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PubMed2000

Beyond cultural competence: a model for individual and institutional cultural development.

Nursing's attention to cultural diversity has been influenced by the changing demographic composition of the U.S. population. Nursing must continue to increase awareness and promote attitudinal and behavioral changes that will result in the delivery of culturally appropriate nursing care. The nursing literature includes several models of cultural development to assist nurses and other health care professionals in conducting a cultural assessment and incorporating cultural data into nursing care plans. This article presents a synthesis model of cultural development that illustrates that cultural awareness, cultural sensitivity, and cultural competence do not achieve the level of cultural development necessary to meet the health care needs of a diverse population. Cultural proficiency is a concept that extends cultural competence into nursing practice, administration, education, and research. It is a philosophical and behavioral approach to cultural diversity that guides and prescribes individual and institutional behavior toward "cultural others."

Community Health Nursing↗

PubMed2005

Cultural competence among nursing students and faculty.

Healthcare consumers are entitled to culturally competent care. Therefore, nursing curricula need to include cultural content and student nurses and faculty members need to be culturally competent. The purpose of the study was to describe cultural competence of students and faculty at a college of nursing and to discuss the implications for nursing curricula related to cultural competence. Campinha-Bacote's model (Campinha-Bacote, J., 1994. Cultural competence in psychiatric mental health nursing. Nursing Clinics of North America 29 (1), 1-8.) of culturally competent care provided the theoretical framework. The Inventory for Assessing the Process of Cultural Competence (IAPCC) (Campinha-Bacote, J., 1998. The Process of Cultural Competence in the Delivery of Healthcare Services: A Culturally Competent Model of Care. Transcultural C.A.R.E. Associates, Cincinnati, OH. Available from: .) was used to measure levels of self-reported cultural competence. A convenience sample of 88 first year, 121 fourth year baccalaureate students and 51 faculty members at a college of nursing was studied. Analysis of variance revealed a statistically significant difference (F=43.915, df=259, p<.0001) between the three groups. A positive correlation was found between IAPCC scores and several demographic variables. Findings suggest that cultural competence can be increased by including structured cultural content in nursing curricula.

Adolescent↗

PubMed2006

A crash-course in cultural competence.

America is a multi-cultural society. Yet, there are cultural dimensions to the clinician-patient relationship that have not been systematically addressed in medical education or in clinical practice. Lack of diversity and lack of cross-cultural skills in the medical profession may contribute to health disparities in America. Cultural competence for the medical profession represents a core set of skills that can be learned to respectfully and effectively communicate healthcare information with diverse patient populations. The authors blended their extensive literature review with the knowledge and experience of a culturally diverse medical team to develop the CRASH-Course in Cultural Competency training program for medical professionals. CRASH is a mnemonic for the following essential components of culturally competent health care--consider Culture, show Respect, Assess/Affirm differences, show Sensitivity and Self-awareness, and do it all with Humility. The goal of the CRASH-Course in Cultural Competency is to build confidence and competence in the clinician's ability to communicate effectively with diverse patient populations.

Clinical Competence↗

PubMedDate not supplied

Addressing barriers to cultural competence.

Although the need for cultural competence in healthcare is well established, the integration of cultural competence approaches in most healthcare settings is not yet a reality. A review of the literature reveals several factors in clinical settings that pose barriers for health providers. The purpose of this article is to explore the barriers to cultural competence faced by nurses and to examine the role of staff development in addressing these barriers.

Attitude of Health Personnel↗

PubMed1995

Child rearing beliefs in the African-American community: implications for culturally competent pediatric care.

Cultural competence is increasingly acknowledged as an essential component of nursing care within the heterogeneous society our nation has become. A necessary antecedent to competence is an understanding of, and respect for, the beliefs and priorities of the families being served. Literature from a variety of disciplines in the areas of attachment, socialization agendas, discipline, and parental teaching is reviewed to provide a description of the cultural context for child rearing in African-American families. Implications for clinical practice are discussed.

Black or African American↗

PubMed2004

The model of cultural competence through an evolutionary concept analysis.

