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PubMed2001

History of medical ethics and perspectives on disparities in minority recruitment and involvement in health research.

The legitimate and successful recruitment of minorities as research participants in clinical trials should be addressed from an ethical and historical perspective. To gain an appreciation of the challenges, to develop strategies and to overcome the disparities of minority involvement in clinic trials, it is essential to be cognizant of previous violations and abuses of ethics and human rights. Also significant are major legislation, regulations and federal initiatives that resulted from those abuses. From history, we have learned we cannot generalize data and assume that, if we have the majority group in clinical trials, then we can accurately apply that data to minorities. There are cultural and environmental differences; thus, it is absolutely crucial that researchers approach recruitment of minority groups with cultural competence and cultural sensitivity. Federal regulations and legislation set the framework for protection of human participants in research.

Clinical Trials as Topic↗

PubMed2001

History of medical ethics and perspectives on disparities in minority recruitment and involvement in health research.

Clinical Trials as Topic↗

PubMed2006

International immersion programs in baccalaureate nursing education: professor and student perspectives.

This article presents the dual perspectives of professor and student in relation to the explicit need for nurses to become acutely conscious of cultural competence through self-awareness and how this influences nursing care. Mary Anne Levine, Professor of Nursing, discusses the development, planning, implementation, and evolution of the International Immersion Program (IIP) at Humboldt State University. The student experience, integration, and evaluation of IIP and its impact on one's professional and personal life are described by Elizabeth Perpetua, currently a practicing RN, who participated in the program in Nakhodka, Russia.

Attitude of Health Personnel↗

PubMed2006

Enhancing Success in Advanced Practice Nursing: a grant-funded project.

The Enhancing Success in Advanced Practice Nursing (ESAPN) Project is designed to improve access to a diverse and culturally competent and sensitive health professions workforce by increasing the number of Hispanic, African-American and Asian nurses recruited, enrolled in and graduated from the MSN program at the University of Medicine and Dentistry of New Jersey-School of Nursing (UMDNJ-SN). In addition, the project plan includes the development and implementation of a comprehensive program that incorporates academic support services, career advisement and mentoring activities to retain and graduate an increased number of culturally, racially and ethnically diverse advanced practice nurses for the State of New Jersey. The project also seeks to improve the quality of care by preparing advanced practice nurses to provide culturally competent and sensitive care by assuring that the MSN curriculum includes content and clinical experiences relevant to the development of cultural competence. Faculty participation in workshops, designed to increase knowledge of cultural competence, is a key component. The success of the project will be evaluated using a variety of measures that track increases in the number of diverse students recruited and enrolled, the number of students accessing services associated with the ESAPN program, and increased retention and graduation of Hispanic, African-American and Asian nurses prepared as advanced practice nurses.

Accreditation↗

PubMedDate not supplied

Diversity issues in the delivery of healthcare.

What does it mean to be culturally competent and proficient? What criteria are used to describe a culturally competent healthcare delivery system and how can an individual or an organization grow in competency? What is the delivery of competent care related to me personally?This article addresses these questions with the assumption that knowing one's viewpoints on how culture change offers a sample of the glasses through which we view others. Culture and culture change are defined, and four models that explain the process of culture change are discussed in detail. These models represent different world views held to explain the phenomena of acculturation. The article concludes with a summary of the recommended National Standards for cultural and linguistic appropriate healthcare services developed by the Office of Minority Health. The concepts described can serve as universal tools for individuals and/or organizations interested in cultural competency.

Attitude of Health Personnel↗

PubMed2005

Cultural aspects of working with students enrolled in a school-based health center.

School-based health centers provide accessible quality health services to culturally diverse student populations. Numerous challenges exist in providing culturally competent services in a school setting. This article presents models of culturally competent care, practice recommendations, and practical resources in an attempt to improve the provision of culturally competent services. In addition, one school health center's initiative to outreach culturally diverse students into health careers is highlighted.

Adolescent↗

PubMedDate not supplied

The struggle for equality in healthcare continues.

