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Persons with severe hearing loss live in a unique cultural context with which social workers may not be familiar. This paper reviews the skills needed for the culturally competent social work assessment with deaf clients, including communication skills, interviewing methods, taking case and family histories and behavioral observation.
It makes sense to move your facility to an attitude of cultural competency, not only because there are certain minimum requirements from the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, and other watchdogs, but also because it's the right thing to do, according to Beth Remus, an expert in the field of cultural awareness and competency in health care.
Shifting population demographics will have a major impact on the practice of advanced practice nurses (APNs). The ethnic composition of people in this country is becoming increasingly diverse. Massachusetts and, in particular, the city of Worcester is also experiencing changes in the diversity of its population. These trends testify to the great need for APNs who are sensitive to and competent to care for culturally diverse populations. To address these changes, specific curricula enhancements focused on ethnically diverse populations were implemented for the nurse practitioner specialties at the Graduate School of Nursing (GSN), University of Massachusetts Worcester. The processes used for this project included visiting community and clinical sites, identifying key curricular components, and evaluating existing didactic and clinical learning experiences. The GSN faculty developed a systematic plan for integrating these components into the graduate nursing core, advanced practice core, and specialty courses of the respective curricula. A major outcome of this project was the enhanced preparation of APN students to meet the multifaceted needs of ethnically diverse patients, families, and communities.
The repair of U.V. damages to DNA in B. subtilis cultures competent for genetic transformation has been studied. The comparison of survival curves for competent and non competent fractions shows that: i) excision repair is more effective in competent than in non competent bacteria; ii) recombination repair is more effective in non competent than in competent bacteria. These facts support the hypothesis that metabolic conditions and, very likely, DNA replication play a role in the regulation of the efficiency of the two different mechanisms of repair.
Teaching medical students to recognize the need for cultural competence and accept their shortcomings in this area is a challenge. A simulated patient scenario was developed to address this challenge. The objective of the simulation is to enhance students' readiness to learn by moving them from 'unconscious incompetence' to 'conscious incompetence'. The patient scenario presents a Cherokee Indian woman with a complaint of abnormal menstrual bleeding who is resistant to gynaecologic care from male providers. A faculty member facilitates a small-group videotape review of student interviews. As students discuss their encounters, they realize they 'misdiagnose' and mishandle the interview. They are confronted by their inability to recognize cultural cues and the impact they may have on health outcomes and begin to question whether cultural beliefs are affecting the care of other patients. This simulation creates an eye-opening situation that must be handled carefully. This activity is an effective method to create awareness in students who feel they 'know all this stuff.'
As the population of the United States becomes increasingly diverse, effective, client-centered, contemporary dental hygiene practice will be realized only if clinicians are equipped to interact with and provide care for clients of varied cultural backgrounds. The purpose of this investigation is to explore ways to incorporate cultural care into the dental hygiene process of care. In addition to a discussion of the integration of cultural sensitivity into communication, assessment, dental hygiene diagnosis, treatment planning, implementation provides recommendations for further research and for the education of both dental hygiene students and practicing dental hygienists in order to facilitate quality care for a culturally diverse clientele.
A position statement developed by the Association of Rehabilitation Nurses (ARN), Appropriate Inclusion of Rehabilitation Nurses Wherever Rehabilitation is Provided, stated that nurses are an essential part of a client's rehabilitation because they provide holistic care and "attend to the full range of human experiences and responses to health and illness" (Association of Rehabilitation Nurses, 1996, p.1). Rehabilitation nurses must become strongly aware of the role that culture plays in this process. This article presents a conceptual model of practice with which to address cultural competence in rehabilitation nursing. The model's constructs of cultural awareness, cultural knowledge, cultural encounters, cultural skill, and cultural desire are discussed. Examples from the field of rehabilitation nursing are presented in the discussion of these constructs.
The author proposes a curriculum guideline of cultural competence for child and adolescent psychiatric residencies, including specific educational objectives, didactic topics and suggested references. These guidelines can be easily incorporated into the existing training curriculum and stress ethnogeneric and developmental perspectives, which can be expanded further to include ethnospecific issues depending on the needs of each training program and trainee.
Anne Fadiman's The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures (Noonday Press, 1997) is widely used in "cultural competence" efforts within U.S. medical school curricula. This article addresses the relationship between theory, narrative form, and teaching through a close critical reading of that book that is informed by theories of tragedy and ethnographies of medicine. I argue that The Spirit Catches You is so influential as ethnography because it is so moving as a story; it is so moving as a story because it works so well as tragedy; and it works so well as tragedy precisely because of the static, reified, essentialist understanding of "culture" from which it proceeds. If professional anthropologists wish our own best work to speak to "apparitions of culture" within medicine and other "cultures of no culture," I suggest that we must find compelling new narrative forms in which to convey more complex understandings of "culture."
