Developing Cultural Competence in PT Practice - APTA
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C MDeveloping Cultural Competence in Physical Therapy Practice Denise Gaffigan Bender PHYS THER. 2006; 86:1169-1170.
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Culture and Critical Care Lipson JG, Dibble SL, eds. San Francisco, CA 94143, UCSF Nursing Press, 2005, paperback, 487 pp, illus, ISBN: 0-94367122-1, $33.95. Developing Cultural Competence in Physical Therapy Practice Black Lattanzi JF, Purnell LD. Philadelphia, PA 19103, FA Davis Co, 2005, paperback, 444 pp, illus, ISBN: 0-8036-1195-1, $36.95. Cultural competency establishes a foundation of mutual respect and understanding, which in turn allows patients and practitioners to communicate successfully with each other. Health care professionals must recognize the impact of culture on issues of health care access, service delivery models, and willingness to participate in care. Cultural competency is not an easy topic on which to write. Authors must skillfully navigate the uneasy line between offering the type of vague generalities that provide little guidance and making sweeping generalizations that inadvertently reinforce stereotypical viewpoints. Lipson and Dibble, faculty members in community health and social/behavioral science programs, and Black Lattanzi and Purnell, faculty in physical therapy programs, have written comprehensive texts that approach the topic of cultural competence from different but complementary viewpoints. Although each book is well written and comprehensive on certain aspects of the topic, together the texts provide students and practitioners alike with a comprehensive overview of the complex topic of cultural competency. Culture and Clinical Care, by Lipson and Dibble, offers a practical, information-oriented approach to cultural issues that often affect interactions between health care professionals and patients. The book begins with an introductory section that provides an overview of the topics of diversity and culturally competent care. The authors frankly express their views that a text on culture should be used as a way to appreciate the differences between, as well as within, cultures rather than as a source of factual information that applies to all members of a particular culture. The introduction also
provides an explanation of the categories of content chosen for inclusion in subsequent chapters. There are 35 chapters of varying lengths in the book and each one addresses the beliefs, values, and attitudes of a different ethnic or cultural group. The chapters include the same content areas for each group. Each provides updated information on cultural identity, spiritual orientation, communication, activities of daily living, dietary practices, symptom management, birth rituals, natal care, sexuality, family relationships, illness beliefs, health issues, and death rituals. Most chapters are written by several authors and include at least one member of the ethnic or cultural group, as well as authors with backgrounds in health, sociology, or anthropology. The end of each chapter lists selected references; however, it would have been more helpful for the reader to have access to the complete reference lists. The authors use their multidisciplinary experiences to provide content that goes beyond standard medical information and allows a glimpse into how different people may feel, believe, and think. This text is an excellent choice for use by students and health care professionals because it offers a more expansive world viewpoint than many medical texts. Developing Cultural Competence in Physical Therapy Practice, by Black Lattanzi and Purnell, provides a mixture of information about each culture, case studies, and reflective exercises for the reader to complete. This text is intended for the physical therapy community, but the title is needlessly limiting. The well-written, thought-provoking information presented in this text would be equally useful for students in nursing, medicine, and other allied health disciplines. The book is divided into 2 parts, with each part split into sections. The first section in part 1, What Is Culture and How Do I Grow in Cultural Competence?, outlines the Purnell Model of Cultural Competence. This model, designed by coauthor Larry Purnell, provides a broad overview of cultural issues from a perspective that spans global, community, family, and individual concerns. According to the authors, this model prepares practitioners to interact more com-
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petently with patients. A therapist who incorporates the models framework will develop a practice based on the steps that Black Lattanzi defines as essential for the achievement of a culturally competent clinical practice. In section 2What Is My Culture and How Do I Understand My Patients Culture?readers explore beliefs about sickness, wellness, and spirituality. Then, through case scenarios and reflective questions, clinician readers can examine the influence of culture on the personal lives, family interactions, and workplace behaviors both of themselves and of their patients. The first section in part 2, Focusing on Selected Ethnic Cultures, offers specific information concerning 6 cultural and ethnic groups. This information, although addressing fewer populations, is similar in organization but narrower in scope than the content provided in the Lipson and Dibble book. Although the authors of sections in Developing Cultural Competence have either personal or professional experience with the populations being discussed, not all sections are written by authors who are actual members of the ethnic or cultural group. That kind of credibility offered additional depth to the Lipson and Dibble material. The second section of part 2, Highlighting the Culture of Various Physical Therapy Populations, discusses some of the subpopulations that are typically seen in a physical therapist practice and that may share one characteristic but have dissimilar cultures or ethnicities. For instance, the authors discuss the cultural characteristics related to military service, homelessness, disability, and age in terms of commonly encountered beliefs, values, and behaviors. The content emphasizes the considerable variation within these populations due to individual differences in primary and secondary cultural characteristics. The extensive reference lists provided for each population in this section are an excellent resource.
