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.     

A goal for nursing education

Current trends of an increasingly multicultural society emphasize the need for nursing education programs that effectively address cultural issues. To understand the diverse cultural backgrounds of clients, nurses must strive to be culturally competent. Cultural competence requires the building of cultural awareness, knowledge, skill, encounters, and desire in the nurse. Clients will feel respected, valued, and have a greater desire to achieve mutually agreed upon health care goals if the nurse is culturally competent. Nurse educators can assist nursing students in acquiring cultural competence using a model created by Campinha-Bacote (1999) entitled "The Process of Cultural Competence in the Delivery of Healthcare Services: A Culturally Competent Model of Care". The model contributes to the development of cultural competence in the nursing profession by providing a concrete guide that is useful for teaching and implementing cultural competence in nursing education.     

Beyond cultural competence: a model for individual and institutional cultural development

Nursing's attention to cultural diversity has been influenced by the changing demographic composition of the U.S. population. Nursing must continue to increase awareness and promote attitudinal and behavioral changes that will result in the delivery of culturally appropriate nursing care. The nursing literature includes several models of cultural development to assist nurses and other health care professionals in conducting a cultural assessment and incorporating cultural data into nursing care plans. This article presents a synthesis model of cultural development that illustrates that cultural awareness, cultural sensitivity, and cultural competence do not achieve the level of cultural development necessary to meet the health care needs of a diverse population. Cultural proficiency is a concept that extends cultural competence into nursing practice, administration, education, and research. It is a philosophical and behavioral approach to cultural diversity that guides and prescribes individual and institutional behavior toward "cultural others."     

Cultural mistrust and use of hospice care: challenges and remedies

Cultural mistrust is a prominent barrier to the involvement of African Americans in hospice care. While disavowing the theory that cultural mistrust has its origin in any single factor or event, it is argued that there needs only to exist the cultural construct of community for cultural mistrust to perpetuate itself among any ethnic group. The attitudes toward hospice care are advanced as illustrative of the relationship between African Americans and the health care system, and many other institutions of American society. From a perspective that accepts the existence of the phenomenon of cultural mistrust, suggestions for structuring training for cultural competence are discussed. These suggestions are relevant for workers in institutions that serve the African American community in critical health care areas in general, and administrators and staff of hospices in particular.     

Enhancing cultural competence: Trans‐Atlantic experiences of European and Canadian nursing students

This paper describes the enhancement of cultural competence through trans‐Atlantic rural community experiences of European and Canadian nursing students using critical incident technique (CIT) as the students' reflective writing method. The data generated from 48 students' recordings about 134 critical incidents over a 2‐year project were analysed by qualitative content analysis. Five main learning categories were identified as: cross‐cultural ethical issues; cultural and social differences; health‐care inequalities; population health concerns; and personal and professional awareness. Four emergent cultural perspectives for the health sector that became apparent from the reflections were: health promotion realm; sensitivity to social and cultural aspects of people's lives; channels between the health sector and society; cultural language and stories of local people. CIT was successfully used to foster European and Canadian undergraduate students' cultural reflections resulting in considerations and suggestions for future endeavours to enhance cultural competence in nursing education.     

Cultural competency among school health educators

Changing demographics in the American classroom make it imperative for school health educators to possess the ability to deliver health education in a manner that takes into account students' cultural backgrounds and practices. The purpose of this article is to describe the level of cultural competence among school health educators and to provide some strategies by which these educators can enhance their cultural competency. Findings from this study show that educators have cultural awareness but illustrate the need for more research in this area in order to understand and increase cultural competency among school health educators.     

Education: nationally achievable solutions

Despite the efficacy of hypertension treatment, knowledge and compliance remain poor in Hispanic patients because of language barriers, low educational levels, and cultural differences. Yet effective physician-patient communication is crucial to patient compliance, satisfaction, and understanding of medical issues. Physicians and health care providers therefore need to develop "cultural competence" skills to achieve effective health education and good treatment outcomes in this patient population. Various strategies such as mnemonic devices can help practitioners communicate with Hispanic patients. National initiatives and research studies continue to address the provision of culturally and linguistically appropriate health care.     

