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At least 19 recordsLinked to original sources
PubMed2004

The ethics of cultural competence.

Cultural competence curricula have proliferated throughout medical education. Awareness of the moral underpinnings of this movement can clarify the purpose of such curricula for educators and trainees and serve as a way to evaluate the relationship between the ethics of cultural competence and normative Western medical ethics. Though rarely stated explicitly, the essential principles of cultural competence are (1) acknowledgement of the importance of culture in people's lives, (2) respect for cultural differences, and (3) minimization of any negative consequences of cultural differences. Culturally competent clinicians promote these principles by learning about culture, embracing pluralism, and proactive accommodation. Generally, culturally competent care will advance patient autonomy and justice. In this sense, cultural competence and Western medical ethics are mutually supportive movements. However, Western bioethics and the personal ethical commitments of many medical trainees will place limits on the extent to which they will endorse pluralism and accommodation. Specifically, if the values of cultural competence are thought to embrace ethical relativity, inexorable conflicts will be created. The author presents his view of the ethics of cultural competence and places the concepts of cultural competence in the context of Western moral theory. Clarity about the ethics of cultural competence can help educators promote and evaluate trainees' integration of their own moral intuitions, Western medical ethics, and the ethics of cultural competence.

Communication Barriers↗
PubMedDate not supplied

Higher stakes ahead for cultural competence.

Cultural competence, as a tool to overcome disparities in mental healthcare to ethnic minorities, is facing unprecedented challenges. Providers are turning to cultural competence as one of the few resources available for badly needed information and strategies for improving clinical care. This essay provides background information about this issue and addresses two broad questions. First, are cultural competence programs ready to meet the test? And second, what are the likely consequences if these programs don't adequately meet expectations? This article also reviews what is at stake for clients, health care providers, and advocates of cultural competency in using this paradigm to address the disparities crisis. Recommendations for future progress in this field are discussed.

Cultural Diversity↗
PubMed2000

Awareness: the heart of cultural competence.

Cultural competency in critical care is providing care to patients and their families that is compatible with their values and the traditions of their faiths. This requires awareness of one's own values and those of the healthcare system. The nurse must also become aware of the cultural and spiritual values of patients and families. Although knowledge of many cultures is impossible, willingness to learn about, respect, and work with persons from different backgrounds is critical to providing culturally competent care. This article discusses elements essential for increasing cultural competency.

Attitude of Health Personnel↗
PubMed2003

Building the case for cultural competence.

Cultural competence in the provision of health care is a very important area of investigation and is receiving recognition at multiple levels. Minority groups constitute a significant and growing percentage of our population. However, there has been no commensurate increase in the number of minority physicians. There is a tremendous need for medical professional schools and health care organizations to implement formal cultural competence training for current and future health professionals. In this article, we present the findings of an extensive literature review that describes how several factors have brought the need for cultural competence to the forefront. These factors include a greater appreciation for the impact of culture on health, changes in U.S. demographics, increased awareness in health care disparities, and modifications in legislative and accreditation mandates.

Cultural Characteristics↗
PubMed2006

Cultural competency: Agenda for Cultural Competency Using Literature and Evidence.

BACKGROUND: Cultural competency has been recognized as an important issue relevant to all health professions. A research agenda is needed to establish a systematic approach to developing an understanding of factors relevant to the delivery of culturally competent health care. OBJECTIVE: Within the context of existing literature, evidence-based, concrete recommendations are developed as an Agenda for Cultural Competency Using Literature and Evidence (ACCULTURE). METHODS: First, key points representing opportunities for intervening in promotion of cultural competent health care are discussed. Following is a review of existing literature with a focus on identifying next steps for future research. Recommendations for licensing, education, and continuing education requirements suggest developing educational research establishing course content and delivery strategies that have measurable impact on improving cultural competency. In addition, existing initiatives need to be evaluated regarding effectiveness in recruiting, retaining, and preparing a diverse workforce. Patient care recommendations focus on further developing an understanding of the factors impacting health outcomes for culturally diverse patients. RESULTS: Further work is needed for translating theoretically-based research into concrete curricula maintaining evidence-based outcomes. It is important to continue with promoting policies ensuring that research and clinical trials include diverse samples and a broad range of variables implicated in differential outcomes. CONCLUSIONS: Based on connections between cultural competency and workforce diversity established within existing literature, data are needed regarding the effectiveness of existing initiatives promoting scholarships, grants, and incentives for improving workforce diversity and funding research on diversity issues. Finally, additional research is needed to evaluate existing and new policies for funding services and access for health services.

