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PubMedDate not supplied

What has the literature taught us about culturally competent care of women and children.

This article describes what is currently in the literature about culturally competent care for women and children. With the population of the United States growing increasingly diverse, there is a developing need for cultural competency among nurses and throughout healthcare organizations. Cultural competence includes both culture-specific and culture-generic knowledge, attitudes, and skills. While databased literature on cultural competency still requires further development, we do have evidence of positive outcomes of culturally competent care. The end result of the provision of culturally competent care by culturally competent nurses and healthcare organizations can be significant improvements in the health and well-being of women and children.

Attitude of Health Personnel↗

PubMedDate not supplied

Cultural competence and health care disparities: key perspectives and trends.

Cultural competence has gained attention as a potential strategy to improve quality and eliminate racial/ethnic disparities in health care. In 2002 we conducted interviews with experts in cultural competence from managed care, government, and academe to identify their perspectives on the field. We present our findings here and then identify recent trends in cultural competence focusing on health care policy, practice, and education. Our analysis reveals that many health care stakeholders are developing initiatives in cultural competence. Yet the motivations for advancing cultural competence and approaches taken vary depending on mission, goals, and sphere of influence.

Cultural Diversity↗

PubMed2001

Monitoring and enforcing cultural competence in Medicaid managed behavioral health care.

In recent years cultural competence has expanded beyond language provisions to include understanding and factoring into services provision the cultural perspectives clients may have that are different from the majority culture. The federal government requires state Medicaid programs to offer culturally competent services, but little is known about how states implement such mandates and monitor and enforce them. We reviewed the origins and implications of cultural competence mandates and conducted a brief case study of 5 states to learn about the implementation of cultural competence provisions in behavioral managed care contracts. We found that states and managed behavioral health organizations (MBHOs) vary in their definitions and implementation of standards to ensure mental health care access for vulnerable populations. Although states had a variety of oversight mechanisms, varying contractual requirements ranging from optional to required, vague contract language, no existing standardized indicators or definitions, and scant data on the cultural characteristics of the populations enrolled in Medicaid managed care hamper monitoring and enforcement of cultural competence by states. Implications for MBHOs, states, and the federal government, as well as services researchers, follow.

Clinical Competence↗

PubMed1995

Educating case managers for culturally competent practice.

This article provides a rationale for incorporating cultural competence into case management practice and examines the content required in educational programs for preparing case managers with appropriate and relevant knowledge, values, and skills. Cultural competence and related concepts are defined and applied in the context of case management. A number of required skills for educating case managers for culturally competent practice are presented. Becoming culturally competent is a developmental process involving self-awareness, understanding others from a cultural frame of reference, and acquiring the skills to provide culturally relevant and culturally sensitive practice.

Clinical Competence↗

PubMed2006

"That never would have occurred to me": a qualitative study of medical students' views of a cultural competence curriculum.

BACKGROUND: The evidence is mixed regarding the efficacy of cultural competence curricula in developing learners' knowledge, attitudes and skills. More research is needed to better understand both the strengths and shortcomings of existing curricula from the perspective of learners in order to improve training. METHODS: We conducted three focus groups with medical students in their first year of clinical training to assess their perceptions of the cultural competence curriculum at a public university school of medicine. RESULTS: Students evaluated the informal curriculum as a more important source of learning about cultural competence than the formal curriculum. In terms of bias in both self and others, the cultural competence curriculum increased awareness, but was less effective in teaching specific interventional skills. Students also noted that the cultural competence curriculum did not always sufficiently help them find a balance between group-specific knowledge and respect for individual differences. Despite some concerns as to whether political correctness characterized the cultural competence curriculum, it was also seen as a way to rehumanize the medical education experience. CONCLUSION: Future research needs to pay attention to issues such as perceived relevance, stereotyping, and political correctness in developing cross-cultural training programs.

Adult↗

PubMed2005

Using the PRACTICE mnemonic to apply cultural competency to genetics in medical education and patient care.

