- To familiarise yourselves with the Papadopoulos, Tilki and Taylor model of cultural competence
Transcultural or intercultural study in health and social care is the study and research of cultural diversities and similarities of people in the way they define, understand and deal with the health/illness and welfare needs. It is also the study of the societal and organisational structures, which either aid or hinder people’s health and welfare.
Papadopoulos, Tilki and Taylor Model for Developing Cultural Competence
As can be seen above the model consists of four stages:
The first stage in the model is cultural awareness which begins with an examination of our personal value base and beliefs. The natures of construction of cultural identity as well as its influence on people’s health beliefs and practices are viewed as necessary planks of a learning platform.
Cultural knowledge (the second stage) can be gained in a number of ways. Meaningful contact with people from different ethnic groups can enhance knowledge around their health beliefs and behaviours as well as raise understanding around the problems they face. Through sociological study we should learn about power, such as professional power and control, or make links between personal position and structural inequalities. Anthropological knowledge will help us understand the traditions and self care practices of different cultural groups thus enabling us to consider similarities and differences.
An important element in achieving cultural sensitivity (the third stage), is how professionals view people in their care. Dalrymple and Burke (1995) have stated that unless clients are considered as true partners, culturally sensitive care is not being achieved; to do otherwise only means that professionals are using their power in an oppressive way. Equal partnerships involve trust, acceptance and respect as well as facilitation and negotiation.
The achievement of the fourth stage (cultural competence) requires the synthesis and application of previously gained awareness, knowledge and sensitivity. Further focus is given to practical skills such as assessment of needs, clinical diagnosis and other caring skills. A most important component of this stage of development is the ability to recognise and challenge racism and other forms of discrimination and oppressive practice. It is argued that this model combines both the multi-culturalist and the anti-racist perspectives and facilitates the development of a broader understanding around inequalities, human and citizenship rights, whilst promoting the development of skills needed to bring about change at the patient/client level.
The underpinning values of the model which was recently further refined and articulated (Papadopoulos I, Lees S, unpublished work, 2003) are based on Human Rights, socio-political systems, intercultural relations, human ethics, and human caring. Specifically these are:
All individuals have inherent worth within themselves as well as sharing the fundamental human values of love, freedom, justice, growth, life, health and security.
All human beings are cultural beings. Culture is the shared way of life of a group of people that includes beliefs, values, ideas, language, communication, norms and visibly expressed forms such as customs, art, music, clothing and etiquette. Culture influences individuals’ lifestyles, personal identity and their relationship with others both within and outside their culture. Cultures are dynamic and ever changing as individuals are influenced by, and influence their culture, by different degrees.
Societies, institutions and family are structures of power which can be enabling or disabling to an individual.
Health and illness
Health refers to a state of well-being that is culturally defined, valued and practised and which reflects the ability of individuals (or groups) to perform their daily role activities in culturally expressed, beneficial and patterned lifeways (Leininger 1991).
Illness refers to an unwanted condition that is culturally defined and culturally responded to.
Caring is an activity that responds to the uniqueness of individuals in a culturally sensitive and compassionate way through the use of therapeutic communication.
Nursing is a learned activity aiming at providing care to individuals in a culturally competent way.
Cultural competence is a process one goes through in order to continuously develop and refine one's capacity to provide effective healthcare, taking into consideration people’s cultural beliefs, behaviours and needs.
In order to be culturally competent practitioners, educators and researchers we need to develop both culture-specific and culture-generic competences. Culture-specific competence refers to the knowledge and skills that relate to a particular ethnic group and that would enable us to understand the values and cultural prescriptions operating within a particular culture. Culture-generic competence is defined as the acquisition of knowledge and skills that are applicable across ethnic groups (Gerrish & Papadopoulos 2000).
The Papadopoulos, Tilki and Taylor (1998) model aims to help us deliver culturally competent care that ultimately ensures high quality care for all.
The Transcultural Skills Development Model published by Papadopoulos, Tilki and Taylor (1998) is situated within health and social care, is applicable across the world and has its strengths in the transparency of what is being asked of the multiculturist. The model conceptualises cultural awareness, knowledge and sensitivity and, through the synthesis of these, cultural competence is achieved
However, culture is not wholly definable, it is relative to those who live it and those who observe it and it is open to rapid changes as the world becomes more interactive. The literature tells us that education alone does not ensure culturally competent practitioners (Papadopoulos et al, 1998; Leininger, 2002) and self-awareness and reflection is essential to gaining cultural insight. There is evidence that care is still being given generically and without regard for culturally specific needs (Coffman, 2004; Cioffi, 2005).
Read more on:
Cioffi J. (2005). ‘Nurses’ experience of caring for culturally diverse patients in an acute care setting’. Contemporary Nurse. September, 20, 1, 78-86.
Coffman MJ. (2004). ‘Cultural caring in nursing practice: A meta-synthesis of qualitative research’. Journal of Cultural Diversity. 11, 3, 100-109.
Gerrish K and Papadopoulos I (1999): Transcultural competence: the challenge for nurse education. British Journal of Nursing, Vol 8 No 21, pp1453-1457.
Dalrymple J and Burke B (1995): Anti-oppressive practice. Social care and the law. Open University Press. Buckingham.
Leininger M M (1991): Culture care diversity and universality. A theory of nursing. NLN, New York.
Leininger M (2002). in Leininger M & McFarland MR. (2002). Transcultural Nursing. (Third edition). USA: McGraw-Hill. p71-98.
Papadopoulos I, Tilki M and Taylor G (1998): Transcultural Care: A guide for Health Care Professionals. Quay Books. Wilts. (ISBN 1-85642-051 5)
Papadopoulos I (Ed): (2006): Transcultural Health and Social Care: Development of Culturally Competent Practitioners. Churchill Livingstone Elsevier. Edinburgh.