Clinical Competence↗
PubMed2000

A literary approach to teaching cultural competence.

Cultural competence is a necessity in today's diverse society and an essential component of clinical practice. As an adjunct to other sources, literature can enrich teaching and sensitize students to cultural issues in health care. The Spirit Catches You and You Fall Down is a beautifully written and compelling story well suited for instructional purposes. Although widely recommended, nurses are largely ignored in this story of a Hmong family seeking medical care. The book describes how the health care system failed to provide adequate care to patients from a different cultural background despite providers' good intentions. Nurse educators can use structured discussion guides to synthesize literary accounts such as The Spirit Catches You and You Fall Down with theory and research about cultural competence.

Clinical Competence↗
PubMed1996

Comparison of cultural competence and cultural confidence of senior nursing students in a private southern university.

American Society is becoming increasingly diverse and multi-cultural. Nursing education must recognize the impact this has on our profession, education and care. A private southern university recently embraced culturalism as a conceptual thread in its curriculum and is providing cultural content to better prepare nursing students to provide culturally appropriate care. This study's purpose was to compare the cultural competence and confidence of senior nursing students who had received cultural content (N = 32) with those who had not received any cultural content (N = 33). The Bernal and Froman Cultural Self Efficacy Scale was used. Findings suggest students who received some cultural course content feel less competent and confident to provide culturally sensitive care than those who received no cultural course content.

Adult↗
PubMed2006

Development and validation of a patient-reported measure of physician cultural competency.

While cultural competency is widely promoted, the lack of a measure of cultural competency limits our ability to evaluate interventions and to understand the effects of cultural competency on health care quality. Based on a conceptual framework of cultural competency derived from expert focus groups, we developed a patient-reported measure of physician culturally competent communication behaviors that we validated in a group of 429 adult primary-care patients with diabetes and/or hypertension and their 53 physicians. Construct validity was supported by a moderate association with both patient satisfaction (r = .32, p < .001) and patient trust (r = .53, p < .001). Predictive validity was supported by an association with a decrease in blood pressure among hypertensive patients (r = -.18; p < .05). This new measure may be useful in assessing levels of culturally competent provider behavior and investigating associations between provider cultural competency and health care processes and outcomes.

Aged↗
PubMedDate not supplied

Developing cultural competence in health care settings. National Center for Cultural Competence.

Increasing cultural and linguistic competence in health care settings is important for several reasons, including: responding to current and projected demographic changes in the United States; eliminating long-standing disparities in the health status of people of diverse racial, ethnic, and cultural backgrounds; improving quality of both services provided and health outcomes; meeting legislative, regulatory, and accreditation mandates; gaining a competitive edge in the market place; and decreasing the likelihood of liability/malpractice claims. Changes in policies, structures, practices, and procedures are often needed to bring about improvements in this arena. To support the process of change, The National Center for Cultural Competence (NCCC) was funded to increase the capacity of health care and mental health systems, institutions, programs, and providers to design, implement, and evaluate service delivery systems for cultural and linguistic competence. Several checklists developed by the NCCC are presented here for use by individual practitioners, programs, and institutions in assessing aspects of cultural competence.

Child↗
PubMedDate not supplied

Assessing culturally competent scholarship.

