Understanding cultural language to enhance cultural competence
Article Outline
- Culture
- Primary characteristics of culture
- Secondary characteristics of culture
- Cultural diversity
- Cultural sensitivity
- Cultural awareness
- Cultural competence
- Cultural relativism
- Cultural imposition
- Cultural imperialism
- Health disparity
- Healthcare disparity
- Race
- Racism
- Stereotype
- Generalization
- Ethnocentrism
- Ethnic minority group
- Stigma
The members of the Expert Panel on Cultural Competence of the American Academy of Nursing (AAN) envisioned definitions related to culture and cultural competency as a way to add consistency in the literature and in discussions to reshape health care policies to eliminate health disparities and health care disparities. Paramount among the concerns related to health care and health disparities is a common understanding of terms used in the delivery of culturally competent care. In his work on multicultural medicine, Dr David Satcher (former Surgeon General of the United States) took note of this general confusion, which tends to hinder the delivery of culturally competent care. For example, a common misused term is health disparities.
Although certain ethnic minority groups are more prone to health disparities, other groups such as Appalachian Whites, the underserved, the poor, and others also have health disparities.
The Expert Panel on Cultural Competence came to a consensus on some of these terms and present them as a way to promote the delivery of culturally competent care by improving communication on this subject. This has been over a three-year period and represents the contributions of the leading experts on cultural competency. The following definitions are reprinted here with permission1 in an effort to bring a common understanding and cultural language to enhance cultural competence.
Culture
A learned, patterned behavioral response acquired over time and includes explicit and implicit beliefs, attitudes, values, customs, norms, taboos, arts, habits, and life ways accepted by a community of individuals. Culture is primarily learned and transmitted within the family and other social organizations, is shared by the majority of the group, comprises an individualized worldview, guides decision-making, and facilitates self-worth and self-esteem.
Primary characteristics of culture
Primary characteristics of culture determine the degree to which a person adheres to the dominant beliefs and practices of his/her dominant culture and includes nationality, race, color, gender, age, and religious affiliation. Primary characteristics are attributes that one cannot easily change.
Secondary characteristics of culture
Secondary characteristics of culture determine the degree to which a person adheres to the dominant beliefs and practices of his/her dominant culture and includes education; occupation; socioeconomic status; political beliefs; military experience; rural versus urban status; marital status; parental status; gender issues; sexual orientation; physical characteristics; length of time away from the country of origin; and reason for migration such as undocumented, immigrant, or sojourner. Secondary characteristics are attributes that one can more readily change.
Cultural diversity
Refers to diversity in race, color, ethnicity, national origin, religion, age, gender, sexual orientation, ability/disability, social and economic status or class, education, occupation, religious orientation, marital and parental status, and other related attributes of groups of people in society.
Cultural sensitivity
Cultural sensitivity is experienced when neutral language, both verbal and nonverbal, is used in a way that reflects sensitivity and appreciation for the diversity of another. Cultural sensitivity is conveyed when words, phrases, categorizations, etc. are intentionally avoided, especially when referring to any individual that may be interpreted as impolite or offensive.
Cultural awareness
Cultural awareness is being knowledgeable about one’s own thoughts, feelings, and sensations and having an appreciation of the diversity of others in terms of the objective (material) culture such as the arts, clothing, foods, and other external signs of diversity.
Cultural competence
Cultural competence is having the knowledge, understanding, and skills about a diverse cultural group that allows the healthcare provider to provide acceptable cultural care. Competence is an ongoing process that involves accepting and respecting differences and not letting one’s personal beliefs have an undue influence on those whose worldview is different are different from one’s own. Cultural competence includes having cultural general as well as cultural specific information so the healthcare provider knows what questions to ask.
Cultural relativism
The belief that behaviors and practices of people should be judged only in the context of their cultural system. Proponents argue that issues such as abortion, euthanasia, female circumcision, and physical punishment in childrearing should be accepted as cultural values without judgment from the outside world. Opponents argue that cultural relativisms may undermine condemnation of human rights violations and that family violence cannot be justified or excused on a cultural basis.
Cultural imposition
Intrusively applies the majority cultural view to individuals and families. Prescribing a special diet without regard to the client’s culture and limiting visitors to immediate family borders on cultural imposition. In this context, healthcare providers must be careful in expressing their cultural values too strongly until cultural issues are more fully understood.
Cultural imperialism
The practice of extending policies and practices of one organization (usually the dominant one) to disenfranchised and minority groups. Proponents appeal to universal human rights values and standards. Opponents posit that universal standards are a disguise for the dominant culture to destroy or eradicate traditional cultures through worldwide public policy.
Health disparity
Health disparity is defined as differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.
Healthcare disparity
A healthcare disparity exists when persons of different races, ethnic groups, and cultures do not receive equal health care, and illness occurs disproportionately from one group to the other.
Race
Race is a viable term that relates to biology but has sociological implications. Members of a particular race share distinguishing physical features such as skin color, bone structure, or blood group. Race is a social construct, which limits or increases opportunities depending on the setting.
Racism
Racism refers to feelings of prejudice against persons of another race or group of people. Racist practices lead to interpersonal tension, isolation, discrimination, and covert anger.
Stereotype
Stereotype includes having a simplified and standardized conception, image, opinion, or belief about a person or group. A healthcare provider who fails to recognize individuality within a group is jumping to conclusions and therefore stereotyping.
Generalization
Generalizations begin with assumptions about the individual or family within an ethnocultural group but leads to further information seeking about the individual or family.
Ethnocentrism
Ethnocentrism is a universal tendency to believe that one’s own worldview is superior to another’s. It is often experienced in the healthcare arena, particularly when the healthcare provider’s own culture or ethnic group is considered superior to another.
Ethnic minority group
An ethnic minority group is a group of people whose members have different experiences and backgrounds from the dominant culture by status, background, residence, religion, education, or other factors that functionally unify the group and act collectively on each other.
Stigma
A characteristic or trait that causes a stain or reproach on a group’s or individual’s reputation or being.
The definitions are excerpted from Giger JN, Davidhizar R, Purnell L, Harden JT, Phillips J, Strickland O. Developing cultural competency to eliminate health disparities in ethnic minorities and other vulnerable populations. American Academy of Nursing Expert Panel Reports. J Transcult Nurs 2007;18(2):100-1.
PII: S0029-6554(07)00142-X
doi:10.1016/j.outlook.2007.05.004