To meet the needs of a multicultural society, health care in the new millennium stresses teamwork in providing culturally sensitive and competent care to improve client outcomes. Publications addressing the future predict an increasingly diverse workforce. Accordingly, care providers can benefit from a conceptual model of cultural competence that can be used by all health disciplines in all practice settings. The Purnell Model for Cultural Competence, developed in 1995, is applicable to all health care providers. This article (a) describes the development of the model; (b) provides a description of the model; (c) lists the major assumptions on which the model is based; (d) describes the model's use in practice, education, administration, and research across disciplines; and (e) includes a brief evaluation of the model. Important cultural domains missing from other transcultural and cross-cultural models, which are found in the Purnell Model, are biocultural ecology and workforce issues.
Recent literature on racial disparities in HIV/AIDS and effective HIV/AIDS health service delivery efforts has underscored the importance of cultural sensitivity, relevance and competence in reducing such disparities and providing effective health service delivery. Less work has been done on the role of cultural competence in the delivery of effective HIV/AIDS prevention programs, perhaps because few such prevention programs aimed at minority populations have to date been demonstrated as effective. This article surveys the various ways that the concept of cultural competence has been studied, extends the concept to the field of HIV/AIDS prevention, and presents a simple-to-use instrument that operationalizes the concept for use with HIV/AIDS prevention programs. The article also explores the idea of evaluation readiness among HIV/AIDS prevention programs in the hope of eventually enlarging the pool of minority-focused HIV/AIDS programs demonstrated as effective. The resultant tool can serve as a research-based framework that: (a) serves as a cost-effective way to select promising programs--especially promising minority-focused programs-for rigorous outcome evaluation; (b) advances the field of HIV/AIDS prevention research by providing a conceptual framework for studying the relationship between cultural competence and program effectiveness; and (c) serves as a framework for building capacity in HIV/AIDS prevention programs, pointing to ways in which such programs can be strengthened.
The purpose of this study is to describe how home care nurses orient to and manage cultural issues during patient visits. Fourteen home care nurse-patient dyads were observed. Interviews were then conducted with nurses. Nurses and the home care agencies for which they worked engaged in practices aimed at minimizing patients' cultural practices and beliefs. A correspondence with how nurses oriented to patients' cultures and how cultural issues were managed during encounters was observed. Overwhelmingly, nurses and home care agencies used strategies to avoid dealing with patients' "different" cultural backgrounds. Work needs to be done to begin integrating theory and practice regarding culturally competent health care.
There is growing recognition among health professionals that being familiar with the culture of a particular group and developing effective partnerships to involve group members in the production of their own health are essential strategies to promote health. Moreover, it is increasingly recognized that providing health care services that are culturally sensitive can result in improved health status for clients. This article describes selected Latino cultural customs that can enhance a nurse's ability to work sensitively and effectively with this ethnic group. Creative strategies to increase the cultural competence of nurses involved in primary care settings are also presented.
There has been a remarkable growth in cultural diversity in the United States over the past 20 years. The population of minority groups has increased at a much faster rate than the European-background population in America, and faster even among children and youth. At the same time, minority youth face increasing disparities in their mental health and in access to mental health services. These are related to the multiple challenges they already face in socioeconomic status, but are aggravated by the lack of culturally competent services that can address their specific mental health needs within the context of their culture, family, and community. This paper reviews the current knowledge about the mental health of culturally diverse youth in the United States, and provides guidance on approaches to address the disparities they face.
Delivering health care to non-English speaking immigrant populations requires knowledge and appreciation of the patient's culture. Acquiring the skills to bridge the two worlds calls for self-awareness by the practitioner and a commitment to cultural competence by the organization.
The profession of midwifery can be part of the solution in America's quest for a culturally sensitive and competent health care system. Midwives who are familiar with a variety of health-related cultural beliefs and practice culturally sensitive inquiry, particularly when using pharmaceutical therapies, can effectively understand and respond to the cultural complexities that impact a client's health. This article describes needed cultural competencies, reviews a variety of health-related cultural beliefs, and relates how these beliefs impact the use and acceptability of pharmaceutical therapies. Specific examples related to culturally sensitive inquiry are discussed along with recommendations.
TOPIC: Mental health care for Puerto Rican children. PURPOSE: To explore the cultural background of Hispanics, present relevant definitions, and review and critique selected literature relevant to culturally competent mental health care of Puerto Rican children. SOURCES OF DATA: Published literature. CONCLUSIONS: Cross-cultural research is important to raise the consciousness of nursing professionals, expose them to other realities, and provide opportunities to establish culturally relevant treatment modalities.
This article describes two courses, Health in Rural Appalachia and Clinical Practice in Appalachia, developed by one of the authors to increase students' cultural competence as professional nurses. Characteristics of the Appalachian culture are described as well as the need for cultural awareness and sensitivity in those providing health care. Both the three-credit seminar course and the one-credit clinical course are described. Students' comments, from journals and other assignments, are interspersed throughout to illustrate various aspects of the cultural heritage they experienced as they worked with nurses and patients in eastern Kentucky.