Cultural Competence in Social Care and Health

What is “cultural competence”?

Culture is an aspect of identity, which we all have. Culture is based on a number of things shared with others such as language, shared history, beliefs, attitudes, celebrations, musical taste, dress, diet and many others. Culture is basically about a shared understanding with others of the same culture. Cultures are neither inferior or superior – they are just different.

In health and social care, there has been a shift in recent years towards ‘cultural competence’ as a key aspect of all professional practice. The idea of workers being ‘competent’ in working with others from different cultures is a step on from being ‘sensitive’ to the needs of other people. The notion that professionals need to be competent in working with difference and culture as opposed to being merely ‘sensitive’ about it has gained strength in recent years. The term cultural competence has therefore largely replaced the term cultural sensitivity in social work and health care.

If workers are to be seen as culturally competent, then they need to be able to articulate what cultural competence is. Conversely, the very concept of competence implies that those who do not hold sufficient knowledge and understanding about the role of people’s culture are by definition ‘incompetent’ at their job if they cannot work in an effective way to meet people’s diverse needs.

There is a long standing view that competence is made up of knowledge, values and skills (e.g.: Maclean and Caffrey 2009).

In our view, culturally competent practice involves:

1. Knowledge and understanding of:

· your own culture
· any culture bias you have
· the concept of culture and how this can affect beliefs and behaviours
· specific cultural knowledge

2. A range of values and attitudes, including a commitment to:

· valuing and celebrating difference
· respecting individuality and the role which culture plays in this

3. And a range of skills, including:

· culturally competent communication
· culturally competent assessment
· culturally sensitive care provision

It is important to recognise that culture is an aspect of a person’s identity. It is not their ‘whole’ identity and it does not act as a predictor of how a person will behave and what they will believe. Everyone will choose which aspects of their cultural identity they will ‘own’ and which they will not. As such, each person will have a unique approach to their culture – leading to a complexity of ways in which culture will affect people’s individual needs and preferences.

Cultural Competence and Self Awareness for workers in Health and Social Care

If workers in social and health care are to be culturally competent, they need to develop some key skills and knowledge for effective practice. In order to appreciate the different cultures to which people associate fully and to form effective working relationships with service users and carers, it is important to understand the diversity there is within daily life.

Within all cultures and religious groups there is wide variation in practice and it is important to realise that degrees of strictness and observance are individually defined. Culturally competent workers will appreciate that culture is not monolithic and it will be dangerous to provide services based on stereotypical concepts of, for example, “a Jew”, “a Hindu”, or “a Muslim”. Some people born into a religious community may not consider themselves to be members of that community. For others their religion, traditions and rituals may be important, but they may not observe, say, strict dietary requirements. Therefore, it is important to allow individuals to define their own culture and religion.

The way in which a person views themselves and their identity will be affected by their culture and their religion, but this can vary between different groups and according to individual personal preferences. The way we live our lives is affected by the environment in which we all live.

If we accept that cultures are not better or worse than each other, but are just different, then we need to be clear that some of the ideas and ‘truths’ that we bring to our work are themselves culturally rooted. As workers in social and health care we also have our own culture, both as individuals in society and as employees of organisations and members of teams which have cultures. Culturally competent practice involves understanding the values we bring to our work, and a sophisticated awareness of how oppression, stereotyping of other people’s culture and prejudice operate to disadvantage others. A competent practitioner is able to understand these concepts, see how they relate to their practices, and reflect on their own values and ‘truths’ about both their own and other people’s cultures.

Robinson (2007: 169) states:

“An etic refers to a universal truth or principle, whereas an emic refers to truths that are culture specific.”

People who work with others must have some understanding of the fact that not all of the truths we grew up with are etics in order to appreciate the impact which our own culture and upbringing has had on our beliefs about the world. We cannot work effectively with other people who have different emics to our own if we insist that all of their ‘truths’ (i.e.: their beliefs, values, aspirations etc) should be the same as ours.

