RAISING AWARENESS: A Quest for New Directions in Cultural Competence Development

Journal of Multicultural Nursing & Health, Summer 2005 by Jeffreys, Marianne R, Riley-Eddins, Essie Alberta

As Special Editor of the Summer 2005 issue of the Journal of Multicultural Nursing and Health (JMCNH), I am pleased to present the Special Edition theme of "Raising Awareness". One purpose of the special edition is to feature cultural topics under-represented in the nursing and health literature that demand greater "awareness" and attention. Another purpose is to introduce strategies and frameworks that can guide future learning, practice, education, and inquiry in the quest for cultural competence development. Throughout the edition, readers are encouraged to pause, reflect, and question in order to gain new insights and perspectives. Hopefully, these new insights will stimulate a new vision that reaches beyond the "safe, popular, and non-controversial" cultural topics. This new vision calls for the re-examination of well-represented topics using new perspectives, a sincere search for under-represented and new topics, and a strong determination to tread new paths despite the challenges and obstacles that accompany the exploration of new territories.

The "Raising Awareness" edition begins with a re-examination of cultural competence using two conceptual models. First, Dr. Larry Purnell presents his model of cultural competence as an organizing framework for guiding cultural competence development among multidisciplinary health care professionals. His paradoxically succinct yet detailed model illustration neatly clusters the primary and secondary characteristics of culture for person, family, community, and global society; his narrative details major concepts and definitions, providing readers with a common framework for further learning and action. In particular, two features of Purnell's model challenge health care professionals to "raise awareness" continually. First, the darkened center of the circle shaped model (representing unknown phenomena) serves as an important reminder that there will always be unknown phenomena in the ongoing quest towards becoming culturally competent. Second, the nonlinear concept of cultural consciousness raises awareness that individuals may be unconsciously incompetent, consciously incompetent, consciously competent, or unconsciously competent, thereby challenging health care professionals to continually re-examine personal and varied perspectives.

Exploring a new and challenging path, Dr. Josepha Campinha-Bacote introduces a new perspective on her well-known model describing the process of cultural competence. She "chose the potentially controversial path of presenting a model of cultural competence that has its foundation in the Bible" (Campinha-Bacote, p. 16). Despite the predominance of Christianity within the United States, articles presenting a Christian or Biblical perspective is a glaringly under-represented topic within the general and multicultural health literature; hence her article adds substantially to the "raising awareness" journal theme. In addition to demonstrating the dynamic changes and evolutionary growth of conceptual models and scholarly inquiry, Dr. Campinha-Bacote's article stimulates readers' philosophical thought and self-reflection on the journey towards becoming more culturally competent.

The journey towards becoming more culturally competent necessitates an ongoing quest for advancing understanding and gaining insight into another's world. Dr. PaJa Lee Donnelly builds upon her previous program of research concerning mental health within the Korean American community by sharing her qualitative study findings concerning mental health beliefs and help-seeking behaviors of Korean American parents of children with schizophrenia. Selected excerpts poignantly describe the anguish, shame, and stigma experienced by the interviewed study participants, contributing new insights regarding Korean Americans and mental health beliefs. Details concerning metaphors, subtle meanings, and nuances unique to Korean communication raise awareness specific to Korean Americans and inspires health care professionals to become more aware about communication differences within and between diverse groups. In her description of "Shin-byung", a Korean culture bound syndrome included in the Diagnostic and Statistical Manual of Mental Disorder (DSM IV), Donnelly raises awareness about this culture-bound syndrome. Readers can also consider the possibility of other culture bound syndromes included in the DSM IV and the possibility that many other culture bound syndromes are not even classified. Finally, Dr. Donnelly's recommendations provide health care professionals with valuable and practical information to develop culturally congruent programs.

Similarly, Dr. Eleanor Campbell provides readers with valuable and practical information to develop culturally congruent approaches for child abuse recognition, reporting, and prevention. First, she takes on the controversial topic by exploring the "dichotomy between cultural practices of child rearing and the legal definition of child abuse" (Campbell, p. 35). Legal definitions provide the reader with a common framework to guide decision-making and mandated reporting. Dr. Campbell skillfully integrates Leininger's theory of cultural care diversity and universality within a case exemplar, demonstrating the easy usability and value of the theory in guiding culturally congruent professional practice. Notably, she raises awareness that issues concerning child care, child rearing practices, and child discipline among culturally diverse, economically diverse, and educationally diverse groups vary tremendously, necessitating further inquiry, understanding, action, and collaboration.