Physiotherapy February 2003/vol 89/no 2

134

Slack Incorporated, Thorofare, New Jersey2001 (ISBN 1 55642 459 0). Illus. 190 pages

by Bette Bonder PhD OTR/L FAOTA, Laura Martin PhD andAndy Miracle PhD £28Current government policies in healthcare indicate that themanagement of culture in clinical care has been generallyignored, treated rather dismissively, or inadequately coveredby practitioners. Thus, those who are seeking guidance onthe topic and have developed levels of competency through'trial and error' should welcome the guidance this bookoffers. It presents a theoretical framework – the 'culture-emergent' from which practice is discussed and developed.

The 'culture-emergent' approach is presented in anuncomplicated way and encompasses the reflection andclinical reasoning that is the concern of practitioners incarrying out their daily work. It is supported by currentresearch and published works in contemporary journals.The authors are particularly careful in not providing aprescription for cultural care, but instead offer carefulguidance on the evaluation of the contexts in which care isdelivered in diverse communities.

The result is that although the book is American in origin,practitioners from other countries could make it applicableto the contexts in which they work. The authors also make itclear that the term ‘culture’ is all-encompassing and notlimited to the notion of ethnicity.

In attempting to tackle developing competencies incultural care, the authors have tried to maintain a dynamicapproach throughout the book by offering readers theopportunity to feed back their comments, and theopportunity to share these with other readers and users ofan identified website. Unfortunately, the registration processfor using the site was not straightforward.

The book is very careful in avoiding value judgements,although non-American readers will pick up an Americanflavour due in part to the backgrounds of the writers and theexamples they offer. It is important that reference is made tothe additional resource of the instructor's manual by anyone

contemplating using this book as a classroom text, since themanagement of the topic is prone to producing multipleconflicts.

One of the main aims of the book is for maximuminteraction between readers and the text through theexamples given, and although this has been in the mainsuccessful, readers who are pressed for time, and looking forready answers, may be tempted to deal with the exercisessuperficially and ignore the challenges.

The chapter headings and objectives are clearly stated andthis allows readers to dip into the appropriate paragraphs,although I would recommend a read of the whole book for individuals who are just beginning to understand thedevelopment of cultural competence.

The cases, developed through the captions, are on thewhole interesting, but for anyone dipping into the booktheir relevance may not be immediately apparent since thediscussions to which they relate are often placed on anotherpage. And some of the photographs are dated and thereforelacking in definition.

Even though it appears that the book is written withAmerican readers in mind, it offers scenarios for discussionsappropriate to any context. The text provides some much-needed guidance on cultural care, but difficulties accessingthe accompanying manual via the suggested website meantthat developing appropriate applications was limited.

Identifiable skills, for example observational ability, arehighlighted as part of the process of developing culturalcompetence from which practitioners can begin to evaluatetheir own position. Additionally, the characteristics ofindividuals engaging in effective intercultural interventionare also offered for reflection.

The general layout of the book makes the material withinit easily accessible and the index of cultures and glossary ofterms help to maintain its overall clarity. The cost of thebook compares favourably with many other texts of this type.Given the dearth of material on the topic and the wealth ofexperience offered by the authors, this book should be anessential text for those who are seeking to improve thequality of care they deliver across diverse communities.

Mel Stewart MEd MCSP DipTP CertEd(FE)

1. Guidance on the single assessment process for olderpeople

A section of this guidance ‘Key Implications for Therapists’is available in hard copy and also on the Department ofHealth’s dedicated single assessment website:www.doh.gov.uk/scg/sap

4. Cost effective provision of disease modifyingtherapies for people with multiple sclerosis

All patients with relapsing multiple sclerosis are eligible tobe entered into the scheme.

8. Pre- and post-appointment checks for all personsworking in the NHS in England

A schedule covering procedures for the appointment of allpersons working in an NHS body, whether they areemployees, volunteers or their services are hired. Where itis found that applicants intentionally or recklessly providedfalse details or withheld information relevant to theiremployment, they can be dismissed.

10.Hepatitis C infected healthcare workers

Recommendations on the circumstances requiring infectedworkers not to perform exposure prone procedures.

Additional copies of Health Service Circulars may be obtainedfrom the Department of Health, PO Box 777, London SE1 6XH.They are also available on the Department of Health website:http://www.doh.gov.uk/publications/coinh.html

Culture in Clinical Care

Department of Health Health Service Circulars 2002