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PubMed2003

Cultural competency--the caregiver connection.

Healthcare that is respectful and ethical must also be culturally competent, and a variety of tools are available to empower caregivers to provide culturally competent care. This article reviews the tools that the University of Michigan Health Care System's Program for Multicultural Health provides to caregivers throughout its many services. Cultural competency begins with self-awareness and knowledge, but it is also to embark upon a lifelong journey. Progress is cumulative, and assessment is an important part of the process.

Academic Medical Centers↗

PubMed2003

Developing culturally competent community faculty: a model program.

The Liaison Committee on Medical Education recently set standards for cultural diversity training as part of the medical school curriculum. To the authors' knowledge, this is the first description of a faculty-development program designed to develop the capacity of the clinical faculty to integrate culture and advocacy education into clinical training. The paper describes the first two years of the development of an ongoing cultural competence curriculum that has been integrated into the training of community preceptors from 13 medical schools in New England and New York. The training, entitled"Teaching the Culture of the Community," consists of four 2.5-hour modules that include interactive lectures and small-group role-play exercises on cultural needs assessment, patient-centered interviewing, feedback on cultural issues and use of the community to enhance cultural understanding. The 137 participants in the first two years of the program (1999-00 and 2000-01) reported a high level of acceptance of the curriculum. In the second year, the program began to document participants' self-reported"intention to change" in relation to the cultural competence curriculum. Many participants reported plans to change aspects of their clinical care and their teaching practices. Intentions to change were most frequently expressed in the context of content on effective communication skills. In summary, cultural competency training has been successfully integrated into an existing faculty-development program for community-based preceptors.

Clinical Competence↗

PubMed2004

Physician language ability and cultural competence. An exploratory study of communication with Spanish-speaking patients.

OBJECTIVE: We studied physician-patient dyads to determine how physician self-rated Spanish-language ability and cultural competence affect Spanish-speaking patients' reports of interpersonal processes of care. SETTING/PARTICIPANTS: Questionnaire study of 116 Spanish-speaking patients with diabetes and 48 primary care physicians (PCPs) at a public hospital with interpreter services. MEASURES: Primary care physicians rated their Spanish ability on a 5-point scale and cultural competence by rating: 1) their understanding of the health-related cultural beliefs of their Spanish-speaking patients; and 2) their effectiveness with Latino patients, each on a 4-point scale. We assessed patients' experiences using the interpersonal processes of care (IPC) in diverse populations instrument. Primary care physician responses were dichotomized, as were IPC scale scores (optimal vs nonoptimal). We analyzed the relationship between language and two cultural competence items and IPC, and a summary scale and IPC, using multivariate models to adjust for known confounders of communication. RESULTS: Greater language fluency was strongly associated with optimal IPC scores in the domain of elicitation of and responsiveness to patients, problems and concerns [Adjusted Odds Ratio [AOR], 5.25; 95% confidence interval [CI], 1.59 to 17.27]. Higher score on a language-culture summary scale was associated with three IPC domains - elicitation/responsiveness (AOR, 6.34; 95% CI, 2.1 to 19.3), explanation of condition (AOR, 2.7; 95% CI, 1.0 to 7.34), and patient empowerment (AOR, 3.13; 95% CI, 1.2 to 8.19)-and not associated with two more-technical communication domains. CONCLUSION: Physician self-rated language ability and cultural competence are independently associated with patients' reports of interpersonal process of care in patient-centered domains. Our study provides empiric support for the importance of language and cultural competence in the primary care of Spanish-speaking patients.

Clinical Competence↗

PubMed2001

Cultural competence: a proposal for physicians reaching out to Native Hawaiian patients.

