UNDERUTILIZATION OF MENTAL HEALTH SERVICES BY ASIANAMERICANS RESIDING IN THE UNITED STATES

Asian-Americans are the fastest-growing minority in the United States, and they are a culturally diverse group. Knowledge about this growing minority population is important for the purposes of planning appropriate mental health care. Asian-Americans living in the United States rarely use mental health services. The reasons for this, along with suggestions for developing more culturally sensitive mental health services, are presented. A model for cultural competence can provide a framework for psychiatric nurses and other mental health professionals (MHPs) to become more aware of Asian-American values and beliefs and provide more culturally sensitive care. Awareness tools are included to guide MHPs in determining whether culturally competent care is available locally to meet the needs of this underserved population.     

Continuing the cultural competency journey through exploration of knowledge, attitudes, and skills with advanced practice psychiatric nursing students: an exemplar

Numerous training and education programs have evolved to address culturally competent health care delivery. This article describes an exemplar educational approach used to teach cultural competency to beginning graduate psychiatric mental health nursing students. Using interactive strategies delivered within the 4 phases of the curriculum, the approach has been shown to facilitate students' ongoing journey to cultural competence. Building on baccalaureate nursing competencies, the course addresses attitudes, knowledge, skills, and cultural humility to strengthen cultural self-assessment, cross-cultural clinical practice expertise, and the use of culturally appropriate research for graduate students.     

Culturally competent nursing care during the perinatal period

Effective nursing interventions require culturally competent nursing practice. Nurses can develop the skill sets needed to provide culturally competent care. These skills derive from nursing principles and practice that support respect for individual dignity and self-determination. Sweeping changes in health care delivery have shortened the length of client exposure to nursing care, especially in perinatal nursing. Moreover, changes in the United States population challenge the nurse's ability to respond appropriately to the expectations, values, and beliefs of many diverse cultural groups. Nursing theoretical frameworks provide a basis for cultural competence in practice.     

Cultural competence among nursing students and faculty

Healthcare consumers are entitled to culturally competent care. Therefore, nursing curricula need to include cultural content and student nurses and faculty members need to be culturally competent. The purpose of the study was to describe cultural competence of students and faculty at a college of nursing and to discuss the implications for nursing curricula related to cultural competence. Campinha-Bacote's model (Campinha-Bacote, J., 1994. Cultural competence in psychiatric mental health nursing. Nursing Clinics of North America 29 (1), 1-8.) of culturally competent care provided the theoretical framework. The Inventory for Assessing the Process of Cultural Competence (IAPCC) (Campinha-Bacote, J., 1998. The Process of Cultural Competence in the Delivery of Healthcare Services: A Culturally Competent Model of Care. Transcultural C.A.R.E. Associates, Cincinnati, OH. Available from: .) was used to measure levels of self-reported cultural competence. A convenience sample of 88 first year, 121 fourth year baccalaureate students and 51 faculty members at a college of nursing was studied. Analysis of variance revealed a statistically significant difference (F=43.915, df=259, p<.0001) between the three groups. A positive correlation was found between IAPCC scores and several demographic variables. Findings suggest that cultural competence can be increased by including structured cultural content in nursing curricula.     

The model of cultural competence through an evolutionary concept analysis.

Becoming a culturally competent health professional is a demanding prerequisite in this multicultural society. Cultural competence is explored and abstracted as a conceptual framework through a concept analysis using the evolutionary method. Its model is constructed from a systemic, comprehensive literature review and analysis. Taking into account how cultural competence is viewed by other disciplines (medicine, psychology, education, and social work), a comprehensive definition, antecedents, and consequences of cultural competence in nursing are described and diagrammed. Additionally, two model cases and future implications are discussed. The broader American society is composed of a mosaic of discrete cultural groups existing within the context of their values and identities. Those distinct cultures affect each patient's ways of thinking and his or her perceptions on health care and health behaviors. The proposed model of cultural competence provides a theoretical guide for developing strategies to achieve culturally competent care in nursing practice and research.     

