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PubMed1996

Cultural diversity and health care in America: knowledge fundamental to cultural competence in baccalaureate nursing students.

In order for undergraduate nursing students to integrate cultural diversity concepts into clinical practice, they require prerequisite theoretical knowledge of the relationships between cultural phenomena and health. This article is an overview of a beginning level theory course designed to enhance students' cultural awareness and sensitivity to United States ethnic groups. These attributes are viewed as two of the antecedents of culturally competent nursing practice.

Clinical Competence↗

PubMed2001

Culturally competent care.

OBJECTIVES: To define key concepts and summarize available guidelines that are important resources to assist nurses to provide culturally competent care. DATA SOURCES: Medline, anthropologic and epidemiologic literature, and National Institutes of Health documents. CONCLUSIONS: Controversy remains about the most appropriate language to use to describe features of diverse populations. IMPLICATIONS FOR NURSING PRACTICE: Becoming culturally competent begins by understanding terms and concepts that are essential in developing cultural awareness, knowledge, and skills. Sensitivity to language and the history of the development of some labels are important.

Clinical Competence↗

PubMed2006

Cultural competence and medical education: many names, many perspectives, one goal.

Two contemporary reports from the Institute of Medicine--Crossing the Quality Chasm and Unequal Treatment--highlighted the importance of patient-centered care and cultural competence training as a means of improving the quality of health care for all and eliminating racial/ethnic disparities in health care. Previous efforts in cultural competence have aimed to teach about the attitudes, values, beliefs, and behavior of certain groups. A more effective approach is to learn a practical framework to guide inquiry with individual patients about how social, cultural, or economic factors influence their health values, beliefs, and behaviors. Rather than learning about individual cultures and their characteristics, this approach focuses on the issues that arise most commonly due to cultural differences, and how they may affect a physician's interaction with any patient. At the end of the day, physicians need a practical set of tools and skills that will enable them to provide quality care to patients everywhere, from anywhere, with whatever differences in background that may exist, in what is likely to be a brief clinical encounter. Call it what you will, the field of cultural competence aims quite simply to assure that health care providers are prepared to provide quality care to diverse populations.

Cultural Diversity↗

PubMed2004

Teaching cultural competence using an exemplar from literary journalism.

Fadiman's work of literary journalism, The Spirit Catches You and You Fall Down, was used as a case study to teach transcultural and other nursing concepts to undergraduate nursing students. Campinha-Bacote's model of cultural competence was used to organize transcultural nursing concepts in the course. Before and after the course, students completed assessments consisting of two cultural attitude questionnaires and a paper describing a personal experience with adherence and failure to adhere by a Mexican American client. After reading Fadiman's book and completing several short writing assignments examining key course concepts, student scores on the questionnaires were mostly unchanged. However, students demonstrated growth in cultural awareness and skill in their "after" papers. Results suggest that valid, reliable tools are needed to detect changes in cultural competence. Qualitative data suggest that students can begin the process of becoming culturally competent through the creative use of literature in nursing education.

Adult↗

PubMed2006

An assessment of cultural competence of first- and second-year medical students at a historically diverse medical school.

OBJECTIVE: The purpose of this study was to measure knowledge of cultural variations of health beliefs and practices, especially among Hispanic patients, in a population of medical students at a historically black medical college. STUDY DESIGN: The modified clinical culture competency questionnaire tapped demographic, self-perceived knowledge, skills, encounter-situations, attitudes, education, and training of medical students. The survey was administered on a course management system. The Hispanic health knowledge questionnaire measured student knowledge of Hispanic culture. RESULTS: The response rate was 51%. No significant gender or racial differences were noted. First-year medical students were more skilled in managing sociocultural issues (40.07 vs 33.70; P = .0089) and less skilled in education and training (1.35 vs 0.57; P = .0222) than second-year students. All students scored below the 60th percentile on the Hispanic health knowledge questionnaire. CONCLUSION: These data point to the importance of cultural competency training in Hispanic health and may be used to develop an educational intervention to better address the health care needs of the local Hispanic population.

Adult↗

PubMed2002

Cultural competency: professional action and South Asian carers.

Inequality and exclusion are characteristic of the experience of UK South Asian communities. In health care, community needs are often not addressed by health and social welfare services. An increase in cultural competency is now part of identified policy. The aim of this paper is to examine the extent to which there is evidence of cultural competency amongst professionals concerning South Asian parents caring for a person with cerebral palsy. Semi-structured interviews were conducted with respondents from 19 service organisations. Results are presented on perceptions of service delivery and on the dynamics of service development: evidence is found that inadequate service delivery continues despite professional knowledge that it exists. Conditions necessary for the achievement of cultural competence are discussed. We suggest that service development to meet the needs of South Asian carers must form part of an overall strategy geared to change at different levels within and outside service organisations.

Asia↗

PubMed1994

Domestic partner abuse treatment programs and cultural competence: the results of a national survey.

