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PubMed2004

Herbal remedies in a Nicaraguan barrio.

To become more culturally competent, nurses need to increase their knowledge of the health practices of their immigrant clients. With the growing Latino immigrant community, it is imperative that nurses learn more about the cultures from which the immigrants come. This article examines the use of herbal remedies in treating common illnesses in a barrio in Managua, Nicaragua. Data were collected in a random sample of households in an impoverished community of more than 1,600 persons. The use of herbal remedies occurred in 78% of the households. Herbal remedies were used for a variety of symptoms. There was no difference in herbal remedy use based on age or education. The discussion focuses on the availability and functionality of these herbal remedies for this vulnerable population. Implications are addressed for incorporating this information into nursing practice with Central American immigrants, thereby increasing cultural competence.

Adult↗

PubMed2005

Overcoming challenges in the diagnosis and treatment of attention-deficit/hyperactivity disorder in African Americans.

The incidence of ADHD appears to be similar in African Americans and white populations. However, fewer African-American than white children are diagnosed and treated for ADHD. Reasons for this disparity have not been fully elucidated; causes are most likely complex. Whereas certain barriers to treatment are driven by patients and their families, others are due to limitations in the healthcare system. Patient-driven obstacles to care include inadequate knowledge regarding the symptoms, treatment and consequences of untreated ADHD and fear of overdiagnosis and misdiagnosis. A survey conducted to explore cultural differences between African-American and white respondents found that African Americans were more likely than whites to be unfamiliar with ADHD. In addition, African Americans felt that they were diagnosed with ADHD more often than whites and that teachers blamed ADHD for learning or behavior problems more often in African Americans. Health system barriers include a lack of culturally competent healthcare providers, stereotyping/biases and failure of the clinician to evaluate the child in multiple settings before diagnosis. Strategies to overcome these challenges include increased dissemination of ADHD information through community events; improved training of clinicians in cultural competence; and open communication among parents, clinicians and school personnel.

Black or African American↗

PubMed2002

When is risk stratification by race or ethnicity justified in medical care?

Issues of race and ethnicity have been controversial in both clinical care and medical education. In daily practice, many physicians struggle to be culturally competent and avoid racial stereotyping. One educational development that makes this goal more complex is the rise of clinical epidemiology and Bayesian thinking. These population-based, probabilistic approaches to medicine help guide the diagnostic and therapeutic pathways for patients, and are foundations of the evidence-based medicine movement. Can Bayesian thinking be applied effectively to issues of race and ethnicity in medical care, or are the dangers of prejudicial stereotyping too great? The authors draw upon lessons from recent cases of racial profiling, and develop a conceptual framework for thinking about ethnicity as a clinical tool. In their typology of ethnicity as a proxy, they argue that the costs of using ethnicity as a proxy for socioeconomic status and behavior are too high, but that ethnicity may appropriately be used as an initial proxy for history, language, culture, and health beliefs. They discuss their approach within the context of new curricula in cultural competence, and argue that viewing the patient within a wider cultural setting can help guide the initial clinical approach, but individualized care is mandatory. Also, physicians must remain sensitive to the changing nature of cultural norms; thus lifelong learning and flexibility are necessary.

Cultural Diversity↗

PubMedDate not supplied

Teaching nursing in a developing country.

Cultural competence is expected of nurses and educators in transcultural relationships. The author describes the Ugandan setting, where she taught registered nurse students for 9 months, and her process of assimilation leading to cultural competence. Concepts and issues pertinent to the acculturation of a nurse educator into international nursing in a developing country are discussed.

Developing Countries↗

PubMed2000

American Academy of Pediatrics. Committee on Pediatric Workforce. Enhancing the racial and ethnic diversity of the pediatric workforce.

PURPOSE: This statement seeks to increase the awareness of the importance of diversity; to encourage the incorporation of principles of cultural competence into all aspects of pediatric education, training, and practice, as exemplified by practitioners, educators, and our national leadership; and finally to identify strategies for implementing this incorporation. KEY CONCEPTS: The increasing cultural diversity of the population has significant implications for the pediatric workforce and for the provision of pediatric health services. Diversity within the pediatric workforce will enhance the potential for pediatricians to acquire the knowledge and practice skills needed to effectively address the health and wellness needs of children and families. Support from this diversity should be integrated into all aspects of education, including providing quality education for minority students and attracting and retaining minority faculty; and should be sought through collaboration locally, regionally, and nationally with organizations and community leaders. ANTICIPATED OUTCOMES: The Policy Statement recommendations will be used to inform educators, administrators, practitioners, and others in the development of curricula, programs, and initiatives to enhance the diversity of the pediatric workforce and increase the cultural competence of practitioners.