Cultural competence is a necessity for nursing practice in a global society, and use of objective criteria to measure cultural competence is a critical need. We used Meleis's eight criteria for assessing culturally competent scholarship as an analytical framework for reviewing an international educational/research experience. We developed operational measures for each criterion, then applied the measures to our experience, citing discrete examples for adherence. While we believe we have met the criteria for cultural competence in our course and scholarly work, our application has helped to identify areas needing improvement. In addition, we hope our application of these criteria will stimulate others to evaluate their own efforts in teaching, researching, or practicing cultural competence.

Cultural Diversity↗
PubMed2006

Unraveling the layers of cultural competence:exploring the meaning of meta-cultural competence in the therapeutic community.

Social work practice has become more complex and complicated, as social workers wade through the burgeoning call for empirical evidence, the demand to deliver services in shorter periods and with restricted resources. In substance abuse treatment organizations, implementing evidence-based, culturally competent treatment initiatives can seem counter-intuitive to program staff and are subsequently not administered or administered in a way that sabotages the integrity of the intervention. This paper examines cultural competence and explores the meaning of meta-cultural competency that is, the organization's culture, the client's cultural background, and how these factors are interpreted by practitioners within the organizational network.

Cognition↗
PubMed2006

Using the tool for assessing cultural competence training (TACCT) to measure faculty and medical student perceptions of cultural competence instruction in the first three years of the curriculum.

PURPOSE: To compare faculty and student perceptions of cultural competence instruction as measured by the AAMC's Tool for Assessing Cultural Competence Training (TACCT) as part of a comprehensive curricular needs assessment. METHOD: In 2005, 25 basic science and clinical course directors and 92 third-year medical students at the University of California, Irvine, School of Medicine were asked to indicate which of 67 separate items listed on the TACCT describing knowledge, skill, and attitude about cultural competence were covered during the first three years of the curriculum. The mean percentage of "yes" responses to each item was computed and compared for both faculty and students. RESULTS: Response rates were 100% (25/25) for course directors and 75% (69/92) for students. Students systematically perceived that cultural competence instruction occurred more often in the curriculum (range of 28% to 93% "yes" responses) compared to the faculty (range of 8% to 64%). However, faculty and students demonstrated a high level of concordance (intraclass correlation coefficient = 0.89 across all items) in their perceptions about instruction, as measured by their relative rank orderings of the 67 TACCT items. Students and faculty identified clusters of TACCT items pertaining to health disparities, community partnerships, and bias/stereotyping as least likely to be presented. CONCLUSIONS: Faculty and third-year students at one medical school responded congruently about the relative degree to which cultural competence instruction occurred. The TACCT can be used to identify significant gaps in cultural competence training and inform curricular revision. Further studies involving other schools are warranted.

Cultural Diversity↗
PubMed2005

Considering the culture of disability in cultural competence education.

Cultural competence extends beyond understanding those values, beliefs, and needs that are associated with patients' age or gender or with their racial, ethnic, or religious backgrounds. People hold many simultaneous cultural associations, and each have implications for the care process. The "culture of disability" is a pan-ethnic culture for which a set of physician competencies are required to ensure appropriate, culturally sensitive care to persons with congenital or acquired disabilities. Such competencies include communicating with patients who have deficits in verbal communication and avoidance of infantilizing speech; understanding the values and needs of persons with disabilities; the ability to encourage self-advocacy skills of patients and families; acknowledging the core values of disability culture including the emphasis on interdependence rather than independence; and feeling comfortable with patients with complex disabilities. Medical schools have developed programs to increase students' exposure to persons with disabilities and it is suggested that such programs are most effective when they are the result of collaboration with community-based facilities or organizations that serve persons with disabilities in the natural environment. Combining lecture-based instruction and structured experiences with the opportunity for students to interact with patients in their natural environments may facilitate development of competencies with respect to patients with disabilities. The culture of disability should be included as one of the many cultures addressed in cultural competence initiatives in medical school and residency curricula.

Attitude to Health↗
PubMed2000

Transforming cultural competence into cross-cultural efficacy in women's health education.