Partner abuse literature reveals that treatment is less effective with minorities than with their white counterparts. Our survey of partner abuse programs (N = 142) indicates that, for the most part, little or no special effort is being made to understand or accommodate the needs of minority populations. This colorblind approach lacks the effectiveness of a culturally competent approach, which fosters an environment that helps minority groups succeed in treatment. Do partner abuse programs make efforts to be culturally competent? The major characteristics of an organizational transformation towards cultural competence occur when these programs do the following: (a) network with the minority community, (b) locate outside consultants with expertise in working with minority clients, (c) obtain information concerning service delivery and programming for minority clients, and (d) have at least one bilingual counselor. These four characteristics accounted for .58 of the variance in the minority-focused activities.

Community Mental Health Services↗

PubMed2006

Noways tired: perspectives of clinicians of color on culturally competent crisis intervention.

The authors demonstrate through case material the clinical benefits of utilizing a culturally competent approach to crisis intervention. The focus here is on intervention with racial/ethnic minorities, in particular Black Americans, Latino Americans and Asian Americans; but the authors also address the importance of culturally competent crisis intervention praxis for all clients.

Adult↗

PubMed2006

Perceptions of cultural competency among elderly African Americans.

We conducted a qualitative study of 23 subjects to determine how African Americans perceive culturally competent care by physicians. Our objectives were to understand patients' perceptions of: 1) high-quality health care by physicians; 2) the role of culture and ethnicity in the doctor-patient relationship; and 3) patients' expectations of doctors. We developed a discussion guide and a questionnaire to capture the perception of competent (desirable or high-quality) health care in the context of cultural beliefs and attitudes. We found that African Americans are concerned with traditional performance aspects of care. In addition to professional demeanor and appropriate diagnosis and treatment, communication and respect were critical aspects of the process of care. Most participants thought that physicians should know something about African American culture but only in the context of healthcare issues. For these individuals, a culturally competent doctor is one who provides effective treatment while showing respect and using effective communication methods, regardless of the ethnicity and sex of the doctor. Future research on cultural competence in the doctor-patient relationship must elicit the full range of patient values--technical performance, general (culture-nonspecific) process of care, and cultural-specific preferences.

Adult↗

PubMed2003

Using role play to develop cultural competence.

Role play is a useful teaching strategy for nursing education. This strategy can simulate patient behaviors, as well as demonstrate nursing interventions that students must learn to be clinically competent. Role play is a dramatic technique that encourages participation to improvise behaviors that may be encountered in nurse-patient situations. Using this technique, participants may test behaviors and decisions in an experimental atmosphere without risk of negative effects in a relationship. Role play is useful in developing cultural competence because participants may experience diverse roles. Cultural competence is the ability to care for patients in a culturally sensitive and appropriate manner. In role play, students may participate as culturally diverse patients or as nurses encountering patients from different cultures. Various teaching strategies facilitate successful use of role play in the classroom, including defining a time frame, selected roles, specific objectives, references, and grading criteria. To optimize learning, the importance of exploration and analysis must be emphasized. Many benefits and potential problems accompany use of role play.

Attitude of Health Personnel↗

PubMed2003

Performance measures and their benchmarks for assessing organizational cultural competency in behavioral health care service delivery.

A project is described in which performance measures of cultural competency in behavioral health care were selected and benchmarked. Input from an Expert Panel representing the four major ethnic and racial groups in the U.S. and persons with extensive experience in implementing cultural competency in health care, along with survey data from 21 sites were used in the process. Measures and benchmarks are made specific to organizations that administrate care networks, and to service entities that deliver care. Measures were selected to parallel an implementation process, and benchmarks were set at "gold standard" levels.

Attitude of Health Personnel↗

PubMedDate not supplied

Enhancing cultural competence among hospice staff.

A critical component in making hospice and palliative care services accessible and acceptable to diverse communities is preparation of all providers to enhance cultural competence. This article reports a study designed to test an educational intervention aimed at expanding cultural awareness, sensitivity, and competence with a multi-disciplinary and multilevel team of hospice workers. The purpose of this quasi-experimental, longitudinal, crossover design was to test the effects of an educational intervention for multidisciplinary hospice providers. Findings demonstrated that even with a modest face-to-face intervention, cultural competence scores were significantly greater after the educational intervention for participants in both groups. Although the intervention proved successful at enhancing cultural competence scores among diverse types of hospice workers, limitations and logistic insights gained from this pilot suggest the need for examination of alternative methods of program delivery.

Adult↗

PubMedDate not supplied

Australian women and heart disease: trends, epidemiological perspectives and the need for a culturally competent research agenda.