All healthcare providers, both institutional and individual, must make every effort to ensure that every person who seeks their medical care is offered competent, sincere, and equal treatment options. Unfortunately, this ideal scenario does not take into account the lack of diversity among care providers and the lack of culturally competent policies within healthcare delivery settings. As a result, many care providers continue to follow racially biased treatment practices and many organizations continue to ignore their public trust of providing fair treatment to everyone, regardless of skin color, gender, economic capabilities, etc. Although developing and implementing a diversity plan and culturally competent policies is very complex practically, politically, and programmatically for traditional institutional care providers, it must be done. The key ingredient to this effort is the absolute commitment and support of the organization's governing bodies and executive management. Institutions can certainly volunteer and begin to develop such programs that foster recruitment, selection, and retention of culturally competent care providers to ensure that equal healthcare is received by their patient populations. However, many institutions are already besieged by too many healthcare challenges to volunteer for such an effort. The Joint Commission on Accreditation of Healthcare Organizations and the National Council of Quality Assurance can certainly help jumpstart this effort by establishing an accreditation standard that requires all healthcare providers to establish and practice culturally competent care within their organizations. Providers must also embrace the diversity that is a part of our society and must not let race or ethnicity be a determining factor in offering treatment options.

Attitude of Health Personnel↗

PubMed2006

Teaching culturally appropriate care: a review of educational models and methods.

The disparities in health care and health outcomes between the majority population and cultural and racial minorities in the United States are a problem that likely is influenced by the lack of culturally competent care. Emergency medicine and other primary-care specialties remain on the front lines of this struggle because of the nature of their open-door practice. To provide culturally appropriate care, health care providers must recognize the factors impeding cultural awareness, seek to understand the biases and traditions in medical education potentially fueling this phenomenon, and create a health care community that is open to individuals' otherness, thus leading to better communication of ideas and information between patients and their health care providers. This article highlights the rationale for and current problems in teaching cultural competency and examines several different models implemented to teach and promote cultural competency along the continuum of emergency medicine learners. However, the literature addressing the true efficacy of such programs in leading to long-lasting change and improvement in minority patients' clinical outcomes remains insufficient.

Attitude of Health Personnel↗

PubMedDate not supplied

Cultural assessment of black American men treated for prostate cancer: clinical case studies.

PURPOSE/OBJECTIVES: To describe aspects of culturally competent care. Two case studies of black American men who received treatment for prostate cancer are presented to illustrate the use of the explanatory model of illness as a guide for conducting a cultural assessment. DATA SOURCES: Published articles, abstracts, and books; case studies developed from interviews of black American men who received treatment for prostate cancer. DATA SYNTHESIS: The explanatory model of illness provides a vehicle for healthcare providers to examine the cultural values and health beliefs of the individual seeking professional healthcare. Knowledge about cultural values and beliefs is essential in order to provide culturally competent care. Beliefs about health and illness, use of a lay referral system, use of folk treatments, and the importance of family, community, and spiritual support are some of the cultural concepts that must be considered. CONCLUSIONS: Culture exerts an important influence on the illness experience of individuals seeking health care. However, culture has not received the same attention as biopsychosocial factors in nursing care. Given the increasing racial and ethnic diversity of the U.S. population, cultural competence must assume a more central role in healthcare delivery. Knowledge and mutual respect for cultural differences are necessary for culturally competent care to become a reality in a changing healthcare environment. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses need to increase their awareness of cultural variations and include them in the patient's plan of care.

Black or African American↗

PubMed1998

Teaching residents to care for culturally diverse populations.