Medical education curricula increasingly are incorporating courses on cultural competency and skills development in working with ethnically diverse patient populations as well as courses on genetics and genomics. The authors support these efforts and believe the next step is integration of genetics into cultural competency programs and similarly, cultural competency into genetics curricula. In this paper, the authors describe the work of the Genetics in Primary Care Faculty Development Working Group on Cultural Competency, a federally-funded initiative to prepare generalist faculty to teach genetics as part of ambulatory education. Over a 12-month period, this team wrote a module on cultural competency and nine new clinical cases, and developed the PRACTICE mnemonic (prevalence, risk, attitude, communication, testing, investigation, consent, empowerment) to help health care professionals integrate cultural competency skills in genetics into primary care. More specifically, the PRACTICE mnemonic integrates information emerging from experts in health disparities and doctor-patient communication to build a comprehensive model for addressing the relevance of culture and ethnicity in the delivery of genetic services. Lastly, this paper illustrates a systematic method of covering key areas of cultural competency through discussion of a patient with a genetic disorder as well as presents an argument as to why cultural competency is highly relevant to the delivery of genetic services especially as part of generalists' clinical practice.

Attitude of Health Personnel↗

PubMed2004

Cultural competence models in nursing: a selected annotated bibliography.

Since the early 1990s, along with a phenomenal growth of nursing literature published on cultural competence, an array of cultural competence and cultural assessment models has been developed. This annotated bibliography provides bibliographic entries to books, book chapters, and journal articles that deal with the construction, development, or conceptualization of cultural competence and cultural assessment models. It also includes entries to books dealing with cultural assessment guides.

Bibliometrics↗

PubMed1998

In search of cultural competence in psychotherapy and counseling.

The characteristics involved in cultural competency in psychotherapy and counseling have been difficult to specify. This article describes attempts to study factors associated with cultural competency and addresses 3 questions. First, is ethnic match between therapists and clients associated with treatment outcomes? Second, do clients who use ethnic-specific services exhibit more favorable outcomes than those who use mainstream services? Third, is cognitive match between therapists and clients a predictor of outcomes? The research suggests that match is important in psychotherapy. The cultural competency research has also generated some controversy, and lessons learned from the controversy are discussed. Finally, it is suggested that important and orthogonal ingredients in cultural competency are therapists' scientific mindedness, dynamic-sizing skills, and culture-specific expertise.

Clinical Competence↗

PubMed2001

Cultural competence for transracial adoptive parents.

This article provides a clear conceptual definition of cultural competence for transracial-cultural adoptive (TRA) parents based on an extensive review of the literature and feedback from both experts and parents. Following the differentiation of cultural competence as defined in the social work literature and cultural competence as applied to TRA parents, a three-part definition of cultural competence for TRA parents is presented. The article expands on each of three constructs: racial awareness, multicultural planning, and survival skills. In addition, it describes the process of beginning to operationalize the constructs. Finally, implications for social work practice, education, and research are suggested.

Adaptation, Psychological↗

PubMed2001

Expanding conceptualizations of culturally competent care.

AIM: The aim of the study was to gain an understanding of cultural competence from the perspectives of non-mainstream nurse educators, specifically those of Latin heritage. BACKGROUND/RATIONALE: Although the theoretical concepts of 'cultural diversity' and 'culturally competent care' have been supported and promoted by the largest professional nursing organizations, the practical application of these concepts has often created difficulties for nurse researchers, educators, and clinicians. The lack of progress in teaching and evaluating cultural competence suggested the need to 'center the margins' and explore cultural competence from the margins of one particular non-mainstream nursing group, Latina nurse educators. DESIGN/METHODS: A grounded theory research design was employed. A group of 10 doctoral, prepared, self-identified, Latina nurse educators participated in face- to-face audiotaped interviews. Data collection, analysis, and theoretical sampling decisions occurred concurrently, strengthening theory generation. Institutional review board approval was received for all steps of the study. The major limitation of the study was the omission of student voices. RESULTS/FINDINGS: The analysis suggests that the Latina participants shared the common purpose of teaching students how to think about difference. The teaching practices of this group of Latina educators was based on a belief that 'difference' is not solely about specific cultural groups. For example, content about 'Hmongs' or 'Latinos'. Rather, Latina faculty focused on teaching students how to directly connect with anyone perceived as different from oneself. CONCLUSION: Latina faculty did not distinguish between competent care and culturally competent care; for them, competence necessarily includes cultural competence. They conceptualize the provision of competent care to all persons who are perceived as different, rather than focusing only on those who are perceived as 'culturally' different. These conceptualizations have the potential to shed new light on how nurses and nurse educators think about, develop, and integrate cultural competence into nursing education, practice, and research.

