Successful Aging In the Division of General Medical Disciplines

Culturally Appropriate Geriatric Care:
Promoting Cross-Cultural Understanding

Nine Aspects that Promote Cross-Cultural Understanding

Assessing and providing culturally competent care is challenging and rewarding.

The Healing by Heart Model of Culturally Responsive Care describes nine aspects for providers to learn in order to promote cross-cultural understanding and maximize quality health care (Vawter, Culhane-Pera, Xiong, Babbitt, & Solberg, 2003). In the model, health care professionals are guided to—

  1. Be aware of the influence of culture on health status, beliefs, practices, and values. This is a basic but critical step toward the concept of culturally responsive care.
  2. Increase self-awareness about your own health beliefs, practices, and values. It is essential that providers recognize the cultural influences that shape their own views of the world, health, illness, and treatment, as these will influence how they respond to other people's cultural worldviews about health and illness.
  3. Learn about the prevailing health beliefs, practices, and values of the cultural groups you serve. Before providers listen to their patients' needs, they need to understand the cultural group's background, including their history, social structure, cosmology, and traditional healing practices.
  4. Identify potential areas of congruity and difference between your personal health beliefs, practices, and values and those of the cultural groups you serve. Once these areas are identified, providers can accentuate similarities, find common ground to compromise, and deflect arguments, in order to maximize care.
  5. Increase self-awareness about your cross-cultural health care ethics. Providers' cross-cultural health care ethics reside on a continuum, from valuing the Western system over traditional healing to valuing patients' choice of traditional healing for all patients regardless of the Western options. Many providers feel most comfortable in a middle ground, where adults can chose traditional healing over Western healing regardless of consequences, but where families cannot chose traditional healing over Western healing for minors if minors have life-threatening conditions. Just as providers need to be aware of their cultural beliefs, practices, and values, they need to be aware of their cross-cultural ethical orientation.
  6. Learn skills to identify, evaluate, and respond to cross-cultural ethical conflicts, with special attention to issues that challenge professional integrity. When providers are uncomfortable with patient's demands, it may be that their personal preference, moral beliefs, or professional integrity is challenged. Challenges to professional integrity may be the most difficult to address, requiring specialized assistance (i.e., an ethics committee consultation).
  7. Develop attitudes that are culturally responsive to the groups you serve. While understanding other people's cultural perspectives is important, attitudes of trust, respect, and accommodation are essential to quality cross-cultural health care.
  8. Learn communication skills that are culturally responsive to the groups you serve. The skills of asking open ended questions to elicit patients' cultural needs; active listening and reflecting; and cross-cultural non-verbal communication are tools used for the improvement of cross-cultural health care.
  9. Develop culturally responsive knowledge, skills, and attitudes that can be applied to specific clinical relationships. This final step integrates the previous steps of self-knowledge, general cultural knowledge, culturally responsive attitudes, and communication skills allowing providers to ask, listen, and respond to patients' cultural needs in a way that maximizes quality health care for patients of all cultural backgrounds.

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