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PubMedDate not supplied

Strategic implications of culturally competent care.

Providing culturally competent care has implications for health care managers and their organizations that go beyond a simple clinical perspective. The article defines culturally competent care and suggests what the specific strategic implications of delivering such care are. The author suggests the definition of culturally competent care for a health care manager as "the ability of any health care provider of any cultural background in one's organization to effectively treat any patient of any cultural background." Four basic steps are suggested for an organization wishing to develop a program of delivering culturally competent care to include situation analysis, strategy formulation, strategy implementation, and strategic control.

Community-Institutional Relations↗
PubMed2003

Self-perceived attitudes and skills of cultural competence: a comparison of family medicine and internal medicine residents.

This study surveyed resident perceptions of competent cross-cultural doctor-patient communication as a step toward developing an integrative primary care cross-cultural curriculum. Respondents were 57 first-, second- and third-year residents in family medicine (FA) and internal medicine (IMA) who completed a questionnaire assessing cross-cultural attitudes and skills relevant to clinical practice. As a group, residents endorsed the relevance of culturally competent communication to patient care, perceived themselves to be fairly competent in the use of culturally competent communication technique, used such techniques frequently, and generally found them to be quite helpful. FM residents rated culturally competent communication as significantly more relevant, themselves as more competent, and culturally competent communication techniques as more helpful than did IM residents. Over half the residents in both specialties tended to identify as serious cross-cultural problems those that focused on perceived patient shortcomings.

Attitude of Health Personnel↗
PubMed2006

Multi-cultural and multi-ethnic considerations and advanced directives: developing cultural competency.

Attention to culturally specific rituals germane to end-of-life rituals are important for the nurse who is delivering culturally competent care. The Patient Self-Determination Act implemented in the United States in 1991 brought with it some specific assumptions of values related to end-of-life care involving patient autonomy, informed decision making, truth telling and control over the dying process (USC, 1990). The assumptions and values assumed in this act are not necessarily shared by persons in the United States who are from a minority culture, particularly one other than White of European descent. This manuscript considers the values of the Patient Self-Determination Act passed in the United States and specific cultural beliefs which may pose a conflict for the care giver in the delivery of culturally competent care. The Giger and Davdihizar (2004) Transcultural Assessment Model is used as a way to assess patient and the family in an effort to plan culturally appropriate care that recognizes the uniqueness of each individual at the end of life.

Advance Directives↗
PubMed2003

A hidden curriculum: mapping cultural competency in a medical programme.

BACKGROUND: Cultural competency can be understood as those learned skills which help us understand cultural differences and ease communication between people who have different ways of understanding health, sickness and the body. Recently, medical schools have begun to recognise a need for cultural competency training. However, few reports have been published that articulate and evaluate cultural competency in medical curricula. AIM: This study was performed in order to evaluate the current status of cultural competency training at a medical school in southern Sweden. METHODS: We used a multimethod approach to curriculum evaluation. We reviewed the published list of learning objectives for the medical programme, interviewed curriculum directors and individual teachers for each term about course content and carried out focus group interviews with students in all stages of the medical programme. RESULTS: Cultural competency is a present but mostly hidden part of the curriculum. We found learning objectives about cultural competency. Teachers reported a total of 25 instances of teaching that had culture or cultural competency as the main theme or 1 of many themes. Students reported few specific learning instances where cultural competency was the main theme. Students and teachers considered cultural competency training to be integrated into the medical programme. Cultural competency was not assessed. CONCLUSION: This evaluation showed places in the curriculum where cultural competency is a present, absent or hidden part of the curriculum. The differences between the 3 perspectives on the curriculum lead us to propose curriculum changes. This study illustrates how triangulation with a multifactorial methodology leads to understanding of the current curriculum and changes for the future.

Cultural Diversity↗
PubMed2002

Cultural competency in the laboratory.

Cultural competency incorporates an awareness of different cultures, and sensitivity to the differences of cultures which results in appropriate behaviors with other cultures. White non-Hispanics currently comprise almost 73.6% of the total United States population, but this percentage will decrease to less than 53% by 2050. Laboratory practitioners must become culturally competent to deal effectively with the changing demographics. Cultural diversity will impact the laboratory workforce and the patients it serves. Laboratory professionals must become skilled in communication with all patient populations served, be aware of personal biases, and be willing to do whatever is necessary to achieve cultural competency. Skills must be integrated into education and training processes to prepare the laboratory professional to work effectively in and with different cultures.

Communication Barriers↗
PubMed1998

Cultural competence for nurses: canonical correlation of two culture scales.