The authors discuss the growing need for primary care residents to learn how to care for patients of many cultural backgrounds. To effectively learn the needed skills, residents must incorporate insights from areas outside medicine. The authors focus on three such areas: cultural competency, public health, and community-oriented primary care. Regarding cultural competency, the authors make clear that on the one hand, physicians must be trained to be sensitive to cultural differences and patterns, but on the other, they cannot be expected to know the many cultures of their patients in depth. They discuss the Core Curriculum Guidelines on Culturally Sensitive and Competent Health Care created by the Society of Teachers of Family Medicine. Regarding community-oriented primary care (COPC), a process introduced from Europe in 1982, the authors state that one of its key elements is to provide accessible care to diverse and often underserved populations. However, various factors have kept COPC, and the federally funded community health centers that address the concerns of COPC, from having the widespread effects they could have. Regarding public health, the authors review the various services and orientations of public health and show how these help foster care for diverse populations. The authors then briefly describe their own residency program and its work with diverse populations. They conclude by emphasizing the importance for residents of learning the principles and practices embodied in cultural competency, public health, and COPC in order to effectively communicate with their patients.

Attitude to Health↗

PubMed2004

Knowledge, skills and attitudes of nursing students regarding culturally congruent care of Native Americans.

The provision of culturally congruent care for Native Americans can improve health care compliance and outcomes. The purpose of this survey was to determine the knowledge, skills, and attitudes students deem essential to provide culturally competent healthcare for Native American clients. This information provides nurse educators with critical information regarding the cultural competence of nursing students and may be used to direct curriculum development. An open-ended survey was administered to associate degree nursing students, and conceptual analysis was used for data analysis. The researcher identified four knowledge themes, two skill themes, and two attitude themes. These themes were interrelated and connected. Findings from this study indicate that the current nursing curriculum supports the development of cultural competence among the student nurses who will practice in a multicultural climate. Practice implications include the use of a cultural assessment tool by the students.

Adolescent↗

PubMed2006

The virtue of multiculturalism: personal transformation, character, and openness to the other.

The social, intellectual, and moral movement known as multiculturalism has been enormously influential in psychology. Its ability to reshape psychology has been due to its ethical force, which derives from the attractiveness of its aims of inclusion, social justice, and mutual respect. The cultivation of cultural competence, presented as a developmental process of acquiring self-awareness, cultural knowledge, and skills, is an important emphasis in the multicultural literature. The authors place the cultural competence literature in dialogue with virtue ethics (a contemporary ethical theory derived from Aristotle) to develop a rich and illuminating way for psychologists to understand and embody the personal self-examination, commitment, and transformation required for learning and practicing in a culturally competent manner. According to virtue ethics, multiculturalism can be seen as the pursuit of worthwhile goals that require personal strengths or virtues, knowledge, consistent actions, proper motivation, and practical wisdom. The authors term the virtue of multiculturalism openness to the other and conclude by describing how attention to cultural matters also transforms virtue ethics in important and necessary ways.

Awareness↗

PubMed2004

Diversity and patient care in a shrinking world.

The purpose of this article is to discuss current standards for preparing nurses to practice as culturally competent generalists in our rapidly shrinking world. Culturally competent care, transcultural nursing practice, and the nursing professions' standards of nursing care for diverse populations are applied to nursing education, renal nursing, and transplant nursing issues. Recommendations for breaking down health care gaps and barriers include ensuring, within the boundaries and control base of our own practice, that cultural, racial, economic, spiritual, and social diversity is respected and acknowledged.

Clinical Competence↗

PubMedDate not supplied

Theories of spouse abuse: relevance to African Americans.

This article reviews several sociocultural theories of spouse abuse. However, their relevance to ethnic people of color, and African Americans in particular, is questionable because of different cultural and historical experiences. It is suggested that the use of unidimensional sociocultural theories may not adequately explain spousal abuse cross culturally. Recommendations are made for the development and testing of multidimensional theoretical frameworks that consider the unique cross-cultural variations related to abusive relationships among ethnic people of color. Additionally, studies that are conducted by culturally competent researchers may better explain cultural similarities and differences regarding spouse abuse and thus ultimately lead to more culturally competent nursing care.

Black or African American↗

PubMed1964

CORRELATION BETWEEN GENETIC TRANSFORMABILITY AND NON-PHOTOREACTIVABILITY IN BACILLUS SUBTILIS.

