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PubMedDate not supplied

Using an eclectic model to educate students about cultural influences on the nurse-patient relationship.

This article describes how the concepts of cultural awareness, cultural sensitivity, and cultural competence are integrated into the nursing curriculum at Lehman College, City University of New York. A culturally diverse student population engaged in lectures, classroom exercises, and clinical experiences in order to learn the ideas and imperatives of cultural diversity in nursing care. The exercises were problem-based learning experiences guided by a university-developed model for teaching students to understand cultural diversity. The model is derived from Leininger's comparative cultural caring model and Paterson and Zderad's humanistic nursing model. By observing differences and similarities among diverse cultures, students learned that the assignment of cultural attributes is an inexact process and should be organized as hints rather than as certainties. Students also learned the importance of integrating cultural awareness, cultural sensitivity, and cultural competence into their nursing care.

Cultural Diversity↗
PubMed2004

A psychiatric residency curriculum on the care of African American patients.

Training psychiatric residents to address cross-cultural issues in their practice of psychiatry is a necessary objective of contemporary psychiatric education. Cultural issues play a critical role in the formation and expression of a patient's personality. In addition, they are a major determinant of the context in which mental illness develops. This proposed curriculum outlines a systematic progression toward cultural competence with populations of African descent. It begins with increasing the residents' awareness of their own cultural identity. The concept of achieving cultural competence as a continuum is utilized. Trainees should be prepared for any unfavorable reactions to this novel material. The curriculum must include accurate historic information about black culture, and general topics of diagnosis and treatment of African Americans must be covered. This should occur in congruence with trainees' development from students to residents to psychiatrists, as they move from inpatient to outpatient, hospital to community, close supervision to autonomous functioning, gaining both skill and confidence.

Black or African American↗
PubMed2001

Cultural discovery in nursing practice with Vietnamese clients.

BACKGROUND: Although there is a developing body of literature dealing with cultural care issues there is a continuing need for research based knowledge of how nurses work within a multicultural population in providing culturally competent care. Nurses' experiences with Vietnamese clients can contribute to the knowledge of how to provide cultural care. PURPOSE: The purpose of this 1997 study was to investigate what North American nurses learned from their work with Vietnamese clients. METHOD: A grounded theory approach was employed. A purposive sample of 27 Registered Nurses, who work with Vietnamese clients in North America, in acute care, community, and clinic settings were interviewed using a semi-structured format. Following ethical approval, an explanation of the study, and data collection, data were analysed using dimensional analysis. Verifiability, adequacy of the findings, and empirical grounding of the theory was established through use of the constant comparative method as well as review of the research method and the study results by selected participants in the study and a nursing expert. FINDINGS: The action process of cultural discovery was found as the most fruitful explanation of nurses' experiences. Properties of cultural discovery were learning to see them, seeing a common humanity, and learning to see how they see health. The condition of cultural discovery was making a connection with the consequences of learning how to provide sensitive care and a changed nurse. CONCLUSIONS: Nurses can learn to become more culturally competent in their care for Vietnamese clients. Nurses learned to be more aware of the differences among people of different cultures as well as recognizing common elements among different groups. They learned to broaden and redevelop their concept of health and to respect the social adjustments that the Vietnamese were making.

Adult↗
PubMed2002

African-American spirituality: a concept analysis.

Culturally competent care for African Americans requires sensitivity to spirituality as a component of the cultural context. To foster understanding, measurement, and delivery of the spiritual component of culturally competent care, this article presents an evolutionary concept analysis of African-American spirituality. The analysis is based on a sample of multidisciplinary research studies reflecting spirituality of African Americans. Findings indicate that African-American spirituality involves quintessential, internal, external, consoling, and transformative attributive dimensions. Findings are considered in relation to previous conceptual analyses of spirituality and suggest that defining attributes of African-American spirituality are both global and culturally prominent. Implications for practice and research are discussed.

Adult↗
PubMedDate not supplied

Managing diversity: the differing perceptions of managers, line workers, and patients.