As the diversity of the US residential population increases, healthcare professionals need to recognize the importance of culturally competent care on health outcomes of individuals and communities. The purpose of this descriptive correlational pilot study (N = 51) was to describe the relationship among scores and sub-scores on scales measuring concepts of cultural competence. An additional purpose was to develop reliability and validity data on each of three culture scales for the population of hospital based registered nurses. Each of the scales had previously reported reliability and validity data but were administered to populations potentially different from southern-based, hospital-employed RNs. A large medical center located in Southeastern US was chosen as the study's site due to its diverse staff and client base. The Giger and Davidhizar Transcultural Assessment Model and Theory was the theoretical foundation for the study and Cultural Self-Efficacy Scale (CSES), Cultural Attitude Scale as developed by Bonaparte (1977, 1979) and modified by Rooda (1990, 1992) (CAS-Modified), and knowledge base questions (Rooda, 1990) were the chosen instruments. For this group of hospital based RNs, the reliability analysis--scale (Alpha) for the 58 item CSES was .9778. The reliability analysis (Alpha) for the 22 knowledge base questions was .6038 and .6412 for the 40 item CAS-M. Canonical correlation analysis was performed between a set of attitude variables and a set of self efficacy variables using SPSS (1995). Both sets of variables demonstrated statistically significant relationships (at an a priori alpha of .05) to each other (with an approximate Eta squared value for practical significance of .336), providing sufficient evidence to reject the non-relationship null hypothesis. For this sample and for these data, cultural self-efficacy toward Asian, Black, Hispanic clients, and self-efficacy regarding nursing skills when caring for diverse clients related to cultural attitudes and cultural self-efficacy. Nursing care, cultural health beliefs, and cultural health attitudes related to attitudes toward care of diverse clients. Both sets of variables related to each other as qualities of culturally competent nursing care.

Adult↗
PubMedDate not supplied

Cultural competence: serving Latino patients.

Culturally competent strategies are necessary as populations in many countries become increasingly diverse. In the United States, Latinos are the fastest-growing minority group. In this study, the authors interviewed Latino patients and families, collected demographics from 570 patients in pediatric orthopedic practices in California, and conducted population census and literature reviews. Based on these sources of information, the authors identified barriers to health care for Latino pediatric orthopedic patients and propose culturally competent strategies to overcome these barriers. This approach can be applied to other populations so that culturally competent care is available to patients from all ethnic, racial, and cultural backgrounds.

California↗
PubMed1998

Using literature to create cultural competence.

PURPOSE: To describe how literature can be used to promote cultural competence. Cultural competence is essential for nurses who practice in diverse societies like the United States. ORGANIZING FRAMEWORK: Cultural competence is viewed as a dynamic process of framing assumptions, knowledge, and meanings from a culture other than one's own. Selected excerpts from "The Color Purple" by Alice Walker are used to illustrate the method. Isler's readers' response theory serves as a guide for imaginative engagement and reflective discussion of the concept of health. CONCLUSIONS: Literature helps to dispel the false notion of a monolithic culture. Reflecting on reputable literature helps us hear the stories of those we hope to help and heal.

Cultural Diversity↗
PubMed1997

Development of culturally competent food-frequency questionnaires.

Health-related behaviors, including food choices, are culturally determined. Culture is the medium through which people interpret their world and the tool individuals use to guide decisions. Recognition of the effect of culture on health-related behaviors has led public health investigators, including nutritionists, to address the concepts of cultural relevancy as applied to intervention strategies and assessment techniques. Drawing on a project involving the development of food-frequency questionnaires for Native American communities, I provide definitions of cultural awareness, cultural sensitivity, cultural appropriateness, and cultural competency. Cultural competency, which involves working within the cultural context of a culturally distinct population, is the approach most likely to reduce miscommunication between investigators and participants and to yield reliable and valid data. Step-by-step guidelines for creating a culturally competent food-frequency questionnaire have been developed.

Culture↗
PubMed2006

Development and evaluation of a cultural competency training curriculum.

BACKGROUND: Increasing the cultural competence of physicians and other health care providers has been suggested as one mechanism for reducing health disparities by improving the quality of care across racial/ethnic groups. While cultural competency training for physicians is increasingly promoted, relatively few studies evaluating the impact of training have been published. METHODS: We recruited 53 primary care physicians at 4 diverse practice sites and enrolled 429 of their patients with diabetes and/or hypertension. Patients completed a baseline survey which included a measure of physician culturally competent behaviors. Cultural competency training was then provided to physicians at 2 of the sites. At all 4 sites, physicians received feedback in the form of their aggregated cultural competency scores compared to the aggregated scores from other physicians in the practice. The primary outcome at 6 months was change in the Patient-Reported Physician Cultural Competence (PRPCC) score; secondary outcomes were changes in patient trust, satisfaction, weight, systolic blood pressure, and glycosylated hemoglobin. Multiple analysis of variance was used to control for differences patient characteristics and baseline levels of the outcome measure between groups. RESULTS: Patients had a mean of 2.8 + 2.2 visits to the study physician during the study period. Changes in all outcomes were similar in the "Training + Feedback" group compared to the "Feedback Only" group (PRPCC: 3.7 vs.1.8; trust: -0.7 vs. -0.2 ; satisfaction: 1.9 vs. 2.5; weight: -2.5 lbs vs. -0.7 lbs; systolic blood pressure: 1.7 mm Hg vs. 0.1 mm Hg; glycosylated hemoglobin 0.02% vs. 0.07%; p = NS for all). CONCLUSION: The lack of measurable impact of physician training on patient-reported and disease-specific outcomes in the current has several possible explanations, including the relatively limited nature of the intervention. We hope that the current study will help provide a basis for future studies, using more intensive interventions with different provider groups.