To prepare students to be effective practitioners in an increasingly diverse United States, medical educators must design cross-cultural curricula, including curricula in women's health. One goal of such education is cultural competence, defined as a set of skills that allow individuals to increase their understanding of cultural differences and similarities within, among, and between groups. In the context of addressing health care needs, including those of women, the author states that it is valid to define cultural groups as those whose members receive different and usually inadequate health care compared with that received by members of the majority culture. The author proposes, however, that cross-cultural efficacy is preferable to cultural competency as a goal of cross-cultural education because it implies that the caregiver is effective in interactions that involve individuals of different cultures and that neither the caregiver's nor the patient's culture offers the preferred view. She then explains why cross-cultural education needs to expand the objectives of women's health education to go beyond the traditional ones, and emphasizes that learners should be trained in the real-world situations they will face when aiding a variety of women patients. There are several challenges involved in both cross-cultural education and women's health education (e.g., resistance to learning; fear of dealing openly with issues of discrimination; lack of teaching tools, knowledge, and time). There is also a need to assess the student's acquisition of cross-cultural efficacy at each milestone in medical education and women's health education. Components of such assessment (e.g., use of various evaluation strategies) and educational objectives and methods are outlined. The author closes with an overview of what must happen to effectively integrate cross-cultural efficacy teaching into the curriculum to produce physicians who can care effectively for all their patients, including their female patients.

Attitude of Health Personnel↗
PubMed1999

Preparing culturally competent practitioners.

Preparing culturally competent practitioners is critical, and evaluating the effect of experiences intended to move students toward cultural competence is important. This research study explored the relationship among short-term international nursing clinical immersion experiences, cultural self-efficacy, and cultural competence. A triangulated research design was used to explore the relationship among the variables with 200 senior undergraduate and graduate nursing students from a university in New England. Quantitative analysis found statistically significant differences in the achievement of cultural self-efficacy for the participants who completed the international clinical experiences versus those who remained in the United States. Qualitative analysis, used to further explain the quantitative results, found that the differences were related to international students' ability to overcome their ethnocentrism, experience a transformative perspective about being culturally aware and sensitive, as well as understand and integrate the patients' cultural practices and beliefs into the students' Western health care practices. It became apparent that something other than cultural self-efficacy had occurred for participants in the international immersion experiences. The students believed they had entered the arena of cultural competence. Short-term clinical cultural immersion experiences have relevance for assisting faculty to move nursing students toward an understanding and achievement of cultural competence in ways currently not possible with nonimmersion community cultural experiences.

Adult↗
PubMed2002

Transcultural communication: the cornerstone of culturally competent care.

Cultural diversity will continue to expand in the "great melting pot"--the United States of America. The ability of the nurse to foster transcultural communication will remain a very real challenge in rendering culturally competent health care. Accepting differences in people and displaying a nonjudgmental attitude are essential for the nurse to communicate successfully across different cultural groups. In conclusion, nurses must be engaged in a dynamic dialogue to ameliorate transcultural communication, avoid language barriers, and employ approaches to enhance nurse-patient rapport.

Clinical Competence↗
PubMed2005

Improving the cultural competence of nursing students: results of integrating cultural content in the curriculum and an international immersion experience.

The purposes of this study were to evaluate the effect of integrating cultural content (ICC) in an undergraduate nursing curriculum on students' self-perceived cultural competence, and to determine whether a 5-week clinical immersion in international nursing (ICC Plus) had any additional effect on students' self-perceived cultural competence. Cultural competence was measured using a 28-item scale regarding students' self-perceived knowledge, self-awareness, and comfort with skills of cultural competence. Pretest scores from admission into the program were matched with posttest scores obtained just prior to graduation for 32 students, 7 of whom also participated in a 5-week immersion experience in Guatemala. Results, expressed in effect sizes, showed small to moderate gains for the 25 students in the ICC group, and very large gains for the 7 students in the ICC Plus group, related to perceived cultural competence. These results are consistent with the two-phase (cognitive and affective) development of cultural competence proposed by Wells.

Adult↗