The Cultural-Competence Model

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The cultural-competence model was described by Campinha-Bacote’s in the year 1998. This model becomes more and more applicable in a culturally diverse society. As more and more people are migrating, the need for becoming cultural competent is arising (Lopes, 2001). Campinha-Bacote defined cultural-competence as a course wherein the healthcare personnel makes a continuous attempt to function efficiently with reference to the cultural outlook of his/her customers, patients, community or family, which he/she serves.

This model specifically applies to nurses, so that they could gradually become culturally competent, rather than being competent culturally.

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According to this model, there are five elements of cultural competence, which include cultural awareness, cultural skill, cultural knowledge, cultural encounters and cultural desires (ASKED). All these elements have to be addressed independently, but a strong interrelationship exists. Once, a healthcare personnel addresses or experiences one of these elements, he/she would also have to look into the other elements.

As a strong and complex interrelationship exists, the process of becoming culturally competent is very dynamic and multivariate (Campinha-Bacote, 2001).

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Now let us look into each of these elements of cultural competence. Cultural awareness or cultural humility – It is a procedure by which the healthcare personnel become responsive, approving and polite with practices, beliefs, emotions, values and the problems faced by the client belonging to a different culture.

Beliefs and biases that exist about an alien culture should be removed. Ethno-centralism (unawareness of other cultures) should be removed and ethno-relativism (attitude to respect other cultures) should be enabled. Cultural awareness is very important, as it would help present any imposition of one’s beliefs, attitudes and practices on individuals belonging to other cultures.

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This helps to recognize and address important problems that people have during treatment (such as pain) (Campinha-Bacote, 2001).

Cultural knowledge – The healthcare personnel should be able to identify the patient’s outlook. Cultural differences should be recognized. A person, who is undergoing rehabilitation for a particular disease, would be seeking more meaning to their condition. There is an important relationship that people develop when they are affected with a particular disease, and it is responsibility of the healthcare personnel to identify this meaning and accordingly interact with the patient. There are 4 processes when cultural knowledge is acquired.

These include unconscious incompetence (unawareness that one lacks cultural knowledge of another individual), conscious incompetence (awareness that one lacks cultural knowledge of another individual), conscious competence (process of intentionally learning about another individual’s culture and becoming culturally more responsive) and unconscious competence (unawareness of becoming culturally more accommodative). In the beginning, the healthcare personnel would not be aware of their lack of cultural knowledge of the patient’s culture.

Slowly, the healthcare personnel would become more and more aware that they are lacking knowledge. Once this deficiency is recognized, automatically the personnel would be trying to gain more and more knowledge. Slowly, the personnel would be gaining knowledge and would be aware of the process. In the last process, the personnel would be unaware of the knowledge he/she is gaining (Campinha-Bacote, 2001). 3. Cultural encounters – Cultural encounters is a process by which interactions with individuals belonging to other cultures is held so that the process of gaining cultural knowledge is enabled.

As the saying goes, “practice makes perfect”, in the same way, getting exposed to another individual’s culture would result in gaining more and more knowledge. When cultural encounters are enabled, verbal responses are generated and several verbal and non-verbal messages are sent across. In the beginning, the process of cultural encounters would be very difficult and negative. With time, as more and more cultural knowledge is gained, the process would become easy and more positive (Campinha-Bacote, 2001).

Cultural Skill – It is the capability of accessing appropriate cultural information. The healthcare personnel should have the skill and the ability to know more about the patient’s history, clinical information, etc. Several assessment instruments are currently available which could help the personnel to acquire such knowledge. The personnel should be able to question the patients in an appropriate format so that a strong feedback is obtained. Whilst this process is going on, the personnel should be culturally responsive.

They should give a lot of importance to the emotions, values, beliefs and attitudes of the patient, however unreasonable it may seem to be (Campinha-Bacote, 2001). 5. Cultural desires – This is some kind of a motivational force that instigates the healthcare personnel to become more and more cultural competent. This would enable improvements in the standards of care provided to individuals belonging to a foreign culture. The personnel should be willing to work for clients that belong from a culturally diverse background.

Although, the learning curve may be very steep, it would be a very interesting challenge to meet. Besides, the satisfaction gained by becoming more and more culturally competent is impeccable (Campinha-Bacote, 2001). Once the process of cultural competence is enabled, automatically a culture habit would be enabled in the healthcare organization. The cultural habits are the junction at which the five elements of cultural competence (that is ‘ASKED’) would meet. Some of the barriers that could exist with relation to cultural competence include: -

Poor awareness of the other individual’s culture (the differences that exist in the culture should be addressed, so that the healthcare personnel could become more and more culturally competent). The healthcare personnel would be unaware of the needs and the expectations of the patient (this results in cancelled appointments and failure of the treatment). Hence, it is important to become culturally more responsive and change negative attitudes towards individuals belonging to other cultures. Freedom of expression of one’s feelings and emotions should be permitted during cultural interactions (Lopes, 2001).