Module 8 - Cultural Competence & Care in Communities

Union of Pan Asian Communities. (photographer). (n.d.) Untitled digital image of Community Healthcare [photograph]. Retrieved from http://www.upacsd.com/index.php/blog/ 

Community health care facilities provide culturally competent healthcare to demographically specific ethnic groups. The cultural diversifies with age, gender, alternative lifestyles, and various ethnic descents with traditional languages and backgrounds to make complex relationships between individuals, community health providers and multi-disciplinary healthcare teams (Ramos, Fox, Simon & Horowitz, 2013). It is imperative that community settings have a tangible perception of the ethnic backgrounds of its clients, and an awareness of sub-cultural variations of assimilated cultural groups within their local community (Edberg, Corey & Cohen, 2011). To combat cultural isolation, many ethnic groups migrate towards culturally demographic pockets within supportive communities that has proven cultural acceptance towards similar ethnic backgrounds (Walton, 2015). In response, previously uni-cultural communities have diverged into multi-cultural communities to alter the new cultural needs of the varying population. Not everyone embraced multiculturalism, with small minorities maintaining cultural ignorance, negative cultural stereotyping and racially-biased attitudes to provide stigmatisation towards cultural ethnicity, inter-racial relationships and cultural taboos (Jang, Park, Chiriboga, Yoon, An & Kim, 2015).

The inequalities associated with homelessness, poverty, poor education, social exclusion and cultural stigmatisation often contributes to chronic health complexities and reduced mental health of ethnic individuals (Weich, 2012). These socio-stressors often lead to negative coping mechanisms such as illicit substance abuse (van Hout, 2011). Community health and government commitment provides socially supportive assistance, remote access, access to housing, monitors medication compliance, helps clients navigate the healthcare system and are fundamental in the cultural transition to community living (Radermacher, Karunarathna, Grace & Feldman, 2011). It is essential for community health nurses to have an awareness of local community services such as crisis support and refuges, emergency accommodation, soup kitchens, mentor programs and skill development services to support their physical, economic, psychological and social wellbeing (Sanders‐Phillips, Kliewer, Tirmazi, Nebbitt, Carter & Key, 2014). Many ethnic groups have traditional beliefs that do not align with the consensus population, for example immunisation (Lu, O’Halloran, Williams, Lindley, Farrall & Bridges, 2015). Where it is fair to respect their values, community health nurses encompass in-depth knowledge bases on immunisation schedules and concerns, and have a duty-of-care to educate non-vaccinators on the health benefice to create awareness and confidence (Greenfield, Page, Kay, Li-Vollmer, Breuner & Duchin, 2015).  

An interview with Rosalie and her intellectually disabled daughter Rikki demonstrated the complex health implications relating to Rikki's healthcare. Communication barriers relating to Rikki's autistic spectrum, the aspiration and pneumonia risks with increased dysphagia dysfunction , and the importance of pressure area care relating to moisture and decreased circulation to maintain skin integrity were some of challenges faced by Rosalie's family and carer support. Hubert (2011) explores parents perceptive fears of negative attitudes and the safety of their child within healthcare facilities, and this is supported by Rosalie's suggestion of providing support groups in hospitals to guide holistic patient care for people with disabilities.

Self Reflection: 

This module has encourage me to focus on my own perceptive experiences with lower socioeconomic classes, intellectual and comorbidity disabilities and ethnic inequalities. I believe with continued empathetic support and guidance implemented into my future clinical practices, will benefit and assist me in being a professionally cultural competent nurse.

References:

Edberg, M. C., Corey, K., & Cohen, M. (2011). Using a Qualitative Approach to Develop an Evaluation Data Set for Community-Based Health Promotion Programs Addressing Racial and Ethnic Health Disparities. doi:10.1177/1524839910362035

Greenfield, L. S., Page, L. C., Kay, M., Li-Vollmer, M., Breuner, C. C., & Duchin, J. S. (2015). Strategies for increasing adolescent immunizations in diverse ethnic communities. Journal Of Adolescent Health, 56(5, Suppl), S47-S53. doi:10.1016/j.jadohealth.2014.10.274

Hubert, J. (2011). ‘My heart is always where he is’. Perspectives of mothers of young people with severe intellectual disabilities and challenging behaviour living at home. British Journal Of Learning Disabilities, 39(3), 216-224. doi:10.1111/j.1468-3156.2010.00658.x

Jang, Y., Park, N. S., Chiriboga, D. A., Yoon, H., An, S., & Kim, M. T. (2015). Social capital in ethnic communities and mental health: A study of older Korean immigrants. Journal Of Cross-Cultural Gerontology, 30(2), 131-141. doi:10.1007/s10823-015-9258-9

Lu, P., O’Halloran, A., Williams, W. W., Lindley, M. C., Farrall, S., & Bridges, C. B. (2015). Racial and ethnic disparities in vaccination coverage among adult populations in the U.S. American Journal Of Preventive Medicine, 49(6, Suppl 4), S412-S425. doi:10.1016/j.amepre.2015.03.005

Radermacher, H., Karunarathna, Y., Grace, N., & Feldman, S. (2011). Partner or perish? Exploring inter-organisational partnerships in the multicultural community aged care sector. Health & Social Care In The Community, 19(5), 550. doi:10.1111/j.1365-2524.2011.01007.x

Ramos, M. A., Fox, A., Simon, E. P., & Horowitz, C. R. (2013). A Community-Academic Partnership to Address Racial/Ethnic Health Disparities through Grant-Making. Public Health Reports, 128(Supp 3), 61-67.

Sanders‐Phillips, K., Kliewer, W., Tirmazi, T., Nebbitt, V., Carter, T., & Key, H. (2014). Perceived racial discrimination, drug use, and psychological distress in African American youth: A pathway to child health disparities. Journal Of Social Issues, 70(2), 279-297. doi:10.1111/josi.12060

van Hout, M. (2011). Assimilation, habitus and drug use among Irish Travellers. Critical Public Health, 21(2), 203-220 18p. doi:10.1080/09581591003777386

Walton, E. (2015). Making Sense of Asian American Ethnic Neighborhoods. Sociological Perspectives, 58(3), 490-515. doi:10.1177/0731121414568568

Weich, S. K. (2012). Experiences of acute mental health care in an ethnically diverse inner city: qualitative interview study. Social Psychiatry & Psychiatric Epidemiology, 47(1), 119-128.