Becoming a culturally competent health professional is a demanding prerequisite in this multicultural society. Cultural competence is explored and abstracted as a conceptual framework through a concept analysis using the evolutionary method. Its model is constructed from a systemic, comprehensive literature review and analysis. Taking into account how cultural competence is viewed by other disciplines (medicine, psychology, education, and social work), a comprehensive definition, antecedents, and consequences of cultural competence in nursing are described and diagrammed. Additionally, two model cases and future implications are discussed. The broader American society is composed of a mosaic of discrete cultural groups existing within the context of their values and identities. Those distinct cultures affect each patient's ways of thinking and his or her perceptions on health care and health behaviors. The proposed model of cultural competence provides a theoretical guide for developing strategies to achieve culturally competent care in nursing practice and research.

Humans↗

PubMedDate not supplied

Cultural competency in occupational therapy: beyond a cross-cultural view of practice.

The purposes of this paper are two. The first purpose is to contribute to cultural competence in occupational therapy practice. The second is to contribute to occupational therapy literature about culture and cultural analysis related to practice. This paper introduces a cultural analysis of stories about the therapeutic process with two Japanese therapists and their Japanese patients. Two therapeutic situations, including therapists' and their patients' experiences, are interpreted by the author, a Japanese occupational therapist, as critical incidents for reflection to improve culture general competence. The stories illustrate the patients' perception of life with illness and, particularly, the emergence of their cultural values within the therapy process. The analyses focus on how an understanding of the patients' illness experience is integrated into the therapy process and how the therapeutic interventions reflect the culture. In one case, the therapeutic occupation of cooking links to the meaning found in the traditional Japanese woman's role. In the second case, the therapist-patient relationship, based on local rather than western social relationships, promoted the patient's engagement in meaningful occupations. Reflection on these stories, which illustrate an alternative cultural view of occupations and therapeutic relationships, may assist occupational therapists in the development of improved level of cultural competence.

Communication↗

PubMed1995

Creating a culturally competent workforce.

Culturally sensitive health care professionals will have a distinct advantage in the 21st century. As the United States continues to grow as a multicultural society, practitioners will require access to cultural diversity training tailored to the needs of health care providers. The American Occupational Therapy Association offers an array of such educational resources through its Multicultural Affairs Program.

Allied Health Personnel↗

PubMed2003

Culturally competent healthcare systems. A systematic review.

Culturally competent healthcare systems-those that provide culturally and linguistically appropriate services-have the potential to reduce racial and ethnic health disparities. When clients do not understand what their healthcare providers are telling them, and providers either do not speak the client's language or are insensitive to cultural differences, the quality of health care can be compromised. We reviewed five interventions to improve cultural competence in healthcare systems-programs to recruit and retain staff members who reflect the cultural diversity of the community served, use of interpreter services or bilingual providers for clients with limited English proficiency, cultural competency training for healthcare providers, use of linguistically and culturally appropriate health education materials, and culturally specific healthcare settings. We could not determine the effectiveness of any of these interventions, because there were either too few comparative studies, or studies did not examine the outcome measures evaluated in this review: client satisfaction with care, improvements in health status, and inappropriate racial or ethnic differences in use of health services or in received and recommended treatment.

Communication Barriers↗

PubMed2003

Applying theory to the design of cultural competency training for medical students: a case study.

Although literature suggests that providing culturally sensitive care promotes positive health outcomes for patients, undergraduate medical education currently does not provide adequate cultural competency training. At most schools, cultural competency, as a formal, integrated, and longitudinal thread within the overall curriculum, is still in its infancy. In this article, the authors summarize the current practice of cultural competency training within medical education and describe the design, implementation, and evaluation of a theoretically based, year-long cultural competency training course for second-year students at Wake Forest University School of Medicine. Evaluation of the results indicate that the course was successful in improving knowledge, attitudes, and skills related to cultural competence as well as bringing about positive changes in the medical school's approach to cultural competency training. Also discussed are the implications of the outcomes for the development of culturally competent physicians and how using appropriate theory can help achieve desired outcomes.

Clinical Competence↗

PubMed2006

A snapshot of cultural competency education in US dental schools.