Adult↗
PubMed2006

A prescription for cultural competence in medical education.

Cultural competence programs have proliferated in U.S. medical schools in response to increasing national diversity, as well as mandates from accrediting bodies. Although such training programs share common goals of improving physician-patient communication and reducing health disparities, they often differ in their content, emphasis, setting, and duration. Moreover, training in cross-cultural medicine may be absent from students' clinical rotations, when it might be most relevant and memorable. In this article, the authors recommend a number of elements to strengthen cultural competency education in medical schools. This "prescription for cultural competence" is intended to promote an active and integrated approach to multicultural issues throughout medical school training.

Cultural Diversity↗
PubMed1996

Culturally competent assessment practice in the United States.

Assessment practice with multicultural populations in the United States requires cultural competence. Culturally competent assessment includes culture-specific styles of service delivery, use of the client's first language, and an evaluation of the client as a cultural being prior to test administration using cultural orientation categories. This information is essential for understanding health/illness beliefs, to indicate the possible presence of culture-specific symptoms, and to select standard or culture-specific tests. Assessment ethics recognize the desirability of alteration or modification of standard tests by translation and development of new norms. Cross-cultural construct validity, response sets, and cultural variables are also research priorities. Culture-specific tests should be constructed and validated for some clients as determined by cultural orientation status. Feedback of test findings to clients and significant others should be consistent with cultural expectations. Professional and societal benefits of cultural competence in assessment are suggested.

Journal Article↗
PubMed2003

Culturally competent psychotherapy.

To provide effective psychotherapy for culturally different patients, therapists need to attain cultural competence, which can be divided broadly into the 2 intersecting dimensions of generic and specific cultural competencies. Generic cultural competence includes the knowledge and skill set necessary to work effectively in any cross-cultural therapeutic encounter. For each phase of psychotherapy--preengagement, engagement, assessment and feedback, treatment, and termination--we discuss clinically relevant generic cultural issues under the following headings: therapist, patient, family or group, and technique. Specific cultural competence enables therapists to work effectively with a specific ethnocultural community and also affects each phase of psychotherapy. A comprehensive assessment and treatment approach is required to consider the specific effects of culture on the patient. Cultural analysis (CA) elaborates the DSM-IV cultural formulation, tailoring it for psychotherapy; it is a clinical tool developed to help therapists systematically review and generate hypotheses regarding cultural influences on the patient's psychological world. CA examines issues under 3 domains: self, relations, and treatment. We present a case to illustrate the influence of culture on patient presentation, diagnosis, CA, and psychotherapeutic treatment. Successful therapy requires therapists to employ culturally appropriate treatment goals, process, and content. The case also demonstrates various techniques with reference to culture, including countercultural, cultural reinforcing, or culturally congruent strategies and the use of contradictory cultural beliefs. In summary, developing both generic and specific cultural competencies will enhance clinician effectiveness in psychotherapy, as well as in other cross-cultural therapeutic encounters.

Adult↗
PubMed2003

In defense of cultural competency in psychotherapy and treatment.

Cultural competency guidelines and policies are being widely established. Yet some critics have challenged the evidence for cultural competency and the lack of efficacy studies that demonstrate its outcomes. Various positions are examined that discuss cultural competency research. They include the need for more resources for research, scientific practices that overlook ethnic research findings, fruitfulness of theory-driven rather than population-based research, problems in defining cultural competency as a technique, and development of policies in the absence of research. Implications of these positions are discussed.

Biomedical Research↗
PubMed2001

A model for the delivery of culturally competent community care.

AIM: To describe the proposed Culturally Competent Community Care (CCCC) model, and the process of development and testing of the model. BACKGROUND: Community health nurses are challenged to provide culturally competent care in all types of communities. However, existing models have not provided community nurses with specific guidelines, and none attempt to explain the effects of culturally competent care on populations in community settings. Therefore, it is necessary to develop a model that is comprehensive in its description of the dimensions of culturally competent care in community-based settings and that also requires a focus on ethnic populations. The model is essential for reducing racial and ethnic health disparities. METHODS: Based on literature review and concept analysis, three constructs of the Culturally Competent Community Care Model were developed. Two of the constructs, the health care system and health outcomes, were developed based on a literature review. The main construct of the model, cultural competence, was developed after a concept analysis, following the development and testing of the Cultural Competence Scale (CCS). Interviews with eight community health nurses and a survey by five community nurse experts were conducted in order to refine and confirm the dimensions of cultural competence and its impact on health outcomes. CONCLUSIONS: The proposed dimensions of culturally competent care are caring, cultural sensitivity, cultural knowledge, and cultural skills. This model focuses on the relationship between cultural competence and health outcomes for culturally diverse populations. The framework provides specific guidelines for community nurses in developing and assessing cultural competence and meeting the health needs of diverse communities.

Clinical Competence↗