The final section of part 2, A Continuum of Cultural Competence, offers advice on how to incorporate the principles of culturally competent care into professional practice. This information, which is not offered in the Lipson and Dibble text, takes the book out of the realm of a student text and makes it equally valuable for practitioners. Too often a textbook focuses only on why cultural competency is important and fails to offer guidance through the crucial step of incorporation into clinical practice. Not only is the Black Lattanzi and Purnell book very appropriate for professional (entry-level) classroom use, but a seasoned therapist could continue to grow professionally by periodically reviewing the cases and participating in the reflective exercises. The authors of both books involved other writers who bring a myriad of academic, research, publication, and personal experiences to these books. They convey their beliefs that cultural competency cannot be treated as specific content that can be quickly mastered and applied. Instead, they propose that cultural competency is a continual process of becoming more aware of our own uniqueness and that of others, and understanding how the cultural perceptions on both sides can affect our interactions in health care and in life. Together, these 2 books cover the depth and breadth of this complex topic in a sensitive and respectful manner. When read together, these books provide the reader with an opportunity to learn new information, apply it to a clinical situation, and then reflect on how this knowledge may change his or her views. Denise Gaffigan Bender, PT, JD, GCS University of Oklahoma Health Sciences Center Oklahoma City, Okla Bender is Associate Professor in the Department of Rehabilitation Sciences Program in Physical Therapy and an attorney licensed in Oklahoma. She teaches in the areas of administration, professional issues, law and medicine, and geriatrics.
Medical Terminology Simplified: A Programmed Learning Approach by Body Systems, ed 3 Gylys BA, Masters RM. Philadelphia, PA 19103, FA Davis Co, 2005, paperback, 587 pp, illus, ISBN: 0-8036-1254-0, $38.95. Medical Terminology Systems: A Body Systems Approach, ed 5 Gylys BA, Wedding ME. Philadelphia, PA 19103, FA Davis Co, 2005, paperback, 559 pp, illus, ISBN: 0-8036-12494, $46.95. Health care professionals must be able to communicate effectively with each other and with patients, both verbally and in writing. Patients and clients need information and instruction in terms that are clear and accessible to the layperson. But communication among health care professionals requires that practitioners use technical language and medical terminology to convey information concisely and unambiguously. These 2 medical terminology texts are straightforward and uncomplicated resources for those in health care and for the layperson, and they attempt to explain and teach the language of health care and medicine. Medical Terminology Simplified: A Programmed Learning Approach by Body Systems is meant to provide an easy and quick way to learn basic medical terminology. The programmed-learning approach uses a wordbuilding method to develop vocabulary in a workbook format. Readers actively participate in learning by filling in blanks as they read the text, completing interpretive activities as new terms are introduced and reinforced, and answering matching questions that reflect current usage. The step-by-step approach of building words from roots, combining forms, and using suffixes and prefixes allows for the rapid acquisition of medical terms. Medical Terminology Systems: A Body Systems Approach is designed to enhance effective communication among health care professionals. It uses a traditional textbook format with learning activities incorporated throughout that reinforce basic principles and promote retention of vocabulary as it is learned.
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Introductory chapters in both texts present the basic rules of medical word building from the 4 elements of word roots, combined forms, suffixes, and prefixes. Body structure is addressed before vocabulary is developed in subsequent chapters that address the integumentary, respiratory, digestive, cardiovascular, lymphatic, musculoskeletal, genitourinary, reproductive, endocrine, and nervous systems. Each text includes a chapter on the special senses of vision and hearing. Each chapter in both texts presents learning objectives; medical word elements; abbreviations; pathological, diagnostic, and therapeutic terms; and learning activities. Medical Record Activities sections incorporate current medical terminology in context of medical record entries. Readers are able to see how the vocabulary and abbreviations are used in typical applications. Progressive acquisition of terms and consistent reinforcement of previously introduced word elements are common to both texts. These editions share common enhancements. Correct spelling and pronunciation are emphasized and reinforced throughout both texts. Audio CDs are available for each edition and provide correct pronunciation in appropriate contexts. Full-color illustrations are used liberally to enhance and visually reinforce the texts. Readers are encouraged to label figures as they learn the names of structures and related physiological, pathological, diagnostic, and therapeutic terms. Each text contains appendixes with answers to the learning activities for each chapter, abbreviations, and a glossary of medical word elements. Pronunciation guidelines and rules for plural suffixes are provided inside the front and back covers. Medical Terminology Simplified contains appendixes of diagnostic and therapeutic procedures, drug classifications, medical specialties, and Spanish translations. Medical Terminology Systems contains indexes of genetic disorders, diagnostic imaging procedures, pharmacology, and oncological terms. These texts can be incorporated into a variety of teaching and learning approaches.
