Cultural competence enhances outcomes
By Dorothy Consonery- Fairnot, MSHA, RN, CCM, CLNC
Chair of the Commission for Case Manager Certification
Mount Laurel, NJ
Founder and President
Fairnot & Associates Health Care Consulting
Atlanta
Kathryn M. Serbin, BSN, MS, CCM
Chair-Elect of the Chair of the Commission for Case Management Certification
Mount Laurel, NJ
Section Chief, Women's Health Clinic,
Senior Nurse, Surgical Clinics,
Ambulatory Care Center of the James A. Lovell Federal Healthcare Facility
Chicago
Many factors come together to affect a patient's attitudes toward healthcare and ability to adhere to a regime of self-care. Among them are cultural issues, from religious beliefs to socioeconomic status and health literacy. For the professional case manager, developing "cultural competence" and "cultural sensitivity" enhances case management practice and ensures the attainment of desired outcomes, including clinical, financial, and patient satisfaction.
Cultural competence can be defined as having specific cognitive and effective skills that are essential to building culturally relevant relationships. In the hospital or other acute-care setting, cultural competence is critical, and its importance has been recognized by the Joint Commission.
Professional case managers, particularly those who are board certified, can enhance the ability of a hospital or other healthcare organization to deliver culturally competent care to patients. The Commission for Case Manager Certification (CCMC), the first and largest nationally accredited organization that certifies case managers, requires all board-certified case managers to adhere to a Professional Code of Conduct, which sets a high standard for delivering patient-centered care. Among the specific principles in the code is the requirement that "certificants will respect the rights and inherent dignity of all their clients," which speaks to cultural competence.
Some cultural aspects, such as certain religious practices, might be common to a particular group. Others are far more individual and reflect a person's cultural identity and upbringing. Thus, the professional case manager cannot make blanket assumptions that all patients who appear to have a particular cultural attribute will think or act in a certain way. Such assumptions reinforce stereotypes that undermine the relationship between case manager and patient, which always must be based in advocacy.
Thus, for professional case managers, the goal of being culturally competent and culturally sensitive requires compassion, open-mindedness, and self-awareness about their own attitudes and beliefs. A culturally sensitive case manager recognizes the importance of cultural assessment as a tool to gain insight about patient values and cultural differences to achieve effective outcomes.
Patient attitudes and cultural influences can only be determined through one-on-one contact with a professional case manager who is attuned to cues about how a person's beliefs and perspectives influence decisions and behaviors around healthcare. Using techniques such as "motivational interviewing," the case manager can ask open-ended questions to encourage two-way communication, establish rapport, and uncover patient attitudes and behaviors. For example, case managers may ask: "What are your goals for improving your health and wellness?" The patient's reply might reveal a willingness to engage in prevention, or a belief that going to the doctor should happen only when a person is sick.
Supporting the patient on a journey toward improved health and wellness requires a holistic, patient approach, addressing not only clinical factors, but also those human elements such as cultural influences. By becoming more culturally sensitive and aware, professional case managers elevate their advocacy, contribute to the healthcare organization's patient support and services, and, ultimately, empower individuals to make their own health and wellness a priority.
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