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.     

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.     

End-of-life care for ethnic minority groups

Death and dying are profound events that bring into focus important ethical and medical questions for all patients, whatever their cultural background. For ethnic minority groups and their families, specific issues or barriers may arise related to culturally appropriate health care practices, cultural or religious differences, diverse health beliefs, and access to services for care and support during end-of-life conditions. National policy and local initiatives in both the United States and the United Kingdom support the development of services that address the care of ethnic minorities. This article examines end-of-life care for ethnic minority groups.     

Occupational health nursing with Navajo workers. Providing culturally competent care.

1. Native Americans in the southwestern United States are considered a "vulnerable population." Native Americans have economic difficulties, poor health, and little access to health care. The Navajo nation is the largest Native American reservation in the United States. 2. Occupational health nurses who provide culturally competent care increase the likelihood for Navajo workers to obtain optimal benefits from workplace health services. 3. The nurse uses cultural assessment skills and critical thinking abilities to maximize therapeutic interactions and minimize barriers in communications with workers of other cultural backgrounds. 4. The nurse who is knowledgeable about the Navajo way can help achieve a balance between the traditional ways and Western ways of addressing serious health care issues facing the Navajo worker. This knowledge and cultural awareness also increases the effectiveness of health promotion and health education programs offered to workers, their families, and their communities.     

Communication strategies for nurses interacting with deaf patients.

Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the deaf community's access to health care services are provided.     

Migrant farm workers and their families: Cultural patterns and delivery of care in the United States

Migrant farm workers and their families represented a critical labour pool in the planting and harvesting of agricultural products in the United States, yet their diminished health status parallel many non‐industrialized communities. The interaction of social, political, environmental and financial obstacles severely restrict access to health care among this community who often perceive insurmountable barriers to navigating the health‐care system. Through the provision of a culturally competent and sensitive assessment, community health nurses and other health providers can positively impact on health outcomes by incorporating the unique health beliefs and practices of this vulnerable population into a mutually defined plan of care.     

Effective communication and delivery of culturally competent health care

Effective communication between patients and health care providers is a critical element to quality health care. Becoming aware of patients' attitudes, beliefs, biases, and behaviors that may influence patient care can help clinicians improve access to and quality of care. Health care providers should develop a strategic plan for improvement, then implement and evaluate the plan to include structured, continuously improving progress toward achieving cultural competency goals. In this challenging health care environment, health care providers need the skills to explore the meaning of illness, to determine patient's social and family context, and provide patient-centered and culturally competent care.     

International students' perceptions of health care.

International students are coming to the United States in increasing numbers to study in the independent school setting. Compared with the general student population, fewer international students seek nursing intervention or medical attention for common illnesses and ailments. The purpose of this study was to determine barriers, real or perceived, that impede international students in high schools from seeking and utilizing health services that are available to them in the school setting. This qualitative study used Leininger's cultural care and universality theory. Self-contained focus groups were used to collect data that provided insight into attitudes, perceptions, and opinions as they relate to health care services, practices, and beliefs. Nursing implications include incorporation of culturally appropriate nursing care and the expansion of nursing practice to include traditional homeland remedies and medications in the treatment of international students in the school setting.     

Culturally competent nursing care: listening to the voices of Mexican-American women

Mexican-Americans represent the fastest-growing minority population group in the United States. Gaining a cultural perspective of health care in the Mexican-American population necessitates listening to the voices of women because they assume primary responsibility for maintaining family health. The Transcultural Assessment Model developed by Giger and Davidhizar (2004) provides the framework for this exploration of Mexican-American women's health care views. From this model the investigators developed an interview guide based on social organization and environmental control. Thematic analysis of interviews with six Mexican-American women revealed the importance of the family, religion, and locus-of-control in the health beliefs, attitudes, and lifestyle practices of this culture. Using the voices of Mexican-American women the investigators seek to promote an understanding of the culture as a guide for nursing care. The purpose of this article is to increase awareness of the Mexican-American cultural phenomena of social organization and environmental control which can guide the nurse to provide culturally competent care that meets the needs of Mexican-American women and their families.     

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.     

Differences in use of health services by children according to race. Relative importance of cultural and system-related factors

Black children make substantially less use of health services than do their white counterparts, despite their demonstrably poorer health status. This relationship is true regardless of income. Various authors have suggested that such differences are due to system-related barriers to access to care by black children. Alternatively, others have noted that blacks have cultural patterns related to health and illness, and these culturally determined beliefs and behaviors may account for the observed differences. The present study compared use of health services by black and white children within a system of care that has sought to decrease barriers to access to care by black children. Within this system, black and white children used health services in a similar fashion, suggesting that system-related factors that assure equity of access to health services may be more important than client-related cultural factors, or that these cultural factors may be overcome.     

Cultural influence on family management of children with cancer.

