Cultural Competency Across Generations

The case study in which I have selected to review for means of this assessment is case study number three, involving Hannah (school counselor), Lucia (friend to Hannah), and Elena (Lucia’s grandmother). Within this case study there are many possible issues to address. Hannah and Lucia’s professional and personal relationships, Elena’s grief from losing her husband, Lucia’s concern for her aging grandmother who may be presenting signs of Alzheimer’s, as well as the doctor’s inability to communicate with the patient (Elena), which leads Lucia to making decisions regarding Elena’s healthcare without discussing it first with her.

Physiological or Biological Perspectives could help address why the grandmother may be losing her memory after experiencing grief. It could be hypothesized that due to the grandmother’s grief, it is greatly impacting her memory (cognitive psychology theory) but if due to heredity it could be biological, and a symptom unavoidable—however, physiological perspectives would also argue the relation to that which an individual has been exposed (Tyonote, 2023). An additional theory that could help explain part of the issues addressed in this case study is Socio-Cultural Perspective. This theory would aid in explaining why the doctor would be willing to allow the granddaughter to make healthcare decisions, without first consulting the grandmother, the patient, as well as explaining why the granddaughter did not discuss the healthcare needs to her grandmother before proceeding with further testing—further, addressing the grandmother’s feelings of loss of control.

This case study specifically relates to culture-related attitudes that may affect future professional behavior due to the language barrier between Dr. Bhandari (English speaker) and Lucia (English speaker), and Elena (non-English speaker, but the case study does not specifically state which language she speaks). However, Dr. Bhandari also spoke in a thick Indian accent, so while she spoke English it made it hard for even Lucia to understand her in full. Having an interpreter present would be ideal in future professional settings to ensure each individual, especially the patient, understands what is occurring.

Cultural Issue

As briefly discussed above, the patients Nationality severely limits her from being able to communicate with her doctor. In this case, the granddaughter is forced to step up, and attempt to understand the doctor through a thick accent. This is assessed by reviewing Hays’s ADDRESSING Model (Hays, 2001), which gives power to U.S. born through National Origin, and less power to those that are immigrants or refugees. It is estimated that roughly 14 million people in 1990 had limited English proficiency (LEP), but it has now been estimated to expand to roughly 25 million in 2013 (Murphy et al, 2019). This is important and relevant to this case study, due to the fact that the patient and doctor were unable to communicate because of a language barrier. “Caring for patients across language differences is an important component of delivering culturally competent healthcare,” (Murphy et al, 2019). The granddaughter, Lucia, was present for this interaction but due to her not translating the conversation with the doctor, it left the English speakers in power over the situation, and gave less power to the grandmother. Which, left the grandmother, the patient, without communication from the doctor.

Theoretical Explanations

First, I would like to discuss the physiological or biological perspective theory, because it could help explain why the grandmother is in fact experiencing memory loss. It is said that grief, is essentially the cost of love, therefore at some point in time we will all experience grief from a human’s perspective, and that grief very well may alter our brains (Mills, 2022). In a lot of ways losing a loved one can be described as losing a part of oneself. Mills (2022) interviews an individual who states that when you fall in love, a part of your brain is re-wired to include them in your everyday normal activities, creating a ‘we’ not a ‘you and me.’ It is also then compared to phantom limb syndrome, where some individuals can feel as if their body part is still attached through itching, or pain in the missing body part. Mills’ interviewee describes a researcher at the University of Colorado-Boulder who studies voles, rodents who mate for life (2022). Within this description, the voles become so intertwined throughout their lifetime that when one of them dies there are physiological changes that are noted in the living vole, and at times it becomes nearly impossible for the vole to return to a normal state (state prior to the death of the loved vole) which causes neural and transcription changes in the brain (Mills, 2022). This very well could explain the memory loss experienced from the grandmother after the loss of her husband, five years prior, as this has been an ongoing concern which has only got worse over time.

The second theory I want to discuss is the Socio-Cultural perspective theory, which is described as “our personality, beliefs, attitude, skills, and values,” (Tyonote, 2023) that shape our “culture ethnicity, gender, religion, and other important socio-cultural factors,” including but not limited to how people interact. This would directly be related due to the fact that Elena’s culture taught her to speak a different language than English, and the doctor’s culture taught her to speak another language. This means that in this healthcare setting, there are two different cultures meeting, making it difficult for them to communicate. While they do have the granddaughter there for interpretation purposes, she may choose not to interpret based on culture beliefs where she may feel the need to take control over the situation, or just in general ensure that the elderly in her family receive all the best possible care. As frustrating as this is for the patient, and potential ethical dilemmas with this issue, the cultural aspect may explain why it was handled this way.

Professional Behaviors

The cultures and ethnicities of the two primary individuals, the doctor and the patient, may have been adversely affected due to their lack of ability to communicate with each other. The doctor’s inability to speak the patient’s language, and even so speaking English with a thick Indian accent, making it hard for the granddaughter as the interpreter to understand the doctor. Potential adverse effects caused due to the lack of communication, due to culture, language and ethnicity barriers, may very well contribute to adverse events in the medical treatment of the patient, as well as medical errors (Partida, 2007). Even with an interpreter, or with a doctor and interpreter who both speak English, many words can have many different means based on which culture you come from; knowing that a typical health dictionary has between forty thousand and fifty thousand words in it, this can still lead to confusion when translated across multiple different cultures, effecting the care the doctor can give and the care the patient can receive.