Many physicians of Native Hawaiian ancestry, as well as others, have noted a cultural gap between themselves and their Native Hawaiian patients. This cultural gap could potentially lead to discordance in the physician-patient relationship, and in turn, result in less than adequate therapeutic outcomes. Native Hawaiian physicians and those who treat Native Hawaiian patients are seeking ways to improve therapeutic relationships. Developing cultural competency in Native Hawaiian physicians and those who treat Native Hawaiian patients may be expected to improve therapeutic relationships. Principles of cultural competency, including increasing awareness of self and others, enhancing one's cultural knowledge base, and developing skills to communicate effectively, could be applied to physician-patient encounters with Native Hawaiian patients. The principles and skills of cultural competency could be learned during the formal and continuing medical education process. Developing an educational system that promotes cultural competency in physicians is necessary to address the health needs of Native Hawaiians and other diverse populations in Hawai'i.

Attitude to Health↗

PubMed2003

Are the treatment goals of culturally competent outpatient substance abuse treatment units congruent with their client profile?

This study examines whether organizational treatment goals varied among outpatient substance abuse treatment (OSAT) units identified as providing a level of culturally competent care for African Americans. Cross-sectional data from the 1995 National Drug Abuse Treatment System Survey (NDATSS) was used. Of the nationally representative, stratified sample of 699 units, 618 (88%) participated. Spearman correlation, analysis of variance, Behrens-Fisher t-tests, chi-square, and multivariate logistic regression were used. Culturally competent units, even after controlling for organizational and client characteristics, were more apt than non-culturally competent units to indicate that achieving steady employment, spiritual strength, and physical health were important treatment goals. A congruency exists among culturally competent OSAT units between the client profile, which is more distressful than that for non-culturally competent units, and the orientation of treatment goals, which are more holistic; that is, treating the total individual, rather than the addiction only.

Black or African American↗

PubMed2004

The impact of an urban outreach teaching project: developing cultural competence.

The purpose of this study was to explore the development of cultural competence in a group of university nursing students in the context of an interactive substance abuse prevention project attached to a health promotion course with 414 racially diverse high school students. The project provided opportunities for contact, interaction, and reflection. A descriptive approach was utilized to elicit the meaning attached to the experience. Data included written content from an exit survey, field notes from onsite debriefings, transcriptions of a focus group interview, and an analysis of theoretical papers. Findings indicate that when university students participate in an urban teaching project under conditions of diminishing anxiety and are given opportunities for reflection, they not only increase cultural competence but they also develop a sense of advocacy. Recommendations are made for building community partnerships to enhance cultural competence.

Adolescent↗

PubMed2002

Working toward cultural competence in the workplace.

Once personal cultural characteristics are identified by the nurse, he/she can begin to hold in abeyance those preconceived beliefs and opinions that may impact a situation. By doing this, the participant deals with the situation in its purest form, and is open to people, ideas, and perspectives of a broader spectrum. These personal cultural characteristics contribute to delivering culturally competent care to a diverse society.

Clinical Competence↗

PubMed1996

Culturally competent scholarship: substance and rigor.

There is an urgency to the development of culturally competent care. This urgency is due to increasing diversity, increasing disclosure of identities, care delivery moving to homes, and increasing inequity in access to health care. The development of a knowledge base for culturally competent care is constrained by substantive and methodological issues, such as the limited view of culture as a unit of analysis and limitations in designs and methods that could capture the integrative nature of participants' experiences. Therefore, I propose that components of foundational knowledge in nursing may include, but should not be limited to, populations and their cultures; culture-specific nursing phenomena; and responses to diversity, marginalization, vulnerability, and transitions. To develop culturally competent knowledge, researchers, theoreticians, and reviewers are urged to address eight criteria to ensure rigor and credibility in scholarship: contextuality, relevance, communication styles, awareness of identity and power differentials, disclosure, reciprocation, empowerment, and time.

Communication↗

PubMed2005

Satisfaction with and perceived cultural competency of healthcare providers: the minority experience.