Kelner, Albert (Brandeis University, Waltham, Mass.). Correlation between genetic transformability and nonphotoreactivability in Bacillus subtilis. J. Bacteriol. 87:1295-1303. 1964.-Photoreactivation after ultraviolet irradiation was studied in the transformable Bacillus subtilis SB-1. Moderate photoreactivability (maximal increase in survival due to photoreactivating light, five- to tenfold) was found in (i) noncompetent vegatative cells produced in Brain Heart Infusion broth, and in (ii) the total viable cells of a competent culture grown in special competency-producing medium and tested either just before or after transformation with deoxyribonucleic acid. However, no, or only trace, photoreactivation (maximal increase in survival, 1.5- to 2-fold) was found in that fraction of a competent culture actually able to be transformed. This nonphotoreactivability was a temporary property of transformable cells, since clones derived from them were normally photoreactivable. Nonphotoreactivability is not explained by injury to transformants caused by photoreactivating light, although transformants are killed by very large doses of light. The findings in B. subtilis strengthen the idea that transformability is generally correlated with nonphotoreactivability.

Bacillus subtilis↗

PubMed2004

Development of cell cultures with competency for contributing to the zebrafish germ line.

The zebrafish is an established model for the genetic analysis of vertebrate development. Forward-genetic screens have generated thousands of mutations, and antisense-based methods have been used to transiently knockdown gene expression during embryogenesis. Although these methods have made the zebrafish a valuable system for the identification and functional characterization of developmentally important genes, one deficiency of the zebrafish model is the absence of methods to introduce targeted mutations to generate knockout lines of fish. Application of gene-targeting methods has been limited in nonmurine species due to the absence of germ-line competent embryonic stem (ES) cell lines. Recently, progress was made in addressing this problem by the derivation of zebrafish embryo cell lines that remain pluripotent and germ-line competent for multiple passages in culture. Zebrafish germ-line chimeras were generated using cultures derived from embryos at two different developmental stages, and targeted insertion of vector DNA by homologous recombination was demonstrated in both cultures. Several strategies are being used to optimize the production and identification of germ-line chimeras. The zebrafish embryo cell culture system should provide the basis of a gene-targeting approach that will complement other genetic strategies and improve the utility of the zebrafish model for studies of development and disease.

Animals↗

PubMed2003

"I saw it in a different light": international learning experiences in baccalaureate nursing education.

Health care providers in the United States are faced with delivering care to an increasingly diverse population. Nursing leaders and their respective organizations long have recognized the need to prepare nurses who understand the effects of the growing global community. Inclusion of cultural content in theory courses and clinical assignments in diverse settings are two ways to increase student nurses' cultural competency. This study explored the experiences of nursing students and faculty mentors who sought to increase their cultural competence through participation in a short-term immersion learning project in Central America. Analysis of data gathered through interviews and journal entries identified three themes--being "other," "I was already a nurse," and expanding my worldview.

Adult↗

PubMed2006

Losing culture on the way to competence: the use and misuse of culture in medical education.

Most cultural competence programs are based on traditional models of cross-cultural education that were motivated primarily by the desire to alleviate barriers to effective health care for immigrants, refugees, and others on the sociocultural margin. The main driver of renewed interest in cultural competence in the health professions has been the call to eliminate racial and ethnic disparities in the quality of health care. This mismatch between the motivation behind the design of cross-cultural education programs and the motivation behind their current application creates significant problems. First, in trying to define cultural boundaries or norms, programs may inadvertently reinforce racial and ethnic biases and stereotypes while doing little to clarify the actual complex sociocultural contexts in which patients live. Second, in attempting to address racial and ethnic disparities through cultural competence training, educators too often conflate these distinct concepts. To make this argument, the authors first discuss the relevance of culture to health and health care generally, and to disparities in particular. They then examine the concept of culture, paying particular attention to how it has been used (and misused) in cultural competence training. Finally, they discuss the implications of these ideas for health professions education.

Clinical Competence↗