Research Findings

One research study conducted internationally included archival data based on fourteen separate studies conducted through various countries, including developed and developing countries, with each study utilizing approximately twenty-two thousand individuals. This resulted in 300,918 participants in total throughout the fourteen different studies. Each study selected utilized a different approach to data collection, ranging from interviews to incident reports to questionnaires to Medicaid records. The findings from this study concluded that interpreter services were necessary for 43.2% of patient and doctor interactions, and between 21% to 76% of doctors stated that they did not have access to interpreter services (Shamsi et al, 2020). Due to the limited access to proper interpreter services, it was analyzed that 30% of the patients had difficulty understanding medical instructions given to the patients, 30% of patients had a problem with reliability of information obtained from their medical provider, 49% of patients had trouble understanding a medical problem or emergency communicated from their doctor, 34.7% were confused about the administration or how to properly utilize medication, 15.8% had a negative reaction to medication, and 20% of individuals refused to seek medical attention unless they knew that proper services would be available for fear of a negative reaction improper healthcare given due to inability to properly communicate or understand (Shamsi et al, 2020).

A second research study regarding the onset of memory related problems after experiencing the death of a loved one was conducted in 2012 and in 2016. The independent variable of the study was whether or not an individual had experienced the death of a loved on within the past calendar year, a loved one could have consisted of spouses, children, family members, or a close friend (Atalay & Staneva, 2020). Men and women were separated and reviewed separately. The final sample included 842 women, and 751 men all aged 60 to 85 years old. Within the span of the four years observed 69% of women, and 67% of men lost their spouse, close friend or relative, with roughly 30% of the entire population selected having lost their spouse. Overall, based on tests utilized to assess reading levels, working memory and information processing, over the span of four years there was a standard deviation decline of between 0.07 and 0.13 cognitive decline for men, and the event was concluded to be insignificant for women (Atalay & Staneva, 2020). The speed of information processing for men would decrease by a standard deviation of 0.25, with the effect being significant at 5% (Atalay & Staneva, 2020). In regards to women, the effect was found to be significant in regard to the working memory where women would see a decrease in working memory at a decrease of a standard deviation of 0.31. It was additionally concluded that the findings showed a decrease in participation of mental exercises and social engagement activities, however these have been found to be preventative factors for cognitive decline if done.

Both of these studies are relevant to my current case study in the manner that the grandmother lost her loved one, spouse, within the previous five years, and now shows a cognitive decline for working memory. The grandmother is unable to have a personalized conversation with the doctor, discussing personal issues and home life that may have contributed to her cognitive functional decline, therefore treatments she receives may not work as effectively due to the cultural divide between the them.

Proposed Cultural Guidelines and Competencies

Cultural competencies that a psychologist can utilize to resolve this culture-related issue could be patient advocating and/or therapy involving a mental health professional who understands the beliefs, backgrounds, values, culture, race, ethnicity, socioeconomic status, and sexuality (Seales, 2022). The most specific competencies that could be utilized by a psychologist for this issue would be someone who understands the individuals background, ethnicity, and values. If the patient, the grandmother, feels understood and is actually understood, she may receive better treatment with fewer mistakes than if she does not.

The principles suggested to fix this issue, and prevent reoccurrence in the future, is to hire medical providers who have a (1) Strong sense of ethics and values, if they don’t believe that a patient can properly understand them, they should have the ethical responsibility to state that; (2) Self-awareness, medical providers should have and demonstrate at all times an appreciation for not only their own culture, but others as well; (3) Cross-Cultural Knowledge and Skills, medical providers should regularly utilize a broad knowledge base on different cultures, and how to interact with each different culture, and when they don’t know how to interact, communicate or so forth, they should know to speak up and ask for assistance for their patient; and (4) Language, lastly there should be plenty of interpreters available for patients across a wide variety of cultures (National Association of Social Workers, 2015). These would be competencies necessary for working in a culturally diverse environment, especially the Cross-Cultural Knowledge and Skills. By effectively utilizing cultural competence in the workplace you can not only help keep employees engaged, but you can also help keep better communication and coordination with co-workers and clients/patients. This will “increase engagement and productivity,” (Maryville University, 2023).

Personal goals and values on mine are to advocate and raise awareness for issues such as domestic abuse. In doing so, I have come across many different individuals from many different backgrounds, cultures, and values. By adopting psychology principles such as beneficence and nonmaleficence, I can ensure that I work to benefit those I am aiding, and not cause them further emotional, or psychological harm in the process; I can also utilize fidelity and responsibility by establishing relationships and trust with those that I work with, and I take note and am aware of the professional and scientific responsibilities I play in society when aiding others through trauma (healed and unhealed); I can additionally utilize principles of integrity, justice and respect for peoples rights and dignity by not only promoting accurate, honest and reliable information, but ensuring that I treat individuals the same across the board—whether that is maintaining confidentiality, privacy, respect for others differences and cultures, and ensuring I don’t have any biases or judgements toward others situations (American Psychological Association, 2017).

Conclusion

In conclusion, I can attest that my own attitudes associated with culture, ethnicity, and diversity affect my current and future professional behaviors by being self-aware of the impact I have when interacting with other individuals. Even if an individual is of the same culture as myself, there may be many differences still such as beliefs, and values. I am mindful of this as I interact with and teach children at the elementary school, and while advocating for abuse victims in my off time. The guidelines developed will assist me and help me grow to being a diverse and culturally accepting professional, advocate, and teacher. I will be able to assist others from varying backgrounds, teach others from varying cultures, and advocate for others that have different values. The guidelines will ensure that I hold no biases nor judgements, and that I maintain an open mind when interacting with individuals of any background. Steps that I would like to take in order to further grow my cultural competencies, is to help others establish and adopt these guidelines as well. Seeing and witnessing others overcome odds with the same guidelines, will help me grow and adapt the guidelines as necessary for practical use.

References

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