Rehabilitation Nursing Rehabilitation NURSING KEY WORDS culturally competent care disability diversity Culturally Competent Care Complements Interactions with People with Disabilities Paul Nathenson, MPA RN CRRN HN-BC This article describes the concept of disability as a culture, discusses key components of cross-cultural communication with people with disabilities, and identifies the key elements of providing culturally competent care to people with disabilities. To gain an understanding of cultural competence, it is important to understand the concepts and definitions of culture, dis- ability, and competence. The World Health Organization classification of functioning, disability, and health will be used as the theoretical model in the discussion on disability. J. Campinha-Bacote’s Cultural Competent Model of Care is used as the theoretical model for the discussion on cultural competence. When one thinks of cultural diversity, ethnic minori- ties immediately come to mind. That in itself is a bias because one of the largest minority groups is people with disabilities, who number 52.6 million in the United States (McColl, 2005). People with disabilities have a distinct culture of shared beliefs and concerns. It is important for nurses to recognize the disability culture so they can provide comprehensive and indi- vidualized care. This article describes the concept of disability as a culture, discusses key components of cross-cultural communication with people with dis- abilities, and identifies the key elements of providing culturally competent care to people with disabilities. Providing culturally competent care ensures sensitiv- ity, respect, and understanding, which enables clinicians to best understand and support patients’ needs and make individualized and appropriate treatment decisions. Each person has his or her own value system and bias. To be- come culturally competent, one must acknowledge and understand their acquired bias. Cultural competence is a developmental process that evolves over an extended period. Both people and organizations have various levels of awareness, knowledge, and skills along the cultural competence continuum (Cross, Bazron, Den- nis, & Isaacs, 1989). According to the American Nurses Association position statement on cultural diversity and nursing practice, “knowledge and skills related to cul- tural diversity can strengthen and broaden healthcare delivery. A culturally competent nurse considers specific cultural factors that impact individual clients and recog- nizes that intracultural variation means that each client must be assessed for individual cultural differences. It is essential that nurses understand how cultural groups define health and illness” (1991). Culturally competent care acknowledges and understands cultural diversity in the clinical setting, respects health beliefs and practices, and values cross-cultural communication. To understand cul- tural competence, one must understand the concepts and definitions of culture, disability, and competence. The World Health Organization (WHO) classification of func- tioning, disability, and health will be used as the theoretical model in the discussion on disability. The Cultural Compe- tent Model of Care will be used as the theoretical model on cultural competence (Campinha-Bacote, 2002). Healthcare agencies define disability differently. The Americans with Disabilities Act (ADA), the U.S. Social Security Administration, the Centers for Disease Control and Prevention (CDC), and the WHO all have different definitions of disability. In addition, publications such as the Guides to the Evaluation of Permanent Impairment, the International Classification of Diseases, and the Diagnostic and Statistical Manual of Mental Disorders (DSM) contain unique definitions. Each agency requires a definition for purposes specific to their mission or charge. For example, the purpose of the ADA is to protect the rights of people with disabilities. The ADA provides a legal definition to identify people protected under the act. The U.S. Social Security Administration defines disability for the purpose of determining eligibility for assistance, such as Medic- aid or welfare. The CDC defines disability in terms of an epidemiological model for disease management. The WHO’s conceptual model can be used universally to define disability and communicate statistics and demo- graphic data about people with disabilities on a global scale. The Guides to the Evaluation of Permanent Impairment defines disability to determine the needs of people with disabilities for the purpose of life planning. The Interna- tional Classification of Functioning, Disability and Health (ICF) provides a standardized language and framework that defines disability for the WHO. The DSM provides definitions and explanations of mental disorders. Although these agencies and pubications provide def- initions of disability for specific purposes, the variety and differences of these definitions can be confusing. A more simplified version can be defined in terms of limitations that may affect one or more activities and affect physical, Rehabilitation NURSING Log onto www.rehabnurse.org and visit the Education page for more details FREE CE OFFERING FOR ARN MEMBERS