A family's cultural context directly influences how they define and manage their child's cancer. Knowing this dynamic can guide nurses in delivering holistic, culturally competent care. This literature review examines the international and domestic pediatric oncology research as it relates to the inclusion of family and cultural variables. Most international studies and comparative studies have investigated Asian cultures and found that health beliefs, communication beliefs, religious practice, and family structure are common themes of cultural influences on families. Additional studies within the United States are needed to explore cultural beliefs through carefully tailored family assessments. Implications for practice include the possibility of providing evidence-based culturally competent care to families of children with cancer.     

Health seeking behaviors of Haitian families for their school aged children

Providing culturally sensitive health care to diverse groups would be enhanced by better understanding of their experiences with the health care system and perceptions of health and illness. Haitians comprise an immigrant group that has increased dramatically in the United States over the past three decades. The purposes of this study were to identify the health seeking behaviors of Haitian parents for their school-aged children and the barriers they experienced in obtaining health care services. Sixty-two Haitian parents and guardians were interviewed. Findings highlighted a lack of health insurance coverage, frequent use of private providers, general satisfaction with health care services, and strong parental values regarding preventive health care behaviors. Parents also reported the combined use of traditional remedies and biomedical treatments during their child's illness episodes. Implications for practice and future research with Haitian parents and children are identified.     

Health care barriers for Latino children and provision of culturally competent care

The demography of the United States is rapidly changing. The impressive growth rate of Latino populations within the United States has great impact on health care. This article includes discussion of a significant increase from 1988 to 2000 in Latino utilization of emergency department and inpatient services at a pediatric medical center in Salt Lake City, Utah, information on health care barriers for Latinos, and suggestions for providing culturally competent care.     

Ensuring cultural sensitivity for Muslim patients in the Australian ICU: Considerations for care

Australia is a diverse and multicultural nation, made up of a population with a predominant Christian faith. Islam, the second largest religion in the world, has demonstrated significant growth in Australia in the last decade. Coming from various countries of origin and cultural backgrounds, Muslim beliefs can range from what is considered ‘traditional’ to very ‘liberal’.It is neither possible nor practical for every intensive care clinician to have an intimate understanding of Islam and Muslim practices, and cultural variations amongst Muslims will mean that not all beliefs/practices will be applicable to all Muslims. However, being open and flexible in the way that care is provided and respectful of the needs of Muslim patients and their families is essential to providing culturally sensitive care.This discussion paper aims to describe the Islamic faith in terms of Islamic teachings, beliefs and common practices, considering how this impacts upon the perception of illness, the family unit and how it functions, decision-making and care preferences, particularly at the end of life in the intensive care unit.     

Cultural assessment and care planning

Culturally competent care adapts care to the patient's cultural needs and preferences and begins with a cultural assessment that forms the care plan's foundation. Nurses who assess their patients' cultural beliefs, values, and practices are better able to individualize care and achieve positive outcomes. This article describes a cultural assessment tool, strategies for obtaining cultural assessment data, and a process for creating a culturally appropriate care plan.     

Challenging Spanish: ways for nurses to become bilingual.

A desire to provide culturally competent care to an increasing population of non-English-speakers may lead some nurses to consider learning another language as a way to minimize cross-cultural communication barriers. Nurses wishing to learn a second language may be surprised at the variety of ways to acquire bilingual skills, particularly in Spanish, the most common foreign language encountered in the United States. Reasons to learn Spanish are discussed and ways to do so are reviewed. Learning Spanish or another language can enrich the nurse-patient relationship, enhance nurses' self-esteem, and advance nurses' employment opportunities. Bilingual proficiency in English and Spanish (or another language) should be regarded as an authentic clinical skill supporting nurses' cultural and clinical competencies.     

Beliefs of mothers in Asian countries and among Hmong in the United States about the causes,treatments, and outcomes of acute illnesses: an integrated review of the literature

An understanding of mothers' beliefs regarding the causes of illness, treatment, and outcome is an important component of culturally competent care. However, little is known about the beliefs of Asian parents related to acute illnesses. The purpose of our article is to synthesize what is known about the beliefs of mothers regarding the causes, treatment, and outcome of acute illnesses in Asian countries and Hmong in the United States. The literature review covers the period from 1990-2000. The electronic bibliographic databases explored included Pub Med, MEDLINE, HealthSTAR, CINAHL, and PsycINFO. Keywords used were beliefs, health beliefs, mothers or parents, cause of illness or etiology, treatment, diarrhea, acute respiratory infection, measles, Asia, and Hmong. A total of 15 articles were retrieved and examined. Using the matrix method, each article was evaluated according to five frames of reference: journal, purpose, sample, method, and findings. Content analysis was used to generate themes. Expressions of belief related to the causes of illnesses among mothers from Asian countries and Hmong who have emigrated from Laos to the United States of America were found to be quite similar. Beliefs about practices were primarily related to feeding and home care. The majority of mothers first provided treatment for their children using traditional practices. When the child did not recover, the mother sought medical advice.