Cultural sensitivity in physician-patient relationships: perspectives of an ethnically diverse sample of low-income primary care patients

BACKGROUND: Health care providers and health care training institutions need more specific, relevant, and useful information for providing culturally sensitive health care. OBJECTIVE: We sought to determine what patients considered to be culturally sensitive health care. RESEARCH DESIGN AND PARTICIPANTS: We conducted 20 focus group interviews with 135 mostly low-income primary care patients from three different ethnic/cultural groups (African American, European American, and Latino American). Focus group interviews were recorded, transcribed, and analyzed into themes by two researchers using the constant comparative method. MEASURES: Participants' responses were grouped into primary and secondary themes. RESULTS: Results revealed the following universal themes of health care delivery by physicians that all three racial or ethnic groups identified as indicators of culturally sensitive health care: people skills, individualized treatment, effective communication, and technical competence. Results also revealed some ethnic group-specific themes. Other factors including physical environment characteristics (eg, culturally sensitive art, pictures, music, and reading materials) and office staff behaviors were unique indicators of culturally sensitive health care identified by African American and Latino American participants but not by European American participants. CONCLUSIONS: These findings can be incorporated into training programs for health care providers, possibly resulting in more effective health care delivery to patients from diverse cultural backgrounds. Future research is needed to evaluate the impact of incorporating patient-identified cultural sensitivity into health care delivery on important outcome measures such as patient satisfaction and treatment adherence.     

Understanding the culture of Chinese children and families.

Providing appropriate health care to a client can be accomplished only in an environment that is sensitive to the cultural values and beliefs of the client. As the population of first- and second-generation Chinese immigrants increases in the United States, the need to develop culturally sensitive health care becomes significant. Chinese immigrants and their families have become an important part of American society, including the school setting. The school nurse, who regularly works with students and families, should work in a manner that allows Chinese immigrants to maintain their cultural values and beliefs, while providing appropriate care for the student. The Chinese culture is unique and holds values and beliefs that contrast with those of the Western culture. A school nurse who understands and incorporates the Chinese culture will be better able to develop a positive interaction with the family and make arrangements for culturally appropriate care.     

Effective promotion of breastfeeding among Latin American women newly immigrated to the United States

Across the United States, advance practice nurses (APNs) are increasingly encountering recently immigrated Latin American populations. This article provides an overview of the situation of Latin Americans in the United States and discusses aspects of Latin American culture such as, respeto (respect), confianza (confidence), the importance of family, and the value of a personal connection. Strategies that will assist practitioners to incorporate culturally holistic principles in the promotion of breastfeeding among Latin American women who are new arrivals in the United States are described. If practitioners are to respond to the increasing numbers of Latin American women who need health care services, and also provide thorough, holistic health care then health care activities must be integrated with cultural competence.     

European higher health care education curriculum: development of a cultural framework

This article concerns the European Curriculum in Cultural Care Project (2005-2009), which aimed at developing a curriculum framework for the enhancement of cultural competence in European health care education. The project was initiated and supported by the Consortium of Institutes in Higher Education in Health and Rehabilitation, whose goal is to nurture educational development and networking among member institutions. The framework is the result of a collaborative endeavor by nine nurse educators from five different European countries. The production of the framework will be described in accordance with the following tenets: developing cultural competence is a continuing process, cultural competence is based on sensitivity toward others, and cultural competence is a process of progressive inquiry. Critique concerning the framework will be presented.     

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.     

