The contemporary society is one that has been significantly affected by globalization. With the increased rate of immigration, there occurs an increased diversity among clients making it necessary to have culturally congruent health care. The medical field is required to adopt a global practice of culturally competent care. Therefore, the professionals must acquire a profound understanding of the cultural differences, practices, and beliefs to avoid generalization and stereotype. They can do this through the help of cultural competence models which continue to play a crucial role in medical practice making it more effective and efficient. This paper describes two of the models and suggesting how they can be applied.
Purnell Model for Cultural Competence
This model emphasizes the need to understand the various attributes of a specific culture, allowing practitioners to sufficiently view the client attributes like notions, experiences, and incitement towards illness and healthcare. The model is represented in a diagram containing parallel circles that are representations of the aspects of the society alongside the person, family, and community. It is based on twelve constructs that affect different cultures; healthcare practices, spirituality, death rituals, pregnancy, nutrition, high-risk behaviors, bio-cultural ecology, workforce issues, family roles and organization, communication, heritage, and healthcare professionals ( Purnell, 2005) .
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Purnell’s model is a representation of general views and beliefs that families and communities have and thus covers most of them. The broader perspective that the model makes it applicable to all healthcare environment and practice disciplines. It enables the provider to learn the different features of cultural diversity and their concepts. The model enables the professionals to consider and reflect on the exceptional characteristics of every client, including their views on healthcare, motivation, and illness.
Campinha-Bacote Model
This model views cultural competence not as a result of certain factors, but as a process. It incorporates five constructs including cultural desire, encounters, knowledge, skill, and awareness. According to Campinha-Bacote, in order for a professional to offer effective care, they need to gradually build cultural awareness, knowledge, and skills that are key to changing the attitudes towards a certain group of people hence leading to cultural competence ( Campinha-Bacote, 2002) .
This is the only cultural competence model that incorporates the all the aspects of Braithwaite’s criteria which are named above. The components build upon each other in a logical advancement thus offering succinct results for interventions. It also enables a clear description of processes and urgent clinical benefit in offering an optimal plan for patient care. The model addresses cultural competence with regards to healthcare delivery hence making it an essential guide to empirical research work and development of scholarly interventions.
Patient-Centered Care and Cultural Competence
Patient-centeredness in healthcare is a practice for caring for individual clients and their families in means that are significant and valuable to the client at a personal level. It encompasses listening to, involving, and informing the patient during their primary care. If the client is too young or old to talk for themselves, it involves the family. According to Institute of Medicine (IOM), patient-centered care is defined as “Providing care that is respectful of and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.”
Cultural competence is defined as a set of culturally congruent policies, behaviors, and practices that allow healthcare professionals to provide services that are high quality in a range of culturally different situations. It does not only seek to provide care for patients of an ethnic or racial minority but also to improve healthcare services regarding socioeconomic status, religion, gender and age differences.
Comparison between Patient-Centered Care and Cultural Competence
Both patient centeredness and cultural competence are approaches that have been promoted as enhancing the service delivery in a healthcare setting. The evolution of both concepts began as guides for interpersonal interaction and later stretched to include healthcare settings. In this regard, the two movements have some similarities or overlaps. Both are centered on the concept that a patient is a unique person. They regard the differences in either culture or interests to plan for an effective care which is specific in the regard of the patient. They respect the attributes of the patients regarding beliefs, needs and preferences, and meaning of illness (Robinson et al., 2008).
The two models also take into consideration personal bias and stereotypes towards certain groups and thus work to deconstruct them. Another convergent point is that patient-centered care and cultural competence try to reach a common ground of care in their respective levels of function. Also, they both involve family and friends as well as offering information that suits the patient’s level of understanding. By creating such avenues, they concepts both create trust and build rapport between the provider and the client. The major difference between the two is that cultural competence emphasizes on the cultural discrimination towards racial minorities while patient-centered care deals with an individual ( Saha et al., 2008) . While cultural competence provides a wider overview of beliefs in a culture, patient-centered care seeks to identify and negotiate the different styles of prejudice, gender and sexual issues, roles of family, and mistrust.
Benefits of Patient-Centered Care
One of the benefits of PCC is that it involves the patient and family and friends in the decision making of care. This makes the client feel to be in control of their health ( Saha et al., 2008) . The overall benefit of this approach is that it brings about satisfaction to both the clients and their families. In return, the reputation of the healthcare providers is enhanced among consumers. Patient-centered care is also considered to improve resource allocation. Also, the collaboration between the patient and the healthcare provider makes it easier to improve disease management.
Drawbacks of Patient-Centered Care
The major drawback of patient-centered care is the uneven distribution of cultural health capital. At times, the client experiences a mismatch between the expectations and preference. What happens during the medical visit can be a determinant of whether the patient would follow the recommendations and directions made by the doctor or not. When the expectations of the patient are not meant, they try to react psychologically to control the situation by doing their own things, or even the contrary of what was directed. The matching of attitudes between the doctor and the client can be a hindrance to the positive outcome. The assets and individual skills of the client may be viewed negatively from the other end.
Possible Ways to Improve and Implement Patient-Centered Care in Health Care Organizations
The development and implementation of a patient-involved care is a complex model that needs to be carried out carefully as it can backfire. The first step is leadership which is supposed to create or transform the organization. The leaders must all support the plan frequently, consistently, and openly. This is essential to drive the success of the change ( Bokhour et al., 2018) . The leadership should also engage the staff to take the risk of change and obtain their feedback to feel they are engaged. The second step is to bring patient and family into the picture. Getting the views of the clients on what matters most to them is crucial to select, plan, and implement PCC models. This can be done through open meetings, patient surveys, and inviting them to serve on the committees. It can also be done through informal communication between staff and patients. The other step is to focus on the different types of PCC models that suit the requirements of the hospital. Some innovations which have senior leadership need mid-level lobbying and staff engagement for success. The facilities can start with simple projects that would ensure early wins. They are quick to implement and allows for early introduction and when successful can garner support from staff. The leadership should align the roles and priorities of the staff to avoid conflicts with the existing duties. The environment of care should also be adjusted to provide a safe and clean avenue for patients’ confidence. It should be adjusted in such a way that it guards the privacy of the clients and encourage the involvement of their families.
References
Bokhour, B. G., Fix, G. M., Mueller, N. M., Barker, A. M., Lavela, S. L., Hill, J. N., . . . Lukas, C. V. (2018). How can healthcare organizations implement patient-centered care? Examining a large-scale cultural transformation. BMC Health Services Research,18 (1). doi:10.1186/s12913-018-2949-5
Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care. Journal of transcultural nursing , 13 (3), 181-184.
Purnell, L. (2005). The Purnell model for cultural competence [Electronic version]. Journal of Multicultural Nursing & Health, 11(2), 7-15. Retrieved February 18, 2011, from ProQuest.
Robinson, J., Callister, L., Berry, J., & Dearing, K. (2008). Patient-centered care and adherence: definitions and applications to improve outcomes. Journal of the American Academy of Nurse Practitioners, 20(12), 600-607. doi:10.1111/j.1745-7599.2008.00360.x
Saha, S., Beach, M. C., & Cooper, L. A. (2008). Patient centeredness, cultural competence and healthcare quality. Journal of the National Medical Association , 100 (11), 1275.
