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PubMed2002

Incorporating multiculturalism into oncology nursing research: the last decade.

PURPOSE/OBJECTIVES: To use the Oncology Nursing Society's cultural competence guidelines to review research studies conducted by oncology nurse researchers with racial and ethnic minorities and published in the Oncology Nursing Forum during 1990-2000. DATA SOURCES: Using selected key words (e.g., cultural competence, cultural diversity, multiculturalism, minorities, African American/Black American, Hispanic/Latino, Asian/Pacific Islander, Native American/Alaskan Natives) the authors identified 27 studies that met the inclusion criteria for review. Case studies, sponsored lectureships, review articles, commentaries, editorials, and the like were excluded. DATA SYNTHESIS: Within the context of the cultural competence guidelines, the primary strengths included sufficient background information and literature to establish the existence of the problem in the targeted culture, use of conceptual and theoretical frameworks to guide the study, identification of salient study limitations, and recommendations for dissemination of the findings to a general audience. Limitations included discussion of culture beyond the background and literature review, consideration of potential ethical concerns the target population may have about the methods to be used, inclusion of racial and ethnic minorities in the design and implementation of the study, and implications for oncology nursing education. CONCLUSIONS: Although much has been gleaned from previous oncology nursing research published from 1990-2000, more fully incorporated content related to cultural competence is needed. This is needed particularly in studies specifically targeting racial and ethnic minority populations. IMPLICATIONS FOR NURSING: Including cultural competence when designing and reporting research has a greater potential to inform oncology nursing practice, design future research studies, strengthen existing nursing curricula, and help to shape health policy related to racial and ethnic minority populations. The Oncology Nursing Society Multicultural Outcomes: Guidelines for Cultural Competence provides guidance for enhancing the next generation of oncology nursing research with ethnically and culturally diverse populations.

Adult↗

PubMed1998

Where does culture fit in outcomes management?

The authors describe the concept of cultural competence and ways in which culture, a structure of care variable, is important to the delivery of culturally competent care. The role of culture in outcomes assessment and management is explored. The culture of the patient, the health care professional, and the organization is examined as it influences the potential to deliver culturally competent care. Strategies for developing a culturally competent work force are proposed with examples from ongoing projects in a large metroplex in the southwestern part of the United States.

Cultural Characteristics↗

PubMed1994

Transcultural psychiatric nursing: diagnostic and treatment issues.

1. Psychiatric nurses are exposed to individuals and families experiencing culture-bound illnesses in which symptomatology closely mimics psychiatric problems. 2. Because of the great potential of misdiagnosis among culturally diverse groups as having a mental illness, a cultural assessment must be done. 3. The culturally competent model of care is a conceptual model of nursing care that views cultural awareness, knowledge, skill, and encounters as components of cultural competence. Cultural competence is viewed as a process in which the psychiatric nurse strives to effectively work with individuals and families from culturally diverse backgrounds.

Adult↗

PubMed2003

Many faces: addressing diversity in health care.

DIVERSITY: The changing demographics and economics of our growing multicultural world, and the long-standing disparities in the health status of people from culturally diverse backgrounds has challenged health care providers and organizations to consider cultural diversity as a priority. The purpose of this article is to present a model that will be helpful in providing culturally competent care. The concept of cultural competence is discussed, "The Process of Cultural Competence in the Delivery of Healthcare Services Model" is described, and a mnemonic to guide in providing culturally competent care is presented.

Cultural Diversity↗

PubMed2006

The interpretation of "culture": diverging perspectives on medical provision in rural Montana.

Seeking to address evident disparities in health care delivery to minority populations, researchers have developed a framework generally referred to as "cultural competency." This framework suggests that increasing providers' knowledge about culturally specific beliefs and behaviors will both assist providers in caring for particular, traditionally underserved groups and enhance the quality of health care delivery for all patients. Meanwhile, a number of critics have challenged the presuppositions of the "culture" concept underlying cultural competency, arguing that such well-intended efforts may merely exacerbate received stereotypes. Despite such criticism, the influence of cultural competency, along with the related categories of cultural sensitivity, cultural humility, cultural proficiency, and cultural awareness, continues to grow in medical schools, governmental agencies, and health care organizations, particularly in the United States. To better assess the varying theoretical and policy claims of proponents and opponents of the cultural competency framework, we undertook a modest qualitative, interview-based investigation. We explored how "culture" is being presented and enacted by Mexican agricultural workers and US health care providers in one rural Montana clinic. While the Mexican agricultural workers in the study emphasized structural dimensions of labor migration as the most relevant factors in shaping patient-provider interactions, the US health care providers tended to focus on the "cultural characteristics" peculiar to their patients. The discrepancy in these assessments serves to extend and complement existing criticism of cultural competency. While our study was limited to one locale with a limited number of participants, its findings highlight the paucity of empirical research in this area and suggest the need to examine the efficacy of cultural competency in settings outside conventional "needs assessment" or "outcome studies" models.