Adult↗

PubMedDate not supplied

African American families and HIV/AIDS: caring for surviving children.

This article presents the preliminary findings of a national project undertaken to examine the medical/health, social service, and legal needs of African American children who have experienced or will experience the death of one or both parents as a result of HIV/AIDS. The project seeks to guide the development of culturally competent policies and practices across delivery systems responsible for managing the care of these children and their families. Services have expanded for the children but much remains to be accomplished to achieve culturally competent, integrated care systems for surviving children and their caregivers.

Acquired Immunodeficiency Syndrome↗

PubMed2003

Health care disparities in emergency medicine.

The Institute of Medicine's landmark report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care," documents the pervasiveness of racial and ethnic disparities in the U.S. health care delivery system, and provides several recommendations to address them. It is clear from research data, such as those demonstrating racial and ethnic disparities in emergency department (ED) pain management, that emergency medicine (EM) is not immune to this problem. The IOM authors describe two strategies that can reduce disparities in EM. First, workforce diversity is likely to result in a community of emergency physicians who are better prepared to understand, learn from, and collaborate with persons from other racial, ethnic, and cultural backgrounds, whether these be patients, fellow clinicians, or the larger medical and scientific community. Given the ethical and practical advantages of a more diverse EM workforce, continued and expanded initiatives to increase diversity within EM should be undertaken. Second, the specialty's educational programs should produce emergency physicians with the skills and knowledge needed to serve an increasingly diverse population. This cultural competence should include an awareness of existing racial and ethnic health disparities, recognition of the risks of stereotyping and biased treatment, and knowledge of the incidence and prevalence of health conditions among diverse populations. Culturally competent emergency care providers also possess the skills to identify and manage racial and ethnic differences in health values, beliefs, and behaviors with the ultimate goal of delivering quality health services to all patients cared for in EDs.

Delivery of Health Care↗

PubMedDate not supplied

"Health is strength": a research collaboration involving Korean Americans in Alameda County.

INTRODUCTION: This is a preliminary report from a research collaboration between Asian Health Services (community health center); Koreans in Alameda County, California; and the University of California at Berkeley School of Public Health. This five-year Centers for Disease Control and Prevention project supports a collaborative community intervention to improve breast and cervical cancer screening behavior among Korean women. METHODS: A Korean Community Advisory Board and Korean-American staff were recruited, and community sensitive research (CSR) and participatory action research (PAR) principles were applied: (1) building community infrastructure for sustainable action, (2) cultural appropriateness, (3) assuring responsiveness to community needs, and (4) a prevention focus that would assist health care providers. We conducted a population-based telephone survey on 676 Korean adults (272 men and 404 women). RESULTS: The collaborative process yielded (1) a high response rate (79%), (2) baseline health information on Korean Americans, (3) broadening of the original research topic, (4) survey responses that will guide intervention design, (5) culturally competent strategies, and (6) expanded Korean-American Community capacity for local action. CONCLUSIONS: Research collaboration between universities, community-based organizations, and ethnic communities can yield high-quality research. CSR and PAR approaches help break through cultural barriers in otherwise "hard to reach" API sub-populations. Determinants of success include sharing common goals; trust, honesty, and integrity; shared decision making; mutual respect of each partner's expertise; cultural sensitivity and cultural competence; flexibility, good communication, and mutual learning; and continuity of partners. Actively engaging members of the study population in the research process builds community capacity, thus laying the foundation for future projects that improve health status.

Adult↗

PubMedDate not supplied

Addressing issues for early detection and screening in ethnic populations.

PURPOSE/OBJECTIVES: To describe how multicultural knowledge and skills are applied in culturally competent practice to develop and deliver available, accessible, acceptable, and appropriate programs in early cancer detection and screening programs in ethnic communities. DATA SOURCES: Literature and clinical community practice reports. DATA SYNTHESIS: Successful community screening programs can be conducted within ethnic minority populations. Practitioners must tailor care based on salient cultural differences of the population of focus. Culturally based practice results in the (a) increased ability to think critically in community and individual assessments, (b) development of more accurate program plans and designs, and (c) increased likelihood that appropriate outcomes will be used in the evaluation of care. CONCLUSIONS: Greater cultural competence increases the accuracy of care and thereby its effectiveness, efficiency, and success in providing acceptable and optimal programs. IMPLICATIONS FOR NURSING PRACTICE: The first step in a cultural assessment is to know one's own beliefs and attitudes. The second step, conducted in parallel, requires knowledge about the groups that make up the patient and staff populations within the practice setting and then integrating those perspectives into practice. Practitioners then can begin the third step of negotiation of all stages of the project with members of the various communities on an equal basis that recognizes the expertise and integrity of all parties.