Extending boundaries: Clinical communication with culturally and linguistically diverse mental health clients and carers

We are often confronted with the dilemmas of interacting with people from different cultural backgrounds. How do we ensure that we meet their needs, if they have some barriers to communicating those needs? This project explores the communication mechanisms used by mental health clinicians, to explore how they modify their communication to reconcile cultural differences and promote self‐disclosure. It also identifies the practical experiences that have enlightened clinicians' practice when interacting with culturally and linguistically diverse (CALD) groups. Through focus groups, mental health clinicians were probed about their experiences with CALD groups and the methods used to facilitate communication. Clinicians were working in either acute adult inpatient or community settings in a large metropolitan health service. Fifty‐three clinicians formed 7 focus groups. In the focus groups, clinicians were asked about their perceptions of communication with CALD clients. Guided questions were used. All focus groups were audio‐taped and transcribed. Two distinct themes emerged. They were ‘respect’ and ‘cultural understanding’. The clinicians recognized that showing and maintaining respect for the CALD client, and their families significantly impacted on the development of a therapeutic relationship. Showing cultural understanding and acceptance for difference also enhanced communication.     

Client satisfaction with nursing services. Evaluation in an occupational health setting.

Client satisfaction surveys have served as a valued appraisal tool of quality nursing care in various health care settings, but there is a paucity of published research using these tools in the occupational health setting. Employing a modified version of the SERVQUAL questionnaire, this study identified employees' current levels of satisfaction and perceived importance of nursing care provided by an occupational health program. Two hundred randomly selected employees were asked to participate by completing the survey, with 86 (43%) responding. Results indicated a positive correlation between client satisfaction and perceived importance of nursing care. Moderately high levels of client satisfaction existed in the sample. The use of client satisfaction surveys based on the strength of client preferences could identify areas of health care that need improvement.     

Assessment of professional nursing students'' knowledge and attitudes about patients of diverse cultures

This study examined personal attitudes of 152 Bachelors of Science in Nursing (BSN), registered nurse (RN) to BSN, and master's students enrolled in a school of nursing in the southwestern United States toward culturally diverse patients and their perceived knowledge of specific cultural practices and culture-specific skills. Three instruments were used to collect data: the Ethnic Attitude Scale-Part I, the Transcultural Questionnaire, and a demographic survey. Findings reveal that students in all three programs had a relatively low knowledge base about specific cultural groups. The only statistically significant difference found in attitudes, perceived knowledge of cultural patterns, or perceived cultural skills by program was the slightly higher perceived ability of generic BSN students to distinguish between concepts such as ethnocentrism and discrimination, intra- and intercultural diversity, and ethnicity and culture. Similar to other studies of measurement of provider attitudes and perceived cultural knowledge, the results of this study reinforce the struggle experienced by educators and the challenges faced by health care administrators grappling with teaching and delivering culturally competent care. The findings imply that nurse educators need to examine alternate models and teaching strategies to move students along the continuum of cultural learning.     

Transcultural nursing: how do nurses respond to cultural needs?

The aim of the study was to explore how nurses responded to the cultural needs of their clients. From the transcultural point of view, healthcare providers must deliver a service that is culturally sensitive and appropriate. However, for a variety of reasons, there is growing concern that the cultural healthcare needs of minority ethnic groups are not met adequately. This study was done to outline nurses' activity in transcultural care. Empirical data were obtained from a sample of registered nurses (n = 126) who were invited to complete questionnaires pertaining to cultural care. As a result of data analysis, the quantitative findings are presented as tables and the qualitative data as categories and themes. The findings suggest that most respondents felt that patients' cultural needs should be given consideration. Cultural aspects of care seem to be a feature of the overall nursing picture within a multicultural context of health care. Many participants claimed that they responded to the cultural needs of patients. Some felt that patients' cultural needs are adequately met; such needs are perceived as religious practices, diets, communication, dying, prayer and culture. Furthermore, a significant number of respondents suggested that they would like further education in meeting the cultural needs of their patients. This study offers some insights into transcultural healthcare practice, and, in accordance with the findings, identifies strategies for improving these practices for nursing and nurse education.     