They are self-instructional and could be used in stand-alone courses or incorporated into traditional and nontraditional educational programs. The medical vocabulary is presented in association with anatomy, physiology, pathology, and medical treatments, and, therefore, readers should have a basic understanding of those topics. However, a comprehensive medical dictionary is needed to fully appreciate new medical vocabulary, and Tabers Cyclopedic Medical Dictionary (also published by FA Davis Co) is the recommended companion reference. Activity packs are available for instructors who adopt the texts. Paperback activity packs contain suggested course outlines, student and instructor-directed activities, medical record activities, crossword puzzles, question banks, and master transparencies. Instructors resource CDs that contain activity packs, electronic test banks, lecture notes, PowerPoint presentations of lecture notes, illustrations, and a Med TERMinator program that reinforces key terms are also available. Students of medical transcription are the only audience identified by the authors; however, these texts are useful to students in all health care professional education programs. Medical Terminology Simplified is a basic introductory text designed to quickly build medical terminology and is appropriate for students in physical therapist assistant programs. Medical Terminology Systems is a more advanced text that is meant to develop verbal and written communication skills among medical practitioners and is most appropriate for students in professional (entry-level) and transitional doctor of physical therapy programs. These updated, enhanced, and timely learning tools are of good value to any physical therapy educational program. The major differences of these editions from previous editions are the inclusion of full-color illustrations that serve to support and enhance understanding of the medical concepts and provide a visual tool to enhance the learning and retention of the related terminology. The other major difference is the authors decision to eliminate the use of possessive eponyms, which is consistent with current usage in medical dictionar-
ies, by the American Association for Medical Transcription, and by the American Medical Association. M J Gelsomino, PT, DPT Utica College Utica, NY Gelsomino is Assistant Professor of the Physical Therapy Program at Utica College. She teaches basic to advanced neuromuscular and musculoskeletal content in the professional doctoral program.
Orthopaedic Clinical Examination: An Evidence-Based Approach for Physical Therapists Cleland J. Carlstadt, NJ 07072, Icon Learning Systems, 2005, paperback, 516 pp, illus, ISBN 1-929007-87-6, $64.95. The stated goal of this textbook is to serve as a supplement in academic musculoskeletal evaluation courses and also to provide a quick reference guide for clinicians who want to enhance their ability to incorporate research evidence into their clinical decision-making process. The intended audience for this book includes educators, students, and clinicians involved in the examination of patients with musculoskeletal impairments. This book contains 12 chapters. The first chapter introduces the evidence-based practice paradigm and reviews statistical concepts and measures relevant to reliability, diagnostic accuracy, and predictive validity. The second chapter deals with search strategies and subsequent critical evaluation of articles on diagnostic utility. The theoretical concepts introduced in these first 2 chapters are clearly illustrated th tables, figures, and clinical examples. The remaining 10 chapters are each devoted to a specific region of the body. Each chapter starts with a review of osteology, arthrology, myology, and neurology. This is followed by a review of data on the reliability of measurements from the patient history and physical examination. All chapters end with a discussion of data on diagnostic accuracy of relevant tests and measures.
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The book is illustrated with 169 highquality, full-color Netter and Netter-style drawings and 173 color photographs. Throughout the book, 281 well-organized tables provide an easy overview of quantitative data on reliability and diagnostic accuracy of specific tests and measures. The tables also provide easy-to-follow information on the performance and scoring of each test and measure. Data on patient population and the reference standard used are included in all tables, which allows readers to determine external validity with regard to their own clinical situation. An appendix includes a clear description of performance and scoring of additional orthopedic tests that have not yet had their psychometric properties investigated. An index at the end of the book allows for quick access to relevant data.
To my knowledge, this book is the only text available that combines clear yet concise descriptions of orthopedic test performance and scoring with data on the psychometric properties of these tests and measures. The text translates relevant statistical concepts to the clinical situation but is not meant to replace more indepth textbooks on statistics and methodology. New research is continuously being produced in the area of reliability and diagnostic accuracy of orthopedic tests and measures, which will surely date the text. However, the text is as comprehensive and the references are as up-todate as can be expected. This book is well written and well organized and the tables, figures, and photographs greatly enhance the text and make the information quickly accessible to the reader. In summary, this book most certainly meets
its stated goals, making this the most logical choice for a required text for a musculoskeletal evaluation course. It also will undoubtedly serve as a muchused, clinically useful reference text for every student, educator, and clinician involved in musculoskeletal care. Peter A Huijbregts, PT, DPT, OCS University of St Augustine for Health Sciences St Augustine, Fla Huijbregts is Assistant Professor of Online Education, teaching courses in orthopedic basic science, research, and spinal instability. He also is a clinical consultant at Shelbourne Physiotherapy in Victoria, BC, where he primarily treats patients with spine-related conditions and is an educational consultant for Dynamic Physical Therapy in Cadillac, Michigan.