Cultural Diversity↗

PubMed1999

Culturally effective pediatric care: education and training issues. American Academy of Pediatrics Committee on Pediatric Workforce.

This policy statement defines culturally effective health care and describes its importance for pediatrics. The statement also defines cultural effectiveness, cultural sensitivity, and cultural competence and describes the importance of these concepts for training in medical school, residency, and continuing medical education. The statement is based on the premise that culturally effective health care is important and that the knowledge and skills necessary for providing culturally effective health care can be taught and acquired through 1) educational courses and other formats developed with the expressed purpose of addressing cultural competence and/or cultural sensitivity, and 2) educational components on cultural competence and/or cultural sensitivity that are incorporated into medical school, residency, and continuing medical education curricula.

Cultural Diversity↗

PubMedDate not supplied

The challenge of cultural diversity for nurse educators.

By the year 2000, one in every three Americans will represent an ethnically diverse cultural group. Nurses are awaking to the critical need to become more knowledgeable and culturally competent to work with individuals from diverse cultures (Leininger, 1994). However, teaching cultural awareness in nursing education can present a major professional challenge for nurse educators. This article discusses cultural competence and presents a conceptual model of culturally competent health care. Based on this model, the article also discusses the implementation of a four-session cultural diversity program in a rural hospital setting.

Clinical Competence↗

PubMed2006

The illness trajectory of elderly cancer patients across cultures: SIOG position paper.

BACKGROUND: Due to the aging of the population, cancer has become a health priority worldwide. While the number of elderly cancer patients is rapidly increasing, many barriers still exist to their effective management. Compared with their younger counterparts, the elderly are less likely to receive optimal medical, psychological and spiritual treatment provided in a culturally competent manner. DESIGN: The scanty literature on cultural competence in elderly cancer patients has been reviewed. Additional material has been selected based on the authors' clinical research in medical oncology and psycho-oncology, and on their scholarly work in anthropology and bioethics. RESULTS: The aging process is a synergistic product of biological, behavioral and social issues within a cultural context. Knowledge about how older people understand, perceive and experience their illness trajectory and make choices is essential to the planning and delivering of effective cancer care. CONCLUSION: This position paper of the SIOG Task Force on Cultural Competence in the Elderly creates awareness of the influence of culture in geriatric oncology. Negotiating cross-cultural issues in geriatric oncology helps managing possible conflicts between patients, families and physicians over differing health care values, beliefs, or practices. Possible areas of future scholarly investigation and clinical research are identified.

Aged↗

PubMedDate not supplied

A curriculum for multicultural education in family medicine.

BACKGROUND AND OBJECTIVES: To deliver effective medical care to patients from all cultural backgrounds, family physicians need to be culturally sensitive and culturally competent. Our department implemented and evaluated a 3-year curriculum to increase residents' knowledge, skills, and attitudes in multicultural medicine. Our three curricular goals were to increase self-awareness about cultural influences on physicians, increase awareness about cultural influences on patients, and improve multicultural communication in clinical settings. Curricular objectives were arranged into five levels of cultural competence. Content was presented in didactic sessions, clinical settings, and community medicine projects. METHODS AND RESULTS: Residents did self-assessments at the beginning of the second year and at the end of the third year of the curriculum about their achievement and their level of cultural competence. Faculty's evaluations of residents' levels of cultural competence correlated significantly with the residents' final self-evaluations. Residents and faculty rated the overall curriculum as 4.26 on a 5-point scale (with 5 as the highest rating). CONCLUSIONS: Family practice residents' cultural knowledge, cross-cultural communication skills, and level of cultural competence increased significantly after participating in a multicultural curriculum.

Curriculum↗

PubMed2004

Changing healthcare professionals' behaviors to eliminate disparities in healthcare: What do we know? How might we proceed?

The patient-healthcare provider communication process--particularly the provider's cultural competency--is increasingly recognized as a key to reducing racial/ethnic disparities in health and healthcare utilization. A working group was formed by the Office of Minority Health, Department of Health and Human Services to identify strategies for improving healthcare providers' cultural competency. This expert panel, one of several working groups called together to explore methods of reducing healthcare disparities, was comprised of individuals from academic medical centers and health professional organizations who were nationally recognized as having expertise in healthcare communication as it relates to diverse populations. During the 2-day conference, the panel identified, from personal experience and knowledge of the literature, key points of intervention and interventions most likely to improve the cross-cultural competency of healthcare providers. Proposed interventions included introduction of cultural competence education before, during, and after clinical training; implementation of certification and accreditation requirements in cross-cultural competence for practicing healthcare providers; use of culturally diverse governing boards for clinical practices; and active promotion of workforce cross-cultural diversity by healthcare organization administrators. For each intervention, methods for implementation were specified. On-going monitoring and evaluation of processes of care using race/ethnicity data were recommended to ensure the programs were functioning.

Attitude of Health Personnel↗

PubMedDate not supplied

Beyond the rhetoric: strategies for implementing culturally effective practice with children, families, and communities.