It is well known that nonwhite minority participation in clinical research is lower than their representation in the community. The goal of this study was to assess satisfaction of minority community members in Omaha with the care received and cultural competency of healthcare providers. We sought input from Omaha minority communities on how to improve the care they received and asked why they did not participate in healthcare research. Seventy-two minority members representing African Americans, Hispanic Americans, Native Americans, Sudanese, and Vietnamese; and eight whites were surveyed. The results of this study indicated that the majority of our respondents were satisfied with the care they received, but for a small percentage, language, communication and/or culture contributed to dissatisfaction. In addition, some respondents did not think the provider was culturally competent, i.e., not sufficiently knowledgeable about their racial, ethnic and/or cultural background. Some participants indicated that they preferred a provider of similar racial, ethnic and/or cultural background, and/or thought some diseases were better treated by a provider of the same racial, ethnic and/or cultural background. Regardless of the cultural competency of the provider, the overwhelming majority of our respondents (with the exception of African Americans) indicated a willingness to participate in healthcare research. In conclusion, this study found that satisfaction with healthcare providers was not associated with perceived cultural competency and that the cultural competency of the provider did not affect patient willingness to participate in healthcare research; however, we acknowledge that the Hawthorne effect may be in operation.

Adolescent↗

PubMed1998

Cultural competence in three human service agencies.

This paper summarizes findings from applications of the Agency Cultural Competence Checklist in three human service agencies. This checklist was developed on the basis of published literature and culture-specific agencies were chosen to document checklist findings in settings known to be culturally competent. As anticipated, all three agencies were culturally competent in attitudes, although the range of services differed. This paper provides some baseline data for using the checklist in mainstream agencies in which predominantly Euro-American providers serve minority populations.

Attitude of Health Personnel↗

PubMed2004

Implementation and evaluation of cultural competency training for pharmacy students.

BACKGROUND: The demographic composition of the US population is rapidly changing. As a result, pharmacists increasingly face the need to interact effectively with and provide care for patients whose ethnic or cultural background may differ from their own. While schools implement curricula to provide pharmacy students with cultural awareness, knowledge, and communication skills they will need in practice, few assessment tools exist to evaluate the impact or effectiveness of such training. OBJECTIVE: To implement and assess the impact of a cultural competency training course designed specifically for pharmacy students. METHODS: An 8-hour elective course offering basic cultural competency training was provided to 60 first-through fourth-year pharmacy students in 2003. A 12-item survey assessing students' perceived awareness, knowledge, and communication skills in the areas of cultural competence and cross-cultural communication skills was administered immediately prior to and upon completion of the course. Surveys were linked, enabling estimation of within-student change as a result of exposure to the program. RESULTS: Fifty-six paired surveys (96.6% of participants) were analyzable. Responses to all survey items (p < 0.05) and total scores (t55 = 16.27; p < 0.001) increased significantly from pre- to posttraining. The mean +/- SD 12-item pretraining scale score was 33.35 +/- 5.48 (range 21-44), and the mean posttraining scale score was 47.88 +/- 4.90 (range 36-59). CONCLUSIONS: Survey results suggest that the course successfully raised student awareness of diversity and provided basic knowledge and skills pertaining to cultural competence and cross-cultural communication.

Adult↗

PubMed2006

Immersion in another culture: one strategy for increasing cultural competency.

Educating nursing students in the United States to be culturally competent is a challenge. Undergraduate and graduate nursing students, including nurse-midwifery students were paired with faculty on a short-term transcultural nursing experience in Choluteca, Honduras. Students provided health screenings, prenatal assessments, and birth attendance. Learning objectives were designed to improve cultural competency in the healthcare setting for nursing students. A case study exemplar in the labor and delivery setting is presented. As a result of the cultural immersion experience, the student demonstrates versatility and flexibility in clinical practice, reflecting the skills necessary to adapt interventions to populations and circumstances.

Adult↗

PubMedDate not supplied

Cultural competence: an evolutionary perspective.

PROBLEM: The need for conceptual clarity, which is essential for effective communication related to cultural competence. Practice, education, administration, and research are identified. METHODS: Rodgers' (2000) method of concept analysis. FINDINGS: Attributes of cultural competence were identified as cultural awareness, cultural knowledge, cultural understanding, cultural sensitivity, and cultural skill. CONCLUSIONS: Cultural competence can best be identified as a nonlinear dynamic process that is never ending and ever expanding. It is built on increases in knowledge and skill development related to its attributes.

