Purnell and paulanka model of cultural competence

CULTURES COVERED IN THE TEXT

People of African American Heritage The Amish People of Appalachian Heritage People of Arab Heritage People of Chinese Heritage People of Guatemalan Heritage People of Egyptian Heritage People of Filipino Heritage People of French Canadian Heritage People of German Heritage People of Haitian Heritage People of Iranian Heritage People of Japanese Heritage People of Jewish Heritage People of Korean Heritage People of Mexican Heritage People of Russian Heritage People of Polish Heritage People of Thai Heritage

CULTURES COVERED ON THE DavisPlus WEB SITE (http://davisplus.fadavis.com)

People of Baltic Heritage: Estonians, Latvians, and Lithuanians People of Brazilian Heritage People of Greek Heritage People of Cuban Heritage People of Hindu Heritage People of Irish Heritage People of Italian Heritage People of Puerto Rican Heritage Navajo Indians People of Turkish Heritage People of Vietnamese Heritage

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Transcultural Health Care A Culturally Competent Approach Third Edition

Betty J. Paulanka, EdD, RN Professor and Dean College of Health Sciences University of Delaware Newark, Delaware

Larry D. Purnell, PhD, RN, FAAN Professor College of Health Sciences University of Delaware Newark, Delaware

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Library of Congress Cataloging-in-Publication Data

Transcultural health care : a culturally competent approach / [edited by] Larry D. Purnell, Betty J. Paulanka. — 3rd ed.

p. ; cm. Includes bibliographical references and index. ISBN-13: 978-0-8036-1865-7 ISBN-10: 0-8036-1865-4

1. Transcultural medical care—United States. 2. Transcultural medical care—Canada. I. Purnell, Larry D. II. Paulanka, Betty J.

[DNLM: 1. Delivery of Health Care—North America. 2. Cross-Cultural Comparison—North America. 3. Ethnic Groups—North America. W 84 DA2 T7 2008]

RA418.5.T73T73 2008 362.1089--dc22 2007043727

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The rise in concern for cultural competence has become one of the most important developments in American health care over the past decade. Medicine and health more generally have moved beyond their traditional equanimous approach of application of scientific rational- ity to clinical problems to one that promotes an easier inte- gration of clinical science with empathy. This development has occurred with a rising tide of the diversity of the popu- lation of the United States. Some of this is driven by actual numbers of immigrants, but other dimensions of this awareness come from the visibility of the “new” ethnics and the waning of the social ideology of the melting pot. Beyond all of this is a younger generation that is much more attuned to diversity as part of their cultural landscape and their comfort with the globalization of perspectives resulting from technological and economic change.

From within health care, the advocacy for culturally competent approaches is driven in part by the dawning recognition of the danger to patient safety and overall inadequacy in the quality of outcomes in what we do. The literature around the disparities of outcomes across ethnic, social, and economic groups provides a com- pelling case to ensure that health care is attentive to these differences. But there is also attention to the costs that are driven up by health care that is not culturally competent and discourages compliance. The excess expenditures are associated with poor communication, the failure to use culturally responsive methods, and ineffective attempts to transfer treatment modalities to make the system cost efficient. Finally, as the health system makes its glacial move to more consumer and individual responsiveness, the system is recognizing that a cultural perspective is essential to provide services that earn high levels of con- sumer satisfaction.

Much of the activity aimed at advancing cultural com- petence has been centered on regulations and mandates. However, a generational change that begins with the edu- cation of each new practitioner is needed to bring about a culturally informed and competent professional commu- nity.