Culture↗

PubMed2000

A review of the concept of culture in holistic nursing literature.

Core Value IV of the American Holistic Nurses' Association includes valuing the client's cultural background. The authors reviewed all article abstracts from two major holistic nursing journals for a 3-year period (N = 198). References to concepts of culture or ethnicity were found in only 9.6% of abstracts. Many theorists and researchers did not discuss how the theory or research findings varied between culturally or ethnically diverse samples. When culture is a core value, practitioners and researchers cannot assume that culture has been considered without stating what was the interaction of culture with the phenomenon of concern. The authors recommend that nurses develop cultural competence in caring for clients from differing cultural orientations by (a) committing to improve their knowledge of multiple cultures; (b) exploring their own cultural background; (c) seeking exposure to cultures other than their own; and (d) regularly discussing culture and ethnicity in nursing theory, research, and practice.

Clinical Competence↗

PubMed1970

Protein difference between competent and noncompetent cultures of a group H Streptococcus.

Acidified phenol extracts prepared from competent cultures of a group H Streptococcus strain Wicky made competent with competence factor derived from cultures of another group H Streptococcus, strain Challis, showed a difference in polyacrylamide-gel protein patterns when compared to extracts prepared from noncompetent cultures of strain Wicky. The prominent single protein band difference did not appear when Wicky cells were simultaneously treated with competence factor and chloramphenicol, an inhibitor of the development of competence. Chloramphenicol had no effect on transformation nor the appearance of the "new" protein band when added to fully competent cells. This new protein, which is associated with the appearance of competence, seems to be synthesized as a result of induction by competence factor; its exact role, however, is as yet unknown.

Bacterial Proteins↗

PubMed2005

The effect of selected macro forces on the contemporary social construction of American Indian ethnic identity.

This article explains selected historical acts and events that continue to impact comtemporary Native American ethnic identity, social policy, and social services delivery. Although cultural competence is increasingly encouraged in social work education, the events of history usually do not appear as partial explanations for current phenomena. For those who work with Native American populations, understanding this history is a critical piece in the process of acquiring cultural competence. These selected historical events provide at least partial understanding of some contemporary issues which are sometimes presented to social workers and other social services professionals who work with Native populations.

Acculturation↗

PubMed2004

The quality of highly regarded adolescent substance abuse treatment programs: results of an in-depth national survey.

BACKGROUND: Drug and alcohol abuse and dependence are the most prevalent causes of adolescent morbidity and mortality in the United States. Effective, accessible treatment for adolescents with substance abuse problems is urgently needed. OBJECTIVE: To conduct the first systematic evaluation of the quality of highly regarded adolescent substance abuse treatment programs in the United States. METHODS: An advisory panel of 22 experts defined 9 key elements of effective treatment for adolescent substance abuse based on a review of the literature. In-depth telephone and written surveys were conducted with 144 highly regarded adolescent substance abuse treatment programs identified by panel members and by public and private agencies. There was a 100% response rate to the initial interviews, and a 65% response rate to the follow-up surveys. The open-ended survey responses were coded by defining 5 components deemed to be crucial in addressing each of the 9 key elements, and quality scores were calculated overall and for each of the 9 key elements. RESULTS: Out of a possible total score of 45, the mean score was 23.8 and the median was 23. Top-quartile programs were not more likely to be accredited. The majority of programs scored at least 4 of a possible 5 on only 1 of the 9 key elements (qualified staff). The elements with the poorest-quality performance were assessment and treatment matching, engaging and retaining teens in treatment, gender and cultural competence, and treatment outcomes. CONCLUSIONS: Most of the highly regarded programs we surveyed are not adequately addressing the key elements of effective adolescent substance abuse treatment. Expanded use of standardized assessment instruments, improved ability to engage and retain youths, greater attention to gender and cultural competence, and greater investment in scientific evaluation of treatment outcomes are among the most critical needs. Expanding awareness of effective elements in treating adolescents will lead the way to program improvement.

Adolescent↗

PubMed2004

Translation research in long-term care: improving pain management in nursing homes.

