more diverse than in 2007 and there is a growing recognition that cultural competence can no longer focus solely on black and minority ethnic groups. The Equality Act 2010 reflects the new understanding that ethnicity and culture cannot be separated from other, equally important characteristics such as age, disability, sexual orientation, religion, gender, race, pregnancy, gender reassignment and marriage/civil partnership. Individuals may, at any point in their lives, find that they possess some or all of these characteristics. Cultural beliefs, values and practices may impact on each one in multiple ways. For example, the culture of an individual of same-sex orientation has to be considered alongside age, ethnicity, marriage/civil partnership status and whether s/he has children. In this context an individual belongs to multiple cultures rather than a single one. While cultural competence is still based on self-awareness, knowledge and skills, the nature of these three factors requires a much deeper understanding of, and sensitivity towards, the reality of complex lives. In particular, nurses need organisations that enable them to develop broad and appropriate repertoires for practice, the confidence to apply these and managers who will support them. A version of this article was previously published in the British Journal of Community Nursing volume 18, no. 6 (June). Some factual and typographical errors were introduced during the editing process. This article is now re-presented with the errors corrected and an afterword added which notes the reinforced relevance of the article to palliative care in the present day. Palliative Care for South Asians: Muslims, Hindus and Sikhs (2007), edited by Rashid Gatrad, Erica Brown and Aziz Sheikh.
British Journal of Community Nursing February 2014 Vol 19, No 2
Box 1. Key questions for developing culturally competent managers in palliative care w Who are we here to serve? w Who are our users? w Who does what? w How are users involved? w How do we work with others? w Do we respect and celebrate diversity? w Do we respect and value our staff? Book priced at £19.99, published by Quay Books. Order it at www.quaybooks.co.uk. Aspinall PJ, Jacobson B (2004) Ethnic Disparities in Health and Health Care: A Focused Review of the Evidence and selected Examples of Good Practice. http:// tinyurl.com/qd3pwls (accessed 2 January 2014) Bashir A, Asif F, Lacey F, Langley C, Marriorr J, Wilson K (2001) Concordance in Muslim patients in primary care. Int J Pharm Practice 9(Suppl): R78 Callinicos A, Jenkins G (1995) Community without care. Socialist Review 186. http://tinyurl.com/pmq3csw (accessed 2 January 2014) Campinha-Bacote J (2003) The Process of Cultural Competence in the Delivery of Healthcare Services: a Culturally Competent Model of Care, 4th edn. Transcultural C.A.R.E. Associates Chirico S, Johnson M, Pawar A, Scott M (2000) The Toolbox: Culturally Competent Organisations, Services and Care Pathways. http://tinyurl.com/oc4lgfo (accessed 2 January 2014) Cornelius N (ed) (2002) Building Workplace Equality: Ethics, Diversity and Inclusion. Thompson, London Department of Health (2003) Building on the Best: Choice, Responsiveness and Equity. http://tinyurl.com/nv2evkr (accessed 2 January 2014) Gatrad R, Brown E, Sheikh A (2007) Palliative Care for South Asians: Muslims, Hindus and Sikhs. Quay Books, London Helman C (2000) Culture, Health and Illness, 4th edn. Heinemann Butterworth, Oxford Johnson MRD (2001) Ethnic monitoring and nursing. In: Culley L, Dyson S (eds), Ethnicity and Nursing Practice. Palgrave, Basingstoke Johnson MRD, Bains J, Chauhan J, Saleem B, Tomlins R (2001) Improving palliative care for minority ethnic communities in Birmingham: a report for Birmingham Specialist Community Health NHS Trust and Macmillan Cancer Relief. April. Kai J (2003) Ethnicity, Health and Primary Care. Oxford University Press, Oxford Kavanagh K, Absalom K, Beil W Jr, Schliessmann L (1999) Connecting and becoming culturally competent: a Lakota example 1999. J Adv Nurse Sci 21(3):13 McGee P (1992) Teaching Transcultural Care. Chapman and Hall, London Papps E, Ramsden I (1996) Cultural safety in nursing: the New Zealand experience. Int J Qual Health Care 8(5): 491–7 Sands R, Hale S (1988) Enhancing cultural sensitivity in clinical practice. J Natl Black Nurses Assoc 2(1): 54–63 Trudgen R (2000) Why Warriors Lie Down and Die: Towards an Understanding of Why the People of Arnhem Face the Greatest Crisis in Health and Education since European Contact. Aboriginal Resource and Development Services Inc, Darwin, Australia
KEY POINTS
w The core elements of cultural competence are developing self awareness, knowledge and the development and application of skills— recognise your own culture and the expectations this creates w The elements of cultural competence can be applied at organisational level as well as in direct patient care, so organisations should monitor and compare their users with their catchments w Managers are responsible for creating organisational cultures which enable and encourage culturally competent practice which embodies continuous learning and development to respond to change
93
