Distance Learning Teaching Strategies in Registered Nurse to Baccalaureate Nurse Programs: Advancing Cultural Competence of Registered Nurses in Providing End-of-Life Care

In order to prepare nurses to effectively provide holistic nursing care to an increasingly diverse patient population, nurse educators must incorporate cultural care practices into the nursing curricula. Specifically, teaching culturally competent end-of-life care is essential but can pose challenges for distance education programs. The purpose of this article is to identify multiple learning strategies utilized in an online nursing program to teach students how to provide culturally competent end-of-life care.     

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.     

Many faces: addressing diversity in health care

DIVERSITY: The changing demographics and economics of our growing multicultural world, and the long-standing disparities in the health status of people from culturally diverse backgrounds has challenged health care providers and organizations to consider cultural diversity as a priority. The purpose of this article is to present a model that will be helpful in providing culturally competent care. The concept of cultural competence is discussed, "The Process of Cultural Competence in the Delivery of Healthcare Services Model" is described, and a mnemonic to guide in providing culturally competent care is presented.     

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.     

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.     

A growing challenge: patient education in a diverse America.

Patient education is a vital part of nursing practice, but the inability to provide consistent culturally sensitive patient care to minority populations has most certainly contributed to disparities in health and healthcare. This article explores minority populations in the United States and their characteristics in relation to health and healthcare, popular cultural competence theories, and nursing school curricula, and discusses teaching strategies for developing more culturally competent nursing professionals.     

Cultural differences with end-of-life care in the critical care unit.

Critical care nurses are providing healthcare for an increasingly multicultural population. This ever-increasing diversity in cultures and subcultures presents a challenge to nurses who want to provide culturally competent care. It is common for patients and families to face difficult decisions about end-of-life care in critical care units, and minority cultures do not always believe in the Westerner's core values of patient autonomy and self-determination. Knowledge of these cultural differences is fundamental if critical care nurses wish to provide appropriate and culturally competent information regarding end-of-life decisions.     

Integrating cultural values, beliefs, and customs into pregnancy and postpartum care: lessons learned from a Hawaiian public health nursing project

Determining the elements of culturally competent health care is an important goal for nurses. This goal is particularly integral in efforts to design better preventive health care strategies for pregnant and postpartum women from multiple cultural and ethnic backgrounds. Learning about the values, beliefs, and customs surrounding health among the targeted groups is essential, but integrating this knowledge into the actual health care services delivery system is more difficult. The success of a prenatal and postpartum program developed for native Hawaiian, Filipino, and Japanese women in Hawaii has been attributed to the attention on training, direct care giving, and program monitoring participation by local cultural and ethnic healers and neighborhood leaders living in the community, with coordination by public health nurses. This article profiles central design elements with examples of specific interventions used in the Malama Na Wahine or Caring for Pregnant Women program to illustrate a unique approach to the delivery of culturally competent care.     

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.     

African-American spirituality: a concept analysis

Culturally competent care for African Americans requires sensitivity to spirituality as a component of the cultural context. To foster understanding, measurement, and delivery of the spiritual component of culturally competent care, this article presents an evolutionary concept analysis of African-American spirituality. The analysis is based on a sample of multidisciplinary research studies reflecting spirituality of African Americans. Findings indicate that African-American spirituality involves quintessential, internal, external, consoling, and transformative attributive dimensions. Findings are considered in relation to previous conceptual analyses of spirituality and suggest that defining attributes of African-American spirituality are both global and culturally prominent. Implications for practice and research are discussed.     

Developing a culturally competent health care workforce in Japan: implications for education

In recent years, the population of foreign nationals and individuals from diverse cultural, racial, ethnic, and linguistic populations has consistently increased in Japan. An apparent failure by the health care workforce to deliver culturally congruent health care services has resulted in dissatisfaction with the health care system on the part of foreign nationals and increased potential for negative health care outcomes. Primary hindrances to the development of a culturally competent health care workforce include limited exposure to foreigners, cultural factors, and language difficulties. Recommendations are proposed for strategic educational actions to address these obstacles and develop in Japan a culturally competent health care workforce.     

Theories of spouse abuse: relevance to African Americans

This article reviews several sociocultural theories of spouse abuse. However, their relevance to ethnic people of color, and African Americans in particular, is questionable because of different cultural and historical experiences. It is suggested that the use of unidimensional sociocultural theories may not adequately explain spousal abuse cross culturally. Recommendations are made for the development and testing of multidimensional theoretical frameworks that consider the unique cross-cultural variations related to abusive relationships among ethnic people of color. Additionally, studies that are conducted by culturally competent researchers may better explain cultural similarities and differences regarding spouse abuse and thus ultimately lead to more culturally competent nursing care.     

FROM THE EDITOR—CAUTION URGED IN PRESCRIBING PSYCHOTROPIC DRUGS FOR OLDER PATIENTS

This article reviews several sociocultural theories of spouse abuse. However, their relevance to ethnic people of color, and African Americans in particular, is questionable because of different cultural and historical experiences. It is suggested that the use of unidimensional sociocultural theories may not adequately explain spousal abuse cross culturally. Recommendations are made for the development and testing of multidimensional theoretical frameworks that consider the unique cross-cultural variations related to abusive relationships among ethnic people of color. Additionally, studies that are conducted by culturally competent researchers may better explain cultural similarities and differences regarding spouse abuse and thus ultimately lead to more culturally competent nursing care.     

Teaching Culturally Appropriate Care: A Review of Educational Models and Methods

The disparities in health care and health outcomes between the majority population and cultural and racial minorities in the United States are a problem that likely is influenced by the lack of culturally competent care. Emergency medicine and other primary-care specialties remain on the front lines of this struggle because of the nature of their open-door practice. To provide culturally appropriate care, health care providers must recognize the factors impeding cultural awareness, seek to understand the biases and traditions in medical education potentially fueling this phenomenon, and create a health care community that is open to individuals' otherness, thus leading to better communication of ideas and information between patients and their health care providers. This article highlights the rationale for and current problems in teaching cultural competency and examines several different models implemented to teach and promote cultural competency along the continuum of emergency medicine learners. However, the literature addressing the true efficacy of such programs in leading to long-lasting change and improvement in minority patients' clinical outcomes remains insufficient.     

Diversity issues in the delivery of healthcare

What does it mean to be culturally competent and proficient? What criteria are used to describe a culturally competent healthcare delivery system and how can an individual or an organization grow in competency? What is the delivery of competent care related to me personally?This article addresses these questions with the assumption that knowing one's viewpoints on how culture change offers a sample of the glasses through which we view others. Culture and culture change are defined, and four models that explain the process of culture change are discussed in detail. These models represent different world views held to explain the phenomena of acculturation. The article concludes with a summary of the recommended National Standards for cultural and linguistic appropriate healthcare services developed by the Office of Minority Health. The concepts described can serve as universal tools for individuals and/or organizations interested in cultural competency.