This study assesses how hospital managers, line workers, and patients understand the impact of patient and workforce diversity on the delivery of hospital care. Data come from managerial interviews and staff and patient focus groups at five voluntary hospitals in New York City. Three findings emerge from the research. Cultural competence is critical to the provision of quality care, but the perceived significance of cultural competence depends on one's role in the organization. Language remains a problem for patients and staff, although all of the hospitals have extensive translation services. Compared with management, staff and patients identify diversity to be more of a problem. Differing perceptions about the meaning of diversity must ultimately be reconciled to effectively provide care.

Attitude of Health Personnel↗
PubMedDate not supplied

Intimate partner violence screening practices of certified nurse-midwives.

It is estimated that 324,000 pregnant women are abused by their partners in the United States each year. The purpose of this qualitative study was to explore the intimate partner violence-screening practices of certified nurse-midwives (CNMs). In-depth interviews were conducted with a sample (n = 8) of CNMs, and the data were analyzed by using with-case and across-case methods. The findings demonstrate that the midwives were inconsistent in their intimate partner violence-screening practice during pregnancy and increase or decrease screening in response to a woman's cultural background. Screening in a culturally competent manner is expected of all clinicians, but the demands of an increasingly complex, culturally diverse practice environment make it difficult. Consistent intimate partner abuse screening in a culturally competent manner is a challenge for all primary care providers.

Adult↗
PubMed1997

A comprehensive Afrocentric rites of passage program for black male adolescents.

The health consequences for African American male teenagers of living in high-risk environments are devastating. Given the existence of cultural barriers to health services use, culturally proficient programs that can engage African American male youths in preventive interventions and primary care are urgently needed. This article reviews the health status of African American male adolescents, noting that the leading health problems are preventable. The article then discusses two frameworks that are of value in social work practice with African American populations, cultural competence and empowerment; reviews of Afrocentric theory and Afrocentric social work; and describes a culturally proficient, Afrocentric program for African American male adolescents. Health social workers can take steps to increase their own cultural competence and that of the health care organizations in which they work.

Adolescent↗
PubMed2006

The Yapunyah project: embedding Aboriginal and Torres Strait Islander perspectives in the nursing curriculum.

The Yapunyah Project is an initiative of the Faculty of Health at Queensland University of Technology. It was instigated to further improve the development of cultural competence in health graduates with respect to Aboriginal and Torres Strait Islander perspectives. The project was informed by the cultural competence in healthcare delivery models of Campinha-Bacote (1998a) and Cross, Bazron, Dennis and Isaacs (1989) and by the cultural safety reforms to nursing curricula in New Zealand. The Yapunyah Project involved extensive consultation and collaboration with Indigenous staff and health experts in the local Aboriginal and Torres Strait Islander community. A core curriculum, and associated graduate transcultural competencies, were informed by these discussions and earlier reforms in health curricula by the Committee of Deans of Australian Medical Schools and the Royal Australian College of General Practitioners. Although the overall project involved four separate schools within the faculty, this paper details the experience of embedding Indigenous perspectives within the undergraduate nursing curriculum. The experience has been a challenging and positive one, and the reforms have been supported by a sustainable framework. This paper outlines how one university faculty is endeavouring to educationally prepare nursing students to practice with evidence-based transcultural nursing knowledge based on culture care values, beliefs, and traditional lifeways of Indigenous people of Australia. As such, the project aims to contribute to the improvement and promotion of the health and well-being of Indigenous Australians in culturally and ethnohistorically meaningful ways.

Australia↗
PubMed2005

Clinical myths of the cultural "other": implications for Latino patient care.

PURPOSE: Cultural competency is now a requirement in the curriculum of many health professions. However, clinicians' understandings of cultural difference, the accuracy of those understandings, and their impact on patient care have not yet been carefully explored. The authors conducted an ethnographic study designed to describe clinicians' views of Latino culture in the context of amniocentesis decision making, compared those to patients' discussions of their decision making, and explored how clinicians' views about culture are manifested in consultations with Latinas. METHOD: Between 2000 and 2002, semistructured, open-ended interviews were conducted in southern Texas with convenience samples of 50 clinicians who discuss prenatal testing with patients, and 40 self-identified Latina patients who had been offered amniocentesis. Observations were also made of 101 genetic counseling sessions. Content analysis focused on the cultural characteristics clinicians identified as affecting Latinas' decision making, patients' self-reported decision-making processes, and clinician and patient comments and actions observed during genetics counseling sessions. RESULTS: Most clinicians said Latinas are likely to decline amniocentesis because they are religious, fatalistic, male-dominated, family-centered, and superstitious. However, patients' discussions of their decision making were not consistent with these characterizations. Furthermore, clinicians reported providing less complete information to Latina patients in their efforts to be culturally sensitive. CONCLUSIONS: Comparing patient and clinician interviews bring into question clinicians' notion of Latino culture's role in amniocentesis decision making. Efforts to be "culturally competent," in the absence of a patient-centered approach, may unintentionally encourage stereotyping, thereby negatively affecting the quality and content of clinical care.

