This case study describes a situation involving an 85-year old resident, Mrs. Thompson, and her care worker Agnieszka at a nursing home. Mrs. Thompson fell in her room the previous night but did not report it due to concerns about losing her independence. The next day she tells Agnieszka she has back and hip pain. Agnieszka assesses Mrs. Thompson without explanation or consent, concluding the pain is minor without addressing her concerns. When Mrs. Thompson's pain increases, a doctor is called and discovers she has a hip fracture. The case highlights issues with lack of cultural competence, privacy, communication and advocacy during Mrs. Thompson's assessment and care.

1. MODULE 4:
CULTURAL COMPETENCE
Prepared by
Irena Papadopoulos and Alfonso Pezzella
Middlesex University London

2. 1. Gaining awareness of the national
and international legal aspects of
equality and discrimination,
guidelines, policies, best practice of
ageism.
4. Cultural aspects of safeguarding
and advocacy for older people
2. Learning to perform culturally
competent assessment of social care
needs of older people
3. Implementing person centred
culturally appropriate and
compassionate care
Module topics
Module 4:
CULTURAL
COMPETENCE
Summary
This module synthesizes and applies your learning from the previous three modules.
In particular this module aims to:
• Enhance your knowledge of principles of equality, non-discriminatory practice,
confidentiality and trustworthiness
• Discuss how to perform cultural competent assessment of patient’ needs
• Explain the importance of person centred culturally appropriate and
compassionate care
• Advocate for the patient’s human rights of older people including that of
safeguarding
There are four topics in this module:
Aims
Module topics

3. This topic aims to discuss how to perform cultural
competent assessment of patient’ needs.
Summary
This topic will help you to learn how to assess an older
person’s healthcare needs through a number of activities.
Firstly, you are introduced to a case study which will be
used in the remaining days of this module to help
integrate all the knowledge skills and other information
you have gathered during the previous three modules.
Secondly, we want you to watch a short video about
cultural competence in healthcare. And lastly, we ask you
to watch and listen a PowerPoint presentation about the
Papadopoulos, Tilki and Taylor model of cultural
competence.
Module 4: CULTURAL
COMPETENCE
Topic 2
Culturally competent
assessment
Day 2: Aim
Importance of consent
Patients as partners
Sensitivity with regards to
time and priorities
Case study
Learning activities
Resources
Quiz of the day

4. Learning activities
1) Please read Mrs Thompson’s case study which you can find
on slide 7. Answer the following questions:
What are the issues outlined in the case study above?
What could have been done to avoid the
misunderstandings?
What could have been done to ensure the provision of
culturally competent and compassionate care to Mrs
Thompson?
2) Watch the following 3.43 minutes video entitled: What is
Cultural Competence in Healthcare?
https://www.youtube.com/watch?v=rEtZChPb-
6c&ab_channel=ArthurWitkowski
3) Watch and listen a PowerPoint presentation about the
Papadopoulos, Tilki and Taylor model of cultural
competence.
https://www.youtube.com/watch?v=ePkAqEv9OuI
4) Post your answers to the three questions in activity 1 to
the discussion board.
5) List the key points made in Professor Papadopoulos’
presentation and post them onto the discussion board.
6) Read 2 to 3 entries of your fellow participants and provide
feedback to one of them.
NOTE: if you have time today or at a later date, please read the
document entitled “Culturally Competent Assessment and
Consultation” by clicking on the link below
https://tinyurl.com/ydaohvz2
Module 4: CULTURAL
COMPETENCE
Topic 2
Culturally competent
assessment
Day 2: Aim
Importance of consent
Patients as partners
Sensitivity with regards to
time and priorities
Case study
Learning activities
Resources
Quiz of the day

5. Case study:
Mrs Thomson is a 85 year old White English lady who is a retired school mistress. She moved to a large and busy care
home following a stroke. Her speech was not affected by the stroke, but she has some memory issues. Mrs Thomson
has a slight weakness on one side of her body and she uses a walking frame which provides stability when she is
moving.
Despite the use of a walking frame, yesterday evening she had a fall whilst on her own in her bedroom but she managed to
get up. However she did not make any of the health workers aware of this. In the past she always took pride in the fact
that she had been very independent and in control of her life. She now feels embarrassed about losing control and fears
her dignity will be compromised if she admits to this. The next day Mrs Thompson wakes up with some back and hip
pain which she hopes it will subsides once she is out of bed. However, due to the persistence of the pain, she has
reluctantly informed her care worker that she has pain in her hip and back and would like to see the doctor.
Mrs Agnieszka Safarova, the care worker assigned to Mrs Thompson, is a qualified nurse in her country, who has recently
moved to the UK. Agnieszka likes working with older people and as a qualified nurse in her own country, she feels well
able to conduct an assessment of Mrs Thompson after which she may or may not call the doctor. Agnieszka believes
that the aim of care for older people should be to keep them safe, clean and fed. She believes that ‘expensive’
interventions for old people should not be provided since they have lived a long life and most probably will not live much
longer even with the latest treatments.
Agnieszka begins her assessment without much explanation as to what she is doing, or explicit consent by Mrs Thompson
who shares a room with another lady. Mrs Thompson shows signs of discomfort when Agnieszka undresses her without
due concern of her privacy, but the signs are ignored by Agnieszka who also fails to answer any of Mrs Thomson’s
questions.
When she finishes her assessment Agnieszka concludes that apart from a small bruise, there is nothing wrong with Mrs
Thompson who, in her opinion, is merely asking for attention. She gives Mrs Thompson a pain killing tablet and
reassures her there is nothing to worry about. She reports her actions to the care home manager and enters a brief note
in Mrs Thompson’s records.
Later in the afternoon, Mrs Thompson reports that her pain is getting worse and she requests again to see a doctor.
Agnieszka, informs the manager who calls the locum doctor, who arrives 20 minutes later.
Mrs Thompson tries to explain how she feels to the doctor but Agnieszka takes over, indicating to Mrs Thompson to be silent
as the doctor “knows what he is doing”. The doctor decides that Mrs Thompson needs an X-Ray to exclude any
fractures. Arrangements are made and Mrs Thompson is accompanied to the hospital by another care worker as
Agnieszka goes off duty. This care worker, is aware that Agnieszka often ignores the residents but she believes this is
because she is always very busy and has no time to listen to them. In this instance, although she was aware and a little
concerned about what was going on with Mrs Thompson, she chose not to intervene or say anything to her colleague or
the manager.
Following the X-Ray, it is discovered that Mrs Thompson has a hip fracture and is kept in hospital for treatment.