Since the beginning of the 21st century, the number of non-Irish nationals living in Ireland has increased from just over 224,000 in 2002, to 535,475 in 2016, according to the results from the most recent census available to the public (CSO, 2017). This number accounted for 11.6% of the population in 2016 and is made up of people from over 200 different nationalities (CSO, 2017). However, this number does not account for those who acquired Irish citizenship during that time, with 104,784 claiming dual Irish nationality in that year, according to the census summary. In 2016, 58,203 people of non-Irish nationality immigrated into the country (CSO, 2017). The evidence provided by the above statistics is clear; Ireland is becoming much more culturally diverse, with many of these people coming from various cultural, ethnic and religious backgrounds. Due to this variety, the need for healthcare professionals to follow an approach of culturally competent care is extremely important in today’s culturally contrasting society.
Cultural competence in healthcare is defined as a crucial tool in aiding health care professionals with providing effective and culturally appropriate healthcare services to the increasingly diverse population, as mentioned above. The aim is to eradicate bias and prejudice surrounding those with different cultural beliefs and practices, and rather respect those beliefs and practices in order to improve outcomes and increase patient satisfaction.
There are many models of cultural competence to assist healthcare professionals internationally to appropriately provide care to clients/patients from different backgrounds. One of these models is the Campinha-Bacote model of culturally competent care. The author based the delivery of effective culturally competent care upon five key components: cultural awareness, cultural skill, cultural knowledge, cultural encounters and cultural desire (Campinha-Bacote, 2002). For the purpose of the assignment, the student will provide an in-depth analysis of the components of cultural awareness and cultural knowledge, and will further discuss the importance of each component when applying the model to everyday midwifery practice.
Cultural Awareness
According to Campinha-Bacote (2002), cultural awareness is defined as the process of one examining and exploring their cultural background. As in any situation, when someone understands his or her perception of a topic, it then makes it an easier process when attempting to understand another person’s opinion. This is exactly how the concept of cultural awareness assists the healthcare professional in delivering culturally competent care. It is extremely important that every healthcare professional understands and is aware of the culture from which they originate, before even attempting to understand any other cultures. This awareness of their own culture allows the healthcare professional to recognise similarities and differences between their culture and another. It also involves the ability to recognise one’s beliefs, prejudices and assumptions about those who are different to them. As a result of this, the healthcare professional becomes respectful, appreciative and sensitive to the values, beliefs and practices of a patient’s culture (Campinha-Bacote, 2002).
Without this ability to be culturally aware, the healthcare professional is at a risk of engaging in cultural imposition and ethnocentrism. Cultural imposition is described as a tendency of someone to impose the beliefs from their culture onto another (Leininger, 1978). Ethnocentrism, however, is essentially the unawareness of diversity among culture and ethnicity. A person who is classed as ethnocentric assumes that the beliefs and practices of their culture are superior compared to others (Capell et al, 2008) and have little self-awareness of cultural differences. Possessing either of the above traits due to a lack of cultural awareness can result in a very frustrating and unsatisfactory experience for the patient. Therefore, having as much cultural and self-awareness as possible when it comes to patient communication is crucial for an optimum experience for not only the patient, but also the healthcare provider.
In practice, a midwife can apply the mnemonic ASKED model (Campinha-Bacote, 2002) when utilising the concept of cultural awareness. The midwife must ask him-/herself if they are aware of any personal biases or prejudices they may have towards a specific culture. For example, in Lyons et al (2008), service providers stated that women of ethnic minority were the ‘noisy ones’ and demanded more attention. This statement is prejudiced towards these women, as in labour, when coping with pain, every woman has different coping mechanisms which are not specific to their culture, but rather to the individual.
Cultural Knowledge
The second key component used in conjunction with cultural awareness is cultural knowledge. Possessing cultural knowledge does not mean that you need to know everything about every culture. It involves the process of seeking and obtaining relevant information about diverse cultures and ethnic groups (Campinha-Bacote, 2002). This is in order to form an educational foundation from which you can base the care that you will deliver to a specific patient.
Cultural knowledge is obtained on the basis of the integration of three key issues; health related beliefs and cultural values, disease incidence and prevalence, and treatment efficacy (Campinha-Bacote, 2002). A patient’s health related beliefs and cultural values explain how they understand their illness, or injury, and subsequent treatment. When a healthcare provider possesses knowledge of the above beliefs and values, they can then fully understand how to communicate with the patient when explaining said treatment or diagnosis. Possessing this trait of cultural knowledge will also allow the healthcare worker to empathise with the patient and understand how they perceive their illness. In addition to this component, the disease incidence and prevalence of a patient’s country of origin, culture, or ethnicity is very important. Disease incidence and prevalence varies among ethnic groups. Healthcare providers should have correct and up-to-date epidemiological data in order to aid them in providing education and information on the disease/illness in question, based on the prevalence of that disease in the patient’s culture. The final piece of information that needs to be obtained is the treatment efficacy. Here, the healthcare professional must obtain knowledge of ethnic pharmacology, which studies the variations of drug metabolism among different ethnic groups (Campinha-Bacote, 2002). This will aid the healthcare professional in deciding which drug therapy or medication will have the best treatment efficacy for the patient, depending on their ethnic background. The above methods used for obtaining knowledge on a patient’s culture must be applied specifically to the individual, and it should not be assumed that the patient follows every practice and belief within their culture. They are not a stereotype of their culture, but rather a unique blend found within (Campinha-Bacote, 2002). During an in-depth analysis of the Dublin maternity services, Lyons et al (2008), found that healthcare workers’ lack of knowledge of ethnic minorities is a common concern among pregnant women availing of this service. Although midwives did express that ethnic minority women had certain unfamiliarity with the healthcare system here in Ireland, therefore resulting in misconceptions and high expectations, they also voiced a difficulty with adapting to certain traditions/practices of different cultures. For example, different cultures/religions have specific practices on how they manage a neonatal or infant death. In Muslim practices, the dead neonate is positioned towards the city of Mecca and the body is washed, dressed and immediately prepared for burial by the parents and immediate family only (Shaefer, 1999). Although not all Muslims may have this belief, it is helpful if a healthcare provider at least knows this information, in order to be prepared on how to approach the family and plan their care.
Conclusion
Although the concept of culturally competent care, and it’s components of cultural awareness and knowledge, has been around for decades, it is even more applicable to care and management in today’s society. The number of non-Irish nationals has doubled since the beginning of the millennium (CSO, 2017) and it can be presumed that this number will continue to grow. Cultural awareness and cultural knowledge are important now more than ever in delivering optimal care which considers and values all aspects, beliefs and practices of a patient’s culture.’