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Traumatic Brain Injury: Rehabilitative Treatment and Case Management, 2nd ed Ashley MJ, ed. Boca Raton, FL 33487, CRC Press, 2004, hardcover, 800 pp, illus, ISBN: 0-8493-1362-7, $149.95. Traumatic Brain Injury: Rehabilitative Treatment and Case Management is a text designed to be both a clinical reference tool and a teaching text for clinicians working with people with acquired brain injury. The text is comprehensive and meets the editors stated objectives of addressing treatment, education, and advocacy issues for clinicians working with people with brain injury. The content richness of this book comes in part from the diverse background of the 43 contributors who represent the work of researchers and clinicians. The book is not meant to provide an all-inclusive reflection on the many unique challenges facing people with brain injury, but it thoughtfully addresses issues affecting the quality of life of people with traumatic brain injury. The text is divided into 3 parts, with chapters organized around the themes of medical, allied health, and case management. The 10 chapters comprising the part on medical themes (part 1) present strong basic science grounding for the allied health chapters that follow. Chapters on the management of posttraumatic epilepsy and on neurotransmitters and pharmacology are particularly useful as reference chapters for clinicians. The chapters on visual and auditory assessment and function provide a neuroscience review with intervention-specific ideas for clinicians specializing in vestibular dysfunction and the challenges of postural control. These chapters could be stand-alone readings used to organize specific units in a professional or postprofessional curriculum. The chapter on aging and related neuromedical issues recognizes the chronicity of traumatic brain injury, and although not intended for a lay audience, reflects the editors desire to provide information for caregivers that allows for planning for the future.
The chapters in the allied health section (part 2) have a strong emphasis on cognitive rehabilitation and behavioral analysis and planning. One chapter in this section is dedicated to the management of physical deficits. This chapter reads as 2 parts: examination and intervention. The examination section is a good resource, providing sample tools and testing procedures for a variety of impairments and functional limitations. The intervention section is categorized by common problems encountered during the rehabilitative process, including pain, mobility dysfunction, impaired postural control and balance, cerebellar dysfunction, and sensory dysfunction. Specific challenges, such as a return to driving, are addressed as well. Future editions of the text should include additional in-depth information on interventions to promote cardiovascular fitness. Special rehabilitation concerns are addressed in separate chaptersmost notably, the strategies for school participation and transition. Most, but not all, chapters in the allied health section make teaching points through addition of thoughtfully presented case studies. The final part addresses issues of case management. Although this section is shorter than the medical- or allied healththemed parts of the text, the inclusion of specific chapters addressing issues of case management, litigation and settlement, bioethics, and discharge planning in this text illustrates the editors attempt to address more than the medical or rehabilitation aspects of brain injury recovery. The bioethics chapter in particular provides the opportunity for reflective discussions about driving, restraints, and informed consent for beginning practitioners who may not have yet experienced these challenges in direct care delivery. The chapter is organized around specific bioethical principles and then features a targeted case study to translate principle into practice. The text meets the needs of beginning or experienced clinicians who want a comprehensive reference text for brain injury rehabilitation. Chapters are well
referenced and provide the reader who wishes to explore additional literature for further information. The book has a bias toward the challenges that cognitive and behavioral impairments present in the return to pre-injury function. That said, often the cognitive and behavioral challenges limit recovery most, so the bias reflects many therapists practice realities. Figures, tables, photographs, and charts are used to augment teaching points throughout. Although a large number of experts contributed to this text, the editor has paid careful attention to readability, and the depth of contributors is a strength, not a distraction. The text as a whole is likely too population-specific to be a primary text for a beginning clinician. Physical therapists will find that the emphasis on examination strategies in many chapters will make this book a welcome reference. Kathryn R Zalewski, PT, PhD University of WisconsinMilwaukee Milwaukee, Wis Zalewski is Interim Program Director for the University of Wisconsin System Consortial Doctor of Physical Therapy programs at the UWMilwaukee campus and currently researches the impact of aerobic activity on the lives of adults with disabilities caused by stroke or brain injury.
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Developing Cultural Competence in Physical Therapy Practice Denise Gaffigan Bender PHYS THER. 2006; 86:1169-1170.
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