Cultural Evolution↗

PubMed2001

The effect of a global multiculturalism track on cultural competence of preclinical medical students.

BACKGROUND: We evaluated the effect of an elective (the Global Multiculturalism Track), including international and domestic immersion experiences, on the cultural competence of preclinical medical students. METHODS: A self-assessment instrument was used to measure cultural competence, and it was administered to Track participants and nonparticipating class cohorts at the beginning and the end of the preclinical years. RESULTS: Track participants (n=26) had a higher level of cultural competence both at the beginning and at the end of the program. At the end of their second year, students participating in the Track had, for the first time, greater knowledge of certain aspects of local cultures, more tolerance of people of other cultures not speaking English, and more comfort with patients of these cultures, compared with non-Track participants. CONCLUSIONS: The results are based on a small sample size, but the suggestion that a multiculturalism track could provide a model for development of cultural competence warrants further research.

Attitude of Health Personnel↗

PubMed1999

Connecting and becoming culturally competent: a Lakota example.

Addressing how nurses become culturally competent is essential for knowledge development beyond why sociocultural understandings are important. This article reports participatory research conducted during intercultural immersion learning experiences of non-native nurses on an Indian reservation. Emphasizing collaborative relationships within unfamiliar social, political, and economic circumstances, and using Diekelmann's "concernful practices" as an organizing scheme, prompted participants to explicate practices that promote intercultural connecting. Suggesting integral shifts in value orientations with changes in cultural competence, the findings argue for attending to associations between those dynamics and potential for developing co-responsibility (with consumer groups) for advocating improved health and health care.

Communication↗

PubMed1998

Workforce diversity and cultural competence in healthcare.

This paper presents a discussion of workforce diversity in healthcare and its attendant requisite of cultural competency. The first section of the paper argues that self-assessments and diversity training are integral to workforce diversity management. This paper maintains that diversity training should be a part of overall strategic goals, and that the development of management goals should be based on self-assessments. The second section of the review offers a framework of cultural competency in healthcare delivery based on the relationship between patient and provider, and the community and health system. For this relationship to be successful, this review argues that health systems should foster providers that can also be cultural brokers. The cultural broker role is seen as core to achieving cultural competency.

Clinical Competence↗

PubMedDate not supplied

Education and practice: dynamic partners for improving cultural competence in public health.

This article reports on a collaborative project linking Washington State University College of Nursing Vancouver and Southwest Washington Health District. Designed to improve the cultural competence and public health skills of registered nurses who are baccalaureate student nurses, quantitative and qualitative evaluative analyses were used to document and describe themes and strategies. The Inventory to Assess the Process of Cultural Competence Among Healthcare Professionals (IAPCC) was useful in measuring the students' progress toward cultural competence, and significant changes were documented. Themes that lead students toward population-focused nursing practice were uncovered as well as barriers to the process of cultural competency.

Canada↗

PubMed2006

Perceptions of graduating nursing students regarding life experiences that promote culturally competent care.

This article describes a qualitative study that explored the perceptions of graduating students from a northeast baccalaureate nursing program regarding their life experiences with cultural diversity. Thirteen students were interviewed using an interview guide, and interviews were recorded on audiotape. Information obtained included participants' cultural heritage, life experiences before entering a nursing program, educational and clinical experiences in the nursing program, knowledge about cultural competence, and the students' reflections on their ability to provide culturally competent care. Primarily qualitative methods were used to gather and analyze data. This article focuses on one of the major themes that emerged: defining life experiences related to cultural diversity. Data were reanalyzed focusing on this theme, and three life patterns emerged: positive, neutral, and conflicted. These patterns affected the students' interest and desire to provide culturally competent care. Implications for further research and nursing education are discussed.

Clinical Competence↗