Shared and Specific: Recognizing, Respecting, and Responding to the Coexistence of Human Universals and Individual Differences

Many other fields have recognized an important distinction between two ideas that can help us address the difference between “multi-” situations and “cross-” situations.

• Higher-order, abstracted constructs are shared, universal, and category-level human needs.

• Specific exemplars represent the single way that universal needs are addressed or met by any particular group or individual.

It is an obvious distinction, in many ways. We know that all human beings need nutrition and shelter, for example, and we also know that foods and housing options look different around the world. We even recognize that our individual home decor and food choices differ from those of our closest neighbors and relatives. Indeed, we started with this idea in Module 2, as we discussed classic anthropology, the many definitions of culture, and the notions of group and individual dimensions and continua.

How do these ideas apply to multi-cultural, cross-cultural, multi-lingual, and cross-lingual speech-language pathology? Let’s think about some ideas we can borrow from three other fields that work with this important combination of shared and specific, or universal and individual.

Transcultural Nursing

The field known as transcultural nursing provides one important example of using these ideas to think simultaneously about both universals and specifics in a clinical realm. Established in the 1950s, transcultural nursing is generally credited to Margaret Leininger, who combined the construct of “culture” from anthropology and the construct of “care” from nursing to develop a model that she called “Culture Care Diversity and Universality.”

Leininger’s construct of “universality” emphasizes that some aspects of human life and of nursing care are universal, or shared across and in all cultures. Relevant examples for nursing include health, wellness, illness, injury, and death, which occur to everyone, as well as such constructs as dignity, safety, and even “caring” itself. Additional examples include the sets of factors that influence how health, caring, or any other universal is defined and experienced by different groups: kinship or social factors, economic factors, and educational factors, among others, occur in all human communities and are central to Leininger’s models.

At the same time, Leininger’s notion of “diversity” also emphasizes that each of these contructs, while universally present as a category, is realized in a wide range of culturally specific ways. Moreover, and crucially, these culturally determined differences must be taken into account in the provision of effective nursing care, because nursing care is provided to individuals, whose specific needs and individual preferences tend to have been shaped by their individual cultural backgrounds, not provided universally to all patients at the same time.

What does the distinction, and the combination, mean for us, as we think about clinical service delivery in speech-language pathology?

It means, as transcultural nursing emphasizes, that universal needs are universal and that all people deserve to have their universal needs respected. It means that we need to be aware of categories, dimensions, and continua, and we need to be aware of our own preferences or assumptions about those categories, dimensions, and continua. It also means that we must be prepared to act differently as we care for individuals who are not ourselves, because human universals are realized in specific, individual ways. To continue with our examples of caring, illness, and kinship factors: Some patients need their extended families in the room to feel cared for, some patients need an older maternal figure in the room to feel cared for, and still other patients need to be left alone to feel cared for. We as the care providers need to understand the difference and act on it, regardless of what we ourselves might want if we were ill.

Most aspects of transcultural nursing emphasize strategies similar to those that we will call cross-cultural or cross-lingual, in that they focus on recognizing and responding to a single client’s specific needs, as shaped by their cultural, linguistic, and identity-based background. At the same time, however, Leininger’s co-existing emphasis on human universals remains critical; again, some universal human needs and rights, including communication, caring, dignity, and safety, span all cultures, transcend any particular culture, or exist above and beyond individual culture or identity. It’s an important combination of thoughts.

(I think Leininger’s extensive body of work, including theory, research, writing, and relatively specific clinical recommendations, deserves much more credit in allied health fields, including in speech-language pathology, than it appears to have received. She was a genuine pioneer in what she called culturally congruent care, and most of her work can be applied relatively directly to our field.)

Universal Design in Architecture and Physical Products

The principles of Universal Design, as a second example, also emphasize the intertwined importance of the universal and the specific, this time as applied to physical spaces and things and this time reaching almost an opposite solution, as compared with transcultural nursing. Universal design emphasizes that spaces and things intended for use by many people can, and should, be developed in ways that recognize people’s shared or universal needs as well as the differences in individuals’ abilities. Generally credited to an architect named Ronald Mace and then to his working group and colleagues, universal design tends to be expressed in terms of seven principles, including equitable use, flexibility in use, and low physical effort.

Classic examples of universal design in architecture include zero-step (flat or ramped) entries and transitions between spaces, which people who walk and people who use wheelchairs can both use. A flat entrance is better than a large staircase, according to universal design principles, because it respects the basic, underlying, shared, or universal function of the entrance, which is to allow people to access the building. Steps, as an alternative, do not meet this universal need, because they do not meet the needs of people who cannot climb steps or cannot climb steps as easily as other people can (a very large group of people: not only wheelchair users, but also adults with bad knees, small children, and otherwise athletic young people who are temporarily using crutches or carrying heavy boxes, among many others).