BACKGROUND: Pain prevalence in nursing homes remains high, with multiple resident, staff, and physician barriers presenting serious challenges to its improvement. AIMS: The study aims were to (1) develop and test a multifaceted, culturally competent intervention to improve nursing home pain practices; (2) improve staff, resident, and physician knowledge and attitudes about pain and its management; (3) improve actual pain practices in nursing homes; and (4) improve nursing home policies and procedures related to pain. METHODS: A multifaceted, culturally competent intervention was developed and tested in six Colorado nursing homes, with another six nursing homes serving as control sites. Both educational and behavioral change strategies were employed. FINDINGS: The intervention was successful in improving the percentage of residents reporting constant pain in the treatment homes. Contextual factors (implementation of Medicare's Nursing Home Compare report card) appeared to exert a positive influence on pain documentation. There was no reduction in the percentage of residents reporting pain or reporting moderate/severe pain. DISCUSSION: Multiple challenges to quality improvement exist in nursing homes. Turnover of nursing staff reduced actual exposure to the intervention, and turnover of directors of nursing influenced constancy of message and overall facility stability. Residents often failed to report their pain, and physicians were reluctant to alter their prescribing practices. IMPLICATIONS: Any intervention to improve pain management in nursing homes must target explicitly the residents, nursing home staff, and primary care physicians. Implementation strategies need to accommodate the high turnover rates among staff, as well as the changes among the nursing home leadership. CONCLUSIONS: Pain is a complex problem in the nursing home setting. Multiple factors must be considered in both the design and implementation of interventions to improve pain practices and reduce pain prevalence in nursing homes.

Aged↗

PubMed2001

Cultural beliefs of Asian Americans associated with terminal illness and death.

OBJECTIVES: Cultural competence often focuses on the skills of the professional; whereas, this article focuses on the needs of the patient. DATA SOURCES: Research studies, review articles, book chapters, and clinical practice. CONCLUSIONS: Patients benefit from health care professionals that are attuned and able to nurture patients in a process of identifying their needs regarding terminal illness and death. The health care professional's ability and sensitivity to be culturally aware, knowledgeable, and open directly influences the patient's quality of life and death. IMPLICATIONS FOR NURSING PRACTICE: As the population becomes more diverse, health care professionals must develop cultural competence to add value to themselves, the profession of nursing, and health care in the future.

Asian↗

PubMed2002

Development of scholars interested in community-based health promotion research.

Culturally consistent community-based health promotion interventions have been identified as integral components of strategies to decrease health disparities. The limited number of culturally competent scholars impedes the development of appropriate interventions. This article examines issues relevant to the development of scholars interested in community-based health promotion research. It is the outcome of a series of discussions by the authors held over a 3-month period. Specific topics include classroom and communal educational opportunities to enhance cultural competence and creation of supportive environments for aspiring community-based scholars. Particular attention is given to the importance of ongoing opportunities for interaction between students and lay community scholars.

Cultural Diversity↗

PubMed2005

Culture and domestic violence: transforming knowledge development.

Cultural competence continues to receive limited attention in domestic violence service provision from research to the evaluation of programs. Yet with changing demographics reflecting larger numbers of people of color and increasing needs for more effective responses, it is critical that we change the way we think about domestic violence. Using a feminist framework, this article examines how knowledge has been developed in domestic violence and its consequence related to service provision and perceptions. The article ends with recommendations as to how to better include culturally competent responses in domestic violence.

Black or African American↗

PubMedDate not supplied

Lung cancer in African Americans. A call for action.

PURPOSE: The authors present information about current trends in the incidence, risk factors, types, presentation, and treatment for lung cancer common to all Americans and highlight factors that are unique to African Americans. Barriers to effective care and strategies for implementing culturally competent programs for lung cancer are outlined. OVERVIEW: Disparity in the incidence and mortality rates of cancer between African Americans and white Americans has been increasing at an alarming rate since 1950. For African-American men and women, lung cancer accounted for the largest increase in the incidence of cancer between 1988 and 1992: African-American men experienced an increase of 170%, and African-American women had a dramatic increase of 464%. Lung cancer is by far the most common cause of cancer death in this population, accounting for 32% of the mortality rate in men and 20% in women. Unfortunately, lung cancer in African Americans has received little attention, and culturally competent programs are needed urgently to promote lung cancer prevention, early detection, and treatment in this population. CLINICAL IMPLICATIONS: Healthcare providers' lack of knowledge about cultural influences on care is a barrier to providing adequate healthcare to individuals of different ethnic groups. Knowledge about cultural differences, respect for individual opinions about health and illness, and ability to negotiate differences are essential qualities for health professionals who serve culturally diverse populations. Because of the morbidity and mortality rates associated with lung cancer in the African-American population, prevention, early detection, and treatment programs are needed urgently. However, for these programs to succeed, the multidisciplinary cancer care team (nurses, physicians, social workers, psychologists, health educators, clergy) must provide information and care in culturally appropriate ways. Partnerships with family, extended kin networks, and religious and community leaders are essential. Finally, to minimize morbidity and maximize quality of life during the illness trajectory, comprehensive education and supportive care services are needed for those who have been diagnosed with lung cancer.

Black or African American↗