Cultural Competence and Patient Safety – ‘ABCD’ for Cultural Assessment
Published on the 20 November 2016
Published on the 20 November 2016
“I went to have some blood tests. The person doing the test was asking me questions but I couldn’t understand anything. There was no interpreter and I couldn’t ask for one because I don’t speak any English. Some days later a man called me on my mobile phone. He was talking in English. I tried to get someone off the street to listen and translate but the doctor just kept talking, talking and then hung up the phone. I don’t know how to get the results of my tests.” (Brough, 2006, p14)
Australia is one of the most culturally and linguistically diverse nations in the world. Almost 25% of the population were born overseas, over 200 languages are spoken, and 116 religions practiced (Australian Bureau of Statistics 2016). Although all Australians have the right to equitable healthcare, patients from culturally and linguistically diverse (CALD) backgrounds (including Aboriginal Peoples) experience almost twice as many adverse events as English-speaking patients (Multicultural Health Communication 2013), and they are more likely to experience medication errors, misdiagnosis, incorrect treatment, and poorer pain management.
Misunderstandings, miscommunication, and culturally-unsafe care by healthcare professionals are frequently reported (Johnstone & Kanitsaki 2006), and CALD patients often describe feelings of powerlessness, vulnerability, loneliness and fear when undergoing healthcare (Garrett et al. 2008).
While there is no single cause of the inequalities in healthcare experienced by CALD patients, research has identified that clinical encounters that do not acknowledge and address cultural factors contribute significantly to adverse patient outcomes and health inequality (Johnstone & Kanitsaki 2008). Thus, practical strategies for improving the provision of culturally competent care are needed. For example:
In this article I will focus specifically on how to undertake a cultural assessment. It is recognised that assessment underpins safe practice, and nurses are all too familiar with the need to routinely conduct fall risks assessments, pressure area assessments, nutrition assessment and vital signs etc.. Although cultural assessments are equally important, they are rarely a part of routine nursing care. The ‘ABCD’ mnemonic for cultural assessment (Kagawa-Singer & Backhall 2001) provides a structure for undertaking a cultural assessment that is easy to remember and put into practice.
Take the time to explore the attitudes and values of the patient and their family with regards to:
Determine the historical and political context of the patient’s life, including:
Also identify community resources that may be of assistance to healthcare professionals, patients and family members, such as translators, healthcare workers, community groups, religious leaders, and traditional healers.
Identify the general decision-making style of the cultural group, and specifically, the patient and their family. Explore whether individual or family decision-making processes are used. Ask questions such as:
When used consistently, the ‘ABCD’ mnemonic for cultural assessment will help you to improve communication with CALD patients and avoid stereotyping. Ultimately, undertaking cultural assessments will help healthcare professionals deliver safe and person-centred care to all people regardless of their race, ethnicity, culture or language.
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Professor Tracy Levett-Jones is the Director of the Research Centre for Health Professional Education at the University of Newcastle. Her research interests include: belongingness, clinical reasoning, empathy, interprofessional education, cultural competence, simulation and patient safety. Tracy has authored ten books, the most recent being 'Clinical Reasoning: Learning to think like a nurse' and Critical Conversations for Patient Safety'; as well as over 200 book chapters, reports and peer reviewed journal articles. Tracy has been the recipient of multiple teaching and learning awards and has been awarded over two million dollars in grant funding.