Consumer feedback on nursing care and discharge planning

BACKGROUND: Gaining consumer feedback about nursing care and discharge planning is especially important given the changes that have occurred in acute inpatient mental health facilities. Consumers can best define the quality of the service they receive and surveys are considered to be good sources of information about nursing care and discharge planning. AIM: The aims of this study were to clarify consumer discharge needs, ascertain consumer perceptions of helpful practice, identify areas that require improvement, identify resources consumers deem important, ascertain satisfaction with specific aspects of services, and obtain baseline data to improve future discharge planning. METHOD: Satisfaction-with-services and discharge questionnaires were completed by clients (39 and 45, respectively) prior to discharge from three acute inpatient mental health units over a 2-month period. FINDINGS: Findings indicated that clients were most satisfied with the respect they received from staff, attention staff gave to concerns and worries, quality of service provided by nurses, way treatment met client needs and overall stay in hospital. The majority of respondents (95%) indicated that their discharge arrangements were explained to them and 90% were satisfied with these. Whilst over two-thirds indicated that the information provided in hospital to assist with discharge had been helpful, they highlighted some areas for service improvement. Resources to prepare them better for discharge included increased contact with consumer consultants and more information about mental health problems, medication and relapse prevention. CONCLUSION: This study constitutes another small step towards decreasing the gap between consumer expectations and actual treatment by asking consumers about their perceptions of discharge planning. The findings provide the basis for the development of more appropriate strategies to improve the continuity of services between hospital and community mental health settings.     

Perceptions of crisis care in populations who self‐referred to a telephone‐based mental health triage service

Although psychiatric crises are very common in people with mental illness, little is known about consumer perceptions of mental health crisis care. Given the current emphasis on recovery‐oriented approaches, shared decision‐making, and partnering with consumers in planning and delivering care, this knowledge gap is significant. Since the late 1990s, access to Australian mental health services has been facilitated by 24/7 telephone‐based mental health triage systems, which provide initial psychiatric assessment, referral, support, and advice. A significant proportion of consumers access telephone‐based mental health triage services in a state of crisis, but to date, there has been no published studies that specifically report on consumer perceptions on the quality and effectiveness of the care provided by these services. This article reports on a study that investigated consumer perceptions of accessing telephone‐based mental health triage services. Seventy‐five mental health consumers participated in a telephone interview about their triage service use experience. An eight‐item survey designed to measure the responsiveness of mental health services was used for data collection. The findings reported here focus on the qualitative data produced in the study. Consumer participants shared a range of perspectives on telephone‐based mental health triage that provide invaluable insights into the needs, expectations, and service use experiences of consumers seeking assistance with a mental health problem. Consumer perceptions of crisis care have important implications for practice. Approaches and interventions identified as important to quality care can be used to inform educational and practice initiatives that promote person‐centred, collaborative crisis care.     

Seeking and defining the ‘special’ in specialist mental health nursing: A theoretical construct

In the context of an enduring debate about the distinct identity of mental health nursing, this qualitative study explored the nature, scope and consequences of mental health nursing practice. Data for interpretation were generated through interviews with 36 mental health nurses, five of their clients and one health care colleague, each of whom were asked to speak in as much detail as possible about what they believe is special about mental health nursing and what had influenced them to arrive at this understanding. Using a constructivist grounded theory approach, the study generated a substantive theory of recovery‐focused mental health nursing expressed as ‘Being in the here and now, side by side, co‐constructing care’. The study revealed that the distinct nature and identity of mental health nursing provides the foundation that primes and drives practice scope and consequences. Conceptual interpretations of the data emphasized the mental health nursing perspective of care as an acquired lens founded in nursing as a profession and enhanced by the relational interplay between the nurse and the client that facilitates the nurse to adopt recovery‐focused practices. This theoretical construct holds the potential to be the mediating connection between client and mental health nurse. By situating mental health nursing and its central role in practice as something co‐constructed, findings from this study can be expanded beyond the Australian context, particularly in terms of mental health nursing's distinct professional identity and practice.     