Cultural Diversity↗

PubMed1998

Concept analysis: cultural competence.

To evaluate theory, concepts with that theory must be identified, analyzed and defined. The aim of this concept analysis of cultural competence is to clarify and differentiate the term as it is used in health care and nursing literature and to separate cultural competence from its measurement. Before the question of what is cultural competence can be answered, culture and competence--as separate terms--must be understood. Components of the cultural competence concept are identified along with its antecedents and consequences. Additionally, terms closely related to cultural competence are described and differentiated from the cultural competence concept. To add meaning to the analysis, a cultural competence model case and contrary case are supplied along with outcome measures and empirical referents for cultural competence. Finally, a concluding definition based on extensive review of literature sources such as archeology, anthropology, history, psychology, policy, criminal justice, occupational therapy, medicine, nursing, and education is provided.

Clinical Competence↗

PubMed2006

A framework for cultural competence in advanced practice psychiatric and mental health education.

TOPIC: Cultural competence in psychiatric advanced practice education. PURPOSE: To present a framework for educators to use when addressing culturally competent advanced psychiatric nursing practice. SOURCES: NONPF competencies, published literature, and Web resources. CONCLUSIONS: Development of cultural competence is an important link to the reduction of mental health disparities. Situating the advanced nursing practice process within a negotiating space allows for incorporation of cultural information into patient care. The framework presented in this paper provides a theoretical and practical approach to orienting students to meeting the elements of cultural competence set out in the NONPF recommendations.

Anthropology, Cultural↗

PubMedDate not supplied

Psychometric evaluation of the cultural competence assessment instrument among healthcare providers.

BACKGROUND: The relevance of healthcare provider cultural competency to the achievement of goals for reduction in extant health disparities has been demonstrated; however, there are deficits with regard to cultural competency measurement. OBJECTIVES: To examine the test-retest reliability of the cultural competence assessment instrument (CCA) among hospice providers, and to examine the reliability and validity of the CCA among healthcare providers in nonhospice settings. METHOD: Test-retest reliability of the CCA was assessed using a sample of 51 hospice respondents who completed the CCA at two time points. The internal consistency reliability and construct validity of the CCA for healthcare providers in nonhospice settings were evaluated using a convenience sample of 405 healthcare providers. RESULTS: The CCA demonstrated adequate test-retest reliability (r = .85, p = .002) in hospice providers over 4 months. Among healthcare providers in nonhospice settings, the CCA had an internal consistency reliability of .89 overall (.91 and .75 for the two subscales). Construct validity was supported by principal axis factor analysis, which showed two factors with item loadings above .40, explaining 56% of the variance. Mean scores of the CCA were significantly higher for providers who reported previous diversity training compared to those who had not. DISCUSSION: Findings for the psychometric properties of the CCA supported its potential as an instrument for measuring provider cultural competence. Knowledge gained will be useful for developing future research studies and specific cultural competence intervention approaches for healthcare providers that may decrease health disparities.

Adult↗

PubMedDate not supplied

Culturally competent care of women and newborns: knowledge, attitude, and skills.

In a variety of health care settings throughout the United States and Canada, nurses are caring for women and newborns from culturally diverse backgrounds. In the technologically complex and bureaucratic world of health care delivery, cultural considerations in provision of care often are overlooked and neglected. The purpose of this article is to define ways in which culturally competent nursing care can be implemented. Nursing education and clinical practice guidelines are clear on the importance of gaining cultural competence. Providing culturally competent care includes understanding the dimensions of culture; moving beyond the biophysical to a more holistic approach; and seeking to increase knowledge, change attitudes, and hone clinical skills. Building on the strengths of women rather than utilizing a deficit model of health care is an essential part of providing culturally competent care. The achievement of both measurable and "soft" outcomes related to the delivery of culturally competent care can make a critical difference in the heath and well-being of women and newborns.