In applications beyond architecture, universal design for other physical things also seeks to address this combination of an underlying or shared need and a diversity of human abilities. The knobs on a stove can work for everyone, for example, including specifically that they can work for people with a range of visual, hearing, cognitive, and finger dexterity abilities, if their size, shape, and markings make it clear in many ways when the knob is set to which setting (i.e., if users can see, hear, and also feel the difference between off, lower heat, and higher heat). Your universal remote for your entertainment system is also attempting to be universal in this same sense: a few larger well-labeled buttons, in different shapes that can be either felt or seen, is more useful in most situations to almost everyone than a small, smooth, remote control with essentially invisible markings that depends on toggling through complex layers of electronic menus.

Notice that the goal in universal design is to use an awareness of both the universal need and the range of different individual abilities to create one building or one product that (almost) everyone can use. Universal design is not private architecture aimed at building the best individual house for any one person or attempting to please any one client. The goals and the processes of universal design include thinking in terms of the wide range of individual specific preferences or needs, the universal element that underlies all of them, and the possibility that one or a few carefully selected specific decisions that address the universal need can work fairly well for most people.

I assume you have seen the connection to multi-cultural or multi-lingual speech-language pathology, and also noticed that this kind of situation is almost the opposite of one nurse caring for one patient? In our multi-cultural clinical situations, as in universal design, the goal is not to meet any one specific person’s individual needs; the goal is to meet the universal or shared needs of a diverse group of people, possibly through the use of one carefully selected choice. In a multi-cultural or multi-lingual situation, we are aware of both the universal and the specifics, and we focus primarily on the fact that our activities in that one situation must be accessible to a wide range of people and must meet their shared or universal need, not necessarily satisfy any one person’s specific individual preferences.

Universal Design for Learning

Universal design for learning, finally, combines the same two constructs (the universal or shared, coexisting with the individual or specific) and reaches a slightly different conclusion.

Consider, in this example, a classroom full of perhaps 20 children. Their universal or shared elements include a right and a desire to learn and also a need for teaching. All children need, want, and deserve to learn, in other words, and all children need help from teachers if they are to be able to learn; we view these issues as universals.

Separately, each child in the classroom comes to the learning situation with their own specific or individual needs and abilities. Some examples are obvious: a child who speaks only Finnish cannot learn effectively from a teacher who insists on explaining in Mandarin. A child who cannot see cannot learn if she is provided only with printed materials. A child who does not yet understand area and volume cannot approach an earth-science lesson about rainwater, lakes, and dams the same way another child might. Some examples are less obvious and reflect the entire realm of all human, cultural, individual, emotional, social, physical, and other realms of human experience.

The dual emphasis in universal design for learning, therefore, is that every child has a universal need to learn and a universally shared right to learn, and also that these universals coexist with each individual learner’s specific abilities and needs. It is very much the same duality that transcultural nursing and universal design recognize.

The solution adopted by universal design for learning differs slightly, however, from the solutions adopted by transcultural nursing or by universal design. In universal design for learning, the emphasis falls on meeting the shared needs of a group of learners by incorporating multiple specifics. Thus, universal design for learning attempts to present new information in multiple ways, provide learners with different ways to engage with the material, and allow learners to act on or express their knowledge in different ways. If you have ever experienced an educational unit that included readings, videos, examples, discussions, and then a choice of final projects, you were experiencing universal design for learning.

This solution obviously does not differ entirely from transcultural nursing or from universal design, in part because the issues and solutions all exist on continua, not as discrete categories. Some situations are one on one, clearly requiring what we might call straightforwardly cross-cultural bridge-building: a tailor makes one suit that fits one client perfectly and will fit no one else, or a speech-language pathologist or a nurse designs one care plan that fits one client perfectly. Some situations are for manageable groups; a teacher with 20 students can plan ahead to meet their shared needs by incorporating a reasonable set of multiple options. And some situations are for unpredictably large or as-yet-undefined groups, requiring the architect or the speech-language pathologist (or our multipurpose-room designer) to seek single solutions that are intended primarily to address the universal needs or to allow multiple people to interact with the space in multiple ways.

The three options are summarized in Box 16.1. Do you see the many options for cross-cultural, multi-cultural, and intermediate or mixed situations that these ideas provide?