Wharerātā

Key concepts: cultural competence

What is cultural competence?

Cultural competence is an ethical and values-based concept that backed up by action (knowledge, self-awareness and demonstrable skill).· Cultural·competence takes us beyond the concept of cultural awareness (the acknowledgement of difference), cultural sensitivity·(the recognition of the importance of respecting difference).· Cultural competence sets a standard of respect for different cultures, and a recognition that cultural differences can create barriers in communication, especially in health and mental health fields.·

Cultural competence·focuses on the skills, knowledge, and attitudes of practitioners; and·operates alongside the·central tenet of cultural safety that it is the patient·[not the professional]·defines what "culturally safe service" means to them.

Sir Mason Durie:·

"There have developed in New Zealand two approaches. [One is]·largely about cultural safety and the perspective from cultural safety was to put the client in the centre and to argue that any healing process, no matter who is doing the healing, ought to be able to take into account the client's perspective. For a time, it was given a political slant and people described it as entirely concerned with political correctness, so there were big debates about that. What wasn't stressed, at least not in the public arena, was that this was essentially about best health outcomes and not about being politically correct.

"Culture is a convenient way of describing the ways members of a group understand each other and communicate that understanding

"Cultural competence is the acquisition of skills to better understand members of other cultures in order to achieve best health outcomes

"Cultural competence focuses less on the client and more on the practitioner and of course concerns all health professionals... The point that I am stressing with cultural competence is that the only justification for embarking on this is that health outcomes should be better. So this focuses on improving health gains rather than on being politically correct."

An absence of cultural competence within a health or mental health interaction between a non-Indigenous provider and an Indigenous client or patient, can in itself be the barrier to successful outcomes.· Consider this:

Comparison of Indigenous and Mainstream Assessments of Intervention (Kelm, 1998)

Inclusive of Indigenous perspectives:·

As a result of the intervention, do you feel:

a) More valued as a person

b) Stronger in yourself as a Māori

c) More content within yourself

d) Healthier from a spiritual point of view

Clinical / Mainstream

As a result of the intervention, do you feel:

a) More able to set goals for yourself

b) More able to think, feel and act in a positive manner

c) More able to manage unwelcome thoughts and feelings

d) More able to understand how to deal with your health problem

This is not about which model is correct or better - this is about raising awareness of the cultural differences in defining health in a way that is inclusive of the beliefs and values of the patient or client.·

Two Models of Cultural Competence

Indigenous Physicians Association of Canada / Association of Faculties of Medicine in Canada

The Cultural Competence Framework for Physicians, and psychiatrists defines cultural competence as knowledge, self-awareness and demonstrable skill.

Knowledge

history and residential schools; cultural, social and spiritual determinants of health; traditional healing practices in the area you live
community development, empowerment, reciprocity and relationships, how to approach indigenous community to build partnership
Inequities in health between indigenous and non-indigenous

Self-awareness

Describe what cultural competence is to you, how and why communication is key, demonstrate ability to build therapeutic relationship
Know your own response to this topic, and explore your beliefs and actions

Demonstrable skill in building relationship

demonstrate collaborative relationship with FN/I/M and non-Aboriginal practitioners, and between mainstream and traditional health practitioners.
Share health information and strategies to improve
demonstrate ways to acknowledge and value indigenous knowledge
demonstrate authentic inclusive relationship

First Nations Health Managers Competency Framework (Canada)

This model defines core Competencies and competency indicators, as part of the full Framework. ·

Core Competencies: ·The First Nations Health Manager demonstrates:

Knowledge and abilities as they understand the traditional and community role of decision making– at the individual, family, and community levels.
Knowledge and abilities to understand the limitations of one’s own knowledge and accepts and incorporates new ways of respecting and understanding with regard to First Nations health practice.
Knowledge and understanding in interacting with First Nations health care workers and communities by applying the Seven Teachings of trust, respect, honour, honesty, humility,courage and truth.
The ability to ensure that culture is an integral part of health care.

Competency Indicators

Utilizes understanding of community and family histories and decision-making to respect fully engage in health planning and providing health services.
Incorporates traditional approaches and protocols as instructed by community (i.e. Elder and traditional healer involvement).
Ensures cultural safety for patients and families is applied in policy and practice.
Establishes a positive therapeutic relationship with First Nations patients and their families, characterized by understanding, trust, respect,honesty and empathy.
Identifies the centrality of communication in the provision of culturally-safe care, and engages in culturally-safe communication with First Nations patients, families and communities.
Addresses population diversity when planning, implementing, adapting and evaluating First Nations health programs and policies.
Applies and respects culturally-relevant and appropriate approaches with people from diverse cultural, socio-economic and educational backgrounds, and persons of all ages, genders, health status, sexual orientations and abilities.
Knows the protocols with respect to approaching the Chief and Elders.
Knows the protocol for healing processes and related activities.
Describes types of First Nations healers/traditional medicine people and healthcare professionals working in local First Nations communities and how they are viewed in the community.
Demonstrates how to appropriately enquire whether a First Nations patient is taking traditional herbs or medicines to treat his or her ailment and how to integrate that knowledge into his or her care.

Some Reflections on the Process of Developing Cultural Competence

Need for "bridge-builders" and "gate-openers".· Successful learning of knowledge and skill in this area requires indigenous people to build bridges with mainstream - but also requires a "gate-opener", a non-indigenous person willing to open the gate in the organization.· Both roles take courage.

Knowledge is the starting place, but cannot be the ending place – the whole package is knowledge, self-awareness and demonstrable skill

Developing self-awareness in areas of culture and racism is a often an uncomfortable process, and is best done with a highly skilled facilitator who can build safety for learning.·

Cultural competence is developed through relationship.· And it·is a life-long journey.