During the last decade, cultural competency has received a great deal of attention in health care and the literature of many fields, including education, social services, law, and health care. The dental education literature provides little information regarding status, strategies, or guiding principles of cultural competency education in U.S. dental schools. This study was an attempt to describe the status of cultural competency education in U.S. dental schools. A web-based thirty-question survey regarding cultural competency education coursework, teaching, course materials, and content was sent in 2005 to the assistant/associate deans for academic affairs at fifty-six U.S. dental schools, followed up by subsequent email messages. Thirty-four (61 percent) dental school officials responded to the survey. The majority of respondents (twenty-eight; 82 percent) did not have a specific stand-alone cultural competency course, but indicated it was integrated into the curriculum. Recognition of local and national community diversity needs prompted course creation in most schools. Respondents at almost two-thirds of schools indicated that their impression of students' acceptance was positive. Teachers of cultural competency were primarily white female dentists. Few schools required faculty to have similar cultural competency or diversity training. Thirty-three of the thirty-four U.S. dental schools responding to this survey offer some form of coursework in cultural competency with little standardization and a variety of methods and strategies to teach dental students.

Attitude↗

PubMed2005

Developing a cultural competence assessment tool for people in recovery from racial, ethnic and cultural backgrounds: the journey, challenges and lessons learned.

In 1997, Maryland implemented a new managed care mental health system. Consumer satisfaction, evaluation and cultural competency were considered high priorities for the new system. While standardized tools for measuring consumer satisfaction were readily available, no validated, reliable and standardized tool existed to measure the perception of people from minority groups receiving mental health services. The MHA*/MHP* Cultural Competency Advisory Group (CCAG) accepted the challenge of developing a consumer assessment tool for cultural competency. The CCAG, composed of people in recovery, clinicians and administrators used their collective knowledge and experiences to develop a 52-item tool that met standards for validity and reliability. Consultation from a researcher helped to further develop the tool into one possessing tremendous potential for statewide implementation within Maryland's Public Mental Health System. Recognizing the limitations of the study and the need for further research, this instrument is a work in progress. Strategies to improve the instrument are currently underway with the Mental Hygiene Administration's Systems Evaluation Center of the University of Maryland and several national researchers.

Adult↗

PubMedDate not supplied

Primary care for women. Cultural competence in primary care services.

The assessment of cultural competence in providing primary care services for women is addressed. Emphasis is placed on the ways in which cultural competency attainment can ensure the availability of key primary care components to all women, especially those from certain vulnerable populations and those who have specific primary health care needs. A cultural competence continuum is described that will assist providers in an assessment of their own cultural competency levels, as well as those of the service settings in which they practice. Six scenarios are provided, describing experience at each level of the continuum that may hinder the development and delivery of effective primary care service interventions. Examples of ways in which nurse-midwives can provide leadership in the area of cultural competence in women's primary care are also included.

Adult↗

PubMed1994

Cultural competence in psychiatric mental health nursing. A conceptual model.

This article presents a conceptual model for enhancing cultural competence in psychiatric nursing. The model, The Culturally Competent Model of Care, views cultural awareness, cultural knowledge, cultural skill, and cultural encounter as critical components of cultural competence. In this dynamic model, cultural competence is viewed as a process, not an end-point in which the psychiatric nurse continuously strives to effectively work within the cultural context of individuals, families, and/or communities from diverse cultural/ethnic backgrounds. The Culturally Competent Model of Care encourages psychiatric nurses to see themselves as always in the process of becoming culturally competent, rather than being culturally competent.

Humans↗

PubMed2002

Developing culturally competent researchers.

