Culture and Critical Care.

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 all 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 competently with patients. A therapist who incorporates the model's 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 2--"What Is My Culture and How Do I Understand My Patient's 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.