Cultural competence in the multidisciplinary rehabilitation setting: are we falling short of meeting needs?

We present issues relevant to rehabilitation providers who wish to develop or improve their cultural competence in their medical setting and interdisciplinary team. Two case scenarios are presented that illustrate the complexities introduced into the medical rehabilitation setting by the increased numbers of minority patients in the United States in the last 20 years. Professional codes of conduct and practice are discussed for 3 rehabilitation disciplines: physiatry, rehabilitation psychology and neuropsychology, and nursing. The current status of and improvements in professional and continuing medical education are then outlined. Challenges faced by rehabilitation providers seeking to become more culturally competent in their practices are related in the following topic areas: (1) continuing education in language and cultural issues, (2) assessment instruments appropriate for diverse patient populations, (3) majority versus minority population values and beliefs, (4) impact of the immigration and acculturation experiences, (5) health care and insurance coverage issues, (6) attitudes and beliefs about disability, and (7) past experiences with medical professionals and systems. Suggestions for developing and applying enhanced cultural awareness in clinical rehabilitation practice are provided.     

Cultural competence in nursing: foundation or fallacy?

Propelled by a national concern with social justice and health disparities, the notion of cultural competency is being incorporated into both government regulation and professional standards. Although most of the standards that are being developed nationally apply at the institutional level, it is in the clinical setting where the expectation of cultural competency is the most demanding. The recommendations for clinicians to become culturally competent generally fall into 2 major categories. The first focuses on the content and structure of the clinical encounter between provider and patient. The second category charges providers with becoming knowledgeable about the cultures of their constituent patients and learning their lifestyles,health beliefs, and behaviors. Although individuals may belong to the same cultural group, the assumption that they are, in fact, the same, is an ecological fallacy. The health care system has nested the accountability for cultural competence with the clinician who provides direct services to individuals, where the application of cultural information is likely to be least useful. We contend that cultural competence is really nursing competence.     

What are our priorities? Addressing the looming shortage of nursing faculty

Let's get our priorities straight. As we continue the essential educational upgrading of the profession through research-focused doctoral programs, and through the new CNL and DNP programs, let's be sure that at least some of these programs attend to the critical need for well-prepared nursing faculty (i.e., provide opportunities for and encourage students to take advanced coursework in nursing education). Let's also pay attention to the reality of limited capacity in our research-focused doctoral programs and look to other viable approaches to having a cadre of well-prepared faculty. For example, let's recognize, value, and reward the important role master's-prepared nurses, especially those with advanced coursework in nursing education, can and must play in our basic programs. And let's be sure that we have faculty in our ranks who have the training, aptitude, and credentials to conduct the research so critical to progress in nursing education.     

Service-learning in the nursing curriculum: are we at the level of evidence-based practice?

Service-learning is implemented as a learning strategy in all levels of education. However,there is little evidence to support its efficacy and influence on student learners and those served, due in part to broad operational definitions and the dearth of empirical evidence. The current trend of including service-learning in the nursing curriculum falls short of evidence-based practice, a valuable pillar in nursing education. The purpose of this systematic review is to review the research that has been conducted on service-learning and to investigate outcomes on nursing students. Suggestions for future research include the development and use of standardized operational definitions. Concepts of interest for measurement and research instruments have been identified.     

Accelerated second-degree baccalaureate nursing programs: what is the significance of clinical instructors?

Accelerated second-degree nursing programs are a popular method of entry into nursing for many individuals beginning a second career in nursing. Using a hermeneutic phenomenological approach, this study analyzed the experiences of 19 accelerated second-degree baccalaureate nursing graduates to understand how their student experiences best prepared them for nursing practice after graduation. The significance of clinical instructors to students' development as nurses was revealed in the data analysis and identified in the theme, Blending Practice and Pedagogy. This article describes the implications of this theme for both accelerated second-degree nursing programs and faculty recruitment and retention.     

Specialisation in nursing: are we ready for the year 2000?

The development of specialty nursing practice and nurse specialists in today's health care arena is a controversial yet growing force, fuelled by a complexity of factors from both within and external to the profession. By narrowing the focus on parts of the whole field of nursing, nurses have met the challenge of increasing technology, complexity of the health care system, and nursing care needs. Although the debate regarding nurse specialists continues to rage, the production of such nurses will push beyond the boundaries of the profession into the new millennium, in the interests of patient care.     

Evidence-based nursing practice: are we there yet?

The volume of evidence for nursing practice has increased as a result of research and scientific discoveries. Yet we are still struggling with the dilemma of how to get evidence into nursing practice. Estimates are that it takes 20 years before innovations are fully put into use. Research is one type of knowledge to be used in practice. Nursing and patient care would benefit from moving more toward knowledge based on research and evidence. This article reviews barriers to and facilitators of using evidence in nursing practice and discusses a model for promoting the systematic use of evidence in practice. The author also offers suggestions for increasing the evidence base of nursing practice. Using evidence in nursing practice is important for all nurses, but requires more that the attention of the individual nurse.     

Academic and clinical dissonance in nursing education: are we guilty of failure to rescue?

The experience of cognitive dissonance in novice clinical nursing students is examined. These students often confront an incongruity between the rule-bound academic ideal of nursing with which they have been prepared and the more flexible, intuition-driven clinical reality they encounter. Without insightful guidance from clinical faculty, the students' response to this dissonance could include disillusionment with clinical nursing practice or devaluation of the academic ideal of nursing. Cognitive Dissonance Theory, the Novice to Expert Model, and the Neuman Systems Model provide insight into this phenomenon and serve as a theoretical foundation for recommended strategies and interventions for optimal response to dissonance between academic ideal and clinical reality in nursing students.