Heart disease commonly manifests as acute coronary syndromes (unstable angina pectoris, or myocardial infarction) and heart failure (HF). These conditions are major causes of morbidity and mortality in Australia and internationally. Australian faces particular challenges in health care delivery given the cultural and ethnic diversity of society and unique issues related to rurality. These factors have significant implications for health care delivery. Following an acute cardiac event women have poorer outcomes: higher mortality rates, higher incidence of complications and greater psychological morbidity compared with men. Language barriers, socioeconomic factors, psychological trauma related to migration and alternate health seeking behaviors and varying perceptions of risk are likely to impact adversely on health outcomes. Self-management in chronic cardiovascular disease underscores the importance of models of care that incorporate aspects related to self-care and promotion of adherence to primary and secondary prevention initiatives. Implicit in this statement is the inclusion of the individual in negotiating and developing their care plan. Therefore health professionals need to be aware of the patient's needs, values, beliefs and health seeking behaviours. These factors are strongly influenced by culture and ethnicity. The cultural diversity of Australian society mandates cultural competence in health care. This paper presents an overview of nursing science related to women and heart disease in Australia and suggests directions for culturally-competent research and development and evaluation of models of care to improve health outcomes for all Australians.

Attitude to Health↗

PubMed2005

Culturally competent HIV prevention strategies for women of color in the United States.

Many studies suggest that aspects of culture be included in human immunodeficiency virus (HIV) education efforts in the United States. Few, however, clearly identify specific strategies that respond to the unique cultural issues of women of color. This article reviews the literature for culturally competent HIV prevention efforts for women of color--Latina, African American, Asian Pacific Islander, and Native American--and synthesizes components that need to be addressed in programs and interventions. Findings suggest that for programs to be culturally competent, both race/ethnicity and gender, along with population-specific, culturally based attitudes, beliefs, and behaviors, must be considered in interpersonal and organizational strategies.

Black or African American↗

PubMed2005

Does service-learning increase cultural competency, critical thinking, and civic engagement?

To prepare for community engagement and partnerships with diverse communities, nursing students must understand the principles of service-learning, as well as the essential skills needed to work within a democracy. The purposes of these two pilot tests were to develop a 15-hour service-learning intervention; refine the 15-hour service-learning intervention; and explore whether participation in the intervention made a difference in the critical thinking, cultural competence, and civic engagement of nursing student participants. Although the sample was small (n = 14), results of paired t tests found that, after the intervention, critical thinking scores measured by the California Critical Thinking Disposition Inventory were significantly lower (t = -2.23, p = .04), particularly on the self-confidence subscale (t = 2.29, p = .039); cultural competence scores measured by the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals were significantly lower (t = 4.83, p = .000); and civic engagement scores significantly increased (t = -3.54, p = .004).

Adult↗

PubMed2003

Cultural competence in the multidisciplinary rehabilitation setting: are we falling short of meeting needs?

We present issues relevant to rehabilitation providers who wish to develop or improve their cultural competence in their medical setting and interdisciplinary team. Two case scenarios are presented that illustrate the complexities introduced into the medical rehabilitation setting by the increased numbers of minority patients in the United States in the last 20 years. Professional codes of conduct and practice are discussed for 3 rehabilitation disciplines: physiatry, rehabilitation psychology and neuropsychology, and nursing. The current status of and improvements in professional and continuing medical education are then outlined. Challenges faced by rehabilitation providers seeking to become more culturally competent in their practices are related in the following topic areas: (1) continuing education in language and cultural issues, (2) assessment instruments appropriate for diverse patient populations, (3) majority versus minority population values and beliefs, (4) impact of the immigration and acculturation experiences, (5) health care and insurance coverage issues, (6) attitudes and beliefs about disability, and (7) past experiences with medical professionals and systems. Suggestions for developing and applying enhanced cultural awareness in clinical rehabilitation practice are provided.

Adult↗

PubMed2003

Cultural competence of faculty and students in a school of allied health.

The School of Allied Health Sciences (SAHS) at East Carolina University administered a cultural competence survey to assess baseline competence for comparison with future, longitudinal assessments. This cultural competence assessment of students and faculty offers a comparison groupfor other schools of allied health that conduct similar studies. The faculty response rate was 59% with 35 completed surveys, and the student response rate was 28% with 151 respondents. The SAHS response rate for the faculty and students combined was 32% (N = 186). The allied health students consistently had higher mean scores than the faculty on knowledge of communities, personal involvement, and total score, although the differences were not statistically significant. This difference may be a reflection of the greater, although still relatively low, ethnic/cultural diversity among the students (82% white) compared with the faculty (97% white). The results are limited in generalizability to other schools of allied health with a predominately white female population.

Cultural Diversity↗

PubMed2005

The use of film, literature, and music in becoming culturally competent in understanding african americans.

Increasing the cultural competence of child and adolescent psychiatrists through the use of film, literature, and music can improve their ability to understand what African Americans experience and the impact these experiences have on mental health. It also may help clinicians recognize their own underlying biases. This understanding, in turn, could improve their ability to address effectively in treatment the issues pertinent to the African-American community and help eliminate the well-documented disparities in the health care quality and health status of minorities.

Black or African American↗