Adolescent↗
PubMed2003

Barriers to breast cancer control for African-American women: the interdependence of culture and psychosocial issues.

BACKGROUND: This study evaluates the cultural context of the behaviors and beliefs of African-American women to determine the success or failure of breast cancer prevention and control interventions. Cultural and psychologic reactions, such as fear, distrust, fatalism, and other "historic rooted" factors, are major determinants to participation in these interventions by African-American women. METHODS: Psychosocial and cultural issues were delineated through a literature review in the areas of cancer prevention, breast cancer control, and African-American women. Assessments were conducted to document key successful models and activities that increased the participation of African-American women in breast cancer prevention and control interventions. Current community-based intervention strategies and activities were assessed. RESULTS: Effective breast cancer prevention and control programs must address and develop cultural competent models that promote behavioral change in this population of women. CONCLUSIONS: Studying the relationship between culture and psychosocial issues is integral to our understanding of how African-American women participate and respond to cancer prevention and control interventions. Cultural competent models that reduce and eliminate cancer disparities in this population must be developed.

Black or African American↗
PubMed2005

Building informed consent for cholinesterase monitoring among pesticide handlers in Washington State.

BACKGROUND: Pesticide handlers in Washington State are predominantly Mexican and, therefore, require a culturally appropriate process of informed consent. In addition, members of this occupational group are vulnerable to coercion because of poverty, lack of insurance, inability to read, and employment status METHODS: To create a process of culturally competent informed consent for Washington State's cholinesterase monitoring program, we used focus groups to collect data about cultural beliefs, attitudes, knowledge, language, and traditions of Mexican-American pesticide handlers. With this information, we developed a final consent form and evaluated it using a 10-item test-retest questionnaire in a sample of 103 handlers. RESULTS: Using qualitative methods, we created English and Spanish consent forms that incorporated culturally defined risk information. Both the written and audiotape formats significantly improved comprehension; but, for subjects with less than 7 years of schooling, audiotapes in Spanish yielded significantly higher scores (mean comprehension score 7.0 vs. 6.1, t = - 2.2, P = 0.03). CONCLUSIONS: Culturally competent informed consent for particularly vulnerable populations of non-native speakers of English is possible. It requires both knowledge of specific cultural elements and the application of appropriate technology.

Adult↗
PubMed2004

"Nobody ever asked me before": understanding life experiences of African American elders.

With the unprecedented growth in the African American elderly population, there exists an urgent need to prepare nurses to deliver culturally competent care. The purpose of this study was to increase the knowledge available about the cultural heritage, worldviews, and life experiences of African American elders. Reminiscence interviews were conducted with African American elders living in a medium-sized northeast urban community. Data were analyzed using Spiegelberg's phenomenological Method. The following themes emerged: (a) nobody ever asked me before, (b) stories of discrimination, (c) coping with discrimination, (d) the hurt of discrimination, and (e) self-discoveries. Nurses, through the use of reminiscence, can gain insight into the cultural heritage, worldviews, and life experiences of African American elders and improve their ability to deliver culturally competent care to this population.

Adaptation, Psychological↗
PubMed2004

Linking aboriginal healing traditions to holistic nursing practice.

With a phenomenal expected growth in the Canadian Aboriginal population and the fact that less than 1% of Canadian health professionals are of Aboriginal ancestry, there is an increased need for culturally competent health professionals. This article explains diverse healing traditions and links those traditions to holistic nursing practice. Respect for culturally sensitive care is necessary for understanding Aboriginal peoples in different contexts. We suggest that nursing practice, which takes into consideration the understanding of Aboriginal healing traditions, strengthens the intention of nurses to be holistic. Holism in nursing allows the profession to be on the fore-front of understanding Aboriginal healing traditions; the linking of holistic nursing practice with Aboriginal healing traditions offers a foundation on which to build culturally competent care.