Cultural Diversity: A Resource in Planning and Implementing Nursing Care

America's cultural diversity challenges the ability of nurses to respond with sensitivity to client needs. Enhancement of the client's health practices is contingent on the nurse's ability to use the individual's culturally based beliefs and values as an integral component in the design of nursing interventions. Nurse and client engage in a truly collaborative planning and implementation of care only after there is mutual understanding of the special meaning of beliefs and values from which health behaviors are derived. Educational preparation with experience in applying cultural knowledge is essential to the development of sensitive nursing practice. Integrating such information and experiences into baccalaureate nursing curricula through a sociocultural project will enhance student awareness of client values and beliefs and their potential nursing implications. Strategies exist for helping students recognize, accept, and use these features in planning and implementing nursing care.     

Exploring cultural competence of nurses and associated barriers in Ethiopian tertiary hospitals: A qualitative study

BackgroundsCultural diversities in both patients and health professionals possess difficulties in cultural care. Such cultural diversities can lead to culturally inappropriate care and health disparities. Delivering culturally competent nursing care is a powerful tool to provide care equally for all patients and eliminate health disparities among culturally diverse people. The present study aimed to explore the cultural competence of nurses and associated barriers in Ethiopian tertiary hospitals.MethodsThe study was conducted on eight purposively selected key informants from March 1 to April 30, 2018. Data was collected using semi-structured questions through face to face in-depth interview. The collected data analyzed using thematic analysis and presented in the form of text and table.ResultsEight (n = 3 females and n = 5 males) participants were involved in the study. After extensive analysis, four themes emerged: cultural competence, linguistic competence, cultural competence education and training, and barriers to cultural competence. Another six subthemes of barriers encountered by participants identified and consisted of the language barrier, trained interpreter and translator limitation, lack of knowledge of the patient's culture, lack of multicultural nursing workforce, and shortage of nursing staff, cultural and linguistic stereotypes.ConclusionsNurses less focused on cultural aspects of patients, and they focused more on biological factors and patients' disease. Interestingly, they expressed respect for the cultural and religious practice of patients and showed an interest to learn about cultural care nursing. Cultural competence of participants was hindered by several barriers that need nurses to overcome it.     

Developing culturally competent researchers

BACKGROUND: Whilst we live in multicultural societies most health researchers tend to take the cultural perspective of the majority ethnic group at the expense of the perspective of minority ethnic groups. AIM: This paper discusses the need for the development of culturally competent health researchers in all areas of research and proposes a model for the achievement of this. DESIGN: A snapshot review of research textbooks used in nursing curricula was conducted to identify whether culturally competent research was being promoted. RESULTS: The review found that whilst a few textbooks touched on ethnicity, race and culture, none of them addressed the issue of cultural competence. Subsequently the authors adapted their existing model of culturally competent health care practice, and in this paper they propose it as a model for the development of culturally competent researchers. DISCUSSION: The model put forward by the authors consists of four concepts: cultural awareness, cultural knowledge, cultural sensitivity and cultural competence. A culturally competent researcher is one who is able to apply the related skills and knowledge in project design, data collection, analysis, report writing and dissemination. Furthermore, the authors identify two layers of cultural competence, those of culture-generic (knowledge and skills that are applicable across ethnic groups) and culture-specific competence (knowledge and skills that relate to a particular ethnic group). The relationship between these two layers is a dynamic and spiralling process as illustrated by the model. CONCLUSION: Current health policy in many developed countries focuses on inequalities of health and managing diversity, including ethnicity. Thus the authors conclude that the development of culturally competent researchers will lead to both valid research and culturally competent practice by health care professionals.