FEMINISM: A PERSPECTIVE FOR THE 21st CENTURY

This article details some of the key elements related to feminism in American society. It suggests that the meaning and significance of a feminist perspective need to be reexamined for their importance and utility in this dynamic and rapidly changing society. A discussion of the meaning of feminism provides a framework for the article. Issues related to cultural diversity and the need for competent health care delivery for all people are some major themes. The other emphasis is related to research and women. Numerous challenges are outlined. A feminist perspective is recommended as a conceptual model through which health care reform can be enhanced. If feminism were embraced, the health status of people would be improved.     

Geriatric rehabilitation: perspectives from the United Kingdom.

Although rehabilitation professionals acknowledge the need for more services for the aging American society, only recently has there been large-scale discussion on the state of geriatric rehabilitation in the United States. In contrast, geriatric rehabilitation has been a central component of British health planning since the beginning of the National Health Service in 1948. In the hope of stimulating discussion, this article examines geriatric rehabilitation services in the United Kingdom. Contrasts between the UK and US are drawn to highlight the relative strengths and weaknesses of each system of care. The importance of cultural determinants to health care services is emphasized.     

Effects of a cultural competence education programme on clinical nurses: A randomised controlled trial

BackgroundThe cultural competence education programme for health professionals aimed to ensure that all people receive effective health care, particularly those from culturally diverse backgrounds.ObjectivesThe purpose of this study was to investigate the effect of a cultural competence educational course on nurses' self-assessment of their cultural competence.DesignA single-blind, randomised control trial design was employed.Participants and settingsEligible nurses were recruited from a northern Taiwan medical centre with 2089 beds.MethodsA permuted block of four was used to randomly assign participants to the experimental (n = 47) and control groups (n = 50). The educational course comprised four units and was conducted once weekly for four weeks, with each session lasting 3 h.ResultsA significant group-time interaction was identified regarding self-learning cultural ability, verifying the education intervention's effect on self-learning cultural ability after a two-month intervention. In addition, a significant main effect over time was discovered for total cultural competence; there was no significant interaction effect.ConclusionsThe study provided evidence that an educational programme effectively improved cultural competence in clinical nurses. The results provide a reference for health care providers to design in-service cultural competence education for improving quality of care.     

Preparing psychosocial nurse practitioners for health care delivery

A central task for faculty in programs preparing health care practitioners is to remain timely in educating for the prevailing and future social and health services context. Current considerations in preparing advanced practice psychiatric nurses include the need for greater recognition of comorbidity, concerns about health care access and utilization for vulnerable populations, and changing patterns of practice. In addition, there is a great need to expand the cultural competence and diversity of the population of advanced practice nurses who deliver care to recipients in an increasingly multicultural society. This article describes the educational program developed at the University of Washington to prepare expanded role Psychosocial Nurse Practitioners and sets forth the rationale for major decisions and current directions.     

Radiology Nursing with the Asian Population

Radiology nursing is a semiautonomous nursing specialty, with professional development requirements related to cultural competency. Standards of cultural competence in radiology nursing are presented and applied to the resolution of three encounters with Asian American patients based on real-life incidents. Recommendations are offered for personal and organizational enhancement of cultural competency as a strategy for quality improvement in patient care, especially for the Asian American population.     

Health beliefs, practice, and priorities for health care of Arab Muslims in the United States.

The Arab Muslim population is one of the dramatically increasing minorities in the United States. In addition to other factors, religion and cultural background influence individuals' beliefs, behaviors, and attitudes toward health and illness. The author describes health beliefs and practices of the Arab Muslim population in the United States. That population is at an increased risk for several diseases and faces many barriers to accessing the American health care system. Some barriers, such as modesty, gender preference in healthcare providers, and illness causation misconceptions, arise out of their cultural beliefs and practices. Other barriers are related to the complexity of the health care system and the lack of culturally competent services within it. Nurses need to be aware of these religious and cultural factors to provide culturally competent health promotion services for this population. Nurses also need to integrate Islamic teachings into their interventions to provide appropriate care and to motivate healthy behaviors.