Canada↗
PubMed2006

Nurses' concerns and practices with using interpreters in the care of Latino patients in the emergency department.

This phenomenological study aimed to describe nursing care of Latinos in the emergency department to determine how care is planned relative to the patient's ethnicity, including linguistic abilities. Unstructured interviews were conducted with 15 registered nurses from four hospitals in the Northwest. Interpreters play a pivotal role in nurses' practices. Nurses' skills with working with interpreters, interpreter availability, engagement, and accuracy enhance or impede effective care. Linguistic differences challenge effective care provision. Culturally competent care requires secure avenues of accurate communication. Administrators must provide nurses with resources that promote culturally competent care, including training with interpreters to facilitate effective communication.

Attitude of Health Personnel↗
PubMed2005

Cultural considerations in interprofessional education and practice.

Promoting cultural competency in health care was examined from the Canadian perspective, and explored practice environments and educational programs for future health professionals that foster cultural awareness and support culturally sensitive care. Many of the issues raised are generic and likely to occur whenever patients' health practices and beliefs differ from conventional Western care. The main theme that emerged with respect to the practice environment was the use of a participatory action approach to foster collaboration with patients, traditional healers and the community. Successful collaboration is likely to result in a blend of ideas and perspectives from traditional health practices and conventional Western health care. With respect to education, programs need to focus on providing opportunities both in the classroom and in the clinical arena for students to work in interprofessional teams. These teams should not only comprise partners from medicine, nursing, physical therapy and other health professions but also include aboriginal paraprofessionals. Pedagogical initiatives also need to incorporate case-based formats and interactive sessions with patients and families. The principles underlying this approach: openness, mutual respect, inclusiveness, responsiveness and understanding one's roles should be fundamental to the delivery of culturally competent health care to all ethnic communities.

Canada↗
PubMed1998

Problems with managed mental health care for multicultural populations.

Managed mental health care has developed a system of care-giving that does not recognize that acceptable and effective services must acknowledge individual differences and cultural or racial identities. This approach is unacceptable in an era when a psychology of differences is necessary to provide services for nearly one-third of the population. This paper suggests that the adequacy of contemporary psychoparmacological and psychological interventions for multicultural populations is either unknown or unsatisfactory. Historically, interventions in the United States were designed primarily for Euro-Americans and thus were culture-specific in derivation. Managed care has reduced the availability and quality of these interventions for all patients and further limited the range of possible options. Culturally competent mental health services are described and related to quality of care. A societal agenda for implementing cultural competence is suggested.

Community Mental Health Services↗
PubMed2004

Recruitment and retention strategies for longitudinal African American caregiving research: the Family Caregiving Project.

OBJECTIVE: This article provides a detailed discussion, guided by a culturally competent approach, on recruitment and retention strategies used to study caregiving to older dependent elders in African American families. METHODS: The study (lasting from 1995 through 2000) included collecting three waves of data, 9 months apart, among 202 caregiving units (containing a maximum of three caregivers per unit). RESULTS: Four key strategies were identified as useful in recruiting and retaining the sample: (a) assigning the same interviewers to communicate with and interview study participants for each wave of data collection, (b) ensuring that all interviewers are knowledgeable of possible family dynamics and social issues within the African American community (e.g., access to health care, income and education issues, and discrimination), (c) providing a mechanism by way of a toll-free number for all participants to contact the project staff at the participant's convenience, and (d) allowing flexibility in scheduling and rescheduling interviews at the participant's convenience. DISCUSSION: Researchers need to acquire knowledge and develop skills that will foster culturally competent approaches when studying diverse cultural groups, which involves incorporating the beliefs, values, and attitudes of a cultural group in every phase of the research project, from conceptualization to interpretation of findings. Additionally, a genuine interest in, knowledge of, and respect for the population are necessary to help improve participant involvement in longitudinal research among African American caregivers.

Black or African American↗