Clinical Neuropsychologists Assessment of Cognitive

Clinical Neuropsychologists Assessment of Cognitive. Cultural and linguistic diversity in the population implies the presence of language differences as well as cultural beliefs and affiliations. Australia is one of the countries with the most diverse populations that have emanated from migration into the country for decades. This multicultural population has adopted diverse belief systems that have impacted societal norms, values (APA, 2003). This has inevitably influenced psychological practices, and the psychological processes.

            Cultural and linguistic diversity poses significant challenges pertaining to neuropsychological assessments of cognitive functioning and presents several ethical dilemmas. Neuropsychological assessment tools face the challenge of cultural sensitivity to avoid issues such as false positives. Like other healthcare disciplines, neuropsychologists are expected to show cultural sensitivity while interacting with culturally and linguistically diverse individuals since this informs the quality of care delivered (Puente et al., 2013). Some of the issues involving assessing individuals from culturally and linguistically diverse backgrounds include a higher likelihood for diagnostic mistakes, ethical risks, and the potential incorrect application of interventions that may result in ineffective treatments. In line with such risks, it is important to address the problem of current neuropsychological assessment tools to improve the validity of the outcomes for those of culturally and linguistic backgrounds. As Daughtery et al. (2017) note, the adoption of more representative normative standards linked to assessment tools is important in neuropsychology since it improves validity of assessments. The paper that follows discusses the current approaches used by clinical neuropsychologists in the assessment of culturally and linguistically diverse individuals as well as factors affecting the validity of the assessments.

Clinical Neuropsychologists Assessment of Cognitive

            The quality of care in the health setting is determined by various influences, where effective nurse-patient communication has been identified as an essential factor affecting the quality of care. The quality of this relationship affects the neuropsychology discipline since health neuropsychologists have to first develop an effective communication approach with the patient. In Australia, the percentage of the population born overseas has been constantly increasing, and this has brought about cultural and linguistic diversity. The diversity has significant impacts on the nurse-patient relationship because the relationship has to be defined by cultural and linguistic competence (Candlin & Roger, 2013). Patients in Australia include not just the English speakers but also others coming from diverse backgrounds including the local indigenous population. In light of this, Shen et al. (2012) identify that communication and language barriers have been identified as a large concern by employers, nurses, and regulatory agencies. The Australian Nursing and Midwifery Council (2018) identifies that registered nurses need to communicate effectively with groups and individuals in the facilitation of care. Despite this, no guidelines have been established to ensure that this occurs; hence, indicating that cultural and language differences remain a major cause of ineffective care delivery.  With neuropsychologists being part of the health professionals, the implication is that the application of assessment approaches for cognitive functioning in culturally and linguistically diverse patients face constraints from cultural and linguistic competence. Where constraints are present in the interaction, they pose a negative impact on the validity of outcomes yielded by the assessment tools.

            Current assessment tools used in neuropsychology raise several validity problems, as procedures, constructs, and standards used in designing the tools are conceived and developed from the dominant culture’s vantage point. In a paper by Nuttall et al. (2016), the researchers identify the notion that neuropsychological assessment tests reflect the values, beliefs, and attitudes of the culture from which they were conceived. As an example, the researchers identify that assessment tools developed in the United States pertain primarily to its culture. Similarly, cognitive functioning assessment tools developed in Australia will be reflective of the dominant culture that informed their development. The implication is that the usage of such tools on individuals coming from other cultures raises validity and ethical issues, as evaluation processes may not be suitable or adequate. In line with this, assessment tools used by neuropsychologists can be classified as unfair to culturally and linguistically diverse individuals since their development is an ascription to the dominant culture (Holmes, 2013). In line with the conclusion by Holmes, tools that do not account for the cultural and linguistic variables have a high likelihood of misdiagnosis and hence lowered validity in the outcomes.

Clinical Neuropsychologists Assessment of Cognitive. Outcomes of tools that are non-aligned to the diverse culture and linguistic affiliation are invalid and negate the essence of quality care for the patient, which, as Norman et al. (2011) identify, misdiagnoses and false-positives emerge in such situations. Their findings indicate that the application of adjusted normative tests for clinical neuropsychological led to a high level of cognitive impairment for healthy African-American subjects as compared to Caucasian participants. Such implies that failure to apply cultural sensitivity in the assessment tools directly affects outcomes of the tests. Essentially, this identifies that most assessment tools used for cognitive functioning misdiagnose culturally and linguistically diverse individuals. The research by Norman et al. (2011) focuses on the issues arising between the Caucasian and African-American cultures only but identifies incongruence in the application of cultural specific assessment tools to another culture. Walker et al. (2010) identify that diagnostic errors emerge where tools are not valid for the particular culture. The conclusion drawn is that failure to apply cultural variables in the tools lead to a misdiagnosis and invalidates the outcomes. There is limited research focusing on the application of assessment tools on differing cultures in Australia. Future research should investigate this area more.

The use of standardised tools during neuropsychological assessment on culturally and linguistically diverse individuals raises an ethical concern in the medical discipline. Brickman, Cabo, and Manly (2006) identify that language is one of the main differences that may emerge between a neuropsychologist and patient, which may confuse understanding of consensus guidelines on cross-cultural tests, as neuropsychologists evaluate patients coming from cultures where they do not have in-depth knowledge.  Essentially, the authors note that ethical standards are breached where neuropsychologist evaluate patients coming from cultures in which they lack in-depth knowledge. The code of ethics that health professionals are tied to require that the professionals must exhibit cultural competence and skills while interacting with patients. Such implies that the assessment tools and approaches used by neuropsychologist do not meet the ethical requirements of the profession where cultural competence is not observed. Future research should establish specific shortcomings resulting from a neuropsychologist’s non-adherence to the ethical dimension of cultural competence.

            Clinical Neuropsychologists Assessment of Cognitive. Non-application of cultural-specific assessment tools results in misdiagnosis, false positives, and low quality of health. The discussion above identifies that the validity of the assessment is affected by the cultural background from which the tool is designed and developed. Brickman, Cabo, and Manly (2006) identify discrepancies in test performance in individuals from different ethnic groups, as they found neurobiological differences of different cultural groups. Such neurobiological differences relate to differing rates of cognitive functioning in individuals from different cultural groups. Further, neuropsychological tests focus on different cognitive constructs in different ethnic/cultural groups while the race is a correlate of other factors influencing the functioning of the brain (Puente et al., 2013; Fasfous et al., 2014). Culture is therefore a significant construct that affects the validity of the assessment, since it informs the design and development of standardised tools.

 Brickman, Cabo, and Manly (2006) also identify that the cultural background and experiences of the neuropsychologist affect assessment of patients. The conceptualisation by Brickman, Cabo, and Manly (2006) relates to the postulation by Crawford et al. (2014) that cultural diversity affects the nurse-patient relationship. The quality of the relationship determines the effectiveness of the assessment since this affects communication and interaction between the neuropsychologist and patient. Cultural competence is not only a factor that affects the validity of the assessment tools but is also an ethical issue that affects the quality of the patient-health professional due to emergent cultural and linguistic differences (AERA. 2014). The implication is that a neuropsychologist’s cultural competence is not only essential for the validity of the assessment but is also an ethical standard that should be adhered.

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