Attitude of Health Personnel↗

PubMed2005

Cultural competence among Ontario and Michigan healthcare providers.

PURPOSE: To examine variables associated with cultural competence among urban, hospital-based healthcare providers in Ontario (Canada) and Michigan (US). DESIGN AND SAMPLE: A cross-sectional descriptive design with a convenience sample of hospital-based providers was used. The sample was 145 providers (n=71 Ontario; n=74 Michigan). METHODS: Providers completed a survey which included the Cultural Competence Assessment (CCA) instrument. Regression analysis was used to examine associations. FINDINGS: Providers with diversity training and higher levels of educational attainment scored significantly higher on cultural awareness and sensitivity and on cultural competence behaviors. CONCLUSIONS: Variables significantly associated with cultural competence included prior training in cultural competency and higher educational attainment among both Ontario and Michigan healthcare providers.

Adult↗

PubMedDate not supplied

Development of a Cultural Competence Assessment instrument.

This article describes initial testing of an instrument designed to provide evidence of cultural competence among health care providers and staff. The Cultural Competence Assessment (CCA) instrument was based on a model describing cultural competence components (fact, knowledge, attitude, and behavior). Content and face validity were confirmed through expert panel review, subject feedback, and field-testing. The CCA was administered to an interdisciplinary health care team in a community hospice setting. Preliminary findings suggest that the CCA performed well. Internal consistency reliability for the scale was 0.92. Construct validity by factor analysis demonstrated that 25 items had loadings above 0.42. Construct validity was supported with a significant correlation to the widely used Inventory for Assessing the Process of Cultural Competence among Health care Professionals (IAPCC). Validity also was supported by significant differences between individuals with different educational levels and prior diversity training. The CCA is a promising tool to measure cultural competence in populations with a wide range of educational levels and backgrounds.

Adult↗

PubMed2004

The role of culturally competent communication in reducing ethnic and racial healthcare disparities.

Promoting culturally competent communication at the provider, care institution, health plan, and national levels is likely to contribute to success in reducing racial and ethnic disparities in the receipt of high quality care. Although some health plans recently have shown interest in addressing racial and ethnic disparities in care, very few have addressed how health plans can improve their cultural competency to reduce disparities. This commentary summarizes the importance of culturally competent communication across several levels of the healthcare system and details concrete steps that managed care organizations can take to maximize their ability to provide culturally competent communication and care.

Communication↗

PubMed2005

Cultural competence: a systematic review of health care provider educational interventions.

OBJECTIVE: We sought to synthesize the findings of studies evaluating interventions to improve the cultural competence of health professionals. DESIGN: This was a systematic literature review and analysis. METHODS: We performed electronic and hand searches from 1980 through June 2003 to identify studies that evaluated interventions designed to improve the cultural competence of health professionals. We abstracted and synthesized data from studies that had both a before- and an after-intervention evaluation or had a control group for comparison and graded the strength of the evidence as excellent, good, fair, or poor using predetermined criteria. MAIN OUTCOME MEASURES: We sought evidence of the effectiveness and costs of cultural competence training of health professionals. RESULTS: Thirty-four studies were included in our review. There is excellent evidence that cultural competence training improves the knowledge of health professionals (17 of 19 studies demonstrated a beneficial effect), and good evidence that cultural competence training improves the attitudes and skills of health professionals (21 of 25 studies evaluating attitudes demonstrated a beneficial effect and 14 of 14 studies evaluating skills demonstrated a beneficial effect). There is good evidence that cultural competence training impacts patient satisfaction (3 of 3 studies demonstrated a beneficial effect), poor evidence that cultural competence training impacts patient adherence (although the one study designed to do this demonstrated a beneficial effect), and no studies that have evaluated patient health status outcomes. There is poor evidence to determine the costs of cultural competence training (5 studies included incomplete estimates of costs). CONCLUSIONS: Cultural competence training shows promise as a strategy for improving the knowledge, attitudes, and skills of health professionals. However, evidence that it improves patient adherence to therapy, health outcomes, and equity of services across racial and ethnic groups is lacking. Future research should focus on these outcomes and should determine which teaching methods and content are most effective.

Attitude of Health Personnel↗