Cultural Competence Introduction There are different ways of formulating cultural competence.

In defining cultural competence, Giger and Davidhizar (1999) state that it is 'a dynamic, fluid, continuous process whereby an individual, system, or health care agency finds meaningful and useful care-delivery strategies based on the knowledge of the cultural heritage, beliefs, attitudes, and behaviors of those to whom they render care' (Giger & Davidhizar, 1999, p.8). Purnell and Paulanka (1998) view cultural competence in developmental terms and as a conscious process that is not linear. Campinha-Bacote Model Of Cultural Competence The following provides a summary of Campinha-Bacote's framework for organising cultural competence (Campinha-Bacote, 1994; Campinha-Bacote, Yahle & Langenkamp, M., 1996; CampinhaBacote, 1999; Campinha-Bacote & Campinha-Bacote, 1999). In order to demonstrate cultural competence, individuals as well as organisations and institutions should first show an intrinsic motivation that is cultural desire, to engage in the process of cultural competence. This concept, one of five within the framework, is perhaps the most crucial in the process of developing cultural competence. The five elements are now described Cultural Awareness The nurse becomes sensitive to the values, beliefs, lifestyle and practices of the patient/client, and explores her/his own values, biases and prejudices. Unless the nurse goes through this process in a conscious, deliberate and reflective manner there is always the risk of the nurse imposing her/his own cultural values during the encounter. Cultural imposition is the tendency to impose one's own cultural values, beliefs and patterns of expected behaviour upon others of a different culture to one's own. During the cultural awareness phase, the nurse becomes aware of her/his own ethnocentric position and the stereotypes that they hold. Gradually, they should become more sensitive to the cultural diversity and modify their attitudes and beliefs. Cultural Knowledge Cultural knowledge is the process whereby the nurse finds out more about other cultures and the different worldviews held by people from other cultures. Understanding of the values, beliefs, practices and problem-solving strategies of culturally / ethnically diverse groups enables the nurse to gain confidence in her/his encounters with them. Cultural knowledge will include aspects of demography, epidemiology, socio-economics and political factors, and nutritional practices and preferences, and other data that are meaningful in understanding variations across cultural/ethnic groups. Cultural Skill Cultural skill as a process is concerned with carrying out a cultural assessment. Based on the cultural knowledge gained, the nurse is able to conduct a cultural assessment in partnership with the client/patient. Interpersonal skills, acceptance, trust, respect, empathy, clinical and diagnostic skills informed by cultural knowledge demonstrates itself through reflective practice. Cultural skill

represents the ability to systematically collect culturally relevant information about the client's health, and interpret these for the purpose of culturally congruent interventions. Cultural Encounter Cultural encounter is the process which provides the primary and experiential exposure to crosscultural interactions with people who are culturally/ethnically diverse from oneself. Exposure leads to further reflection and integration of the learning about culturally congruent care and its delivery. Cultural Desire Cultural desire is an additional element to the model of cultural competence (Campinha-Bacote, 1999). It is seen as a self-motivational aspect of individuals and organisations to want to engage in the process of cultural competence. The willingness and desire has to come from within. It is an intrinsic and positive factor that does not have to be imposed or brought about through regulatory mechanisms. Cultural Assessment 'A cultural assessment is needed on every client, for every client has values, beliefs and practices that must be considered when rendering health care services. Therefore, cultural assessments should not be limited to specific ethnic groups, but rather conducted with each individual' (Campinha-Bacote et al, 1996, p61). Cultural assessment should not imply a simplistic notion that it only refers to people in relation to a limited view of cultural diversity. In our resource, the broadest sense of cultural diversity is being implied, although it is not possible to make this explicit on every occasion. It is worth noting that cultural assessment can be carried out using the frameworks provided by any of the models that we describe below.