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.     

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.     

Cultural aspects of working with students enrolled in a school-based health center

School-based health centers provide accessible quality health services to culturally diverse student populations. Numerous challenges exist in providing culturally competent services in a school setting. This article presents models of culturally competent care, practice recommendations, and practical resources in an attempt to improve the provision of culturally competent services. In addition, one school health center's initiative to outreach culturally diverse students into health careers is highlighted.     

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.     

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.     

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.     

Culturally Congruent Care in Radiology Nursing

The United States' diversity is growing, making it difficult for nurses to meet the needs of patients from a wide range of cultures, belief systems, and groups. Nursing is not new to providing culturally competent care; however, the profession's demographic shift has made it a priority. Improving nurses' cultural competency can lead to increased access to health care and, as a result, better health outcomes. Nurses in all specialties work with people from all walks of life, which necessitates that they have the knowledge and skills necessary to care in a culturally appropriate manner. Radiology nurses, in particular, influence care in a variety of settings and provide care to people of all ages and acuities, making the commitment to fostering culturally congruent practice even more critical. Nurses can begin this process by critically reflecting on their own biases as well as the concepts of cultural humility, competence, and competemility.     

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.     

Cultural considerations in interprofessional education and practice

Promoting cultural competency in health care was examined from the Canadian perspective, and explored practice environments and educational programs for future health professionals that foster cultural awareness and support culturally sensitive care. Many of the issues raised are generic and likely to occur whenever patients' health practices and beliefs differ from conventional Western care. The main theme that emerged with respect to the practice environment was the use of a participatory action approach to foster collaboration with patients, traditional healers and the community. Successful collaboration is likely to result in a blend of ideas and perspectives from traditional health practices and conventional Western health care. With respect to education, programs need to focus on providing opportunities both in the classroom and in the clinical arena for students to work in interprofessional teams. These teams should not only comprise partners from medicine, nursing, physical therapy and other health professions but also include aboriginal paraprofessionals. Pedagogical initiatives also need to incorporate case-based formats and interactive sessions with patients and families. The principles underlying this approach: openness, mutual respect, inclusiveness, responsiveness and understanding one's roles should be fundamental to the delivery of culturally competent health care to all ethnic communities.     

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.     

An innovative approach for affirming cultural diversity among baccalaureate nursing students and faculty

"Cultural Diversity" has become the buzz word of the nineties. The United States has become the most culturally diverse nation in the world. Since there is no arena where cultural diversity is more critical than health care, it is imperative that nursing students and faculty become comfortable with the issues surrounding the delivery of culturally competent care. The University of Southern Mississippi has developed an innovative program with a dual purpose: (a) to provide an environment of mutual understanding and respect for people of different cultures; and (b) to provide a comfortable environment where minority students can be valued and nurtured.     

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.     

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.     

Race consciousness and the health of African Americans

The historical experience of African Americans in our country has been shaped by the institution of slavery, dehumanization of blacks, segregation, pursuit of civil rights, and racism in contemporary American society. Disparities in health care provide compelling evidence that issues of race or skin color for the descendants of slaves and other ethnic minorities persist in the 21st century. Nurses providing care for African Americans must bridge the racial divide and incorporate culturally relevant content in the health history. As an integral aspect of their professional growth as culturally competent health care providers, they must incorporate the idea of "race consciousness" which is described as an awareness of the historical journey of the group, knowledge of disparities in health care for the people, and a self appraisal of one's attitudes and biases toward the group.     

Prerequisites to providing culturally competent care to Mexican migrant farmworkers: a Delphi study

The purpose of this study was to identify prerequisites to providing culturally competent care to Mexican migrant farmworkers. A national sample of nurse experts who worked with Mexican migrant farmworkers (N = 93 [50.2%] in round 1; and N = 142 [54.8%] in round 2) participated during the period of August 1998 to April 1999. Using a two-round modified Delphi method, a list of 89 items was generated. The nurse experts agreed that the 89 items identified were prerequisites to cultural competence, showing consensus rates of 85.4% in round 1 and 88.8% in round 2. The prerequisites to culturally competent care identified by participants encompassed caring, cultural sensitivity, cultural knowledge (general/specific), cultural abilities/skills, and others (bi-cultural status; cultural and learning experiences).     

Health as balance for the Sto:lo Coast Salish.

The purpose of this study was to examine the concept of health for the Sto:lo Coast Salish of the Pacific Northwest and describe their ways of being healthy within their specific context, considering the climate, the resources of their natural environment, and their spiritual heritage. This study, using a grounded theory approach, focused on the meaning of health for the Sto:lo. A sample of 18 participants and two cultural experts, using the constant comparison method and dimensional analysis, yielded three themes. Health as "balance," spirituality as "it's an ongoing thing," and transitions as "those times of change" were the resulting themes. Nurses, who take the themes into account when providing care, will be more culturally competent.