BACKGROUND: Whilst we live in multicultural societies most health researchers tend to take the cultural perspective of the majority ethnic group at the expense of the perspective of minority ethnic groups. AIM: This paper discusses the need for the development of culturally competent health researchers in all areas of research and proposes a model for the achievement of this. DESIGN: A snapshot review of research textbooks used in nursing curricula was conducted to identify whether culturally competent research was being promoted. RESULTS: The review found that whilst a few textbooks touched on ethnicity, race and culture, none of them addressed the issue of cultural competence. Subsequently the authors adapted their existing model of culturally competent health care practice, and in this paper they propose it as a model for the development of culturally competent researchers. DISCUSSION: The model put forward by the authors consists of four concepts: cultural awareness, cultural knowledge, cultural sensitivity and cultural competence. A culturally competent researcher is one who is able to apply the related skills and knowledge in project design, data collection, analysis, report writing and dissemination. Furthermore, the authors identify two layers of cultural competence, those of culture-generic (knowledge and skills that are applicable across ethnic groups) and culture-specific competence (knowledge and skills that relate to a particular ethnic group). The relationship between these two layers is a dynamic and spiralling process as illustrated by the model. CONCLUSION: Current health policy in many developed countries focuses on inequalities of health and managing diversity, including ethnicity. Thus the authors conclude that the development of culturally competent researchers will lead to both valid research and culturally competent practice by health care professionals.

Attitude of Health Personnel↗

PubMed1996

Promoting cultural competence in HIV/AIDS care.

The importance of cultural competence in providing health care to a diverse patient population is well-recognized throughout the health professions, though there is as yet no widely accepted set of criteria for establishing and maintaining cultural competence. In HIV/AIDS, where behavioral factors figure so prominently in transmission, prevention, and treatment, cultural appropriateness is crucial to providing patient education and nursing care. This article suggests some specific cultural competence training strategies and offers a broad conceptual framework for teaching and learning about the issues involved in cultural competence, with specific illustrations relating to HIV/AIDS.

Clinical Competence↗

PubMed2006

Cultural competence of baccalaureate nursing faculty: are we up to the task?

Reported low levels of cultural competence among baccalaureate nursing students, as well as professional nurses, have raised questions about nursing faculty's readiness to prepare culturally competent graduates. This study examined cultural competence among faculty of baccalaureate nursing programs in Louisiana. Using a five-point Likert-type scale, the respondents were asked to express their level of agreement with statements addressing the components of cultural competence. The data analysis revealed the respondents' rating of their cultural awareness (4.14), desire (3.67) knowledge (3.65), skills (3.65), and encounters (3.56). Overall cultural competence was rated as 3.73. When the overall cultural competence index was regressed on the index of each subscale, the cultural knowledge index and the cultural encounter index significantly explained 87% of the variance in the model. These findings suggest that faculty should be encouraged to attend continuing education programs on cultural competence to improve their knowledge in this area. This continuing education, coupled with more local and/or international cross-cultural encounters should significantly improve the overall cultural competence of the respondents.

Adult↗

PubMed2026

Haemodialysis Nurses' Self-Reported Cultural Competence and Responsiveness: A Cross-Sectional Survey.

BACKGROUND: People receiving in-centre haemodialysis have distinct cultural care needs and preferences, and nurses are expected to respond to these. However, haemodialysis nurses' cultural competence and responsiveness are unknown. OBJECTIVES: To examine nurses' cultural competence and responsiveness when caring for people with diverse cultural characteristics. DESIGN: An online cross-sectional survey. PARTICIPANTS: Haemodialysis nurses from Australia and New Zealand (n = 123), recruited through the Renal Society of Australasia and professional networks. MEASUREMENTS: The 25-item Cultural Competence Assessment instrument measured cultural awareness and sensitivity, and culturally responsive behaviours. Demographic characteristics were also collected. RESULTS: Of 123 complete responses, overall cultural competence was high (M = 5.09, SD = 0.76), particularly awareness and sensitivity (M = 5.76, SD = 0.53), with significantly higher scores among those who had completed cultural awareness training (p = 0.009). In contrast, culturally responsive behaviours were moderate (M = 4.53, SD = 1.23), highlighting the gap between cultural competence and responsiveness. The lowest scoring areas were documentation of patients' cultural needs (M = 3.88, SD = 2.02) and access to cultural learning resources (M = 3.02, SD = 1.75), indicating limited supports. Qualitative findings reflected practices of culture care preservation and accommodation, with themes of cultural awareness and language differences highlighting barriers related to language and resources. CONCLUSIONS: High cultural competence does not necessarily translate into culturally responsive behaviour. Organisational supports, including guidance for documenting cultural needs, cultural assessment tools and accessible learning resources, may help strengthen culturally responsive haemodialysis care.

Humans↗