The sixth edition of this best-selling resource continues to teach nursing, health professions, medical and social science readers the importance of cultural competence and cultural awareness in the health care industry. The new edition will include revised organization to create a better flow of content, new content on gererational differences, updated chapter on health care delivery system, updated illustrations and tables and MediaLink icons. For undergraduate and graduate courses in patient care and basic health related profession programs, as well as medical, social work, and other health disciplines.
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You don't need a masterpiece to get the idea.
– Pablo Picasso
In 1977 I wrote the first edition of Cultural Diversity in Health and Illness and have revised it several times since then; this is the sixth edition. The purpose of each edition has been to increase the reader's awareness of the dimensions and complexities involved in caring for people from diverse cultural backgrounds. I wished to share my personal experiences and thoughts concerning the introduction of cultural concepts into the education of health care professionals. The books represented my answers to the questions:
As I had done in the classroom, I attempted to bring the reader into direct contact with the interaction between providers of care within the North American health care system and the consumers of health care. The staggering issues of health care delivery are explored and contrasted with the choices that people may make in attempting to deal with health care issues.
It is now imperative, according to the most recent policies of the Joint Commission of Hospital Accreditation and the Centers for Medicare & Medicaid Services, that all health care providers be culturally competent. In this context, cultural competence implies that within the delivery of care the health care provider understands and attends to the total context of the patient's situation; it is a complex combination of knowledge, attitudes, and skills. Yet,
It can be argued that the development of cultural competency does not occur in a short encounter with cultural diversity; but that it takes time to develop the skills, knowledge, and attitudes to safely and satisfactorily deliver CulturalCare.
Unit I focuses on the background knowledge one must recognize as the foundation for developing cultural competency.
Unit II explores the domains of HEALTH, blends them with one's personal heritage, and contrasts them with allopathic philosophy.
Once the study of each of these components has been completed, Unit III moves on to explore selected population groups in more detail, to portray a panorama of traditional HEALTH and ILLNESS beliefs and practices, and present relevant health care issues.
These pages can neither do full justice to the richness of any one culture nor any one health-belief system. By presenting some of the beliefs and practices and suggesting background reading, however, the book can begin to inform and sensitize the reader to the needs of a given group of people. It can also serve as a model as to how to develop cultural knowledge in populations that are not included.
The Epilogue is devoted to an overall analysis of the book's contents and how best to apply this knowledge in health care delivery, health planning, and health education, for both the patient and the health care professional.
There is so much to be learned. Countless books and articles have now appeared that address these problems and issues. It is not easy to alter attitudes and beliefs or stereotypes and prejudices. Some social psychologists state that it is almost impossible to lose all of one's prejudices, yet alterations can be made. I believe the health care provider must develop the ability to deliver CulturalCare and a sensitivity to personal fundamental values regarding health and illness. With acceptance of one's own values comes the framework and courage to accept the existence of differing values. This process of realization and acceptance can enable the health care provider to be instrumental in meeting the needs of the consumer in a collaborative, safe, and professional manner.
The first edition of this book was the outcome of a promesa—a promise—once made. The promise was made to a group of Black and Hispanic students I taught in a medical sociology course in 1973. In this course, the students wound up being the teachers, and they taught me to see the world of health care delivery through the eyes of the health care consumer rather than through my own well-intentioned eyes. What I came to see I did not always like. I did not realize how much I did not know; I believed I knew a lot. I have held on to the promesa, and my experiences over the years have been incredible. I have met people and traveled. At all times I have held on to the idea and goal of attempting to help nurses and other providers be aware of and sensitive to the beliefs and needs of their patients.
I know that looking inside closed doors carries with it a risk. I know that people prefer to think that our society is a melting pot and that old beliefs and practices have vanished with an expected assimilation into mainstream North American life. Many people, however, have continued to carry on the traditional customs and culture from their native lands, and health and illness beliefs are deeply entwined within the cultural and social beliefs that people have. To understand health and illness beliefs and practices, it is necessary to see each person in his or her unique sociocultural world.
The shattering events of September 11, 2001, represent in many ways the clarion call for all of us to wake up and hear and listen to the voices of all people. Indeed, the events are symptomatic of Global Polarization in such conflicts as:
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