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Applying the Principles of Social Care as a Level 4 Worker

In social care and social work many staff are starting to develop their skills and knowledge in respect of the Health and Social Care SVQ or NVQ level 4.

You may have recently been appointed to a management post in a social care service or you may have been a manager or assistant manager for some time, alternatively you could be on a field work team but are not yet social work qualified. In terms of your own professional development you are now, or will be working on your Health and Social Care SVQ or NVQ level 4.

As a level 4 candidate, you should be familiar with the principles of good care practice, having incorporated them into your everyday work. In your role as a level 4 worker you should be supporting others to incorporate the principles of good care into their everyday work.

Challenging

The Health and Social Care SVQ and NVQ standards refer regularly to candidates for the level 4 “challenging” others – for example where they observe poor practice etc. Sometimes people aren’t comfortable with this term – what exactly does “challenging” mean and how can you challenge effectively? This is a key aspect of a level 4 worker’s role – so it is worth exploring the skill as a key principle.

Wherever you come across a situation which you feel you want (or indeed, need) to challenge you should ask yourselves: Why? What? Who? How? and When?

Why challenge?

It is important to challenge poor practice, oppressive practice, etc. because we all have a commitment to promote good practice. Through challenging we are able to ask questions about practice which otherwise remain unasked. We can make positive changes and we can ensure others adopt a challenging approach.

What are you challenging?

Be clear about exactly what you are challenging. Listen, examine the issue, think about the context etc. Make the links with institutional oppression
and structural forces. Working in this way, we avoid making challenging personally threatening.

Who are you challenging?

Ask yourself about the person you are challenging. It is our view that we should never avoid challenging because of the individual, but clearly we will need to alter the focus and content of our challenge based on the understanding and experiences of the individual. Think about communication in terms of the individual you are challenging.

How are you going to challenge?

You should choose the right way of challenging. You need to put thought into this. As a starting point we suggest you consider the following:

Understanding

There could be a difference in what you understand and what the person you are challenging understands.

Values

There may be a difference between what is important to you and what is important to the person you are challenging.

Styles

There may well be a difference in the way you do things and the way the other person does things. That does not necessarily mean that the other person’s way of doing something is bad practice. Don’t just challenge because someone does things differently to you.

Opinions

There could be differences between what you think and what the person you are challenging thinks.

If you bear all of the above in mind, when deciding how to challenge, your approach is much more likely to be effective. In addition, we
believe that it is important to choose the least oppressive way of challenging someone.

When should you challenge?

This is very closely linked to thinking around the area of how to challenge. Is it appropriate to challenge at the time or later? Bear in mind that the longer you leave something the more distant and vague a person’s recall becomes. In general sooner rather than later is best.

Consequences of challenging

In addition to considering the questions we have outlined, it is also important to think about the consequences of any challenge both in terms of yourself and the person you are challenging.

As a level 4 worker any challenge should be assertive but also supportive of the professional development of the person you are challenging.

You may also need to think about the needs of the ‘victim’ of the poor practice, the oppression etc (ie: the victim of whatever you are challenging). Do you need to locate support systems? etc.

Potentially this can be complicated or even daunting. However the recent publication by Mark Shiner, Siobhan Maclean and Iain Maclean has already been seen as a major new resource for all staff working through their Health and Social Care SVQ or NVQ Level 4. The book covers all the mandatory (or core) units of the Health and Social Care SVQ and NVQ Level 4. At a cost of only £15 it is one of the most accessible books available.

Potentially this can be complicated or even daunting. However the recent publication by Mark Shiner, Siobhan Maclean and Iain Maclean has already been seen as a major new resource for all staff working through their Health and Social Care SVQ or NVQ Level 4. The book covers all the mandatory (or core) units of the Health and Social Care SVQ and NVQ Level 4. At a cost of only £15 it is one of the most accessible books available.

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