Culturally effective practice remains elusive within child welfare agencies. Recognizing the hierarchical nature of becoming culturally competent, this article presents specific strategies that enhance cultural effectiveness at the individual, interprofessional, middle management, and upper management levels. The approaches evolve from a five-stage model of change: precontemplation, contemplation, preparation, action, and maintenance. Becoming culturally competent requires a clear assessment of where the individual practitioner and agency are on the change continuum. The article also explores barriers to culturally competent practice, with a focus on multilevel strategies that work within child welfare agencies.

Child↗

PubMed2000

Cancer and men from minority ethnic groups: an exploration of the literature.

The authors reviewed literature which has been published in the last 20 years. Cancer is the second leading cause of death in developed countries and is expected to become a significant cause of death in developing countries. Whilst there are a large number of studies on cancer and men, there is a paucity of data on men from minority ethnic groups. In the USA, African Americans are more likely to develop cancer than any other ethnic group. Although cancer rates amongst minority ethnic groups in the UK are thought to be low, 11% of Indian and African men and 19% of Caribbean men died from cancer during 1979-1983. There is also further evidence in the USA that African American, Filipinos and Native Americans have the lowest cancer survival rates. Service utilization, especially tertiary care, is also thought to be low amongst minority ethnic groups from the USA and the UK. Reasons for these variations include artefactual, cultural, materialist and social selectivist explanations as well as the effects of migration, racism and genetic disposition. This area is under-researched, in particular cultural beliefs about cancer. Further research into this area should apply culturally competent methods to ensure valid data to inform cancer policy, education and practice.

Attitude to Health↗

PubMed1999

Mental health nursing and cultural diversity.

The focus of this article is on ethnic cultural difference. The establishment of a bi-cultural model of health care delivery has been a recent priority in New Zealand. Bi-culturalism has become an important concept for Maori and Pakeha (Europeans), working in partnership in the planning and implementation of mental health services in New Zealand. Adoption of the principles of respect and recognition of the uniqueness of different cultural identities, by nurses, has meant that clients who use mental health services in New Zealand are beginning to benefit from nursing care that is culturally competent.

Attitude to Health↗

PubMed1998

Indigenous people in a multicultural society: unique issues for human services.

Indigenous peoples have a unique place within a multicultural society. The history of indigenous people in the United States differs from those who came here as immigrants. For many Native Americans a primary goal has been self-preservation through separation and isolation rather than seeking a place within a multicultural society. Many people are not aware that the federal government and some state governments have specific moral and legal rights and responsibilities toward Native Americans, unlike other groups in the United States. Human services providers who work with Native Americans must understand the issues specific to indigenous people in a multicultural society. This article examines the unique status of Native Americans in the United States and explores the practice implications of that status. The article begins with an overview of the components of culturally competent social work with Native Americans, then examines specific issues such as historical trauma and sovereignty with which social workers and other human services workers should be familiar to serve Native American clients effectively.

Clinical Competence↗

PubMed2002

Caring for the patient who has undergone female circumcision.

Home health and hospice nurses are increasingly called to care for patients the world over. The provision of culturally competent and culturally sensitive care is critical to patient care planning. Viewing the patient holistically and within the context of family and culture provides the basis of most effective care. While nurses may not be providing skilled care directly related to female circumcision, it is important to include all of the patient's concerns within the framework of a comprehensive plan of care.

Africa↗

PubMed2002

Understanding adolescent depression in ethnocultural context.

Asian-American adolescents often are regarded as a "model minority" and as being less likely to experience depression than adolescents of other ethnic groups. African-American adolescents are more often diagnosed with schizophrenia than depression. Do these epidemiologic phenomena reflect the real facts, or are these just artifacts shaped by cultural bias or insensitivity prevailing in this society? This article explores the diagnostic bias resulting in misdiagnosis of adolescent depression and reviews the role of culture/ethnicity in mental health and the ethnocultural variations in depression among African-American, Hispanic-American, and Asian-American adolescents. By discussing the issues, this article guides nurses to enhance cultural competence in nursing care.

Acculturation↗

PubMed2003

Ensuring cultural diversity among California nurses.

The California Strategic Planning Committee for Nursing cultural diversity work group surveyed deans and directors from RN prelicensure and vocational nurse education programs in California in 1998. With a 49% response rate, key survey findings were that 48% of programs were actively recruiting ethnically diverse students using a variety of strategies; various approaches were being used to retain students; barriers to student success were primarily financial and educational; and most programs included curricular content and programming designed to ensure culturally competent and sensitive graduates.

California↗

PubMed1999

The moral imperatives for diversity.

The debate over diversity and affirmative action remains contentious at best and divisive or polarizing at worst. The profession of orthopaedics, like all elite professions, is very much involved in this debate. Starting with the assumption that there are reasonable arguments on both sides of this question, this paper will search for common ground by focusing on three issues: the ethical and pragmatic reasons for overcoming the present effects of past discrimination; the importance of ensuring the clinical and cultural competence of the specialty of orthopaedics in taking care of a diverse population; and the value of preserving a commitment to equality.

Clinical Competence↗